Article summary with Assessment and intervention: Bridging the gap with a practice-based model by Pameijer - 2017

What is this article about?

Before one can decide on diagnosis and interventions, accurate assessment is necessary. Assessment is defined as a process of hypothesis testing, which is designed to answer the questions that clients have, and to solve their problems. This is an important process, so it is better if this process happens in a systematic, objective, and consistent way. The process should also be transparent to colleagues and clients.

In this paper, an assessment model for the special educational needs of children is described. This is the Assessment for Intervention (AFI) model. This model has the goal of providing recommendations which are science-based and which are feasible for the child, the parents, and the teachers. The model will be described, and the outcomes of an evaluation study will also be described.

In practice, there is often a gap between diagnoses and recommendations. Therefore, the Assessment for Intervention (AFI) model tries to bridge this gap. This model was developed in the Netherlands. It is a model which prescribes a decision-making process for a school-psychologist. This psychologist systematically proceeds through the stages: first questions of the teacher, parent, and child are analysed. Then, these questions determine what the purpose of the assessment is, what decisions will be made and what questions will be answered. The AFI can be functional, because it can lead to a diagnosis, and it also provides recommendations (interventions) on how to deal with this diagnosis.

Assessment involves two topics: the assessment process and the assessment methods. The AFI differs from other assessment models, because it is science and practice-based. It offers guidelines for teachers, parents, and students. It also includes all topics that have been determined to be important on the assessment of students with special educational needs.

What are recent developments that are incorporated in the AFI-model?

The concept of assessment has changed considerable over the last decade. Now, it is more focused on the teacher’s role, such as teacher’s instruction. Assessment for Improvement or Functional assessment is used to improve the instructional environment. A recent development is that the needs of students are more relevant for their interventions, instead of their disorders. So, instead of looking for specific diagnosis such as ADHD, school psychologists now focus on student’s abilities, and try to determine what next steps are needed for a good development. Another development in the concept of assessment is that assessment is now more focused on empowerment of teachers, parents, and students. Also, it seems that interventions work better when the people involved are part of the assessment process, from the beginning. There is also a therapeutic value of assessment: during the process of assessment, clients’ awareness and understanding of the situation, and their motivation, changes. This makes assessment also functional.

Children are also allowed to state their opinion, and they should participate in the assessment. Another important aspect of assessment is that the assessment process should be evidence-based. It should include a case formulation of the student and his instructional and home environment. On the basis of this case formulation, goals are set and the best intervention is chosen. The school-psychologist who uses the AFI, applies successful practices based on science. Thus, the psychologist is a scientist-practitioner.

The AFI model focuses on the content of the steps within the cycle, the communication skills of the school psychologist, and the different roles of the teacher, parent, and child within this cycle. The assessment process is specific to each client. This helps to decrease the gap between assessment and intervention: it is easier to stick to an intervention that fits your situation best. The AFI is thus scientifically fully sound and can be used by school psychologists. They can also use this model to reflect, and ask themselves questions such as: ‘What are my targets for assessment for intervention (what are my goals)?’, and ‘Which elements of AFI am I already successfully implementing?’.

What are the seven principles of AFI?

Pameijer and Van Beukering, the creators of the AFI, came up with seven principles which are important for the quality of assessment, namely;

1. AFI is goal-directed, it is aimed at recommendations that are both meaningful and useful for clients and beneficial to the child;
2. AFI applies a transactional perspective on development and therefore not only focuses on child factors, but also on teachers’ strategies and parental support;
3. AFI focuses on educational needs: what does this child need to achieve a specific goal?;
4. AFI focuses on the needs of parents and teachers, because they are key factors in achieving educational goals, so the AFI looks at what they need to support the child’s educational development;
5. AFI focuses on risk as well as protective factors of the child, school, and parents;
6. The school psychologist collaborates with the teacher, child, and parents;
7. AFI follows a systematic and transparent stage-like process

Goal-directed and functional assessment

In this principle, it is stated that only necessary information should be gathered. So, only information that helps to solve the problem. Then, this information is used to come up with feasible interventions. These interventions should be not too difficult. The school-psychologist therefore tries to determine what kind of strategy fits into the daily work of the people involved. Therefore, assessment can be seen as a change-oriented cycle of investigation, case formulation, intervention, and evaluation. Using the AFI, the focus is on variables that can be translated into interventions.

Transactional perspective

This principle is based on the fact that children develop through a continuous interaction with their instructional and home environments. Thus, the context is very important in the AFI. These interactions are transactional: children’s behaviours evoke reactions from their teachers, peers, and parents. This is also related to risk factors. For example, the risk factor ‘aggressive behavior at an early age’ is not directly related to behavioural problems at a later age. But, when a teacher clashes with this students, and parents physically punish the child, this can lead to more behavioural problems later in life. There are also protective factors, which reduce the impact of risk factors. Therefore, the AFI also takes these protective factors into account, and determines which interactions are already favourable, and which are not.

Special needs of the child

The AFI focuses on the student’s educational needs. So, it is not focused on coming up with a diagnosis. Instead, the focus is on what the student actually needs to develop and perform well. Questions are: which SMARTI goals are we pursuing? And, which approach does this student need to reach these goals? These questions help to change the focus from problem-oriented toward solution-focused acting. The school-psychologist also cooperates with all involved parties: the child, the teacher, and the parents. He or she discusses with them what they are already doing that is beneficial to the child (goodness of fit), and what is missing (poorness of fit).

Teacher’s impact

Teachers are important for the development of children, and especially for vulnerable students. Competent and effective teachers are able to prevent problems in learning and behaviour in their students. A positive teacher-student relationship is also very important: a warm relationship offers a student emotional support and security. This has a positive impact on his relationship with peers and on his learning behaviour in the classroom. Thus, it is important to try and create a positive teacher-student relationship. Therefore, the AFI also focuses on the student-teacher relationship.

Protective factors and strengths

All students show some positive behaviors, no matter how severe their problems are. Protective child factors are for example having an easy temperament, having good intellectual capabilities, having strong emotion-regulation, having an internal locus of control and strong coping skills. The social environment can also serve as a protective factor: a supportive school team and a family network. For example, children with attachment problems can really benefit from a warm relationship with their teacher. Having a good relationship with parents is also a protective factor. Therefore, the AFI also focuses on strengths. These positive aspects are included in the assessment report, and are used in the interventions. The school-psychologist tries to determine what are positive exceptions, so: when is the student able to display the desired behavior?, and also tries to determine the successful teaching approach: what does the teacher do in this situation? Balancing these risk and protective factors results in a case formulation. An important remark is that it is easier to boost positive factors, than to change risk factors.

Collaborative partnerships

The clients of an assessment are important. They have good insights into the possibilities for change. Therefore, the school-psychologist collaborates with the students, teachers, counsellors and parents. Thus, this principle is about talking with the student, and not talking to or about them. The AFI is really personal and focuses on what do the student, the teacher, and the parents need? Scientific information is translated and made understandable for all the parties. This makes it possible for them to understand the case formulation and recommendations. Thus, for the AFI, transparency is key.

A systematic and transparent assessment process

For assessment to be of good quality, it should follow a systematic, objective and consistent way. The process should also be transparent. The AFI is based on the empirical model of scientific thinking. It includes five stages and each stage has its own guidelines. These guidelines support clinical decision making, and protect the school-psychologist from common pitfalls in decision making, such as tunnel-vision, confirmation bias, and over-confidence.

What are the five stages of the AFI-model?

Each stage in the AFI is closely linked to the other stages. The stages may overlap, but each stage will be discussed separately.

Stage 1: Intake

This stage has the goal of collecting information. Based on this information, the school psychologist can determine what the strategy will be for the client. Another goal of the intake stage is to create a good relationship with the school, student, and parents. Questions, goals, expectations and requests will be discussed. For example: what is intended to accomplish? Why? How?

Stage 2: Strategy

The information gathered in the intake stage will be used to determine a strategy that fits the specific situation. Relevant information is organised in four sections: student, instructional environment, parental support of learning and relevant history. The psychologist tries to determine whether more information is needed. If this is the case, he or she proceeds on to Stage 3. If this is not the case, he or she proceeds on to Stage 4. Each question that is asked, is based on an if-then reasoning: if we know…, then we recommend…. Thus, no questions are asked that do not fit in this if-then reasoning: only necessary information is collected. Information gathering is thus goal-directed!

Stage 3: Investigation, answering the selected questions

In this stage, the hypotheses determine which information will be gathered. Thus, it is goal-directed. The content of information varies for each specific client. To get answers, tests, questionnaires, interviews, and observations can be carried out. For example, the classroom may also be studied to determine whether the teacher or child are acting in a negative way. Data collected in this context may have a higher ecological validity compared to data gathered out of this classroom. Also, interventions can be based on this context, making the interventions personalised.

Investigating the potential for change

To get more feasible interventions, the psychologist can explore the learning ability of students. For example, by manipulating one variable, it can be determined whether an expected positive change occurs. This can yield insights into the child’s changeability, and the teacher’s changeability. Provoking and reinforcing factors are also identified, by looking at what occurs prior (antecedents) to the student’s behaviour, and what occurs after (consequences). This is a functional analysis, and can be used to create interventions in the classroom. For example, if someone thinks that a child’s problem behaviour (making funny noises) is reinforced by classmates’ laughter and teacher’s correction, one might create an intervention in which both the child and his peers are rewarded when they show task-oriented behavior. This would be expected to lead in a reduction of disruptive behavior.

Stage 4: Integration, goals, and needs

In this stage is the bridge from the diagnoses to intervention. It is therefore also called the ‘pre-treatment-assessment’. All the information gathered is integrated, and it is determined: how can the situation be understood? Then, this is translated into goals for the student, teaching strategies, and parental support, educational needs of the student, and needs for the teacher and/or parents.

The case formulation thus also includes risk and protective factors. This formulation includes what needs to be changed, but not how this should be changed. Therefore, the psychologist determines on interventions which are tailored to the client. There can be several interventions, so a decision should be made.

Examples of effective interventions are for example self-reported learning, in which the student gives himself a grade in advance, predicted on past performance with an emphasis on high expectations, direct informative and positive reinforcing feedback during learning, direct instruction models and strong classroom management.

Stage 5: Recommendations, appointments, and feedback

In this last stage, the clients are informed about what the outcomes are of the assessment. It also involves answering the clients’ questions, objectifying goals, matching these goals to specific needs and supporting clients in choosing the best intervention. All involved parties will attend, and they will discuss with each other. The result of this stage is a tailored intervention, which is supported by all relevant parties. The school-psychologist also asks whether all parties are willing to ‘start tomorrow’.

Also, appointments to monitor and evaluate the intervention are also made: who is doing what, when, and how?

How is the AFI in practice?

The AFI was developed in 1997, and it has been evaluated in 2004 and 2015. It is now the standard model for assessment. However, the AFI has not been evaluated systematically. Therefore, an evaluation study was carried out in the Netherlands. The following questions were analyzed:

• Are the principles of the AFI implemented as intended?
• Are the aims of AFI achieved?
• Does assessment offer a better understanding of the student and the support he needs?
• Does assessment generate recommendations for teachers and parents?
• Are teachers able to apply the recommendations in their classroom?
• What method was used?

The assessors were school psychologists and external school-coaches. The study took place for two years. In the first two years, these psychologists and coaches were trained in using the AFI.

What are the results?

It seems that the principles of the AFI were implemented as intended. Most teachers and parents also reported a positive collaborative partnership with the assessor. However, the assessors collaborated less with children. 77% of children enjoyed the investigation stage. So, it would have been better if students were more involved in the process. Counsellors and parents reported that the assessment process evolved systematically and transparently, so that is great, because it’s one of the principles of the AFI.

Are the aims of AFI achieved?

If the aims of the AFI would have been achieved, this would mean that the assessment lead to a better understanding of the student, and that the teachers were able to apply the recommendations in their classroom. The teachers gained more insight into the child’s situation compared to before the assessment. For parents, this was less true, but this makes sense because parents knew their children well before the assessment, and assessors did not know the children at all.

Teachers also felt like they are more capable of teaching the child. For 80 percent of them, the cost-benefit analysis is balanced: the time and energy they invested in the assessment paid off. Two out of three teachers also stated that the recommendations based on the AFI were feasible in the classroom.

What were successes and limitations in the evaluation study?

There were different limitations. For instance, questionnaires were only send to valid email addresses. There was also a low response rate, especially from parents. Successes were:

• The stages of the AFI made the assessment process structured from the beginning to the end. It also made it easier for professionals to discuss things, because they all followed the same aim and language;
• All relevant parties ‘sat at the table’. They worked at a shared goal, namely an optimal development for the child;
• The assessment helped the parents and teachers in collaborating;
• Counsellors, teachers, and parents valued the partnership and communication with the assessors;
• Parents appreciated the AFI-model, they reported positive aspects of it in the open questions.

What could be improved?

In a subsequent study, SMARTI goals for all students should be formulated, and also for the instructional environment and parental support of learning;

There should be a greater focus on translating the case formulation into the teacher’s approach in the classroom;

The case formulation should be explained to parents in an understandable way. It should be meaningful for them. Parents should also be told how they can support their child’s learning at school. They should also be complimented about things that they are doing well.