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Article Excerpt
This study provides preliminary analysis of reliability and validity of scores on the Screening Test for Emotional Problems, which was designed to identify students ages 5 to 18 years who are referred for wide-ranging emotional disturbances categorized under the Individuals With Disabilities Education Improvement Act (U.S. Department of Education, 2004). Matched teacher and mother responses for 4 independent samples were analyzed.
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Originally enacted in 1973, Public Law 94-142, formerly known as the Education for All Handicapped Children Act (U.S. Department of Education, 1973), and now known as the Individuals With Disabilities Education Improvement Act (IDEIA; U.S. Department of Education, 2004), guarantees special education services to students with a wide range of disabilities. Although the number of students receiving services under the IDEIA has grown steadily since its introduction (Epstein, Nordess, Cullinan, & Hertzog, 2002), confusion remains among school personnel regarding assessment of eligibility for students with some disabilities. Perhaps the most ambiguous category of disabilities is emotional disturbance. Eligibility guidelines for this category, although detailed, are in large part subjective, making consensus among school personnel difficult (Cullinan & Sabornie, 2004; U.S. House of Representatives, 1997).
Part of the difficulty experienced by educators is that few inventories exist to help accurately screen or identify emotional disorders based on the five diverse characteristics outlined in the IDEIA (U.S. Department of Education, 2004), and of those that do, cost, time, training, and legal liability present substantial barriers. This article examines the five specific eligibility characteristics for the category of emotional disturbance defined in the IDEIA and presents preliminary pilot studies of reliability and validity of mother and teacher responses on the Screening Test for Emotional Problems (STEP), a new screening-level test designed to aid in the identification of school-age youth with emotional disturbances as defined by the IDEIA.
IDEIA ELIGIBILITY CRITERIA
The eligibility criteria for emotional disturbance are twofold. To receive services, a student must demonstrate the presence of an emotional or mental disorder as defined by descriptions contained in the IDEIA (U.S. Department of Education, 2004) and further demonstrate that this disorder significantly impairs learning and academic success. Section 300.7(c) of the law defines an emotional disturbance as
a condition exhibiting one or more of the following characteristics over a long period and to a marked degree that adversely affects a child's educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems.
Although the IDEIA (U.S. Department of Education, 2004) certainly can serve as an aid for categorizing or structuring the identification of emotional disturbances, it can hardly be viewed as a theory-driven model for understanding mental disturbance and educational implications in school-age youth. Educators, including professional school counselors, are charged with collecting assessment data about student emotional disturbances and making decisions about program placement (i.e., the IDEIA), accommodations (i.e., Section 504 of the U.S. Rehabilitation Act of 1973), or referrals (e.g., to private or community sources) and look to other authoritative sources for identification of mental and emotional disorders. However, public school systems have not agreed on a comprehensive, centralized resource or assessment tool to screen for and identify students with emotional disturbances. This lack of a comprehensive tool is due to at least three primary reasons: legal liability, training and competence, and cost- and time-effectiveness.
Public school administrators and employees frequently do not want to incur the liability associated with diagnosis (and potential misdiagnosis) of students with mental disorders, despite encouragement by some advocates for increased mental health diagnostic and treatment services in schools (Dryfoos, 1994; Keys, Bemak, & Lockhart, 1998). Professional counselors and other mental health practitioners (e.g., psychologists, psychiatrists, social workers) in private or community agencies are not constrained by such concerns. These practitioners frequently use authoritative nosological diagnostic sources, such as the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000), and standardized clinical assessments, such as the Minnesota Multiphasic Personality Inventory-Adolescent version (Butcher et al., 1992) or the Millon Adolescent Clinical Inventory (Millon, Millon, & Davis, 1993) for diagnostic purposes.
In addition, related to the reticence spurred by potential liability is the issue of training and competence. Some school-based mental health professionals may be concerned about whether they have the training and expertise required to use the DSM-IV-TR (APA, 2000) and diagnostic clinical instruments effectively. Often, professional school counselors, school psychologists, and school social workers are not provided substantial training in clinical diagnosis in their master's-level training programs and are rightly cautious about the ethical and legal ramifications of practicing beyond the scope of their perceived level of competence. As such, they rely primarily on screening-level instruments that require less sophistication and expertise to administer, score, and interpret than the more complicated diagnostic clinical instruments used in agencies, institutions, and the private sector.
A third, even more practical, concern involves limitations on the time and financial resources necessary to engage in comprehensive mental health assessments. Just as most individual and group counseling services in schools are time limited and goal focused (Erford, 2007), assessments for emotional difficulties conducted in schools are generally limited to quick, screening-level instruments. As a result, referrals for more time intensive and costly diagnostic assessments and treatment are frequently made for moderate-to-severe clinical cases. Taken together, these three constraints indicate that school-based mental health professionals, especially professional school counselors, will benefit most from quick, inexpensive, screening-level instruments to help make accurate decisions about students with emotional disturbances pertaining to IDEIA (U.S. Department of Education, 2004) eligibility.
Unfortunately, no quick, inexpensive, comprehensive instrument currently exists that align precisely with IDEIA (U.S. Department of Education, 2004) guidelines for identification of students with emotional disturbances. As a result, school personnel ordinarily purchase and administer several instruments of varying accuracy, length, cost, and sophistication. Some currently existing instruments measure one or several facets of emotional disturbance. Some of the rating scales and clinical inventories commonly used in schools along with the IDEIA categories of emotional disturbance assessed are presented in Table 1. When used cumulatively, these instruments present the same constraints on time, cost, and competence as outlined earlier. In addition, some of the instruments are self-report only, and only the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001), Behavior Assessment System for Children-Second Edition (C. R. Reynolds & Kamphaus, 2006), and Conners's Rating Scales-Revised (CRS-R; Conner's, 1997) have both teacher and parent versions so that different perspectives can be assessed for confirmation of severity and presence of problems. It is particularly essential to assess multiple perspectives regarding emotional disturbances when the clients are children and adolescents.
Given the importance of providing a free and appropriate education for students with emotional disturbances in public schools and the fact that thousands of children are identified with a handicapping condition of emotional disturbance each year in public schools, the development of an efficient and accurate screening-level test aligning with all five characteristics described in the IDEIA would be an important contribution to the emotional assessment of students.
PURPOSE OF THE STUDY
This article presents the pilot study results of the development of a new instrument, the STEP, which was designed to screen emotional disturbances in children and adolescents as defined by the five characteristics included in the IDEIA (U.S. Department of Education, 2004). The following studies include preliminary results of reliability and validity of teacher and mother responses. It should be noted that a student version of the STEP has also been developed and that fathers can respond to the same version as the mothers. However, student and father responses were not evaluated in the following studies. Furthermore, even though the items on the parent, teacher, and student versions are identical, with the exception of the use of the words home and school, it has not been established that parents, teachers, and students recognize the items as equivalent and respond to the items in similar manners.
Reliability of scores on the STEP was determined through studies of internal consistency and test-retest stability. Criterion-related score validity was explored through convergent validity and decision accuracy procedures. Convergent validity was determined by correlating scores on the STEP with other tests that also measure emotional problems and disorders, including the Disruptive Behavior Rating Scale (DBRS; Erford, 1993), the CRS-R, and the ASEBA. Decision accuracy assesses the proficiency of STEP scores in identifying participants with various types of emotional problems compared with actual clinical diagnoses. Decision accuracy allows analysis of the STEP's sensitivity, specificity, positive predictive power (PPP), negative predictive power (NPP), and percentage of correct classifications (%CC; Erford, 2004; Erford & Stephens, 2005). An exploratory factor analysis (EFA) was used to examine the number of dimensions that underlie the STEP items. Because five rationally determined subscale scores are interpreted for the STEP, a five-factor structure was targeted....
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