Strength-based report writing – The “integrated report format”

Jennifer Engle

Main Body

13 Strength-based report writing – The “integrated report format”

Learning Objectives

Describe one method of translating a strength-based assessment approach into a strength-based report.

Integrated report format

If you are looking for a way to write reports which fits with the approach presented in this book, consider using what I call the “integrated report format”. In this format, you include all of the same information you would in any assessment report, but organized in a different way, integrating the assessment findings across sources. This format recognizes that your assessment is not just based on test results, but rather on the integration of multiple sources of information. It also has the benefit of lending itself very easily to discussing strengths and what a child is able to do. It is quick to write and easy to read. Using an integrated report format, you would include:

Reason for referral.
List sources of information including tests administered.
Relevant background information. Note here that many children with multiple, severe, disabilities have very extensive medical histories, including complicated birth histories, multiple surgeries, a list of medical diagnoses, etc. For children who are well cared for by medical teams who know them well, there is no need to summarize all of their history. Rather, note the key points that are essential to your case conceptualization.
General observations/adaptations/structure of the assessment. In this section, discuss general alertness, cooperation, and overall presentation of the child. Also discuss the format of the assessment (e.g., play based, combination of standardized measures + observation), any adaptations or modifications provided, anyone else who was present for the assessment and the role they played.
Results section. This is where the flexible report format may be very different from your standard report. The results section may be broken down into domains of functioning, similar to other formats. In each domain, integrate parent report of current functioning, your observations, adaptive functioning report, teacher report of functioning, and standardized test data. Domains may include Communication (sometimes broken up by expressive/receptive), Behaviour, Socio-emotional/play skills, Physical/motor/sensory, Learning/Cognitive, Pre-academic (or combined with cognitive), Self-help skills (not covered elsewhere). In each section, say what the child can do, while acknowledging what limitations are present.
Very brief “Summary/impressions section” which ties it all together. “Julia is a child who…”. Be clear and definite about diagnoses (i.e., do not say “appears to meet criteria for”).
Recommendations & Resources – keep this to the essentials.
Data table with standard scores. I suggest including adaptive functioning standard scores (with 95% confidence interval) as community services are sometimes based on these numbers. If there is no contraindication to doing so, I would also suggest including the 95% confidence interval for the Full Scale IQ (or whatever IQ score you are using), particularly at the mild to moderate borderline of functioning.

Results Section – Examples

Note: All names and identifying details have been changed for confidentiality purposes.

Observations and overview of assessment: This assessment is based on direct observation of Susie in the presence of her mother, an interview with her mother, and a telephone interview with her teacher. Susie uses very few words, has minimal use of her hands and arms due to spasticity, and had very limited interaction with me during the assessment. Thus, formal, direct testing was not possible. The direct portion of the assessment utilized a functional approach attempting to engage Susie with play materials and social games. The report below incorporates direct observations with parent and teacher report in order to give a picture of her typical level of functioning. According to her mother, Susie’s presentation during the assessment was typical. This, in addition to the well-informed report from the adults who know her best means that this assessment is believed to be an accurate reflection of Susie’s current functioning. Please see the appendix for adaptive functioning scores.

Social skills, play, and behaviour: Susie’s mother and teacher both described her as a very happy young girl, except when she is in pain or tired. There are no concerns with self-harm or harm towards others. During the assessment, Susie smiled in response to games (e.g., peek a boo) and laughed easily when her mother playfully interacted with her. She enjoys listening to music, looking at books, playing in water, and watching children play. She demonstrates her interest by becoming quiet, and making eye contact. At home and at school, while she responds to playfulness, she does not initiate/request games such as peek a boo.

Motor skills: Due to spasticity, Susie’s arms and hands are tightly clenched and she does not use them for any fine movements such as grasping or pointing. She uses a head switch successfully, and has at times been successful with using her forearm to press a large button. She receives botox for spasticity and her ability to use her arms fluctuates depending on the currently level of spasticity. Other things Susie is able to do include reaching for objects placed in water, flipping something off her wrist, and knocking things off her lap. She will assist with dressing by raising her arms.

Academics: Jill is working at a pre-Kindergarten level in academics. When writing, she used her left hand with an awkward pencil grip. She did not direct her gaze at her writing. She was able to spell her first and last name aloud, but she was not able to write anything legible. She was able to produce scribbles. She demonstrated emerging pre-literacy skills including knowing the sounds that (most) individual letters make, the ability to rhyme simple words, and the ability to orally blend sounds into words. Jill correctly named colours, and some shapes (circle, square), but could not name a triangle. She did not understand the concept of more/less (on paper, or using real objects). Jill was able to count objects with 1:1 correspondence, at least up to 10 by moving each object in turn. In oral math, she could do +1 problems. She did not understand the concept of “take away” or “minus,” even when using real objects.

Everyday living skills: Adaptive functioning, or skills for everyday living, were evaluated using an interview with Joe’s parents (VABS-2) and a comprehensive questionnaire completed by his Learning Support Teacher (VABS-2). In some areas, Joe requires help and support due to his physical disability and visual impairment. For example he needs help dressing and undressing, and with toileting. He is able to feed himself using a spoon or his hands. He enjoys being helpful around the house (setting out placemats, returning his dishes to the kitchen). Overall, Joe needs a lot more help and support in all areas of everyday functioning, well above what would be expected based on his physical and visual impairments. Ratings by both his school and family place him overall within the moderate to severe range of intellectual disability.

Expressive language: According to his parents, at home Steve will point to objects that he wants that are out of reach (while making eye contact), or take parents by the hand and lead them where he wants to go, placing their hands on what he wants. He will sometimes wave “bye”, but not when requested. He will make a choice between 3 DVDs, but this is the only type of choice he makes in this way. He does not copy gestures, facial expressions, or word sounds, even when requested. He will sometimes copy other children’s play. At school, Steve has trialed an iPad with Proloquo2Go which use visuals for choice making and verbalizes the choice. However, he has not had success thus far. Various other augmentative communication devices and picture communication systems have been trialed, with varying success depending on his interest at the time. At a previous school, he apparently successfully used a card with 4 pictures and could point to the one he wanted. Currently he has words for Yes and No printed on his wheelchair. His EA believes he does not understand these choices and at this time they are rarely used. Like at home, his primary mode of communication at school is taking an adult by the hand and placing their hand on what he wants. During the assessment, Steve frequently made noises to indicate pleasure or displeasure. No word approximates or signs were observed. He indicated his desires quite clearly by pushing things away, grabbing things, putting an adult’s hand on what he wanted, or attempting to leave the room. He gave high-5’s when requested.

Cognition: During this assessment, Peter demonstrated knowledge of object permanence (when something is out of sight, it continues to exist), and basic cause and effect reasoning(e.g., press a button and something happens). Of note, he was only able to focus on one thing at a time. For example, when given a second block, he would drop the first. He did not show coordination of use between his two hands. Rather, he tended to use just one hand at a time. He was able to briefly hold in mind a location (where something was hidden), but he was not able to keep track of location when the hiding place was changed within his sight.

Summary/Impressions Section – Examples

Peter is a happy, social 12 year old boy. He has a history of learning difficulties, ataxia (difficulty coordinating movements), and epilepsy which has been difficult to control with medication. There are known differences in the white matter of his brain. His parents have done a wonderful job of getting Peter involved in engaging activities outside the home. At school, he receives full time 1:1 support. Peter is nonverbal, and communicates through eye contact, facial expression, tone of voice, and a few simple gestures such as clapping. He can follow familiar, simple instructions when provided with encouragement and gestures. He is dependent on others for all aspects of daily living. He enjoys simple social games, physical interaction with objects, music, and using his gross motor skills. Fine motor skills are very limited. He is familiar with his routines and gets upset when they are altered. When he is able to predict what is going to happen, he is a generally a happy, easygoing boy. Results of the current psychology assessment found that in general, Peter demonstrates cognitive, communication, and social skills at approximately the 10-12 month old level. He meets DSM-5 criteria for an Intellectual Disability in the profound range.

Andy is a social, friendly, enthusiastic grade 4 student with a history of spastic dystonic cerebral palsy secondary to premature birth. Andy uses a wheelchair for mobility, and has limited use of his hands (right better than left). He has a long history of services, interventions, and therapies to support his development. He is involved in many supported community activities, and has an incredibly enriched, encouraging, and supportive home environment. Andy is best able to focus when he is presented with one thing at a time, and when he is given sufficient processing time. He does best with short, focused learning sessions. It is wonderful to see that Andy is developing some nice early literacy skills. He is starting to sound out words, and is able to read short sentences using sight words, at the early Grade 1 level. Math concepts, on the other hand, have been extremely challenging for him. He has difficulty with pre-Kindergarten skills such as counting objects and naming shapes. Andy’s difficulty with pre-math skills is consistent with his very significant difficulty with visual processing and reasoning in general. He has difficulty making sense of visual patterns and thinking logically through problems. He also has difficulty with demonstrating his knowledge and reasoning through language. However, Andy is able to understand and remember more than he is able to express in words. With cues or prompts (such as a multiple choice format), he is able to show that he knows much more than he is able to express on his own. Overall, Andy is an easy-going, friendly, adaptable boy who meets DSM-5 criteria for a mild intellectual disability.

Acknowledging and building on strengths

When children’s standardized scores are all below the 1st percentile, it can be helpful to identify personal areas of strengths which likely lie outside of the formal test results. Examples of strengths may include:

Motivated by social connections, friendly, cheerful, eager to please others
Sense of humor, playful
Engagement with learning, curious, agreeable to trying new things
Motivated by special personal interests
Loves animals
Loves music/singing/dancing
Easy-going nature, patient, able to stay calm when frustrated
Exuberant, high energy, strong, energetic
Thrives with routine/adaptable to change
Learns through repetition, learns by watching others
Responds well to encouragement, proud of successes
Persistent, likes to try to do things for self
Able to use communication strategies when frustrated (e.g., looks away from book rather than throwing book when does not want to read book)

It is especially helpful if you can tie the child’s personal strengths to recommendations.

Sally is very socially motivated. Thus, she would benefit from learning through interactions with peers.

Important areas to address in recommendations

Building communication skills is often an important areas for development in children with multiple, severe disabilities.
Are there factors in the child’s presentation that are impeding development or the ability to function to their greatest personal capacity? (e.g., sleep issues, undiagnosed Autism, safety or behavioural issues).
What accommodations/supports/interventions would be helpful?
What opportunities/activities would enrich the child’s life?
What community supports and services would the child/family qualify for?
Can we help the child to have a voice in decision making? Helping the child develop choice making skills is important.

Key Takeaways

The “Integrated report format” discussed in this chapter describes an alternative format for writing strength-based reports.
The essential component of this format, is that the in the “Results” section, your assessment findings (from various sources) are integrated. For example, the section on Communication integrates your observations and direct testing results with reports from teachers and parents. The results section focuses on what the child can do, rather than comparing them to their same aged peers.
The Summary/Impressions section should be brief and include only the key features from the results section. Diagnoses should be made explicit.

License

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Beyond the WISC: Psychological assessment of cognitive functioning in special populations Copyright © 2019 by Jennifer Engle, Ph.D., Registered Psychologist is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.