Reports

School psychologists strive to maximize students’ ability to benefit from instruction by addressing academic, social-emotional, and behavioral concerns that serve as obstacles to success in the classroom. In doing so, school psychologists work in concert with educators and other related services professionals to support learners on an individual student level and a schoolwide systems level. School psychologists are expected to serve school-age children and youth with a wide range of needs. However, their preparation in graduate school tends to focus on supporting students experiencing the learning and behavioral concerns that are most prevalent in schools (e.g., learning disability, attention concerns, behavioral challenges). This report explores how graduate preparation in school psychology can be expanded to better equip school psychologists with the competencies and experiences needed to be strong advocates for the quality inclusion of students with significant cognitive disabilities.

The report will begin with a review of the rationale for inclusion and highlight the role a school psychologist can play in promoting inclusive practices within the National Association of School Psychologists Practice Model Domains (NASP, 2020a). Finally, it provides recommendations for ways that school psychology preparation programs can increase the competence and confidence of future school psychologists to advocate for the quality inclusion of students with significant cognitive disabilities in schools. 

Overview of the Method

The recommendations generated in this report were developed through an evaluative inquiry that involved: (a) an examination of the current standards for the preparation of school psychologists, (b) a review of the relevant research literature in school psychology and special education, (c) a search of the NASP Community dedicated to the topic of Autism and Pervasive Developmental Disorders to identify individuals with expertise in meeting the needs of students with significant cognitive disabilities, and (d) individual interviews with noted experts. The process began with a critical review of The Professional Standards of the National Association of School Psychologists (NASP, 2020b) to identify the core competencies needed to support students with significant cognitive disabilities. The review also determined the degree to which adherence to the 2020 NASP Standards serves as effective preparation for promoting the use of inclusive practices for students with significant cognitive disabilities. Based on the literature review and search of the NASP Community, we identified 17 faculty members in a school psychology program with expertise in supporting inclusive practices for students with significant cognitive disabilities. Twelve of the experts recruited agreed to participate in a structured interview. Through the interview process, peers recommended five additional experts, and two of these individuals agreed to participate in the inquiry. In all, 14 school psychology faculty experts participated in interviews regarding the preparation of school psychologists to support the quality inclusion of students with significant cognitive disabilities.

Educational Inclusion

The Individuals with Disabilities Education Act (2004) states that all students should be educated in the Least Restrictive Environment (LRE), yet abiding by this legal mandate is often met with greater ease for students with specific learning disabilities and other high-incidence disabilities than it is for students with significant cognitive disabilities. Students with significant cognitive disabilities include students with intellectual disabilities, autism spectrum disorder or another pervasive developmental disorder, and students with multiple disabilities, although not every student in these categories has a significant cognitive disability (Thurlow et al., 2016). Students with significant cognitive disabilities may also have complex needs related to chronic health conditions and communication challenges (e.g., requiring the use of Augmentative or Alternative Communication - AAC). Research indicates that only 7% of students with significant cognitive disabilities are served in general education settings (Kleinert et al., 2015). Although inclusion has previously been considered the physical presence of a student within a general education setting, acceptance, participation, and achievement of students within that setting are the true markers of inclusion (Farrell, 2004). Students with significant cognitive disabilities have been shown to perform as well, or better, academically in inclusive settings than in specialized educational settings. They have also demonstrated greater communication and social skills improvements in inclusive settings (Buckley et al., 2006; Dessemontet et al., 2012; Nota et al., 2019). In addition, research shows that peers benefit from the inclusion of students with disabilities in the general education setting. Benefits include increased knowledge and acceptance of people with disabilities (Sirlopú et al., 2008; Stahmer et al., 2003; Tomasik, 2007). The successful participation and integration of a student within a setting requires appropriate supports to be provided.

Role of School Psychologist in Inclusion

Advocacy for greater inclusion of students with significant disabilities can be increasingly powerful when a school psychologist is equipped with the specialized knowledge in evidence-based approaches for the prevention and intervention of academic and behavioral challenges, consultation and collaborative problem solving, databased decision-making, and an understanding of systems operations to create the conditions necessary for student success. School psychologists are uniquely qualified to work alongside educators, parents, and building leaders to ensure students with significant disabilities are meaningfully included in their grade-level general education classroom (Farrell, 2004).

National Association of School Psychologists (NASP) Practice Model

            The National Association of School Psychologists (NASP) developed the Model for Comprehensive and Integrated School Psychological Services, also known as the NASP Practice Model (https://www.nasponline.org/standards-and-certification/nasp-practice-model), to advance the consistent quality implementation of school psychological services. The NASP Practice Model describes the range of knowledge and skills that school psychologists must possess across ten domains of practice to meet the needs of students, families, and schools. The NASP Practice Model domains guide both the preparation and practice of school psychologists. In this next section of the report, we highlight how these domains of practice align with the competencies needed to support the quality inclusion of students with significant cognitive disabilities.

Domain 1: Data-Based Decision Making

Domain 1 focuses on using assessment methods to collect data from multiple sources, considering ecological factors as a context for identifying strengths and needs, developing effective interventions, services, and programs, and measuring progress within a multi-tiered system of support (NASP, 2020a). Although the use of standardized norm-referenced tests of intelligence and academic achievement are closely associated with the role of a school psychologist, overreliance on norm-referenced tests may lead to a focus on identifying areas of weakness that could serve to justify a determination that a student is not appropriate for an inclusive setting. The appropriate use of norm-referenced tests as part of a multi-factored evaluation acknowledges that the value of these tests is limited by the fact that all measurement is imperfect. No single test can capture the complexity of human intelligence. High-inference measures validated to sort and classify students relative to a norm have little utility in the instructional planning process (Nisbett et al., 2012; Reschly & Grimes, 2002).

Rather than focusing exclusively on student deficits identified through norm-referenced tests, multiple, direct measures of student skill acquisition and fluency gains can be used to identify the areas of strength and targets for specially designed instruction (Jimerson et al., 2004). For example, curriculum-based measurement involves the direct, short-cycle, repeated assessment of specific skills over time for goal setting and progress monitoring. Direct measures of student skills (e.g., curriculum-based measurement, classroom observation) have appeal over indirect measures (e.g., teacher report, parent report), as they yield information that is more appropriate and useful for educational planning for students with significant cognitive disabilities using a strength-based assessment approach. In contrast to norm-referenced tests, direct observation or curriculum-based measurement can be modified or adapted to the student's specific needs. For example, a student with an Augmentative and Alternative Communication (AAC) system, such as a voice output system, can use that system during direct observation or measurement of the student's specific ability in an area, such as labeling specific items. Additionally, the use of direct measures of student skills can result in more meaningful and functional Individualized Education Program (IEP) goals. More meaningful and functional goals have been shown to lead to a more independent life for students with significant cognitive disabilities (Hunt et al., 2012). 

Domain 2: Consultation and Collaboration

Domain 2 emphasizes the critical importance of consultation and collaboration to promote the use of evidence-based practices at the individual, classroom, school, or systems-level (NASP, 2020a). School psychologists can be a valuable part of that support to teachers of students with significant cognitive disabilities by providing consultation on the implementation of behavioral management strategies and instructional supports and the use of progress monitoring. Similarly, school psychologists improve outcomes for students with significant disabilities by consulting with caregivers to identify feasible and effective strategies in the home and community to increase access to inclusive settings outside of school.

Domain 3: Academic Interventions and Instructional Supports

According to Domain 3, school psychologists must be knowledgeable of biological, cultural, and social influences on academic skills and understand theories of human learning, cognitive, and developmental processes (NASP, 2020a). This foundational knowledge informs their selection and use of assessment and data collection and supports evidence-based instructional strategies. Identifying an individual student's current skill level is essential for providing well-matched, quality instruction and evidence-based academic interventions. This is particularly true for students with significant cognitive disabilities whose abilities could be underestimated, leading to lower expectations for academic skill development and placements in more restrictive settings. Assessments conducted by school psychologists can be useful for establishing functional goals for students with significant cognitive disabilities to be achieved in an inclusive classroom.

Domain 4: Mental and Behavioral Health Services and Interventions

Domain 4 emphasizes school psychologists' knowledge of biological, cultural, and social influences on behavior and mental health, impacting learning, social skills, and adaptive skills (NASP, 2020a). Challenging behavior can often be a barrier to inclusion for students with significant cognitive disabilities. Students with significant cognitive disabilities may demonstrate inappropriate behaviors to communicate their wants and needs, particularly when a student is not provided with appropriate AAC strategies. School psychologists can address challenging behaviors by conducting a Functional Behavioral Assessment (FBA) to discern the communicative intent of the challenging behavior and teach the student alternative, functional behaviors. Competency in conducting an FBA is essential for school psychologists to develop appropriate, individualized behavior plans with collaboration from other school personnel, including teachers, speech and language pathologists, and occupational therapists, to alter the context in which challenging behaviors occur to teach more functional behaviors. An example of teaching functional behaviors is the use of functional communication training, an evidence-based intervention in which the student is taught a communication strategy, such as a verbalization, gesture, sign, or use of an augmentative communication system, to access a want or need that is functionally equivalent to the challenging behavior (Durand & Moskowitz, 2015). Understanding and recognizing mental health concerns for students with significant cognitive disabilities is also an essential skill for a school psychologist. Mental health concerns are often overlooked or incorrectly attributed to cognitive disability (Mason & Scior, 2004).

Like their typically developing peers, students with significant cognitive disabilities must navigate the often choppy waters of their social environment, which may include responding appropriately to bullying. Students with significant cognitive disabilities may need additional, specialized support in their efforts to develop positive peer connections (Wright, 2016). School psychologists have the knowledge and skills to support teachers in establishing goals for students without disabilities to initiate interactions and engage meaningfully with their peers with disabilities. For example, school psychologists can support peer-mediated interventions in general education settings, creating opportunities for students with disabilities and their peers to interact with one another and develop relationships. School psychologists can collaborate with other educators to maximize the meaningful social interactions available to the students. Examples might include promoting student involvement in extracurricular activities or ensuring they have access to AAC devices during non-academic times (recess, lunch, or transitions) to fully benefit from the social opportunities provided during these activities. School psychologists have a critical role in collaborating with others in designing, implementing, and evaluating interventions and supports to promote positive behavior and resilience, support socialization, and enhance mental health.

Domain 5: School-Wide Practices to Promote Learning

            Domain 5 indicates that school psychologists should apply their knowledge of systems theory and implementation science to promote evidence-based, school-wide practices to improve learning, positive behavior, and mental health (NASP, 2020a). School psychologists work collaboratively with other professionals in the school to strengthen the multi-tiered systems of supports (MTSS) needed to create safe and supportive schools for all learners. This is particularly pertinent given that the misapplication of MTSS may lead to a view of students with disabilities as being served "outside" the system of tiered interventions and supports (Thurlow et al., 2020). A positive, preventive approach to meeting students' needs school-wide sets the expectations for how school staff and students engage with students with significant cognitive disabilities.

Domain 6: Services to Promote Safe and Supportive Schools

            Domain 6 affirms school psychologists' role in championing a multi-tiered system of evidence-based supports to promote preventive and responsive services that enhance learning, mental and behavioral health, and psychological and physical safety of all students (NASP, 2020a). School psychologists can ensure collaborative efforts around bullying prevention, suicide prevention, school completion, and crisis response for all students, including students with significant cognitive disabilities.

Domain 7: Family, School, and Community Collaboration

According to Domain 7, school psychologists have an important role in applying the principles and research related to family systems, strengths, needs, and cultures to maintain effective collaboration between families and schools (NASP, 2020a). This is particularly important for students with significant cognitive disabilities who often need additional supports from therapists, behavior specialists, and health care professionals in home and community settings. Coordination of care across caregivers, school, and community providers is essential. School psychologists are often the best suited in the school to coordinate communication and collaboration amongst all caregivers of a child with complex needs to ensure consistency of care and maximize supports available in all settings.

Domain 8: Equitable Practices for Diverse Student Populations

            Equitable practices for diverse student populations, respect for diversity in development and learning, and advocacy for social justice are foundational to effective school psychological service delivery. Domain 8 focuses on school psychologists' critical role in applying their knowledge of individual differences, abilities, and other diverse characteristics and the impact they have on development and learning (NASP, 2020a). School psychologists ensure that students with significant cognitive disabilities receive what they need to access general and special educational opportunities while addressing occasions in which students are excluded unnecessarily from everyday experiences available to other students. On a systems level, school psychologists can apply data-based decision-making to drive an audit of educational placement decisions and to disaggregate outcomes for particular groups of students, such as students with significant cognitive disabilities. Based on this periodic audit, corrective action can be made informally and proactively. Corrective action can ensure the strengths and specific needs of each student are accounted for in reevaluating the student's LRE while advocating for quality inclusion.

            School psychologists also need to be vigilant to guard against the under- and over-identification of students for special education services based on gender, race, ethnicity, and socioeconomic status. Disproportional identification of students as having a cognitive disability may be due to measurement bias, educator bias, or inequitable access to resources and supports (Sullivan & Bal, 2013). Using multiple, direct measures to assess student performance over time considering ecological factors within an MTSS framework is key to ensuring fairness in eligibility and placement decision making.

Domain 9: Research and Evidence-Based Practice

            School psychologists evaluate and apply research to inform school-based practices as a foundation of their service delivery. An extensive research base exists to guide teachers and school teams in planning for the quality inclusion of students with significant disabilities. The school psychologist should provide the team with information on current research related to inclusive practices and ensure school practices align with evidence-based instruction and intervention. School psychologists can support these efforts by continually collecting and reviewing data to evaluate inclusive practices at individual, group, and/or systems levels.

Domain 10: Legal, Ethical, and Professional Practice

            School psychologists are expected to have a thorough knowledge of the legal, ethical, and professional standards that guide their work. Understanding the federal legislation pertaining to special education (i.e., IDEA) and the state standards and guidance in its application is essential for upholding the rights that safeguard the education of students with disabilities. School psychologists have an important role in advocating for the rights of students with significant cognitive disabilities.

Areas for Improvements and Advancements in Graduate Preparation

Although the NASP Practice Model outlines the knowledge and skills school psychologists need to serve all school-age children, graduate coursework and field experiences (i.e., practicum, internship) tend to focus on meeting the needs of students experiencing the learning and behavioral concerns that are most prevalent in schools. This report highlights six areas school psychology graduate preparation programs can strengthen to ensure future school psychologists enter the profession with the competencies they need to support students with significant cognitive disabilities.

Recommendation #1. Assessment: Applied Behavior Analysis

            One of the most powerful and versatile tools school psychologists wield is a functional behavioral assessment or FBA. Conducting an effective FBA requires in-depth knowledge of applied behavior analysis. Although some school psychology programs offer the Verified Course Sequence (VCS) in applied behavior analysis as a foundation for graduate students to earn their Board Certification as a Behavior Analyst (BCBA) credential, most do not (Gadke et al., 2016). Coursework in applied behavior analysis (including direct assessment methods, effective interviewing skills, selecting socially meaningful target behaviors, and behavior intervention planning) is critical for preparing school psychologists to promote quality inclusion for students with significant cognitive disabilities. This coursework should include opportunities to engage these competencies with high-intensity and complex needs students. It is essential that school psychologists can collaborate with education teams to develop feasible, acceptable, and effective behavior intervention plans. Doing so may also involve communicating the rationale for using specific behavioral strategies and providing support and feedback to ensure strategies are implemented successfully.

Recommendation #2. Consultation and Interdisciplinary Collaboration

            School psychologists are most effective when they collaborate with individual teachers and teams of teachers to support learners. This is particularly true in promoting inclusive practices for students with significant cognitive disabilities, as many specialists may be involved to address learning (across general education and special education programs), communication, behavioral health, motor skill, and medical health needs. Graduate programs can most effectively prepare school psychologists for team-based interdisciplinary collaboration by providing all graduate students with ample opportunities to apply these skills to support students with significant cognitive disabilities.

Recommendation #3. Designing, Selecting, and Evaluating Interventions

            School psychologists build their knowledge of evidence-based interventions to address the learning, social-emotional, and behavioral concerns throughout their coursework. To fully develop this competence in designing, selecting, and evaluating interventions, graduate students need multiple opportunities to apply these competencies in their field settings as part of their practicum and internship experiences. School psychology programs must ensure practicum students and interns have sufficient, intentional opportunities to design, select, and evaluate interventions implemented with students with significant cognitive disabilities.

Recommendation #4. Coursework and Dedicated Field Experiences

            School psychologists have a vital role in establishing and maintaining a supportive school climate in collaboration with building leaders, general and special education teachers, paraprofessionals, and other specialized support personnel. Advocating for students with significant cognitive disabilities involves an investment of time and interest in programs and supports that enable inclusion and the removal of barriers that are often systemic. School psychology graduate students need explicit coursework and dedicated field experiences in creating opportunities and navigating challenges to building a positive school climate that includes students with cognitive disabilities and their families. These opportunities include involvement in extracurricular activities, peer engagement strategies in the classroom and less-structured school settings (e.g., cafeteria, playground), and occasions for a parent/caregiver to participate in school activities.

Recommendation #5. Promoting Equitable Practices through Inclusion

Advocating for equitable practices supporting students with disabilities is a social justice issue. As part of their graduate preparation, school psychologists need to understand, reflect on, and challenge their own implicit biases towards students from diverse backgrounds, including students with cognitive disabilities. Graduate programs can support this personal and professional growth by providing direct, experiential learning opportunities, in addition to difficult discussions on the topics of diversity, equity, and inclusion for all students. Additionally, to disrupt instruction practices contributing to differential outcomes based on gender, race, ethnicity, and socioeconomic status, graduate students need to develop their competencies in databased decision making on a systems level. They need to be skilled in disaggregating student outcome data underpinning special education eligibility determinations.

Recommendation #6. Legal Basis for Inclusion

School psychologists need to be well versed in special education law to be strong advocates for students with disabilities and their families. School psychology programs should take great care to ensure graduate students have a mastery of the concepts of Free and Appropriate Education (FAPE) and LRE and the assurances and constraints of each. Coursework and field experiences should include opportunities for school psychology graduate students to rehearse their role as advocates for the legal rights of students with significant cognitive disabilities. 

Summary

School psychologists are expected to demonstrate a wide range of professional competencies to meet the academic, social-emotional, and behavioral needs of diverse learners on both individual student- and systems levels. The NASP Practice Model (NASP, 2020) describes this range of knowledge and skills across ten domains of practice to proactively meet the needs of students, families, and schools. School psychologists have a unique role to play as a quarterback, or synthesizer, of information to identify shortcomings in actual practice as opportunities for systemic improvements. School psychologists can be highly effective in promoting inclusive practices for students with significant cognitive disabilities. Their ability to engage in productive interdisciplinary collaboration and advocacy for students’ legal rights and equitable treatment is backed by technical know-how in direct assessment and applied behavior analysis. Other important contributors are the development and selection of evidence-based interventions and school-wide efforts to promote a positive, inclusive school climate. To prepare them for this role, graduate preparation programs need to ensure that future school psychologists have ample opportunities to generalize the knowledge and skills they acquire across the ten domains of practice to support students with significant cognitive disabilities. Through extensive and intentional field experiences, school psychologists will build the competence and confidence needed to serve as strong advocates for the quality inclusion of students with significant cognitive disabilities.