RESEARCH QUESTIONS 1. What clinical services are pediatric school psychologists providing and for whom are they providing them?  2. What types of referral concerns are pediatric school psychologists addressing and which of those are associated with CBC service delivery?  3. Under what conditions are CBC services desirable and appropriate in medical settings and when are such services not warranted

Blevins, C.A.

Burt, J.D.

Ellis, C.R.

Magee, K.L.

Olson, S.C.

Sheridan, Susan M.

Swanger, M.S.

Taylor, A.M.

Warnes, Emily D.

Woods, K.E.

English

DigitalCommons@University of Nebraska

University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Posters, Addresses, & Presentations from CYFS Children, Youth, Families & Schools, Nebraska Center for Research on August 2006 Handouts for “The roles of school psychologists working within a pediatric setting” Emily D. Warnes University of Nebraska - Lincoln, ewarnes2@unl.edu S.C. Olson University of Nebraska - Lincoln Susan M. Sheridan University of Nebraska - Lincoln, ssheridan2@unl.edu A.M. Taylor University of Nebraska - Lincoln K.E. Woods University of Nebraska - Lincoln See next page for additional authors Follow this and additional works at: https://digitalcommons.unl.edu/cyfsposters  Part of the Pre-Elementary, Early Childhood, Kindergarten Teacher Education Commons Warnes, Emily D.; Olson, S.C.; Sheridan, Susan M.; Taylor, A.M.; Woods, K.E.; Burt, J.D.; Blevins, C.A.; Magee, K.L.; Swanger, M.S.; and Ellis, C.R., "Handouts for “The roles of school psychologists working within a pediatric setting”" (2006). Posters, Addresses, & Presentations from CYFS. 7. https://digitalcommons.unl.edu/cyfsposters/7 This Article is brought to you for free and open access by the Children, Youth, Families & Schools, Nebraska Center for Research on at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Posters, Addresses, & Presentations from CYFS by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Authors Emily D. Warnes, S.C. Olson, Susan M. Sheridan, A.M. Taylor, K.E. Woods, J.D. Burt, C.A. Blevins, K.L. Magee, M.S. Swanger, and C.R. Ellis This article is available at DigitalCommons@University of Nebraska - Lincoln: https://digitalcommons.unl.edu/cyfsposters/7 Warnes, E. D. Olson, S. C. Sheridan, S. M. Taylor, A. M. Woods, K. E. Burt, J. D. Blevins, C. A. Magee, K. L. Swanger, M. S. Ellis, C. R.   Handouts for   “The roles of school psychologists working within a pediatric setting”   Presented at the 114th Annual meeting of the  American Psychological Association,  New Orleans, LA. (2006, August). APA ‘06 1The Roles of School Psychologists Working Within a Pediatric Setting Emily D. Warnes, Ph.D. – University of Nebraska-Medical Center Stephanie C. Olson, M.A., Susan M. Sheridan, Ph.D., Ashley M. Taylor, M.A., Kathryn E. Woods, M.A., Jennifer D. Burt, M.Ed., Carrie A. Blevins, B.S., Katie L. Magee, B.S., Michelle S. Swanger, M.A. – University of Nebraska-Lincoln Cynthia R. Ellis, M.D. – University of Nebraska-Medical Center BACKGROUND IN PEDIATRIC SCHOOL PSYCHOLOGY • With an increasing number of children presenting with health conditions, pediatric care has expanded from solely a medical definition to a more comprehensive service delivery approach that includes psychology and education (Perrin, 1999). • An interdisciplinary, inter-systemic approach is necessary to meet the needs of children across systems (Power, Shapiro, & DuPaul, 2003).  • School psychologists are uniquely qualified to facilitate collaboration between settings and systems due to their expertise in consultation and intervention. • Roles in pediatric school psychology include: advocating for children’s educational and social needs; consulting with care providers, families, and educators; and facilitating collaboration among these individuals (Power & Parrish, 1995).   • Conjoint behavioral consultation (CBC): o A structured, indirect model wherein a consultant works with a parent and teacher to promote collaborative, problem-solving partnerships across home and school (Sheridan, Kratochwill, & Bergan, 1996). o Effective in addressing a range of concerns across home and school (Sheridan, et al., 2001); high levels of parent and teacher acceptability and satisfaction reported (Freer & Watson, 1999; Sheridan & Steck, 1995). • Other roles:  Individualized Education Plan (IEP) consultation, parent- or teacher-only consultation, observations, and provision of resources/referrals. • To date, no research has explored the conditions in which CBC is warranted in a pediatric medical setting and ones in which other services are appropriate.    RESEARCH QUESTIONS 1. What clinical services are pediatric school psychologists providing and for whom are they providing them? 2. What types of referral concerns are pediatric school psychologists addressing and which of those are associated with CBC service delivery? 3. Under what conditions are CBC services desirable and appropriate in medical settings and when are such services not warranted?   APA ‘06 2METHODS Participants:  • 5 school psychology doctoral students who had completed university- and clinic-based practica in pediatric school psychology. • 53 children (34 males; 19 females) referred by behavioral pediatricians at an outpatient medical setting and their parents and/or teachers who were involved. Measure: • The Pediatric School Psychology Referral Form: Checklist and free response form asking consultants to provide the following information for each referred client: o Demographic information (e.g., gender, age, ethnicity, diagnosis) o Referral concerns:  Medical (e.g., medication side effects, medication type/dose in question)  School (e.g., academic, behavior, social problems)  Home (e.g., behavior, homework, emotional, social problems)  Communication (e.g., divergent parent-school problem perception) o Pediatric school psychology services provided:  Observation – observing the child in relevant settings and sharing that information with parents, educators, and/or physicians.  Resources/Referrals – providing community resources (e.g., pamphlets) and/or contact phone numbers for additional services to families.  IEP Consultation – gathering information from parents and/or teachers about school performance, concerns, and current services and making IEP recommendations based on that information.  Parent Consultation – gathering information from parents, developing a plan with them, and following-up on the plan’s effectiveness.   Teacher Consultation – gathering information from teachers, developing a plan with them, and following-up on the plan’s effectiveness.   CBC – meeting with parents and teachers to implement the 4-stage collaborative problem-solving process. o Reasons for selected services:  Consultants provided qualitative data regarding the factors influencing the types of pediatric school psychology services selected. Analysis: • Research Question 1: Descriptive statistics • Research Question 2: APA ‘06 3o Chi square (x2) tests: Computed to measure the unadjusted association between predictor variables (referral concerns) and CBC.  Odds ratios identify whether the odds for receiving CBC vary as a function of concern.  o Logistic regression analysis: Tested the independence of associations using a model that included all predictor variables (referral concerns). Adjusted odds ratios (along with 95% confidence intervals) report the degree to which each referral concern predicted CBC when other concerns were accounted for.  • Research Question 3: o 3-stage coding process derived from Grounded Theory (Strauss & Corbin, 1998)  Step 1: Open Coding with Triangulation ─ 2 coders, blind to the types of services provided, independently identified categories by assessing similarities and differences in responses.   Step 2: Axial Coding with Triangulation  ─ Each coder reevaluated the responses and categories and identified any subcategories.   Step 3: Selective Coding with Member Checking ─ 4 consultants reviewed the lists developed by the coders and finalized the categories.   ─ 2 coders independently placed each response into the appropriate category.   ─ Frequencies for each category were calculated, as were frequencies for CBC and non-CBC cases.    RESULTS & DISCUSSION Research Question 1: Client Demographic Information  64% male  85% Caucasian  Mean age = 9.9 (SD = 3.1; range = 5-16)  Percentage of Clients with Various Diagnoses  APA ‘06 4 Diagnosis % of Clients ADHD 72.0 ODD 14.0 MH 12.0 AUT 28.0 Other 22.0 Comorbid 50.0            Note: ADHD = Attention Deficit Hyperactivity Disorder; ODD = Oppositional Defiant Disorder; MH = Mental Handicap (mild or moderate); AUT = Autism Spectrum Disorders (Pervasive Developmental Disorder, Aspergers, Autism); Other = Cerebral Palsy, Cystic Fibrosis, Tourette’s Syndrome, Fetal Alcohol Syndrome and other low incidence disorders; Comorbid = presence of 2 or more of the above disorders.  Percentage of Cases Involving Each Type of Service Service % of Cases Observation 75.5 Resources/Referrals 18.9 IEP Consult 20.8 Parent Consult 11.3 Teacher Consult 11.3 CBC 28.3             • ADHD was the most frequent diagnosis for referred clients.  o This may be representative of a large population of clients with ADHD at the outpatient clinic; alternatively, pediatric school psychologists may be referred clients with ADHD in greater number because symptoms present across settings and may be viewed as responsive to collaborative intervention (e.g., CBC). APA ‘06 5• Half of referred clients had comorbid diagnoses, and it was not uncommon for pediatric school psychologists to be referred clients with low incidence diagnoses. o These are clients that comprise a low percentage of the population in schools, but seek services in behavioral pediatric clinics. The high referral rate may indicate the relevance of pediatric school psychology services for these clients. • School observation was the most frequently delivered service for referred clients and occurred in the majority of cases. o Pediatric school psychologists may use observations to gather critical information that can be used to identify needs and direct service selection.   • CBC was the second most common service, occurring in over a quarter of cases. This may suggest that CBC is a portable service that is useful and valued in the pediatric setting. Research Question 2: Referral Concerns Associated with CBC Service Delivery   Referral Concern  % of Sample  % of CBC Cases with Concern  Unadjusted Odds Ratio2 Adjusted Odds Ratio3 School1 96.2  100  --  --  Home        Not Present 48.1 12.5 Referent Referent Present 51.9 87.5 12.39*** (2.4 – 63.2) 9.9** (1.87 – 52.34) Communication     Not Present 55.8 31.3 Referent Referent Present  44.2  68.8  4.4* (1.2 – 15.6) 2.95 (.72 – 12.16) Medical     Not Present 82.7 81.3 Referent Referent Present 17.3 18.8 1.15 (.25 – 5.3)  .862 (.14 – 5.38)       * p < .05      ** p < .01     *** p < .001 1  The high percentage of cases for which school concerns were prevalent limited the variance related to this factor and its usefulness as a separate variable.  Thus, it was dropped from all further x2 and logistic regression analyses. APA ‘06 62  Unadjusted odds ratio is the relative odds of receiving CBC services when a particular referral concern is present, as compared to when not present, without adjusting for the effect of other concerns.  Numbers in parentheses represent confidence intervals.  Results were considered significant when p < .05.  3  Adjusted odds ratio is the relative odds of receiving CBC services when a particular referral concern is present, as compared to when not present, after the other concerns are accounted for. • The vast majority of cases were referred due to school concerns followed by home and communication concerns.  A limited number involved medical concerns.   o These latter concerns may have been more frequently referred due to a perception that they would be more successfully addressed through collaborative efforts. • After adjusting for the other concerns, the odds are approximately 10 times higher that CBC services were delivered if a home concern was noted than if it was not.  The odds ratio for home concerns and CBC is highly significant, and the significance holds up even when medical and communication concerns are taken into account. o Only CBC and parent consultation target concerns at home, making them the most likely options when home concerns were present; however, since most cases involved school concerns, it would be time and resource effective to use a strategy that addresses both home and school concerns at once (e.g., CBC). • Only the presence of a home concern appears to influence the selection of CBC.  The odds ratio for communication concerns is significant; however, that significance did not hold up when taking into account other concerns. Medical concerns also did not appear to be important in determining CBC services. o Communication, school, and medical concerns may not have been key factors in the selection of CBC since they can be addressed via a broader range of services (e.g., IEP consultation, teacher consultation, and observations). Research Question 3: Reasons Identified for CBC and non-CBC Service Delivery  Response Categories Frequency of response for CBC Cases Frequency of response for non-CBC Cases Concern is in one environment 1 3 Divergent home and school issues 7 4 Unable to initiate due to logistical concerns (e.g., parental time constraints, distance, end of school year) 0 20 Referred out to other psychological service provider 0 3 Shared concerns and goals across home and school 11 1 APA ‘06 7Satisfied with current behavior/services 0 7 Parents or physician seeking information and/or support (e.g., regarding child’s school behavior or community resources)  17 30 Concerns with home-school connection (e.g. consistency and/or communication across environments) 11 0  • Most frequently reported reasons for use of CBC: (1) Shared concerns and goals for child across home and school, and (2) Concerns with home-school connection. o These categories deal with concerns across home and school and are in line with the CBC goal of addressing connections across environments in which children function. • Most frequently reported reasons for use of non-CBC services: (1) Logistical concerns, (2) Referred out to another psychological service provider, and (3) Satisfied with current behavior/services. o These may be contraindications for CBC within a medical setting.   o Logistical problems appear to be the biggest factor in predicting non-CBC services.      LIMITATIONS & FUTURE DIRECTIONS • External validity is questionable due to the small sample of trainees and clients. o Results may be different for pediatric school psychologists who work in other clinics and who did not receive the same training. o Future research should investigate how representative the results of this study are for pediatric school psychologists in other settings. • Effectiveness of services and satisfaction of clients/consultees has yet to be established. • Future research should explore the extent to which the referred sample of clients is representative of the clinic from which they were referred. o Differences between the referred sample and the clinic population could suggest that pediatric school psychologists are viewed as beneficial for one particular subset of the population (e.g., clients diagnosed with ADHD). • Differences in perceptions of effectiveness and case outcomes should be investigated among different types of service delivery. • Barriers to implementing CBC should be explored to determine how this practice can be implemented most effectively. 

Handouts for “The roles of school psychologists working within a pediatric setting”

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University of Nebraska - Lincoln 
DigitalCommons@University of Nebraska - Lincoln 
Posters, Addresses, & Presentations from CYFS Children, Youth, Families & Schools, Nebraska Center for Research on 
August 2006 
Handouts for “The roles of school psychologists working within a 
pediatric setting” 
Emily D. Warnes 
University of Nebraska - Lincoln, ewarnes2@unl.edu 
S.C. Olson 
University of Nebraska - Lincoln 
Susan M. Sheridan 
University of Nebraska - Lincoln, ssheridan2@unl.edu 
A.M. Taylor 
University of Nebraska - Lincoln 
K.E. Woods 
University of Nebraska - Lincoln 
See next page for additional authors 
Follow this and additional works at: https://digitalcommons.unl.edu/cyfsposters 
 Part of the Pre-Elementary, Early Childhood, Kindergarten Teacher Education Commons 
Warnes, Emily D.; Olson, S.C.; Sheridan, Susan M.; Taylor, A.M.; Woods, K.E.; Burt, J.D.; Blevins, C.A.; 
Magee, K.L.; Swanger, M.S.; and Ellis, C.R., "Handouts for “The roles of school psychologists working 
within a pediatric setting”" (2006). Posters, Addresses, & Presentations from CYFS. 7. 
https://digitalcommons.unl.edu/cyfsposters/7 
This Article is brought to you for free and open access by the Children, Youth, Families & Schools, Nebraska Center 
for Research on at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Posters, 
Addresses, & Presentations from CYFS by an authorized administrator of DigitalCommons@University of Nebraska - 
Lincoln. 
Authors 
Emily D. Warnes, S.C. Olson, Susan M. Sheridan, A.M. Taylor, K.E. Woods, J.D. Burt, C.A. Blevins, K.L. 
Magee, M.S. Swanger, and C.R. Ellis 
This article is available at DigitalCommons@University of Nebraska - Lincoln: https://digitalcommons.unl.edu/
cyfsposters/7 
Warnes, E. D. 
Olson, S. C. 
Sheridan, S. M. 
Taylor, A. M. 
Woods, K. E. 
Burt, J. D. 
Blevins, C. A. 
Magee, K. L. 
Swanger, M. S. 
Ellis, C. R. 
 
 
Handouts for  
 
“The roles of school psychologists working 
within a pediatric setting” 
 
 
Presented at the 114th Annual meeting of the  
American Psychological Association,  
New Orleans, LA. (2006, August). 
APA ‘06 1
The Roles of School Psychologists Working Within a Pediatric Setting 
Emily D. Warnes, Ph.D. – University of Nebraska-Medical Center 
Stephanie C. Olson, M.A., Susan M. Sheridan, Ph.D., Ashley M. Taylor, M.A., Kathryn 
E. Woods, M.A., Jennifer D. Burt, M.Ed., Carrie A. Blevins, B.S., Katie L. Magee, 
B.S., Michelle S. Swanger, M.A. – University of Nebraska-Lincoln 
Cynthia R. Ellis, M.D. – University of Nebraska-Medical Center 
BACKGROUND IN PEDIATRIC SCHOOL PSYCHOLOGY 
• With an increasing number of children presenting with health conditions, pediatric 
care has expanded from solely a medical definition to a more comprehensive 
service delivery approach that includes psychology and education (Perrin, 1999). 
• An interdisciplinary, inter-systemic approach is necessary to meet the needs of 
children across systems (Power, Shapiro, & DuPaul, 2003).  
• School psychologists are uniquely qualified to facilitate collaboration between 
settings and systems due to their expertise in consultation and intervention. 
• Roles in pediatric school psychology include: advocating for children’s educational 
and social needs; consulting with care providers, families, and educators; and 
facilitating collaboration among these individuals (Power & Parrish, 1995).   
• Conjoint behavioral consultation (CBC): 
o A structured, indirect model wherein a consultant works with a parent and 
teacher to promote collaborative, problem-solving partnerships across home and 
school (Sheridan, Kratochwill, & Bergan, 1996). 
o Effective in addressing a range of concerns across home and school (Sheridan, et 
al., 2001); high levels of parent and teacher acceptability and satisfaction reported 
(Freer & Watson, 1999; Sheridan & Steck, 1995). 
• Other roles:  Individualized Education Plan (IEP) consultation, parent- or teacher-
only consultation, observations, and provision of resources/referrals. 
• To date, no research has explored the conditions in which CBC is warranted in a 
pediatric medical setting and ones in which other services are appropriate.   
 
RESEARCH QUESTIONS 
1. What clinical services are pediatric school psychologists providing and for whom 
are they providing them? 
2. What types of referral concerns are pediatric school psychologists addressing and 
which of those are associated with CBC service delivery? 
3. Under what conditions are CBC services desirable and appropriate in medical 
settings and when are such services not warranted? 
 
 
APA ‘06 2
METHODS 
Participants:  
• 5 school psychology doctoral students who had completed university- and clinic-
based practica in pediatric school psychology. 
• 53 children (34 males; 19 females) referred by behavioral pediatricians at an 
outpatient medical setting and their parents and/or teachers who were involved. 
Measure: 
• The Pediatric School Psychology Referral Form: Checklist and free response form 
asking consultants to provide the following information for each referred client: 
o Demographic information (e.g., gender, age, ethnicity, diagnosis) 
o Referral concerns: 
? Medical (e.g., medication side effects, medication type/dose in question) 
? School (e.g., academic, behavior, social problems) 
? Home (e.g., behavior, homework, emotional, social problems) 
? Communication (e.g., divergent parent-school problem perception) 
o Pediatric school psychology services provided: 
? Observation – observing the child in relevant settings and sharing that 
information with parents, educators, and/or physicians. 
? Resources/Referrals – providing community resources (e.g., pamphlets) 
and/or contact phone numbers for additional services to families. 
? IEP Consultation – gathering information from parents and/or teachers 
about school performance, concerns, and current services and making IEP 
recommendations based on that information. 
? Parent Consultation – gathering information from parents, developing a 
plan with them, and following-up on the plan’s effectiveness.  
? Teacher Consultation – gathering information from teachers, developing a 
plan with them, and following-up on the plan’s effectiveness.  
? CBC – meeting with parents and teachers to implement the 4-stage 
collaborative problem-solving process. 
o Reasons for selected services: 
? Consultants provided qualitative data regarding the factors influencing the 
types of pediatric school psychology services selected. 
Analysis: 
• Research Question 1: Descriptive statistics 
• Research Question 2: 
APA ‘06 3
o Chi square (x2) tests: Computed to measure the unadjusted association between 
predictor variables (referral concerns) and CBC.  Odds ratios identify whether 
the odds for receiving CBC vary as a function of concern.  
o Logistic regression analysis: Tested the independence of associations using a 
model that included all predictor variables (referral concerns). Adjusted odds 
ratios (along with 95% confidence intervals) report the degree to which each 
referral concern predicted CBC when other concerns were accounted for.  
• Research Question 3: 
o 3-stage coding process derived from Grounded Theory (Strauss & Corbin, 1998) 
? Step 1: Open Coding with Triangulation 
─ 2 coders, blind to the types of services provided, independently identified 
categories by assessing similarities and differences in responses.  
? Step 2: Axial Coding with Triangulation  
─ Each coder reevaluated the responses and categories and identified any 
subcategories.  
? Step 3: Selective Coding with Member Checking 
─ 4 consultants reviewed the lists developed by the coders and finalized the 
categories.   
─ 2 coders independently placed each response into the appropriate category.   
─ Frequencies for each category were calculated, as were frequencies for 
CBC and non-CBC cases.  
 
 
RESULTS & DISCUSSION 
Research Question 1: 
Client Demographic Information 
? 64% male 
? 85% Caucasian 
? Mean age = 9.9 (SD = 3.1; range = 5-16) 
 
Percentage of Clients with Various Diagnoses 
 
APA ‘06 4
 
Diagnosis % of Clients 
ADHD 72.0 
ODD 14.0 
MH 12.0 
AUT 28.0 
Other 22.0 
Comorbid 50.0 
 
 
 
 
 
 
 
 
 
 
 
Note: ADHD = Attention Deficit Hyperactivity Disorder; ODD = Oppositional Defiant 
Disorder; MH = Mental Handicap (mild or moderate); AUT = Autism Spectrum Disorders 
(Pervasive Developmental Disorder, Aspergers, Autism); Other = Cerebral Palsy, Cystic 
Fibrosis, Tourette’s Syndrome, Fetal Alcohol Syndrome and other low incidence disorders; 
Comorbid = presence of 2 or more of the above disorders. 
 
Percentage of Cases Involving Each Type of Service 
Service % of Cases 
Observation 75.5 
Resources/Referrals 18.9 
IEP Consult 20.8 
Parent Consult 11.3 
Teacher Consult 11.3 
CBC 28.3 
 
 
 
 
 
 
 
 
 
 
 
 
• ADHD was the most frequent diagnosis for referred clients.  
o This may be representative of a large population of clients with ADHD at the 
outpatient clinic; alternatively, pediatric school psychologists may be referred 
clients with ADHD in greater number because symptoms present across settings 
and may be viewed as responsive to collaborative intervention (e.g., CBC). 
APA ‘06 5
• Half of referred clients had comorbid diagnoses, and it was not uncommon for 
pediatric school psychologists to be referred clients with low incidence diagnoses. 
o These are clients that comprise a low percentage of the population in schools, 
but seek services in behavioral pediatric clinics. The high referral rate may 
indicate the relevance of pediatric school psychology services for these clients. 
• School observation was the most frequently delivered service for referred clients 
and occurred in the majority of cases. 
o Pediatric school psychologists may use observations to gather critical 
information that can be used to identify needs and direct service selection.   
• CBC was the second most common service, occurring in over a quarter of cases. 
This may suggest that CBC is a portable service that is useful and valued in the 
pediatric setting. 
Research Question 2: 
Referral Concerns Associated with CBC Service Delivery 
 
 
Referral Concern 
 
% of Sample 
 
% of CBC 
Cases with 
Concern 
 
Unadjusted Odds 
Ratio2
 
Adjusted Odds 
Ratio3
 
School1
 
96.2 
 
100 
 
-- 
 
-- 
 
Home 
  
 
 
 
 
 
Not Present 48.1 12.5 Referent Referent 
Present 51.9 87.5 12.39*** 
(2.4 – 63.2) 
9.9** 
(1.87 – 52.34) 
Communication     
Not Present 55.8 31.3 Referent Referent 
Present 
 
44.2 
 
68.8 
 
4.4* 
(1.2 – 15.6) 
2.95 
(.72 – 12.16) 
Medical     
Not Present 82.7 81.3 Referent Referent 
Present 17.3 18.8 1.15 
(.25 – 5.3) 
 
.862 
(.14 – 5.38) 
 
     * p < .05      ** p < .01     *** p < .001 
1  The high percentage of cases for which school concerns were prevalent limited the variance 
related to this factor and its usefulness as a separate variable.  Thus, it was dropped from all 
further x2 and logistic regression analyses. 
APA ‘06 6
2  Unadjusted odds ratio is the relative odds of receiving CBC services when a particular referral 
concern is present, as compared to when not present, without adjusting for the effect of other 
concerns.  Numbers in parentheses represent confidence intervals.  Results were considered 
significant when p < .05.  
3  Adjusted odds ratio is the relative odds of receiving CBC services when a particular referral 
concern is present, as compared to when not present, after the other concerns are accounted for. 
• The vast majority of cases were referred due to school concerns followed by home 
and communication concerns.  A limited number involved medical concerns.   
o These latter concerns may have been more frequently referred due to a 
perception that they would be more successfully addressed through 
collaborative efforts. 
• After adjusting for the other concerns, the odds are approximately 10 times 
higher that CBC services were delivered if a home concern was noted than if it 
was not.  The odds ratio for home concerns and CBC is highly significant, and the 
significance holds up even when medical and communication concerns are taken 
into account. 
o Only CBC and parent consultation target concerns at home, making them the 
most likely options when home concerns were present; however, since most 
cases involved school concerns, it would be time and resource effective to use a 
strategy that addresses both home and school concerns at once (e.g., CBC). 
• Only the presence of a home concern appears to influence the selection of CBC.  
The odds ratio for communication concerns is significant; however, that 
significance did not hold up when taking into account other concerns. Medical 
concerns also did not appear to be important in determining CBC services. 
o Communication, school, and medical concerns may not have been key factors in 
the selection of CBC since they can be addressed via a broader range of services 
(e.g., IEP consultation, teacher consultation, and observations). 
Research Question 3: 
Reasons Identified for CBC and non-CBC Service Delivery 
 
Response Categories Frequency of response for 
CBC Cases 
Frequency of 
response for 
non-CBC Cases 
Concern is in one environment 1 3 
Divergent home and school issues 7 4 
Unable to initiate due to logistical concerns (e.g., parental 
time constraints, distance, end of school year) 
0 20 
Referred out to other psychological service provider 0 3 
Shared concerns and goals across home and school 11 1 
APA ‘06 7
Satisfied with current behavior/services 0 7 
Parents or physician seeking information and/or support 
(e.g., regarding child’s school behavior or community 
resources)  
17 30 
Concerns with home-school connection (e.g. consistency 
and/or communication across environments) 
11 0 
 
• Most frequently reported reasons for use of CBC: (1) Shared concerns and goals 
for child across home and school, and (2) Concerns with home-school 
connection. 
o These categories deal with concerns across home and school and are in line with 
the CBC goal of addressing connections across environments in which children 
function. 
• Most frequently reported reasons for use of non-CBC services: (1) Logistical 
concerns, (2) Referred out to another psychological service provider, and (3) 
Satisfied with current behavior/services. 
o These may be contraindications for CBC within a medical setting.   
o Logistical problems appear to be the biggest factor in predicting non-CBC 
services.     
 
LIMITATIONS & FUTURE DIRECTIONS 
• External validity is questionable due to the small sample of trainees and clients. 
o Results may be different for pediatric school psychologists who work in other 
clinics and who did not receive the same training. 
o Future research should investigate how representative the results of this study 
are for pediatric school psychologists in other settings. 
• Effectiveness of services and satisfaction of clients/consultees has yet to be 
established. 
• Future research should explore the extent to which the referred sample of clients is 
representative of the clinic from which they were referred. 
o Differences between the referred sample and the clinic population could suggest 
that pediatric school psychologists are viewed as beneficial for one particular 
subset of the population (e.g., clients diagnosed with ADHD). 
• Differences in perceptions of effectiveness and case outcomes should be 
investigated among different types of service delivery. 
• Barriers to implementing CBC should be explored to determine how this practice 
can be implemented most effectively. 


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