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Journal of Applied School Psychology
ISSN: 1537-7903 (Print) 1537-7911 (Online) Journal homepage: https://www.tandfonline.com/loi/wapp20
Response to Intervention and Interdisciplinary
Collaboration: Joining Hands to Support Children's
Healthy Development
Michael L. Sulkowski , Robert J. Wingfield , Douglas Jones & W. Alan Coulter
To cite this article: Michael L. Sulkowski , Robert J. Wingfield , Douglas Jones & W. Alan Coulter
(2011) Response to Intervention and Interdisciplinary Collaboration: Joining Hands to Support
Children's Healthy Development, Journal of Applied School Psychology, 27:2, 118-133, DOI:
10.1080/15377903.2011.565264
To link to this article: https://doi.org/10.1080/15377903.2011.565264
Published online: 11 May 2011.
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Journal of Applied School Psychology, 27:118–133, 2011
Copyright © Taylor & Francis Group, LLC
ISSN: 1537-7903 print / 1537-7911 online
DOI: 10.1080/15377903.2011.565264
Response to Intervention and Interdisciplinary
Collaboration: Joining Hands to Support
Children’s Healthy Development
MICHAEL L. SULKOWSKI, ROBERT J. WINGFIELD,
and DOUGLAS JONES
University of Florida, Gainesville, Florida, USA
W. ALAN COULTER
Health Science Center, Louisiana State University, New Orleans, Louisiana, USA
School psychologists often are involved with the provision of ser-
vices to students with chronic physical health conditions and men-
tal health problems. However, collaborative efforts between school
psychologists and the medical professionals who treat these youth
often are lacking despite the benefits that may result from inter-
disciplinary collaboration. To address this disconnect, the authors
discuss various ways school psychologists and medical professionals
can collaborate to enhance the provision of services to youth with
health and mental health problems in a response-to-intervention
framework. Specifically, the authors discuss ways in which school
psychologists can improve interdisciplinary collaboration across
multiple tiers of service provision. In addition, the authors provide
a case example to illustrate the benefits of interdisciplinary collabo-
ration among school psychologists, allied health professionals, and
physicians.
KEYWORDS response to intervention, interdisciplinary collabo-
ration, consultation, school mental health
School psychologists and health professionals (e.g., physicians, nurses) of-
ten see the same children in different settings (Wodrich, 2004). More than
Received 07/07/2010; revised 01/24/2011; accepted 01/27/2011.
Address correspondence to Michael L. Sulkowski, University of Florida, Department of
Special Education, School Psychology and Early Childhood Studies, 1403 Norman Hall, Box
117050, Gainesville, FL 32611, USA. E-mail: sulkowsm@ufl.edu
118
Interdisciplinary Collaboration 119
9 million U.S. children or about 13% of all students in U.S. schools have sig-
nificant health needs, and about 16% have substantial mental health needs
(Roberts, Attkisson, & Rosenblatt, 1998; van Dyck, Kogan, McPherson, Weiss-
man, & Newacheck, 2004). Furthermore, 52% of students who receive special
education services take psychotropic medications, and 8% of general edu-
cation students take these medications (Lien, Carlson, Hunter-Oehmke, &
Knapp, 2007; Mattison, 1999). However, interdisciplinary collaboration be-
tween school psychologists and medical professionals is lacking despite the
benefits that may result from working together (Bradley-Klug, Sundman,
Nadeau, Cunningham, & Ogg, 2010; Davis, Montford, & Read, 2005; Ku-
biszyn, 1999; Shaw & Woo, 2008). The purpose of this article is to discuss
ways that school psychologists and medical professionals can collaborate to
address the health and mental health needs of students in the context of
a response-to-intervention (RTI) service delivery framework. We provide a
case example to illustrate this approach.
STATUS OF INTERDISCIPLINARY COLLABORATION
The benefits of interdisciplinary collaboration can be mutually fulfilling
across disciplines. Almost all school psychologists (97%) report a desire
to increase their knowledge of psychopharmacology (Carlson, Demaray, &
Hunter-Oehmke, 2006), and most physicians (91%) appreciate information
on patients’ academic and psychosocial functioning (HaileMariam, Bradley-
Johnson, & Johnson, 2002). However, less than a third (31%) of health pro-
fessionals actually receive this information, and many (38%) school psychol-
ogists do not collaborate with medical professionals when they assist with
students’ medical treatment plans (Carlson et al., 2006)—a “best practice” ac-
cording to the National Association of School Psychologists and Division 16
of the American Psychological Association (Carlson, 2009; Ysseldyke et al.,
2006, p. 15). Perhaps to address the apparent breakdown in information shar-
ing between school psychologists and medical professionals, some school
psychology programs now train students to facilitate interdisciplinary col-
laboration. For example, the school psychology training programs at Lehigh
University, Eastern Carolina University, and the University of Houston of-
fer pediatric school psychology subspecializations in which students learn
how to address chronic health problems in educational settings as well as
collaborate with individuals from allied health professions.
The need to increase interdisciplinary collaboration between school psy-
chologists and medical professionals is further illustrated by the high per-
centage of U.S. children who have unmet health and mental health needs.
Approximately 18% of U.S. children lack adequate health care (Roberts
et al., 1998), and 79% lack adequate mental health care (Kataoka, Zhang, &
Wells, 2002). Many of these children are socially, ethnically, culturally, and
economically disadvantaged. In addition, they often live in rural or urban
120 M. L. Sulkowski et al.
communities that are underserved by mental health and medical profession-
als. The unmet needs of these children further contribute to the perpetua-
tion of social and economic disparities as their caregivers often experience
financial difficulties, disruptions in occupational functioning, and increased
overall stress associated with caring for a child with a chronic medical or
mental health condition (Roberts et al.).
Schools may be an optimal environment to address the unmet health
and mental health needs of these children. More than 95% of youth spend at
least 40 hours a week in school (Resnicow, 1993), and research suggests that
disparities in the provision of health and mental health services are reduced
in educational settings (Cummings, Ponce, & Mays, 2010). However, most
schools do not provide comprehensive medical and mental health services,
and decades may pass before these services are universally available, es-
pecially in schools with limited financial resources. Therefore, considering
the importance of addressing student needs while recognizing current lim-
itations in policy and practice, the number of students with unmet needs
may be reduced through greater collaboration between school psycholo-
gists and medical professionals (DuPaul & Carlson, 2005; Kubiszyn, 1999;
Sexson & Madan-Swain, 1995; Wodrich, 2004; Wodrich & Landau, 1999).
With this in mind, Sulkowski, Jordan, and Nguyen (2009) discussed spe-
cific ways that school psychologists and physicians can overcome barriers to
collaboration. These authors recommend clarifying roles and goals among
professionals, increasing buy in from school administrators, using timesaving
approaches to communicating (e.g., e-mail, faxed updates), and reducing real
(or perceived) barriers to information sharing. However, these authors do
not discuss how advances in the implementation of RTI will likely influence
collaborative efforts.
THE RTI SERVICE-DELIVERY FRAMEWORK
RTI, also referred to as multitiered systems of support or early interven-
ing services, is a service-delivery framework that aims to provide children
with timely evidence-based intervention services. Instead of simply evaluat-
ing students, diagnosing an impairment or exceptionality, and then providing
supportive services as was traditionally done during a special education eval-
uation, RTI involves screening youth for academic and behavioral problems,
intervening early for at-risk youth, and monitoring students’ response to
the intervention as well as their general educational performance (Wodrich,
Spencer, & Daley, 2006). Persistent lack of a satisfactory RTIs by a student
over time usually results in a comprehensive evaluation and the provision of
additional intervention services.
The RTI framework is most widely applied to support academic suc-
cess and address students’ academic problems (for a review, see Fletcher
Interdisciplinary Collaboration 121
& Vaughn, 2009). However, positive behavior intervention and support im-
plements—a multitiered system of interventions—often is integrated within
an RTI framework (Sailor, 2010). Principles of RTI, both academic and
behavioral, include the use of evidence-based interventions, collaborative
problem solving, progress monitoring, systemwide screening, early interven-
tion, primary prevention, and universal service provision (Jimerson, Burns, &
VanDerHeyden, 2007).
Similarly, an RTI framework may be useful in addressing the unmet
needs of youth with chronic health conditions or mental health problems. In
fact, the originating concept for RTI or multitiered services can be found in
concepts of public health in the 1950s (Kratochwill, Clements, & Kalymon,
2007). For example, Tier 1 interventions can target pervasive health prob-
lems in a school community such as substance abuse or precocious sexual
behavior, Tier 2 interventions can address problems in segments of a pop-
ulation (e.g., children with diabetes, children with limited social skills), and
Tier 3 interventions can be individually administered to support the needs of
youth with significant health and mental health problems. As an example of
a potential Tier 3 intervention, a home-school medication management plan
can be implemented for a child with epilepsy who inconsistently receives his
or her medication at home. Thus, a RTI framework is a useful way to con-
ceptualize health and mental health service delivery in schools. However, in
contrast with addressing academic and behavioral problems in which mem-
bers of educational communities often have experience in implementing,
school psychologists may need to collaborate with medical professionals to
provide (or facilitate the provision of) these interdisciplinary services.
Interdisciplinary Consultation and Collaboration
Because of the high number of students with significant academic, behav-
ioral, health, and mental health needs and the limited number of school-
based professionals who can meet these needs, school psychologists often
consult or collaborate with others to address student needs. School-based
consultation involves the provision of indirect services to a student through
the relationship between a consultee and a consultant (Bergan & Kratochwill,
1990; Swanger-Gagn´
e, Garbacz, & Sheridan, 2009). The consultation process
generally moves through a series of routine steps. These steps include the es-
tablishment of cooperative relationships, conducting interviews to determine
the nature of a student’s problem, collecting baseline data, setting reasonable
goals, selecting and implementing an appropriate intervention, monitoring
a student’s response to the intervention, evaluating the student’s outcome,
conveying results to important stakeholders (e.g., parents, teachers, physi-
cians), and deciding what steps are needed next. However, this process
may not flow evenly across all stages or be practical for use across different
122 M. L. Sulkowski et al.
disciplines and settings. For example, students already receiving Tier 2 or
3 services may have records that detail their response, or lack thereof, to
various interventions. In addition, some steps in this process may need to
be streamlined because of time limitations, large caseloads, and a variety
of other variables that can affect consultation between medical and school
personnel (DuPaul & Carlson, 2005; Sulkowski et al., 2009). Therefore, an
abbreviated approach to working with busy or overextended medical pro-
fessionals may be appropriate. In this regard and out of respect for time
limitations and professional boundary concerns, school-based mental health
and medical professionals may better address the needs of students through
interdisciplinary collaboration instead of through consultation.
Although the literature on school-based consultation and collaboration
is replete with contradictions and disagreements over the use of these terms,
one characteristic defines collaborative practice: collaboration involves the
establishment of a working relationship between a consultant and consul-
tee to solve a problem (Schulte & Osborne, 2003). Collaborative efforts can
be highly structured and follow a planned series of steps or merely involve
the provision of educational resources across disciplines or settings. Thus,
it is important for school psychologists and medical professionals to clearly
articulate goals and expectations for mutual collaboration to reduce con-
flicts and misunderstandings. In other words, each professional must prac-
tice within his or her own area of competence and respect the knowledge
of the other. Furthermore, the establishment of a nonhierarchical working
relationship is integral for effective interdisciplinary collaboration between
school psychologists and medical professionals (Knotek & Sandoval, 2003).
Nonhierarchical and collaborative relationships also may facilitate the devel-
opment of prevention-focused goals, dexterity in problem-solving, greater
buy-in across disciplines, and aid in the general sustainability of consultation
efforts (Knotek, 2007; Schulte & Osborne, 2003).
In addition to these suggestions, Shaw, Clayton, Dodd, and Rigby (2004)
highlighted the importance of actively inviting medical professionals to par-
ticipate on school-based teams or simply provide their professional insight
when it is needed. Time limitations, significant pressure to generate clini-
cal revenue, and restrictions in third-party reimbursement rules may prevent
medical professionals from attending school meetings, yet school psychol-
ogists still can provide physicians with pertinent information and inquire
about the effect of a student’s educational or behavioral goals on his or her
medical or mental health treatment. Furthermore, school-based professionals
can maximize the utility of a meeting, phone contact, or electronic message
with a physician by asking direct and focused questions and providing ob-
jective information in return. In this vein, Shaw et al. (2004) suggested that
school psychologists should limit the amount of extraneous or nonessential
information discussed during contacts with physicians who tend to value
brevity and objectivity over chattiness and subjectivity.
Interdisciplinary Collaboration 123
When facilitating interdisciplinary communication, it is important to en-
sure the confidentiality of shared information. Information security is a grow-
ing concern for health and mental health professionals and it may be ap-
propriate to speak in hypotheticals and use pseudonyms or initials when
discussing cases, especially when communicating through email, text mes-
sage, and other forms of communication that could be viewed by third
parties. In addition, it is important to coordinate when and where faxes are
sent to ensure that the appropriate recipients receive them. Overall, school-
based and medical professionals must collectively ensure that the integrity
of a student’s private health information and educational records is not com-
promised. Medical professionals may be more vigilant about protecting the
confidentiality of medical records than various members of the educational
community because of the periodic training medical professionals must re-
ceive in complying with the Health Insurance Portability and Accountability
Act. Conversely, medical professionals may be less familiar with maintain-
ing the confidentiality of educational records as mandated by the Family
Educational Rights and Privacy Act.
PUTTING IT TOGETHER: INTERDISCIPLINARY COLLABORATION
IN THE CONTEXT OF RTI
Flexibility and creativity are needed to facilitate interdisciplinary collabora-
tion within an RTI framework because different problems and goals are likely
to exist at each broad level of service delivery. Depending on the nature of
rendered services and the tier of intervention support, different approaches
are needed to address students’ health and mental health needs. School-
based health clinics, when available, provide additional opportunities for
interdisciplinary interaction to meet student needs. These clinics minimize
some barriers to collaboration and often make it easier to share information
among important professionals.
As a final caveat, despite strong efforts to facilitate interdisciplinary col-
laboration, these efforts may be frustrated if the issue of case management
is not adequately addressed. It is likely that a variety of disjointed or even
overlapping services will be provided if concerted efforts to designate who
will be responsible for providing specific services and how information will
be communicated are not predetermined. Therefore, it may be beneficial to
designate one specific individual as a case manager who is able to delegate
other roles and responsibilities to others. For example, under the direction of
the director of pupil appraisal (the case manager), a school psychologist may
be responsible for monitoring a student’s behavior at school, a nurse may be
responsible for communicating with a physician, and a social worker may be
responsible for communicating with caregivers/family members. Then, with
124 M. L. Sulkowski et al.
an established team and responsibilities appropriately delegated, the case
manager can schedule specific dates and meetings in which information can
be shared and communicated among team members.
Tier 1 Collaboration
Tier 1 interventions aim to enhance the educational performance of all stu-
dents. These interventions generally are delivered through specific evidence-
based programs and curricula (Fuchs & Deschler, 2007). Because all youth
receive these interventions, it is important for school administrators to iden-
tify broad areas of concern and then support school-based mental health
or medical professionals in their effort to provide supportive services. For
example, out of concern about falling attendance rates, a principal may dis-
cover that a large number of absences are flu-related. In response to this
problem, the principal could have a school nurse or community physician
provide information to members of the educational community on ways to
prevent the spread of flu. Teachers and school health personnel could then
include this information in a healthy lifestyles unit or lesson. In addition,
as part of a schoolwide focus on health promotion, parents and caregivers
can be provided with brochures from community health professionals about
preventing the spread of disease and who to contact if a child becomes
ill (Westmaas, Gil-Rivas, & Silver, 2007). Families also can be invited to
attend free presentations from school or community health professionals.
Professionals who work in private practice may be amenable to providing
presentations and workshops in schools to increase their exposure in the
community and possibly generate new clients.
As alluded, key stakeholders must be involved in coordinating Tier 1
intervention services because these services broadly affect all students, re-
quire considerable planning, and significant buy in from diverse members of
the educational community. Therefore, it behooves school psychologists to
develop brief plans and prospective reports that district supervisors, super-
intendents, and school board members can quickly read, understand, and
support to advance the implementation of Tier 1 services. Further, it is im-
portant to augment these plans with local data presented in an appealing
and unambiguous manner (Hood & Doorman, 2007). Last, it may be benefi-
cial to have an administrator lead Tier 1 intervention efforts, even if a school
psychologist or other school-based mental health professional do much of
the work developing and implementing specific services given that these
services affect all students and require considerable buy in from school staff.
Tier 2 Collaboration
According to many RTI models, approximately 5–10% of students are ex-
pected to need Tier 2 interventions that aim to address growing risks or
Interdisciplinary Collaboration 125
concerns among groups of students. Consistent with the previous example
involving school absenteeism, students who accumulate excessive absences
even after the implementation of Tier 1 interventions may need additional
attention and support. For example, a school psychologist or social worker
may regularly contact caregivers to identify and overcome barriers to stu-
dent attendance. From these efforts, it may be discovered that some fre-
quently absent students share similar characteristics such as having a chronic
health condition (e.g., asthma, sickle cell anemia, pediatric diabetes), signifi-
cant mental health problems (e.g., obsessive-compulsive disorder, substance
abuse), or limited caregiver support. Depending on the nature of identified
attendance barriers, different Tier 2 interventions may be warranted. For ex-
ample, even though this approach has yet to be empirically verified, a school
nurse, knowledgeable guidance counselor, or school psychologist may form
a treatment adherence group for students with chronic health problems who
failed to respond to Tier 1 interventions. Similarly, a school-based health or
mental health practitioner can form a psychotherapy group to assist students
and families with mental health needs.
Under the umbrella of providing Tier 2 services, at-risk students also
can be required to check in with a nurse before school to make sure that
the student is taking his or her medication and receiving necessary medi-
cal treatments. The school nurse can monitor students’ response to various
medications, check for side effects, and contact a physician if changes are
needed to a student’s treatment plan. In addition, school nurses can admin-
ister medication to students at school who may have limited access to it at
home. Some physicians may refrain from prescribing stimulant medication
(e.g., Adderall, Ritalin) if they suspect that the medication will be abused
by caregivers or sold illegally instead of being taken by a student (Levine,
2007). Physicians may be more willing to prescribe certain medications if
school personnel can convince a caregiver to consent to having the medi-
cation administered by an appropriate person at school (e.g., school nurse,
consulting physician).
Tier 2 intervention services should be coordinated by individuals who
have considerable experience in addressing the needs of at-risk youth as well
as the ability to easily contact caregivers to obtain consent to implement these
services. Some people who may effectively coordinate Tier 2 services for
students with health or mental health concerns include school psychologists,
social workers, school counselors, special education teachers, and school
administrators (Shaw et al., 2004). In addition, individual education plan
RTI team leaders also could coordinate the provision of health and mental
health supports in addition to academic and behavioral supports. These
individuals usually are accustomed to collaborating with individuals from
different disciplines to address students’ academic and behavioral needs.
Thus, these individuals also can be key stakeholders in efforts to address
students’ health and mental health needs.
126 M. L. Sulkowski et al.
Tier 3 Collaboration
Tier 3 interventions aggressively target problems that could not be resolved
by Tier 1 or 2 interventions. Students who receive these interventions gener-
ally represent a small percentage (about 1–5%) of the school population and
often have overlapping behavioral and academic needs that require individ-
ualized attention. Furthermore, these students may have significant physical
and mental health disorders, environmental risk factors (e.g., inadequate care
giving, poverty), developmental delays, and cognitive impairments that affect
their functioning across multiple domains. For example, children with poorly
regulated diabetes symptoms often develop health complications (e.g., ke-
toacidosis) and mood and anxiety problems (Kovacs, Goldston, Obrosky, &
Bonar, 1997). In addition, these children may experience significant disrup-
tions in academic functioning as a result of hypoglycemia (i.e., lower than
normal level of blood glucose; Schmitt, Wodrich, & Lazar, 2010; Wodrich,
Hasan, & Parent, 2010).
Before implementing Tier 3 intervention services or collaborating with
outside professionals to address a student’s health or mental health prob-
lem, caregivers must sign informed consent forms that include the following
information: The names of individuals/parties to whom records will be re-
leased, the purpose and intended use of the records, official record titles,
when the records will be provided and when they expire, the names and
signatures of consenting caregivers, and the consenter’s relationship to the
child (Koocher & Keith-Spiegel, 2008). In addition, all medical, health, men-
tal health, and educational information collected and shared must be stored
in a secure location (e.g., a locked cabinet, secure filing room) as mandated
by federal laws (i.e., Health Insurance Portability and Accountability Act,
Family Educational Rights and Privacy Act).
It may be beneficial to designate one specific individual who regularly
is at school as a case manager for children who need Tier 3 intervention
services. On a regular basis, this person then can collect and compile infor-
mation to present at meetings or share with relevant medical professionals
(Shaw et al., 2004). With administrative support, the case manager can assign
duties to other school personnel. For example, this person can recommend
for a social worker to interview a student’s caregivers, a school psychologist
to observe the student’s classroom behavior, and a school nurse to complete
a medication symptoms checklist. In addition, the case manager may col-
laborate with a physician to provide information on the student’s condition
and treatment and consult with teachers to complete behavior rating forms
that may help guide the physician’s practice. No single individual or pro-
fessional discipline is perfectly suited to fulfill the role of case manager for
the delivery of Tier 3 services to address the needs of youth with significant
health and mental health needs. However, school psychologists who have
administrative support as well as training or experience with implementing
Interdisciplinary Collaboration 127
evidence-based interventions, interdisciplinary collaboration, and the provi-
sion of services under a RTI framework may be well suited.
SCHOOL REINTEGRATION
School psychologists also can help facilitate hospital to school transitions
or school reentry for children who have undergone significant medical pro-
cedures or treatments. Specific transition plans can be written and applied
in educational settings. Research suggests that children benefit and adjust
more quickly to the demands of school when medical and school profes-
sionals are actively engaged in collaboration (Katz, Rubenstein, Hubert, &
Blew, 1988; Katz & Varni, 1993; Prevatt, Heffer, & Lowe, 2000). Kaffenberger
(2006) offered some helpful suggestions to guide this process such as having
school-based personnel contact caregivers as soon as they become aware of
a child’s discharge, address any questions that caregivers may have, assess
the level of care that the child will need, and convey to the family that
the school is anticipating the child’s return. Caregivers may be unaware of
school policies, available services, laws and regulations (e.g., 504 plans),
have concerns about a stigma associated with illness, and the possibility of
social exclusion for a child during the reentry process that may need to be
addressed (Benner & Marlow, 1991).
Once a child returns to school, school psychologists can monitor his or
her adjustment to the school environment, assess for fatigue and treatment
side effects, ensure that the child is establishing positive peer interactions,
and that instruction is appropriately matched (i.e., sufficiently challenging
yet not overwhelming). During this time, it also may be beneficial to con-
sult with students, teachers, nurses, administrators, and other members of
the school community to understand their role in supporting a returning
student. These individuals may have limited knowledge about the child’s
physical or mental health condition, misunderstand his or her psychosocial
needs, feel uncomfortable around the student as a result of not knowing
how to relate to him or her, and even fear catching the student’s illness
(Kaffenberger, 2004). To disabuse these misguided notions and perceptions,
school psychologists can arrange for a physician to speak with school mem-
bers and caregivers. Even a short workshop can provide needed information
about physical and emotional effects of chronic illness, normalize students’
behaviors during reentry, and have a positive effect on how teachers treat
the transitioning student (Prevatt et al., 2000). Similarly, school-based men-
tal health professionals can consult with medical professionals to design
or convey developmentally appropriate information about a child’s condi-
tion as well as how to interact with the transitioning student. One study
found a single-session brief classroom-based workshop to increase students’
knowledge of a chronic health condition, decrease their fears, and increase
128 M. L. Sulkowski et al.
their willingness to interact with the students with chronic illness (Benner
& Marlow, 1991). Another study found that the process of providing edu-
cators with information on student’s chronic health conditions (e.g., Type I
diabetes) allowed them to address student health and learning needs better
(Cunningham & Wodrich, 2006).
Last, it is important to be sensitive to the individual needs and styles of
children and families when implementing Tier 3 intervention services. Chil-
dren respond differently to varying amounts of attention during the reentry
process because of a variety of individual and cultural factors. Some students
easily adjust to the demands of school, whereas others struggle considerably
(Sexson & Madan-Swain, 1995). Thus, children should be provided with ad-
equate supports, although it also is possible that too much support can be
overwhelming or belittling.
A CASE EXAMPLE
Mark Smith (pseudonym) was referred to a school psychology intern due
to his hyperactive, inattentive, and impulsive school behavior. Mark was an
8-year-old student in the second grade, and his referring teacher (Ms. Jones)
tried to reinforce him verbally for displaying positive behavior. In addition,
she tried using response cost strategies. However, these efforts were largely
unsuccessful in modifying Mark’s behavior.
Classroom observations indicated that Mark acted aggressively toward
his classroom peers and displayed low academic engagement. While his
peers attempted to read along to a story, Mark crawled on the classroom
floor, threw erasers at other students, and attempted to tear posters off the
classroom wall. Overall, he was engaged in instruction 38% of the time he
was observed. In addition, he displayed about ten significantly disruptive
behaviors (e.g., throwing objects, grabbing other students) on average each
day as recorded by his teacher over a ten day period.
Because of his limited progress and insufficient response to Tier 1 in-
terventions over a 2-week period, Mark was referred to an individual ed-
ucation plan team to assess his eligibility to receive exceptional student
education services. Mark met all criteria in the Diagnostic and Statistical
Manual for Psychiatric Disorders (4th edition, text revision) for attention
deficit/hyperactivity disorder (combined type). He also was aggressive to-
ward his peers and had few peer relations. Because of his poor response to
academic and behavioral interventions, a referral was made to a community-
based psychiatrist (Dr. Jones) at the request of Ms. Smith. Following this
referral, a school psychology intern faxed Dr. Jones information on Mark’s
problematic classroom behavior and spoke with him over the phone to dis-
cuss Mark’s school behavior.
Interdisciplinary Collaboration 129
Mark was prescribed Adderall (5 mg) by his psychiatrist, which de-
creased his hyperactive and impulsive classroom behavior and allowed him
to focus better during instruction. A school psychology intern observed Mark
while he was taking medication and Mark appeared to be engaged in instruc-
tion about 69% of the time. His disruptive behaviors also decreased while
on Adderall, from about ten problematic behaviors a day to about four over
a three-week period.
A school nurse also evaluated Mark’s response to Adderall and screened
for side effects. Mark reported that he was having difficulty falling asleep at
night and was sometimes too tired to complete his homework. A school
psychology intern then contacted Ms. Smith and Dr. Jones to discuss this
concern. Because of Mark’s favorable response to his current dose of Adder-
all and concerns about using a second medication to assist with Mark’s
emerging sleeping problems, Dr. Jones was hesitant to change his medical
treatment regimen. However, during conversation with Ms. Smith the school
psychology intern discovered that Mark did not have a regular bedtime, often
stayed up watching television in his room, and sometimes ate his dinner late
in the evening. Therefore, the school psychologist consulted with Ms. Smith
to establish regular bedtime routines for Mark and his sleeping difficulties
gradually decreased.
School psychologists and medical professionals often are involved
with the provision of services to students with chronic physical health con-
ditions and mental health problems. However, collaborative efforts between
these individuals often are limited despite the benefits that may result from
these efforts. This article reviewed various ways school psychologists and
medical professionals can collaborate to enhance the delivery of services
to students within a RTI framework. Specifically, school psychologists and
medical professionals can work together to provide universal health pro-
motion and prevention programs for all students at Tier 1. At Tier 2, school
psychologists and medical professionals can conjointly target specific groups
of at-risk students (e.g., students with chronic health problems). Moreover,
these professionals can collaborate to provide Tier 3 services to students who
do not respond to previous intervention efforts and need additional support.
On a final note, the benefits of interdisciplinary collaboration must be
supported by research even if they seem intuitive. Research is needed to
elucidate ways in which school psychologists and medical professionals can
efficiently provide universal support services, direct or support health pro-
motion groups in schools with limited resources, and most effectively ad-
dress the needs of youth with significant health and mental health problems
through interdisciplinary collaboration. Given that applied research and prac-
tice ought to go hand and hand, researchers also may need to join hands
with school psychologists and medical professionals to support children’s
healthy development.
130 M. L. Sulkowski et al.
REFERENCES
Benner, A., & Marlow, L. S. (1991). The effect of a workshop on childhood cancer
on students’ knowledge, concerns and desire to interact with a classmate with
cancer. Children’s Health Care,20, 101–107. doi: 10.1207/s15326888chc2002 5
Bergan, J. R., & Kratochwill, T. R. (1990). Behavioral consultation and therapy.New
York, NY: Plenum Press.
Bradley-Klug, K. L., Sundman, A. N., Nadeau, J., Cunningham, J., & Ogg, J. (2010).
Communication and collaboration with schools: Prediatricians’ perspectives.
Journal of Applied Psychology,26, 263–281. doi: 10.1080/15377903.2010.518583.
Carlson, G. A. (2009). Treating the childhood bipolar controversy: A tale of
two children. American Journal of Psychiatry,166, 18–24. doi: 10.1176/
appi.ajp.2008.08091362
Carlson, J. S., Demaray, M. P., & Hunter-Oehmke, S. (2006). A survey of school psy-
chologists’ knowledge and training in child psychopharmacology. Psychology
in the Schools,43, 623–633. doi: 10.1002/pits.20168
Cummings, J. R., Ponce, N. A., & Mays, V. M. (2010). Comparing racial/ethnic dif-
ferences in mental health service use among high-need subpopulations across
clinical and school-based settings. Journal of Adolescent Health,46, 603–606.
doi: 10.1016/j.jadohealth.2009.11.221
Cunningham, M. M., & Wodrich, D. L. (2006). The effect of sharing health informa-
tion on teachers’ productions of classroom accommodations. Psychology in the
Schools,45, 553–564. doi:10.1002/pits.20166
Davis, T. K., Montford, C. R., & Read, C. (2005). Interdisciplinary teamwork in a
school-based health center. Nursing Clinics of North America,40, 699–709.
doi:10.1016/j.cnur.2005.07.002
DuPaul, G. J., & Carlson, J. S. (2005). Child psychopharmacology: How school
psychologists can contribute to effective outcomes. School Psychology Quarterly,
20, 206–221. doi: 10.1521/scpq.20.2.206.66511
Fletcher, J. M., & Vaughn, S. (2009). Response to intervention: Preventing and re-
mediating academic difficulties. Child Development Perspectives,3, 30–37. doi:
10.1111/j.1750-8606.2008.00072.x
Fuchs, D., & Deschler, D. (2007). What we need to know about responsiveness to
intervention (and shouldn’t be afraid to ask). Learning Disabilities Research &
Practice,22, 129–136. doi: 10.1111/j.1540–5826.2007.00237.x
HaileMariam, A., Bradley-Johnson, S., & Johnson, C. M. (2002). Pediatricians’ pref-
erences for ADHD information from schools. School Psychology Review,31,
94–105. Retrieved from http://web.ebscohost.com
Hood, C., & Doorman, C. (2007). Best practices in the display of data. In A. Thomas
&J.Grimes(Eds.),Best practices in school psychology (5th ed., pp. 2117–2132).
Washington, DC: National Association of School Psychologists.
Jimerson, S. R., Burns, M. K., & VanDerHeyden, A. M. (2007). Response to interven-
tion at school: The science and practice of assessment and intervention. In S. R.
Jimerson, M. K. Burns, & A. M. VanDerHeyden (Eds.), Handbook of response to
intervention: The science and practice of assessment and intervention (pp. 3–9).
New York, NY: Springer.
Interdisciplinary Collaboration 131
Kaffenberger, C. J. (2004). School reentry for students with chronic illness. In B.T.
Erford (Ed.), Professional school counseling: A handbook of theories, programs
& practices (pp. 681–692). Austin, TX: PRO-ED.
Kaffenberger, C. J. (2006). School reentry for students with chronic illness: A role for
professional counselors. Professional School Counseling,9, 223–230. Retrieved
from http://www.schoolcounselor.org/files/9-3-223%20Kaffenberger.pdf
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental
health care among US children: Variation by ethnicity and insurance status.
American Journal of Psychiatry,159, 1548–1555. Retrieved from http://ajp.
psychiatryonline.org/cgi/content/full/159/9/1548
Katz, E. R., Rubenstein, C. L., Hubert, N. C., & Blew, A. (1988). School and so-
cial reintegration of children with cancer. Journal of Psychosocial Oncology,6,
123–140. doi: 10.1300/J077v06n03 09
Katz, E. R., & Varni, J. W. (1993). Social support and social cognitive problem-
solving in children with newly diagnosed cancer. Cancer,71, 3314–3319.
doi:10.1002/1097-0142
Knotek, S. E. (2007). Consultation within response to intervention models. In S. R.
Jimerson, M. K. Burns, & A. M. VanDerHeyden (Eds.), Handbook of response
to intervention: The science and practice of assessment and intervention (pp.
53–64). New York, NY: Springer Science.
Knotek, S. E., & Sandoval, J. (2003). Current research in consultee centered con-
sultation. Journal of Educational and Psychological Consultation,14, 243–250.
doi: 10.1207/s1532768xjepc143&4 2
Koocher, G. P., & Keith-Spiegel, P. C. (2008).Ethics in psychology and the men-
tal health professions: Standards and cases (3rd ed.). New York, NY: Oxford
University Press.
Kovacs, M., Goldston, D., Obrosky, D. S., & Bonar, L. K. (1997). Psychiatric disorders
in youths with IDDM: rates and risk factors. Diabetes Care,20, 36–44. doi:
10.2337 /diacare.20.1.36
Kratochwill, T. R., Clements, M. A., & Kalymon, K. M. (2007). Response to in-
tervention: Conceptual and methodological issues in implementation. In S. R.
Jimerson, M. K. Burns, & A. M. VanDerHeyden (Eds.), Handbook of response
to intervention: The science and practice of assessment and intervention (pp.
25–54). New York, NY: Springer.
Kubiszyn, T. (1999). Integrating health and mental health services in schools: Psy-
chologists collaborating with primary care providers. Clinical Psychology Re-
view,19, 179–198. doi: 10.1016/S0272-7358(98)00073-7
Levine, D. (2007). ‘Pharming’: the abuse of prescription and over-the-
counter drugs in teens. Current Opinions in Pediatrics,19, 270–274. doi:
10.1097/MOP.0b013e32814b09cf
Lien, M. T., Carlson, J. S., Hunter-Oehmke, S., & Knapp, K. A. (2007). A pilot inves-
tigation of teachers’ perceptions of psychotropic drug use in schools. Journal
of Attention Disorders,11, 172–177. doi: 10.1177/1087054707300992
Mattison, R. E. (1999). Use of psychotropic medications in special education stu-
dents with serious emotional disturbance. Journal of Child and Adolescent Psy-
chopharmacology,9, 149–155. doi: 10.1089/cap.1999.9.149.
132 M. L. Sulkowski et al.
Prevatt, F. F., Heffer, R. W., & Lowe, P. A. (2000). A review of school reintegration
programs for children with cancer. Journal of School Psychology,38, 447–467.
doi: 10.1016/S0022-4405(00)00046-7
Resnicow, K. (1993). School-based obesity prevention: Population vs. high-risk
interventions. Annals of the New York Academy of Sciences,699, 154–166.
doi:10.1111/j.1749–6632.1993.tb18847.x
Roberts, R. E., Attkisson, C. C., & Rosenblatt, A. (1998). Prevalence of psychopathol-
ogy among children and adolescents. American Journal of Psychiatry,155,
715–725. doi: 10.1037//0735-7028.29.3.293
Sailor, W. (2010). Making RTI work: How smart schools are reforming education
through schoolwide response-to-intervention. New York, NY: Wiley.
Schmitt, A. J., Wodrich, D. L., & Lazar, S. (2010). Type 1 diabetes mellitus case deci-
sions: Health-related service considerations for school psychologists. Psychology
in the Schools,8, 803–816. doi: 10.1002/pits.20505
Schulte, A. C., & Osborne, S. S. (2003). When assumptive worlds collide: A re-
view of definitions of collaboration in consultation. Journal of Educational &
Psychological Consultation,14, 109–138. doi: 10.1207/s1532768xjepc1402 2
Sexson, S., & Madan-Swain, A. (1995). The chronically ill child in school. School
Psychology Quarterly,10, 359–368. doi: 10.1037/h0088311
Shaw, S. R., Clayton, M. C., Dodd, J. L., & Rigby, B. T. (2004). Collaborating with
physicians: A guide for school leaders. Principal Leadership,5, 11–13. Retrieved
from http://www.nasponline.org/resources/principals/nassp collab.aspx
Shaw, S. R., & Woo, A. H. (2008). Best practices in collaboration with medical
personnel. In A. Thomas & J. Grimes (Eds.), Best practices in school psychol-
ogy (5th ed., pp. 1707–1717). Washington, DC: National Association of School
Psychologists.
Sulkowski, M., Jordan, C., & Nguyen, M. L. (2009). Current practices and fu-
ture directions in psychopharmacological training and collaboration in school
psychology. Canadian Journal of School Psychology,24, 237–244. doi:
10.1177/0829573509338616
Swanger-Gagn´
e, M. S., Garbacz, S. A., & Sheridan, S. M. (2009). Intervention im-
plementation integrity within conjoint behavioral consultation: Strategies for
working with families. School Mental Health,1, 131–142. doi: 10.1007/s12310-
009-9012-y
van Dyck, P. C., Kogan, M. D., McPherson, M. G., Weissman, G. R., & Newacheck,
P. W. (2004). Prevalence and characteristics of children with special health
care needs. Archives of Pediatrics and Adolescent Medicine,9, 884–890. doi:
10.1001/archpedi.158.9.884
Westmaas, J. L., Gil-Rivas, V., & Silver, R. C. (2007). Designing and implementing
interventions to promote health and prevent illness. In H. S. Friedman & R. C.
Silver (Eds), Foundations of health psychology. New York, NY: Oxford University
Press.
Wodrich, D. L. (2004). Professional beliefs related to the practice of pediatric
medicine and school psychology. Journal of School Psychology,42, 265–284.
doi: 10.1016/j.jsp.2004.04.002
Wodrich, D. L., Hasan, K., & Parent, K. B. (2010). Type 1 diabetes mellitus and school:
A review. Pediatric Diabetes,11, 1–8. doi: 10.1111/j.1399-5448.2010.00654.x
Interdisciplinary Collaboration 133
Wodrich, D. L., & Landau, S. (1999). School psychologists: Strategic allies in the con-
temporary practice of primary care pediatrics. Clinical Pediatrics,38, 597–606.
doi:10.1177/000992289903801005
Wodrich, D. L., Spencer, M. L., & Daley, K. B. (2006). Combining RTI and psycho-
educational assessment: What we must assume to do otherwise. Psychology in
the Schools,43, 797–806. doi: 10.1002/pits.20189
Ysseldyke, J., Burns, M., Dawson, P., Kelley, B., Morrison, D., Ortiz, S., ... Telzrow,
C. (2006). School psychology: A blueprint for training and practice III. Bethesda,
MD: National Association of School Psychologists.
