How Long Do We Have to Wait?

Liz Shaw, a school psychologist for the Blackwood School District, is presented with a crisis situation involving a student, Jimmy Landon. She recognizes the seriousness of the situation but is bound by a three-week waiting list. Meanwhile, Jimmy's bizarre behaviors are escalating and his teacher is concerned.

Liz Shaw, a school psychologist for the Blackwood School District, was struggling to keep herself balanced. Her bulging briefcase and leather bag were weighted on her right shoulder, while the monstrous catalog case in her left hand was dangerously close to the ground. Manipulating the door to her district office required the skill of an Olympic athlete, especially on a Friday night just before five. As Liz precariously continued her juggling act down the hall, Fran, the department secretary came from behind her desk bearing an inch-high stack of phone messages.

As Liz dropped her bags just inside her office door, Fran began the litany of important messages: "The guidance counselor at Westview Elementary School has been calling every half hour since 2:00. She said she would be at the school till 4:30, but left her home phone number also. She said it's urgent she speak to you A.S.A.P. Your schedule for next week is typed up and on your desk. I ran off a copy and put it in Dr. Tiva’s file. I also need your mileage sheet for the month by Monday morning and all of these other calls came in for you today. Other than that, have a great weekend."

Liz grimaced and stuck out her tongue, "How can you even mention a great weekend after giving me all these messages?  I'll be here till seven just trying to return calls to people already on their way to the beach."

Fran skipped down the hall and turned around midway to say, " I'm not going to the beach, but I am going to check out the new exhibit at the museum. See ya."

Liz collapsed into her chair and reached for the phone. She could not remember a Friday when she was able to leave by 5:00. Her rural school district covered about 100 square miles located an hour outside of a major urban area. There were 12 high schools, 19 junior highs, 36 middle schools, and 62 elementary schools. Being a "bedroom" community to a major city meant lots of families and lots of children. The district served approximately 56,000 students and employed a staff of about 54 psychologists.

As Liz finished dialing, she wondered what Sara Winston, the guidance counselor at Westview Elementary, wanted that was so important. Sara's voice over the phone reflected her anxiety. "Oh, Liz, I am so glad you called. Remember two weeks ago, we filled out a referral for testing on Jimmy Landon in Miss Kramer's fourth grade? He's the young man who just transferred into the district. We got some records on him, but they seem to be incomplete. We have observed some rather bizarre behavior in just the two weeks he has been with us, but today he really crossed the line. In the referral, we mentioned the fact that there was reason to suspect he was responsible for the trashing of the kindergarten over the weekend. Today, we discovered him trying to hurt one of the neighborhood cats at the edge of the playground. I contacted his mother, but she says she has no control over him. He has actually threatened to do her bodily harm and she's too frightened of this kid to even sleep."

This was the type of phone call Liz always dreaded. She asked Sara to hold the line while she grabbed her master calendar. Jimmy was scheduled to be tested in three weeks. Liz looked over her list for next week, but there was no way she could alter her schedule. All of those students had been waiting more than a month to be seen by a psychologist. Liz knew that at least half of the phone messages sitting on her desk were from school personnel or parents who wanted to know how much longer they would have to wait for testing or test results.

Liz averaged about 276 cases per school year. Most testing took between four and six hours to complete and the nine- or ten-page reports took approximately six to eight hours to create. The stress of the job was magnified when you added the 17,000 miles Liz traveled on a yearly basis and the time she wasted when a school failed to notify the office or Liz when a student was absent on the scheduled test date.

Two nightmares plagued Liz. One was the chance of a misdiagnosis and all of the ramifications that might entail. The second fear focused on unavailability: not being able to test and provide the results to the school for a child in major distress.

Liz returned to the phone and tried to prepare herself for Sara’s onslaught. "Sara, according to the master schedule Jimmy is scheduled for testing three weeks from Monday. I know this is not what you want to hear, but if I have a cancellation, I will contact you immediately."

"Liz, I am not a reactionary person, but there is definitely something drastically wrong with this child's behaviors. We need help and we need it now. Not only is the mother frightened, but the classroom teacher, Miss Kramer, is very worried about the boy. If you read my referral, you'll see I documented the fact that this young man has been talking to people no one else sees. This is unsettling to the class."

"Sara, I have to follow the procedures set up by the school district. I have to take the referrals in the time order that they come into the office. The only time I can change the schedule is when a child is a definite threat to himself or others within the school. Has Jimmy ever threatened the teacher or students?"

"No, Liz. He hurt the cat, but he has avoided threatening or hurting any person. Is there nothing I can do?"

"Sara, my only suggestion is that if you feel strongly enough about this case, then you can call Dr. Tiva. He's the head of the department and can change schedules if he feels it is justified. Maybe if the principal called with how serious this situation is....."

"Well, Liz, I appreciate you calling me back. I wish I didn't have such a bad feeling about this child. I'll talk to the principal first thing Monday morning and see what he thinks. See you soon, I hope. Bye."

Liz sat at her desk trying to find some way that she could work Jimmy into her schedule for next week. It was impossible. According to national statistics, the school district had sufficient psychologists to cover the testing needs of the student population in a timely manner. Liz knew that the instincts of the people in the field were usually correct, and yet the characteristics of the case did not fall under the emergency testing guidelines. Three weeks was a long time.

On Monday morning the principal, Sara Winston, and Miss Kramer met to discuss Jimmy. Sara recounted her conversation with Liz. When she finished, Miss Kramer blurted out in frustration, "I can’t believe we have to wait until he hurts someone. This child is a ticking time bomb. He just wanders the classroom talking to himself with a glazed look in his eyes. He is not interested in anything we are doing in class and he doesn’t seem to want to communicate with the other students or me. Sometimes he just pounds his fists on the desk. I don’t know what to do. What would you suggest?"

1.    List what you learned/know about each of the characters in the case.

2.    What do you think is motivating the thoughts/actions of each of the characters? 

3.    What are the issues/problems in the case?

1.    What crisis/prevention strategies might be used to circumvent this situation in the interim until testing and
        referral procedures are accomplished?

2.    If Liz were to go against district policies and test Jimmy immediately, what are some consequences she could face? What          about the consequences for other students on her schedule to be tested?

3.    Do you think that Jimmy's behavior constitutes a definite threat to himself or others? Would you consider this          an          emergency situation even though Jimmy has not harmed anyone yet? Why?

4.    What steps should Liz take to ensure that she has acted ethically for all concerned in this matter?

Typical procedures used for screening, pre-referral, referral, and classification.

Strategies for crisis prevention/intervention.

Ethical concerns related to assessment.

Similarities and differences between the cognitive, physical, cultural, social, and emotional needs of typical and exceptional individuals.

Importance and benefits of communication and collaboration which promotes interaction with students, parents, and school and community personnel.

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