In a paper published in the International Journal of Inclusive Education, Danish researchers Bjørn Hamre, Lotte Hedegaard-Sørensen, and Søren Langagerb examine the nature of collaborative relationships between educational psychologists (working in schools) and child psychiatrists (working outside of schools independently or through external agencies).
Through comprehensive, semi-structured interviews with Danish educational psychologists, researchers concluded that there is an overall openness and interest among school-based psychologists to join forces with professionals across disciplines to maximize the quality of life and educational performance among students. However, the team was also able to establish a picture of some of the obstacles that challenge the interpersonal relationships and joint student support efforts between educational psychologists and the out-of-school psychologists/psychiatrists with whom they collaborate.
Some of the themes that emerged in interviews included 1) an interest in better integration to avoid a reactive culture, in which student risk factors are discussed and addressed in advance, 2) a desire to eliminate the perceptions of hierarchical roles among collaborators, and 3) the potential for educational psychologists to assume the role of facilitator for supports to students in school settings. Some features of inclusive schooling, a movement in Denmark prompted by statutory policy changes in 2014, are at odds with the medicalization of social and emotional elements of childhood. However, interviews pointed to an interest among Danish educational psychologists in addressing student needs based on function instead of a diagnostic label.
The publication begins with the following quote from one of many qualitative interviews Hamre and colleagues conducted with participants:
“It seems to me that it’s all about the definition of power, and it’s about professional imperialism.” (A psychologist, commenting upon collaboration between psychologists and psychiatrists)
Historically, schools in Western contexts have relied heavily on disciplinary and educational practices that exclude students with pronounced social, emotional, and behavioral challenges from engagement with all peers. Students with “special needs” are sometimes separated from their peers with classroom behaviors more conducive to the learning environment. The current push for inclusive learning environments, although sometimes politically and monetarily motivated, enables students with diverse psychosocial and contextual backgrounds sharing the same classrooms.
In Denmark, as in Australia, the UK, and the US, this movement is coinciding with an increasing trend in childhood psychiatric diagnoses. There has been a reduction in children with “special educational needs” classifications by two thirds since the country’s 2014 reform, and the national goal is to halve the number of students being referred to be educated in segregated environments. However, according to authors, Denmark’s efforts towards inclusion “… appear to be on a collision course with the rising interest in psychiatric diagnoses and the rapid increase in the number of children encompassed by the child and youth psychiatric assessment.” Ultimately, there are more students in typical classrooms with psychiatric labels than ever before.
“Educational psychology has shifted from a culture of testing and trouble-shooting towards more attention to a child’s environment and socioemotional factors, mostly due to the national political agenda of inclusion,” the researchers write.
“International research and debates within ‘critical educational psychology’ seem to have had very little impact. This may partly be an underlying explanation for some of the findings in the empirical study highlighting why the professional development of educational psychology is challenged by the growing dominance of child psychiatry.”
Shifts in educational policy and psychiatry necessitate interdisciplinary collaboration between educational psychologists and child psychologists. Educational psychologists, or school psychologists, are typically responsible for improving school-based supports available to students with unique social, emotional, and behavioral profiles, whereas child psychologists and psychiatrists tend to embrace a more biomedical understanding of behavior.
Most child psychologists and psychiatrists practice outside of an educational setting. When placement and intervention determinations are made by external agencies, they are often made by individuals a few steps removed from those ultimately implementing in-school supports.
“Sociological critiques of special needs education have emphasized the problematic aspects of segregated provision: injustice, marginalization, stigmatization, and exclusion. The current debate on special needs education and inclusive education is aligned with this critique and focuses on teaching to diversity,” the researchers add.
“The emphasis is on teachers’ ability to make sense of individuals’ differences in their teaching, without relying on specific disability categories for teaching strategies. The question about differences between students in school is how these differences are understood and what difference they make for teaching.”
Qualitative, empirical examination of educational psychologists’ perceptions of interdisciplinary collaboration occurred between 2013 and 2015, during a larger project through the Copenhagen Municipality’s Children and Young People’s Service Department designed to improve the quality of collaborative efforts between psychologists working to support students across environments. Interviews pertained to dynamics associated with interdisciplinary service delivery and were limited to the perspectives of professionals employed within one particular discipline. All discussions were approximately 45-minutes in length.
Consistent with Foucauldian philosophy, Hamre and team approached their investigation with the guiding notion that “neither psychology nor psychiatry reflects a neutral scientific position.” They endeavored to explore educational psychologists’ perspectives about the sociopolitical climate guiding psychological science at this moment in time in a particular cultural context.
“Psychiatric diagnostics have long been an integral part of the educational system. The inclusive agenda implies a desire on the part of teachers, educators, and politicians to rethink how diagnoses are produced and transferred in schooling. The present study questioned how the transfer of diagnostic knowledge from educational psychologists to teachers problematizes the school system’s role in the (re-)production of psychopathology. Achieving inclusive education requires an awareness of the structures of exclusion. This article has touched upon the need to focus on how diagnostic language and practice are constructed in interprofessional settings and risk interrupting the inclusive agenda.”
There are characteristics of Hamre and colleagues’ study that may not directly translate to structures in place in the US, yet their findings have internationally relevant implications. Efforts to promote interdisciplinary collaboration, broaden channels of communication, and develop common language accessible across school-associated support personnel could together serve to improve in-school experiences for students of all sorts in classrooms composed of children with diverse backgrounds, learning styles, needs, and goals.
Hamre, B., Hedegaard-Sørensen, L., & Langager, S. (2017). Between psychopathology and inclusion: The challenging collaboration between educational psychologists and child psychiatrists. International Journal of Inclusive Education, 22(6), 655-670. (Link)
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.