Referral and Evaluation

Processes & Consideration

Referral Process

• Referral may come from:• Teacher• Parent• Physician• School Psychologist• Student• SLP?• Mass Screening

Mass Screenings

• Also include vision and hearing screenings

• Current state standards recommend screening PreK, K, 2, 4, 6, 8, and one grade at high school level (must consistently screen same grade) **This is relatively new

Screening Procedures

• Typically SLPs screen incoming kindergarten and preschool students.

• They may screen at other grades or screen all new students

• * Examples of 2 Screening Instruments• Joliet• PLS-4 Screen

Practice

• Divide up into 4 groups and practice giving the screenings to each other.

Student Support Team

• The team leader leads team in a problem-solving discussion about the student following a familiar, two-part process such as

• 1. Gathering known information• Strengths• Concerns• What intervention strategies have been

attempted? What were the results?

S Team continued

• 2. Troubleshooting• Brainstorm ideas for assistance• Select what to try next and assign

responsibility• Schedule when to meet again and

report on progress

Criticisms of S-Team

• Often viewed as a process to delay special education identification.

• Intent is actually to provide adjustments to the instructional program to facilitate a student’s learning.

• Not all children who are struggling in school have disabilities.

At Risk Students

• Children with low achievement, poor attendance, children from homes with poverty or cultural/linguistical differences may often struggle in classroom

• They should not necessarily be identified as disabled learners who require special education and RELATED Services

At Risk Students cont.

• Congress specifically addressed the problem of over-identification of minority children as being disabled, stating “Greater efforts are needed to prevent the intensification of problems connected with mislabeling and high dropout rates among minority children with disabilities.

At Risk Students

• This is one reason why many districts and states require several intervention strategies to be documented before referral to special education.

• These children clearly need assistance, but often this can take place in the regular education program.

SLP Role in S-Team

• Inservice training• Consultation with parents and

teachers• Ideas for pre-referral interventions• Screenings

SLP Role in S-Team

Our role also serves to prevent inappropriate referrals for speech-language services.

Also, allows us the benefits of marketing the skills of SLPs, as we demonstrate their knowledge and expertise to parents, teachers, and administrators.

“Speech only” problems

• Should there be an S-Team?• The benefit of using the S-Team process

is to ensure that other academic or social issues are not also affecting the student.

• Whether the concern is language or just speech only, concern about academic impact must also be considered by the team in terms of reading skills

“Speech Only” cont.

• Going through S-Team process guarantees that the team reviews the student’s progress in all learning areas.

• As a result of the SLPs participation on the S-Team, other team members will develop awareness about the relationship of speech-language skills to academic performance.

Referral may be to:

• Student Support Team (S-Team)• SLP

• ***REVIEW S-TEAM documents

Classroom behaviors that may be indications of possible communication problems. • Difficulty with reading• Difficulty with spelling and writing• Difficulty being understood when speaking in

class• Vague or evasive answers• Frequent absences or avoidance of schools• Inability to attend or stay focused• Rubbing ears or complaining of pain in ears• Unusual vocal quality or recurrent hoarseness• Avoiding making eye contact with teachers and

others ( not culturally based)• Unwillingness to speak in front of the class

Student Support TeamS-Team

• Classroom Strategies for Teachers • What is the SLPs role in the S-

Team process?• EDUCATION (answer questions from

teachers about how to implement strategies in classroom).

Classroom Interventionsfor Articulation, Voice, Fluency, and Language• SLPs may be asked to participate

in staff development to train teachers on strategies to implement prior to being referred for assessment.

• ARTICULATION CLASSROOM INTERVENTION STRATEGIES*• (Articulation strategies are presented for common classroom

concerns.)• 1. General Strategies (applicable to all articulation concerns)• Use Developmental Norms to determine if articulation error is

developmental in nature• Model precise speech sound production using appropriate rate and

volume• Exaggerate the targeted sound in classroom activities such as

when reading to the children and giving directions• Have the student watch your mouth as you make the targeted

sound, and tell the student to listen to the sound – this is known as modeling the speech sound production

• Have the student identify correct/incorrect productions of the target sound (the sound that the child does not produce correctly) in your speech (You would ask the student whether or not your production of the sound is correct or incorrect. To determine auditory discrimination, make sure that you produce the target phoneme both correctly and purposefully incorrectly.)

• Practice the targeted sound in isolation• Practice the targeted sound in syllables with long vowels• Have the student practice trying to correctly produce the incorrect

sound in at least 10 different words (You can use spelling words, vocabulary words, or key terms related to a specific subject.)

2. Difficulty Understanding the Student’s Articulation Encourage the student to restate his/her communicative message Ask the student to repeat his/her communicative message Repeat back to the student any portion of message that is intelligible (This allows you to establish a context for the student’s utterance and lets the student know that you understood a portion of the message.) Ask a question about what the student said (e.g., Johnny went where?) Ask for additional information from the student Ask the student to show you or take you to the item/place (if possible) Repeat the communicative message back to your student when the message is understood (e.g., Oh! You said you went to the toy store.) (This lets the student know he/she was understood and provides the student with an appropriate language model.)

• 3. Student displays signs that he/she is aware and upset by the speech sound errors

• Assure student that it’s okay that everything he/she says is not understood right now – emphasize that we all learn at a different pace and that we all have new things to learn every day.

• Acknowledge your student’s attempt to communicate

• Prohibit students from teasing others about speech sound errors

• *When dealing with communicative disorders, especially articulation or fluency, the teacher should remember to be sensitive about discussing the situation in front of other students.

• Certain strategies adapted from Fujiki, M., & Brinton, B. (1984), Supplementing language therapy: working with the classroom teacher. Language, Speech, and Hearing Services in Schools, 15, 98-109.

• FLUENCY CLASSROOM INTERVENTION STRATEGIES*• (Fluency strategies are presented for common classroom concerns.)• General Strategies (applicable to all fluency concerns)• Speak slowly to the student, using pauses and breaks • Keep eye contact during a dysfluencies• Allow enough time to finish speaking• Avoid filling in words/sentences• Avoid comments to “slow down” or “relax”• Minimize verbal activities that are timed• Use unison reading (if reading aloud results in increased dysfluencies)• Reduce competition• Encourage smooth speech• Give the student a cue before calling on him/her to answer or respond –

this will allow the student time to mentally “prepare” an answer• Encourage and praise ALL attempts at verbalizations • Acknowledge that you understood the student’s communication• Make statements that encourage interaction with the other children

during class and recess time• Prohibit teasing• * When dealing with communicative disorders, especially articulation or fluency,

the teacher should remember to be sensitive about discussing the situation in front of other students.

• Some strategies adapted from The Stuttering Foundation (www.stutteringhelp.org)

• LANGUAGE CLASSROOM INTERVENTION STRATEGIES:

• 1. General Strategies (applicable to all language concerns)

• Check student file for any significant medical history that may influence academic performance (i.e., ear infections)

• Use preferential seating (close to teacher/wall word banks/good peer models, away from distractions)

• Practice “wait time”, which allows the student additional time (up to 5 seconds) to process the message (Following “wait time,” prompting with a question or the beginning of a statement may be necessary.)

• 2. Language Processing Skills: Difficulty understanding and completing directions

• Supplement auditory information with visual materials, instructions, or cues

• Restate directions or questions using different or more basic vocabulary Use student re-statement of assignment requirements Assign a peer “study buddy” to help explain or demonstrate directions

• Give instructions individually to the student after you have given them to the whole class

• Check for comprehension for that student individually• Demonstrate to the student and work with him on learning

to ask specific questions or state exactly what he/she does not remember or understand. (“I don’t know what _____ means?” “I only remember part of the question, directions, or information.”)

• Encourage the student to rehearse internally what he/she has heard or needs to do in order to complete a task or answer a question

• 3. Semantic Word Knowledge: Difficulty understanding classroom vocabulary/limited vocabulary/weak comprehension of academic concepts

• Provide visual supports - word banks (a different wall for each subject, or individualized vocabulary folder), actual objects, pictures, graphic organizers

• Demonstrate and practice using contextual clues to define unfamiliar vocabulary

• 4. Syntax Development: Uses incorrect grammar/difficulty using and understanding more complex grammar forms

• Use “forced choice” and/or “echoing” techniques (Forced Choice – teacher asks, “What sounds better, “I seen them boys.” or “I saw those boys.” Echoing - teacher restates the student’s sentence with a questioning tone of voice at its conclusion to encourage the student to restate using a correct or alternate form (This is best done on an individual basis.)

• Incorporate worksheets in which the student must choose the correct grammatical forms (where and when appropriate)

• 5. Pragmatic Language: Displays difficulty expressing opinion, giving factual information, asking relevant questions, understanding figurative language, and using appropriate conversational skills

• Use prompting to help the student create more interesting interactions. When prompting, ask questions that require more than a yes/no response as those questions typically stop a conversation.

• Vary the types of responses expected on exams and in class discussions. Use “unison responses” to provide opportunities for the less verbal student to practice answering with the security of saying the same thing as the other students.

• Introduce examples of figurative language with pictures, role playing, stories, etc.

• Self-monitor teacher use of figurative language. Explain idioms that may be unfamiliar to students.

• Certain strategies adapted from Fujiki, M., & Brinton, B. (1984), Supplementing language therapy: working with the classroom teacher. Language, Speech, and Hearing Services in Schools, 15, 98-109.

For Direct Referral To SLP

• You are the case manager• Best Practice:

• Speak to parent• Inform them of the referral• Are parents aware of the problem?• What is their perception?• Describe the process• Avoid potential fears and confusions that may

arise from “special ed” language

Take Time for a Good Initial Evaluation• Screening – many times completed at mass

registrations • Vision/hearing screening – do before you begin

evaluation • Examination of oral mechanism**See forms• Standardized / Non-standardized tests• Observations:

• Teacher• SLP

• Parent Input• **Review complete packet

Evaluation Timelines

• Receive referral• Obtain parental permission for

evaluation• At point you receive written parental

permission, the 40 day timeline begins• All testing must be completed and

eligibility meeting held by the end of the 40 day timeline.

• Don’t forget *** Give 10 school days notice for invitation to meeting.

Procedural Timeline for a State Special Education Program Designed to Meet IDEA (1997) Requirements

• 15 calendar days – referral in individual with special needs and parents contacted. Assessment plan developed. Parents receive written rights and safeguards. Notification of assessment is written.

• 15 calendar days – Parents have this amount of time to decide and provide written consent if they wish to proceed.

• 20 calendar days – Students who transfer into a district may be placed in a comparable program for this length of time before additional assessment or previous records are obtained.

Continued• 50 Calendar Days (40 school days in TN) –

Assessment is conducted by multidisciplinary assessment team. Parent receives written notice of IEP team planning meeting. Meeting is held and eligibility is determined.

• 30 calendar days – An interim placement determined by IEP team

• Immediately or within a few days – Parent consents in writing to the IEP. The plan is implemented.

• Three years (sooner if requested) – Reassessment, as needed or at parent request and determination if student continues special education services.

Evaluation Action Timelines• Request for assessment received – 10

to 15 days to present parents with an assessment plan (I typically do this in the consent paperwork)

• Signed assessment plan received – Team has specified days to complete assessment

• IEP meeting held – Meeting notice 1-15 days prior to meeting date (10 days in TN for 1st notice – if they do not show, you can send a notice for meeting the next day or whenever convenient).

What tests do I use?

• What are examples of Articulation tests you are aware of?

• What are examples of Language Tests you are aware of?

• ***Review Tests

Evaluations (continued)

• Preschool• Elementary• Middle/High School• Special Populations

• Autism/Nonverbal/Medically Fragile• Augmentative Communication• Dyslexia• Auditory Processing• Fluency

Assessment Documentation

• Review sample forms from TN Dept of Special Education

• Speech Impairments• Language Impairments

SLP Evaluation Specialists

• Pros• Efficient• Timely• Another professional opinion

• Cons• Lack of familiarity when beginning service

• Who will write the goals?• Who will explain results of evaluation?

• What if you disagree with recommendations?

Practice

• M.B. 5 year 7 month old female• GFTA-2 standard score 40• Percentile <1• Age-equivalent <2-0• OWLS Receptive Language 90• Expressive Language 79 (scores

negatively affected because of speech intelligibility.

First Step

• Evaluation Report• Hearing screening Passed 9/10/08• Vision passed 9/10/08• Test is considered valid• She was cooperative and attentive

Evaluation Report

• Recommendations:• Amount of service time• Goals

• List about 4-5 goals.

Assessment Documentation

• Speech Impairments• Language Impairments

Severity Rating Scales

• Speech Severity Scales• Language Severity Scales

Prior Written Notice

• What are we recommending? • Is there anything else to consider?• What tests/assessments were used

to make this decision?

Easy IEP: An Introduction

• Insert data for M.B. into Easy IEP! It really is EASY!!!