Transcript CASELOAD TO WORKLOAD: Redefining Your Role in the Schools

Michigan Speech-Language Guidelines
Suggestions for Eligibility, Service Delivery, & Exit Criteria
Revised
Maureen Staskowski, Ph.D., CCC-SLP
March 9, 2007
Available at
www.michiganspeechhearing.org
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Acknowledgements
Thank you to the many professionals and their school
districts responsible for this document
With Special thanks to
Dr. Lizbeth Stevens
Keisha Nolan Karen Graham
Terry Lange-Winkel
Kendall Giovannini
Lana Budde
Tina Kunarski
Jan McCosky
Heather Webber
Yvonne Belleman
Andrea Phillips
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Thank You to the many professionals
& their school districts responsible for this
document
Belinda Andrews
Deborah Beeler
Georgia Boyle
Michele Bridges
Robin Brighton
Darlene Broome
Kathleen Bungart
Beth Burkhard Yeary
Mary Lee Campbell
Laurie Capoferi
Sheila Carrier-Woods
Angela Ciraulo
Joan Cortright
Gail Curi
Candy Cutt
Susan Dilgard
Amy Dinno
Gail Elliott
Kelly Falter
Laura Griffith
Marybeth Grosfield
Katy Hime
Anne Howard
Cathryn Kelenske
Ilene Klegon
Mary Ann Knittel
Jill Konwinski
Alicia Li
Judy Lytwynec
Dara Ludeus
Lynn Marshall
Shirley Matuszewski
Mary McAuliffe
Carrie McCarter-Barnes
Arlene Millman
Stephanie Nagy
Nickola W. Nelson
Kimberly Renshaw
Sue Rosko,
Susan Swarz
Megan Shuboy
Sally Shumway
Susan Smith
Gail Speiwak
Maureen Keating
Gail Sterling
Carol Washchuk
Katy West
Alesia Williams
Jane Witkop
Alex Johnson
Johanna Bauer
Sandra Ponzetti
Yvette Hyter
Kelly Cosguff Colin Macpherson
Annett Lauria Diane Shovan Elizabeth Semple
Marianne Fish
Julie Angeli
Eileen Presnell Deanna DeVlaminck Rae Mendell Susan Hardin Karen Sabuda
Kathleen Juhl Lisa Boike
Nancy Garan
Katie Flannery
Mary Towler Lee Timer
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The Purpose
Resource for SLPs and administrators
Facilitate discussion related to practices
and procedures
To inform
It is NOT meant to
Provide policy or mandatory
procedures
Supersede district policy
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1992
Last version released
1995
Addendum for
Standards for Delivery
2006
Reorganization
Updates
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Why Revise?
Changes in Federal Laws & Regulations
Changes in State Rules and Regulations
Changes in Field & Professional
Understanding
Changes in Population
Changes in Practice
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The Guidelines: Outline
Preliminary Sections
SLI as Primary Disability
SLI as a Related Service
Special Issues
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Preliminary Sections
Forward
School Practice & Professionalism
Workload Approach to Caseload
Culturally and Linguistically
Diverse
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Professionalism
ASHA and MSHA Code of Ethics
Individuals shall honor their
responsibility to
Hold paramount the welfare of
persons they serve professionally
Achieve and maintain the highest
level of professional competence
Promote public understanding of the
professions
Maintain harmonious interprofessional
and intraprofessional relationships
and accept the profession’s self9
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imposed standards
Professionalism
You show up
You show up on time
You show up prepared
You show up in the frame of mind appropriate to
the task
You accept directions (including correction) from
those who are more knowledgeable or more
experienced You provide direction (including
correction) to those who are less knowledgeable
or less experienced
You vigorously seek and tell the truth even those
truths that may be less than flattering to you.
P-3
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Feeling Frantic?
How can we do all that is expected?
Are your practices from the 21st
century but your schedule from the
20th century?
Many others feeling the same way
have found a better way.
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The Workload Approach to
Caseload
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SLP Workload Activity
Clusters
Direct services to
students
Indirect services that support
students’ educational programs
Indirect activities that
support students in
LRE/general education
curriculum
Activities that support
compliance with
federal/state/local
mandates
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Workload Activities
WC-5
This approach takes into
account
Enrollment of a student into direct
intervention, regardless of service delivery
options, will add to the workload in other
clusters of activity.
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(Estomin, 1/2005)
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Examples of Flexible Scheduling
Flexible Monthly Schedule
4 week schedule
Allows for blocks of time for intensive treatment
Expands the “A-B” approach used in many
highschools
3:1 Model
Three Weeks direct service: One week Indirect
Oregon implementation
SLP job satisfaction
Integration with general education
Less cancellations (and more make-ups)
More direct therapy time
More third-party billing
Block Scheduling
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SLI as a Primary Disability
Language
Articulation
Fluency
Voice
School-age Students
Adolescents
Preschool Students
Infants and Toddlers
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Prevention
Identification
Assessment
Intervention
Dismissal
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Early
Intervening /
Response to
Intervention
for SLI
L-7
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Sample form for documenting early
intervening services
General Education Assistance Plan for Early Intervening Services
Name: _____________________________ DOB: ____________ Grade: ___________________
Meeting date: _______________________
Follow-up date: ________________________
Persons Attending the Meeting
Name:_______________________________ Name:___________________________________
Name:_______________________________ Name:___________________________________
Name:_______________________________ Name:___________________________________
Person(s) who referred: __________________________________________________________
Specific Concerns: _______________________________________________________________
________________________________________________________________________________
Review of Pertinent Information
________________________________________________________________________________
________________________________________________________________________________
Current Accommodations and Modifications Progress and Results Time Frame
Articulation
Language
Voice
Fluency
Learning Disabilities
Hypothesis of Problem: ___________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
New
Early Intervening Plan Who is Responsible Time Frame Response to Intervention
Parent Notification and/or Signature: __________________________________Date:_________
Recommendations: _______________________________________________________________
________________________________________________________________________________
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________________________________________________________________________________
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Language Assessment
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Michigan Rule 1710
Rule 340.1710 of the Michigan Special
Education code provides the following
definition of a speech and language
impairment:
Subrule (1) A “speech and language impairment”
means a communication disorder that adversely
affects educational performance, such as a language
impairment, articulation impairment, fluency
impairment, or voice impairment.
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Eligibility Guide /
Team Summary
LANGUAGE ELIGIBILITY GUIDE/TEAM SUMMARY
Student
Speech-Language Pathologist
Birthdate
Team Members
Date
Eligibility Determination
Phase
*Collected in part during pre-referral phase
Input
Teacher(s) □ interview /observations
Parent
Student
□ notification (pre-referral) □ interview /observations
interview /comments
Does not
support
eligibility
Supports
eligibility
*
*
*
Review of Pertinent Information
Educational achievement and other
records such as: MLPP, DIBELS, student permanent record (CA-60)
*
Consideration of cultural / linguistic differences
*
Complete the process in the Culturally and Linguistically Diverse - Language Section if
indicated
Consideration of environmental or economic differences
Provide documentation from team reports, teacher, and parent Reviews if needed.
Curriculum-Based Language Assessment
*
*
Watch the student attempt a curricular task reported to be difficult either with you or in the classroom. Determine
whether the student’s language is adequate for successful participation in that curricular task or whether the student
lacks the language skills and strategies needed.
Language
Articulation
Voice
Fluency
Word level: Phonology, morphology, semantics, reading
decoding, spelling, word retrieval, and pragmatics
Sentence level: Morphology, syntax, semantics, formulation,
Collect oral and written language
and pragmatics
samples to further investigate the
Discourse level: Organization, semantics, syntax, formulation,
student’s language function
cohesion, and pragmatics
within the curriculum.
Results of Student’s Response to Intervention
*
Language Samples/
Narrative Tasks/
Portfolio Assessment
Document the results of the early intervening process. Note the level of accommodation or intervention
strategies that the student requires to be successful in the curriculum. Could the student be successful if
the classroom teacher used these strategies or are special education services needed?
Assessment Activities
Trial Intervention
If early intervening was not done prior to the referral then provide a period of trial intervention in order
to assess the level of accommodation or intervention strategies that the student requires to be successful
in the curriculum and get information needed to design intervention plan related to the curriculum.
Test Profile
Test scores below average by standards set for that test
Variation within language test profile
Summary of Disability
Summary of Adverse Educational Effect
Team comments about the presence or absence of
disability.
Team comments about the presence or absence of adverse effects on social, vocational, or
academic performance based upon all of the above assessment components.
Summary of Eligibility in Language
Team comments and decision regarding the student’s eligibility.
Medical History Input: Attach report or interview of students’ doctor or other appropriate medical professionals if applicable
Hearing Screen
Pass______
Fail_______
History of chronic otitis media
Yes______
No_______
History of medical issues related to articulation
Yes______
No_______
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L-8
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Input
Teacher L-13
Parent L-15
Student L16/17
Use interview or other techniques to
Define/explore the presenting
problem
Determine the aspects of the
curriculum/school
performance affected
Review of Pertinent Information
Review MLPP, MEAP, teacher assessments,
medical reports, private therapists...
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Consideration of
Cultural and Linguistic
Differences
Environmental and Economic
Differences L-18
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Curriculum-Based Language
Assessment
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Curriculum-Based Language
Assessment
Guiding questions:
What language skills are needed for successful
participation in this part of the curriculum?
What does the student usually do when
attempting this task?
What language skills and strategies might the
student acquire to become more successful?
How should the task be modified?
(Nelson, 1989; Nelson, 1998)
L-19 27
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CBLA Examples
page L-20
A teacher reports that student has difficulty understanding the
classroom discussion and the textbook. Together, you have agreed
that these difficulties would most likely be observed during social
studies. The SLP decides to observe a classroom discussion and group
assignment, then to take the student to the therapy room and discuss
what went on. The SLP helps the student by showing the student how
to use imagery and questioning as they discuss the content and
complete the assignment.
A teacher reports that a student’s language is confusing and hard to
follow (disorganized discourse). Together, you have agreed that these
difficulties would most likely be observed during a story retelling task.
The teacher described how they typically do retellings and the SLP
simply brought the task to the therapy room. The task is completed
with no help, then varying degrees of help. In some instances, the SLP
may add the student to a language intervention group working on
something similar.
The teacher reports that a student has difficulty following oral and
written directions. Together you have agreed that these difficulties
would most likely be observed during a science lab project. This could
be an observation in the classroom followed by a brief retell of
instructions outside the classroom, or the SLP may decide to review
oral and/or written directions for a home science project in the therapy
room.
A teacher reports that a student has difficulty with pragmatics.
Together, you have agreed that these difficulties would most likely be
observed when the student is participating in cooperative groups for
science experiments. This could be an observation in the classroom
followed by a brief retell of instructions outside the classroom or in the
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therapy room.
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Tools for You
CBLA Language Assessment
and Summary
Reading Assessment and
Summary
Writing Assessment and
Summary
L-35-40
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Record Results of RTI
or
Dynamic Assessment
Try out language strategies or skills that
might help the student access the
curriculum
How does the student respond to
intervention?
Single or multiple sessions
In the classroom, in a group, or alone
SLP or other team members
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Language Samples
Oral and written
Portfolio
Probes
Assessment
Collect oral and written samples and consider comprehension
& expression of oral/written language
L-23-24
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L-41-45
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Methods for Collecting Language
Sampling
Receptive
Direction Tasks
Main Idea Tasks
Details, Inference and Synthesis Tasks, or
Comprehension Strategy Probes
Think Alouds Questioning Hierarchies
Comprehension/Retelling (MLPP) Evaluation
Analysis/Analysis Tools/Checklists
Reading Miscue Analysis of Children with Suspected Listening
Difficulties Teacher Checklist for Listening Early Identification
of Language Based Reading Disabilities – A Checklist Language
Speech and Hearing Services in Schools
EXPRESSIVE LANGUAGE- Speaking and Writing
Probes/Sample Types
Narrative Curriculum based retelling task grades 1-8 Children’s
Narrative Developmental Stages and Strategies Oral Language
(MLPP) Expositive Compare/Contrast, Sequence,
Question/Answer, Problem/Solution, Cause/Effect, Persuasion,
Description, or Explanation
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Test Profile
Not the first activity
Based on the information collected so
far
Selected carefully for purpose and the
population
Multiple assessments-doesn’t mean
multiple tests
Compared to IQ not sole criterion
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Tests and IQ
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Why not compare solely to IQ?
(Cognitive Reference)
Based on faulty
assumptions
Students with
commensurate language
and IQ scores won’t
benefit from language
therapy.
IQ scores are stable.
There are nonverbal IQ
measures
Research has shown
that they do benefit.
IQ scores actually fluctuate
across tests and within the
same tests over time.
Consequently, discrepancies
are unstable
Many question whether any
measure is truly language
free
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Problems with cut-off scores
Intent-appropriately identify student as
disabled
Avoid over-identification or underidentification
Identifies unevenly across tests
No cut-off in Michigan Rules or IDEA
Practice in Michigan using 11/3SD arbitrary
Cut-off scores may be different across
tests
(Plante, 2003)
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Test Guidelines
Knowing there is not a specific
requirement for standard deviations from
the mean in regulations or law, districts
may develop their own practices.
An overwhelming number of reviewers
(SLPs and administrators) wanted specific
guidelines
The committee suggests that
continuing to use 1 1/3 SD as one
contributing factor to the overall
assessment is reasonable.
(unless there is evidence that the cutoff should be greater for that test)37
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The lesson in all of this…..
Tests alone are not reliable means
of identifying students with
communication disabilities that
adversely affect school
performance.
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Acceptable levels of sensitivity &
specificity levels by
Clinical Evaluation of Language Fundamentals4 CELF-4)
Clinical Evaluation of Language FundamentalsPreschool 2 (CELF-P 2)
Preschool Language Scales 4 (PLS-4)
Structured Photographic Elicitation Language Test –
Preschool (SPELT-P)
Test for Expressive Morphology (TEEM)
Test of Language Competence-Expanded (TLC-E)
Test of Narrative Language (TNL)
Test of Early Grammatical Impairment (TEGI)
(Spaulding, Plante, & Farinella, 2006)
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Form Impressions regarding
Presence of a Disability
Adverse affect of Disability on
Educational Performance
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Language Intervention
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Goal Setting
From the authentic assessments
Selected as a team
Related to helping the student access the
curriculum
Reference Michigan Curriculum Framework
or Grade Level Expectations (Reading
/Math)
Annual goal - 12 months, STO/outcomes
steps to measure progress toward that
annual goal
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CURRICULUM-RELEVANT THERAPY PLANNING FOR SLPS
Ehren (1999, 2005)
Curriculum
Underpinnings
Language Disorder
Standard:
Benchmark:
Therapy Targets
Long-term therapy goal:
Assistance to Teachers
Performance
(Actual & Predicted)
Accommodations written into IEP:
IEP:
Lesson Modifications:
O:
Therapy Strategies:
Generalizing Therapy Goals:
Reproduced with the Author's permission
L-47
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CURRICULUM-RELEVANT THERAPY PLANNING FOR SLPS
Ehren (1999, 2005)
Curriculum
Standard: Students write
competently for a variety of
purposes and audiences.
Benchmark: Creates written texts
using the writing process (K-4).
Therapy Targets
Long-term therapy goal: Use a variety of strategies to
process and produce spoken and written language
effectively, efficiently and independently.
IEP: O: Write narrative and expository text, rated at
a level 3 on a 6-point MLPP rubric.
O: (1) Use vocabulary commensurate with peers in
classroom tasks. (2) Construct targeted syntactic
patterns in classroom writing assignments (3)
Rephrase 2-3 sentence sequences taken from
classroom materials.
Therapy Strategies: (1a) Skim class novel or
textbook for unknown words. (1b) Create word bank
cards with buddy (1c) Co-construct with SLP and
peers scenarios for each word.
Underpinnings
Vocabulary
Sentence structure
Topic elaboration
Strategic approach
Knows/remembers the steps
Self-monitoring
Self-correction
Performance
(Actual & Predicted)
Writes short pieces
Uses simple sentences
Redundant word
usage
Doesn't proofread
Is finished with
assignment after 1st
draft.
Language Disorde r
Limited vocabulary
Restricted syntax
(complex clauses)
Syntactic inflexibility
Non strategic
Assistance to Teachers
Accommodations written into IEP:
More explicit cues and frequent
practice opportunities with
guidance.
Lesson Modifications: Writing
process cue card taped to writing
folder or desk. (2) Paired writing
activities.
Generalizing Therapy Goals: Bring
word bank cards to class and do
word usage activities at a learning
center.
Reproduced with the Author's permission
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Curriculum Relevant Intervention
Goal Monitoring
Team responsibility
Addressing Goals
Noting progress
Service delivery fits the goal/strategies
Progress data analyzed
Intervention approach adjusted
Team considers next steps
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So……. what has changed?
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Culturally Linguistic Diverse
Populations
Michigan Guidelines
Karen Graham – L’Anse Creuse
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Cultural Competence of the SLP
The awareness of the SLP’s own cultural
values and standards which could impact
the assessment and intervention process.
It is necessary to understand the history
and social customs of the student’s
culture.
Self Assessment for Cultural Competence.
Got It? ASHA web site.
www.asha.org/about/leadershipprojects/multicultural/
Graham, 2006
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BICS and CALPS
Basic
Interpersonal
Communication
skills
Develops
informally
through
conversations
and social
interactions
Cognitive
Academic
Language
Proficiency
Develops
through
organized
instruction of
literacy skills in
school settings.
Graham, 2006
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Second Language Acquisition
Conversational skills often
approach native proficiency
with about two years of
exposure to English.
Academic proficiency may
require five or more years to
reach proficiency levels.
Graham, 2006
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Bidialectal
Students who use dialect of
English other than SAE are
called Bidialectal.
Example: Southern Dialects of
English
Students can be dialectal in
other languages as well.
Graham, 2006
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Use of interpreters
Interpreters can be used
throughout the pre-referral and
assessment process.
Should be fluent in both oral
and written modalities of the
student.
Facilitators of language between
the parents/caregivers and the
SLP.
Graham, 2006
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Interpreters
Discuss roles
and
responsibilities
Review key
concepts,
phrases, words,
and procedures
Remind the
interpreter that
he/she must
not alter, omit,
or add to the
communication.
Ask the
interpreter if
specific
words/concepts
are not
translatable.
Ask about
cultural
considerations
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CULTURALLY AND LINGUISTICALLY DIVERSE
GUIDE/TEAM SUMMARY
Student
Birth date
Speech-Language Pathologist
Native Language
Dialects Spoken
Date
Team Members
Other Languages Spoken
Languages Spoken in Home
.
Inp
ut
Suggests
Speech or
Language
DIFFERENC
E
Team Summary
Suggests
Speech or
Language
Disorder
Teacher(s) □ interview/observations
Bilingual Staff Interview
Obtain information about the student and the culture
Parent
Complete parent interview (with interpreter, if needed. To obtain socio-cultural
CLD
Referral
Decision
history, developmental history, and information about language competence
Student
interview/comments
Review of Pertinent Information Educational achievement and
other records
such as: MLPP, DIBELS, student permanent
record (CA-60)
Family-Student Observation – if available
Observations
Observe the student interacting with family
Classroom Observation
Observe the student participating in the curriculum
Curriculum Presentation/Student-teacher interaction
Determine whether the student is responding to the presentation format of
the classroom or curriculum materials. Does the student expect a different
presentation given their cultural background? Is this mismatch causing
learning or language difficulties? (For example, students from Asian
cultures may need to learn that it is expected to ask questions and to interact
in a group).
Further classroom adaptations/modifications
Similar Format
LD
CI
Add Service
Decision
Select additional classroom accommodations and modifications to support the student during a trial
period.
Dynamic Assessment /Trial Intervention
Assist the student with the task during single or over multiple sessions. How well does the student
perform with help? Does the student experience success with minimal scaffolding or accommodation
(e.g., given a strategy, can do it independently) or does the student continue to have difficulty?
REFERRAL Decision
Together with the student’s team, decide whether the student is suspected of having a disability beyond a language difference and
needs a formal
evaluation. 2007
If a formal evaluation is completed, now turn to the appropriate section of these guidelines and follow those
MSHA
Staskowski
procedures along with the considerations below.
Graham, 2006
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Guide Team Summaries
Input
Observations
Curriculum
Classroom modifications
Dynamic Assessment
Referral
Other Considerations
Graham, 2006
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Assessment
Nonstandardized approaches
should be the primary method
of gathering information.
Standardized testing- consult
the examiners manual for
interpretations of responds
Graham, 2006
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Language Dominance
It is important to determine
the dominant language
Bilingual English Proficient
Limited English Proficient
Limited in Both Languages
Graham, 2006
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Extended Case History
Language development
Student’s residency
Cultural beliefs
Language dominance
Exposure to primary and
secondary language
Student’s academic history
Graham, 2006
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Language Samples
Obtain language samples in
both languages
Obtain language samples
across settings
Obtain language samples with
multiple partners
Look at multiple formats
Curriculum Based Language
Assessments
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Test Selection and Use
Look at the normative sample of test.
Does it adequately represent the
student’s culture?
Does the student have some familiarity
with the language of the test?
Does the student have some familiarity
with situations presented in the test?
Is the vocabulary geographical or cultural
specific?
Does the test display a potential for
bias?
Graham, 2006
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Test Modification
Test modification is an alternative way of
assessing skills of a CLD student.
It can involve addition, deletion or
modification of test items
Beware: Violation of test reliability, and
validity.
Reword instructions, allow extra time for
responses
Increase the number of practice items
Test beyond the ceiling
Ask for explanation of incorrect
responses.
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2006
Dynamic assessment
Intervention
Bilingual Speech and Language
Pathologist
Most studies recommend early
intervention in the student’s native
language
Provide a cultural linguistic framework to
facilitate language skills
In service training
Consultative
Training ESL staff to facilitate language
skills in the classroom
Graham, 2006
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Web Sites
www. readingrockets.org Look
under web casts
Differentiated Reading Instruction
From Babbling to Books
Assessment of English Language Learners
English Language Learners in Middle and High
School
Comprehension: Helping English Language
Learners Grasp the Full Picture
ASHA’s web site under
Multicultural issues
Graham, 2006
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Articulation
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Articulation: Special Issues
Lateral Lisp
Intelligibility
Single Sound Errors
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Development Sounds Charts: The
Challenges
Controversy
Type of research –
50% versus 90%
Two sets of well-respected data
What to do?
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Articulation Team Summary
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What is Adverse Effect
on Educational Performance
Academic and nonacademic
performance.
Letters from Department of
Education
IDEA - Curriculum is
Academic
Nonacademic
Extracurricular
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Fluency
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What’s New
Risk Factors
Cluttering Inventory
Teasing and Bullying
Parent Handout
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Voice
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SLI as a Related Service
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SLI as a Related Service
Speech and Language Services for
Students with other Primary Disabilities
Autism Spectrum
Disorders
Cognitively
Impaired
Early Childhood
Dev.
Physically
Impaired
Otherwise Health
Impaired
Learning Disabled
Severely Multiply
Impaired
Emotionally Impaired
Traumatically Brain
Injured
Hearing Impaired
Visually Impaired
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Michigan Special Education
Code
Rule 340.1710
Subrule (4) Students who have a communication
disorder, but whose primary disability is other
then speech and language may be eligible for
services under R. 340.1745 (a).
Rule 340.1745(a)
The speech and language services provided by an
authorized provider of speech and language
services shall be based on the needs of a student
with a disability as determined by an
individualized education program team after
reviewing a diagnostic report provided by an
authorized provider of speech and language
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Considerations for Related
Services
Eligibility under primary impairment.
Diagnostic report documents need
for service
Standardized test scores are not
required
Allows for fluid service provision for
students who need changing
amounts of speech and language
support throughout school career
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Learning Disabilities
New laws
What the student needs… who
does what? Page LD13
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Cognitive Impairments
Team Summary Guide
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Common Issues
Transitions
Intelligibility
AAC
CBI/Vocational Instruction
Behavior
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Traumatic Brain Injury
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Hearing Impaired
Auditory Processing
SIFTER
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ECDD
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Special Issues
Auditory Processing
Assistive Technology
Feeding and Swallowing
Selective Mutism
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Thank You!!
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