collaborating with teachers to make great referrals: identifying treatment methods that work across...

Collaborating with teachers to make great referrals

Identifying treatment methods that work across languages and cultures

Outline

•The greatest issues facing educators in the schools

•Studying our current situation▫Case Study of a Texas School District▫Defining RTI▫Gathering data on our campuses

•Improving services in the schools▫Reducing our caseloads▫Improving the referrals that we receive

from teachers▫Improve our relationships and success with

other professionals

Learner Objectives

•Participants will:▫View RTI from a broad perspective▫Introduce a macro approach to looking at

the results of RTI and further driving accurate assessment

▫Evaluate the make-up of students in special education

▫Show how RTI can reduce caseload work, better identify students, and reduce special education spending.

What are the greatest difficulties we face?

Speech Language Pathologists:

•My caseload is too large• I have too many campuses• I have too much paperwork• I don’t have time to complete the

evaluations given to me

•Any others?


Principals and Assistant Principals:

• I can’t get this student into special education

•There are too many annual meetings• I can’t believe this child didn’t qualify?•The evaluation process is too long

•Any others that you have heard?


Speech Department Leads:

•My staff is stretched too thin•There are not enough bilingual SLPs•There is no money in the budget•We are over-identifying certain minority

groups

•Any others that you have heard?

1. How do we solve these problems and appease everyone in the process?

Conflicting interests and needs Speech

Pathologists

Speech Department

Administration and School

Staff

2. How are we currently trying to solve these problems and how successful are we?

Response to InterventionDistrict Proportionality Study

What is RTI?

A regular education initiative to deal with the problems of the discrepancy model (discrepancy between IQ and achievement).

A way to determine how students respond to intervention (in the classroom with the teacher)

A screening to identify children with learning disabilities.

A way of determining whether children who receive “intensive” intervention in the classroom respond.

•RTI is an approach to LD identification that was first proposed by a 1982 National Research Council report.*▫ Google: “Response to Intervention + Year (1982-2009)”

*Heller, Holtzman, & Messick, 1982

1982

1983

1985

1986

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1991

1992

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1994

1995

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0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

Hits in Millions

Year

When was RTI created?

•“RTI was first proposed by Gresham (2002 ) as a viable alternative to the discrepancy model.”

• Provide children from culturally and linguistically diverse populations with the assistance they need to succeed.

• To better identify children with reading disabilities.• To better identify children with learning disabilities.• Do SLPs use a discrepancy model?• How does RTI serve SLPs in it’s intended mission of

correctly identifying populations?

*Fasko, 2006

Why was RTI implemented?

•Are we correctly identifying students?

•Are we still over- or under-identifying?

•Have we improved the types of referrals that we receive from general education?

•Has our involvement in the referral process gone down?

Is RTI Successful?

Vice or Virtue?

RTI seems to be successful or unsuccessful for the very same reason:

The fact that it is largely undefined.

Virtue

•RTI is hugely successful in situations in which good collaboration takes place.

•It can be adapted to current campusinitiatives.

•It combines Special Education personnel, General Education personnel and resource professionals.

Vice

RTI allows people on the same team to perceive their role differently.

It does not provide consistency or a framework.

It encourages immense bureaucracy and paperwork in order to cover all our bases.

Using the RTI Process Effectively – A Case StudyEthnicity, RTI, and Campus Populations

RTI Problem Solving Method*

*Adapted from NASDSE, 2006

Identify a student

with needs

Analyze student’s

difficulties

Develop strategies

Implement the

strategies

Evaluate student’s success

Is there a problem?Why is

this happenin

g?

What shall we do about

it?

Here are the steps.

Did our plan

work?

MICRO

RTI Problem Solving Method*

*Adapted from NASDSE, 2006

Identify a student

with needs

Analyze student’s

difficulties

Develop strategies

Implement the

strategies


Are we over- or under-

identifying?

Where are they? What do they look

like?

For whom? On what topics?

Attend in-service trainings.

Identify a student

with needs

Analyze student’s

difficulties

Develop strategies

Implement the

strategies


Identify a District’s

Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

MACRO

Has our identificatio

n improved?

Identify a District’s Population

•Full data on any district is available from the state agency (TEA in Texas)

• It includes:▫DISTRICT NAME▫TOTAL # of REGULAR ED. STUDENTS▫ TOTAL # of Special ED. STUDENTS▫% of REGULAR ED. STUDENTS▫% of SPECIAL ED. STUDENTS

•We couldn’t provide all the data points for Texas here but have it if you would like to see it.


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

1

State Percentage of Students

•Districts work toward maintaining a special education population that matches 8% of the gross population.

7%7%

85%

Under-identifying 71 districts

Correctly Identify-ing 76 districts

Over Identifying 860 districts


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

1

What does it mean to be “over-identifying?”

# Regular Ed. Students

% Special Ed. Students

# Special Ed. Students

# of SPED students at

8%

# of Students

over- identified

*Increased Cost to district

1188 9.382 123 104.88 18.12 $99,660

1376 9.354 142 121.44 20.56 $113,080

2559 9.32 263 225.76 37.24 $204,820

3221 9.37 333 284.32 48.68 $267,740

4439 9.334 457 391.68 65.32 $359,260

8365 9.362 864 738.32 125.68 $691,240

12836 9.337 1322 1132.64 189.36 $1,041,480

18860 9.327 1940 1664 276 $1,518,000

20301 9.387 2103 1792.32 310.68 $1,708,740

42156 9.334 4340 3719.68 620.32 $3,411,760

*Chambers, Parrish, & Harr, 2002


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

1

Analysis of a District’s Population

0

5

10

15

20

25

30% of Special Education Students

8 %860 Districts Over-Identifying

7.96%


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Concerns a the Campus and District Level

Requests for increased assistance at other campuses

Workload low on some campuses

Campus level

Under-identification Over-identification

Difficult to refer students Too many evaluations

District level


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2


Question #1

How do a district’s numbers breakdown when taking into account ethnicity?


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

District Percentage by Ethnicity

Special Education Population Assuming 8% 1594 Students

Actual SE Population 1538 Students


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2


Question #2

How do a district’s numbers breakdown when taking into account NUMBERS of students and not PERCENTAGES?


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

District Number by Ethnicity

Amer

ican

Indi

an

Asian

/ PI

Black

Hispa

nic

Whi

te

0

200

400

600

800

TEA versus District Special Education Population

Hypothetical 8% SE Popu-lation

Actual SE Population

American Indian Under by 3 studentsAsian / PI Under by 125 studentsBlack Over by 57 studentsHispanic Under by 31 studentsWhite Over by 47 students


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2


Question #3

What does each campus special education population look like, compared to 8%?


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Campus PercentagesSchool 1 School 2

School 3School 4

School 5

School 6

School 7

School 8

School 9

School 10

School 11School 12

School 13School 14School 15

School 16

School 17

School 18

School 19

School 20

School 21

School 22

School 23School 24

School 25

-2%

3%

8%

13%

18%

Actual SE Population Expected SE Percentage


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Limitations of the data

•The numbers do not account for special units on the campus.

•Do not account for gender differences•Do not account for population

percentages at the middle or high school level

•Do not separate by disorder or LD/SI


Question #4

What does each campus’ special education population look like when taking into account each ethnicity by number?

These are based on research indicating that roughly 8% of the general population have special education needs. This is not always the case by ethnicity but understanding and being able to explain your numbers is critical.


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Campus Ethnicity – White

= +47


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Campus Ethnicity – Hispanic

= -31


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Campus Ethnicity – Black

= +57


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Campus Ethnicity – Asian / PI

= -125


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

2

Develop a Training Plan

•Answering the “WHY?”▫It is incumbent on the staff to share the

results and ask why the population is skewed the way it is.

▫“BAD” numbers can be: Insignificant Point to a real issue


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

3

What do we do with this information?

Form committees Meet in cluster

groups throughout the school year

Spend an entire day asking questions and then form teams to research the answer

*This is how this study came about


Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

3

How do I generate reports?

You need two sets of numbers:

•General Ed. Numbers Ethnicity Totals by Grade, Gender and

Building – All Students•General Ed. Numbers

Ethnicity Totals by Grade, Gender and Building –Sp Ed Students Only

Campus Special Education Excel Spreadsheet

Generating Reports

Filling in the Campus Spreadsheet. Fill in the gray boxes

•Each Campus needs an approach that simultaneously:

Correctly identifies students Reduces caseload numbers

Implement a New PlanIdentify a District’s

Population

Analyze District

Population

Develop training

plan

Implement training

plan

Evaluate success

4

Questions?

Guidelines Help Texas Clinicians Manage Caseloads• “A 10-year effort in Texas to implement consistent guidelines

for identifying students with speech impairments is yielding successful results, according to a survey conducted by the Texas Speech-Language-Hearing Association (TSHA).

• The effort began in 1999 when school-based professionals concerned about high caseloads and over-identification of students with speech impairments met during the TSHA annual convention. The attendees reached consensus on the statewide need for appropriate and consistent identification of children with speech impairments. Ten speech-language pathologists volunteered to serve on a TSHA task force to develop guidelines for eligibility for services in the four areas recognized in the Individuals with Disabilities Education Act (IDEA)—articulation, language, voice, and fluency.”

Reducing Caseload Numbers

Reducing Caseload Numbers

Groups

• Age/grades• Severity

Teache

r Interaction

• First Encounter• Recurring Encounters

Studen

t Interaction

• First Session• Recurring Therapy

Paperwork

• Data• Student Info

Caseload Study

First Name DOB TX Time Grade TeacherLast Annual

ARDLast FIE

DateBRANDON 2/28/1999 60 Grade 3 Finlayson

5/20/2008 10/15/2007OSCAR 1/9/1998 60 Grade 4 Izaguierre

10/2/2007 3/31/2006JESUS 6/21/2001 60 Grade 1 Leiker

9/18/2007 4/16/2007Justin 2/20/2001 60 grade 1 Laredo

5/5/2008 5/1/2007RICARDO

6/8/1999 60 grade3 Finlayson 2/5/2008 4/4/2007

Christhian 8/30/2003 60 pre-KArias

12/12/2007 11/13/2007

Alejandro 12/11/2002 60 pre-KArias

10/17/2007 4/27/2007

Kevin12/19/2001 60 Kindergarte

nRuiz

9/12/2007 1/8/2008PATRICK

6/16/2000 60grade 2 Corona

1/23/2008 1/18/2008Alma 1/24/2001 30 grade 1 Saenz

1/9/2008 12/12/2007FRANCISCO 10/7/2001 30 Kindergarte

nThomei

11/28/2007 11/18/2005JEFF 12/13/2004 60 Kindergarte

nThomei

4/16/2008 3/28/2008Elliott

6/30/2003 60 pre-KSmith

9/12/2007 1/8/2008

Groups

• Organization of Groups▫Disorder classes

together▫Grade/age together

• Individual or Group TX?▫More severe = More

time▫More severe =

Individual▫Moderate/Mild =

Group

Groups

• Traditional Plan

Groups

• New Plan

Organization of Groups Disorder classes

together There is no such thing as

artic therapy Ability trumps grade/age

Grade/age together Individual or Group TX?

More severe = group More severe = Inclusion

Time Mild = Individual

•First Encounter▫Hi there!▫I’m introducing

myself and will be back next week.

•Recurring Encounters▫Can you send Pepe

down?▫See you at the ARD.

Teacher Interaction

• Limited Contact

Teacher Interactio

n

• New Plan

First Encounter Hi, I’m … Here is a folder with:

Goals, schedule, teacher letter, parent letter

I will be taking Pepe at X. I will be back in one week to

see how I can help you in the classroom.

Recurring Encounters Thank you, I will work on X Here is how Pepe is

successful at X.

Initial Student Folder

• Terapia de Habla y Lenguaje• • • Estimados padres,• Me llamo ____________y soy el

terapista de habla que trabaja con los niños que hablan español. Tengo el placer de trabajar con su niño este año y espero que yo tenga la oportunidad de conocerles pronto o verles de nuevo. Si tiene preguntas o si quiere hablar de los progresos de su niño, me pueden llamar o escribirme por correo electrónico. También estaré alegre de reunirme con Ustedes. Llámeme antes y podemos reunirnos cuando sea posible para Ustedes.

• • ¡Mucho gusto!• • Name• Number

• Speech and Language Services• 9/2/09• Dear Teachers,• It’s good to see everyone back and we are

looking forward to a great year. For those of you that I haven’t met yet, my name is Scott Prath and I am the bilingual speech pathologist that will be working with the Spanish-speaking students this year. It is a pleasure to meet you and I am looking forward to working with you and your students.

• Included is a letter of introduction for the parent. Please send it home with the student. My goal is to address the speech and language needs of each student while supporting you in the classroom. Please let me know if the student is struggling in any area. Often I can include vocabulary and concepts from the classroom in the speech sessions. I welcome any ideas you may have in order to collaborate with you to best serve the student.

• I currently serve multiple campuses and am best reached through Lotus Notes.

• Thank you for all that you do,

• Your Student’s schedule:• Students Times Days

Parent Letter Teacher Letter

•First Session▫Tell me about

yourself▫Here are the rules▫Here are your

buddies•Recurring Therapy

▫Do you remember what we worked on last week?

Student Interaction

• Subordinate

Student Interaction

• New Plan

First Session Photocopy of formal

measure Collect initial data Here are your buddies

(for now)

Recurring Encounters Here is your chart

with your goals We are taking that test

again in 3 weeks

•Data▫TX data▫Medicaid▫Testing

•Student Info▫Attendance▫Caseload Summary▫Class schedule▫Teacher, grade,

school

Paperwork

•Copious Paperwork

•New Plan

DataData is testing is MedicaidStudent Info

Only 2 pieces of paper with all pertinent information

Caseload ARD dates Weekly schedule Testing schedule

The new process is:

•Always novel ▫Ask yourself how you can serve students

differently not better•Concise•Focused on moving students off your

caseload•Focused on the classroom which is:

▫The one true measure▫The reason why people on campus will love

you

Supporting Teachers

Identify students

with needs

Implement pre-referral intervention strategies

Support IEP goals in the classroom

Collaboration between Teachers and SLPS

Are Teachers Referring the Right Students?

Research on agreement between teachers and SLPs

• Numerous studies have explored the rate of agreement between teachers and SLPs about who should receive speech services (Friberg, 2008).

Diehl & Sinnet (1959) – 60% James & Cooper (1966) – 40% Clauson & Kopatic (1975) – 18% Davis and Harris (1992) – 81% Cartwright-Gard, Harmon & Bryne (2002) – 58%

• On average, teachers- SLP agreement is 60%.• Research indicates that 40% of students who

should be referred are not (Mosheim, 2009)

Teacher confidence

•Cartwright-Gard, Harmon & Bryne (2002) surveyed teachers and found:▫75% of teachers reported low confidence in

making referrals▫80% of teachers indicated a desire for more

training to improve their referrals•Many teachers report very low confidence

when making referrals for bilingual children

Are Teachers Referring the Right Students?

Distribution of a time over a student’s week

Functional Language ModelInput -> Output

•We need to train teachers for short-term and long-term interventions

•Teachers spend at least 25X more time with students than the SLP.

•It is essential that the SLP and teacher communicate

In addition to short-term interventions…

•We need to train teachers to effectively utilize speech and language enrichment activities in the classroom for our speech students.

•Teachers spend far more time with students than SLPs do so it is essential that they are working toward the same goals.

Teacher knowledge of speech and language disorders and SLP Scope of Practice

•Student teachers had difficulty describing what speech and language skills were.▫Most common responses:

Speech = articulation Language = vocabulary (Friberg, 2007)

•Phuong’s study at RR▫Most teachers had limited understanding of

the scope of practice of SLPs

Back to Basics

Meeting 2:Meet and review

the four-page initial information pages.

Based on the concerns, provide the teacher with strategies.

Expressive LanguageA. SyntaxB. MorphologyC. SemanticsD. PragmaticsReceptive LanguageE. SyntaxF. MorphologyG. SemanticsH. PragmaticsSpeech concerns ENGSpeech concerns SPN

Questions?

Models of SuccessOngoing Collaboration between Classroom Teachers and SLPs

Life Skills and PPCD

•Speech-language goals are a part of the curriculum

•Inclusion therapy using classroom topics•Multiple disciplines are responsible for

addressing IEP goals.

•This is a collaborative effort that can be used in the pre-referral process as well.

Studies related to SLP-Teacher Collaboration

•Teachers who had 3 short training sessions on voice disorders made significantly better referrals than a control group with no training.

•Teachers in individual trainings, small group trainings, and large group trainings all implemented increase use of strategies in the classroom after training.

•Classroom demonstrations, team teaching and consultations were effective models.

Ways to collaborate

•Can range from informal to formal▫Reviewing resources and describing what

to look for▫Sharing instructions for data collection▫Reviewing data weekly or biweekly▫Modeling intervention in classroom▫Providing pointers for incorporating

language goals into regular lessons▫Meeting with team leaders▫Attending teacher meetings▫Presenting at teacher in-service meetings

Characteristics of Successful Collaboration

•Expectations are set•Materials are shared•Team members communicate•Rationale for intervention is discussed•Families are included•Staff education and training•Consistent and frequent

communication•Progress check

The Equitable, Collaborative, Functional Referral ProcessSteps for referring for speech and language difficulties.

The pre-referral process

•The RTI referral process requires that teachers attempt to intervene in the classroom before referring to special education.

•When this process is ineffective it is:▫Abandoned – leading to immediate signed

consent▫Stretched out – leading to long referral

processes

The RTI Process

Check with

parent teacher &

nurse

Collect data on

concerns

Attempt to remediate

in the classroom

Refer if remediatio

n fails

Documents for Support

•Apples To Apple•Red Flags For Language Impairment in Bilinguals

•RTI Student Concerns

Red Flags For Language Impairment in Bilinguals

• Difficulty learning both languages, even with adult assistance

• Family history of language/learning disabilities • Slower development than siblings• Difficulty interacting with peers• Inappropriate pragmatic/social language skills

(i.e., turn-taking, topic maintenance, considering listener needs, non-verbal communication)

• Difficulty with language in many routines• Language performance unlike others with

similar cultural/linguistic experiences

RTI Concerns

• Hearing Concern• Parent Concern• Teacher Concern

• I can’t understand the words that my student uses.

• My student doesn’t speak enough, is confusing, or can’t understand me.

Part A - Everyone

Part B – Which best describes your student

Speech and Language Concerns

The Language Information generates data about each area of possible concern.

Teachers read it from top to bottom

SLPs read it from left to right

Speech and Language Concerns

• Teacher makes referral• SLP completes

assessment

• Teacher expresses concern about student

• Consults with team• SLP provides resources for

intervention• SLP provides training• SLP models interventions

In summary:

Thank you!

collaborating with teachers to make great referrals: identifying treatment methods that work across...

Education

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view rti

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