no. 2. print. - eric · frey stockdale, andrew hickman, kay slavin smith, and roxanne mogen staff...

ED 276 211

AUTHORTITLE

DOCUMENT RESUME

EC 190 977

Hickman, Andrew C.; And OthersNotebook for Data Collection and Submission: AWorking Paper for Use by Special Education Local PlanArea Representatives, Participating Districts, andSchools in the Cooperative Evaluation Study ofExisting Student Study Team Processes, Working PaperNo. 2.

INSTITUTION California State Dept. of Education, Sacramento.Office of Program Evaluation and Research.

SPONS AGENCY Department of Education, Washington, DC.PUB DATE 11 Oct 85CONTRACT G0084C3505NOTE 67p.; For related working papers and the final

report, see EC 190 976-981. Several pages may notreproduce well due to marginal legibility and smallprint.

PUB TYPE Reports - Descriptive (141)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS Check Lists; Data Collection; *Disabilities;

Elementary Secondary Education; Guidelines;*Interdisciplinary Approach; *Records (Forms);*Spacial Education; *Student Evaluation; StudentRecords

IDENTIFIERS California; Child Study Teams

ABSTRACTThe paper is the second of a series of working papers

developed by a project which conducted a cooperative study ofexisting student study team processes in nine California specialeducation local plan areas. The working papers augment the finalreport by providing detailed descriptions of the methods used and thepreliminary findings. This document consists of a compilation of datacollection forms and includes an overview with flowchart andtimeline, checklist of data collection tasks, guidelines for theselection of staff, student study teams, and students participatingin the school data collection, the survey form for study teamparticipants, the log of student study team process decisions, a listof participating districts, the individual student record datacollection form, a partial listing of possible instructionalmodifications, and survey compilation forms. (DB)

***************Reproducti

***************

************************ons supplied by EDRS are

from the original************************

***************the best thatdocument.***************

*****************can be made

*****************

1

Notebook for Data Collection and Submission

A Working Paper for Use by Special EducationLocal Plan Area Representatives,

Participating Districts, and Schoolsin the Cooperative Evolution Study

of Existing Student Study Team Processes

Prepared by

Program Evolution and Research DivisionSpecial Studies and Evolution Reports Unit

Andrew C. Hickman, Research AssistantGeoffrey P. Stockdale, Research Associate

Margaret Merrick Scheffelin, Project Director

October 11, 1985

Cooperative Agreement Number G0084C3505Working Paper No. 2

AV,

Coop Aretalterit No.

e0034C3505

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

TO THE EDUCATIONALRESOURCES

INFORMATION CENTER (ERIC)."

U.S. DEPARTMENT OF EDUCATIONOffice of EducationalResearch and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)-R4s document has been reproduced asreceived horn the person or organizationoriginating it.0 Minor changes have been made to improve

reproduction quality.

Points ol view or opinions stated in this docu-ment do not necessarily represent officialOERI position or policy.

PROJECT DIRECTOR'S FOREWARD

This document is one in a series of five working papers produced bystaff members of a project established to conduct a cooperative evaluationstudy of existing student study team processes. The project was partiallyfunded under a cooperative agreement between the Office of Special Educa-tion Programs of the U.S. Department of Education and the Program Evalua-tion and Research Division of the California State Department of Education.The Division assigned the responsibility for administering the project totbe Special Studies and Evaluation Reports Unit. The study was conductedin close collaboration with a Project Advisory Committee and staff from 31schools in 22 school districts in nine randomly selected Special EducationLocal Plan Areas in California. All local partiCipating agencies andschools were volunteers and were operating some form of student study teamprocess. The duration of the study was from October 1984 through June1986.

The purpose of this series of working papers is to augment the finalreport of the study by providing detailed descriptions of (1) the methodsdeveloped and used in the study and (2) the preliminary findings which hadbeen presented to local and state- level participants in the study fortheir review and comment. The title of the final report is "Existing Stu-dent Study Team Processes in Selected Volunteer Special Education LocalPlan Areas, School Districts, and Schools in California: A DescriptiveEvaluation Study." The report, like the working papers, has been submittedto ERIC for dissemination.

The working papers are listed below in the order in which they werecompleted in final form.

Stockdale, Geoffrey, and Margaret Merrick Scbeffelin. "Six Aspects orExisting Student Study Team Processes in Participating Schools, Districts,and SELPAs." Working Paper No. 1. July 1985.

hickman, Andrews Geoffrey Stockdale, and Margaret Merrick Scheffelin."Notebook for Data Collection and Submission: A Working Paper for Use bySpecial Education Local Plan Area Representatives, Participating Districts,and Schools in the Cooperative Evaluation Study of Existing Student StudyTeam Processes." Working Paper No. 2. October 1985.

Moser, Roxanne. "Existing Student Study Team Processes in SelectedVolunteer Special Education Local Plan Areas, School Districts, and Schoolsin California: A Descriptive Evaluation Study: Draft Preliminary Find-ings." Working Paper No.1. April 1986.

3

Hickman, Andrew, and Geoffrey Stockdale. "A Summary of Responses to theSurvey of Student Study Team Participants." Working Paper No. 4. June 1986.

Smith, Kay Slavin. "Procedural Treatment of Individual Student Record Form(Form 13) Data." Working paper No. q. June 1986.

To tbe project staff's knowledge, this study is the first in thenation to yield information on the characteristics of students brought tothe attention of student study team processes. There were no tested datacollection instruments available for use or adaptation. Project staff,members of the Advisory Committee, and local.staff worked cooperatively todevelop, review, and complete the data collection forms; to.review and cri-tique the preliminary findings; and to review the draft of the finalreport. The analysis of the data was done by project' staff. Analyzing sur-vey data was fairly straightforward; analyzing the intensive student datawas a task of another order of magnitude. Much credit is due to the projectstaff, who successfUlly carried on the simultaneous tasks of data analysisand flood control. It is common to safeguard one's data from ordinarymishaps such as misfiling or inadvertent discarding of subtotals. It israre to safeguard one's data from the ever-rising waters of a riverthreatening to overflow the levee behind the building in which one is work-ing.

In the Writ a shared scholarship the staff offers these workingpapers as a record of their thought and work and as an assist to scholarswho may be examining similar topics in the future. In the spirit of givingcredit where credit is due, I wish to acknowledge the creative and assidu-ous work of the members of the project staff, all of whom were graduatestudents at California State University, Sacramento, during their work inthe project. In the order in which they began their work, they are Geof-frey Stockdale, Andrew Hickman, Kay Slavin Smith, and Roxanne Mogen Staffmembers Stockdale, Smith, and Moger are in the field of communication stuLdieb; Mr. Hickman's field is psychology.

A. one of the first evaluation studies funded under the expandedevaluation authorization of Public Law 98-199, the information may be usedat local, state, and federal levels. It must be noted that nothing inthese working papers, or in the final report, is to be construed as anofficial policy or position of either the California State Department ofEducation or the U.S. Department of Education. Finally, the responsibilityfor omissions and inaccuracies must remain mine, as project director.

Earearet Merrick Scheffelin, Ph.D.Consultant, Program Evaluation & Research Division

Sacramento, California.June 1986.

4

TABLE OF CONTENTS

I. Figure 1: Data Collection Overview 1

II. Checklist of Data Collection Tasks 2

III. Figure 2: Selecting School Staff, Student Study Teams, and Studentsto Participate in the School Data Collection 3

IV. Project Overvlew 4

V. Form 10: Survey of Student Study Team:Participants 5

VI. Form 11: Log of Student Study Team Process Decisions 20

VII. Confidentiality Coding 22

VIII Form 13: Individual Student Record 23

IX. Partial List of Modifications 53

X. Form 14: Compilation Form for Survey 58

XI. Form 15: Compilation 'Form for Logs 59

XII. Form 17: Compilation Form for Student Record 60

5

Figure 1

Data Collection Overview.

Coop Agreement Nor

G008403506

Data Collection and

Compilation Flowchart.

Prt, eFOVAS1.1=1N11=0=4

AS tr?

Etiote..4114.1y

;Ater riled tg"

. tool.

Copit 5

Fort4s

sELFA

compIRAA

Fa riNts

tComi).

S.

amrmilmmompamommosuisamiaism111.1MINIMEMMIMINImPIMINIMMIMMINIMINII

!intim

6

110111114%.1.01IMSPimmnionwlmonmlamminlimmiliimiIMum

Form ii Approx. Date Data Collection All Forms

Mailed by at Schools Ends Due at

Project Project

dellmmisemimm 1001110/14 Oct. 15 Nov. 4 Nov. 15

Survey

11/15 Oct. 15-10 Dec. 13 Dec. 20 to

Jan. 6/86

1 2/16 --DROPPED

13/17 Oct. 15-20 Dec. 13 Dec. 2Q to

Jan. 6/86

AH/MS/0

10/11/85 7

CHECKLIST OF DATA COLLECTION TASKS.

1. Select samples at school:

a. Staff for Survey

b. Student study teams for Log

c. Students for Student Record

2. Copy and distribute:

a. Survey and Project Overview

3. Select and orient persons to complete:

a. Log(s)

b. Student Record(s)

4. Copy and distribute Log and Student Record forms:

a. Log form with Confidentiality Coding and Partial

List of Modifications

b. Student Record forms with Confidentiality Coding

and Partial List of Modifications if needed

5. Return of data collection forms to SELPA

a. Form 10: Survey (Nov. 4?)

b. Form 11: Log (Dec. 13 to 19?)

c. Form 13: Student Record (Dec. 13 to 19?)

6. CompleteCompi.lation forms and send with completed data

collection forms to Sacramento:

a. Forms 14 and Surveys

b. Forms 15 and Logs (photocopy before sending)

c. Forms 17 and Student Records (photocopy before sending)

r'

2

8

Qgop Agreement Bo.130084M16011

Date Done:

GS/MS 10-9-85

Figure 2:

Selecting School Staff, Student Study Teams,and Students to Participate in the

School Data Collection

Form Recommendations on Selections

#10 SurveySchools that have 10 staff orfewer.

Schools that have more than10 staff.

Select all 10

Select at least 10, and may addothers as desired.Example: All regularly attendingmembers plus--a random sample ofother staff.There is no limit on the number ofsurvey forms the project staffwill analyze.

#11 LogSchools that have only oneStudent.Study Team

Schools that have more thanone Student Study Team

Select that team

If you have more than one teamask yourself, do you want .

information about all of them?Is it feasible? If not, whichlevel gives you the most typicalpicture? Do you need all levels?There is no limit to the number ofLog forms the project staffwill, analyze.

#12 DROPPED

#13 Individual Student RecordStudent Study Teams that have10 students or fewer.

Student Study 'Itams that havemore than 10 students.

logged in Use all students

logged

3

9

Select a minim= of 10 and a maximum of20 students, Chicxme 10 at random andselect others (up to 10) toillustrate the variety of studentcharacteristics and types ofmodifications suggested.

MS/GS/AB/ 10/8/85

CALIFORNIA STATE DEPARTMENT OF EDUCATION Bill Honig

721 Capitol Mall Superintendent

Sacramento, CA 95814-4785 of Public Instruction

Coop AGreema: o.6008403505

COOPERATIVE EXPLORATORY STUDY ON STUDENT STUDY TEAM PROCESSES

Project Overview

Conducted under a cooperative agreement between the California State Department of Educationand the United States Department of Education, the project is examining the purposes,composition, operation, and outcomes ol existing student study team processes with a selectedgroup of 29 regular elementary and secondary schools in California in 22 sthopl districts in ninevolunteer Special Education Local Plan Areas: Co lust County, Modoc County SELPA, Mt. DiabloUrdfied School District, North Region SELPA of Alameda County, Siskiyou County SELPA,Tri-City Consortium (Calaveras, Amador, Tuolumne), Ventura County' SELPA, and West End SESRof San Bernardino County. One main purpose of a student study team process is to providetechnical assistance to teuhers in order to help their students to succeed. The study isdescriptive, not experimental or prescriptive. The 18 month funding period is from October 1,1984 through March 31,1986, with costs shared (state $81,560 and federal $122,340). The largescope of the project is possible only with local contribution of interest, experience, time andenergy. The authorization for the Secretary of Education to enter into cooperative agreementscomes from P.L. 98-199.

A Project Advisory Committee is actively involved in planning and reviewing the operation of theproject. The members of the Project Advisory Committee are as follows: Dr. Stephen A. Fiss,Alum Rock Union Elementary School District; Dr. Carolyn Fowle, Assistant Director, ProgramEvaluation and Research Division, California State Department of Education; Ms. Dora Golden,Los Angeles Unified School District; Milton B. LeCouteur, Ventura County Special EducationServices Area Consortium, and President, SELPA Directors Association; Betty Richland,Assistant Director, Special Education Division, California State Department of Education; MarieOtto, Superintendent, Huntington Beach Union High School District; Dr. S. Jerry Trow, Office ofthe Stanislaus County Superintendent of Schools, and Professor. Alice Watkins, California StateUniversity, Los Angeles, Member, Commission on Special Education.

The second of three scheduled workshops was held on September 27, 1985. Intensive datacollection will take place in the fall semester of 1985-86. Information gathered by school staffwill be analyzed by project staff, Geoffrey Stockdale and Andrew Hickman, and shared amongparticipants. A final report is expected to be ready by June 30, 1986. For futher information,contact Margaret Merrick Scheffelin, Ph.D., Project Director, Program Evaluation and ResearchDivision, (916) 322-5012.

MS/GS/AN 10/10/85

4

1 0

DATA 'COLLECTION FORM 10

Please return to:

District

Survey of Student Study Team Participants SELPA

Cooperative Evaluation StudyOf Existing Student Study

Team Processes

Information recorded by:(Name)

(Position)

(School)

(DateY

Instructions

Coop AgreementNo.GO0a4C3505

Answer these questions from your own experience with student study team processes.For each iten please check all that apply.

1. There are many purposes of the student study team. Check all of thepurposes of the student study team at your school, and the effective-ness with which they are met.

1.1 In some cases the student is an explicie focus of studentstudy team purposes.

a. To provide a quick, professionalapproach to maximizing eachstudent's education.

b. To ensure correct academicplacement of students.

c. To develop interventions whichenable students to function inthe regular education program.

5

11

Effectiveness atMeeting Goals

yurposeOf Our Moder- Excel-SST Poor ate lent

( ) ( ) ( ) ( )

( ) ( ) ( ) ( )

( ) ( ) ( ) ( )

Rev. 10/15/85

CkmpAgrommenthko.430084C3505

d.

e.

To serve all students experiencing

Purpose


)

Moder- Excel-Poor ate lent

( ) ( ) (

Of OurSST

)(learning problems.


f.

emotional problems.


( ) ( ) ( ) ( )

g.

behavioral problems.

To serve students in the regulareducation program having learning

( ) ( ) ( ) ( )

h.

problems.

To serve students in the regulareducation program having emotional

( ) ( ) ( ) ( )

i.

problems.

To serve students in the regulareducation program having behavioral

( ) ( ) ( ) ( )

j.

problems.

To provide a vehicle for deliveringappropriate services and interventions

( ) ( ) ( ) ( )

for students in a coordinated manner. ( ) ( ) ( ) ( )

1.2 In some cases the technical assistance activities of the student studyteam are an explicit focus of student study team purposes.

a. To coordinate delivery of servicesto students. ( ) ( ) ( ) ( )

b. To make recommendations forinterventions. ( ) ( ) ( ) ( )

c. To act as a resource in developinginterventions. ( ) ( ) ( ) ( )

d. To develop creative ways of dealingwith students. ( ) ( ) ( ) ( )

e. To provide assistance to classroomteachers. ( ) ( ) ( ) ( )

f. To monitor progress of interventions. ( ) ( ) ) ( )

g. To provide an immediate support systemto classroom teachers. ( ) ( ) ( ) ( )

6

12 Rev. 10/16/85

4140144.=

4400 1140 UP**

4. 4000000111s 4-900484** 0040,410440

*003440ms smomoim0mF,4 *4IIINK04001-40.* 040111100 440044*** 1, I It II4, ipietvilli 4011Ir 1111.01110* 00 0011,0 640$111110 * 414410100 00 00/040/0,401t. sr 9 1 1 I I I

1. 004140440 40460., 044400400 4m40,

40.0.s.4460* om 46006, 46r 0.404AP00,.

4,41100041441446 10. 401000040 logo 0040 400

0004.04M00 401de 4*****440041* 044004100 **444 *0 *4

4 44 44141400. meow 060m mois 604240140s s * 4 04.a 4110401.

4 dose MOOP 446004044444 40,00,14.0 400140004140# .111. 441014114044 e* IMO 41000ommilmmisp megro.44. 044=44411

44. AS 4444011444, 4 0 4 i * *

a. 4m *WNW, 414 OlikoMMWO 016110

oolopoismit sm iftwftiow 0010040040'.

4101401.

414.0 swim smeop40p, 104M000440 00004004 406 40 41410404 4 Omowsale 444000140 0104014 40466 44.14mmoo

girUMW

SMOMMI 4,10041044100 000 4401

O g4 00imommm0 sommoseses oporeeMme. 4 4 1 4 1 4 4 0

44. 010tJ'J10 410441614444 4440111.11414

5504444440 4000104. 000100040

ill OOP. *SO 4111. gapappompo alloriro400

4 1 4 1 a 1 a

401Ik 0111001Mle 4 $ 1 $ I 1

O 41* ossimmer 04- 410001.44140 4110 404000,00

4. 4040 4160640*000

004411o40 40411100000 041 gem00001110 000M0

4 ewe gomm41eimo memespo4000 40446110444,

4* s* *4 14

* 4 *

low *Or Wollio

Coop Agreement No.a00114C3808

Effectiveness atMeet na Coals

Pur oso0 Our Moder- Excel-SST Poor ate lent

V To review individual student problemsand plan altereative instructionalstrategies that can be tested in theregular classroom before a decisionis ludo I. refer the student to

special edueatioe. ( ) ( ) ( ) ( )

g To discwes problems of students ratherthee decisions as to eligibilityOr--:Meet for special educatiom programs. ( ) ..( ) ( ) ( )

b. To make remediation a total schoolMierpftell rather than a concernfor special iducatioe ) ) )

1.4 1e east cases am educational statute is an explicit focus of studentstudy team purposes.

a. To misers compliance with

purpose


Moder- Excel-Poor ate lent

Of OurSST

Calitermia Education Code$4102. (Idestificatioe andreferral of students, modification

b.

of regular imstructiooal program.)

To ensure compliamce with

( ) ( ) ( ) ( )

California Education Code 56303.(Referral of student only afterthe ',Noumea of the regular educationprAgran have been coesidered and where

c.

eppropriate, utilised.)

To ~ere compliaace with the

( ) ( ) ( ) ( )

provision of Public Law 94 -''2. ( ) ( ) ( ) ( )

8

1 4 Rev. 10/16/85

GOOPAgreemennyoCRW4D3.50t

1.5 There may be other purposes for student study teams. not mentioned above,that apply at your school; please list them:

2. There are many participants in student study teams. Check those participantsyou consider regular members, or intermittent or support members, and addcomments if you wish.

Intermittent orParticipants Regular Members Support Members Comments

a. Administrators

Principal ( )

Assistant Principal ( )

Vice-Principal ( )

Principal's Designee ( )

Management Trainee ( )

b. Teachers

Student's classroomteacher

Student's previousteacher

Teacher receivingstudent

15Rev. 10/16/85

ParticipantsIntermittent or

Regular Members Support Members

COV Agreemmt No.G0084C3505

Comments

Student's coreteacher ( )

Student's electiveteacher ( )

Teacher-member ofstudent study team ( )

Other interested teacher ( )

Miller-Unruh Projectteacher ( )

Opportunity classteacher ( )

Resource teacher ( )

Speech teacher )

Special day-classteacher ( )

English-as-SecondLanguage Teacher (ESL) ( )

Remedial/Supplementalteacher ( )

c. Specialists

Reading

Mathematics

Physical Education

Resource

Speech

Bilingual Education

Migrant Education

Gifted and TalentedEducation (GATE)

Chapter 1

6

Rev. 10/16/85

Participants Regular Members

Coop Agreement tk..cotitmertos

Intermittent orSupport.Members Comments

School Improvement ( ) ( )

Audiologist ( ) ( )

Psychologist ( ) ( )

Counselor ( ) ( )

Guidance Consultant ( ) ( )

Nurse ( ) ( )

Home-schoolCoordinator ( ) ( )

Special EducationClerk ( ) ( )

Administrative Secretary ( ) ( )

Interpreter ( ) ( )

Social Worker ( ) ( )

Physician ) ( )

Probation Officer ( ) ( )

Parents ( )

Student ( )

d. Other (Please specify.)

11

1 7

Rev. 10/16/85

Coosolcasosreesi!entNo.

3. The Student Study Team Process:

Student study teams engage in a variety of activities. Indicate the state-ments below that apply to the student study team process at your school.

a. Identification of students meriting referral.

b. First stage data gathering in referral.

c. Review of referral/request for SST assistance.

d. Student study team scheduling.

e. The student study team meeting.

f. Implementation of modifications/interventions.

g. Review of case (follow-up, progress report, update).

h. Other (Please specify.)

4. Many resources for suggestions, modifications and interventions are describedin the literature.

4.1 Which of the following resources are available at your school. (Check allthat apply.)

a. Teacher time

b. Teaching aids and materials rt

c. Other participants' time

d. Assessment/Data collection materials

e. Student study team process materials (forms, etc.)

f. Miscellaneous materials/resources (Please specify.)

1 2

.18

Rev. 10/16/85

coop Agreement 1411).-G008403505

4.2 Which of the following modifications are practical for a student study teamat your school to suggest?

a. Environment (example: change seating)

b. Materials (audio-visual aids)

c. Assignments (shorten or simplify)

d. Teaching techniques

e. Learning modality (visual, auditory, tactile)

f. Parent contact

g. Outside resource intelventions

h. Behavior shaping

i. Miscellaneous other; specify:

5. What process(es) does your student study team use to recommend interventiontechniques?

a. individual discussion and group decision

b. individual discussion and referring teacher reaction

c. student participation in discussion

d. parent participation in discussion

e. leader directs discussion

f. leaderless group, leader emerges

g. other; specify:

13

1 9

Rev. 10/16/85

coosotuticasosreement No.

6. Which of these procedures are used to report or determine the "success" ofrecommended modifications?

a. Wo feedback is given to the student study team on the "success" ofmodifications and the absence of feedback:1. is taken as "no news is good news" ( )

2. is a problem for the student study team ( )

b. Verbal or written feedback is given to the student study team by:1. person(s) responsible for modfications/interventions ( )

2. other observers to modifications/interventions ( )

c. Verbal or written feedback is given to the student study team by:1. a predetermined review date2. any regularly scheduled meeting3. emergency meetings

d. Student study team discusses feedback on "succe*s" ofmodifications/interventions and:1. unquestioningly accepts judgments of person

offering feedback2. discusses and evaluates feedback on "success" of

modifications/interventions3. develops a consensus on judgment of the "success" of

modifications/interventions4. accepts the interpretation of an influential team

member on the "success" of modifications/interventions

e. A formal report by an outside agency (such as community

mental health, the probation department, child protectiveservices, etc.) may lead to a student study team judgmentof the "success" of modifications/interventions

f. Other procedures may be used to determine th.1 "success" ofmodifications/interventions. Please specify those thatapply at your school:

14

20

Rev. 10/16/85

cloraZsosnenttio.

7. Which of these procedures are used to report or determine the success ofparticular students after modification/intervention?

a. Irdividual judgments of student school behavior, academic performance,and social/emotional adjustment may be made by:

1. the student's teacher(s)

2. other teachers

3. student study team members

4. other involved professionals

5. the student's parents

6. the studenk.'..: tutor

7. others; please specify:

b. Records may be used to judge changes in student.school behavior, academicperformance and social/emotional adjustment by:

1. countinq the number of tardies( )

2. counting the number of ahsences/truancies( )

3. counting the number of fights( )

4. incidence of "acting out" in class( )

5. counting the number of questions answeredin group discussions

( )

6. classroom test scores ( )

7. completeness of work ( )

8. achievement test scores ( )

9. proficiency tests for graduation ( )

10. expert observers' reports (such as school nurseor psychologist) ( )

11. various accepted tests of emotional development orstability ( )

12. other; please specify:

15 Rev. 10/16/85

21

vOop Agreement No.G0084C3505

8. Which of these criteria are used to judge the "success" of a particularstudent after modifications have been made?

a. A change in academic achievement such as:

1. a decline from previous performance

2. an improvement over previous performance

3. a closer match between achievement and ability


b. Behavioral changes such as:

1. a reduction of an unwanted behavior

2. elimination of an unwanted behavior

3. persistence of an unwanted behavior

4. appearance of a new, desirable behavior (suchas participation in group discussions)


c. Social/emotional changes such as:

1. increased emotional maturity

2. improved emotional stability

3. increased frustration threshold

4. decrease in visible anxiety

5. reduction in emotional display (crying,intense anger, etc.)


16

2 2Rev. 10/2/85

Coop Agreement No,G0084C3505

9. Which of these factors support an effective student study team processat your school?

(Many student study team participants are ac_ive in teams at more thanone school level, intermediate ar cecondary, or elementary and inter-mediate. Therefore, some respond will want to check more than onebox at the right where applicable.)

a. Leadership is provided to the student study team through:

Elemen- Inter- Secon-tary mediate dary

1. site administrator attendance ofstudent study team meetings ( )

2. attendance of a "designee" of thesite administrator at student studyteam meetings

3. a chairperson of student studyteam meetings ( )

4. a facilitator to keep discussions"on track" at student study teammeetings

S. expressed (written or verbal)support of the student study teamby the site administrator

6. an expressed (written or verbal)expectation by the site adminis-trator that regular educationstaff will participate in studentstudy team meetings

7. staff time for a student study teamcoordinator

8. expert discussion in student studyteam


Comments:

17

23

Rev. 10/16/85

AgreeMEN1tNO.

b. There is active acceptance of responsibility for team success:


1. the team as a group "shares" in thesuccesses of modification/intervention ( )

2. individuals accept responsiblity fortasks to be completed outside meetings ( )

3. regular education teachers accept respon-sibility for student referrals to thestudent study team ( )

4. individuals complete tasks outside meetings -by expected completion dates ( )

5. other, please specify:

Comments:

c. There is active cooperation in problem identification and modification/intervention:

1. all staff involved with modificationsfor a particular student attend meetingsof the student study team

2. regular education and special educationstaff communicate informally outsidestudent study team meetings on student,problems

3. representatives of appropriate communityagencies are invited to participate instudent study team meetings

4. parents are invited to become activemembers of student study team meetingsto discuss their children

5. other, please specify

( )

Comments:

18

24 Rev. 10/2/85

d. Communication supports team effectiveness by:

No.


1. keeping records of student studyteam decisions and task assignments C )

2. written reminders to student studyteam members of upcoming meetings ( )

3. written reminders of upcoming meetingsthat include student names and informa-tion on the current status of modifications ( )

4. review dates specified at the time ofinitial modifications

5. other, please specify

Comments:

e. There may be other factors that support effective student study teams atelementary, intermediate and secondary levels. Please indicatewhich level of school applies.

Thank you. Please return this form as soon as possible toyour school representative who will send it to your SELPA repre-sentative. We appreciate your time and effort.

A copy of the preliminary version of the final report ofthis project should be arriving at your school/SELPA aboutMarch 1, 1986.

19

25 Rev. 10/2/85

DATA COLLECTION FORM #11

Log of Student Study TeamProcess Decisions


Team Processes

boop AQrderiittmfi0.10:14C350S

Please Return to:

District

SELPA

Recorded for a period beginning no later than November 1, 1985 (data may covera period beginning as early as the first of the fall semester 1985-86) and endingno later than December 13, 1985.

Name of person keeping log:

Position:

School:

Instructions

This Log should be kept for each meeting of each student study team selected

for data collection in the project. For each student check whatever decisions

were arrived at, including any modifications to the regular class program

suggested to the referring teacher, and any referral to other services/assessment.

At the end of the data collection period, please return this log to the

school representative for returning to the SELPA representative, who will return

it to the project director at the State Department of Education. Thank you in

advance for your participation in the study and your time and effort during the

data collection period.

Instructions for Assuring Confidentiality of Personally Identifiable Information.

Before the completed form is returned to the project director at the StateDepartment of Education; the student names must be removed, and their projectidentification numbers must be marked on the form.

FORM 11, Rev. 10-9-85; AH/GS/MS

26

26

000000 4.00010010 40 = 0.04.1000 ~Pe** st, *NM 4.04111.0. 00 +tooMom aollw 410 14,ilwo Moo 000.000

l0000m **ow&Milk

0111. 40 alMok .01., 40 et% **mom

0i!

Sto

owyropeos owe to OW

Coding Per Student Confidentiality

We have drafted a coding scheme to ensure the confidentiality of data on individual

Students. We believe a five digit code will suffice for maintaining student

amftdentsality ufwile allowing for descriptive differentiations of SSLPAs, districts and

edmOls. The first digit would represent the IMELPAI in a series from I to 9; the second

digit would indicate a school in a services from I to 4; and the student within each

Wool would be coded successively in order of participation in the student study team

process in the last throe digits, we believe a nnge of I to 999 'should be sufficient for

individual student numbers within each school. The confidentiality coding is presented

in noon S.

We intend for all data on students to be identified with their code number in place

ef student's names. In no case should material leave school sites as data collected for

thle prOpet with the names of students as identification. An example of this coding

scheme would be 101101, the follwing relationship between names and numbers is

1Weeent:

The code number 32007 would represent the seventh student (thetast I digits:007O ilifted for dats collection at College ParkHigh tthe second Agit SI in the ikmcial Education Local PlanArta of Nt. Diablo Unified School District (the first digit: 3);hence, $1007 represents SIVA 11, school 3, and the studentmember 007.

Figure 3

PARTICIPATING SCHOOLS, SCHOOL DISTRICTS AND

SPECIAL EDUCATION LOCAL PLAN AREAS

Agreenfflt No.5

SELPAs Districts Schools

1 Colusa County Colusa Unified 1 Burchfield PrimaryMaxwell Unified 2 Colusa High

3 Maxwell Elementary

2 Modoc County Modoc Joint Unified 1 Alturas Elementary2 ModocIr.. High3 Modoc High

3 Mt. Diablo Unified Mt. Diablo Unified 1 Ayers Elementary2 Glenbrook Intermediate3 College Park High

4 North Region SELPA Alameda City Unified 1 Alameda HighAlbany City Unified 2 Cornell ElementaryBerkeley Unified 3 Berkeley HighPiedmont City Unified 4 Piedmont Middle

5 Siskiyou County Hornbrook Elementary 1 Hornbrook Elementary(one school district)

Weed Union Elementary 2 weed Elementary

Yreka Union High 3 Yreka High

6 Tri-City SELPA Beverly Hills Unified 1 Beverly Hills HighCulver City Unified 2 Farragut ElementarySanta Monica-Malibu 3 John Adams Jr. HighUnified

7 Tri-County Consorti-tm Amador County Unified 1 Ione ElementaryCalaveras Unified 2 San Andreas ElementarySonora Elementary 3 Sonora Elementary

Fillmore Unified8 Ventura County 1 San Cayetano Elementary

Consortium Las Virgenes Unified 2 Calabasas HighRio Elementary 3 Rio Del Valle Elementary

9 West End SESR Alta Loma Elementary 1 Alta Loma Jr. HighUpland School District 2 Foothill Knolls Elementary

'3 Sycamore Elementary

4 Valencia Elementary

Totals9 Special Education Local Plan Areas (SELPAs)

22 School Districts29 Schools

29MS/GS/AH 10/15/85

Information Recorded by:

DATA COLLECTION FORM #13

Individual Student Record


Team Processes

Ccc AsireersieraC-0084c3505

Please Return to:

District

SELPA

(name)

(school)

Instructions for Assuring Confidentiality of Personally Identifiable Information.

Before the completed form is returned to the project director at the State

Department of Education, the student's name must be removed, and his or her project

identification number must be marked on the form.

General Instructions.

There are five parts to this-form, along with a partial list of possible

modifications. Parts I,II,IV, and V should be completed for each student in

your school sample. In completing Part II for a particular student, use only

those pages that pertain to that student. Part III should be completed only

for those students whom the student study team refers to ctber school or community

services or to assessment.

patta Collection Period.

The ending date for entering new data in this Student Record Form isft

December 13, 1985. The beginning date is at the discretion of the school/SEPLA.

That is, existing data already in student study team files or school files can

be entered into this record.

Returning the Completed Forms.

At the end of the data collection period (December 13, 1985) please return

the completed form to your school representative, who will forward it to your

SELPA representative, who will forward it to the project staff in Sacramento.

We appreciate your time and effort. A preliminary report on the project

should be arriving at your school/SELPA around March 1, 1986.

FORM 13, Rev. 10-9-85; GS/MS

23

30

FORM 13, Part I. Student Information

A. Student's name:

B. Identification codes:SELPA School Student

Last First Middle

C. Student's birthdate: ,19month date

D. Gender (check one) Male [ ) Female [ )

E. Grade level of enrollment in fall semester 1985-86:

F. Dominant language: , other language(s) (specify)Ire

G. Program enrollment(s) as of referral date: 19 .

(a) regular education (specify) [ )

(b) categorical programs (specify) [ )

(c) special education programs (specify) [ )

(d) school/district developed programs (specify)

[ )

(e) other (specify) [

24

31

FORM 13, Rev. 10-9-85; GS/MS

FORM 13, Part II, Page A. READING Student Name:

Student I.D.#:

STUDENT CHARACTERISTICSIn Relation ToModifications:

COMMENTS

BEFORE AFTER

decoding [ ] .

word attack skills/phonics . . [ ] .

comprehension [ ] -.

speed [ ] .

fluency [ ] .

sight vocabulary

confuses words (was/saw, on/no,want/went)

...

[ ]

[ I

.

.

Other, specify: [ ] .

[ i .

[ i .

[ i .

[ i .

[ i .

BEFORE: Check if a characteristic is a problem BEFORE modification.

AFTER: Note "OK" if no longer a problem; "CP" if a/continuing problem; and

"NP" if the characteristic is a new problem.

MODIFICATIONS/INTERVENTIONS: (please be specific and concrete)

Type(s) of modification:

Date(s) of modification:

Provider(s) of modification:

Team judgment of student success after modification:

Criteria used?

COMMENTS:

25 FORM 13, Rev. 10-3-85; GS/MS

32

FORM 13, Part II, Page B. MATHEMATICS/ARITHMETIC Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

facts/terms/symbols (.=,+,-.±,x)

basic computation

word problems

concepts

application-(money, time,measurement)

numeral reversals (12/21) .

Other, specify:

[ ]

I ]

I ]

I ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

'

.

..

.

.

...

.

.

-

.

.

.

BEFORE: Check if #. characteristic is a problem BEFORE modification.

AFTER: Note "OK" if no longer a problem; "CP" if a1 continuing problem; and







Criteria used?

COMMENTS:

,

26 FORM 13, Rev. 10-3-85; GS/MS

33

FORM 13, Part II, Page C. SPELLING Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

skill well below readingachievement

-

omits or adds letters . . .

poor sequencing ( ] .

spells phonetically . . . . I ] .

...

poor visual memory ( ] .

-

...

sound-symbol difficulty . . . ( ] .

endings

cannot spell from list ordictation

spells poorly in writtenassignments

( ]

( ]

( ]

. .

.

.

guesses wildly when spelling . [ ] .

skills well below qrade level . [ ] .



AFTER: Note "OK" if no longer a problem; "CP" if .4 continuing problem; and




.Date(s) of modification:



Criteria used?

COMMENTS:

27 FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page D. WRITTEN LANGUAGE Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

grammar

punctuation

capitalization

Writing sentences

writing paragraphs

poor written expression . .

Other, specify:

[

[

[

[

[

[

[

[

[

[

[

[

4

)

)

)

I

I

I

)

)

)

)

I

]

]

.

.

.

.

.

.

.

.

.

.

.

.

-

..r-


AFTER: Note "OK" if no longer a problem; "CP" if continuing problem; and"NP" if the characteristic is a new problem.






Criteria used?

COMMENTS:

28

35

FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page E-1. SPOKEN LANGUAGE Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

poor grammar, articulation . . [ ] .

poor listening skills . . . . r ] .

poor understanding of commands or -

directions

limited vocabulary: speakinglistening

[ ]

[ I

.

:.

.:,

poor comprehension of discussion

poorly retained auditory input .

confusion between dominant andsecondary language . . . .

[ 7

[ ]

[ ]

. ,

.

.

poor pronunciation

blocks on "easy words" (wordfinding/retrieval difficulty)

poor verbal orgainzation . . .

uses words inaccurately . . .

[ [

[ ]

-[ ]

......_

.

.

.

(Continued on E-2)


AFTER: Note "OK" if no longer a problem; "CP" if alcontinuing problem; and







Criteria used?

COMMENTS:

29

36FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page E-2. SPOKEN LANGUAGE Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

unable to express thoughts andfeelings I 7 .

nonfluency I 7 .

voice disorders I 7 .

language processing difficulty . [ ] .

:

Other, specify: I 7 .z.

:

[ ] .

[ ] .

[ ] .

[ ] .

I 7 .

I 7 .

I 7 .

-6_


AFTER: Note "OK" if no longer a problem; "CP" if a; continuing problem; and







Criteria used?

COMMENTS:

30

37FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page F. HANDWRITING Student Name:

Student I.D.#:

STUDENT CHARACTERISTICSIn Relation TeModifications:

COMMENTS

BEFORE AFTER

illegible ( ] .

reverses (7-r, J-1-4 - - - - C ]

difficulty copying from page and

I

.

blackboard ( ] .

skills well below grade level .

tense-tight writing style . .

(

(

] .

poor rhythm

poor writing posture or pencil

f ]

,

.

grip

unusual difficulty staying onlines

crowds writing at margins .

[

[

]

]

.

.


[ ] .

I_


AFTER: Note "OK" if no longer a problem; "CP" if a'continuing problem; and







Criteria used?

COMMENTS:

31

38FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page G-1. GENERAL ACADEMICPERFORMANCE

Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

arade point average (GPA) . . . [ I .

credits: behind, completed . . [ I .

performance in comparison to grade

low achievement in relation to"ability"

[

[

)

I

.

.

slow learner; [ I

.

.

-

few academic strengths . . . . [ I .

"appears to be very bright" . .

previous intervention/modification history . . .

[

[

I

I

.

.

test results [ ) .

does not exhibit reasoning . . [ I .

difficulty in learning and using ..

concepts [ I .

(Continued on G-2)


AFTER: Note "OK" if no longer a problem; "CP" if a continuing problem; and







Criteria used?

COMMENTS:

32

3 9FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page G-2. GENERAL ACADEMICPERFORMANCE

Student Namet

Student I.D.#:


COMMENTS

..-

BEFORE AFTER

forgets previously learnedmaterial

knowledge gaps (surprises withwhat does/doesn't know)

learns better through some channelsthan others

learns some skills better thanothers .........

Other, specify:

f ]

f ]

f ]

f ]

( )

f 1

C ]

f ]

C ]

C ]

1 1

.

..

.

-

. -

.

.

.

.

.

.

.

. ,

BEFORE: Check if a characteristic is a problem BEFORE modification.rf




Type(s) of.modification:




Criteria used?

COMMENTS:

33 FORM 13, Rev. 10-3-85; GS/MS

** **,0* sic emm 0 'maw mommoom,

4110016 016006, 00614

410* 4We 4014, arldrow4ereop es 1000001/

01111* 400* elPr ellosermre

4040* 00 0.00e0 44400**44me,

400110 0446 Weemelome

414mo 10 4600* 44. 41000001

40400 440W

4111.04,erfteee 0. *01000* mope.

011110.040, 'Wee 1040001,

10010*0100441. mem* goon411W elellellellr4

001500.00010 01111118010404/4**

Illoosowoom, womi searemes.

010.411111100 *400000010

01/11/01040* 40414111110011 411Pre 1/0140

0011110141141111111111) * 0 its

0141114.111111 ON,

I

4

4

4 $

4

4 $

4

4 1

4 1

r 4

fika/Nii 01$010-

11444/00. $0. 1

4104104. 4000 44 0410,000 4.* ~al UMW ematedsolomms

001111W 410. 4114,* 4* 'MOW 00101420 Mir OF mums ims posibuftMOP 4a 41, oluse*** o A* am* ~ob.

woirea isk wove***

tormr4 0004,041604...

4spistuim 0.040.040..

4111111011ertoil

01111111011944110k 10 411.111,4444004401-.

4100. 44110050 # wham* 000.4.440-

410044140". 01110404 '44;2;ii.:41;.4

411111smislw

OS

41

0111111 esi, Ore, $411, Pelf UM

POW 13, Pert 11, Page N-2. ACADINIC BEHAVIOR Student Name:

Student I.D.2:

113121111.-Sigin RelationNodificItions;

To

AFTER

COMMENTS

BEFORE

carelessly osecuted work

poor quality work

Other specify:

. ( 1

1 1

( 1

( 1

( 1

( 1

i 1

( 1

I 1

( 1

( )

( 1

4 1

.

.

.

.

.

-

..

.

.

.

.

BEFORE; Check if characteristic is a problem BEFORE modification.

AVM: Note 'OK" if no longer problem; "CP" if a'continuing problem; and

"Wm if the characteristic is a new problem.

MoirICATIOW/mummicial (please be specific and concrete)

Type(*) of modification:



Teem judgment of student success after modification:

Criteria used?

COMMENTS:

35 FORm 13, Rev. 10-3-85; GS/MS

42

FORM 13, Part II, Page I-1. SOCIAL/EMOTIONALADJUSTMENT

Student Name:

Student I.D.#:


COMMENTS

.BEFORE AFTER

emotional cycle (good days andbad days) [ ] .

cries easily [ ] .

seems withdrawn [ ] .

nervousness [ 1 .

nailbiting, other nervous tics . [ ]

.

.

-.

is often angry [ ] .

inadequate self-concept . . . [ ] .

does not display emotion . . . [ ] .

often appears depressed . . . [ ] .

hypoactive [ ] .

hyperactive [ ] .

temperamental [ ] .

(Continued on-I-2)


AFTER: Note "OK" if no longer a problem; "CP" if al continuing problem; and-







Criteria used?

COMMENTS:

36

43

FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page 1-2. SOCIAL/EMOTIONALADJUSTMENT

Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

poor frustration tolerance .

does not adjust to changes.inroutinE ( 1 :

is often afraid ( ] .

is loud and boisterous . . . . [ ] ..

-frequently fights ( 1 .

destroys property

steals

lies

( ]

( 1

.

.

does not relate well to peers . ( ] .

is hostile to other students . . ( ] .

is argumentative [ ] .

is very social (has many friends) [ ] .

(Continued on 1-3)









Criteria used?

COMMENTS:

37

44FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page 1-3. sOCIAL/EMOTIONALADJUSTMENT

Student Name:

Student I.D.#:


.

COMMENTS

BEFORE AFTER

seems threatened by other students

does not participate in games orother sports activities .

is withdrawn/shy

Other, specify:

[

[

[

[

[

[

[

[

[

[

[

[

)

)

I

I

)

I

)

I

I

I

I

)

.

..-

.

.

-.

.

.

.

.

.

.

.

.






De,-,e(s) of modification:



Criteria used?

COMMENTS:

38 FORM 13, Rev. 10-3-85; GS/MS

45

FORM 13, Part II, Page J-1. SCHOOL BEHAVIOR Student Name:

Student I.D.N:


.

COMMENTS

BEFORE AFTER

does not participate in classactivities [ ] .

does not "own" actions, blamesothers for his actions .

makes "excuses" [ ]

..

.

makes inappropriate noises . [

is impulsive

has difficulty workingindependently

[

[

]

]

.

.

completes little work . . . . [ ] .

is inattentive [ ] .

is easily distracted . . . . [ ] .

often daydreams [ ] .

has vacant expression . . . . [ ] .

(Continued on J-2)






Date(s) of - lification:

Provider(s) modification:


Criteria used?

COMMENTS:

39

46

FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part It,, Page J-2. SCHOOL BEHAVIOR Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

cheats on tests [ ) .

is defiant [ ]...

talks without permission . .

plays with objects while workingor listening

[

[

)

)

.

. -

often out of seat [ ) .

cannot/will not work with others

does not follow rules in class oron playground/school property

[

[

)

]

.

.

is in constant motion . . . . [ ] .

is a passive resister . . . . [ ) .

has excessive absences . . . . [ ) .

is excessively tardy . . . . [ ) .

is hostile toward adults . . . [ ) .

(Continued on J-3) -









Criteria used?

COMMENTS:

40 FORM 13, Rev. 10-3-85; GS/MS

Ff.

FORM 13, Part II, Page J-3. SCHOOL BEHAVIOR Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

encourgaes peers to disrupt class/other activities

will not follow direction/guidance

poor attitude towads adultauthority

Other, specify:

(

(

(

(

(

[

(

(

[

(

(

1

1

1

1

1

)

1

1

1

1

1

.

.

.

.

.

.

.

.

'

-

.




MODIFTCATIONS/INTF vENTIONS: (please be specific and concrete)

Type(s) of mJ, ILILation:




Criteria used?

COMMENTS:

41 FORM 13, Rev. 10-3-85; GS/MS

48

FoRm 13, Part II, Page K. MOTOR COORDINATION Student Name:

Student I.D.#:


-

COMMENTS

BEFORE AFTER

fine coordination:

handwriting [ ) .

cutting [ )

pasting [ ) .

printing

drawing

[

[

) .

-

difficulty in making designs .

gross coordination:

[ ) ..

walking [ ) .

running [ ) .

jumping [ ) .

poor balance . . . . . . [ )'

poor eye hand coordination . . [ )'

Other, specify: [ )'









Criteria used?

COMMENTS:

42

49FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page L. PRESCHOOL DEVELOPMENT.00

Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

self-feeding [ ] .

uses spoon [ ] .

uses fork [ ].

.

.

uses knife [ ] .

-

self-dressing [ ] .

ties own shoes [ ] .

self-toileting [ ] .

washes self [ ] .


[ ] .

[ ] .

[ ] .

[ ] .









Criteria used?

COMMENTS:

43 FORM 13, Rev. 10-3-85; GS/MS

50

FORM 13, Part II, Page M-1. PERCEPTUAL DYSFUNCTIONS Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

reversals [ )

distortions [ )

visual problems:

decoding . . . . [ )

discrimination [ )

constancy [ )

figure-ground confusion [ )

auditory problems:

discrimination [ )

closure C )

sound blending [ )

memory problems:

visual input [

(Continued on M-2)


AFTER: Note "OK" if no longer a problem: "Cr" if a continuing problem; and







Criteria used?

COMMENTS:

44 FORM 13, Rev. 10-3-85; GS/MS

51

FORM 13, Part II, Page M-2. PERCEPTUAL DYSFUNCTIONS Student Name:

Student I.D.#:


.

COMMENTS

BEFORE AFTER

memory problems, cont.

oral input

retrieval/output:

oral

written

kinesthetic

Other, specify:

[ )

[ )

[ )

[ )

[ )

[ )

[ )

[ )

[ )

[ 1

[ )

t

.

. -...

..

.

.

.

.

.

.

.

'









Criteria used?

COMMENTS:

45

52FORM 13, Rev. 10-3-85; GS/MS

FORM 13, Part II, Page N-1. GENERAL HEALTH Student Name:

Student I.D.#:


COMMENTS

BEFORE AFTER

excessive physical symptoms(pains) [ ]

low vitality [ ]

frequent illness [ ]

headaches: frequent or severe . [ ] ..

--

dizzy spells ( ] ...

visual problems [ ] .

wears glasses [ ] .

auditory problems

wears hearing aid

takes a regular medication .

[ 1

[ ]

.

.

uses illicit drugs [ ]

freqUentibathroom.7trips [ ] -

(Continued on N72)

BEFORE: Check if a characteristic is a problem BEFORE modification.r








Criteria used?

COMMENTS:

46 FORM 13, Rev. 10-3-85; GS/MS

536!:'

FORM 13, Part II, Page N-2. GENERAL HEALTH Student Name:

Student I.D.#:


.

COMMENTS

BEFORE AFTER

drooling ( ] .

continual or severe drainage of:.

eyes ( ]

.

ears ( ] ..

-nose ( ] .

fondles self excessively (this has

been reported as a possibleearly clue to child molestation,sexual abuse) ( ]

-

.

Other,-specify: ( ] .

( ] .

( ] .

( ] .

( ] .

,









Criteria used?

COMMENTS:

47 FORM 13, Rev. 10-3-85; GS/MS

54

OM 14, 4440 44, 448044 440***,0401$49/0 440404,20/0 ~OW

NOM ANIMOMMOSIsti

440.0444 001N0140000601,.004 4140

0410,4411404,411.1 44 1144,4441ft 4111.*A4 +ISO* 41

49101* 4.110444,044.41 O4401114,04 0414,404.4,

oar.

414011400

1

I

4 1

11 1

11

1 1

;

4

101 41044 *ow.

1444411414 4,40.11/

a

a

a

a

WOW Om* VI orestePoso++404 110 Os 44a. 400041 444stier44

NOW 0044 .11Vo +4 4* 4044.44 04141444 *er 1141 41astal prebies *MI0100 44 401, 41110**0100 4 441 IA Ow poluMes

koloss weest 44 aid ammestitI

0144110404 40 40,4444,44",

4144weiti4

04411/000ww et 4410+44441444....

440 ellumeso 40 +4444 414rowato 4o1 eot aillatoirettoki

0.44140*4 VOW

41011011.11111" pg. Kht01.11.1111. 7,11...01.3111a,a101111011111"

MN IS, Om. 110-).414 00/110Of g5

PORN 13, Part Ill, Team Referral for Student NameServices/Assessment

Instructions.

Student I.D.#

Complete mix for those students whom the team refers to other school or

community ervice or to aesment. Check all that apply.

This part of the Individual Student Record has four response options for

each item in listing of possible service providers. In some cases all options

may be neceary to describe the service/assessment levels for a student. In

some cae one, two, or three, or none of the options apply to a particular

student. Below is an xample of a student who was referred, feviewed and found

ligible for 'medical ervices but who had not begun therapy for a continuing

health problem at the end of the fall semester 1985-85 data collection period:

(a) public health

Referred Reviewed/ Eligible ServedAssessed

(x] [x] (x] ( ]

If, alternatively, the student had been referred and assessed and was ineligible

for services only the first two options would have been checked.


1. Other school programs and community services:

(a) public health [ ( ] ( ] (

(b) mental health ( el [ ] ( ] (

(c) rehabilitation [ ( ] ( ] (

(d) vocational/career education [ ( ] ( ] ( ]

(e) English as a Second Language (bilingual) ( ] ( ] ( ] (

(f) GATE (Gifted and Talented Education) ( ] [ ] ( ] (

(9) CE (Chapter 1/97E (State Onnvensatory Siucatial))

(h) employment/job service ( ]

(i) service clubs (example: Lions) ( ]

[

(

(

(j) social services, welfare,

(k) child protective services

family services (

[

]

]

(

(

]

]

(

(

]

]

(

(

FORm 13, Rev. 10-10-85; GS/MS

FORM 13, Part III, cont. Student Name

Student I.D.#1. Other school programs and community services, cont.


(1) Head Start [ ] [ ] [ ] [ ]

(m) truancy control officer [ ] [ ] [ ] [ ]

(n) school district attendance and reviewboard (SARB) [ ] [ ] [ ] [ ]

(o) remedial math

(p) remedial reading

(4) school office (principal)

(r) counselor

(s) school nurse for medical evaluation,followup, home visits

[ ]

[ ]

[

[

]

]

[

[

]

]

[ ]

[ ]

[ ] [ ].. [ ] [ ]

[ ] [ ] [ ] [ ]

[ ] [ ] [ ] [ ]

(t) psychologists [ ] I ] [ ] [ ]

(u) general education consultant

(v) School Improvement Program (SIP)

(w) assessment for possible special

[ ] [ ] I ] [ ]

[ ] [ ] I ] [ ]

education services [ ] [ ] [ ] [ ]

(x) other, specify: [ ] [ ] [ ] [ ]

COMMENTS:

50

57

FORM 13, Rev. 10-10-85; GS/MS

Form 13,PartIV, Student Status at the Endof the Data Collection Period(December 13, 1985)

Instructions.

Student Name

Student. I.D.#

Complete this part of the Individual Student Record for all students in

your school sample. Check all that apply.

(a) original modifications still in progress

(b) modifications have been changed, new modificationsare in progress

(c) student succeeding with modifications, team isstill involved

(d) student successful with modifications, team isno longer involved (case closed)

(e) student has been referred for other school orcommunity services

(f) other, specify

COMMENTS:

51

58

FORM 13, Rev. 10-10-85; GS/MS

FORM 13, Part V, Student Enrollment at Endof Data Collection Period(December 13, 1985)

Instructions.

Check all that apply and specify where required.

Student Name

Student I.D.#

(a) regular education (specify) [

(b) categorical programs other than special education (specify) [ ]

(c) school/district developed programs (specify) [ ]

(d) special education programs (specify types of instructional programand exceptional need classification, for example: resource specialistprogram (RSP), speech therapy (DIS) and speech impaired)

(e) student has moved out of school attendance area[ ]

(f) student has dropped out of school [ ]

(g) student has transferred to another school [ ]

(h) other (graduation, illness, death, specify) [

COMMENTS:

52

59

FORM 13, Rev. 10-10-85; GS/MS

Coop Agreement Nn.G008403505

PARTIAL LISTING OF MODIFICATIONS

A. Environment

study carrelschange seating, preferentialseating

reduce distractions where possiblechange to another classchange groupscreate more physical space forlearnerconsider physical health problemcross-age, cross-grade, peer or

adult tutorsspecial study areause small groupsindividualized groupschange: teacher, grade, schoolchange of scheduleadjustment of length of dayreduce length of dayuse activity breakssystematic exclusion:-student works in conf. areagoes to class only when willing

to follow directionsuse "timeout" (remove student from

classroom)seat student next to teacher's desk

use detentionmove student- away from friends-close to front of class-close to center of instruction- to lighter side of room

-to dark side of room- near solid "security" object

after school

B. Materials

use different materials:- tapes

-manipulatives-task cards- slates

-"math their way"-work job blocks-filmstrips-overhead projectors-records

use typewriteruse diagnostic materialsuse district continuums

53

B. Materials (continued)

use computerremedial reading, math programsChapter I/School ImprovementProgram/Miller-Unruh servicesSan Diego Quick Assessment & ReadingContinuumcomputer assisted instructionuse timer to direct & stimulateattention -

directio7,:: or letter/number modelson desk for easy reference &self-correction

C. Assignments

simplifyshortenindividual contractsuse buddy system/partnersuse of notebooks for assignmentuse copying for visual/motorreinforcement-alternative assignment structure-extend time to completeassignments

use boldface typeuse alternative assignments structure(i.e.,offgr a choice of threemethods of reportinguse specialized assignments to bedone at home with assistance oftheir parentsSSR & SSW to generate fluency inreading/writing-SSRiesustained silent reading-SSW-sustained silent writing

assign specific tasks that mightbuild self-esteem use highinterest/low level materialsbreakdown tasks into small stepsgive student permission to "contract"for reduced assignment

form small work groups where allstudents are responsible for makingsure that each member successfullycompletes assignments

restructure priorities/assignments

Rev. 10-15-85; AH/GS/MS

Coop Agreei;sca AO.

6008403505

D. Teaching Techniques

agreement on learner's part toaccept designated responsi-bilitiesclassroom contractshave learner keep study bookif learner is told somethingit is done (i.e., compliancewith directions)

have a joint teacher/pupil signalthat the student gives whenhe doesn't understand materials,directions, etc., or needs morehelp

teach child strategies on "how toremember"

team the student with a higherfunctioning student as a rolemedel

have student close his/her eyes &try to visualize the information,seeing things in their minds

determine time of day student feelsand works best

vary voice volumne as required,vary pace (speak slowly)

use eye contactuse hand on shoulder contactreduce situational amount/degreeof work when appropriate

teacher circulates through roomrepeat instruction-same waylist assignments and/orinstructions on board

use behavior modificationuse visual aids in givinginstructions (overhead/board)

don't grade during the learningphase but do analyze and feedback to learneruse language master"show me" cards or other wholeclass participation

use stopwatch/timer to motivatechildern to master combinations,etc.build concepts by dramatization,movement, concrete materialsan agreement to "back-off" from thestudent to see if he or sheresponds to a type of "benignneglect"

5 4

61

reinforce correct responses promptlyuse praisereword for starting, continuing orcompleting tasks

clarify rulesprovide routine schedulelist & use student's intereststeach to student's strength areasuse modifications on whole class(rather than single-out student)

compare student to him/herself not

to othersgrade student on progress from pointA to point BRe-teaching (defined as presentinginstructions with a differentmodality, technique or material)have student rehearse expectationsduring the day

grade on quality of workwith administration approval allowstudent to take course pass/failsimplify communication, adapt styleto learnerrepeat directions slowly and havestudent repeat themsimplify oral directions to a maximumof three sequential actionsspend extra time reviewing whathappened yesterday, what willhappen today, and what will happen

tomorrowwalk through or rehearse newclassroom activities, routines, orhabitsestablish simplified, consistentroutines & provide assistance/supervision during transition fromone activity to another

use visual exercisesvary instructional materials/methodsemphasize auditory materials & methodssuch as rhymes, songs, records, tapes,etc.

Rev. 10-15-85; AH/GS/MS

E. Learning Channel

for auditory sequencing problems:-limit number of oral instruction-teach note taking skills-use lessons on overhead/taperecorder

auditoryvisualkinestheticreview kindergraten inventory ofdevelopmentgive the Learning Methods Testand/or Learning Rate Test (fromreading center)

neurological impress systemdetermine strongest sensorymodality & structure assignmentsaround it.

F. Miscellaneous

retention in gradeadjustment of gradesocial promotionsmake documentation ofinterventions/modificationshistory available to other staff,

special education personnelkeep work samplesreview cumulative folderdevelop special classes for studyskills, homework (and otherneeds that arise for studentsunable to fit into the "specialeducation" mold)

G. Parent Contact

parent/teacher conferencesparent/teacher/student conferences

parent/teacher/student/principal/assistant principal/counselorconferences

classroom intervention throughphone calls to parent

parent as volunteer classroom aideenlist parent in special homeworkassignments

daily/bi-weekly/weekly reports to

parents containing progress,performance, effort orcitizenship information

Coop Agreement No.G0084C3505

G. Parent Contact (continued)

develop home-school-contracts formonitoring, disciplining,enctivraging or shaping behavior ofstudent effectively andconsistentlybe explicit, frank & tactfulencourage parents to express theirfeelings about what's happeningand/or to give additionalbackground information (diet,sleep habits, behavioral history,etc.)use active listeningoffer direction & specific assistancerequire parent to assume responsi-bility for some specific activity,do not hesitate to use suchstatements as: %I need you to...getback to me by Friday...", "It isabsolutely necessary to..."put problem into broader perspective,e.g., "If we allow this tocontinue, down the road, Susie

be generous with "I care" messages &statements about what the childdoes do that is right & appropriatein conterences with parent & pupil:-state problem in terms of specificbe' wior, instead of "you are a bad

or "he/she" is a "bad kid" typemessagesin conferences, con't.-use specific & concise statements ofwhere "we are" & where "we want" togo, should"be positive, a way ofsharing, discussion of differentways to "get there"- be frank, but nonpunitive aboutpossible negative consequences ifbehavior continues

- setup timeline in near future toreview effects of plan in teacher/parent/principal conferences:

- focus on relative severity ofproblem, review effects ofalternatives used already

-encourage parent to express feelingsabout situation and/or to giveadditional background information-plan strategies & define solutions-be specific about what teacher,

principal, 6 parent should/will do

55 Rev. 10-15-85; AH/GS/MS

62

H. Outside Resource Intervention

referrals to other programs,offices & agencies: -Head Start- public health

-mental health- far northern-truancy control officer- school district attendancereview board

- Bilingual Education-ESL- remedial math program/specialist- remedial reading program/specialist

- refer for special educationassessment

- refer to office

-refer to counselor-refer to nurse for medicalevaluation, followup, homevisits- refer to psychologist- refer to general educationconsultant

-refer to speech and languagespecialist

-refer to School LmprovementProgram

-refer to Title Irefer to other agencies as student

eligible/resources areavailable

consult with other staff onappropriate and/or availableresources for referral

establish a school-level guidanceor solution committee

refer to community specialservices family counseling

I. Behavior Shaping

1) Set aside five minutes at sametime everyday to allow andencourage student to expressfeelings and attitudes abouthimself and school. Be asnonjudgemental, open ended, andwarm as possible. Then brieflyreview progress and make a fewdirective statements.

ttiL

56

Coop Agreement ka.G0084C3505

I. Behavior Shaping (continued)

2) Perform thorough task-analysis ofproblem behavior; sequenceall components and shape throughfrequent feedback andreinforcement.

3) Teacher and student establish asignal or cue to help monitor/control the problem behavior.4) Work with aide: train aide inshaping procedures and learningtheory as much as possible. Afterteacher given instructions anddemonstration, have aide providepositive, guided practice beforeallowing student to start workindependently.5) Use cross-age tutor, peer tutor,or peer counselor to model specifictypes of behavior.

6) Use a "classroom contingencymanagement program, a) includingsystematic monitoring of some kind.Teacher monitored or childmonitored, must be quiet and easy todo; b) benefits include moreimmediate and predictable feedback,makes it easier to be accountable/responsible for oneself, makes workmore manageable, less confusing,visual representations helpmotivate; c) perform a thoroughbehavioral analysis, identifyantecedent behavior consequencesequences, manipulate/experimentwith antecedents and consequences;d) collecedata to share with otherpersonnel, administrators, parents(may be frequency, duration orinterval data).

enlist student in active problemsolving through elicitation ofinformation pertaining to goals,interests:-areas in which student feels he/shedoes really well

-areas in which student would likemore help

-student goals or ambitious for therest of the year, for next year,after finishing school.

Rev. 10-15-85; AH/GS/MS

6 3

I. Behavior Shaping (continued)

-student goals for a job/careerhe/she would like after finishingschool

-ways student learns best-school activities enjoyed most-community activities enjoyed most-home activities enjoyed mostinvolve student in extra curricularactivities/other special interestgroups

pursue before or after schoolcontact time with student

encourage student to expressfeelings about situations, useactive listening"

state problem in terms of specificbehavior,instead of "you are a badkid" type messages"reiterate limits, guideltnes andconsequences in a calm manner

discuss ways of helping studentstay within guidelinesrequire student to choose and beaccountable for a plan of actionprovide student with special timesto discuss problems, feelings,accomplishments

57

Rev. 10-15-85; AH/GS/MS

64

Coop Agreement No.G0084C3505

Ooop Agreeinent No.G0084C3505

Draft Form 14, Compilation of Surveys of Participants in Student Study Teams,

Form 10, Fall Semester, 1985-86.

TO: Margaret Scheffelin, Pioject DirectorProgram Evaluation and Research DivisionDepartment of Education721 Capitol MallSacramento, CA 95814

FROM:Name of SELPA Date

( )

SELPA Representative Phone No.

SUBJECT: COMPILATION OF SURVEY FORM lOs FROM PARTICIPATING SCHOOLS

Participant survey forms (Form 10) were distributed and returned as shownin the chart below. A total of (number) completed survey forms areattached.

Display of Participation in Survey

Number of Forms Number of Forms

Participating Distributed at Completed and

Schools the School Returned

1.

2.

3.

4.

TOTALS

Coop Agreement No.60084C3505

Draft Form 15, Compilation of Logs of Student Study Team Process Decisions,


TO: Margaret Scheffelin, Project DirectorProgram Evaluation and Research DivisionDepartment of Education721 Capitol MallSacramento, CA 95814

FROM:Name of SELPA

SELPA Representative

Date

APhone No.

SUBJECT: COMPILATION OF LOG FORM 11 FROM PARTICIPATING SCHOOLS

Log forms (Form 11) were distributed and returned as shown in the chartbelow. A total of (number) completed log forms are attached. All

student names have been replaced with student project identification numbers.

Display of Participation in Survey

Number of Student Number of Completed

Participating Study Teams Keeping Logs Returned to

Schools a Log at the School the SELPA

1.

2.

3.

4.

TOTALS

Draft Form 17, Compilation of Individual Student Records


TO: Margaret Scheffelin, Project DirectorProgram Evaluation and Research DivisionDepartment of Education721 Capitol MallSacramento, CA 95814

FROM:Name of SELPA

SELPA Representative

-Coop Agreement No:G0084C3505

Date

Phone No.

SUBJECT: COMPILATION OF STUDENT RECORD FORM 13 FROM PARTICIPATING SCHOOLS

on.Student record forms (Form 13) were distributed and returned as shown in the

chart below. A total of (number) completed student record forms areattached. All student names have been replaced with student project identificationnumbers.

ParticipatingSchools

1.

2.

3.

4.

TOTALS

Display of Participation in Student Records

No. of Students No. of Students No. of CompletedReferred to SST For whom a Student RecordsIn Record Period Record was Kepe. Returned to SELPA

60

no. 2. print. - eric · frey stockdale, andrew hickman, kay slavin smith, and roxanne mogen staff...

Documents