criterion 1: there is a severe ongoing primary …€¦ · web viewspeech-language pathologist...

Education Adjustment Program (EAP) EAP Verification Form – SLI (EAP 7 updated 2014)

Verification of Disability in the Education Adjustment Program Category of Speech Language Impairment

Education Adjustment Program – Verification of DisabilityCover Sheet & Checklist

Student: Click here to enter text. School: Click here to enter text. Year Level: Click here to enter text.

Disability Category: Speech Language Impairment

☐ Initial Verification (i.e. no previous verification)

☐ Review of an existing verification☐ Adding a new category to an existing verification: Adding ☐HI ☐PI ☐VI ☐SED☐ Removal from an existing category: Removing ☐ASD ☐HI ☐ID ☐PI ☐SLI ☐VI ☐SED☐ Changing from an existing category to a new category: Change from to SLI

☐ Transferring into the RI System from a Non-Catholic sector

Documentation Checklist: (All documents to be enclosed and ticked off by school to confirm inclusion in the submission.)

Copyright in this work is owned by the State of Queensland (Acting through the Department of Education, Training and Employment) and has been adapted by Religious Institute Colleges with consent.

P a g e | 1

Process School RI Verifier CommentsEAP Consent Form(EAP 1 updated 2013)EAP Verification FormSLI (EAP 7 updated 2014)PART A – Student DetailsPART B – Evidence Supporting VerificationCriterion 1 –Criterion 1.1 History spoken communicationCriterion 1.2 Language Assessment Scores Criterion 1.3 Performance spoken communication Criterion 1.4 Targeted interventionsCriterion 1.5 Psych educational Assessment PART B – Criterion 2Educational impact and adjustments

PART B – Profession Specific Quality Assurance Consulting Speech Pathologist to signConsulting Guidance Counsellor/ Psychologist to sign

PART B – Verification OutcomeSchool to complete Student DetailsVerifier to sign the outcomePART C – Principal Request/SignatureEAP Profile

Educational Planning Document (IEP, PLP, ISP) (or equivalent school planning doc.)

If Review – previous EAPConfirmation DocumentationRequired Documentation Attachments:Current Speech Pathologist Report and assessment resultsCurrent Guidance/Consulting Psychologist Report and – Psychoeducational assessment scoring pagesAudiological test resultsSchool Work SamplesAny additional reports/assessments



Members of the school team complete this form collaboratively, ensuring that relevant personnel have been involved in the data gathering and decisions relating to the impairment and activity limitations and participation restrictions for this student.

The verification form in each of the EAP categories consists of the following sections which must be completed:

PART A Student Details PART B Evidence Supporting Verification of Disability PART C Principal Request for Verification of Disability

Two (2) copies of this form and required attachments (outlined in Part B) to be submitted to:The RI EAP Verification Team at the RI Equity Network meeting

Part A: Student Details

Last Name Click here to enter text. Date of Birth Click here to enter text.

First Name Click here to enter text. Gender Click here to enter text.

School Click here to enter text. Year Level Click here to enter text.

School Address Click here to enter text. School Phone Click here to enter text.Contact person in school for this verification Position

Email Address Phone

Existing Categories:

☐Nil ☐ASD ☐HI ☐ID ☐PI ☐SLI ☐VI

This verification request is for:

☐ Initial Verification (i.e. no previous verifications)

☐ Review of an existing verification

☐ Adding a new category to an existing verification

☐ Changing EAP Category

☐ Removal from an existing category

☐ Transferring into RI College from a non-Catholic sector


P a g e | 2



Part B: Evidence Supporting Verification of Disability in the Education Adjustment Program Category of Speech Language Impairment

Required DocumentationThe following must be included:☐ Current signed report from Speech-Language Pathologist☐ Current signed report from Guidance Officer/Consulting Psychologist☐ Evidence of audiological test results☐ Analysis of speech language samples / school work samples as appropriate☐ Relevant additional reports/assessments

Speech-Language Pathologist Proposal (to be signed by the consulting Speech-Language Pathologist):

☐ The information gathered by the school team on this form and in the related attachments MEETS the DETE criteria for the EAP category of Speech-Language Impairment.

☐ The information gathered by the school team on this form and in the related attachments DOES NOT MEET the DETE criteria for the EAP category of Speech-Language Impairment.

Contact Details:Name of consulting Speech Language Pathologist: Click here to enter text.

Email: Click here to enter text. Phone: Click here to enter text.

Signature: Fax: Click here to enter text.

Name of consulting Psychologist / School Counsellor: Click here to enter text.Email: Click here to enter text.

Phone: Click here to enter text.Signature:

Fax: Click here to enter text.


P a g e | 3



Evidence Supporting Verification

Criterion 1: There is a severe ongoing primary spoken communication disorder.

Criterion 1.1 Evidence of an ongoing history of poor performance in spoken communication.Background information (provide details as relevant):

Information may include medical history, developmental history, relevant family history, language background, ESL/NESB factors, other factors etc.

Previous standardised assessment of spoken communication (provide results as relevant):

Assessment tool Date Administered Area of language Standard score Percentile rank

Range (e.g. 90% confidence nterval)

Comments on previous standardised assessment of spoken communication (include interpretations as relevant):

Previous non-standardised assessment details (provide details as relevant):

Criterion 1.2 Scores obtained from standardised, individually administered current assessment measures of spoken communication development are at least two standard deviations below the mean.


P a g e | 4



Current assessment (within 12 months of the verification request) (provide results as relevant):

Assessment tool Date administered Area of language Standard score Percentile rank

Range (e.g. 90% confidence interval)

☐ Results of standardised assessment are compromised by test conditions or other factors (comment below)☐ Results of standardised assessment do not reflect the student's abilities in spoken communication (comment below)☐ Standardised assessment is inappropriate for this student (comment below)☐ This summary includes interpretation of assessment administered by another Speech-Language Pathologist (comment below)☐ Analysis/interpretation of speech and/or language samples is provided to support standardised assessment results or to provide further information (comment below)

Interpretive comments (provide details as relevant): Consider test conditions, behaviour, concentration, attention, memory, fatigue, health, reluctance, auditory processing, etc. Mention anything unusual about the results (e.g. spread of subtest scores or why a score may not have been calculated). Explain results if standardised tests do not assess the areas of difficulty in spoken communication. Outline reasons why standardised tests may not be appropriate for the student.

Current non-standardised assessment details (provide details as relevant):

Criterion 1.3 Description of student’s performance in spoken communication domains. Criterion 1.4 Response to appropriately targeted intervention for identified spoken communication difficulties.

Language Comprehension (understanding others)


P a g e | 5



1.3) Description of student's day-to-day performance in spoken communication within the school environment.

1.4) Targeted interventions provided (including by whom, when and frequency) and outcomes achieved.

Speech Processing (difficulty in this area alone does not constitute SLI)

1.3) Description of student's day-to-day performance in spoken communication within the school environment


Language Production (expressing self)



Language Use (appropriate use of speaking for a range of purposes)



Speech Production (including intelligibility ratings)



Criterion 1.5 Evidence that the spoken communication disorder is distinguished from disorders of spoken communication that are attributable to:

• Cognitive functioning• Socio-cultural factors• Hearing Impairment

• Social-emotional factors• Intellectual Impairment• Physical Impairment


P a g e | 6



• Autism Spectrum Disorder • Vision Impairment

Previous cognitive and adaptive behaviour assessment(information gathered by School Counsellor/Consulting Psychologist):

Test nameDate

administered

Test administrator

(name and position)

Overall result Subscale scores

Range (95% confidence interval)

Current cognitive and adaptive behaviour assessment (information gathered by School Counsellor/Consulting Psychologist):

Test nameDate

administered

Test admiistrator (name and position)

Overall resut

Subscale scoresRange (95%

confidence interval)

☐ Results of standardised assessment are compromised by test conditions or other factors (comment below)☐ Results of standardised assessment do not reflect the student's abilities (comment below)☐ Standardised assessment is inappropriate for this student (comment below)

Comment on assessment as relevant:

Summary of cognitive ability and interpretation of results (to be completed by School Counsellor/Consulting Psychologist)

NB: Where standardised assessment is inappropriate, also comment on how the team has determined that the spoken communication disorder is not accounted for by cognitive ability.


P a g e | 7



Hearing (Information collected by the school team):

☐ Hearing has been tested and is within the normal range (note details below)

☐ There is a hearing loss (and there is a mismatch between the audiological profile and the profile of spoken communication difficulties expected for that type of hearing loss) (note details below)

☐ The student has a history of conductive hearning loss – otitis media (note details below)

Rationale for excluding hearing as the primary cause of the identified spoken communication disorder (e.g. dates of hearing test and results, otitis media and related treatments, hearing aid, audiologist reports, case history etc):

Social-emotional Factors:

Are there social-emotional factors that may impact on the student’s spoken communication or functioning at school?

☐ Yes (note details below)

☐ NoRationale for excluding social-emotional factors as the primary cause for the identified spoken communication disorder and student’s functioning at school.

Socio-cultural Factors:

Is the student from a culturally and/or linguistically diverse background, including students from indigenous backgrounds?

☐ Yes (note details below)

☐ NoCultural and linguistic background and considerations made in assessment and diagnosis of spoken communication disorder (e.g. home language, parents' skills in English, first language acquisition, age when exposed to English, language use survey, ESL support provided and progress/outcomes, and adjustments that have been made).

Proposal for Verification in the EAP Category of Speech Language Impairment(To be completed by the consulting Speech-Language Pathologist)

Statement of Professional Reasoning


P a g e | 8



Briefly outline the reasoning and decision-making in determining that:

☐ There is a severe ongoing primary spoken communication disorder.

OR

☐ The information no longer meets the departmental criteria for the EAP category of SLI.

Criterion 2: The student’s identified level of functioning results in activity limitations and participation restrictions at school requiring significant education adjustments. This section is to be completed through a collaborative process which MUST include input from the student’s teacher/s.


P a g e | 9



Evidence of the educational impact of the identified impairmentThe Prompts for SLI Criterion 2 Form can be used as a guide for the completion of this section

(http://education.qld.gov.au/students/disabilities/adjustment/verification/forms.html)CURRICULUMachieved curriculum knowledge, functioning and understanding of the

world teaching strategies resources assessment/reporting

Describe the student’s functioning (activity limitations and participation restrictions) related to the speech language impairment:Outline the associated significant education adjustments that are currently in place for this student:

COMMUNICATIONreceptive expressive pragmatics (language use) speech specialist staff supportDescribe the student’s functioning (activity limitations and participation restrictions) related to the speech language impairment:

Outline the associated significant education adjustments that are currently in place for this student:

SOCIAL PARTICIPATION/EMOTIONAL WELLBEINGsocial/interaction skills self-management strategies individualised plans use of social development resources specialist staff supportDescribe the student’s functioning (activity limitations and participation restrictions) related to the speech language impairment:


LEARNING ENVIRONMENT/ACCESSclassroom and non-classroom environment organisational skills sensory needs transition skills specialist staff supportDescribe the student’s functioning (activity limitations and participation restrictions) related to the speech language impairment:



P a g e | 10

http://education.qld.gov.au/students/disabilities/adjustment/verification/forms.html



HEALTH AND PERSONAL CARE, SAFETYhealth management risk management self-care skills specialised self-care procedure individualised plans specialist staff supportDescribe the student’s functioning (activity limitations and participation restrictions) related to the speech language impairment:


Evidence Supporting Verification of Disability in the Education Adjustment Program Category of Speech Language Impairment

Student Name: Click here to enter text. Date of Birth: Click here to enter text.School: Click here to enter text. Year Level: Click here to enter text.

Profession Specific Quality Assurance and Decision-Making (to be completed by the RI Verification Team)The gathering and interpretation of data and other information related to the DETE criteria for the EAP disability category of SLI requires specialist knowledge and professional decision making. This section of the verification form is used by the RI Verification team consisting of a speech-language pathologist and guidance counsellor/psychologist who act in the capacity of professional supervisors for ensuring quality and consistency in monitoring the data gathering, professional interpretation and reporting processes across RI Colleges.

☐ Appropriate data and information have been reported as evidence related to the departmental criteria for the EAP category of SLI.AND☐ Appropriate data gathering, assessment, interpretation and reporting processes have been used in collecting the data andinformation provided as evidence related to the departmental criteria for the EAP category of SLI.OR☐ Further data gathering/information is recommended before submitting the verification request to the EAP Verification Team (see notes below).

Eligibility☐ The process indicated in the Religious Institute Colleges protocols has been

followed and I confirm that this student meets DETE’s criteria for the category of Speech Language Impairment

Ineligibility☐ The process indicated in the Religious Institute Colleges protocols has been

followed and I confirm that this student does not meet DETE’s criteria for the category of Speech Language Impairment

Comment:

Recommendation for review of eligibility: Review required ☐ YES ☐ NO Date: Click here to enter text.


P a g e | 11



Criterion 1 ☐ YES ☐ NO Date: Click here to enter text.

Criterion 2 ☐ YES ☐ NO Date: Click here to enter text.

Name of RI Speech Language Pathologist: Name of RI School Counsellor / Psychologist:

Address: Address:

Telephone contact: Telephone contact:

Email contact: Email contact:Signed: Date: Signed: Date:

Criterion 1: There is a severe ongoing primary spoken communication disorder.

Criterion 1.1 Evidence of an ongoing history of poor performance in spoken communication

Needs in spoken communication have been identified early in the student’s history.

Needs in spoken communication have been ongoing in nature.

Ongoing history of poor performance in spoken communication has been substantiated by data collected over time.

For removal from the EAP category of SLI, considerations related to this aspect of the criteria are outlined below.

Comments

Criterion 1.2 - Scores obtained from standardised, individually administered current assessment measures of spoken communication development are at least two standard deviations below the mean.

Relevant factors that impact on assessment results have been considered and reported.

Current assessments (within the last 12 months) have been used to inform decisions, and the possible impact of development and intervention has been considered.

A range of assessment tools and data has been used to inform decisions (related to current assessment and assessment over time).


P a g e | 12



Current assessment results have been interpreted in the context of the student’s assessment history and relevant interpretations have been reported.

If standardised assessments are inappropriate, other appropriate assessments have taken place and relevant interpretations have been reported.

The area of impairment is clearly described and is demonstrated on a range of assessment tools (e.g. expressive language, speech, receptive/expressive etc.).

Scores in the area of impairment are at least 2 standard deviations below the mean on a range of assessment tools.

Scores are reported with relevant explanations and rationale by the SLP (e.g. unusual scores/scores not calculated etc.).

The assessment results are consistent with/supported by other student data/observations.

If the request for verification is in the area of speech only:

A motor speech impairment has been demonstrated i.e. evidence of features in all of the following:

phonological planning

oromotor and speech control phonetic programming

Scores on standardised speech and oromotor assessments are at least 2 standard deviations below the mean.

Speech intelligibility ratings are based on appropriate data/measurement.


Comments

Criterion 1.3 - Description of student’s performance in spoken communication domains

Descriptive analysis and interpretation of speech and/or language samples are provided.

The performance in spoken communication within the school environment is consistent with evidence provided from standardised and other assessments.

If the performance is not consistent, professional reasoning has been provided to explain any mismatch.



P a g e | 13



Comments

Criterion 1.4 - Response to appropriately targeted intervention for spoken communication difficulties

Interventions have been provided that focus on the specific areas of need in spoken communication.

Sufficient intervention (amount and intensity) has been provided to gain a picture of the student’s underlying capacity to learn in the identified areas of spoken communication.

Needs in spoken communication are likely to be ongoing in spite of appropriately focused interventions.


Comments

Criterion 1.5 - Evidence that the primary spoken communication disorder is distinguished from disorders of spoken communication that are attributable to: cognitive functioning, socio-cultural factors, Hearing Impairment, Autism Spectrum Disorder, Social Emotional Disorder, Intellectual Disability, Physical Impairment and Vision Impairment.

Psychoeducational Assessment and Reporting

The guidance officer/psychologist is accredited to administer the assessment tools used.

Assessment measures have taken into account the spoken communication disorder as appropriate.

Current assessment results have been used to inform decisions (i.e. the assessment has been administered within a time frame considered current by the guidance officer, taking into account assessment history, age and other factors).

All previous assessments have been considered, reported and used to inform the most recent assessment.

If standardised assessments are inappropriate, other appropriate assessments have taken place and relevant interpretations have been reported.

Cognitive Functioning

Measures of cognitive functioning on the most appropriate assessments are within the average range OR

Measures of cognitive functioning on the most appropriate assessments are below the average range

AND


P a g e | 14



Measures and description of language functioning are not commensurate with measures of cognitive functioning (i.e. there is at least 1 SD between them).


Comments

C riterion 1.5 continued

Hearing

There is no reported hearing loss or history of hearing loss.

The student has a hearing loss or a history of a hearing loss, and the school team has explained why this does not account for the spoken communication disorder.

Social-emotional Factors

There are no reported social/emotional factors that account for the spoken communication disorder.

There are social/emotional factors that may impact on the student’s spoken communication disorder. The team has explained why these factors do not account for the spoken communication disorder.

Socio-cultural Factors

There are no reported socio-cultural factors that account for the spoken communication disorder.

If the student is from a culturally and linguistically diverse background:

Appropriate procedures have been used in relation to psychoeducational assessment .

Appropriate procedures have been used in relation to spoken communication assessment.

The school team has provided clear evidence and explained why socio-cultural factors do not account for the spoken communication disorder.

Other impairments

The student is not identified in any other EAP disability category.

The student is identified in another EAP disability category and the school team has provided evidence and explained why this impairment does not account for the spoken communication disorder.


P a g e | 15




Comments

Criterion 2: The identified severe ongoing primary spoken communication disorder results in activity limitations and participation restrictions for the student at school requiring significant education adjustments.

There are activity limitations and participation restrictions related to learning, communicating and interacting socially.

The difficulties in learning, communicating and interacting socially are related to the spoken communication disorder and not other factors.

Significant education adjustments and interventions are in place.

The significant education adjustments are related to the identified spoken communication disorder and not other factors.

Outcomes/effectiveness of educational adjustments and interventions have been monitored and reported.


Comments


P a g e | 16



Part C: Principal Request for Verification of Disability in the Education Adjustment Program Category of Speech Language Impairment

Verification of disability in the EAP category of Speech Language Impairment according to DETE’s criteria is requested for the following student according to the details outlined in PART A and PART B of this report and the related attachments:

Student Name Click here to enter text. Click here to enter text.

School Click here to enter text. Date of Birth Click here to enter text.

Year Level Click here to enter text.

In making this request I have ensured that:

the student is enrolled and attending the school

discussions have been held with the parent and/or student regarding this verification and agreement to


P a g e | 17



proceed has been reached

agreement to proceed with verification in this category has been obtained from the parent

appropriate personnel have been involved in data gathering and reporting

processes are in place to support this student within the school

all documents for verification are complete

original EAP documentation is held in the student’s school file

copies of relevant documents will be sent to the EAP Verification Team

Principal Name:

Principal Signature: Date


P a g e | 18

criterion 1: there is a severe ongoing primary …€¦ · web viewspeech-language pathologist...

Documents