The Road to Good Referrals Ellen Kester, PhD., CCC-SLP Scott Prath, M.A. CCC-SLP Bilingual TETN Series 2011-12 Region 13 Texas Educational Service Center January 27th, 2011
Learner Objectives • Participants will: ▫ View RTI from a broad perspective ▫ Introduce a macro approach to looking at the results of RTI and further driving accurate assessment ▫ Evaluate the speech pathologist’s role in the referral process ▫ Show how to use the referral process to reduce caseload work, better identify students, and reduce special education spending.
Outline The greatest issues facing educators in the schools • Studying our current situation ▫ Identifying the greatest issues for : Speech Pathologists Administrators Teachers Speech Department Leads • Case Study of a Texas School District ▫ Follow 23 students through the referral process during Fall 2011 • Share Resources to Improve the Referral Process
What is our goal today?• Improving services in the schools ▫ Reducing our caseloads ▫ Improving the referrals that we receive from teachers ▫ Reducing the number of DNQs from evaluations ▫ Improve our relationships and success with other professionals
What are the greatest difficulties weface? Speech Language Pathologists: • My caseload is too large • I have too many campuses • I have too much paperwork • I don’t have time to complete the evaluations given to me • Can you think of any others?
What are the greatest difficulties weface? Principals and Assistant Principals: • I can’t get this student into special education • There are too many annual meetings • I can’t believe this child didn’t qualify • The evaluation process is too long • Any others that you have heard?
What are the greatest difficulties weface? Speech Department Leads: • My staff is stretched too thin • There are not enough bilingual SLPs • There is no money in the budget • We are over-identifying certain minority groups • Any others that you have heard?
What are the greatest difficulties weface? Teachers: • I can’t understand my student • I want to help in the classroom but I don’t know what to do • I have 19 other students • The referral process: ▫ Is complicated ▫ Takes too much time ▫ Involves a lot of paperwork ▫ Doesn’t result in students getting help.
1. How do we solve these problemsand appease everyone in the process? Conflicting interests and needs Speech Pathologists Administration Speech and School Department Staff
2. How are we currently trying tosolve these problems? Response to Intervention • Referral Team (RT) • Student Success Team (SST) • All Children will Learn (ACWL) • Impact Process • Student Progress Monitoring • Database Decision Making • …
What is RTI? A regular education initiative to deal with the problems of the discrepancy model (discrepancy between IQ and achievement). A way to determine how students respond to intervention (in the classroom with the teacher) A screening to identify children with learning disabilities. A way of determining whether children who receive “intensive” intervention in the classroom respond. All of these lead to reduced disproportionality.
When was RTI created? • RTI is an approach to LD identification that was first proposed by a 1982 National Research Council report.* ▫ Google: “Response to Intervention + Year (1982-2009)” 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 1982 1983 1985 1986 1988 1989 1990 1991 1992 1993 1994 1995 20… 1996 1997 20… 1998 20… 1999 Hits in Millions 20… 2001 20…*Heller, Holtzman, & Messick, 1982 20… 2005 2007
Why was RTI implemented? • “RTI was first proposed by Gresham (2002 ) as a viable alternative to the discrepancy model.” • Provide children from culturally and linguistically diverse populations with the assistance they need to succeed. • To better identify children with reading disabilities. • To better identify children with learning disabilities. • Do SLPs use a discrepancy model? • How does RTI serve SLPs in it’s intended mission of correctly identifying populations? *Fasko, 2006
3. Is RTI Successful? • Are we correctly identifying students? • Are we still over- or under-identifying? • Have we improved the types of referrals that we receive from general education? • Has our involvement in the referral process gone down?
Analysis of a District’s Population % of Special Education Students 30 25 20 15 8.0% 10 5 860 Districts Over- Identifying 0
How successful are we?District Proportionality Study Results • Out of 1008 Districts in Texas, 860 are over- identifying • The referral process takes 4- 8 months on average • There is a high rate of DNQs each school year from testing • Teachers do not unanimously feel supported • The system is often abandoned by “fast-tracking” students or “work-arounds.”
4. Should RTI be abandoned? RTI seems to be successful or unsuccessful for the very same reason:The fact that it is largely undefined. Vice or Virtue?
Virtue RTI is hugely successful in situations in which good collaboration takes place. It can be adapted to current campus initiatives. It combines Special Education personnel, General Education personnel and resource professionals.
Vice RTI allows people on the same team to perceive their role differently. It does not provide consistency or a framework. It encourages immense bureaucracy and paperwork in order to cover all our bases.
Supporting ourColleagues Effectively –A Case StudySimultaneously:Supporting TeachersResponding to AdministrationsMonitoring Student ProgressImproving ReferralsReducing our workload
Case Study of a District• Timeframe: Fall Semester, 2011• Population: ▫ Kindergarten and first grade students on two campuses ▫ Dual Language Program• Number of Students: 23• Teacher Concerns: ▫ Speech ▫ Language ▫ Fluency ▫ Attention/Pragmatics
Our Question:Can we improve the referral process?• Measures ▫ Reduced # of referrals resulting in a full evaluation ▫ Reduced # of evaluations resulting in a DNQ ▫ Reduced SLP time spent on referrals and evaluations ▫ Teacher satisfaction ▫ Administrator satisfaction ▫ SLP satisfaction
RTI Problem Solving Method* is Who concerned ? Did our Gather Is there a plan work? Student problem? Information Evaluate Analyze student’s student’s success difficulties What shall Here are we do the steps. about it? Implement Develop the strategies strategies*Adapted from NASDSE, 2006
Gather Student Information Gather Student Information Evaluate Analyze Student 1 Student Success Difficulties 1. Name Implement Strategies Develop Strategies 2. Date of Birth 3. Grade 4. Teacher 5. Vision and Hearing 6. Parent Concern and History 7. Teacher Concern 1. I can’t understand my student 2. My student doesn’t speak enough, is confusing, or can’t understand me
Initial DataPart A - Everyone • Hearing Concern • Parent Concern • Teacher ConcernPart B – Which best describesyour student • I can’t understand the words that my student uses. • My student doesn’t speak enough, is confusing, or can’t understand me.
Speech and Language Concerns Gather Student Information Evaluate Analyze Student 1 Student Success Difficulties Implement Develop Strategies Strategies The Language Information generates data about each area of possible concern. Teachers read it from top to bottom SLPs read it from left to right
Speech and Language Concerns Gather Student Information Evaluate Analyze Student 1 Student Success Difficulties Implement Develop Strategies Strategies
GatherAnalyze Student Difficulties Student Information Evaluate Analyze Student 2 Student Success Difficulties 1. I can’t understand my student. Implement Strategies Develop Strategies 2. 27 common outcomes (not including multiple issues, 2nd language, or age).
GatherAnalyze Student Difficulties Student Information Evaluate Analyze Student 2 Student Success Difficulties 1. My student doesn’t speak enough, is Implement Strategies Develop Strategies confusing, or can’t understand me 2. 7 common outcomes across expressive and receptive domains
Why referrals might be Gather Student Information Evaluate Analyze Student 2 Studentdaunting to teachers Success Difficulties Implement Develop Strategies Strategies • There are 7 pieces of data from three sources • Multiple Causes ▫ There are 27 common speech outcomes ▫ There are 7 common language outcomes • There are 12 steps across 3 tiers • Referral Manuals can be 12-58 pages • Teachers on average receive less than 2 hours of training per year
GatherAre Teachers Referring the Student Information Evaluate Analyze Student 2 StudentRight Students? Success Difficulties Implement Develop Strategies Strategies Research on agreement between teachers and SLPs • Numerous studies have explored the rate of agreement between teachers and SLPs about who should receive speech services (Friberg, 2008). Diehl & Sinnet (1959) – 60% James & Cooper (1966) – 40% Clauson & Kopatic (1975) – 18% Davis and Harris (1992) – 81% Cartwright-Gard, Harmon & Bryne (2002) – 58% • On average, teachers- SLP agreement is 60%. • Research indicates that 40% of students who should be referred are not (Mosheim, 2009)
Are Teachers Referring Gather Student Information Evaluate Analyze Student 2 Studentthe Right Students? Success Difficulties Implement Develop Strategies Strategies Teacher confidence • Cartwright-Gard, Harmon & Bryne (2002) surveyed teachers and found: ▫ 75% of teachers reported low confidence in making referrals ▫ 80% of teachers indicated a desire for more training to improve their referrals • Many teachers report very low confidence when making referrals for bilingual children
Distribution of time over a Gather Student Information Evaluate Analyzestudent’s week Student 2 Student Success Difficulties Implement Develop Strategies Strategies 30 72% 25 20 15 10 12% 12% 5 3% 0 Teacher Specials lunch Speech and Langauge Therapy
GatherDevelop Strategies Student Information Evaluate Analyze Student 3 Student Success Difficulties 1. What problem is a child having? Implement Strategies Develop Strategies 2. Example: Answering questions
GatherImplement Strategies Student Information Evaluate Analyze Student 4 Student Success Difficulties 1. Example: Answering questions 2. Tell the student this story and ask him these Implement Strategies Develop Strategies questionsWho wanted togo to the ball?What didCinderellalose?When did shehave to leave?Where did theprince live?
GatherEvaluate Student Success Student Information Evaluate Analyze Student 5 Student Success Difficulties 1. Example: Answering questions Implement Strategies Develop Strategies 2. How did he do?Who wanted togo to the ball?What didCinderellalose?When did shehave to leave?Where did theprince live?