Adverse Worksheets

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					              CRITERION 1                                                     CRITERION 2                                             CRITERION 3
 DISABILITY DETERMINATION                                                   ADVERSE EFFECT                                     NEED FOR SPECIALIZED
                                                    Oral Expectation, Listening Comprehension, Writing Expectation,                INSTRUCTION
                                                     Basic Reading Skills, Reading Comprehension, Math Calculation,
                                                                     Math Reasoning, Motor Skills
         Is there a disability?                               Is there an Adverse Effect in the basic skills?                  Is there a need for special
     o    Give rationale for                              o   If the student is determined to have a disability, on            o Report the skill deficits
          suspected disability                                which basic skill area is an adverse effect experienced?            discovered the adverse
     o    Describe learning profile                       o   If student is experiencing education difficulty in a                effect protocol
                                                              basic skill area (though not found to have a disability)
                                                              what information does the ESS need to
                                                              support/accommodate the student?
     o    What measures will you use                What measures will you use to answer the adverse effect question?          o   Identify and develop the
          to answer the disability                        o   Look at the 'disability' measures to see if any of that              appropriate instructional
          question?                                           information can be applied to adverse effect criteria                strategies for this student
     o    Look at disability                              o   Review measurement outcomes. Decide if they meet                     to progress in the general
          categories in the                                   the criteria for an adverse effect                                   education curriculum
          regulations                                     o   EPT determines if student is below age or grade norms;
     o    Decide which tests and                              in the 15th percentile or below; or a -1.0 standard
          measures you will use                               deviation below the mean; or equivalent. Choose three
     o    Review measurement                                  out of five different measures gathered over a six-
          outcomes                                            month period of time.
                                                              - standard or percentile scores on an individually-
                                                              administered nationally normed achievement test
                                                              - grades
                                                              - curriculum-based measures
                                                              - normed referenced assessments
                                                              - student work, language samples, portfolios
  Answer the Disability Question                                  Answer the Adverse Effect Question                       Answer the Need for Specialized
                                                                                                                                Instruction Question
                Answer:                                                          Answer:                                                   Answer:
     If YES, proceed to criterion 2                        If YES for criterion 1 and 2 proceed to criterion 3.            If YES for criterion 1,2,and 3 then the
    If NO, proceed to criterion 2 to                If YES for criterion 1 and NO for criterion 2, refer to the building        student is eligible for special
            inform the ESS                               administrator for 504 consideration (section 2362.2.6)            education. If YES for criterion 1 and 2
                                                                                                                            and NO for criterion 3 refer to bldg
                                                                                                                            administrator for 504 consideration

VT Dept. of Education Family and Education Support Team
                                                                 ADVERSE EFFECT WORKSHEET

Directions: In the first row of boxes, list three to five measures that may indicate an adverse effect on educational performance, along with relevant
scores or results. In the second row of boxes, check if the scores or results for each measure indicate if the student is performing above or below the
 15th percentile or 1 standard deviation or equivalent. If three or more boxes are checked as 'below' then an adverse effect has been demonstrated.

Basic Skill Area: ________________________________________________________

                            Measure 1                     Measure 2               Measure 3                Measure 4                 Measure 5
                            Measure: ___________          Measure: ___________    Measure: ___________     Measure: ___________      Measure: ___________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            Score/Results: ______         Score/Results: ______   Score/Results: ______    Score/Results: ______     Score/Results: ______
                            __________________            __________________      __________________       __________________        __________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
                            ___________________           ___________________     ___________________      ___________________       ___________________
15th Percentil or 1
Deviation or                            Above                    Above                   Above                     Above                    Above

                                        Below                    Below                    Below                    Below                    Below

                                    3 or more boxes checked below 15th percentile/1 standard deviation/equivalent = adverse effect

VT Dept. of Education Family and Education Support Team
                                                      Adverse Effect Measures and Suggested Criteria for Comparison

                     MEASURE                                                    EXAMPLES                               CRITERION FOR COMPARISON
         Individually-administered nationally-                      Woodcock-Johnson Psycho-Educational              Scores at or below 15th percentile or 1
          normed achievement test                                     Battery Tests of Achievement                      standard deviation below the mean
                                                                     Weschler Individual Achievement Test              (typically a standard score of 85 or
                                                                     Test of Reading Comprehension                     below)
                                                                     Test of Mathematical Abilities                  Age and grade norms
                                                                     Gray Oral Reading Test                          Use grade norms if the student has been
                                                                                                                        retained, otherwise age or grade norms
                                                                                                                      Scores should reflect performance over
                                                                                                                        a period of at least 6 months

                                                                     Stanford Achievement Test
         Group administered norm referenced                         Metropolitan Achievement Test                     Same as above
          assessments                                                Terra Novas
                                                                     Comprehensive Test of Basic Skills
         Grades                                                     Standards-based Report Cards               Generally, in comparison to the Vermont
                                                                     Teacher-determined grading system          Framework of Standards and Learning
                                                                     IEP-based individualized grading           Opportunities
                                                                      system                                          In heterogeneous classrooms, the
                                                                                                                         student's grade is among the lowest 15%
                                                                                                                         of grade level classmates
                                                                                                                      Otherwise, the students grades represent
                                                                                                                         the lowest 15% in comparison to the
                                                                                                                         expected level of performance for
                                                                                                                         average grade level peers.
         Curriculum-based measures:                                 Charts, graphs, or checklists indicating   Comparison to performance of average grade
          Teacher made tests                                          student performance over time              level peers on same measure
                                                                     Classroom assessment                            Performance indicates that the student is
                                                                     Running Records                                    among the lowest 15%
                                                                     Fluency measures
                                                                     Math Mad Minutes
         Individually-administered                                  Qualitive Reading Inventory - 3            Test results indicate that the student lacks skills
         Criterion-referenced tests                                 Brigance Inventories                       or knowledge typical of an average student at
                                                                     Diagnostic Test of Arithmetic Strategies   the student's grade level
                                                                     Durrell Analysis of Reading Difficulty

VT Dept. of Education Family and Education Support Team
         Group-administered Criterion-                      Developmental Reading Assessment   Comparison to performance of average grade
          Referenced Tests                                    (DRA)                              level peers on same measure in relation to
                                                             New Standards Referenced Exam      Vermont Framework of Standards and Learning
                                                              (NSRE)                             Opportunities
                                                             Vermont's Mathematics Portfolio         Performance indicates that the student is
                                                             Vermont's Writing Portfolio                among the lowest 15%

         Other-Individualized measures of                   Student Work                       Comparison to performance of average grade
          adverse effect                                     Language Samples                   level peers on same measure
                                                             Classroom Portfolios                    Performance indicates that the student is
                                                                                                         among the lowest 15%

VT Dept. of Education Family and Education Support Team

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