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Examining How Health Impacts Learning: Using Root Cause Analysis to Drive Instruction . Robert Frantum-Allen, MA Colorado Association of School Nurses March 2014. The Trouble with Handouts . http://rcause.wikispaces.com. Paper on Specially Designed Instruction and Root Cause Analysis - PowerPoint PPT Presentation
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Examining How Health Impacts Learning: Using Root Cause Analysis to
Drive Instruction Robert Frantum-Allen, MA
Colorado Association of School NursesMarch 2014
The Trouble with Handouts http://rcause.wikispaces.com
• Paper on Specially Designed Instruction and Root Cause Analysis
• Today’s Presentation• Sample Root Cause Analysis in Reading on 6
students • Blank Templates for Root Cause Analysis
Mystery!A sailor goes into a
restaurant. His hands are tanned except for where a watch and wedding ring once belonged. He orders albatross, eats one bite which reminds him of something. He goes outside and kills himself.
Mystery!
Bob and Carol and Ted and Alice all live in the same house. Bob and Carol go out to a movie, and when they return, Alice is lying dead on the floor in a puddle of water and glass. She has multiple lacerations all over her entire body. It is obvious that Ted killed her but Ted is not prosecuted or severely punished.
Outcomes 1. Developing an understanding that learning,
specifically Reading, is a physiological activity
2. Understanding that cognitive processing is impacted by health and processing disorders can be the root to academic learning problems
3. Gain a deeper understanding of how a Root Cause Analysis drives your instruction
4. Participate in a sample Root Cause Analysis
What would this body of evidence indicate?
• Sneezing• Stuffy or running nose• Sore throat• Coughing• Watery eyes • Mild headache• Mild body aches
What would this body of evidence indicate?
• High number of dis-phonetic errors on a spelling test (spells lump lup)
• Receptively identify rhyme but not expressively generate a rhyme
• Inability to segment and blend sounds • Poor results on an elision test “Say
smack. Now say it without the /m/”
Playing Darts in the Dark
Specific Learning Disability • Definition: Specific Learning Disability means
a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
Psychological Processor
Cognitive Sweat • She had a large piece of birthday cake.• I would love to have a slice of cake. • The first slice was very little.• Is there a chance I could talk to the
person in charge?• The house mouse also likes to eat cake. • Where are you going with that cake?
Why is there a silent e? 1. Cake, Slice2. Love, Have3. Large, Piece, Charge, Chance, Slice 4. Little5. House, Mouse6. Where, Are
Executive Functioning
Reasoning
VERBAL NONVERBAL
Reading Processors
orthographic phonologic
semantic
context
/r/ /ŭ/ /n/
run
Brain Images Comparing 9-Year-Old Average Reader and 9-Year-Old Un-remediated Poor Reader
Changes in Brain Activation Patterns in Response to Instruction
p. 63
Processing Speedrapid
retrieval
accuracy
Language Processing
What role do we play inhelping to determine the
processing disorder?
Medical Conditions, Medicines and Cognitive Processing
AlbuterolAsthma • uncontrollable shaking of a
part of the body• nervousness• headache• Nausea• vomiting• cough• throat irritation• muscle, bone, or back pain
Executive Functioning
Reasoning Phonological Processing
Orthographic Context and Meeting
Processing Speed
Language Processing
Medical Conditions, Medicines and Cognitive Processing
InsulinDiabetes • Hypoglycemia • Confusion• Nausea, • hunger,• tiredness• Heart palpitations• Blurred vision• Irritability
Executive Functioning
Reasoning Phonological Processing
Orthographic Context and Meeting
Processing Speed
Language Processing
Medical Conditions, Medicines and Cognitive Processing
AmoxicillinInfections • Skin Rash• Breathing Problems• Blistering• Seizures• Diarrhea• Difficult y urinating• Weak or tired• Dizziness• Headache• Trouble sleeping
Executive Functioning
Reasoning Phonological Processing
Orthographic Context and Meeting
Processing Speed
Language Processing
Medical Conditions, Medicines and Cognitive Processing
MethylphenidateADD/ADHD • Nervousness, • Insomnia• Loss of Appetite• Sleep problems• Dizziness, • Involuntary Movement • Psychosis• Tics• Depression• Glaucoma
Executive Functioning
Reasoning Phonological Processing
Orthographic Context and Meeting
Processing Speed
Language Processing
Working Memory and ADD/ADHD
Executive Functioning
Short Term Visual Sketch
pad
Short Term
AuditoryMemory
Retrieval from Long Term Memory
Medical Conditions, Medicines and Cognitive Processing
Anticonvulsant Seizure • Prolonged Fever• Rash• Severe Sore Throat• Mouth Ulcers• Easy Bruising• Pinpoint Bleeding• Weakness• Excessive Fatigue• Lack of Appetite
Executive Functioning
Reasoning Phonological Processing
Orthographic Context and Meeting
Processing Speed
Language Processing
ROOT CAUSE ANALYSIS
datadatadatadata
datadatadatadata
data
data constipation
Fishbone diagram is used when….
… a team needs to study a problem/issue to determine the root cause.
… a team wants to study all the possible reasons why a process is beginning to have difficulties, problems, or breakdowns.
… a team needs to identify areas for data collection.
… a team wants to study why a process is not performing properly or producing the designed results.
1) Draw the fishbone diagram
2) List the problem in the head of the fish
3) Label each bone with categories to be studied
4) Identify the factors within each category that maybe affecting the problem
5) Continue until you no longer get useful information
6) Analyze the results
ACADEMIC FISHBONE
● Background Knowledge● Vocabulary Knowledge● Language Structures● Verbal Reasoning● Literacy Knowledge
● Phonological Awareness● Decoding (and Spelling)● Sight Recognition
SKILLED READING: fluent execution and coordination of word recognition and text comprehension.
LANGUAGE COMPREHENSION
WORD RECOGNITION
increasingly
automatic
increasinglystrategic
Reading is a multifaceted skill, gradually acquired over years of instruction and practice.
Reading: Scarborough's Rope
Fluency/naming speed and language comprehension
Phonology and fluency/naming speed
Phonology and language comprehension
All three issues
Subtypes of Reading Disability
Phonological Awareness (Blevins, Rosner and Words their Way)
Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness)
Vocabulary and Comprehension
(DRA/SRI, Core Vocabulary and Critchlaw)
Fluency (ORF, Fry and RAN)
Rhyme:Oddity Task:Oral Blending:Oral Segmentation:PhonemicManipulation:
Alphabet Skills:
Reading and Decoding:
Spelling Skills:
Morphology:
# of Orthographic errors on spelling:
Site Words:
ORF Rate:
ORF Accuracy:
# of phoneme errors on spelling test:
Color naming RAN:
Reading Level:
Oral Language Vocabulary:
Name: ________________
Executive Functioning Skills:
Reasoning Skills:
Other:
Rosner Auditory Analysis:
Reading Vocabulary:
Reading
Fishbone Analysis
CASE STUDY: ANGELA
Case Study • K-2 Reached Benchmarks • 3rd Grade CSAP Satisfactory • 4th Grade CSAP P. Proficient • 5th Grade CSAP Unsatisfactory • Currently 6th Grade at a K-8 School • SRI Lexile- 498 or 2nd grade
Case Study Student Intervention TeamAcademic Detectives
Read Naturally for 2 days a weekGuided Reading Plus for 3 days a week
Progress Monitoring Oral Reading Fluency – no progress after 6 weeks.
Special Education • GORT- showed she is at the 21%ile
Program Manager Called the program manager and not sure
what to doReview indicated a very poor BOEA BOE was developed
Case Study
Phonological Awareness Alphabetic Principle
Vocabulary and Comprehension
Fluency
Reading Level: SRI 498 GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark (spring 2010) PP
DRA Level 40 MAZE Passage: 38%ile
Angela is struggling with reading
Clues tabletibltabltebl
Clues
Clues
Clues
Clues
Clues
Total number of seconds
Grade level
>111 < K
111-95 K
94-76 1st grade
75-67 2nd grade
66-64 3rd grade
63-59 4th grade
58-52 5th grade
51-49 6th grade
48-45 7th grade
45-40 8th grade
<40 9th grade +
Angela is struggling with reading
Phonological Awareness (Blevins, Rosner and Words their Way)
Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness)
Vocabulary and Comprehension (DRA/SRI and Critchlaw)
Fluency (ORF, Fry and RAN)
Rhyme: 11/12Oddity Task: 12/12 Oral Blending: 12/12Oral Segmentation: 23/24PhonemicManipulation: 12/12
Phoneme/Grapheme: Short vowels: 21/21 Consonant Blends w/ short vowels: 15/15 Short vowels, digraphs, and trigraph: 15/15 R-Controlled vowels:13/15 Long vowels spellings: 13/15 Variant Vowels: 10/15 Low frequency vowel /consonant spellings: 8/15 Multisyllabic words: 14/24
Morphology: Structural analysis 1/12 Inflectional Morphemes 11/12Derivational Morphemes 0/12
Site Words: San Diego 5th grade level
ORF Rate: 93.8 Below Average ORF Accuracy: 92% Below Average
# of phoneme errors on spelling test: 57%
Color naming RAN: 6th grade level
Reading Level: GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark PP DRA 40 (5th grade level) MAZE Passage: 38%ile
Oral Language Vocabulary:
Rosner Auditory Analysis: 1st Grade Level
Reading Vocabulary:
GORT Fluency: 16%ile
7th Grade Level
5th grade level
Executive Function: excellent focus, initiates tasks, can shift in midstream; no concerns with executive functioning
Reasoning : excellent verbal and non-verbal reasoning
Other: English is first language; no family history of reading problems; older sibling have no issues with academics; engaged family; no sig medical concerns
No concern
Slight Concern
Serious Concern
Is there evidence to suggest
difficulty with executive
functioning?
Is there evidence to suggest
difficulty with Language
Processing ?
Is there evidence to suggest
difficulty with reasoning ?
Root Causes of Reading Difficulty
Student has the ability to sustain focus when basic
skills are automatic
Is there evidence to suggest
difficulty with processing speed?
Student is able to learn through
various methods (mastery, inquiry)
yes
no1.
2.
3.
Is there evidence to suggest
problems with phonological processing?
Is there evidence to suggest
problems with orthographic processing?
yes
no
yes
no
yes
no
yes
noyes
no
Prioritize the concerns 1. _____Basic Phonological_________2. _____Basic Orthographic _________3. ______________________________4. ______________________________5. ______________________________6. ______________________________
Executive Functioning
Concerns
Reasoning Concerns
Reading Comprehension
Concerns
Reading Fluency
Concerns
Basic Reading Phonological
Concern Basic Reading Orthographic
Concern
Create the Treatment
Plan
Name: ___________Angela ________________
RESULTS: TWO STORIES
Literacy Focus Schools
Case Study Diagnostic/ Root Cause Analysis
Treatment Plan Progress Monitoring
Evaluation
-Informal Measures-20 Minutes
-As many people to participate as
possible
-Collaborative-Based on building
resources -Fidelity to IEP
-All children receive core
-Treatment based on the deficit
-IEP Driven-Quick
-After each 5 hours of treatment
-Check in-Mentoring,
Coaching and Collaboration
Near North East Year One
• 13 E. S. • Mostly SPED and SLP Teachers • 3rd grade CSAP status of P or PP grew 25%
for a total of 43% of Special Education Students were P or PP on CSAP
• Sustained these levels in year two with less support
West Side Literacy Focus Year Two
• 18 E. S. • Mostly SPED and SLP Teachers• Largest ELL Population in the district • When doing root cause-introduced the
concepts of errors of transfer for ELL • 3rd grade CSAP status of P or PP grew 14%
for a total of 26% of Special Education Students were P or PP on CSAP
Green Valley Ranch
• Turn Around School• New Leadership• New Curriculum
Green Valley Ranch • 60 4th and 5th Graders Scoring
Unsatisfactory• Screening data indicated
• 40 needed word level reading• 15 needing phonological awareness
work • 12 needed language • 8 needed comprehensive intervention
Green Valley Ranch Word Level Reading (40) Language (12) Comprehensive (8)
Grapheme Work (25)
-Writing Road to Reading 1 hour daily
Phoneme Work (15)
-Writing Road to Reading with Phonological Awareness work daily
Vocabulary and Oral Language work with leveled (LLI) and decodable text (text from the Core)
Language!
September to December 2012
Green Valley Ranch • 48 have returned to the general
education classroom• Remaining 12 had a deeper root cause
analysis completed • 9 will continue intervention that focuses
more on multi-syllable word work and morpheme instruction
• 3 have been referred to special education
What was one take away?