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1
JCPS Technical Assistance Manual
Speech-Language Pathologists
Revised: October, 2014
This is in intraoffice document intended to assist JCPS SLPs.
This document is not to be reproduced, disseminated or
formally referenced for any other purpose.
2
JCPS Technical Assistance Manual
TABLE OF CONTENTS
GENERAL INFORMATION 4-22
QUICK CALL LIST 5
ADDITIONAL NUMBERS 6
SCHOOL CALENDAR 7
DAILY SCHEDULE FORM 8
ABSENCES/LEAVES 9-10
FACULTY MEETING SCRIPT 11-12
TIME MANAGEMENT SUGGESTIONS 13
RESOURCES FOR INSTRUCTIONAL MATERIALS 13
INSTRUCTIONS FOR ORDERING 15-18
EXTRA PAY 19
TRAVEL 19-21
HOSPITALITY GUIDELINES 22
STUDENT RECORDS 23-25
LOCATING STUDENT RECORDS 24
PRINTING ECE LISTS 25
LETTER TO PARENTS 26
SCREENING 27-37
SCREENING INFORMATION 28
HEARING SCREENINGS 28
REQUEST FOR SCREENING FORM 29
PRE-K SCREENING 30
PRE-K SCREENING (2) 31
ELEMENTARY SCREENING 32
TEACHER IDENTIFICATION CHECKLIST 33-35
HEARING RESULTS 36
ECH HEARING SCREENING LOG 37
REFERRAL AND ASSESSMENT 38-58
INITIAL REFERRAL PROCESS 39
REEVALUATION 40-41
ORAL MOTOR EXAM 42-45
OROFACIAL SCREENING 46
CRANIOFACIAL NERVE ASSESSMENT 47
DIAGNOSTIC QUESTIONS 48
MEDICAL VOICE EXAM 49
QUESTIONS TO ASK PARENTS OF ELL STUDENTS 50
COMMUNICATION ASSESSMENT REPORT 51-54
CONFERENCE SUMMARY 55-56
3
ECE UPDATE WORKSHEET 57-58
IEP, ANNUAL REVIEW & REEVALUATION 59-62
STAPLING 60
ANNUAL REVIEW PROCEDURES 61
CONSIDERATIONS FOR RELEASE 62
NON-PUBLIC STUDENTS 63-68
NON-PUBLIC REFERRALS 64-65
SERVICE DELIVERY 66-67
TRANSPORTATION REQUEST FORM 68
SERVICE LOGS 69-76
SCHOOL BASED HEALTH SERVICES (MEDICAID) 70-71
EZTRAC 72-76
RECORDS, ACCOUNTABILITY, ESY, & END OF YEAR 77-92
CHECKLIST FOR ARC 78
APPROPRIATE DOCUMENTATION 79
TRANSITION SERVICES 80-88
TRANSITION FORM 89
TRANSFER OF RECORDS 90
END OF YEAR CHECKLIST 91-92
MISCELLANEOUS INFORMATION & FORMS 93-102
CEU REQUEST 94
CREDENTIALS 95-96
ELECTRONIC SIGNATURE FORM 97
PK HOME RESIDES SPEECH FORM 98
PD REQUIREMENTS 99
EVALUATION CHECKLIST 100
OTOLARYNGOLOGIST REPORT 101
SBARC FOLDER 102
SPEECH FOLDER 102
4
GENERAL
INFORMATION
Quick Call Communication Disorders Program: 2014-15
VanHoose Education Center 4th Floor
5
Phone: 485-3254 Fax: 485-6349
Melissa Weedman Kinsey Chambers
Program Specialist Speech Language Liaison
485-3254 485-3254 [email protected] [email protected]
Douglas Keefe Cathy Weaver
Speech Language Liaison Program Clerk
485-3254 485-3254 [email protected] [email protected]
Brian Franklin Cindy Simpson
ECE Technology Liaison ECE Technology Liaison
485-6060 485-6060 [email protected] [email protected]
Barbara Greenwell Barbara Hatton
ECE Technology Clerk Audiologist
485-6060 485-6060 [email protected] [email protected]
Laura Cullens ECE Records Room:
O.T./P.T. Office Stacey Perkins A-E #3261
485-3509 Loretta McClain F-J #3266
[email protected] Sandra Miracle K-Q #3906
Christine Beck R-Z #3027
Assessment Office Early Childhood Office
485-6052 485-6034
6
Additional Resources
Jefferson County Public Schools:
Preschool-12th grade referrals contact SLP or counselor @ local school
(students attending a JCPS public school)
K-12 referrals (non-public) 485-3254 Cathy Weaver)
Preschool referrals (non-public) 485-3982 or 3979 (Janice Neff or Eddie Smith)
Early Childhood Special Services Office 485-6034 (Mike Murphy/Beverly Wathen)
Preschool Find 485-5324
ECE Assessment Office 485-6052 (Dr. Joe Bargione)
ECE Placement Office 485-3215 (Kathy Whitehead/Pat Wantland)
Websites:
www.nncc.org/Child.Dev/child.dev.page.html
www.asha.org
www.jefferson.k12.ky.us
Healthtouch: www.healthtouch.com (click on health info, then “s”, then “speech and language”)
Parent Pals: www.parentpals.com
Stuttering Foundation of America: www.stutterSFA.org e-mail: [email protected]
7
JCPS SCHOOL CALENDARS
To access JCPS school calendars via the Internet:
From the JCPS Home Page (www.jcpsky.net), you will find a drop box that contains
school calendars for:
The current school year
Schools on alternate calendars
Future school calendars that have been approved by the Board
From the drop down menu, select and click on the appropriate school calendar.
8
JEFFERSON COUNTY PUBLIC SCHOOLS SPEECH/LANGUAGE CLINICIAN’S DAILY SCHEDULE
SLP: HOME SCHOOL: PHONE #: The permanent schedule is to be filled out no later than the third week of school. Copies should be given to each principal and a copy sent to the Communication Disorders Program office. This form should be reproduced throughout the school year, as scheduling changes occur. Preferred E-mail Address
Day Mornings Afternoons
Monday
School:_________________ Time: __________________ Phone #
School:__________________ Time: ___________________ Phone #
Tuesday
School:__________________ Time: ___________________ Phone #
School:__________________ Time: ___________________ Phone #
Wednesday
School:__________________ Time: ___________________ Phone #
School:__________________ Time: ___________________ Phone #
Thursday
School:_________________ Time: _________________ Phone #
School:__________________ Time: ___________________ Phone #
Friday
School:_________________ Time: __________________ Phone #
School:__________________ Time: ___________________ Phone #
This form should be reproduced throughout the school year, as scheduling changes occur
9
.ABSENCES AND LEAVES
As of July 2014, from Human Resources The Substitute Center should not be called to report an absence for a position that is not allotted a
Substitute Teacher. Also, the absence should not be reported through SmartFind, but to the supervisor
as normal.
Speech Language Pathologists should report absences to their home school in whatever manner is
deemed appropriate by their principal. If a SLP has more than one location they serve, they should
contact the home school first, followed by the school they will actually be absent from that day. A sick
card should be filled out when returning to work and submitted at your home school.
Speech Language Pathologists may also request up to 3 days of personal leave each school year.
Please see JCTA contract and your home school for specifics.
10
All employees, including SLPs, are credited with 2 emergency leave per year. Per JCTA contract,
emergency is defined as a sudden unexpected happening; an unforeseen occasion or condition; a
sudden or unexpected occasion for action. Please refer to JCTA contract as well as your home school
for specifics.
With regard to professional leave to attend conferences such as the Kentucky Speech Language
Hearing Association (KSHA) Annual Conference, the speech language pathologist will need to fill out
a Professional Leave Request for and submit to their principal. If principal grants permission the form
will need to be sent to Tiffeny A. Armour, Director, Administrator Recruitment and Development.
11
FACULTY MEETING SAMPLE SCRIPT
All Kentucky students are expected to master the KDE Academic Expectations as measured through
standards-based assessment. The ability to use basic communication skills such as listening and
speaking are integral components of the standards and common core. Students with communication
disabilities (speech or language impairments) are at significant risk in the educational setting because
they lack the ability to use communication skills that are basic to literacy development. Therefore, it is
critical that students with communication disabilities be identified and provided appropriate
intervention. The Communication Disorders program is an Exceptional Child Education program and
is bound by the same due process procedures for interventions, referral, evaluation, placement, services
and re-evaluation as all other special education programs. This includes:
1. appropriate program modifications and interventions prior to referral
2. formal written referral
3. initial Admissions and Release Committee meeting attended by the required members
4. parental permission for individual assessment
5. verification of adverse effect on educational performance
6. determination of eligibility and placement recommendation by consensus of members of
the ARC
7. development of an IEP, when appropriate, by the ARC
8. parental permission for placement for specially-designed instruction
Therefore, students whom teachers suspect of having a disability in the area of communication, must
first be provided opportunities to be successful communicators in the regular classroom. The
classroom teacher may request assistance from the school’s speech/language pathologist to develop
appropriate intervention strategies. The teacher may also request a communication screening. If the
results of the interventions and screening indicate that further evaluation is warranted, the teacher
should complete a formal written referral accompanied by documentation of the interventions. This
information is reviewed by the ARC and, if a complete assessment is indicated, written parent
permission is obtained.
The SLP then conducts a comprehensive evaluation of the student’s communication skills in the
area(s) of concern: articulation, voice, fluency, and language. The evaluation consists of standardized
norm-referenced tests, informal measures, and documentation of adverse effect of the communication
disorder on educational performance. Sources of data used to document adverse effect on educational
performance may include, but are not limited to, two classroom observations, work samples, portfolio
reviews and teacher/parent interviews.
The SLP submits the written evaluation report to the ARC chairperson along with supporting
documentation. When the ARC chairperson determines that all necessary data have been collected,
he/she schedules a meeting to discuss the results of the evaluation and to make a determination of
eligibility for special education and related services.
It is important to note that a student who exhibits a communication impairment, which does not
interfere with his/her ability to benefit from his/her educational program and make progress in the
general curriculum, is not eligible for speech/ language services. It is critical that the impact of the
communication deficit on the student’s access to and ability to benefit from core content instruction be
thoroughly documented. An individualized education program is developed only for those students
12
who meet all eligibility criteria and for whom parental consent for specially-designed instruction is
obtained.
The communication disorders program is not intended to serve students with communication
differences or simple communication delays. Students must demonstrate a communication
DISABILITY that adversely impacts their educational performance in order to receive speech-
language therapy services.
13
Time Management Strategies and Scheduling Tips Use time before first bell to test/screen students who are waiting for teachers to pick them up.
Block schedule, especially for collaborative or in-class therapy.
See students in larger groups or classroom setting at beginning of year so you don’t have to
wait for “permanent” schedule.
Schedule teachers with restrictive scheduling needs, first.
Complete Service Logs at the end of each session while students are gathering their materials,
getting their stickers, etc.
Obtain class lists from the school secretary; highlight speech students to help organize your
schedule by teacher.
If you are comfortable with mixed group therapy, group by teacher rather than disorder (see
next bullet).
Lay out large blank therapy grid on bulletin board. Give each teacher index cards with his/her
students’ names on them. Use color-coded index cards to block out planning, lunch, testing
time and any other time that can’t be changed (non-pub. time). Give teachers a deadline and
have them put their students in the available time slots. Any conflicts or changes need to be
resolved by the teachers involved, not the SLP. This works if you’re comfortable with mixed
group therapy.
Schedule weekly blocks. For example, during the first week of every month see mild artic. and
language students in math settings in classroom or pull-out during math time. During second
week, pull out during science/computer combinations, etc. This avoids pulling students from
same class every week.
Provide services in the self-contained and resource classrooms.
Provide services in a “listening center,” during the literacy block in the classroom.
Serve preschoolers during uninterrupted reading block, or schedule planning time,
screening/testing if you absolutely have no students you can see at this time.
Document when you are unable to see a student, “SLP attending a SBARC meeting,” but make
up the time later in the week or within the next week. Document on the log if you are
providing make-up time.
Keep a small index card file near your work space with a card for each student containing:
name, DOB, grade, teacher, room #, IEP review date, 3 year re-eval. date, and benchmarks.
This is very helpful at beginning of year when you aren’t familiar with who is where and
working on what. It also helps keep you on track for conducting probes needed for reviews and
re-evals..
Use time in hallways to and from therapy with students to preview or review lesson…this is
therapy time.
Ask counselor not to schedule meetings at same time each week if it means canceling therapy
for the same students.
Ask counselor to schedule SBARC meetings before and after school.
14
Resources for Instructional Materials
Office: ECE Technology Center Location: Churchill Park Contact: Brian Franklin and Cindy Simpson (AT Liasons) Contact: Barbara Greenwell, Clerk Phone: # 6060 Office: Communication Disorders Program Location: VanHoose Education Center Contact: Cathy Weaver, Clerk Phone: # 3254 Other Resources: Speech Language Pathologist Budget ($184.00/ call Cathy Weaver for additional information) School PTA Budget (many clinicians have been allocated monies for
instructional materials by their local PTA) Principal’s Instructional Budget
(principals often allocate monies for the SLP(s) serving their school)
15
Instructions for Ordering
Tests and Protocols from the Assessment Office
Speech/Language Pathologists may order tests and protocols from the Speech Office by contacting
Doug Keefe via email ([email protected]). Please identify the test and/or protocols
by using the complete test name as well as how many protocols you are requesting.
All requests for tests and protocols are purged during the summer, therefore, you will need to complete
a new order form at the beginning of the school year for items that may have been on backorder.
Orders will not be taken over the phone.
REMEMBER: It is a violation of copyright law to copy test forms/protocols!
16
SPEECH/LANGUAGE OFFICE ORDER FORM
Only One Item Per Line Only One Company Per Page
CLINICIAN’S NAME CLINICIAN’S SCHOOL COMPANY STREET or P. O. BOX CITY, STATE & ZIP CODE AREA CODE/TELEPHONE NUMBER DATE OF CATALOG
Catalog Page #
Quantity Item Number
Warehouse Code #
Description Unit Price
Total Price
See back of form for Warehouse Code Numbers Total (order form)
17
WAREHOUSE CODES
Audio Cassettes 1711009
Book 1707425
Bulletin Board Supplies 1713979
Cards, Flash 1713981
Computer Software 1711109
Games 1713985
Manual 1714841
Maps 1711139
Misc. Office Supplies 1713545
Misc. Teaching Aids 1713543
Misc. Teaching Supplies 1714002
Novelties, Misc. 1713607
Pencils 1714214
Posters 1714078
Publications 1713535
Puppets 1718834
Puzzles 1713984
Reproducible Worksheets 1715809
Sets (Picture) 1713983
Signs 1714613
Special ECE Supplies 1722342
Stamps 1713978
Stickers 1713976
Study Guide 1714771
Study Material 1714772
Teacher Manual 1714224
Teaching Kit 1711144
Test 1711140
Test Forms 1714929
Toys 1713989
Video Tapes 1707428
Workbook 1711138
18
Examples of Resource Books/Materials
Available for Loan from Speech Office
Planning Individualized Speech and Language Intervention Programs: Objectives for Infants,
Children, and Adolescents; Nickola Wolf Nelson; Pro-Ed
The IEP Companion; Wilson, Lanza and Evans. Lingui Systems
The Speech and Language Classroom Intervention Manual; Hagan, McDannold, Meyer; Hawthorne
Educational Services
The Assessment Companion; Huisingh and others. LinguiSystems
Curriculum for Oral Language Development; Mattes. Academic Communication Associates
Sourcebook for Speech and Language Assessment; Mattes. Academic Communication Associates
The Reading Teacher’s Book of Lists; Fry and others. Prentice-Hall.
Desk Reference of Assessment Instruments in Speech and Language; Harris & Shelton. Academic
Press
Books are for Talking Too! Gebers. Pro-Ed
The Speech and Language Classroom Intervention Manual
SPARC: Stimulus Pictures for Assessment, Remediation, and Carryover (Lingui-Systems)
Assessment of Bilingual Learners: Language Difference or Disorder? (ASHA)
The Source for Bilingual Students with Language Disorders. (Lingui-Systems)
19
Pay for SBARC Meetings In 2013, JCPS and JCTA most current contract states in Article 11-Teaching Load and Duty Hours
Section D:
Every reasonable effort will be made to schedule Open House as far in advance as possible.
There will be no mandatory faculty meetings during the week that Open House is held. Attendance at
all other meetings and all other duties beyond the Employee’s normal duty hours shall be voluntary
except for parent conferences which shall be scheduled when possible to take place during normal duty
hours. Mandatory attendance at meetings, including ARCs, beyond the one (1) hour per week wil be
paid at the hourly rate of pay except Open House and parent conferences.
The appropriate forms for all teachers to complete and turn in to be paid for extra service for
mandatory meetings and/or making up their planning time after school shall be available online on the
Employer’s website. From JCBE-JCTA Agreement 2013-2018
Instructions for Completion of Travel Vouchers Mileage for itinerant teachers (including SLPs) who travel between schools during the school day is
reimbursable. To increase instructional time for students and reduce travel costs, SLPs should
schedule students in a manner that minimizes travel time. Travel between schools is limited to the
amount of travel necessary to appropriately serve students.
Travel vouchers must be completed on the electronic travel voucher forms. Electronic travel vouchers
may be found by going to the JCPS website at www.jcpsky.net.
Click: Employees
Under Quick Clicks, select JCPS Forms Online
Click: Form Title.
Type the word Travel in the second box and click the Find It! button.
Click: Local In-County Travel Expense Voucher, then click the Open button.
Before completing the form, it is best to save the form to your desktop. To do this:
Click: File, and select Save As
Click to Save Document on: Desktop
Click: Save
Close the web version of the form. The form is now on your desktop. You may use this desktop
template throughout the year (or until mileage allowances change).
To complete the travel voucher, go to your desktop and click the Copy of In-County Travel icon.
Fill in your travel information.
To save a copy of your completed travel voucher, simply click File, and select
Save As. Name your document (i.e., March ’08 Travel) and save to your desktop.
To print your completed travel voucher, click File and select Print.
All travel vouchers must be signed by both the SLP and the SLP’s home school principal. Please
forward all completed travel vouchers (via pony mail) to:
Melissa Weedman, Specialist
Communication Disorders Program Office
Van Hoose Education Center - 4th Floor
REMEMBER: An insurance affidavit must be on file prior to reimbursement for travel. Call 485-
3313 to obtain the
20
TRAVEL GUIDELINES
EFFECTIVE AUGUST 1, 2014
In-County Travel
1. The current mileage reimbursement rate follows the state travel regulations and will be updated
annually. Intra-day travel to Frankfort for JCPS business, or to any Kentucky Department of Education
(KDE)-sponsored event held in the Commonwealth of Kentucky, will be considered in-county travel.
2. Travel for JCPS business is allowable if it is between JCPS locations, to and from destinations for
required meetings during the business day, to and from conferences and training sessions, or to and from
PTA meetings. Any non-JCPS location should be identified with a brief one-or two-word explanation
(e.g. student supervision, bank deposits, evaluation, etc.).
3. Reimbursement is limited to mileage in excess of round-trip from home to school/office unless the
required attendance is outside of regular business hours. The in-county travel voucher includes
information previously supplied by separate payment vouchers. It is no longer necessary to submit a
separate payment voucher and a D & F with the in-county travel form.
Travel Voucher Instructions
1. Name: as it appears in the JCPS Employee system
2. Vendor Number: as provided by the Speech Office
3. Title Of Your Position: official title according to JCPS job descriptions
4. Department: Exception Child Education
5. Date Of Submission: current date you are completing the form
6. Division or Institution: Academic Services
7. Accounting Code: see example below
8. Month of Travel: separate voucher required for each month
9. Enter the DATE (of travel): a separate line is required for each transition from one location to another
10. Enter only one location in the TO and FROM colums. The only excepton is to indicate a round trip
(RT). Do not use abbreviations.
11. For travel to a non-JCPS location (UofL, Daycare, etc.) you must include a brief reason in the
“PURPOSE OF TRAVEL (NON JCPS ONLY)” column and also attach a Mapquest (or other online
application or website) printout verifying the milage for that line. Travel to KED meetings statewide is
considered in-county travel but Mapquest verification is still required.
12. Enter the number of PRIVATE AUTO MILES for travel on each line. Using an online map application
or website, calculate the SHORTEST DISTANCE between locations. JCPS compensates for the
shortest distance, not time.
13. CHARGE is set automatically
14. All items listed in OTHER should include an explanation such as parking fees, etc.
15. LICENSE NO. OF AUTO: license plate number (do not include driver’s license number, make, model,
etc.)
16. ADDRESS OF OFFICIAL HEADQUARTERS: home school
17. SIGNED (CLAIMANT); voucher must be signed for submission in BLUE INK
18. FULL HOME ADDRESS
19. APPROVED: signature of your supervisior and budge director
20. DATE: leave blank. This is competed by the person who approves the voucher.
**MILEAGE SHOULD BE SUBMITTED MONTHLY. THERE ARE NO EXCPETIONS. All vouchers are
to be turned into your supervisor by the 10th day of the month following the month submitted for reimbursement.
21
IN-COUNTY TRAVEL VOUCHER
Submit monthly, or upon completion of travel, to Finance after approval by department head. Please print all data with exception of signatures. A receipt must be submitted for each item in excess of $2 (or $6 for parking only)
NAME (PLEASE PRINT) VENDOR NUMBER TITLE OF POSITION
DEPARTMENT DATE OF THIS SUBMISSION
DIVISION OR INSTITUTION ACCOUNTING CODE MONTH OF TRAVEL
DATE FROM TO PURPOSE OF TRAVEL PRIVATE AUTO OTHER * TOTAL
(NON JCPS ONLY) MILES CHARGE
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
0.48 $ -
TOTAL FOR PAGE - 0.48 $0.00 $0.00
LICENSE NO. OF AUTOMOBILE OWNED & USED BY ME ADDRESS OF OFFICAL HEADQUARTERS
I hereby certify that all items of expense included in the above statement were incurred in the discharge of offical business; That they were proper charges against Jefferson County Public School System; That all items in excess of two dollars are supported by receipts; That any private auto allowance claims use of the automobile owned by me, identified herein by listed license number; and that all data furnished herewith are true and correct to the best of my knowledge. I determine that personal auto is a single source expense.
SIGNED (CLAIMANT) FULL HOME ADDRESS OF CLAIMANT
APPROVED (DEPARTMENT HEAD OR AUTHORIZED AGENT) DATE
* ALL ITEMS LISTED IN "OTHER" MUST BE EXPLAINED ON REVERSE SIDE OF FORM.
"OTHER" INCLUDES EXPENSES SUCH AS PARKING FEES, PHONE ETC.
22
Hospitality Guidelines
1. A planter or flower arrangement ($32.00) will be sent to those
hospitalized. A card will be sent to those requiring outpatient surgical care.
2. A charitable contribution ($25.00) will be made following the death of a spouse, child, or
parent. A card will be sent to those who lose a brother or sister.
3. A gift ($20.00) will be sent for 1st marriages and the birth of a first child.
4. Cards will be sent for marriages and new babies (other than the first) and for other occasions
warranting a ‘thinking of you’ card.
5. Tokens of appreciation will be given to the program specialist, liaisons and clerks at holiday
time.
6. A gift ($50.00) and complementary lunch will be given to those who retire.
7. If an individual has not contributed to the fund, a card will replace flowers or gifts.
8. A donation of $100.00 will be sent for the sponsorship of a speaker at the KSHA conference.
9. The fee for belonging to the fund is $15.00 a year (for both full and part time SLPs).
FYI
1. Although we will collect dues all year, your promptness is greatly appreciated.
2. Additional donations may be requested if the fund becomes significantly depleted.
3. Suggestions or comments regarding hospitality issues may be passed along to any of the
committee members listed below.
23
STUDENT RECORDS
24
Locating Students/Records First week of school:
Check Infinite Campus printout from counselor; look for “05” codes (“speech only”)
Look for list of active students from previous end-of-year report
Look in files in speech office at your school for speech folders
Check in counselor’s office for SBARC and speech folders
Check previous year’s April 1 computer class list
Ask students (verify with parent or records or previous clinician)
Non-Public Students:
Contact parent.
Arrange therapy times according to Service Plan minutes (between 9:30 and 1:00 if needing JCPS
transportation; 2:30 or later is often preferred by parents when JCPS transportation is not needed).
FYI: Students who receive JCPS transportation must leave your school by 1:30.
Complete Transportation Request form (if appropriate) and fax to transportation office (see form in
Non-Public section of this Technical Assistance Manual)
Notify parent and school when transportation will begin
What do you do if you have a record or a name on a list, but no student?:
Check with school secretary and/or counselor
Call parent (“where is child attending school?”)
Call Speech Office
What do you do if you have a name and a student, but have no records?:
Check with school counselor and/or secretary
Have counselor/school secretary contact previous school
Call SLP at previous school
Call ECE Records Office
Call Speech Office (last resort)
25
Quick Clicks for Printing ECE Lists
Getting/Printing ECE List 1. Log in to Infinite Campus
2. Select “year” field
3. Select “Student Information”
4. Select “Reports”
5. Select “JCPS Current ECE Students”
6. Choose School
7. Select “All Grades”
8. Choose order sort: alpha by location/student or disability/student name
9. Select “View Report” (wait while program generates report)
10. Select format “Excel”
11. Export
12. Shrink to 95%
13. Print preview
14. Print
Getting/Printing Related Service List 1. Log in to Infinite Campus
2. Select “Student Information”
3. Select “Reports”
4. Select “JCPS ECE Related Services”
5. Select your school
6. Select school calendar (there are several calendars for each school which will appear in a drop
down box)
7. Select grade (“all grades”)
8. Order Sort: several options for sorting
9. “Related Service”, choose both “S/L Therapy” and “S/L Therapy Shared Time”
10. Enrollment service type, choose “all”
11. Select “View Report” (wait while program generates report)
12. Select format “Excel”
13. Shrink to 95%
14. Print preview
15. Print
26
Dear Parents:
My name is ____________________ and I am the speech-language
pathologist at _____________________ School. As we move into a new
year of Speech-Language learning, I encourage your support and
involvement to help your student be the best communicator he/she can be.
This week (date), I will begin scheduling continuing students on my
caseload. We will be working on the goals listed on your child’s IEP that
address his/her communication needs. Speech-Language learning may
include work on speech sounds, language, voice or fluency (stuttering) skills.
I will also be involved in screening and testing new referrals and updating
assessments.
If you have any questions or concerns regarding your child’s communication
program prior to our annual review conference, please contact me at school
(phone #). This year, I plan to be in the building (list the days and times you
will be in this building). My classroom is room (#). I am looking forward to
working with you and your child this year.
Sincerely,
(Your Name)
27
SCREENING
28
Screening Information A communication screening is administered upon request of a teacher, parent, school staff member, the
ARC, or any other source including the speech-language pathologist. Please note that if it is at the
request of a parent, screening must be completed within 15 school days. The purpose of the screening
is solely to determine if a student is in need of further intervention. Screening information is not used
to determine possible placement in a special education program, therefore, parent permission does not
need to be obtained prior to performing an initial screening for an individual student. However, SLPs
should review the student’s health card to ensure that the parents have not signed a Non-Consent for
Health Screening form.
When the communication screening is requested and performed before the ARC convenes to consider
development of an evaluation plan, the screening is considered a pre-referral intervention strategy. If
the student fails the screening, interventions based on the area of concern(s) will be given to the
classroom teacher to implement for a minimum of 4 weeks. Screening results as well as documentation
of additional pre-referral intervention strategies are included in the written referral (IDEA-1) as
documentation of the level of communication functioning and the need for further evaluation.
In order to provide information to the ARC regarding communication functioning, all students referred
for possible special education and related services must receive a communication and hearing
screening (or screening results on file that are less than 12 months old). The communication screening
should be conducted prior to evaluations in other domains, so that the results may be used by other
professionals conducting evaluations. Use of a standardized screening instrument is recommended, but
not required to provide specific pass/fail criterion in the area of communication. (See optional non-
standardized, informal screening instruments, intervention documentation forms and hearing screening
referral letter in this section of the handbook.)
Results of communication, oral-motor and hearing screenings may be noted on, or attached to, the
student’s health card. You may also ask your counselor to add to information on Infinite Campus
under the “Health” tab.
Hearing Screenings
Health services conducts hearing screenings at each elementary school on an annual basis. As good
team members SLPs should agree to provide hearing screenings one of the two days annually. SLPs
will also be available to complete hearing screenings in their schools at the request of parents or
counselors. Preschool students who do not receive exceptional child education services will need to
receive a hearing screening within their 1st 45 days of entry to school. SLPs will work in conjunction
with the preschool staff to assist with these screenings. Dedicated preschool sites will have 2 large
group hearings screenings per year provided by Health Services.
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Request for Screening
Type(s) of screening(s) requested: ____ Communication ____ Oral Motor ____ Hearing
Student Name: ______________________________________ D.O.B.: __________________
Teacher: _____________________________________________ Date: __________________
Grade/E.C.E. Program: ________________________________ Room #: __________________
Screening Requested By: _____ Teacher ______ Parent
_____ ARC ______ Other: ___________________________
Reason for Request/Area of Concern: _______________________________________________
___________________________________________________________________________________
****************************************************************************************
Speech-Language Clinician: __________________________________________
Date(s) of Screening: __________________________________________
Communication: ______ No concerns at this time
______ Need for further evaluation (give brief description of screening instrument
and results): ________________________________________________
___________________________________________________________
___________________________________________________________
Oral Motor: ______ No concerns at this time
______ Need for further evaluation (give brief description of screening instrument
and results): ________________________________________________
___________________________________________________________
___________________________________________________________
Hearing: ______ No concerns at this time
______ Need for further evaluation (give brief description of screening instrument
and results): ________________________________________________
___________________________________________________________
___________________________________________________________
Recommended Follow-Up Activities (i.e.: classroom interventions, referral to ARC, etc.): ______________
________________________________________________________________________________________
________________________________________________________________________________________
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SPEECH/LANGUAGE SCREENING Preschool
Student________________________________________ Date Screened__________________
Date of Birth___________________________________ School________________________
Screened by: _________________________________
Picture Id./Articulation Following Directives
______ monkey ______ Stand up then close your eyes______
______ hammer ______ Touch your nose then clap
______ book ______ your hands______
______ baby ______ Bring me the book then jump up
______ bathtub ______ and down______
______ pie ______ 3-4 years (pass 2/3)
______ cup ______ 4-5 years (pass 3/3)
______ fork ______
______ knife ______ Comprehension of Prepositions
______ gum ______ Put the truck in the box________
______ cat ______ Put the hat under the table______
______ blocks ______ Put the pencil on the paper______
______ dog ______ 3-4 years (pass 2/3)
______ table ______ Put the book on the table________
______ lamp ______ Put the paper under the box______
______ house ______ Put the pen next to the book______
______ shoe ______ Put the book in the bag__________
4-5 years (pass 4/4)
Story/Event Retelling:
Age-appropriate syntax__________________________________________________________
Forms phrases/sentences of 3 or more words (3-4 years) _______________________________
Forms sentences which are 4 or more words (4-5 years) ________________________________
Connected speech is intelligible ___________________________________________________
Oral Motor Exam: ___________________________________________________________
Hearing Screening: ___________________________________________________________
Recommendations: ___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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SPEECH/LANGUAGE SCREENING
Preschool
Student Name: ______________________________ Date Screened: __________
Date of Birth: ______________________________ Chronological Age: ______
SAY: REPEAT:
____ monkey ____ I like pizza.
____ hammer ____ I can count.
____ book ____ I’m a big (boy, girl).
____ baby ____ The dog chases the cat.
____ bathtub
____ pie
____ cup ASK:
____ fork ____ What’s your name?
____ knife ____ What’s your favorite T.V. show?
(or favorite food/toy/etc.)
____ gum
____ cat
____ blocks TASKS:
____ dog ____ Have the child count or repeat
numbers after person.
____ table
Give the child a block. Have him/her
____ lamp put it:
____ house ____ on the table
____ shoe ____ under the table
____ give it to me (do not put hand out)
Signature of Evaluator: ____________________________________________________
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Informal Screening Elementary
Student’s Name: ______________________________ DOB: _________ Grade: __________ School: _______________________________ SLP: ____________ Date: _______________
Language: Pass Fail Developmental
1. Oral Expression A. Verbal Sequencing (student retells the following story):
Jason put on his new roller skates and went outside. He skated along the sidewalk and fell down. Oh no! Jason scraped his knee and bumped his head.
Were the story events related in proper sequence? _____ Yes _____ No
B. Syntax and Semantics: Engage the student in a conversation and record at least two sentences. Note syntax, semantic content and length: _________________
2. Auditory Comprehension
C. Following Directions (circle correct responses) i. Stand up and put your hands behind your back. ii. Pick up a book, open it up, then put it under a chair. iii. Give the book back to me, walk to the door and knock two times.
Is student able to follow spatial concepts included? Yes___ No___ Is student able to follow all directions in sequence? Yes___ No___
D. Question Comprehension (circle the numbers for items answered correctly) i. Who helps you when you are sick? (nurse, doctor, mom) ii. What do people do with books? (read, check out from library) iii. Where would you find a sink? (kitchen, bathroom) iv. When do we sleep? (naptime, nighttime, when we’re tired) v. Why don’t we walk in the street? (might get hit by a car)
Articulation: Pass Fail Developmental Circle errors noted:
Age 2-4 m n h b p n d w t Age 4-5 g k f y Age 5-6 ½ v l j z ch sh Age 6-7 s r th th z
Voice: Pass Fail
Fluency: Pass Fail Description of Findings/Comments: ________________________________________________
_______________________________________________________
Recommendations:
Passed all areas, no further testing needed
Developmental errors, recheck in ____ months
Failed in 1, 2, 3, 4 areas. Recommend diagnostic testing
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Classroom Screening/Teacher Identification Checklist for Communication Grades K-12 Student’s Name: Date of Birth: Grade: ________ Communication ______ has ______ has not been checked as an area of concern on the referral. (If communication has been checked as an area of concern on the referral, please document appropriate intervention strategies on the “Classroom Modifications/Intervention Strategies for Communication” form in the referral packet.) 1. Do you think that this student has difficulty pronouncing speech sounds? ____ Yes _____ No (If “yes”, please answer the following and provide specific examples)
a. The student substitutes one sound for another. (e.g. “tat” instead of “cat”) Example: __________________________________________________________________________ b. S/he leaves out sounds or syllables or speech is mostly vowels. (e.g. “teo” instead of telephone”) Example: __________________________________________________________________________ c. S/he consistently leaves off word endings. (e.g. “ca” instead of “cat”) Example: __________________________________________________________________________ d. S/he distorts sounds. Example: __________________________________________________________________________ e. S/he is difficult to understand in connected conversational speech. Example: __________________________________________________________________________ f. S/he appears to be disturbed by his/her inability to be understood. Example: __________________________________________________________________________ 2. Do you think that this student stutters? _____ Yes _____ No (If “yes”, please answer the following and provide specific examples)
a. S/he repeats sounds, syllables, or words more than his/her classmates. Example: __________________________________________________________________________ b. S/he frequently struggles to speak. Example: __________________________________________________________________________ c. S/he makes unusual facial or body movements to start talking or while talking. Example: __________________________________________________________________________ d. S/he talks too fast or too slow. Example: __________________________________________________________________________ 3. Do you think that this student has a voice problem? _____ Yes _____ No (If yes, please answer the following and provide specific examples)
a. His/her pitch is higher or lower than that of most of the classmates of the same gender. Example: __________________________________________________________________________ b. His/her voice is monotone. Example: __________________________________________________________________________ c. S/he is hoarse most of the time. Example: __________________________________________________________________________
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d. There is an obvious cleft of the lip, teeth ridge or palate. Example: __________________________________________________________________________ e. S/he sounds like s/he is talking through his/her nose. Example: __________________________________________________________________________ 4. Do you think that this student has difficulty comprehending auditory information ? _____ Yes _____ No
(If “yes”, please answer the following and provide specific examples)
a. S/he frequently asks for directions or information to be repeated. Example: __________________________________________________________________________ b. S/he frequently misinterprets what you have said. Example: __________________________________________________________________________ c. S/he frequently provides an answer that is unrelated to the question. Example: __________________________________________________________________________ d. S/he turns his/her head to one side as you speak. Example: __________________________________________________________________________ e. S/he often mispronounces multi syllabic words, gets the syllables in words mixed up, or leaves out syllables in words when speaking spontaneously. Example: __________________________________________________________________________ f. S/he does better with written than oral directions/information. Example: __________________________________________________________________________ 5. Do you think that this student has difficulty with oral expression? _____ Yes _____ No (If “yes”, please answer the following and provide specific examples)
a. S/he frequently leaves out small words or leaves off word endings (past tense -ed, plural -s, -es, or
other endings) in spoken sentences. Example: __________________________________________________________________________ b. S/he has a limited spoken vocabulary for his/her age. Example: __________________________________________________________________________ c. S/he has difficulty retelling (orally) simple stories or events in sequence. Example: __________________________________________________________________________ d. S/he consistently speaks too loudly or softly, stands too close to the listener, or does not
seem to use polite social forms of address. Example: __________________________________________________________________________ e. S/he uses shorter and simpler sentences and more elementary grammar forms than his/her
classmates speaking. Example: __________________________________________________________________________
6. Are there any noticeable abnormalities of structure or function of the mouth, tongue, lips, teeth?
___Yes ___No
7. Does/has this student receive(d) speech therapy? ______ No______ Yes, from Jefferson County Schools from _____________ to _______________ (date) (date)
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______ Yes, from from to (list agency providing therapy ) (date) (date)
Additional comments concerning this student’s communication skills: _________________________________________ _____________________________________________________________________________________________________
Teacher’s Signature _______________________________________________ Date_______________________
DATE:
RE: DOB:
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Your child did not pass a recent hearing screening conducted by the communication disorders department at
school. Since even a mild hearing problem can affect speech, language, and learning, it is suggested that you
obtain further evaluation of your child’s hearing as soon as possible.
Options for children’s hearing testing include the following:
1. The Commission for Children with Special Health Care Needs (CCSHCN) is located at 935 Eastern
Parkway. This state run facility serves children in our community with a variety of health care concerns,
including hearing evaluations and hearing clinic. You MUST call ahead at 595-4459 to request an
appointment. Also, it is required that you take your child’s Personal Health Insurance card, Medical
Card, or Passport Card with you. Ask about any possible charges for this testing at the time you call,
since this may vary depending on financial need.
2. You may choose to obtain the hearing evaluation from a private audiologist (hearing specialist), or your
doctor at your own expense.
If your child is currently under the care of a physician or an audiologist for a known
hearing loss, please write in the specialist’s name, sign this letter, and return to me at
school.
YES, my child is currently under the care of the doctor or
audiologist name below.
Doctor’s Name:
Audiologist’s Name:
Parent/Guardian Signature:
The results of any evaluation you obtain should be sent to me at your child’s school. Please call if you have
questions regarding this screening and recommendation.
Speech Language
Pathologist:
School: Phone:
NOTE: If your child is currently undergoing any educational evaluations through the school, that testing
will not be able to proceed until the student either passes a follow-up hearing screening, or has a note
from the physician saying the child is under care for ongoing hearing or ear concerns. This is so that
educational testing will not be affected by an underlying hearing problems
HEARING SCREENING RESULTS Date of Screening
Right Ear 1000 Hz 2000 Hz 4000 Hz
Left Ear 1000 Hz 2000 Hz 4000 Hz
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School______________________________ Teacher_____________________________
Student’s Name Date of Screening Results Notes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
All Students must be screened within 45 calendar days of entry
Children who were absent on their classroom screening day and newly enrolled children should
be referred to your site’s speech pathologist for screening.
For assistance, please contact your Resource Teacher or Health Coordinator (Laura Boisseau
6847)
ECH Centers will receive additional information for screening new children. Speech Pathologists: Please return this form to the classroom teacher
Teachers: Please enter results on the ECH Hearing screening tab.
Jefferson County Public Schools
Early Childhood Hearing Screening Results
2014-2015
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REFERRAL
AND
ASSESSMENT
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Initial Referral Procedures
1. Referring person (parent, teacher, SLP, other) completes the Evaluation Referral Form and
attaches screening information and intervention documentation.* The completed referral form is
given to the School-Based Admissions and Release Committee (SBARC) chairperson.
2. SBARC chairperson schedules meeting and notifies parent and other SBARC members.
3. At the SBARC meeting, the chairperson reviews the parent rights and safeguards, provides the
parent with information regarding screening results, areas of concern, recommendations for
additional testing (if appropriate), and answers any questions the parents or teachers may have.
4. After discussion, any of the following options may be considered:
a) if the SBARC agrees that the referral is complete and an evaluation is warranted, the
SBARC develops the evaluation plan and obtains parent permission for the evaluation.
b) if the SBARC determines that the referral is not complete, a plan is implemented to obtain
the information needed for completion.
c) if the SBARC determines that the referral is complete but that testing is not warranted,
members of the school staff may make recommendations for continued or additional
intervention strategies to address identified concerns.
5. All proceedings and decisions of the committee are documented on the ARC Meeting Summary
form.
* Screenings and intervention data with graph and analysis statement
Please refer to the
JCPS Exceptional Child Education Policies and Procedures Manual
for more detailed information on this subject.
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SPEECH LANGUAGE UPDATE NEWSLETTER
7/21/14
DISMISSAL FROM SERVICES
Has to take place in 2 different meetings. You must have a reevaluation to exit a student-even from speech services.
Exiting and reeval cannot happen in the same meeting. First, schedule your meeting to plan the evaluation (can take
place at annual review the year before or a newly scheduled meeting), plan what type of evaluation you want (A, B, or
C), and get permission. Once evaluation is complete, schedule meeting, review results and dismiss.
JCPS has made the decision that ALL students need a determination of eligibility form when evaluating or reevaluating
regardless of what the actual form says. If a student comes in with an eligibility form they must leave with an eligibility
form.
Developmental Delay….if the child qualified as DD using “communication” as one of their qualifying areas you must do
a complete DD re-eval in order to consider dismissal from speech/language services. Best place to find this information
is in the conference summary and on the determination of eligibility on IC
EVALUATIONS/REEVALUATIONS
Minimum of 2 behavior observations for initial evaluations or Type C reevaluation
On the evaluation planning form—form states “assessment” Merriam Webster dictionary defines assessment as the
act of making a judgment about something : the act of assessing something
Interventions must be done. They need to be research based interventions, data driven, and data collect must be in
graph format with an analysis statement. Interventions must be done for a reasonable amount of time. It is your
responsibility to provide to the teacher. It is the teacher’s responsibility to implement them.
There are times, particularly with K-12 non pubs, that they may pass a screening and no SLP is at the meeting but the
committee and discussion leads to the decision to request testing.
OTHER IMPORTANT FACTS
Remember 60 day time lines
Conference summary is important—make sure it has everything you want and need
It must be stated in the conference summary how the student will be given access to the missed content material
when coming for speech/language services
Determination of eligibility form has different types of language disabilities—use your professional judgment
Students must receive services if they are in ISAP, STOP, etc
Speech only students who have behavior issues must follow the same guidelines as all special education students with
regard to suspension, behavior intervention plan, functional behavior analysis, manifestation of disability, etc.
Present levels need to have strengths, weaknesses with base line data, discussion with percentages of current goals,
adverse impact statement
Methods of Measurement will include authentic, direct, indirect, and can include curricular
Your graph will need to have an analysis statement
Graphs with statements will be attached to the IEP for which it is associated in IC
Referral must be completed for all students you are going to evaluate—even speech only students need a referral
Determination of Eligibility Form (supporting evidence section): list your tests with their standard scores, brief summary of
behavior observations, list of non-standardized assessments, and please include your adverse impact statement. You can have
this information drafted but the checks and determination of eligibly must be done and take place in the actual meeting.
Least Restricted Environment:
Special Education this will be where you put pull out sessions
Co Teaching/Collaboration if you are going into the classroom it goes here
Regular Education here is where you list the regular ed info
Listing of services (matrix under LRE) Special Education—when a student is speech only Related Service-when student is
speech plus
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SPEECH LANGUAGE REQUIREMENTS FOR INITIAL ASSESSMENTS AND REEVALUATIONS
INITIAL EVALUATION TYPE C REEVAL
ON TIME REEVALUATION TYPE B
ON TIME REEVALUATION TYPE A REEVALUATION WHEN POSSIBLY ADDING ANOTHER DISABILITY AREA
Based on current referral and evaluation planning form:
Standardized assessment
Informal assessment data
TWO behavior observations*
Documentation of adverse academic impact
Based on current evaluation plan an “X,E” would be in a section under communication status
Formal assessment (can be a subtest of a board based assessment
Analysis of progress data
Documentation of adverse academic impact
Based on current evaluation plan an “E” would be in a section under communication status
Analysis of progress documentation
Documentation of adverse academic impact
This would be an initial evaluation for the “new” area of disability and yours would be a “reeval” as the student is currently identified as a “speech only” student Based on current evaluation plan: If “X: is checked under communication status consider it a Type C or Type B reeval (see conference summary to determine which type) If “E” is checked under communication status consider it a Type A reeval
FORMS FORMS FORMS FORMS
Communication Written Report
Appropriate Assessment Summary Report
Appropriate Severity Rating Scale (Matrix)
Determination of Eligibility
RAR
Communication Section of ReCes
Determination of Eligibility
Communication Section of ReCes
Determination of Eligibility
If “X” is checked: follow procedures for Type C or Type B as listed in this document If “E”:
RAR
Determination of Eligibility
ADDITIONAL INFO ADDITIONAL INFO ADDITIONAL INFO ADDITIONAL INFO Behavior
observations can be on the communication behavior observation form, or uploaded and attached to your CWR, or within the body of the communication written report under the header “Behavior Observations”
If pragmatic language is checked on the evaluation plan, you must completed a dedicated pragmatic language assessment
This situation would typically happen when a student is placed as a speech only student and there are now other areas of concern. This process will keep the timelines current on all areas of disability. For a speech only student who is being referred for an additional area that is still under the communication umbrella, if an E is placed in the old area and an X for the new area, integrate progress information into the CWR that is written for the new area.
If a student has an identified disability of DEVELOPMENTAL DELAY and you request an early reevaluation based on progress on communication goals, a total reevaluation in all areas that student is eligible for developmental delay is warranted.
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Orofacial Screening Profile Name: ________________________________________
Birthdate: ____________________ Age: __________
Head Size: Normal Suspect
Examples: Macrocephaly Microcephaly Facial Symmetry: Normal Suspect
Examples: *Hemifacial Microsomia *Craniosynostosis Hair & Skin: Normal Suspect
Examples: Sparse Hair Course Hair White Forelock Hypo/Hyper Pigment Ears: Normal Suspect
Examples: Abnormal size, shape, or position Skin Tags Microtia Ear Pits Eyes: Normal Suspect
Examples: *Colombo Hypertelorism Proptosis Eye Slant Nose: Normal Suspect
Examples: *Bifid Nasal tip Nasal Asymmetry Lips: Normal Suspect
Examples: *Cleft Lip *Lip Pits on Lower Lip *Notch in Upper Lip Alveolus & Teeth: Normal Suspect
Examples: *Cleft Alveolus *Notch in Alveolus Missing Teeth Maxillary Hypoplasia Tongue: Normal Suspect
Examples: *Bifid *Hamartomas Hard Palate: Normal Suspect
Examples: *Cleft of Hard Palate High Vaulted Palate Notch in Posterior Palate
Soft Palate: Normal Suspect
Examples: *Cleft of Soft Palate *Bifid Uvula Wide, Flat Uvula Fissured Uvula Faucial Pillars: Normal Suspect
Examples: Webbed Pillars Lower Jaw: Normal Suspect
Examples: Micrognathia Prognathism Neck: Normal Suspect
Examples: *Webbed Neck *Branchial Cysts Skeletal Abnormalities Hands: Normal Suspect
Examples: *Syndactyly Polydactyly Brachydactyly Palmar Creases Speech: Normal Suspect
Examples: Hypernasality Nasal Air Escape Compensatory Articulation Nasal Turbulence Nasal Grimacing Stature: Normal Suspect
Examples: Undergrowth
COMMENTS: *Suggests need for genetic referral (even when this is the only sig Evaluator (sign): ___________________________________________
Date: _____________________________________________
Refer for genetic counseling
Referral not warranted at this time
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Craniofacial Nerve Assessment Name: ________________________________________
Birthdate: ____________________ Age: __________
CRANIAL NERVE PHYSIOLOGY LOOK FOR/LISTEN FOR COMMENTS
Olfactory I Sensory/Smell C/O loss of smell Affected by allergies
Optic II Vision Loss of vision Visual field defect
Occulomotor III
Motor nerve fibers to eyelid and ocular muscles
Eye lateralization and medially (look at nose);
Ptosis of eyelid(s)
Dilated pupils
Diplopia
CNs Class III maxillary/mandibular relationship, This is the initial visit to this clinic., and VI control eye muscles. May wear eye patch.
Trochlear IV Superior oblique muscles in the eye
Eyes move down and to side.
Diplopia
Trigeminal V
Mastication, jaw movement Tensor veli palitini of soft palate
Unilateral: Jaw deviates to weak side.
Bilateral: Jaw open or cannot clench teeth.
Loss of muscle tone in the floor of mouth. One intact side is sufficient.
Abducent VI Lateral rectus muscle of eye Turns head rather than
lateralizing eyes.
Diplopia
Eye pulls toward nasal side.
Facial VII
Motor: Facial muscle tone Sensory: Taste – anterior ⅔ of tongue
Distorted /p/ & /b/
Flattened nasolabial fold
Drooping of corner of mouth
Incomplete closure of eyelid(s)
Evaluate three branches: Mouth, eyelids, and forehead. Elevate eyebrows, close eyes.
Vestibulocochlear VIII (Auditory)
Hearing Equilibrium
Poor sound localization
C/O tinnitus
Incorrect repetition of sounds or words
Unsteady Gait
Finger rub. Test sound/word/sentence repetition with speaker’s mouth covered and uncovered.
Glossopharyngeal IX
Sensory: Intrinsic branch to superior larynx, pharynx, and posterior ⅓ of tongue.
Lack of gag reflex
C/O choking
Wet-hoarse voice
Test left and right.
Vagus X
Pharyngeal: Motor to both sides of soft palate Superior Laryngeal Nerve (SLN): Motor to cricothyroid (CT); Sensory to lower pharynx. Recurrent Laryngeal Nerve (RLN): Motor to all other intrinsic laryngeal muscles. Sensory to vocal folds.
Hypernasality
Nasal air escape
Uvula deviates to intact side
Velum droops on impaired side
Diplophonia
Wet-hoarse voice
Swallow difficulties 2° loss of sensation
Breathiness
Aphonia
Weak cough
Accessory XI Supplies trapezium and sternocleidomastoid muscles.
Cannot raise shoulder Shrug shoulders, turn head side to side, weakness of neck.
Hypoglossal XII
Supplies tongue musculature. Distortions of lingual stops (/t/ & /d/) vs. sibilants.
Tongue tip deviates to weak side when protruded.
Atrophy
Fasciculations
Refer for neurological evaluation
Referral not warranted at this time
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Evaluator (sign): ___________________________________________ Date: ____________________________________________________
DIAGNOSTIC QUESTIONS
Do test scores support teacher’s/parent’s concerns?
Do area-specific test scores support findings of broad-based test?
Do non-standardized procedures fit with findings of standardized tests?
Do classroom observations verify that the problems reported by the teacher/parent and identified in testing occur, and do they occur in more than one educational setting?
Can the results of the evaluation be explained by factors other than communication abilities?
If pieces don’t fit, what further information do you need? Where can you get it? Have you double-checked test administration and scoring?
Is the pattern one of normal communication development? Delayed communication development? Disordered communication? Communication difference? Dialectal difference?
Is the pattern consistent with what you know of the student’s history?
What is the best fit between evaluation results and teacher/parent reports of concerns?
What is the specific impact of the disorder on educational performance?
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PARENTAL INFORMATION REGARDING
THE MEDICAL VOICE EXAM
STUDENT’S NAME: __________________________________________________________________ SPEECH/LANGUAGE PATHOLOGIST: __________________________________________________ SCHOOL: __________________________________________________________________________ A medical evaluation by an otorhinolaryngologist (ear, nose and throat specialist) is a required component of your child’s voice evaluation. This evaluation is necessary so that your speech/language pathologist can make appropriate decisions regarding voice therapy, and to ensure that there are no medical reasons to prevent your child from receiving voice therapy. If you have medical insurance or a medical card that will cover the cost of the examination without penalty to you (i.e., higher premiums, reduction of the lifetime cap, etc,), please consider having the physician bill your insurance provider. If, however, you want the Jefferson County Public School (JCPS) to pay for the examination, it is important to understand that the JCPS can ONLY pay for an examination to determine whether there are contraindications to voice therapy.
Jefferson County Public Schools CANNOT pay for
medical treatment or audiological (hearing) examinations. Hearing screenings are provided, free of charge, by the JCPS Health Services Program.
Please give the attached information sheet to the receptionist at the ENT’s office. I have read the above and understand that the Jefferson County Public Schools CANNOT pay for medical treatment or audiological examinations.
______________________________________ _____________________ Parent’s Signature Date
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Questions to Ask Parents of ESL Students
What language(s) is spoken in the home?
How many years has the student been in the U.S.?
How many years has the student been in an English-speaking school?
Can you, other members of the family and friends who speak the student’s native language understand
the child when he/she speaks (native language)?
Does the student pronounce words correctly in his native language?
Does the student speak his/her native language almost as well as you (parents) or his/her siblings?
Which language does the student speak and understand better…English or native language?
When did the child say his/her first words (in either language)?
When did the child say his/her first sentences (in either language)?
Does the student understand directions and stories when spoken in his/her native language
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Quick Clicks for JCPS Communication Assessment Report Forms
Log in to Infinite Campus
Under IDEX tab
Select Student Information
Select Special Education, General
Under SEARCH tab
Type in last name of student
Select name of student from list
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Choose DOCUMENTS tab
Select “New Document”
From menu select the form you wish to create
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Create New Plan for IEP or
Service Plan
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Create New Simple Form for any assessment form needed.
Demographic data should automatically fill in
Complete the form
Save
Select student’s name (from list on left) to return to “Documents”
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Primary Disability on Conference Summary and IEP
The logic for populating Primary Disability from the Conference Summary has been updated. The print of the
Primary Disability will now populate the most recently selected Primary Disability on the
Eligibility/Continued Eligibility Editor.
When a new Conference Summary is created before an IEP, Primary Disability will pull from the most recent
saved Conference Summary.
The Get Disability from Evaluation button on the IEP Enrollment Status Editor will pull the most recent
Primary Disability from the most recent saved Conference Summary.
NOTE: Conference Summary does not have to be locked for the new Primary Disability to populate on the
IEP using the Get Disability from Evaluation Button.
Primary Disability: Click ‘Get Disability
from Evaluation’ button to auto-populate the Primary Disability as Read only from student’s Conference Summary | Eligibility/Continued Eligibility Editor.
NOTE: Special education data
should be populated using the ‘Get Disability from Evaluation’ button. Data for IDEA December
1 Child Count will populate from this editor.
DO NOT use “Get Special Ed
Status from Enrollment”
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Summary Components
REASON FOR REFERRAL: Should state child’s name, referring person, and primary concern for which
child was referred as well as response to interventions. (e.g. John Doe was referred for a complete speech
language evaluation by his teacher because she was concerned about his difficulty expressing his thoughts
clearly and his immature expressive language. Language interventions completed in the classroom focusing
on sequencing (50%) and sentence formulation (62%) did not improve John’s performance to a significant
degree.)
DIAGNOSIS: Statement of severity and type of disability. Include current information from outside agency
reports, if available. (e.g. Results of standardized and non-standardized assessment indicate a moderate
expressive language disorder.)
STATEMENT OF STRENGHTS AND WEAKNESSES: (e.g. John demonstrated average listening and
comprehension skills with particular strengths in picture vocabulary, auditory discrimination, and appropriate
use of word endings. Relative weaknesses ere noted in naming vocabulary, word finding , and use of basic
concept words. Significant deficits were noted in formulation of complex sentences, sequencing of ideas
verbally and in writing and story retelling).
DESCRIPTION OF TEST BEHAVIOR AND RELIABIITY OF RESULTS: (e.g. John was cooperative
during the testing situation and the results of the assessment are felt to be an accurate estimate of his language
abilities.)
SUMMARY OF OBSERVATIONS AND INTERVIEWS: Should include a statement of confirmation or
denial of test results as well as impact on classroom performance. (e.g. Classroom observations, work
samples, and teacher interview confirm the presence of an expressive language disorder that negatively affects
John’s ability to participate effectively in classroom discussions, express ideas verbally, and to use language
to facilitate problem-solving.)
57
ECE Database Update Worksheet for Infinite Campus Program
Student Name: DOB: ARC Date: Student ID#:
JCPS School:
Private School:
Referral Meeting or Meeting to Review Reevaluation Needs
Student Information > General > School Enrollment > Special Ed
Status: Active/Referred Referred NO CHANGE IN STATUS REQUIRED FOR ROUTINE 3-YR REEVALS
Student Information > Special Ed > Documents Tab > Create a New Form labeled Eval and Elig Data
Eval Type: Initial Reevaluation – Add. Info Needed Reevaluation – No Add. Info Needed
Consent Date: ______________ (Date parent signs IDEA-3 – Parent Consent for Evaluation/Reevaluation
Eligibility Meeting
Student Information > General > School Enrollment > Special Ed (IF ELIGIBLE, Status of Active will be entered in IEP and Service Data)
Status: Not Eligible Eligible – Parent Refused and Date Eligible but Refused: ______________
IF ELIGIBLE, Status of Active will be entered in the IEP and Service Data Editor.
Student Information > Special Ed > Documents Tab > Open Existing form labeled Eval and Elig Data
Eligibility Date: ______________ (Date ARC determines student eligible for services/ or continued services.)
IEP Meeting
Student Information > Special Ed > Documents Tab > Create NEW form labeled IEP and Services Data
Date of ARC: ____________ Type: Initial Annual Adopted from Another District
Start and End Date if different from default dates: Begin: ____________ End: ____________
Primary Disability: Code Description Code Description 01 Mild Mental Disability 02 Functional Mental Disability
04 Hearing Impairment 05 Speech or Language Impairment 06 Visually Impaired 07 Emotional-Behavioral Disability 08 Orthopedically Impaired or Phys. Dis. 09 Other Health Impaired 10 Specific Learning Disabled 11 Deaf-Blind 12 Multiple Disabilities 13 Autism
14 Traumatic Brain Injury 15 Developmental Delay
Secondary Disability: _____________________ _____________________ _____________________
Enter in Student Information > Special Ed >Custom Tab
Note: Designate Secondary Disability(ies) or the components of Multiple Disabilities. If more than one secondary, add additional disabilities in the Custom Tab.
Status: Active Active/Referred
LRE Codes: For 6 to 21 For 3 thru 5
(Circle Correct 6A 80% or > Regular Education 3A 80% or > Regular Education Code) 6B 40 to < 80% Regular Education 3B 40 to < 80% Regular Education
6C < 40% Regular Education 3C < 40% Regular Education 6U Separate School 3U Separate School 6H Homebound/Hospital 3X Home 6I Correctional Facilities 3P Service Provider Location
6J Parentally Placed in Private School Completed by: _______________________________________________ Phone: _______________________
Note: Category should not change unless ARC made an eligibility decision.
Remember to Mark Eval and Elig editor as Completed following data entry.
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Modifications for Assessments: Readers Scribes Paraphrasing Reinforcements & behavior modifications strategies Prompting/cueing Use of Technology Manipulitives Braille Interpreters Extended Time
Other: ________________________________
Alternate-Assessment System: (If ARC has determined that student will be completing the Alternate-Assessment)
Student Information > Special Ed >Custom Tab Performance Dimension A Performance Dimension B
Special Education Services
Type: Spec Ed – Collaboration Spec Ed – Pull Out Beginning Date: ___________ Ending Date: ___________ Service Minutes: _______________ Frequency: Daily Weekly Per 2 week period _______________
Type: Spec Ed – Collaboration Spec Ed – Pull Out Beginning Date: ___________ Ending Date: ___________ Service Minutes: _______________ Frequency: Daily Weekly Per 2 week period _______________
Related Services
01 Adaptive P.E. 02 Assistive Technology Services 03 Audiology 04 Counseling Services 06 Hearing Impaired Services 07 Interpreter Services 08 Medical Services 09 Occupational Therapy 10 Parent Counseling and Training 11 Physical Therapy
12 Psychological Services (Evaluation) 13 Psychological Services (Other) 14 Recreation 15 Rehabilitation Counseling 16 Social Work Services 17 School Health Services 18 Speech/Language Therapy 19 Transportation (No Lift) 20 Transportation (With Lift) 21 Visually Impaired Services
22 Orientation & Mobility Services for VI Students 23 Feeding Methods 24 Toileting/Bowel/Bladder Services 25 Respiratory Assistance 26 Medication (Other Than Oral) 27 Other Health Procedures 28 Emergency Plan Of Action 30 Travel Training
Rel Service 1: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 2: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 3: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 4: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 5: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 6: _________________
Begin Date: ________ End Date:_________
Service Minutes: _________(Time)
Freq.: Daily Weekly Per Month Per Semester Other (List)____________
Rel Service 7: __________________ Beginning Date: ____________ Ending Date: ____________
Service Minutes:_________ (Time) Freq.: Daily Weekly Per Month Per Semester Other(list) ___________________
Meeting to Exit from Special Education Student Information > General >School Enrollment > Special Ed
Status: Inactive Note: Do not delete any of the other information such as Disability, LRE, etc.
Special Ed Exit Status: Transferred to Regular Education Maximum Age Graduated with a Diploma Cert. of Attainment
Special Ed Exit Date: _______________ (Date of release or exit.)
Student Information > Special Ed > Documents Tab > Open New or Existing form labeled Eval and Elig Data Eligibility Date: ______________ (Date ARC determines student eligible for services/ or continued service Eval Type: Reevaluation – Add. Info Needed Reevaluation – No Add. Info Needed
Remember to Mark IEP and Services Data editor as Completed following data entry.
59
INDIVIDUAL
EDUCATION
PLAN*
ANNUAL REVIEW
3 YEAR REEVAL
*Please refer to your IEP Guidance Document and Speech Language Newsletter 7-14-14 for Specifics
60
STAPLING PROGRESS DOCUMENTATION TO ASSOCIATED IEP
1. Save graph as a PDF (should be a choice) and save on your desktop or in documents folder.
2. On Infinite Campus, find student and go to student information, then special education, then
documents
3. Look on top in the yellow section on the far right & click “Upload Document”
4. Assign a name (ex. M.Weedman,S/L Data Analysis Graph)
5. Under date, type in meeting date.
6. Under comments, skip
7. For Document File Path, browse to find the PDF of the student’s data graph on your desktop or in
your documents.
8. Under Organization options, check the box “staple to existing form”
9. Select IEP DATA IS ASSOCIATED WITH to attach
10. On the top left in the yellow area, click save
**You will know it attached if you go back to documents and look at the IEP plan the data is associated with
and see a small + next to it. If you click on that you should be able to see your data graph listed.
61
Annual Review Procedures
Continuing students:
1. SLP will complete/compile data (progress data, probe data, graph with data analysis statement.) to
document progress and to substantiate recommendations.
2. SBARC (School-Based Admissions and Release Committee) chairperson notifies parent of
SBARC meeting.
3. Progress and recommendation are discussed at the SBARC meeting.
4. An IEP (or Service Plan for non-public students) is developed.
5. A summary of the meeting is documented.
Students being considered for release from ECE services:
(prior to the 3-year re-evaluation date)
SLP analyzes current data and conferences with teacher and parent
SBARC chairperson schedules SBARC meeting and notifies parent.
Progress data and present levels of performance are documented on the Conference Summary and
an Evaluation Planning Form is completed, parent signs Permission to Evaluate Form. Depending
on the time frame and date of current IEP, a new IEP may be written.
After SLP completes evaluation, a second meeting is held to discuss results and determine if
student is or is not eligible for continued services.
Please refer to the
JCPS Exceptional Child Education Policies and Procedures Manual
for more detailed information on this subject.
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Considerations for Release from Speech Language Services
A student should be considered for release from speech language services when one or more of the following
occur:
The student has met all speech and/or language objectives on his/her IEP, and no additional concerns in the
are of communication are presently noted.
The parent requests release and/or revokes consent for services. NOTE: If ARC committee members believe
release form services will be educaitonaly detrimental to the student, the ARC should consult with their
liaison to consider appropriateness of due process proceddings.
Specially Designed Instruction (SDI) no longer results in measurable benefits, despite documented use of a
variety of appriorpriate approaches and/or strategires
Student has developed compensatory/functional skills that llow him/her to access the general curriculum and
to participate within his/her educational program.
Student’s deficit areas can be managed through classroom accomodations and/or modifications.
Student’s deficit areas can by managed by another service provider (S/L is no longer needed as a related
service).
The student no longer needs speech language therapy as a rimary or related service in order to access and/or
pariticipate in the general curriculum.
Note: Before a student is released from services and determined to no longer be a child with a disability
under IDEA, the LEA must re-evaluate the student according to state and local reevaluation procedures.
A reevaluation is not reuqired if the student is graduating with a regular high schol d oploma or if the student
has exceeded the age of eligibilyuty for FAPE under state law.
The ARC may consider “suspension” of services for a brief period of time, due to special circumstances
during which thime speech langauge services may be contraindicated (i.e., following palatal surgery, during
serious illness, during extensive orthodontic work). Documentation of the ARC decision to suspend services
should be made on the Conference Summary form. An ARC must be re-convenend prior to re-instatement of
services.
The ARC must document all discussion, data, and evidence used to reach the decision to release a student
from services. (It is suggested that the ARC Conference Summary form be used for this purpose.)
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Non Public School
Students
64
Referral and Evaluation of
Non-Public School Students
Students who attend non-public schools in Jefferson County and who meet the Kentucky Eligibility Guidelines
for Speech or Language Impairment- Revised may receive speech-language services through JCPS. This includes
students in parochial, private, and special schools as well as those students who are home-schooled and
preschoolers who attend non-approved preschools/daycare centers or who do not yet attend school. The
procedures for identification, referral, assessment, placement and service delivery for these students are
outlined below.
Identification and Referral (Preschool):
Preschoolers in non-approved sites or who are not yet in school are typically identified and referred through
the Early Childhood Special Services Program. If you receive an inquiry about one of these preschoolers,
please refer the parent to 485-3979 to obtain a referral packet and information.
Identification and Referral (K-12):
Parents or teachers of a non-public school student suspected of having a communication disability should contact
the Speech-Language Office to begin the referral process. When the completed referral is received, a
speech-language liaison will schedule an ARC (Admissions and Release Committee) meeting to review
the referral. The meeting is typically held at the student’s home resides public school. The public school
SLP, the parent and the student’s comprehensive program teacher are invited to the meeting. The speech-language
liaison or a placement specialist acts as chairperson for non-public students until they are placed for ECE services.
Evaluation (Preschool):
Typically, preschool evaluations are conducted through the Early Childhood Diagnostic Center for
preschoolers in non-approved sites or who are not yet in school, although special circumstances sometimes necessitate
assignment for evaluation to an SLP who is not assigned to the Diagnostic Center.
Evaluation (K-12):
The home school SLP receives a copy of the IDEA-3 (permission for testing), the IDEA-5 (ARC
meeting summary) and a cover letter with a due date for the report and any other documentation that is
needed for the evaluation.
The SLP conducts a complete evaluation* according to the Kentucky Eligibility Guidelines-Revised, including
standardized, norm-referenced assessments, non-standardized, curriculum-based measures, two classroom
observations, and teacher/parent/student interviews.
The SLP completes a Communication Written Report, including appropriate assessment summary forms.
Three 3 copies of the completed report are sent to the Speech Office. The SLP keeps one copy of the report,
and all test protocols, behavior observations, interview forms, etc. until the placement meeting.
The ARC chairperson (typically, a speech-language liaison) schedules a meeting at the student’s home resides school
(or cluster school) to discuss the test results and determine eligibility. If appropriate, a Service Plan
65
(“IEP” for non-public students) is developed at the meeting. The SLP should come to the meeting prepared
to present assessment results, discuss eligibility and to develop appropriate IEP/Service Plan goals and
benchmarks.
ARC decisions regarding goals/benchmarks, type of services needed, and amount of time for ECE services
are driven by student need. Eligible non-public students are not denied services nor placed on a waiting list.
At no time should an SLP suggest that he/she does not have room to serve a student who is eligible for
services. Parents can be contacted at a later date (within a few days) regarding the implementation of
services if adjustments need to be made in the SLP’s schedule or if another site is necessary. The
speech-language office will assist in this process, when necessary.
Once services have been scheduled, the SLP provides services according to the Service Plan. The home
resides counselor acts as chairperson for the annual reviews and any other SBARC meetings that may be
needed. Procedures for these meetings are the same as for public school students in that building. The
non-public school teacher must be invited to SBARC meetings.
* Any part, or all, of the evaluation may be conducted at the student’s non-public school. However, in
the interest of time and scheduling, it is often efficient to make arrangements for the parent to bring the
student to the SLP’s school for initial evaluation. Classroom observations should be conducted in the
child’s regular classroom.
Remember: Eligibility for ECE services if determined by the ARC. The SLP should not discuss recommendations
and eligibility decisions outside the ARC meeting.
66
Service Delivery for Non-Public School Students
1. Home school policy
The ECE department follows the JCPS student assignment plan when determining service sites for
non-public school students. Non-public school students are served at their home resides school
(or cluster school) unless a transfer has been requested and approved by the speech-language office
(due to JCPS transportation or school staffing concerns). If the student resides out-of-county, the
service location is typically determined by the address of the school that the student attends.
2. Transfer requests
Transfer requests are handled through the speech-language office only. SLPs may NOT give parents
permission to take their child to another school for services, nor agree to serve a child at their
non-home school unless the request has been approved by the speech-language office (in writing).
3. Age-appropriate settings
Non-public students are served in age-appropriate settings. Students in preschool through 5th grade
must be served in an elementary school. Students in 6th - 8th grade are served in middle schools and
students in grades 9 – 12 are served in high schools. Students in ungraded schools
(i.e. Meredith-Dunn, Summit Academy, etc.) must follow the same age guidelines as JCPS students.
SLPs should contact the speech-language office at the end of the school year (prior to a student’s
transition to the next level) so that the new home school can be verified.
4. Scheduling
Non-public students may be scheduled at any mutually-agreed upon time within the SLP’s regular
work day. This includes, but is not limited to, a later afternoon (2:30-3:00, 3:00-3:30) time slot.
However, if JCPS is providing transportation, services must be scheduled to begin no earlier than
9:30 a.m. and to end no later than 1:30 p.m. Once a schedule has been agreed upon, the SLP must
fax the Transportation Request Form to the JCPS Transportation office (fax numbers are on the
form). The speech-language office, counselors and parents are not responsible for arranging bus transportation.
After confirmation of travel arrangements, the SLP should notify the parent and
the child’s non-public school when transportation is to start.
5. Schedule changes
When SLPs are absent or unable to meet with a non-public school student at their scheduled time,
they must:
notify the parent
notify the student’s school
notify transportation
If the parent must cancel therapy, the parent (or the child’s non-public school) is responsible for
canceling the bus. Parents and the non-public schools should have the contact information for
the driver and/or bus compound. Unlike public school students, it is often difficult to re-schedule
non-public school students, therefore, it is strongly encouraged that SLPs make every effort to please
keep scheduling conflicts and cancellations to a minimum and to communicate well with the parents
of non-public school students.
6. Reviews and records
67
After initial placement, the responsibility for coordinating annual reviews and re-evaluations of
non-public school students shifts to the local school ARC chairperson and SLP. Distribution of
paperwork resulting from these meetings is the same as for public school students served by that
school, with one exception.
Also, it is very important that the SLP notify the speech-language office when a non-public school
student is released from services, moves, enters a public school or transitions to another level
(i.e. elementary to middle school).
7. Checklist for the Beginning of the School Year
Contact parents of non-public school students served last year.
Establish a schedule and arrange transportation if needed.
Contact speech office if student has moved or if you are unable to locate the student.
Shared time attendance reporting may be required. As of 9/9/08, we are awaiting more
detailed information about reporting attendance (i.e., may be done through Infinite Campus).
Additional information regarding shared time reporting will be sent to SLPs as appropriate.
8. Checklist for the End of the School Year
Notify parents if student will be served at a different school next year (i.e. middle school
instead of elementary school).
Invite the receiving SLP to a transition meeting to discuss the student’s needs
(or make arrangements to consult with the receiving SLP via phone, e-mail or written
communication; see Student Information for Transition form in this Technical Assistance
Manual).
Place speech-language folder inside the student’s SBARC folder. Make certain that the
folder is clearly marked “Non-Pub Student.”
Important: Do not send records to the Speech-language office, unless specifically
requested to do so.
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Request for Transportation
Private School Students
Request for Transportation Private School Students
Date: Fax to: Transportation Office Fax: 3729 Sheila Bryant Teacher/SLP: Phone: School: Fax:
Student Name: DOB: Home Address: Age:_____ Grade: ______ Parent Name: Phone Number: @ home @ work Transport From: To: Address: Phone Number: Student will Receive Services: Service Day(s): Time: (arrival time) (departure time) Date to Begin Services: Services must be scheduled between 9:30 AM and 1:00 PM. The student must leave your
building by 1:30 PM if receiving two-way transportation.
69
SERVICE LOGS
70
School-Based Health Services
(Medicaid)
The school District can be reimbursed for school-based health services provided to Medicaid
eligible children who are being provided an appropriate education as described in the IEP.
These services include nursing, audiology, speech/language, occupational therapy, mental
health, incidental interpreter, transportation, orientation and mobility.
Currently all speech language students are documented using our online logging system,
EasyTrac. We currently have a company, PCG, determines which students are Medicaid
eligible and which services and particular treatments can or cannot be billed.
Service logs should be printed at each annual review meeting and at the end of each school
year. They no longer need to be signed as all SLPs have an electronic signature on file.
FAQ’s Regarding Service Logs for Medicaid Submission
Service logs should be completed by the following Monday of the week of treatment. At no time should any
SLP be 3 weeks behind in logging treatments.
What to log:
evaluations that result in an IEP with billable services.
direct therapy (service provided directly to the student in an individual or group setting, including
instruction in use of AT)
ARC meetings
compensatory education (if applicable)
services provided by students and substitutes (they will have their own log in
What not to log:
time spent writing Service Logs, progress notes, writing notes to parents, designing
communication boards, etc.
therapy time that exceeds the time specified on the IEP, unless the extra time is scheduled to make
up a "missed" session and this is noted on the log
S/L screenings (because screenings happen prior to referral)
services provided when that service is not indicated on a student’s IEP
planning time
services provided during a period of time when an IEP is out-of-date
time spent walking a student to-and-from therapy
services provided to students past the age of 21 years
71
Additional Information
We do NOT change the type or amount of service that we provide to any student just because
they are Medicaid-eligible. Type and am ount of service is based on the student’s educational
needs under IDEA, not based on eligibility for Medicaid.
You are not required to state accuracy levels (ex., percentages correct) for every session,
however, there must be evidence of periodic progress monitoring. Our district suggests that
data be taken two times per grading period (6 weeks).
We collaborate with other agencies/private providers (as long as the parents have given us
written permission to do so). If a student is receiving therapy at school and is also getting
therapy at a private site after school, both sites may bill Medicaid IF the service delivery times
are different and treatment is for different reasons (i.e. education therapy vs. home and
community functioning).
Service Logs can NOT be released to outside agencies without parent consent.
72
EasyTrac Logging System Information
https://go9.pcgeducation.com/kyjefferson
Link to our
EasyTrac
Your
personal
log in
“Wizards” for
setting up caseload,
logging services,
running reports, &
progress
monitoring
73
Message
Center-look
here for
important info
Files to print-yours as well as “how to” handouts regarding the system
74
75
EasyTrac™ School Based Health Services Documentation
Quick Reference Card To Log In Connect to the Internet
Start your web browser
Enter URL (web address)
o https://go9.pcgeducation.com/kyjefferson
Enter your:
o User Name: firstname [space] lastname (not case sensitive)
o Password: PCG will provide a randomly generated password for your first login. Once you have logged in you make your password
unique by using the "My Info" tab. Your User Name will always be the same.
All EasyTrac™ information is confidential. The server uses Secure Socket Layer (SSL) technology to encrypt information as it is transmitted over
the Internet. Please adhere to the following security procedures:
o Keep your account name and password secure at all times
o Do not save or send information on an unsecured computer
o Always log off of EasyTrac™ and close your browser when finished
My Info The first time you log in to EasyTrac™ please click on the "My Info" tab to change your password. Passwords are case-sensitive and should be
kept secure at all times. Update your personal information including your title, work phone number and email address. This
information is important so that we can communicate via the
Message Board.
Main Menu/Message Board When you first log in you will see the main menu of the site. The Message Center can be used by your district and Public Consulting Group to post
messages and add information regarding updates or scheduled site maintenance. The Document Library at the bottom of
the page will have school district and PCG reference materials that you can download.
The Message Board is the most secure way to ask questions, give suggestions, or report issues. These links are found at the top of the Main
Menu. Simply click on the blue hyperlinks and fill out the information required. Due to HIPAA requirements please use the message board when
needing to exchange confidential information. DO NOT use email to send us student information.
It is important to keep your "My Info" up-to-date as we will reply to your Message Board questions using that contact information. When we reply
to your message, you will receive an email indicating that there is a "New Message" in your EasyTrac™ mailbox. Sign on to EasyTrac™ and
click on the envelope to the right of the “Message Center” banner to read our reply.
To Set Up Your Caseload The “Caseload Setup Wizard” provides a quick way to adjust
caseloads in EasyTrac™. Click on the “Wizards” tab from the main menu and select the “Caseload Setup Wizard”.
To add students to your caseload:
Click on the "Add more students to caseload" button
Search for the student(s) you would like to add to your caseload. For best results, keep the search as broad as possible.
Click on "View Students".
Check the IEP Team button next to the student(s) you would like to add to your caseload (you do not need to select the "Case Manager"
button).
The related service you provide will automatically be selected on the right side of the screen (i.e. Speech, OT, etc). Do not uncheck this
box.
Click "Add Students to Caseload".
The students will be added to your caseload along with the related service you provide.
To remove students from your caseload:
Click on “Wizards” and choose "Caseload Setup Wizard" Uncheck the IEP Team or Case Manager check box next to the student(s) you
would like to remove from your caseload.
Click the "Update the Database" button. This will remove all of the students you selected.
To Document a Service Using Individual Logging Wizard The “Logging Wizard” provides a quick way to log multiple
services per student on a monthly basis. You may also have a monthly services logging wizard for Medicaid eligible students only.
Click on the “Wizards” tab.
Click the “Service Logging Wizard”. Your caseload will appear.
All students will be checked.
You may log services for all students or click “Check None” and select certain students and click "Continue".
On the drop down menu in the upper right of the page choose the month for which you want to document
76
Record the service for each student that you serve. Verify that you are logging a service for the correct student. Note: the student's name
is listed in Bold-Blue letters on the top of your window.
"Pre-fill" button - Clicking on this button will pre-fill the typical service information that may not change from one service to the next
such as "Service Type", "Group Size", and "Areas Covered/Assessed". This is designed to make the documentation process as efficient as
possible.
Make sure to fill out the “Date”, “Service Type”, “Duration of Service”, “Group Size”, “Progress Report”, any “Comments” you may
wish to add, and “Areas Covered/Assessed”.
After completing the documentation click "Add to Table" at the bottom.
The service will then appear in the table at the top of the screen in turquoise indicating that it is a newly entered log. The turquoise-
colored logs in this table can be removed until they are confirmed. If you need to remove the service click on the garbage can icon to the
left of the service and re-enter it. Note: if there is an error in the details of the service log, you must delete the entire log and re-document
the service.
Review the services you have entered into the table. If all of the information is correct you may select either: "Confirm newly entered
logs then allow me to enter more logs for this student" or "Proceed to the next student". Once the services are confirmed or saved they
appear with a gray background and cannot be deleted from the table on this screen.
You will notice that some entries on the table have a light gray background and some have a darker gray background. Logs that you have
entered and saved will be darker gray. Logs entered and saved by others will be lighter gray.
To Document a Service Using the Group Logging Wizard
Click on the Wizards tab.
Click on the ‘Wizards’ button from the “Main Menu” tab. Next, click on the "Group Logging Wizard". You may also have a group
services logging wizard for Medicaid eligible students only.
You should now see a list of students from your caseload. Select the students for whom you would like to log a group service. These are
students that you served in a group setting at the same time on the same day for the same amount of time. The student selection applies to
one group service log. Click the button at the bottom of the screen to continue.
Now select the group service information: date of service, service type, duration and/or start and end time, group size, and Areas
Covered/Assessed. The "Areas Covered/Assessed" selections on this screen should be those covered with the entire group. You will have
the opportunity to add or remove areas covered on the next screen if the selections vary from student to student. When you are finished,
click ‘Add Student Specific Information.’
Enter the progress, comments, and update the Areas Covered/Assessed if necessary for each student. Click the button at the bottom of the
screen to continue. Note: If a student is absent, instead of removing him or her from the group, “Student Not Present” should be selected
from the Service Type Dropdown menu.
The confirmation screen will allow you to review each service that is about to be logged. At the bottom of the page, there are three
buttons. ‘Yes, log these services’ will log all of the services. ‘No, I wish to abort this entry’ will cancel the entire group log. The ‘Edit
Log Entries’ button will return you to the page where the student specific information is entered allowing you to correct any errors.
How to View Services
Click on the “Generate Reports” tab.
Under the Drill-Down Reports Section, click on ‘Service Log Report’.
Select either “Date of Service” or “Date service entered into system”.
Select a date range for services you wish to view; enter a Start Date and an End Date.
Select the field to sort by, under Order the results by.
Click on the ‘Next’ button to continue.
Select a student by clicking on the student’s name (This will bring you to a list of the services you provided to that student during that
date range).
If you want to view the details of the service, including duration and comments, click on the View link to the right. If you want to view
the services for another student, click on the back button to bring you back to the student list.
Requesting That a Service Log Be Removed
Follow the instructions listed in the How to View Services section above to view your service log for a student.
Click the box under Request Removal for the log you wish to have removed.
Click ‘Update the Database’.
After clicking ‘Update the Database,’ you will be directed to the confirmation screen.
In the drop-down box marked, "Are you sure you wish to request removal of this service log?" Choose Yes to have the log deleted.
Type a simple reason for deleting the log in the text box and click on Request Log Removal.
After a log has been requested to be removed, viewing the log will display a red X in the Request Removal column, instead of the
checkbox. This will remain until the log has been deleted by PCG staff. You can now re-log the service.
Printing the Service Log History
Go to the Reports tab.
Select “Printable Service Report” Enter a date range of services to view.
Enter a student ID (leaving blank will print all students on your caseload).
If appropriate, select “Page break between students” Select “Generate Report”.
You will receive an email confirmation when the report has been generated.
The report will be delivered to your Reports Inbox tab where you can view it on the screen or choose to print it.
Important Things to Remember—always log out of the browser!
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RECORDS
ACCOUNTABILITY
TRANSITION
ESY
END-OF-THE-YEAR
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Checklist for ARC Meetings Prepare the following prior to the meeting:
___ IEP data recorded on current IEP*
___ Draft PLEP statement
___ Draft IEP goals/benchmarks (if needs speech)
___ Assessment report with appropriate addendums (for eligibility meeting)*
___ ReCES form or assessment report (for re-evaluation meeting)*
___ Draft eligibility form(s) (for eligibility/re-evaluation meetings)*
___ Graph with analysis statement**
_____ Print out of service logs from current IEP***
____ Current graph stapled to current IEP (not the draft) on IC
*Give originals to counselor at the meeting
**Please have 3 copies, one for counselor, one for speech folder, one for parent
***Please have 2 copies, one for counselor, one for speech folder
Purge the following at ARC meeting:
___ Protocols from assessments that are over 3 years old (this is optional; if you think the protocols provide
important information, you may keep them in the speech folder)
___ Extra copies of IEPs
___ Copies of IDEA forms; no need for these to be in the speech folder since the SBARC folder and central office
records file have copies
___ Psychological assessment reports (these should not be in the speech folder; they stay in the SBARC folder)
Do not purge:
___ Assessment reports, eligibility forms
___ Current IEP
___ Progress reports (report cards)
___ Current protocols (within last 3 years)
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Questions to Ask Yourself to Ensure
Appropriate Documentation of Needs and Services
Does PLEP include:
Current data (brief description based on current testing or progress notes)?
Brief description regarding specific areas of communicative concern?
What can child do (strengths), and under what circumstances?
What is the student unable to do (weaknesses)?
How does disorder impact the student’s education?
Baseline data
Do the goals match the PLEP?
Are there goals for each specified area of deficit on the PLEP? If not, is there a statement of priorities
within the PLEP or in the conference summary?
Do the benchmarks/short term objectives match the goal?
If, for example, the goal is word relationships, then all benchmarks should be related to semantics.
The benchmarks would not include syntax/morphology objectives.
Is there more than one benchmark per goal? If not, then the benchmark is actually an annual goal and
the SBARC should reconsider whether there is truly a need for services.
Are the benchmarks limited in scope, easy to replicate and measurable? If not, the benchmark may
include too many skills and should be broken down and written as 2 or more benchmarks/objectives.
Is SDI listed and appropriate to address the goal/benchmarks? (direct instruction in)
Do the Service Logs include:
Date of service?
Time in/time out?
Group/individual or number in group
Statement of what student did and their response to treatment?
Does the Re-evaluation include:
Current data/IEP data?
Information from both standardized and functional assessments?
Detailed summary of strengths/weaknesses and adverse effect?
Areas are checked as either “more information needed/not needed?”
Eligibility matrix completed at ARC meeting?
Do you have a graph with analysis statement?
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Transition Services “Transition services” means a coordinated set of activities for a child with a disability that:
(a) is designed within an outcome-oriented process, (i.e., a process that outlines how a student will achieve goals consistent with the general curriculum, as appropriate), that promotes movement from school to post-school activities, including post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation;
(b) is based on the individual student’s needs, taking into account the child’s preferences and interests; and
(c) includes: 1. instruction; 2. related services; and 3. community experiences; 4. the development of employment and other post-school adult living objectives; and 5. if appropriate, acquisition of daily living skills and functional vocational evaluation.
707 KAR 1:280, Section 1(55)
Transition services for children with disabilities may be special education, if provided as specially designed instruction or related services, and if required to assist a child with a disability to benefit from special education.
707 KAR 1:320, Section 6(3)
Student Age 14 (or younger, if appropriate):
Beginning at age fourteen (14), or younger if deemed appropriate by the ARC, the IEP for a child with a disability shall include a statement of the transition service needs of the child under the applicable components of the child’s IEP that focus on the child’s course of student. This statement shall be updated annually.
707 KAR 1:320, Section 6(1)
The purpose of the requirement for the consideration of transition service needs beginning no later than age fourteen (14) is to focus attention on how the youth’s educational program can be planned to help the youth make a successful transition to his or her goals for life after secondary school. The ARC, in determining appropriate measurable annual goals (including benchmarks or objectives) and services for a student, must determine what instruction and educational experiences will assist the student to prepare for transition from secondary education to post-secondary life.” (Federal
Appendix A, Q & A #11) The statement of transition service needs should relate directly to the youth’s goals beyond secondary education, and show how planned studies are linked to these goals. Student Age 16 (or younger, if appropriate):
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For a child beginning at age sixteen (16), or younger if deemed appropriate by the ARC, the IEP for the child with a disability shall include a statement of needed transition services for the child, including, if appropriate, a statement of the interagency responsibilities or any needed linkages.
707 KAR 1:320, Section 6(2)
Transition services for children with disabilities may be special education, if provided as specially designed instruction or related services, and if required to assist a child with a disability to benefit from special education.
707 KAR 1:320, Section 6(3)
Transition planning at this level requires a broader focus on coordination of services across, and linkages between, agencies beyond the District. If the ARC determines that a youth needs assistance from other service agencies to make a transition to post-school activities, the ARC chairperson/district representative invites potential service providers (e.g., Department of Vocational Rehabilitation, Department for the Blind) to be members of the ARC. If an agency, other than the LEA, (or state agency responsible for developing the child’s IEP) fails to provide the transition services described in the IEP, the LEA (or the state agency responsible for developing the child’s IEP) shall reconvene the ARC to identify alternative strategies to meet the child’s transition objectives set out in the IEP. 707 KAR 1:320, Section 6(5)
Alternative strategies might include the identification of another funding source, referral to another agency, the public agency’s identification of other district-wide or community resources that it can use to meet the child’s or youth’s identified needs appropriately, or a combination of these strategies. A participating agency shall not be relieved of the responsibility under IDEA to provide or pay for any transition service that the agency would otherwise provide to children with disabilities who meet the criteria of the agency.
707 KAR 1:320, Section 6(6)
Student Age 16 Through 18:
At least one year prior to the youth reaching age eighteen (18), the IEP will include a statement that the youth and his parents (§ 300.517 IDEA) have been informed of his rights under 707 KAR Chapter 1 and that rights will transfer to the youth upon reaching age eighteen (18). This notification will take place at the annual review meeting beginning when the youth is sixteen (16), and will be documented by the ARC on the IEP.
(From Exceptional Child Education Procedures, 2002)
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STUDENT INFORMATION FOR TRANSITION
“CONFIDENTIAL”
TO (receiving SLP): School:
FROM (sending SLP): School:
RE (check one): Transition to Kindergarten
Transition to Middle School
Transition to High School
Other:
DATE:
Student Name: D.O.B.:
Min./Week: Annual Review Date: 3 Yr. Re-Assess. Date:
Communication Disability (check all that apply):
Speech Sound Production and Use
Description/Progress:
Language
Description/Progress:
Voice
Description/Progress:
Fluency
Description/Progress:
Other Comments/Recommendations:
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Directions for Filing, Storing, Requesting and
Transferring Student Records
A speech/language folder must be completed, maintained and updated for all students receiving speech/language services. The speech/language folder must be housed in such a manner as to ensure confidentiality. The speech/language folder typically contains:
Communication Written Report
Appropriate Assessment Addendums
Individual Education Plan/Service Plan
Test Protocols
KY Eligibility Guidelines Rating Scale(s)
Service Logs
Progress Reports (“Report Cards”) The speech/language folder is typically purged of outdated information during each annual review meeting. However, the speech/language clinician may keep information within the speech/language folder for a period longer than 12 months, when needed. All purged information must be sent to the ECE Records Room at the VanHoose Annex. The speech/language folder should be housed within each student’s SBARC folder during the summer months to ensure both accessibility and efficient transfer. All pressure sensitive assessment reports and due process forms should be filed according to the key at the bottom of each form. Additionally, a copy of the following eligibility supportive documents should be filed in the student’s central office file in the ECE Records Room:
Developmental and Social History form
Behavior Observation form(s)
Teacher/Parent Interview form(s) Information regarding access to ECE student records, and procedures for requesting and transferring student records is available in section 9.0 of the ECE Policies and Procedures Manual. All other questions regarding student records should be forwarded to the Director of Pupil Personnel and/or the Coordinator of ECE Placement/Pupil Assessment.
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End-of-the-Year Checklist Records:
Hold annual review meeting for any student(s) whose IEP expires before October of the next school year
Complete outside of speech-language folders
Complete the Student Information for Transition form or contact the receiving SLP for students who are transitioning from preschool, elementary school or middle school
Print copies of electronic service logs electronically along with graphs and file in each student's speech-language folder before you leave for summer break
Send Progress Reports home for every student on your caseload (keep a copy in each student's speech folder)
Submit Service Logs and IEP for 2 Medicaid eligible students for peer review
File speech folders inside SBARC folders in the school office before you leave for summer break. *note some schools have a different way they like folders filed
Leave a list of all active speech students in a logical place so that next year, you or the new SLP will have a quick reference list for locating students.
Contact the speech office @ 3254 if you have specific questions regarding transition of non-pub. students (PK-12).
Do not send any speech or SBARC folders to the speech-language office unless specifically requested to do so **SLPs who have non pub PK folders that need to be returned to the speech office will be personally notified
Do not send any records to the ECE Records Room unless the student has been formally released from services (via an ARC meeting), moved out of Jefferson County, or the parent has formally declined services (IDEA-5)
Materials:
__ Return audiometer (for summer calibration) __ Store all assessment materials in a secure location before leaving for summer break (remember, if you are transferring to another school in the fall, assessment materials are to be left at your original school, they do not transfer with you
Follow specific instructions for storage or return of materials/equipment 'checked out' from the ECE Technology Center. If you are uncertain of these procedures, please contact Cathy in the speech office or Barbara in the Tech. Center.
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Other:
Register for summer in-services via pDCentral. If you find that you will be unable to attend a session that you have registered for, please go to pDCentral to “un-register” so someone else
can take advantage of the in-service opportunity.
Check pdCentral throughout the summer for documents/handouts that may be posted online for sessions you will be attending
If you move during the summer, be certain to provide Cathy (485-3254) with your new address, phone numbers, e-mail addresses, etc. Also, be certain to notify personnel (485-3229) of any changes to ensure that paperwork and paychecks are properly distributed during the summer months.
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MISCELLANEOUS
INFORMATION
AND
FORMS
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PROFESSIONAL CONFERENCE REQUEST FOR CEU and/or JCPS INSERVICE CREDIT
SLP: ___ School: ____ Name of Conference: Note: Sessions attended on Saturday and/or after school hours may be eligible for JCPS inservice credit. Weekday sessions after a completed 7 hour work day are eligible to be counted as inservice credit.
Please list or attach a copy of your registration receipt and ALL sessions attended.
Title
Speaker Date Time Hours
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total number of inservice hours requested:
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Professional Credentials July 2014
SLP with Teacher Certification:
“A speech-language pathologist employed solely by the public schools in a certified position who holds a
teacher certification in communication disorders issued by the Educational Professional Standards Board
shall be exempt from holding a licensed issued by the Kentucky Board of Speech-Language Pathology and
Audiology.” (HB002900.100-215)
Kentucky Teacher Intern Program (KTIP): The Kentucky Internship Program is an
internship program designed to provide assistance to new teachers. KTIP is similar to
(and often overlaps) the Clinical Fellowship Year required for initial certification by
ASHA. The main goal of the KTIP is to help new teachers (SLPs) experience a
successful first year in the classroom. All SLPs applying for teacher certification will
complete the KTIP.
To apply:
1. inform speech-language office of your intent to do the KTIP year
2. the personnel office will assist SLPs with their application, but generally:
a) new graduates complete the TC-1 form and have their university submit transcripts to the
Educational Professional Standards Board (EPSB), or
b) SLPs with a teaching certificate from another state complete the TC-35 form
3. submit Statement of Eligibility form (from KDE) to Personnel Office, if applicable (send copy to Speech Office)
4. attend KTIP orientation meeting (scheduled by principal)
5. complete all KTIP requirements
Teacher Certification Office (EPSB): 502-573-4606; www.kyepsb.net
SLP with KY License:
“A speech-language pathologist in a classified position who does not hold a teacher certification in
communication disorders issued by the Education Professional Standards Board shall apply for and maintain
appropriate licensure.” (HB001200.100-215)
KY Board of Licensure: 502-564-3296, ext. 223
Applications for KY Licensure can be found online (Laws and Regulations Relating to Licensure as a Speech-Language Pathologist or Audiologist: http://www.state.ky.us/agencies/finance/occupations/speechaudiology/index.htm)
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Speech-Language Pathology Assistant:
“A person who has a baccalaureate degree in the area of speech-language pathology or communication
disorders as defined by administrative regulation shall apply for an interim license as a speech-language
pathology assistant during the time that person is completing his or her professional experience as established
by the board by administrative regulation. Upon completion of the postgraduate professional experience, the
speech-language pathology assistant shall make immediate application to the board within 30 days for
permanent licensure,….” (HB002900.100-215)
(Laws and Regulations Relating to Licensure as a Speech-Language Pathologist or Audiologist:
http://www.state.ky.us/agencies/finance/occupations/speechaudiology/index.htm)
ASHA Certification (optional):
While not required for employment, all licensed and/or teacher certified SLPs are encouraged to apply for and
maintain ASHA certification
ASHA Action Center: 1-800-498-2171
Web: www.asha.org
The speech-language office will be happy to assist SLPs with supervision and mentoring as required by the
various credentialing agencies, or as needed for professional growth.
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EasyTrac™
ELECTRONIC DOCUMENTATION SIGNATURE FORM FOR SPEECH LANGUAGE PATHOLOGISTS
DISTRICT:_____________________________________________________________ I _______________________________________ (print name), Speech Language Pathologist, agree that the services supplied by me to students in DISTRICT:_________________________________ will be documented in the EasyTrac™ component of Public Consulting Group’s EasyIEP™ Internet-based tool. These services will be provided in accordance with each student’s Individualized Education Program (IEP) or as a result of a request for evaluation. All services will be documented under my personal name using my personally created password. Signature______________________________________________ Date_________________ Certification(s): Please complete all sections that apply
Credentials Yes/No Number
(if applicable) Date
Obtained Date
Expires
ASHA (CCC) Certification
Other
Local Education Agencies currently enrolled with Medicaid to provide health-related services are eligible to provide this service. Refer to the Basic Medicaid Billing Guide for information on how to enroll as a Medicaid provider. It is the responsibility of the LEA to verify that staff meet the qualifications listed in 42 CFR 440.110. A copy of this verification (current licensure or registration or online verification) must be maintained by the LEA. A speech-language pathologist:
a) meeting applicable requirements of 42 CFR 440.110, including the possession of a current Certificate of Clinical Competence from the American Speech Hearing Association (ASHA).
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Date_______________________ Dear Counselor/SLP:
Attached is the SBARC/Speech Folder for ______________________________
D.O.B.____________, a communication disordered (preschool-aged/school-age)
non-public school student. Please contact the student’s parents to make arrangements for therapy.
If JCPS transportation is needed, please schedule therapy between 9:30 and 1:00 and fax a
transportation request to the Transportation Office at 485 – 3729.
Attends School:______________________________________________
Home School:________________________________________________
Service School:______________________________________________
Parent’s Name (s):____________________________________________
Phone: (Home)______________________(Work)___________________
(Cell)________________________
Comments:______________________________________________________________________
_______________________________________________________________________________
__________________________________
Sincerely, ________________________ Speech/Language Liaison 485 - 3254
Due Within 30 Days
Immunization Certificate
School Medical Form
Copy of State-Issued Birth
Certificate
Vision Exam
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Professional Development Requirements for Teachers 14-15 Professional development is a facilitated learning experience that addresses instructional improvement for the school, district, or a group of teachers and supports the Board Goals, District Vision and Comprehensive Plan. While the district encourages staff to pursue their personal professional growth in various ways, staff should be aware that not all learning experiences result in professional development credit.
Requirements All certified teachers are required to earn a minimum of 24 hours of professional development credit (not stipend) (per KRS 158.070). Teachers who do not earn the required number of hours may be reported to the Kentucky Education Professional Standards Board. If a teacher chooses to take a personal/sick day on a district designated PD day, he or she must still earn 24 hours of professional development credit (not stipend) per contract year. Job-sharing teachers must each earn 24 hours of professional development credit (not stipend) per contract year. Part-time teachers (including retirees) must earn a minimum of 12 hours of professional development credit (not stipend) per contract year. Part-time teachers hired after the first semester (hired: Jan., Feb., Mar., Apr., May) must earn 6 hours of professional development credit (not stipend) per contract year. Teachers hired after the August non-flex day, but before the end of the first semester, must earn 18 hours of professional development credit (not stipend) per contract year. Teachers hired after the first semester (hired: Jan., Feb., Mar., Apr., May) must earn 12 hours of professional development credit (not stipend) per contract year. The 2014-15 professional development year begins June 14, 2014 and ends May 29, 2015. Please be aware that this date could change due to inclement weather or other board action.
Non-Flex and Flexible Credit The non-flex day (Aug. 12, 2014) is the only time teachers earn credit (6 hours) and are paid. The remaining 18 hours are earned as flexible credit. The flexible credit offerings must be scheduled: a. on non-duty time,
b. on the scheduled flexible professional development dates (October 3, February 27, May 1), or
c. a combination of a. and b.
Gold Days Gold Days are not included in the remaining 18 hours. The Gold Days (October 6 and November 3, 2014) are contract work days where teachers are paid salary and therefore MAY NOT receive credit. The district does not require schools to submit proposals and sign in sheets for Gold Days.
Silver Days Silver Days are not included in the remaining 18 hours. The Silver Days, which include Parent-Teacher Conference days, are extended days where teachers may be paid extended time and therefore MAY NOT receive credit. The district does not require schools to submit proposals and sign in sheets for Silver Days.
Important Reminders The district does not award professional development credit for earned hours of college credit. The district will grant twelve (12) hours per year for conference/convention participation on non-duty time. Conference participation must be approved by the supervisor and/or the school Professional Development Committee. A certificate of attendance must be submitted with the proposal form.
Professional Development Days Hours Needed Non Flex August 12, 2014 (Only
day you get paid & credit)
6
Flex October 3, 2014 12 Flex February 27, 2015 18 Flex May 1, 2015
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*Can find this form on Infinite Campus
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Blue SBARC folder-
counselor keeps
Brown “Speech” Folder—you keep. Each of your students
should have one of these. Your bookkeeper at your school
will be able to order for you. BIC#170-203-5. If you are at a
“non traditional” site Cathy will order for you.