JCPS Technical Assistance Manual - · PDF file17.07.2015 · 2 jcps technical assistance manual table of contents general information 4-23 quick call list 5 additional numbers 6 school

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JCPS Technical Assistance Manual

Speech-Language Pathologists

Revised: July, 2015

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.

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JCPS Technical Assistance Manual

TABLE OF CONTENTS

GENERAL INFORMATION 4-23

QUICK CALL LIST 5

ADDITIONAL NUMBERS 6

SCHOOL CALENDAR 7

DAILY SCHEDULE FORM 8

ABSENCES/LEAVES 9

FACULTY MEETING SCRIPT 12

TIME MANAGEMENT SUGGESTIONS 14

RESOURCES FOR INSTRUCTIONAL MATERIALS 15

INSTRUCTIONS FOR ORDERING 16

EXTRA PAY 20

TRAVEL 21

HOSPITALITY GUIDELINES 23

STUDENT RECORDS 24-27

LOCATING STUDENT RECORDS 25

PRINTING ECE LISTS 26

LETTER TO PARENTS 27

SCREENING 28-38

SCREENING INFORMATION 29

HEARING SCREENINGS 29

REQUEST FOR SCREENING FORM 30

PRE-K SCREENING 31

ELEMENTARY SCREENING 33

HEARING RESULTS 38

REFERRAL AND ASSESSMENT 39-60

INITIAL REFERRAL PROCESS 40

SPEECH LANGUAGE UPDATE NEWSLETTER (7/15) 41

REEVALUATION 42

ORAL MOTOR EXAM 43

DIAGNOSTIC QUESTIONS 50

MEDICAL VOICE EXAM 51

QUESTIONS TO ASK PARENTS OF ELL STUDENTS 52

COMMUNICATION ASSESSMENT REPORT 53

CONFERENCE SUMMARY 57

ECE UPDATE WORKSHEET 59

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IEP, ANNUAL REVIEW & REEVALUATION 61-64

STAPLING 62

ANNUAL REVIEW PROCEDURES 63

CONSIDERATIONS FOR RELEASE 64

NON-PUBLIC STUDENTS 65-70

NON-PUBLIC REFERRALS 66

SERVICE DELIVERY 68

TRANSPORTATION REQUEST FORM 70

SERVICE LOGS 71-78

SCHOOL BASED HEALTH SERVICES (MEDICAID) 72

EZTRAC 74

RECORDS, ACCOUNTABILITY, ESY, & END OF YEAR 79-100

CHECKLIST FOR ARC 80

APPROPRIATE DOCUMENTATION 81

TRANSITION SERVICES 82

END OF YEAR INFORMATION AND CHECKLIST 97

MISCELLANEOUS INFORMATION & FORMS 101-114

CEU REQUEST 102

CREDENTIALS 103

ELECTRONIC SIGNATURE FORM 105

PK HOME RESIDES SPEECH FORM 106

PD REQUIREMENTS 107

EVALUATION CHECKLIST 108

OTOLARYNGOLOGIST REPORT 109

SBARC FOLDER 110

SPEECH FOLDER 111

ECE CASELOAD REPORT 112

RTI/INTERVENTIONS 114

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GENERAL

INFORMATION

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Quick Call Communication Disorders Program: 2014-15

VanHoose Education Center 4th Floor

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


Brian Franklin Cindy Simpson

ECE Technology Liaison ECE Technology Liaison


Lynn Miller Barbara Hatton

ECE Technology Clerk Audiologist


Laura Cullens ECE Records Room:

O.T./P.T. Office Stacey Perkins A-E #3261

485-3509 Loretta McClain F-J #3286

[email protected] Sandra Miracle K-Q #3906

Christine Beck R-Z #3027

Assessment Office Early Childhood Office

485-6052 485-6034

mailto:[email protected]









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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/Becky Hollkamp)

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]

http://www.nncc.org/Child.Dev/child.dev.page.html

http://www.asha.org/

http://www.jefferson.k12.ky.us/

http://www.healthtouch.com/

http://www.parentpals.com/


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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.

http://www.jcpsky.net/

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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



Wednesday



Thursday

School:_________________ Time: _________________ Phone #


Friday

School:_________________ Time: __________________ Phone #


This form should be reproduced throughout the school year, as scheduling changes occur

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.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.

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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.

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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

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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.

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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.

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Resources for Instructional Materials

Office: ECE Technology Center Location: Churchill Park Contact: Brian Franklin and Cindy Simpson (AT Liasons) Contact: Lynn Miller, 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)

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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!

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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)

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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

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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)

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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

http://www.jcpsky.net/

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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.

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IN-COUNTY TRAVEL VOUCHER

Submit monthly, no later than the 20th of the following month, to Finance after approval by department head. Please print all data with exception of signatures. A receipt must be submitted for all items.

NAME (PLEASE PRINT) VENDOR NUMBER TITLE OF POSITION

Your name as it appears in JCPS Employee system Cathy can give this to you Speech Pathologist

DEPARTMENT DATE OF THIS SUBMISSION

Exceptional Child Education Date form is being completed

DIVISION OR INSTITUTION ACCOUNTING CODE MONTH OF TRAVEL

Academic Services EC11043-0581 Must be turned in monthly

DATE FROM TO PURPOSE OF

TRAVEL PRIVATE AUTO OTHER

* TOTAL

(NON JCPS ONLY) MILES CHARGE

9/8/15 VanHoose Bloom 3 0.43

$ 1.29 -

Bloom Noe 8.2 0.43 $ 3.52 -

Noe VanHoose 6.02 0.43

$ 2.58 -

9/9/15 VanHoose Churchill Pk (RT) 10.22 0.43

$ 4.39 -

9/10/15 VanHoose

Visually Impaired Preschool (RT) Therapy** 2.1 0.43 . $ .90 -

1906 Goldsmith Lane 0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

9/11/15 Home Valley 13 0.43

$ 5.59 -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

0.43 $ -

TOTAL FOR PAGE 42.45 - 0.43

$18.25

INSURANCE REQUIREMENT ADDRESS OF OFFICAL HEADQUARTERS

INSURANCE AFFIDAVIT MUST BE ON FILE FOR MILEAGE REIMBURSEMENT Fill in your HOME SCHOOL address only I hereby certify that all items of expense included in the above statement were incurred in the discharge of official business; That they were proper charges against Jefferson County Public School System; That all items 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

Your signature Your street address with zip code

APPROVED (DEPARTMENT HEAD OR AUTHORIZED AGENT) DATE

Your HOME school Principal’s signature Principal to fill in date of signature

Must attach a map as you are going to a

non JCPS site

Must attach map from home address to your

home school. Travel is figured from your

home address to JCPS location MINUS daily

commute from home address to home school.

SAMPLE

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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.

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STUDENT RECORDS

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Locating Students/Records First week of school:

Check JCPS Speech Caseload report (see page 111 for a “how to”)

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)

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Quick Clicks for Printing ECE Lists

**See page 111 for Quick Clicks for printing JCPS Speech Caseload Report

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

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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)

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SCREENING

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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


and results): ________________________________________________

___________________________________________________________

___________________________________________________________

Hearing: ______ No concerns at this time


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)

36

______ 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:

37

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. Jane Doe 9/9/14 Pass/Fail

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 teache

Teachers: Please enter results on the ECH Hearing screening tab.

Jefferson County Public Schools

Early Childhood Hearing Screening Results

2014-2015

39

REFERRAL

AND

ASSESSMENT

40

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, interventions, 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 (see page 112 for details)

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

7/17/15

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

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. Annual goal WILL contain

specific name of method of measurement.

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

42

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


Based on current evaluation plan an “E” would be in a section under communication status

Analysis of progress documentation


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

Reevaluation summary

Evaluator Assessment


Reevaluation Summary



If “X” is checked: follow procedures for Type C or Type B as listed in this document If “E”:

Reevaluation Summary



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.

43

44

45

46

47

48

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

49

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

50

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

55

Create New Plan for IEP or

Service Plan

56

Create New Simple Form for any assessment form needed.

Demographic data should automatically fill in

Complete the form

Print

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.)

59

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: _________________




Rel Service 3: _________________




Rel Service 4: _________________




Rel Service 5: _________________




Rel Service 6: _________________




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.

61

INDIVIDUAL

EDUCATION

PLAN*

ANNUAL REVIEW

3 YEAR REEVAL

*Please refer to your IEP Guidance Document and Speech Language Newsletter 7-16-15 for Specifics

62

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.

63

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.

PLEASE NOTE: Student’s speech language logs MUST be printed AND filed in their brown speech

folder on an annual basis. You may choose to print them at the time of the ARC meeting, at the end of

the year, or a different schedule. We must find a hard copy in the speech folder on an annual basis.

64

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 diploma 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.)

65

Non Public School

Students

66

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.

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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

(“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.

68

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

69

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

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.

70

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.

71

SERVICE LOGS

72

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 MUST be printed AND filed in their brown speech folder on an annual basis. You may

choose to print them at the time of the ARC meeting, at the end of the year, or a different schedule. We

must find a hard copy in the speech folder on an annual basis.

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.

73

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

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 amount 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 also suggest student response to

therapy be indicated in your service logs 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.

74

EasyTrac Logging System Information

https://go9.pcgeducation.com/kyjefferson

Link to our

EasyTrac

Your

personal

log in

75

Message

Center-look

here for

important info

Files to print-yours as well as “how to” handouts regarding the system

“Wizards” for

setting up caseload,

logging services,

running reports, &

progress

monitoring

Wizards take

you your

needed

screens

76

*** PLEASE SEE OUR PCG WEBSITE FOR THE MOST UP TO DATE TRAINING VIDEOS AND

INFORMATION

77

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"

78

On the drop down menu in the upper right of the page choose the month for which you want to document

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 Thing 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)*

___ Reeval 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.

Do you have your specific method of measurement?

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


Voice


Fluency


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 if you have not done so throughout the year

Send Progress Reports home for every student on your caseload

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 Lynn 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)

http://www.kyepsb.net/

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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.

http://www.asha.org/

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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 The 2015-16 professional development year begins June 9, 2015 and ends May 26, 2016. Please be aware that this date could change due to inclement weather or other board action. All certified teachers are required to earn 24 hours of professional development credit annually (KRS158.070). Prorated PD Credit Hours

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.

Part-time teachers (including retirees), and ESS teachers must earn 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.

Job-sharing teachers must each earn 24 hours of professional development credit (not stipend) per contract year. KRS 158.070 (3) (a) requires that school districts incorporate a minimum of four (6-hour) professional development (“PD”) days in the school calendar. Designated professional development days in JCPS are August 11, October 2, March 14, and May 6. KRS 158.070 (3) (c) provides for approval of a flexible PD plan that permits teachers to “participate in professional development activities outside the days scheduled in the school calendar or the regularly scheduled hours in the school work day and receive credit towards the four-day professional development requirement.” Non-flexible Of the four scheduled PD days, only one is non-flexible, (August 11). Teachers earn 6 hours of credit and are paid. Flexible The remaining three days (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 2, March 14, May 6), or c. a combination of a. and b. The chart below shows the number of earned credit hours needed in order to be excused on each flexible PD day. *includes the 6 hours earned on the non-flex day, August 11 Important Reminders

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.

The district does not award professional development credit for earned hours of college credit. Gold Days

PD hours earned on a scheduled Gold Day do not count toward the number of hours required to be off on a flexible PD day.

PD credit hours earned on a scheduled Gold Day may count toward the annual state-legislated 24-hours requirement. Job-embedded According to KRS158.070 (3) (c), “if a local board approves a flexible PD plan, a teacher may earn his/her required PD credit outside the four days reserved in the school calendar for PD. However, a teacher may not earn flexible PD credit during regularly scheduled hours in the school work day” (job-embedded).

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*Can find this form on Infinite Campus

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Blue SBARC folder-

counselor keeps

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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.

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Using JCPS ECE Speech Caseload

Report to find student records 1. Log into Infinite Campus

2. Choose “Index”

3. Scroll down to “Reports”

4. Choose “JCPS Speech Caseload” report

5. From drop down box choose YOUR school

6. Enrollment Service Type “All”

7. Show header “True”

8. Select “All” for grade

9. Order for Option should be “Disability/Student Name”

10. Click “View Report”

11. Report should contain “05” speech only students, related service

students. Nonpublic schools students will not be on your list at

the beginning of the year as they have to be enrolled each school

year.

12. Click on the disc for a drop down menu to export to excel

13. From there you can manipulate the list to meet your needs

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Choosing “Evaluation” will

give you access to the

referral, evaluation

planning form, a place to

note your CWR,

revaluation form, and

determination of eligibility.

Drop down boxes will

your counselor to

select the type of

evaluation (initial or

reeval) and include the

relevant dates.

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Response to Intervention

*see additional documents on our blog

The interventions

we give to teachers

to work with

students

individually and

collect data on are

TIER 3

interventions