Signature Assignment 5: Develop a RTI SLD Assessment Report
Instructions
Background
This week you will have the opportunity to expand your report writing skills. In the last report, you explored SLD eligibility using PSW; this week, you will develop an SLD report using the RTI method. You may use the report you created earlier in this course (Signature Assignment 3-SLD Discrepancy SLD Report) as much of the data is the same (interviews, observations school history, etc.). This report will include the previously provided content for the WISC-V, TAPS-4, and CTOPP-2 (the data from those assessments are also provided below if you are unable to locate your previous work). You can use your most recent report data (this is not considered plagiarism of your own work as you are building the work). You will REMOVE the WJ-IV ACH data. You will add in the TVPS-4, VMI-6, new WIAT-4 data to replace the WJ-IV ACH data, and data related to Tier 2 interventions (provided below).
I strongly suggest referring to the rubric below as you write the report to ensure you are covering all relevant areas.
Instructions
Use the data below to develop your report.
Demographics
The report includes the following demographics:
- Student name – Albert Adams
- Student’s gender
- Student’s grade level
- Student’s date of birth
- Student’s chronological age
- Date of assessment
- Name of assessor
- Language spoken by student English is the primary language spoken at home
- Report date
- Student’s ethnicity – Student is Non-Hispanic/Asian Indian
Reason for Referral
Mr. Adams and Mr. Barker (Alberts fathers) have expressed their concern with Alberts learning. They are most concerned with his ability to perform in math. He struggles considerably with this subject matter. They shared that they have hired a tutor and it has not been helping. The teacher recommended that Albert receive math intervention (detailed below), which he has been attending for six months now, and he has had minimal improvement. His parents are requesting assessment so they can better understand Albert’s learning profile.
History: School History, Interventions, and Report Cards
School History
- Kindergarten: Peppermint Patty Elementary School
- First Grade: Peppermint Patty Elementary School
- Second Grade: Charlie Brown Elementary School
- Third Grade: Charlie Brown Elementary School
- Fourth Grade: Charlie Brown Elementary School
- Fifth Grade: Charlie Brown Elementary School
Intervention
Albert has had the following interventions:
With these interventions, Alberts math skills remain stagnant as they are about a year and a half behind his peers.
Report Cards/School Attendance
Please review the .pdf to include in the report.
Developmental History
Information provided by parent and school nurse: please review .pdf to include in your report. It is easiest to separate the content into sections, such as Prenatal through Delivery, Developmental Milestones, Family History, Responsibilities, etc.
You will want to include the following in your report:
1. The name of the nurse is included.
2. The date of the health assessment is included.
3. The findings of the vision (near and far) screening are included.
4. The findings of the hearing screening are included.
5. Medication information is shared (if taking meds, they are listed, if none are taken, it is noted that medication has not been prescribed).
6. Immunization status is provided.
Assessment Instruments/Procedures
Make sure to include all data points used for the assessment process (usually a list is sufficient).
Current Health/Attendance/Behavior Assessment and Home Constellation
- Please review the .pdf for information about Alberts current vision, hearing, and overall health.
- Albert has had 6 absences and 3 tardies so far this academic year.
- Behavior as of this time: there are zero behavioral incidents recorded for this academic year.
- The members of the home include Mr. Adams (father), Mr. Baker (father), a younger sister, and a younger brother. They also have two dogs and one cat.
Interviews
Teacher Interview (Mr. Markson):
Albert performs better with ELA activities, although he still seems to struggle with this subject area a bit, though not nearly as much as with other subjects. Math concepts seem very challenging for him. He really applies himself in Science. He seems to have a lot of things going on at home. He is friendly with his peers, but he has a hard time with group work if his peers go in a direction different from his. When this happens, he tends to remove himself from the group and to work by himself. I suspect he gets his way at home, and no one holds him accountable, so he expects the same at school. I also think he plays a lot of video games at home, and I don’t think his father limits his screen time.
Note: Write this up in a way that is professional and not offensive to the parent or teacher.
Parent Interview (Mr. Barker and Mr. Adams):
Albert is the oldest. Albert has always been a boy who goes to the “beat of his own drum.” He likes things to go his way and when they don’t fights can happen with his siblings. We recently got married and Albert was “The Best Man” for both of us. It was a fantastic day for all of us. Albert seems to really enjoy his time with our two dogs and one cat. Taking care of our “furry kingdom” is one of Albert’s chores. Albert really likes playing video games, and it is almost impossible to get him to stop once he starts. Albert does not like math, and we can’t get him to do any homework. We can’t fight with him about these things, or it will ruin the entire night for the whole family. We would really like Albert to focus more on his studies and be kinder to his siblings.
Note: Write this up in a way that is professional and informative.
Student Interview (Albert):
Use this to see a quick interview (it is the first 90 seconds or so of the clip). Use the information provided by the student in this video to include in your report about the student.
Observations
- Use to view a video of an assessment; you will use this information to describe the testing observation. (It is a video of a student taking a different test.) Review the Sattler text for what to notice while you are assessing.
- Here is a clip to watch of Albert in his classroom during Math. You will complete a write-up of the behavior you observe of Albert in the classroom during this classroom observation.Albert is the student with jeans and a black sweatshirt in the front of the class; there is a red circle around him in the image below. Note the following
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- classroom description
- class activity
- student behavior
- student engagement
-
The information below should already be in your report, but if you have misplaced it or do not have it, you can use these documents to assist you in writing the report:
You will include the data from the VMI and TVPS-4 scored in Week Five for Albert Adams.
- VMI
Once you remove the WJ-IV academic scores from the Signature Assignment 3 report, replace with the WIAT-4 scores provided below. Keep in mind, you will need to adjust the academic section as the WIAT-4 and the WJ-IV ACH are NOT the same. They have different subtests/tests, so your report will need to reflect the correct tests for the . Use the manual to write this up.
- Below is the data related to the math intervention (called dreambox) provided to Albert.
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- Albert’s progress was monitored using EasyCBM Math: Math Numbers and Operations
- Students are routinely screened on their math performance using iReady benchmark assessments
- Albert participated in Math 180, 30 minutes 5 days a week during Phase 1
- Albert received an additional 30 minutes of 1:1 support for math weekly due to lack of progress during phase 2.
Phase 1
Phase 2: Intervention now implemented 1:1 for an additional 30 minutes a week in addition to a small group (4 students) 30 minutes on the computer using Math 180.
Use these data to compare Albert’s scores; these are Grade 5 Basic Math Measures.
Eligibility
Eligibility Form
All of the items listed below are complete and correct on the form.
1. Student name
2. Date of birth
3. IEP date (list it as the due date for the assignment-even if you turn it in early)
4. School name
5. Check initial (not 3-year re-eval)
6. If the data supports eligibility, check the A box in Section I; If the data does not support eligibility leave Section I blank.
7. If the data supports eligibility, select the correct academic area that aligns with the assessment findings (e.g., oral expression, basic reading, etc.). If the data does not support eligibility leave this section blank.
8. Section II: Check yes or no to align with the assessment findings. If you check yes, then select the correct processing area/s; if you check no, leave the processing areas blank.
9.Section III: Mark the exclusionary factors yes or no for all items.
10. Section IV: Check the first box to indicate the psychoeducational evaluation (your report) is what is being used to come to the eligibility determination; leave the other box (other) blank.
11. Section V: Summarize the behavior noted through the classroom observation and testing session (summarize in 1-2 sentences).
12.Section VI: List if there are any diagnosis noted for the student; if none, write NA.
13.Section VII: Check yes or no for the two questions (to align with the assessment findings). If the data does not support eligibility, mark no on both of these boxes.
14. Sign your name and title (School Psychology Student) and include the date you signed it.
Summary
This section provides the reader with a brief overview of the content provided in the report. It should include the reason for referral, an overview/summary of report cards grades, school history and any relevant health information. The interviews should be summarized with a synthesis of themes. The observations (assessment and classroom) should be reflected on. The majority of the summary should be focused on the cognitive battery reviews. What areas were developed or relative strengths for the student and what areas were noted to be less-developed? No new information should be provided in this section.
Recommendations
This section should be a bulleted area where recommendations are provided that are directly linked to the cognitive weaknesses discovered in the assessment. Recommendations can be developed based on the concerns expressed by the parent, teacher or student. The recommendations should include strategies to assist the student, environmental recommendations (seating position in class, word wall, etc.), instruction materials, and possible classroom instruction recommendations. The recommendations should NOT include providing additional people to support the student as special education services and resources are decided on as a team at the Individualized Education Program (IEP) meeting.
- Include information about Special Education Eligibility-does the data support SLD eligibility?
Signature
Include your name and title (school psychology student). Include date of report and another signature line for School Psychology Student Supervisor.
Make sure to list your course instructor as the School Psychologist at the end of the report.
Note: This report will be used again in the other assessment courses, please hold on to this report as well as make adjustments to this report once you have turned it in and received instructor feedback.
Last Step
You must also complete the IEP document Form. If you are able to type onto it, do so, if not, you have a copy of this form from the first in-class session in the documents you were provided. Complete the form and attach this document into the assignment as a separate document. It is also located here: .pdf
Rubric:
| Criteria | Exceeds Standard |
At Standard |
Below Standard |
Criterion Score |
|---|---|---|---|---|
|
Demographics |
10 points The report provides the
|
8 points The report provides some (at least 9) but not all demographic data. |
6 points The report provides 8 or less pieces of demographic data, or the data is not reflective of the data provided for this section. |
Score of Demographics, / 10 |
|
Reason for Referral |
10 points Clear reason for referral is listed and includes:
|
3 points General referral listed, but it is not clear who requested the assessment or why it was requested or what the concern is. May include 3 of the 4 items listed in Exceeds Standardcolumn. |
2 points Statement is missing or 2 or less of the 4 items are missing or the data is not reflective of the data provided for this section. |
Score of Reason for Referral, / 10 |
|
History: School History, Interventions, & Report Cards |
20 points The report provides:
3.report card data for each year starting with the most recent and indicating the trimester/semester/semester grades as well as the number of days absent/tardy for each year. You can summarize the report cards by listing the general areas (reading, writing, math, speaking and listening, art, PE, science, social science). You do not need to provide each subset for reading. You can also list the range for each area such as 1-2 in Reading. Make sure you provide a key for the grades, so the reader is able to understand what the ratings mean. You can also summarize the teacher comments listed in the report cards (look for themes). |
17 points The report includes most of the required criteria, but data may be brief/limited. The school names may bey missing, or the grade level at the school is not listed. The interventions may be missing one of the interventions/supports provided and/or the data regarding the outcome of the interventions are not clear or are minimally reported. Report card data may be missing or has been cut and pasted from the actual report cards and the data may be difficult to read or understand. |
13 points The report is missing a significant portion of the required criteria.Data may be brief/limited. The school names may be missing for more than one year or the grade level at the school (more than one) is not listed. Interventions, supports, data outcomes may be missing. Outcomes of the interventions are not clear, minimally reported, or missing. The report cards may be cut and pasted from the actual report cards and/or the data is difficult to read or understand. More than one year of report cards may be missing or the data is not reflective of the data provided for this section. |
Score of History: School History, Interventions, & Report Cards, / 20 |
|
Developmental History |
20 points Developmental History includes
|
17 points The developmental history may include 11 of the 14 criteria or the data in each section is limited. |
13 points The development history includes 10 or less of the 14 item. Data may be limited or nonsensical or the data is not reflective of the data provided for this section. |
Score of Developmental History, / 20 |
|
Health Assessment of Nurse |
10 points
|
8 points At least 5 of the 6 items from the “Exceeds Standard” are included. |
6 points Four or less tems from the “Exceeds Standard” are included. |
Score of Health Assessment of Nurse, / 10 |
|
Interviews |
20 points The report provides detailed information gathered from the interviewees. The report must include notes gathered from the parent, teacher, and student. The content must be written in a way that is cohesive and kind to others who will read the report. If the parent makes a negative comment about the teacher or the teacher makes a negative comment about the parent or child, it is written in a way to maintain a civil response from the readers. |
17 points The report provides sparse information on home, family setting, and student interests. The report is missing one interview or negative comments are not rewritten to maintain a civil tone from parent, teacher, or student. |
13 points The report provides limited information on home, family setting, and/or student interests. The report is missing two interviews or negative comments are not rewritten to maintain a civil tone from parent, teacher or student, or the data is not reflective of the data provided for this section. |
Score of Interviews, / 20 |
|
Testing Session Observations |
10 points Report addressess student affect, reality contact, hygiene, resistance or attention to task, eye contact, compliance, and other relevant testing observations. |
8 points Observations are incomplete, or irrelevant (i.e., comments about the curliness of a student’s hair, or the cute way she giggles). |
6 points Observations are missing or the data is not reflective of the data provided for this section. |
Score of Testing Session Observations, / 10 |
|
Classroom Observation Part 1: Classroom Description |
5 points The report describes the classroom setting including four aspects:
|
4 points The report includes at least three of the four items listed in the “Exceeds Standard” category. |
2 points The report is missing is missing two or more of the descriptions listed in the Exceeds Standard category, or the data is not reflective of the data provided for this section. |
Score of Classroom Observation Part 1: Classroom Description, / 5 |
|
Classroom Observation Part 2: Classroom Activity |
5 points The report describes the activity and lesson occurring during the observation and includes three parts:
|
4 points The report includes at least two of the three items listed in the Exceeds Standard category. |
2 points The report is missing two or more of the descriptions listed in the Exceeds Standard category, or the data is not reflective of the data provided for this section. |
Score of Classroom Observation Part 2: Classroom Activity, / 5 |
|
Classroom Observation Part 3: Student Behavior |
5 points The report includes all three aspects listed below:
*Make sure to describe the student behavior using language that describes the behavior (what it looks like) but does NOT imply internal thoughts of the student (e.g., bored, angry, sad, happy, etc.). |
4 points The report includes at least two of the three items listed in the Exceeds Standard category. |
2 points The report is missing two or more of the descriptions listed in the Exceeds Standard category,or the data is not reflective of the data provided for this section. |
Score of Classroom Observation Part 3: Student Behavior, / 5 |
|
Classroom Observation Part 4: Overall Student Engagement |
5 points Report provides a summary that includes two aspects:
|
4 points Report includes at least one of the two items listed in the Exceeds Standard category |
2 points Section is missing or both items are missing (the section is listed, but the content provided does not align with the rubric)or the data is not reflective of the data provided for this section. |
Score of Classroom Observation Part 4: Overall Student Engagement, / 5 |
|
Data Consistency Statement and Assessment List |
10 points Statement covers the following four items:
|
8 points One of the four components from the “Exceeds Standard” category is missing. |
6 points Two of the four components from the “Exceeds Standard” category are missing. |
Score of Data Consistency Statement and Assessment List, / 10 |
|
Test Battery/Score Explanation |
15 points Test Battery is explained (what does the battery measure), composite scores are defined, and an overview of the assessment tool is provided. Scores obtained from the test battery are explained for all scores scaled Scores, index/standard/composite, percentiles, etc. The deceptive category (average, high average, etc.) is provided with the scores. |
13 points Test Battery is generally described. Report may miss one composite area (but not more than one). The majority of scores provided on the measure are included, but may miss one (scaled scores, standard/index/composite scores, percentiles, etc.). |
10 points Test Battery is not clearly explained.It may include an overview of the measure, but misses more than one composite/standard/index score. Not all scores (scaled scores, T scores, percentiles, etc.) are defined (missing more than two that are provided in the report). |
Score of Test Battery/Score Explanation, / 15 |
|
Cognitive Data |
15 points Each discreet instrument is described and both data and interpretations are given in logical, understandable terms. Test data is scored correctly (95% or higher) and reflected as such in the report.Report includes all scaled scores and composite/index scores of items assessed/administered. Data provided for each subtest and composite area are reflective of if the scores are cohesive/consistent in each Index/Composite area and if they are not, the data is explained, and follow-up information is provided to address the inconsistencies. The composite/index scores are explained with an indication of the students skill level (well-developed, developed, less-developed, or under-developed) in those areas (compared with the majority of his or her same-aged peers). If scores are inconsistent (in a given area) an explanation of the inconsistent score is provided and steps taken to address the inconsistency (future assessment or provide additional assessment data provided to assist in addressing the inconsistency) |
13 points Instruments are not well delineated, data is incomplete, or interpretations are not intelligible to the layperson. Little or no analysis is provided. Test data is scored incorrectly (85-94% correct). The report includes no more than one missing score (scales, index/composite/etc.) for the items administered. The data provided are mostly reflective of the scores and those that are consistent are noted as such and the skill of the child is defined (developed or under-developed/less-developed skill). If there are inconsistencies (such as a high and low score in a given processing area), they are noted as well as the steps taken to address those inconsistencies. |
10 points The section is an incomprehensible mishmash of tests & interpretations. Test data is scored incorrectly (84% or lower correct) and reflected as such in the report, or the data is not reflective of the data provided for this section. Little to no analysis is provided related to the scores and skills or the data provided about a given skill are incorrect (e.g., Processing Speed is defined incorrectly) or the score data is incorrect. |
Score of Cognitive Data, / 15 |
|
Achievement/Academic Data |
15 points Each discreet instrument is described and both data and interpretations are given in logical, understandable terms. Evidence of specific error analysis is present. Test data is scored correctly (95% or higher) and reflected as such in the report. |
13 points Instruments are not well delineated, data is incomplete, or interpretations are not intelligible to the layperson. Little or no analysis is provided. Test data is scored incorrectly (85–94% correct) and reflected as such in the report. |
10 points This section of the report is an incomprehensible mishmash of tests & interpretations. Test data is scored incorrectly (84% or lower correct) and reflected as such in the report. |
Score of Achievement/Academic Data, / 15 |
|
Auditory Processing Data |
15 points Each discreet instrument is described and both data and interpretations are given in logical, understandable terms. Evidence of specific error analysis is present. Test data is scored correctly (95% or higher) and reflected as such in the report. |
13 points Instruments are not well delineated, data is incomplete, or interpretations are not intelligible to the layperson. Little or no analysis is provided. Test data is scored incorrectly (85–94% correct) and reflected as such in the report. |
10 points This section of the report is an incomprehensible mishmash of tests & interpretations. Test data is scored incorrectly (84% or lower correct) and reflected as such in the report. |
Score of Auditory Processing Data, / 15 |
|
Visual Processing Data (VMI and TVPS-4( |
15 points Each discreet instrument is described and both data and interpretations are given in logical, understandable terms. Evidence of specific error analysis is present. Test data is scored correctly (95% or higher) and reflected as such in the report. |
13 points Instruments are not well delineated, data is incomplete, or interpretations are not intelligible to the layperson. Little or no analysis is provided. Test data is scored incorrectly (85-94% correct) and reflected as such in the report. |
10 points This section of report is an incomprehensible mishmash of tests & interpretations. Test data is scored incorrectly (84% or lower correct) and reflected as such in the report. |
Score of Visual Processing Data (VMI and TVPS-4(, / 15 |
|
SLD RTI Eligibility Criteria |
15 points RTI SLD criteria is explained, data related to this criterion is provided and a clear indication is made if the student is eligible with a SLD which includes which processing deficit is identified and which academic area was identified. (If student is not eligible, you can still identify which processing area/s and academic area/s are developed/less-developed). If the data does not support SLD eligibility, it must be clearly explained why the eligibility criteria have not been met. This section must include the exclusionary factors a statement regarding if the student needs special education services (only if the data support eligibility). |
13 points RTI SLD criteria is explained, data related to this criteria is provided, but with vague language regarding eligibility. Processing deficits are not clearly defined. The academic area/s are not clear and specific. (If student is not eligible, processing and academic area will not be identified.) |
10 points RTI SLD criteria is not explained or is only minimally explained. Data is not consistent with the eligibility or processing areas are not identified or academic area/s are not identified. |
Score of SLD RTI Eligibility Criteria, / 15 |
|
IEP SLD Eligibility Form |
15 points All of the items listed below are complete and correct on the form.
|
13 points At least 12 of the items listed from the “Exceeds Standard category are completed with no more than 4 errors across all aspects. |
10 points Less than 12 of the items from the Exceeds Standard category are completed with no more than 5 errors across all aspects. |
Score of IEP SLD Eligibility Form, / 15 |
|
Summary/Conclusions |
15 points The summary is concise, accurate, and describes manifested strengths and weaknesses. It includes a summary of the reason for referral, general themes noted from report cards and attendance, themes discovered from the interviews, and observations. The cognitive battery data is clearly explained addressing where the students skills are (using index/composite areas-think CHC Theory). No new data is provided in this section. |
13 points The summary is either:
|
10 points The summary is missing several aspects noted in the Exceeds Standard column. Themes may be missing, and/or data is provided but it is nonsensical, or the data is not reflective of the data provided for this section. |
Score of Summary/Conclusions, / 15 |
|
Instructional Recommendation |
15 points Recommendations are specific to the needs of the student and described in plain terms. There is a relationship between error patterns and recommendations. Recommendations can be reasonably implemented by school personnel. There may also be recommendations for further assessment by OT, PT, or SLP. Report does NOT recommend aides or 1:1 support from an adult on the report. |
13 points Recommendations are non-specific or are too complicated to be realistically implemented by classroom teachers. There is little or no relationship between error patterns and recommendations. Report does NOT recommend aides or 1:1 support from an adult on the report. |
10 points Recommendations are missing or not at all related to the manifested needs of the student. |
Score of Instructional Recommendation, / 15 |
|
Signature |
5 points Your name and title are listed (school psychology student) w/ date of report listed and another signature line for School Psychology Student Supervisor. |
4 points Two of the 4 items from the Exceeds Standard category are present. |
2 points One or none of the 4 components from the Exceeds Standard category are present. |
Score of Signature, / 5 |
|
Spelling/Grammar |
10 points There are few to no grammar/spelling/punctuation errors in the report. The report is written in third person (no reference to me, or I, or we). The students name remains the same throughout the entire report and all corresponding pronouns reflect the student. The parent(s)/caregiver(s)names are consistent throughout the report. Font/spacing is consistent throughout the report. |
8 points Report contains some grammar/spelling errors. Gender confusion in report (student identified as female or male and later in the report is referred to as by the wrong pronoun). Report uses something other than third person narrative. There is confusion regarding the names of the student and/or parent(s)/caregivers(s) in the report (I.e., listing student as Mark and later referring to student as Maria). There are some inconsistencies with fonts/spacing in report sections. |
6 points There is a large amount of grammar/spelling/punctuation errors throughout the report and/or significant errors regarding gender reference, name usage, point of view, and/or font/spacing inconsistencies. |
Score of Spelling/Grammar, / 10 |

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