High School Student Sample – Low Visual-Low Receptive Interpreter Input
Interpreter Input Form for Florida’s Communication Plan
Student name: Student Interpreters’ Names & Credentials:
Interpreter 1 RID CI, CT
Interpreter 2: RID NIC
Interpreter 3: RID NIC
Interpreter 4: RID NIC
Interpreter 5: Level Pending
Interpreter 6: Level Pending
Grade: 11 th
School Name: Forest High School
Days & Periods Interpreter is with Student: Interpreter 1: 5 th
Interpreter 2: 1 st
Interpreter 3: 3 rd , 6 th
Interpreter 4: 2 nd , 4 th
Interpreter 5: Study Period
Interpreter 6: Study Period
All interpreters are contracted by the district and placed at the school
Expressive
X
X
Receptive
X
X
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
Please describe your observations of the student’s communication skills:
Student appears to understand each interpreter’s signing styles. He needs the interpreters to sign concepts in the most simple and concrete mode possible. He often requires visual aids, gestures, and acting out examples to make a concept completely understood. Student needs prolonged repetition to internalize a new concept.
e also has a limited vocabulary. Student’s use of American Sign
Language is significantly impacted due to his struggle to retain the correct spelling of words. He has little comprehension of how to communicate without the use of an interpreter with peers and adults.
He does have the ability to express basic needs and will use his voice when he feels a concept is not clearly communicated via sign language. We are working on independent living skills and how to advocate for his needs once he leaves high school. He recognizes his need for an interpreter and advocates that need appropriately.
2. Instructional Communication Access Checklist
General Skills- The student demonstrates the ability to:
Learn abstract and/or decontextualized material with minimal expansion?
Learn new vocabulary from typical classroom exposure?
Comprehend class content and instructions?
Understand what to do without the interpreter directing?
Make age-appropriate progress without excessive assistance?
Complete classwork and assignments without interpreter assistance?
Self-advocate for communication and learning needs?
Never
< 10%
X
X
In American Sign Language
Rarely
10-39%
X
X
Some
40-69%
X
X
Frequently
70-89%
Always
>90%
Receptive Language- Does the student: Never
< 10%
In American Sign Language
Rarely
10-39%
X
Some
40-69%
Frequently
70-89%
Always
>90%
Understand connected discourse used by adults in the current education setting?
Comprehend and follow directions related to the curriculum?
Understand the language of instructional activities?
X
X
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
Demonstrates a language base strong enough to learn topics in depth with minimal simplification or restructuring of language?
Attend to group conversations?
Demonstrate incidental learning?
Exhibit relative speed in processing new information comparable to classroom peers?
Demonstrate the above receptive skills for language in the following settings:
X
One-on-one
Small Group
Large Group X
X
X
X
X
X
Expressive Skills- The student demonstrates the ability to:
Express himself in a manner that is easily understood by familiar adults
Express himself in a manner that is easily understood by less familiar adults
Peers in academic and social conversations?
Use no more than 2 to 3 repairs/rephrases per conversation with an adult?
Carry on a conversation with one peer independently?
Carry on a conversation with one (hearing, nonsigning) peer with assistance?
Participate in group conversation independently
(NOTE: group number should be comparable to the typical size in the current or proposed educational setting)
Participate in group conversation with facilitation with an adult (NOTE: group number should be comparable to the typical size in the current or proposed educational setting)
Express ideas and convey a meaningful message using connected language?
Adjust expressive style (pragmatics) to match environmental conditions?
Never
< 10%
X
X
3. Other observations related to language or communication:
In American Sign Language
Rarely Some Frequently
10-39%
X
40-69% 70-89%
X
X
X
X
X
X
X
Always
>90%
Student
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
1.
Please describe your observations of the student’s monitoring, maintenance, and use their
amplification:
X
X
X
2.
Please complete the “Guide to Self-Advocacy Skill Development and check off the skills you have observed the student using consistently:
X
The student will…..
Be responsible to put own hearing devices on and report when problems occur
He asks the interpreter to repeat the message, but does not usually rely solely on hearing
X
Be encouraged to ask for repetition when it is evident that s/he did not hear message
X
X
Typically, during loud classroom sessions, Student will remove his Baha
Recognize effect of distance re: easier ability to listen to close speech versus far speech (Early Listening Function item demonstrations, discussion via My World Tool)
Self-select or move to an appropriate seat in proximity to the teacher or desired class peers
Appropriately ask for repetition of messages missed (i.e., more slowly, clearly. louder)
Recognize effect of interfering noise that occurs in learning environment ; demonstrate by closing classroom door, moving away from noise or requesting reduction in noise
N/A
Use pre-determined signal with teacher to indicate challenges listening/understanding
Request that FM microphone be passed, remind teacher to turn on FM microphone
Report simple names and purposes of hearing device parts and what can go wrong (no sound, intermittent, distorted
(Hearing Aid Tic-Tac-Toe Bingo, FM Bingo)
Describe purpose and use of FM in simple terms to classroom teacher, with assistance
Increase awareness of recognizing when she has missed information (“When do you know that you didn’t hear or hear everything?)
Be able to report “When is it hard to listen/hear/understand?”
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
N/A
X
Unknown
N/A
Recognize when a question/direction is nonsensical
Appropriately use simple addition communication repair strategies
Improve in listening-in-noise skills
Demonstrate ability to perform basic troubleshooting when hearing device malfunctions
Describe purpose and appropriate use of FM with classroom teacher, with oversight
Identify challenging listening situations in school
Identify if the source of the listening difficulty was due to speaker, listener or environment issues
Describe self-advocacy strategies to address challenging listening situations. Prioritize and implement use of strategies in some situations
Improve ability to describe appropriate use of self-advocacy activities
Discussion with classroom teacher to describe purpose and appropriate use of FM, set up signal system and request preferred accommodations, with assistance
Identify challenging listening situations and improvements in self-advocacy strategies used
Appropriately uses advanced communication repair strategies when requesting clarification in school or social situations
Match appropriate self-advocacy strategies to identified listening challenges in school and social settings; meet expectations for use when priority listening challenges occur
3.
Do you believe the student does or would benefit from any of these visual access considerations:
DOES
X
X
X
X
WOULD
Preferential/flexible seating
X
X
Line of sight considerations
Copies of assignments/lessons/reading materials provided in advance
Captioned media
X
Alternate or Assistive Technology Device(s)
Considerations for Visual Fatigue
Lighting Considerations (ensuring the students can see the interpreter and other visual aids)
Other
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
4.
Do you believe the student does or would benefit from any of the following service provider accommodations:
DOES WOULD
X Note-taker or notes provided (to allow students to watch the interpreter)
X Sign Language Interpreter/Cued Speech Transliterator
Intervener (for duel-sensory impaired/deaf-blind students)
Real Time Speech-to-Text Captioning Services (CART, C-Print,
Typewell)
Other
A note-taker or advanced notes provided in all classes would be most advantageous for
Student’s optimum learning needs.
5.
Do you believe the student does or would benefit from any of the following tactile access considerations:
DOES WOULD
Tactile Access to Sign Language
Other
6.
Describe the student’s skill in utilizing support and any actions needed (such as monitoring or training) for the staff of the student to ensure the student’s effective use of their accommodation you identified above:
Student does have preferential seating in each of his classes to maximize his line of sight for the interpreter and visual aids. Student would greatly benefit from hard copies of reading materials and notes as well as visual aides to maximize comprehension; not all teachers do this. Student does not reach his optimum learning potential with lecture and often misinterprets the message. He relies greatly from lesson plans including visual aids, examples, and hands on learning experiences.
Student’s ability to utilize an interpreter has improved this year. He has acquired more language this year evident by understanding new, abstract concepts (he still requires the use of visual aids to understand this) and being able to express the newly learned concept expressively. He is also able to maintain his attention span longer with watching an interpreter when rhetorical questions are utilized frequently in the interpreting process.
7.
This inventory is intended to aid collaboration among students, parents, and educational team members in order to determine educational services and appropriate goals for the student’s
Individual Education Plan. It is very important to include the student’s input and to recognize that even very young children should be building skills related to independence and selfadvocacy. Discussion should include what would be considered appropriate for the child’s age,
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input cognitive abilities, and mode of communication when determining the items that may or may not be applicable.
0-1.5 Lacks independence and self advocacy skills
1.5-3.0 Some independence and self advocacy skills
3.0-4.0 Growing advocacy and independence
4.5-5.0 Substantial advocacy and independence
Takes responsibility for own amplification needs (uses consistently; indicates when it is not working; charges equipment or changes batteries independently).
Takes responsibility for completing daily assignments and projects.
Keeps track of assignments and materials and completes assignments on time.
Follows schedule and manages time independently.
Attempts to follow directions without assistance.
Average of Response
5.0
4.0
4.0
2.5
3.0
3.7
0-1.5 Lacks independence and self advocacy skills
1.5-3.0 Some independence and self advocacy skills
3.0-4.0 Growing advocacy and independence
4.5-5.0 Substantial advocacy and independence
Understands technology (cochlear implants, hearing aids, FM) and can explain its benefit.
Expresses personal opinions concerning current educational program / services.
Notifies the appropriate person to request additional explanation or tutoring.
Assists with training staff in relation to communication access and needed support services.
Advocates for communication accessibility and accommodations. (i.e. captioning, preferential seating. lighting, note-taker, FM use)
Explain his needs to a new teacher, interpreter or staff member.
Explain type and degree of hearing loss and implication to the educational setting.
Attends and participates in IEP meetings and transition planning.
Average of Response
2.0
1.5
N/A
1.0
1.0
0
0
2.0
1.07
0-1.5 Lacks independence and self advocacy skills
1.5-3.0 Some independence and self advocacy skills
3.0-4.0 Growing advocacy and independence
4.5-5.0 Substantial advocacy and independence
Participates in class discussions, making comments relevant to topic.
Takes a role in cooperative learning activities and self-advocates for communication needs.
Uses communication strategies to interact with peers (requests interpreter, writes notes, gestures)
1.5
0.5
2.0
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
Average
Response of 1.33
0-1.5 Lacks independence and self advocacy skills
1.5-3.0 Some independence and self advocacy skills
3.0-4.0 Growing advocacy and independence
4.5-5.0 Substantial advocacy and independence
Makes telephone calls using technology (amplification, CapTel, Videophone), following expected procedures and etiquette.
Accesses community services for the deaf and knows how to request specific services (i.e., interpreter, CART).
Aware of community events for the deaf and hard of hearing
Knows rights related to communication access (IDEA, ADA, etc.)
Uses assistive technology in non-school settings (flashing/vibrating alarms, captioned media).
Independently communicates in community. (orders in restaurants, makes purchases).
Aware of deaf culture/community and self-identification options (D/deaf, hard of hearing)
Average of Response
3.0
1.0
2.0
0
3.5
Unknown
0
1.58
TOTAL POINTS EARNED There are a total of 23 items. Subtract the number of NA responses from 23 then average the student’s responses. Compare to the continuum below to monitor growth over time.
0-1.5 Lacks independence and self-advocacy skills
1.5-3.0 Some independence and self-advocacy skills
3.0-4.0 Growing advocacy and independence
Average
Of
Response
1.43
4.5-5.0 Substantial advocacy and independence
(©2005) Developed by: George Clark, MS. Ed, CI, NAD-IV & Laura Scheele, MS Ed, NIC-
Advanced The authors grant permission for use in K-12 educational settings.
0-1.5 Lacks independence and self advocacy skills
1.5-3.0 Some independence and self advocacy skills
3.0-4.0 Growing advocacy and independence
4.5-5.0 Substantial advocacy and independence
Recognizes the need for interpreting services and respects their role as professionals.
3.0
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
Explains the role of the interpreter versus the role of the teacher.
Attends to the interpreter according to age expectations and student needs.
Asks interpreter for clarification when interpretation is unclear and notifies interpreter of unclear signs/concepts.
Uses interpreter effectively during testing situations.
Gives appropriate feedback during interpretation to indicate comprehension of interpreted message.
0.5
3.0
0
1.5
1.5
Articulates specific needs regarding interpretation (transliterating versus interpreting).
Requests interpreting services, as needed, for printed English materials.
Works with interpreter to prepare for presentations.
Limits personal conversations with interpreter during instruction times.
0
0
0
3.0
0 Generally understands RID/NAD Code of Professional Conduct in relation to educational and community interpreting.
Knows grievance procedures for solving problems/conflicts with interpreter.
Requests interpreting services for extra-curricular activities.
0
0
Average of Response 0.96
Based on the findings of the above inventory, the identified skill sets, and knowledge of deficits need to be addressed collaboratively.
List the action steps that the following people will make to ensure progress on goals.
Student:
Classroom Teacher(s):
Deaf/Hard-of-Hearing Itinerant Teacher (Teacher’s name)
Interpreters ( names ): We will continue to educate Student about how and when he can utilize an interpreter. We will continue to expose him to ASL grammar, structure, and vocabulary so that he can begin to communicate his needs and function more independently upon graduation. We are empowering
Student to communicate with staff and peers to express his needs independently while in a safe and supportive environment to help him develop self-advocacy skills. We have a Deaf community liaison working with Student to educate him on the resources available in the Marion County and surrounding areas, resources available nationwide, and laws applicable to the Deaf community.
Speech Language Pathologists (Name):
Family Members:
Other:
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
8.
Videophones
Visual Alert/Alarms
Tactile Alerts
Other (Personal Electronic
Devices)
Cellular Phone

Student has access at school and home

He has access to strobe fire alarms at school

Student would greatly benefit from having these at home
N/A

Student has access to a cellular phone that is not connected to a data plan. While it is not imperative to communication while in school, it helps him communicate his needs via text and IP relay if needed to communicate a 911 situation
1.
Complete the Checklist of “Socio-Pragmatic Language Behaviors” and please indicate the your observations of the student’s language skills
3
Uses language for this purpose occasiona lly
2
Use of language for this purpose is emerging
X
1
Never uses language for this purpose
0
No opportunity to observe this behavior/ unknown
Visually attends to the speaker or interpreter (directed gaze or nodding to show attending)
4
Uses language for this purpose easily and often
X States, signs, or writes identifying information when asked: Name
States, signs, or writes identifying information when asked: Birth Date
States, signs, or writes identifying information when asked: Phone Number
States, signs, or writes identifying
X
X
X information when asked: Address
States, signs, or writes identifying information when asked: Family (#, who)
Respects personal space of others (maintains
12” to 18” between self and others)
Appropriate body postures; smiling
Uses appropriate gestures
X
X
X
X
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
Maintains physical appearance (age appropriate)
Requests attention or assistance
Responds to simple directions (whether response is correct or not)
Requests objects or permission
Makes a response to questions
Uses appropriate vocal loudness and intonation for differing situations, i.e.: classroom vs. library vs. playground
Asks questions to gain information
Gives commands
Gives simple directions (minimum of two steps)
Opens a conversation appropriately
Takes turns speaking in a conversation
Closes a conversation appropriately
Maintains topic in a conversation
Changes topic appropriately in a conversation
Can clarify an idea when asked
Can give reasons when asked
Demonstrates polite interaction with peers
Demonstrates polite interaction with authority figure
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Shows awareness of needs of and empathy toward others
Responds appropriately to humor
X
X
2.
Please describe the student’s typical behaviors during a teacher-lead read-aloud:
Does not watch interpreter and follows text appropriately and independently
Does not watch interpreter and cannot follow text appropriately and independently
Watches interpreter and does not look at text
Watches interpreter and text simultaneously (such as with an interpreter next to a document camera or interactive white board)
Does not watch the interpreter or look at text
X Student switches back and forth from watching the interpreter to looking at the text, but is not able to see both at the same time
1.
How do you observe student communicating with:
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input
X
(Prefers)
X
PEERS (Hearing and Deaf/Hard-of-Hearing
Does not communicate with peers
Communicates directly with peers using speaking/listening sign language, gestures, a communication device, etc.
Communicates with peers through an additional source, such as an interpreter or captioner
X
X
(Prefers)
ADULTS (Librarian, Principal, Counselor)
Does not communicate with adults
Communicates directly with adults using speaking/listening sign language, gestures, a communication device, etc.
Communicates with peers through an additional source, such as an interpreter or captioner
X
TEACHERS (Signing and Non-signing)
Does not communicate with teachers
Communicates directly with teacher using speaking/listening sign language,
X
(Prefers) gestures, a communication device, etc.
Communicates with peers through an additional source, such as an interpreter or captioner
2.
Describe how instructional content is delivered to the student in various settings, such as with a classroom teacher, DHH itinerant teacher, Occupational Therapist, coach, speech-language pathologist, etc. The student communicates directly with these teachers:
Student needs his academic instruction via American Sign Language. He is able to comprehend simple vocabulary and minimal ASL grammar. He appears to receptively comprehend instructions better when it is explained in American Sign Language grammar/syntax structure evidenced by his ability to accurately follow instructions. He still needs set-by-step instruction to complete any academic work. He does attempt to independently communicate directly to his teachers for simple needs such as “water” or “bathroom”, but he prefers to use an interpreter.
Student is able to communicate directly with her DHH Itinerant Teacher and her Speechlanguage Pathologist due to their signing capabilities and his voicing capability.
The student communicates through an additional source with these teachers:
NA
3.
In your opinion, do you feel that additional training could benefit you or any other staff involved with this student to provide an environment most conducive for language development and educational success? Please explain.
Yes, we believe an in-service for teachers that specifically work with Student would benefit from an hour training to:
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016

High School Student Sample – Low Visual-Low Receptive Interpreter Input

Provide a typical history of deaf students entering the school system
 explain more about the process of interpreting
 discuss how to plan with an interpreter to affectively meet the daily classroom objectives while simultaneously meeting Student’s annual individualized educational goals
 explain diverse methodologies of teaching a deaf student so that lessons can be more visual and more accessible
 discuss why completing academic assignments while the teacher is lecturing is not accessible for

 the deaf student discuss the difference between ASL and English and how this may impact lessons, specifically in vocabulary, reading comprehension, and grammar based subjects/topics
Explain facial expressions and body language and how that is vital to communication (and easily misconstrued by both hearing to deaf and deaf to hearing cultures.
1.
Describe any accommodations needed to provide communication access to non-classroom components of the school day, such as recess, lunch, assemblies, extracurricular activities, school plays, sports, field trips, etc.
Student should always have an interpreter available to him during assemblies, school plays, joining an after school sports team, and off campus field trips. Student does not require an interpreter during lunch, but has access to one if a need were to arise.
2.
Describe any other areas of need or concern you have for this student that is not yet been addressed (Social-emotional, cultural, etc.)
Student would greatly benefit from more exposure to Deaf professionals within the community.
He also needs to have more information about the alerting and notification systems available to create a more inclusive environment (e.g. strobe fire alarms, door bell, carbon dioxide, and crying alarms, etc.). He needs to know and understand the laws that are in place to prevent discrimination and to provide a sign language interpreter for his needs. We would also like to teach more coping skills on how to interact with the hearing community.
Student struggles with memorizing information and this greatly hinders his independence. We will teach Student coping skills to aid with this issue, e.g. keeping important information and phone numbers in his wallet, using his phone to show pictures of needs/wants, when to contact a community liaison for help, etc.
Created by Sheri Arthur, Deborah Flagg, Margie Tyner, Linda Feliciano, Ann Cournoyer and Kayla Surdam
2016