****Confidential*****
Sample Evaluation Summary Report Template
St. Croix River Education District (SCRED)
Student Name: Jimmy John
Date of Birth:
ID #:123456789
School: SCRED Elementary
Grade: 1
Date of ESR: 5/25/05
Reason for Referral:
Jimmy was referred to the problem solving team by his teacher, Mrs. Smith due to
concerns she had about his reading performance. Jimmy currently reads 15 words correct
per minute out of first grade level text. The SCRED spring target for first grade students
is 49 words correct per minute with an expected growth rate of 1.36 words per week.
Sources of Information
Evaluation Tool:
Review of Records
Classroom Observations
Information Processing
Checklist
Teacher Interview
Parent Interview
General Outcome Measures
of Reading
Review of Student
Response to Intervention
Completed by:
School Psychologist
SLD Teacher
School Psychologist
Parent & Teacher
Date:
5/1/05
5/1/05
5/6/05
5/12/05
School Psychologist
SLD Teacher
SLD Teacher
5/2/05
5/8/05
Student Support Team
5/25/05
Background Information
A review of Jimmy’s health history indicates that he was born full term with an
uncomplicated pregnancy and delivery. Jimmy’s mother reports that he reached all
developmental milestones within the normal range. Jimmy has not had any serious
illnesses or injuries. His general health has been good.
A review of Jimmy’s records indicate that he has attended school in the SCRED
district since Kindergarten. Data from his Kindergarten year indicate the following:
Measure
Date
Actual Performance
Letter Naming Fluency
Letter Sound Fluency
Letter Sound Fluency
Letter Sound Fluency
September, 2003
November, 2003
January, 2004
May, 2004
5
0
1
6
Expected
Performance
20
7
16
36
Nonsense Word Fluency
May, 2004
5
33
His records indicate he missed 4 days of school in Kindergarten and 3 days in first grade
due to illness. As of May 15th, Jimmy has not had any discipline reports.
Jimmy was referred to the problem-solving team in November of 2004. The team
developed scientifically based interventions and monitored Jimmy’s progress in the area
of reading. This process is described in more detail in the next section. The problem
solving team determined that Jimmy did not respond to the interventions put in place by
the team and referred Jimmy to the Student Support Team (SST) in April, 2005.
Problem Solving Process: Response to Scientifically-Based Interventions
Problem Identification
Jimmy was referred to the Problem Solving Team on November 1st, 2004. The
problem solving team determined that a problem exists in the area of reading. In
November, Jimmy read 5 words correct per minute out of first grade level text. The
SCRED Winter target for first grade students is 20 words correct per minute. Please
review the problem solving forms attached to this report for additional information
regarding problem identification.
Information used to identify the problem
x
x
x
x
x
Review of records
Reviews of student work
Interviews with student, parent, or teacher
Observations of student
Tests (Please list below)
Other (Describe below)
Tests: General Outcome Measures of Reading collected across time.
Problem Analysis
The team reviewed information, conducted observations, interviewed teachers and
parents, and conducted tests across the areas of instruction, curriculum, environment, and
the learner to analyze the problem. Data indicated that Jimmy currently identifies 15
letter sounds per minute. The target score for Spring of Kindergarten is 36. In addition,
Jimmy’s score on a Nonsense Word Fluency task was 13 (Spring of Kindergarten target
is 33). The team used converging information to hypothesize that Jimmy is displaying
difficulty with reading because he lacks adequate phonics skills to accurately decode 1st
grade level text. Please review the problem solving forms attached to this report for
additional information regarding problem identification.
Plan Development
The team developed interventions for Jimmy tailored to his needs. The first
intervention consisted of a supplemental program which was added to his program in
addition to his current core reading program. Jimmy participated in a small group of 7
students receiving the teacher directed Peer Assisted Learning Strategies (PALS)
program. Jimmy participated in this group three days per week for 20 minutes each
session. Jimmy’s reading progress was monitored weekly on Mondays by a classroom
paraprofessional. This intervention was observed by the school psychologist on two
occasions to ensure integrity of the intervention. The team set a goal that by the end of
May, 2005, Jimmy would read 49 WRC/minute.
The team met in January to review Jimmy’s progress and found that we was not on track
to meet his goal. In January, he read 5 words correct per minute while his goal was to
read 20 words correct per minute to be on track to meet his goal in May. The team
developed a second intervention consisting of an alternate supplemental program in
replacement of Teacher Directed PALS. Jimmy participated in a small group of 5
students receiving instruction in Level 1 of the Phonics for Reading program. This group
met 5 days per week for 30 minutes each session. The team maintained the goal of 49
WRC/min for Jimmy, and progress monitoring continued following the previous
schedule. The special education teacher observed the intervention session to ensure the
program was implemented as intended.
Plan Implementation and Evaluation
The team reviewed Jimmy’s academic progress over the course of the two interventions.
Following the second intervention, Jimmy read 15 words correct per minute compared to
his goal of 49 words correct per minute. A member of the team observed both
interventions being implemented and concluded that the interventions were delivered
with integrity. The team determined that a referral to the Student Support Team (SST)
was necessary to evaluate whether Jimmy meets the criteria for SLD.
Based on the information provided above, did the team confirm that the student
failed to respond to scientifically-based interventions?
x Yes
No
Severe Low Achievement
Rate of Progress: Data collected on Jimmy’s rate of progress indicate that his growth rate
is significantly different from local expectations. Jimmy’s rate of progress is .4 words
per week compared to an expected growth rate of at least 0.84 words per minute per
week.
Level of Achievement: Data collected on Jimmy’s level of achievement indicate that it is
significantly discrepant from local expectations. He currently reads 15 words per minute
compared to an expected level of 49 words correct per minute, and the 7th percentile
score of (insert score for district) words per minute.
Based on the information provided above, is the student severely discrepant from
local expectations on both rate of progress and level of achievement?
x Yes
No
Statement of Educational Needs:
Briefly summarize the student’s needs in the area of instruction. (Instruction is how the
student should be taught. Describe the components of the student’s instructional plan that
will best enable learning.)
Systematic observational data indicate that Jimmy’s rate of accurate responding is
increased when he is provided explicit instruction with frequent modeling and guided
practice, as well as enough repetition and practice with feedback to allow Jimmy to
master the skills. Jimmy likely needs additional time and more practice to make adequate
progress.
Briefly summarize the student’s needs in the area of curriculum. (Curriculum is what
needs to be taught. This includes the specific skills the student needs to learn or the
student’s level or placement.)
In reading, Jimmy needs intensive work on decoding skills, including vowel sounds,
blends, and sight word identification. He needs more practice on the phonemic awareness
skill of segmenting words into sounds. He also needs to practice reading easy text to
build fluency.
Briefly summarize the student’s needs in the area of environment (including
accommodations and modifications).
Observational data and teacher report indicate that Jimmy’s rate of on-task behavior and
accurate responding are increased when he learns in a small group environment. In both
small and large group settings, a motivational strategy such as a sticker chart is needed to
maintain expected rates of active participation and persistence. Teacher reports indicate
that Jimmy does not consistently request assistance with independent work when hi needs
it. Jimmy needs consistent and timely feedback on his independent work to ensure
accurate progress. Jimmy will need content area text above his reading skill level read to
him so he is able to fully participate in this instruction. He may also need additional time
to complete reading assignments.
Based on the information provided above, are the student’s instructional needs
significantly different from expectations in all areas of concern?
x Yes
No
(If no is checked, list the areas where the student’s needs do not significantly differ
from what is expected.)
Information Processing:
Jimmy’s current performance in the area of Information Processing was obtained through
observations, testing, and different parent and teacher reported information obtained
throughout this evaluation. Both teachers and parents reported problems with acquiring
information, storing information, organizing information, and expressing information.
Based on the information provided above, is their evidence that the student has
needs in the area of information processing?
x Yes
No
Exclusionary Factors:
The team determined that the student’s underachievement is not the result of the
following factors (check all that apply):
x
x
x
x
x
x
x
Vision
Hearing
Motor Impairment
Cognitive Disability
Emotional Behavioral Disorder
Environmental, Cultural, or Economic Variables
Lack of Scientifically Based Instruction in Basic Skill Areas
Summary and Conclusions
Jimmy was referred for evaluation for SLD. The team determined that Jimmy’s reading
progress is significantly different from local expectation. Jimmy’s growth rate is .4
words per week compared to an expected growth rate of .84 words per week. The team
determined that Jimmy’s level of reading achievement is significantly different from
local expectations. Jimmy currently reads 15 words per minute from 1st grade level
materials which is at or below the 7th percentile.
Prior to special education entitlement consideration, the problem solving team designed
and implemented two intervention tailored to Jimmy’s needs. Interventions were
designed based on analysis of the defined problem, parent input, and professional
judgment about the potential effectiveness of the plan. Interventions were delivered with
integrity as judged by direct observation. Progress monitoring data collected weekly,
indicated a lack of response to the interventions.
Based on the information provided in the evaluation, the team determined that the
student’s instructional needs are significantly different from expectations in all areas of
concern. In addition, the team determined that Jimmy has information processing needs
in a variety of settings.
Finally, the team confirmed that Jimmy’s underachievement is not the result of other
factors, such as vision, hearing, motor impairment, mental impairment, EBD,
environmental, cultural or economic variables, and/or lack of scientifically-based
instruction in basic skill areas.
I agree with the team decision finding the student eligible for special education services
under the category of SLD:
Team Member Name and Title
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________
___ Yes
____ No __________________________________________________