hesconnection.weebly.comhesconnection.weebly.com/.../2/1/3/...sept_2013_2.docx · web viewuses...
TRANSCRIPT
FULTON COUNTY SCHOOLSServices for Exceptional Children
Jo Wells Center54 Parkway Drive
Hapeville, Georgia 30334404-763-5600
Collaborative Evaluation for Occupational Therapy
NAME: ADDRESS: DOB: SCHOOL: AGE: GRADE: Type of Evaluation: Initial Re-EvaluationTEACHER/DIAGNOSTICIAN (SECTION I) OCCUPATIONAL THERAPIST (SECTIONS II, III): SPECIAL EDUCATION ELIGIBILITY: 504 PLAN YES NO
PART I
REQUEST FOR ASSISTANCE
MEDICAL HISTORY:
Uncomplicated pregnancy Premature delivery Cesarean delivery Breech birth Developmental milestones on time Developmental milestones delayed Healthy child Diagnosed with Medical Precautions/Allergies List Current Medications
PHYSICAL DEVELOPMENT AND ACCESS:
Hearing Normal Hearing Loss Wears hearing aides Cochlear implant Classroom FM SystemVision Normal Wears glasses/contacts Far sighted Nearsighted
EDUCATIONAL HISTORY: Small group intervention Team Taught Combination Team Taught and Small Group Self-contained class No formal schooling/group settings Babies Can’t Wait: OT PT Speech
THERAPY HISTORY: Currently receiving occupational therapy in school setting Currently receiving private therapy Previously received School Therapy Private Therapy
PRESENTING PROBLEM(S)/AREAS OF OCCUPATIONAL PERFORMANCE: SELF HELP SKILLS: The student’s ability to manage personal needs within the educational environment. CLASSROOM PERFORMANCE & PARTICIPATION: The student’s abilities in the areas of attention, organization,
peer interaction, social-emotional functioning, activity level, etc. as they relate to functioning in the classroom. FINE MOTOR SKILLS: The student’s ability to manipulate and manage materials within the educational environment PRE-WRITING/HANDWRITING SKILLS: The student’s demonstration of early writing readiness, including visual
motor and visual perceptual aspects of pre-writing/handwriting. PHYSICAL ACCESS & PARTICIPATION: The student’s physical status and ability to perform basic motor actions as
needed to function in and move throughout the educational environment. Other: describe:
CONTEXT/SETTING in which presenting problem occurs: General Education ClassroomSpecial Education ClassroomHall/stairwaysCafeteria BathroomPlayground/recess CBI LocationOther
DESCRIPTION OF PROBLEM(S):
DESCRIPTION OF CLASSROOM STRATEGIES/ INTERVENTIONS:
RESULTS OF DATA COLLECTION FROM RTI STRATEGIES
SPECIFIC IEP GOALS / IEP OBJECTIVES NOT PROGRESSING:
Teacher: ___________________________ Date:_______________________________
PART 2STRUCTURED OBSERVATION/INFORMAL ASSESSMENT
(Complete only those sections related to Presenting Problem(s)/Areas of Concern)
Student Date
ASSESSMENT PROCEDURES :
Observation Parent Report Teacher Report Checklists Work samples
SELF HELP
Dressing Skills: Educational Impact: Yes No
Jacket: Takes off Independently Physical Assist Unable
Puts on Independently Physical Assist Unable
Backpack: Takes off Independently Physical Assist Unable
Puts on Independently Physical Assist Unable
Shoes: Takes off Independently Physical Assist Unable
Puts on Independently Physical Assist Unable
Zipper: Takes off Independently Physical Assist Unable
Puts on Independently Physical Assist Unable
PE Clothes: Takes off Independently Physical Assist Unable
Puts on Independently Physical Assist Unable
Comments:
Bathroom Skills: Educational Impact: Yes No
Toileting age appropriate
Toilet Trained Yes No In process of being toilet trained Trip Trained
Able to Access Bathroom Commode Toilet Paper Sink Soap Paper Towels
Requires Adaptive Equipment Yes Describe
Clothing Independent Physical Assist Unable
Difficulty with Bathroom Noises: Yes No
Comments:
Mealtime Skills: Educational Impact: Yes No
Independent with all mealtime tasks
Eats with Spoon Independent Assist
Fork Independent Assist
Fingers Independent Assist
Drinks from Cup Sippie cup Milk Carton Adaptive cup
Uses Straw Yes No
Tray Independent Tilts tray causing spills Unable
Containers Independent Physical Assist Unable
Food Pockets Overstuffs loss of food from mouth
Wipe Face Independent Physical Assist
Comments:
Managing Materials: Educational Impact: Yes No
Manages personal belongings Yes No
Handles materials roughly causing breakage/spills Yes No
Classroom Tools:
Backpack: Hang up Independently Physical Assist Unable
Retrieve items Independently Physical Assist Unable
Manages Notebook Independently Physical Assist Unable
Supplies(pencil eraser) Independent Physical Assist Unable
Locker Independent Physical Assist Unable
Comments:
CLASSROOM PERFORMANCE AND PARTICIPATION
Attention/Level Distractibility: Educational Impact: Yes No
Attends and participates in: all activities group activities 1:1 activities
Visual attention: good inconsistent good but does not actively participate
Easily distracted by: auditory visual stimulation
COMMENTS:
Following Directions: Educational Impact: Yes No
Follows class rules and routines Yes No
Follows directions across all settings Yes No
Follows: 1 step directions 2 step directions 3 step directions directions in a group
Performs directions in proper sequence Yes No
Comments:
Transitions: Educational Impact: Yes No
Difficulty with: new environments changes in routine transitions between activities
Comments:
Personal Space: Educational Impact: Yes No
Invades personal space of peers Touches peers/materials without permission
Not able to stay in designated areas Bumps into furniture/peers objects
Difficulty walking in line in hallway Leans on people/surfaces
Comments:
Self Regulation/Modulation: Educational Impact: Yes No
Self-regulation Good in all environments No, Describe
Handles frustration without outburst or aggression verbal outbursts physical outbursts
Works with peers Cooperatively Unable to work cooperatively with peers
Difficulty with self-regulation in: Large groups small groups 1:1
Distressed by: Accidental touch Imposed or unexpected movement Loud Noises
Demonstrates self-stimulating behaviors Yes No Describe Click here to enter text.
Affect or arousal Low High Adequate
Persistent fidgeting Yes No
Comments:
FINE MOTOR SKILL
Hand Dominance: Right Left Switches Hands
Upper Extremity ROM: Within Functional Limits No, Explain
Upper Extremity Tone: Within Functional Limits No, Explain
Reach: Adequate Overshoots Undershoots
Grasp and Release Patterns: Educational Impact: Yes No
Grasp: Raking pincer grasp 3 jaw-chuck Lateral
Release Raking for small objects/finger foods Difficulty with gradation of release
Writing utensils: Closed webspace Thumb wrap Pronated palmer grasp
Tripod grasp Fisted Quadrupod grasp
Comments:
Manipulation Skills: Educational Impact: Yes No
Good finger isolation Yes No
Uses both hands efficiently for bilateral tasks Yes No
Able to translate object from palm to fingertips Yes No
Drops objects during manipulation Yes No
Stabilizes on surface or body Yes No
Comments:
Scissor Skills: Educational Impact: Yes No
Scissors: Regular Adaptive Scissors. Describe
Age appropriate cutting skills Yes No
Grasp Able to sustain grasp on scissors Pronated grasp Assist to aintain grasp
Cutting Snips paper 1-2 times Makes consecutive cuts Choppy cutting pattern
Unable to cut forward Unable to cut simple shapes within ¼ inch of line
Difficulty rotating paper Unable to open scissors independently
Comments:
PRE-WRITING/HANDWRITING
General Visual Classroom Observations: Educational Impact: Yes No
Scanning L>R(e.g. calendar/counting) Yes No
Scanning vertically (e.g. board>desk) ) Yes No
Scanning environment Yes No
Able to trace Yes No
Able to copy Yes No
Observations Squints Tends to look with peripheral vision Covers eyes/complains about light
Comments:
Physical Observations/Tracking: Educational Impact: Yes No
Track moving target Yes No
Track in all planes with smooth pursuits Yes No
Head posture: Midline on shoulders Tilts to left Head tilts to right
Disassociates eyes from head movement Yes o
Eye turns right left in out
Comments:
Coloring: Educational Impact: Yes No
Age appropriate coloring Yes No
Visual attention adequate not adequate
Pressure adequate excessive light
COMMENTS:
Prewriting: Educational Impact: Yes No
Spontaneously scribbles Yes No
Draws simple pictures Yes No
Imitates: _ l O X + triangle square
Copies: _ l O X + triangle square
Comments:
Handwriting: Educational Impact: Yes No
Letters size Appropriate Large Small
Letter formation Appropriate Illegible Bottom to Top
Reversals Yes No
Adequate space between letters Yes No
Adequate space between words Yes No
Orients left to right Yes No
Pressure Adequate Excessive Light
Erasing Adequate Excessive Light
Speed Adequate Rushes to complete Takes more time to complete
Baseline adherence Adequate Letters float Letters stray below the line
Comments:
Keyboarding/Technology Use: Educational Impact: Yes No
Use of Mouse age/grade appropriate: Yes No
Keyboarding Skill age/grade appropriate: Yes No
Uses network word prediction software: Yes No
Uses network software with auditory feedback: Yes No
Comments:
PHYSICAL ACCESS AND PARTICIPATION
Sitting Posture: Educational Impact: Yes No
Sits erect, feet flat Yes No
Rounded Back Yes No
Legs Wrapped around Chair Yes No
Sits on Legs Yes No
Able to Move in and Out of Positions at Desk Yes No
Comments:
Upper Extremity Functional Strength: Educational Impact: Yes No
Within Functional Limits
Decreased on: Left Right Both
Comments:
Endurance: Educational Impact: Yes No
Fatigues easily with sustained fine motor activity Yes No
Fatigues easily with sustained gross motor activity Yes No
Postural fatigue with prolonged sitting Yes No
Comments:
Playground/Recess: Educational Impact: Yes No
Participates appropriately Yes No
Safety awareness on playground Yes No
Enjoys movement in all planes Yes No
Excessive force during movement games Yes No
Fears playground equipment Yes No
Comments:
SUMMARY AND RECOMMENDATIONS
The results of this observation are considered to be an accurate reflection of current school functioning: Yes No for the following reasons: Implement the following recommendations for weeks.
Occupational Therapist:______________________ Date:_____________________
FOLLOW UP DATE: Click here to enter text.
RESULTS OF CLASSROOM INTERVENTIONS:
Classroom interventions effective. Continue strategies.Classroom interventions not effective. Consider formal assessment.
Occupational Therapist: Teacher:
Date:
PART 3
STANDARDIZED ASSESSMENTS
Name Date
Peabody Developmental Motor Scales (PDMS-2) provides information regarding fine motor skills. The areas measured indicate a child’s ability to use his or her hands as well as visual perceptual skills needed to perform complex eye-hand coordination tasks such as reaching/grasping objects, copying designs, and controlled use of the fingers of both hands for manipulation of objects within the child’s environment.
Two subtests from this test were used:
Grasping (Gr): This subtest measures a child’s ability to use his or her hands. It begins with the ability to hold an object with one hand and progresses up to actions involving the controlled use of the fingers of both hands to button and unbutton garments.
Visual –Motor Integration (Vi): This subtest measures a child’s ability to use his or her visual perceptual skills to perform complex eye-hand coordination tasks such as reaching and grasping for an object, building with blocks, and copying designs.
Subtest Raw Score Standard Score (avg 85-115)
Percentile (avg 16-84)
Grasping
Visual Motor Integration
Fine Motor Quotient (FMQ): This quotient measures a child’s ability to use his or her hands and arms to grasp objects, stack blocks, draw figures, and manipulate objects. High scores on this composite are made by children with well-developed fine motor abilities. These children would have above average skills picking up small objects, drawing figures, and stringing beads. They are likely to be described as good with their hands; low scores are made by children who have weak grasping and visual-motor skills. They have difficulty in learning to pick up objects, draw designs, and use hand tools. A fine motor deficit can be mild; the child’s skills may be described as immature. Some children may have problems severe enough to need specially designed utensils to feed themselves.
A Fine Motor Quotient (FMQ) of ___ represents ______ performance. The FMQ is a numeric representation of the child’s overall performance on the Grasping and Visual-Motor Integration subtests.
Quotient Sum of Standard. Scores
Quotient Score
(35 to 165)
Percentile Rank
Fine Motor (FMQ)
Interpretation of test results:
The Wide Range Assessment of Visual Motor Abilities (WRAVMA ) assesses three areas using three subtests. These three areas have been selected because of their relevance to school-related activities. The drawing (visual-motor) test has children copying from designs which are developmentally arranged in order of increasing difficulty. Starting at an age appropriate item, the child copies a standard design and proceeds until three consecutive items are failed. The Matching (Visual-Spatial) test provides a measure of spatial skill by presenting visual spatial tasks developmentally arranged in order of increasing difficulty. The child continues until he/she makes six errors within a series of eight consecutive items. The pegboard (fine motor) test has the child insert as many pegs as possible within 90 seconds using a nearly square pegboard. The pegboard is waffled to add to its fine motor demands.
Scores are listed below:
Raw Score Standard Score (avg 85-115)
Percentile Score (avg 16-84)
Drawing test (visual-motor)
Matching test (visual-spatial)
Pegboard test (fine motor)
VMA Composite
Interpretation of test results:
Bruininks-Oseretsky Test of Motor Proficiency
The Bruininks-Oseretsky Test of Motor Proficiency was given to assess fine motor skills in various areas of performance. The Bruininks tests different aspects of fine-motor control and functioning. Fine motor control, dexterity, upper-limb coordination and visual-motor control are tested to determine if children have the foundation skills and abilities to perform everyday fine-motor tasks.
Scaled Score Sum of Scaled Scores Standard Score
Mean=15, SD=5 Mean=50, SD=10
Fine Motor Precision Fine Manual Control
Fine Motor Integration
Manual Dexterity Manual Coordination
Upper-Limb Coordination
Bilateral Coordination
Interpretation of test results:
The Test of Visual Perceptual Skills, 3rd Edition
The TVPS-3 assesses an individual’s visual perceptual abilities without requiring motor involvement when making a response. The test utilizes black and white line drawings as stimuli for the perceptual tasks. The items are presented in a multiple-choice format. Visual perceptual subtest scores are very highly inter-correlated because of those high inter-correlations, it should be recognized that any one subtest may not measure discretely just one perceptual ability.
Subtests Subtest Scores
Average range 7 to 13
Index Scores
Average range 85 to 115
Raw Score (avg. range 7-13)
Scaled Score
Percentile Rank (avg. range 16-84)
Overall Basic Processes
Sequencing Complex Processes
Visual Discrimination
Visual Memory
Spatial Relations
Form Constancy
Sequential Memory
Figure Ground
Visual Closure
Sum of Scaled
Scores
Standard Scores
Interpretation of test results:
The Test of Visual-Motor Skills, Revised, and (TVMS) was given to assess visual motor skills. These skills are needed to support handwriting and other academic tasks. The TVMS requires children to copy increasingly complex geometric designs. Students are not allowed to erase while copying designs. The mean Standard score for the TVMS is 100 and the mean Scaled score is 10.TVMS scores:Raw Score Standard Score Scaled Score
Interpretation of test results:
The Beery-Buktenica Developmental Test of Visual Motor Integration, 5 th Edition (VMI)
The VMI measures a student’s ability to reproduce shapes of increasing complexity following a developmental sequence. It is designed to assess the extent a student can integrate his visual and motor abilities (visual-motor integration). The visual and motor subtests respectively measure one’s ability to discriminate visual details and to draw lines in specific areas
Standard Score (avg 85-115)
Scaled Score (avg 7-13)
Percentile (avg 16-84)
VMI
Visual
Motor
Interpretation of test results:
SENSORY MOTOR SKILLS
The Sensory Profile School Companion was administered as part of a comprehensive assessment to determine whether aspects of sensory processing might be contributing to a student’s challenges in the classroom or school environment.
The Sensory Profile School Companion is a measure of students’ responses to sensory events in the classroom. The teacher completes the Sensory Profile School Companion by assessing the frequency of a student's responses to environmental sensations, body sensations and his or her classroom behaviors as described in 62 items. We know from research that the Sensory Profile School Companion can help identify a student’s sensory processing patterns; the results can then be used to consider how these patterns might be contributing to or creating barriers to performance in the classroom.
His\her classroom teacher completed the School Companion.
The Sensory Profile looks at 2 primary factors, neurological thresholds and self-regulation strategies.
Neurological thresholds are the way the nervous system responds to sensory input. Self regulation strategies are the ways that people manage the input that is available to them. Many things can
affect responsiveness or the way that a person’s self-regulation strategies affect daily life. Demands of a person’s environments, an activity or a person’s self-regulation strategies can affect responsiveness.
o Hypo-responsive (or under responsive) is when a system is responding too little.o Hyper-responsive (or over responsive) is when a nervous system is responding too much.
Everyone has times when we are hyper-responsive or hypo-responsive; it is only when a response interferes with everyday life consistently that it needs to be addressed.
There are 4 basic patterns of responding to sensory events in everyday life.
Sensation Seeking is the combination of high neurological thresholds and an active self regulation strategy. Low registration is the combination of high neurological thresholds and a passive self regulation strategy. Sensation Avoiding is the combination of low neurological thresholds and an active self regulation strategy Sensory Sensitivity is the combination of low neurological thresholds and a passive self regulation strategy
Sensory Profile School Companion Scores:
Less Than Others Similar to Others
More Than Others
Much Less Than Others
Less Than Others
More Than Others
Much More Than Others
Section Raw Score Total
Definite Difference
Proable Difference
Typical Performance
Probable Difference
Definite Difference
1. Auditory: /50 50 49----------38 37-----X-----31 30----------10
2. Visual: /55 55----------53 52----------39 38----------31 30----------11
3. Movement: /70
70----------56 55------X----48 47----------14
4. Touch: /60 60----------51 50----------45 44----------12
5. Behavior: /75
75 74----------58 57----------49 48----------15
Less Than Others Similar to Others
More Than Others
Much Less Than Others
Less Than Others
More Than Others
Much More Than Others
Quadrant Raw Score Total
Definite Difference
Probable Difference
Typical Performance
Probable Difference
Definite Difference
1. Registration: /85
85 84----------64 63----------53 52----------17
2. Seeking: /60 60----------43 42----------34 33----------12
3. Sensitivity: /80
80----------79 78----------60 59----------51 50----------16
4. Avoiding: /85 85-----------70 69----------61 60----------17
Less Than Others Similar to Others
More Than Others
Much Less Than Others
Less Than Others
More Than Others
Much More Than Others
School Factor Raw Score
Definite Difference
Proable Difference
Typical Performance
Probable Difference
Definite Difference
1. School Factor 1: /105
105----------79 78----------64 63----------21
2. School Factor 2: /65
65----------64 63----------44 43----------34 33----------13
3. School Factor 3: /85
85----------70 69----------61 60----------17
4. School Factor 4: /55
55-----------42 41----------35 34----------11
The student scored in the Definite Difference range for:
The student scored in the Probable Difference/More Than Others range for:
The student scored in the Definite Difference range for:
School Factor 1: External supports to be prepared for learning. (Seeking and Registration) Typically “Definite Difference” scores in this area correlate to a student who requires extra sensory input to reach the higher threshold of registration in order to be prepared for learning. These students generally require the attention of the teacher or environmental things to get their sensory needs met in order to reach their higher threshold of sensory input needed for active learning.
School Factor 2: Awareness and attention within the learning environment. (Seeking and Sensitivity)With “Definite Difference” scores in this area, students are being pulled away from learning activities because of attention to other stimuli in the environment. Students that fall into this category often need a learning environment with less distraction or stimulation so they can focus on their work.
School Factor 3: Tolerance for sensory input. (Avoiding and Sensitivity) A student who has a “Definite Difference“, a score in this area will avoid a stimuli, otherwise they will become over reactive and frustrated in a situation. These students may become overloaded quickly in typical learning environments which, can interfere with their ability to get directions, complete class work, or cooperate with other students in large groups. These children can appear less tolerant, over reactive, and picky compared to their peers.
School Factor 4: The student’s level of availability for learning. (Avoiding and Registration) These students are missing opportunities to participate and often look uninterested, making them look like they need to “check back into” classroom activities. With these students they need the “just right” level of sensory stimuli to keep them engaged, but not too much to over stimulate them.
MODULATION: Sensory modulation is the ability to modulate or self-regulate one’s mental arousal level. Students with good sensory modulation are calm and focused most of the time, and therefore are ready to do their classwork. Children who are easily over-stimulated or who tend to be under-active may have difficulty with modulation, and therefore have trouble concentrating on their work.
DISCRIMINATION:
The following sensory processing skills appear to be adequate or inadequate for classroom work, based on observations:
The Sensory Processing Measure was administered as a way of obtaining a complete picture of the student’s sensory functioning across different environments including home, as well as the main classroom. It is a standardized norm referenced tool with scores for five sensory systems (vestibular, proprioceptive, tactile, visual, and auditory) as well as praxis (motor planning / ideation) and social participation. Scores for each scale fall into one of three interpretive ranges: Typical (40-59T), Some Problems (60-69T), or Definite Dysfunction (70-80T).
Scores for Main Classroom Form Interpretive Range Typical Performance Some Difficulties Definite Dysfunction
Raw Score T-Score Raw
Score T-Score Raw Score T-Score
Social ParticipationVisionHearingTouchBody AwarenessBalance and MotionPlanning and IdeasTotal Sensory SystemsInterpretation
SOCIAL: VISION: HEARING: TOUCH: BODY AWARENESS: PLANNING AND IDEAS:
The Sensory Processing Measure is an integrated system of rating scales that enables assessment of sensory processing issues, praxis and social participation in elementary school-aged children. It consists of three forms: the Home Form, The Main Classroom Form and the School Environments Form. The measure provides a perspective on a child’s sensory functioning in home, school and community environments. The Main Classroom Forms was completed by……………. The Home Form was completed by …………. The School Environment Forms were not included with this evaluation. The results are as follows:
Main Classroom Form
Social Participation
Visual Hearing Touch Body Awareness
Balance and Motion
Planning and Ideas
Total
Raw Score
T-Score
Interpretive Range
Typical (40T-59T)
Some Problems (60T-69T)
Definite Dysfunction (70T-80T)
Home Form
Social Participation
Visual Hearing Touch Body Awareness
Balance and Motion
Planning and Ideas
Total
Raw Score
T-Score
Interpretive Range
Typical (40T-59T)
Some Problems (60T069T)
Definite Dysfunction (70T-80T)
The Print Tool was used to assess handwriting skills. The Print Tool is designed to assess students over six years old who are having handwriting difficulties. It evaluates uppercase letters, lowercase letters and numbers for:
1. Memory: remembering and writing dictated letters 2. Orientation: facing letters in the correct direction (non-reversal) 3. Placement: putting letters correctly on baseline of the paper 4. Size: How big or small letters are written 5. Start: where each letter begins 6. Sequence: order and stroke direction of the letter parts7. Control: neatness and proportion of the letter parts8. Spacing: the amount of space between letters in words and words in sentences
The Print Tool provides an appropriate remediation plan to increase handwriting skills.
Handwriting Results are as follows:
Memory Orientation
Placement Size Start Sequence
Control Letter Spacing
Word Spacing
UC Letters
LC
Letters
Numbers
The Student’s overall score is ____% Accuracy for handwriting skills. The areas that are in bold are in need of remediation.
Suggested Targets for children 6 years old are as follows:
Memory Orientation
Placement Size Start Sequence Control Letter Spacing
Word Spacing
UC Letters
85% 85% 80% 70% 85% 80% 75% N/A N/A
LC
Letters
85% 85% 80% 70% 85% 80% 75% 80% 80%
Numbers 85% 85% 80% 70% 85% 80% 75% N/A N/A
Suggested Targets for children 8 years or Older are as follows:
Memory Orientation Placement Size Start Sequence
Control Letter Spacing
Word Spacing
UC Letters
100% 100% 95% 85% 95% 95% 95% N/A N/A
LC
Letters
100% 100% 95% 85% 95% 95% 95% 100% 100%
Numbers
100% 100% 95% 85% 95% 95% 95% N/A N/A
Interpretation of test results:
Test of Handwriting Skills-Revised
The Test of Handwriting skills is an untimed assessment of manuscript and/or cursive handwriting. The test assesses writing spontaneously from memory, writing from dictation, copying letters, copying words and copying sentences.
Subtest Raw Score Scaled Score Percentile (avg. 7-13) (avg 16-84)
Airplane(UC Alphabetical order)
Bus(LC Alphabetical order)
Butterfly (UC Random order)
Frog(LC Random order)
Bicycle(Numbers Random order)
Tree(Copy 12 UC letters)
Horse(Copy 10 LC letters)
Truck (Copy 6 words)
Book(Copy 2 sentences)
Lion(Dictated Sentences)
Sum Scaled Scores
Standard Score (avg. 100 ± 15)
Overall Percentile Rank
Interpretation of test results:
School Functional Assessment (SFA)
School Functional Assessment (SFA) is used to measure a student’s performance of functional task that support his or her participation in the academic and social aspects for grades K-6. It is designed to facilitate collaborative program planning for students with a variety of disabling conditions.
The SFA is comprised of three parts:
Part 1 Participation which examines the student’s participation in six major school activity settings: regular or special education classroom, playground or recess, transportation to and from school, bathroom and toileting, transitions to and from class, and mealtime or snack time.
Part 2 Task Support which examines the support currently provided to the student when he or she performs school-related functional task that are required to participate in an educational program. Two types of task support are examined: assistance and adaptation.
Part 3 Activity Performance which examines the student’s performance of specific school-related functional activities. Each scale includes a comprehensive set of activities that share a common functional demand such as moving around the classroom/ school, using school materials, interacting with others, following school rules, and communicating needs. If a student achieves a criterion score less than 100, the criterion cut-off score will determine whether this score is below the level of his or her typically performing peers.
Interpretation of the SFA
Part 1 Participation: Lower scores indicate that the student participates less than his or her same grade peers while higher scores indicates that the students participates more fully in the school activities settings rated.
Part 2 Task Support: Lower scores indicate that the student needs more frequent, extensive, and individualized help or modification to support task performance in that domain. Higher scores indicate that the amount and type of support the student receives for task performance is more like that offered to same grade peers.
Part 3 Activities Performance: Lower scores indicates that the student is limited in his or her performance of some or all of the activities that form a particular scale, whereas higher scores indicate that the student performance approaches that expected at his or her grade level.
Functional Profile
Reg. Classrm
Special Classrm
Playgrnd/Recess
Transportation
Bathrm/Toileting
Transitions Meals/Snacktime
Setting
Rating
Part I Participation Total Raw
Score
Criterion
Score
Standard
Error
Criterion Cut-
Off Score (K-3)
Criterion Cut-
Off Score (4-6)
Regular Classroom + 5 Settings
Special Education Classroom + 5 Settings
Part II Task Supports
Physical Tasks – Assistance
Physical Tasks - Adaptations
Cognitive/Behavioral Tasks-Assistance
Cognitive/Behavioral Tasks-Adaptations
Optional
Tasks
Up/Down Stairs-Assistance
Up/Down Stairs-Adaptations
Written Work-Assistance
Written Work-Adaptations
Computer and Equipment Use-Assistance
Computer and Equipment Use-Adaptations
Physical
Tasks
Part III Activity Performance
Travel
Maintaining and Changing Positions
Recreational Movement
Manipulation with
Movement
Using Materials
Setup and Cleanup
Eating and Drinking
Hygiene
Clothing Management
Up/Down Stairs
Written Work
Computer and Equipment Use
Cognitive/Behavioral
Tasks
Functional Communication
Memory and Understanding
Following Social Conventions
Compliance w/Adult Directives and School Rules
Task Behavior/Completion
Positive Interaction
Behavior Regulation
Personal Care Awareness
Safety
Interpretation of test results:
Summary:
The members of the student’s Individual Education Program will review the results of this evaluation, along with the Georgia Consideration Tools to make appropriate educational recommendations to address identified needs.
Occupational Therapist: Date: