1

CONFIDENTIAL

SPECIAL EDUCATION DEPARTMENT CONEJO VALLEY UNIFIED SCHOOL DISTRICT

1400 East Janss Road Thousand Oaks, CA 91362

(805) 497-9511

PSYCHOEDUCATIONAL REPORT CONFIDENTIAL

TRIENNIAL

The following report was developed to assist the IEP team in determining eligibility and need for special education and related services according to the code of Federal Regulations, Sections 300.304 to 300.306. A student shall qualify as an individual with exceptional needs of the results of the assessment demonstrate that the degree of impairment requires special education. The decision as to whether or not the assessment results demonstrate that the degree of the student’s impairment requires special education shall be made by the IEP team, including assessment personnel. The IEP team shall take into account all relevant material which is available on the student. No single score of product of scores shall be used as the sole criterion for the decision of the IEP team as to the student’s eligibility for special education. (From CCR 5 Sec. 3030)

PRIMARY LANGUAGE DETERMINATION: English Language Learner The Bilingual Background Questionnaire for Parents of Bilingual Students was used to obtain information from the parents regarding language use in the home, as well as health and developmental history. This was completed as an interview conducted over the phone by the school’s ESL Facilitator with the father. XXXXX’s father reported that parents speak Spanish 100% of the time at home and that XXXXX does not speak Spanish, but instead English. Mr. YYYYY reported that he and XXXXX’s mother sometimes have difficulty understanding XXXXX, as he mixes both Spanish and English when he speaks. He reported that other people do not always understand XXXXX when he speaks. He is not able to answer yes and no questions appropriately. Since he entered school, Mr. YYYYY has noticed that XXXXX speaks much more English than Spanish. It was reported that XXXXX will initiate conversation with other children in English. There is no history of speech/language problems in the family. However, Mr. YYYYY reported that he, himself had academic difficulties when he was in school. It was also reported that XXXXX lacks self-esteem.

NAME XXXXX YYYYY BIRTH DATE

SCHOOL Conejo Elementary AGE 9-9

GRADE 4 SEX Male

TEACHER Mrs. Wonderful ADDRESS 123 N. Skyline Dr.#12 Thousand Oaks CA 91362

REPORT DATE 1/2/12 PHONE 805) 123-4567

2

CONFIDENTIAL

If ELL, current level of English proficiency based on the California English Language Development Test (CELDT):

■ Beginning

□ Early Intermediate

□Intermediate

□ Early Advanced

□ Advanced

DOMAIN 2010 2009 2008

Listening Intermediate Intermediate Early Intermediate

Speaking Intermediate Advanced Early Intermediate

Reading Beginning Beginning n/a

Writing Beginning Early Intermediate n/a

TOTAL Beginning Early Intermediate Early Intermediate

The Woodcock-Munoz Language Survey – Revised, Normative Update was administered in order to determine current language proficiency in both English and Spanish. XXXXX was born in the United States and has lived here his entire life. His first language was Spanish. At home, XXXXX reports to speak Spanish (less than 25% of the time) and English (about 75% of the time). He reports that his parents speak Spanish (about 75% of the time) and English (less than 25% of the time). In informal social situations and in the classroom, XXXXX speaks English. He has been exposed to academic instruction in English at school since Kindergarten (4 years). XXXXX was administered this test by two different assessors. The Speech and Language Pathologist administered the English version. The School Psychologist administered the Spanish version. XXXXX’s conversational proficiency seemed typical for his age level in English. Whereas in Spanish, XXXXX’s conversational proficiency was limited. Although XXXXX was cooperative throughout testing he appeared fidgety and restless at times. XXXXX’s score on the Oral Language Scale in English was Limited (Level 3). Oral Language measures listening and speaking, including language development and verbal reasoning. His performance is comparable to that of the average individual at age 6-3. Oral language tasks below the age 5-3 level will be quite easy for XXXXX; those above the age 7-4 level will be quite difficult for him. XXXXX’s score on the Oral Language Scale in Spanish was Negligible (Level 1). His performance is comparable to that of the average individual at age 2-11. Oral language tasks below the age 2-4 level will be quite easy for him; those above the age 3-8 level will be quite difficult for him. However, inspection of his test scores shows significant variability in Spanish oral language performance. Performance on the vocabulary test was significantly lower than performance on the verbal reasoning test. For his age level, XXXXX performs parallel oral language tasks with 1% success in Spanish and with 34% success in English.

3

CONFIDENTIAL

Test/CLUSTER ENGLISH

CALP LEVEL PERCENTILE RANK

STANDARD SCORE

CALP

Picture Vocabulary - 12 82 -

Verbal Analogies - 4 74 -

ORAL LANGUAGE Limited 4 74 3

Test/CLUSTER SPANISH

CALP LEVEL PERCENTILE RANK

STANDARD SCORE

CALP

Vocabulario sobre dibujos

- <0.1 30 -

Analogias verbales - 2 69 -

LENGUAJE ORAL Negligible <0.1 42 1

■ Materials and procedures were provided in a form most likely to yield accurate information on what

the child knows and can do academically, developmentally, and functionally. Assessment(s) administered in: English, with allowance for responses in Spanish as needed on some tests, by a bilingual school psychologist. REASON FOR REFERRAL____________________________________________________________ XXXXX was referred for a full psychoeducational assessment as part of an early triennial evaluation, as requested by his parents. The last complete evaluation was conducted in March 2010. The purpose of this current evaluation is to determine eligibility and to determine if his current placement and services continue to be appropriate. XXXXX is being evaluated for continued special education consideration. PREVIOUS ELIGIBILITY: Speech/Language Impaired

4

CONFIDENTIAL

BACKGROUND INFORMATION__________________________________________________________ ENVIRONMENTAL, CULTURAL, AND ECONOMIC INFORMATION: Health, developmental, and social information was obtained from XXXXX’s parents. Additional information was obtained through a review of school records. XXXXX currently lives with his mother and father, Hugo and Lidia YYYYY. Mr. YYYYY is disabled does not work outside of the home. Mrs. YYYYY is employed cleaning houses. Also living in the home is XXXXX’s sister, Sophia (5 years). XXXXX’s parents reported the following in terms of XXXXX’s behavior at home:

Attention: not good

Activity level: variable

Eating habits: normal

Temperament: depends on how he is feeling

Relationship with sibling: normal

Relationship with friends: normal, very friendly

EDUCATIONALLY RELEVANT HEALTH AND DEVELOPMENTAL INFORMATION: The previous report indicated that XXXXX is the result of a normal pregnancy and delivery. Developmental milestones were met within expected limits. Health/medical history: XXXXX has a history of inattention. He has been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder). He has been prescribed Vyvanse 30 mg. to be taken in the morning prior to school each day. XXXXX is under the medical care of Dr. Gwen Hoffer, Developmental Behavioral Pediatrics, Clinical Del Camino Real – Ventura. XXXXX is also prescribed Singular for nasal allergy and Miralax for constipation. He is also allergic to cats. There is a family history of diabetes. XXXXX has not had any major accidents or injuries. Current vision and hearing results: The vision test performed on 9/14/11 indicated L 20/50 and R 20/100. XXXXX now wears glasses.

The hearing screening performed on 9/14/11 indicated hearing within the normal range.

5

CONFIDENTIAL

EDUCATIONAL BACKGROUND: ATTENDANCE HISTORY- XXXXX is a 9-year old 4th grader at Conejo Elementary School. He has attended Conejo Elementary School since Kindergarten. XXXXX attended Roots and Wings preschool. He has received tutoring since Second Grade. XXXXX has been receiving special education services since March 2010 as a student with a Speech/Language Impairment. XXXXX has received DIS speech since March 2010. Current services: DIS Speech/Language OTHER RELEVANT EDUCATIONAL HISTORY- STAR:

Grade 3 Grade 2

English Language Arts Far Below Basic 252 Below Basic 265

Math Basic 319 Basic 333

BEHAVIORAL OBSERVATIONS: OBSERVATIONS IN CLASSROOM AND OTHER APPROPRIATE SETTINGS, INCLUDING RELATIONSHIP OF BEHAVIOR TO STUDENT’S ACADEMIC AND SOCIAL FUNCTIONING: XXXXX was observed in his classroom on 9/7/11 during Math. He was seated at the front of the classroom, closest to the teacher. XXXXX appeared focused, listening to the teacher’s aide giving directions. XXXXX was again observed in Mrs. Pease’s 4th grade class on October 5, 2011 from 11:30-12:00pm. He was sitting up front close to the white board and overhead projector. The teacher was directing a large classroom activity when she asked students to take out their completed assignments. The teacher’s aide checked XXXXX’s paper and gave him credit. XXXXX and his classmates waited patiently for the teacher’s aide to check everyone’s assignment. The class was then asked to pull out their math workbook. XXXXX took out his workbook quickly. His teacher asked many questions that he raised his hand to answer. XXXXX was given tickets for raising his hand and answering questions correctly. XXXXX continued to pay attention to the teacher speaking while following the lesson on the overhead.

6

CONFIDENTIAL

BEHAVIOR DURING TESTING, INCLUDING RELATIONSHIP OF BEHAVIOR TO THE RELIABILITY OF THE CURRENT ASSESSMENT RESULTS: XXXXX presented himself in a polite manner. He was compliant with examiner instructions and was able to follow all directions. Rapport was established somewhat easily. However, XXXXX did not initiate conversations with the examiner. There was limited spontaneous conversation. XXXXX’s ability to sustain attention and remain focused in the one-on-one setting was appropriate. His activity level was age-appropriate. Test results appear to be valid measures of his ability and achievement. ASSESSMENT INFORMATION: SOURCES OF DATA USED:

■Review of cumulative records

■Statewide Testing and Reporting results (STAR program)

■Work Samples

■Existing assessment reports (list below)

Date Type Assessor

3/2010 Psychoeducational Assessment Report Elizabeth Farley, CVUSD

■Parent interview

■Teacher survey or interview

■Other data sources

■New Assessments (see following section)

Name of new assessments administered: Woodcock-Munoz Language Survey – Revised, Normative Update Sentence Completion Test (psychologist) Conners-3 (psychologist) Family Drawing and School Drawing (psychologist) Observation (psychologist) Student Interview (psychologist) Piers-Harris 2 (psychologist) Wechsler Individual Achievement Test – Third Edition (special education teacher) Teacher Evaluation (classroom teacher)

7

CONFIDENTIAL

■Student was assessed in all areas of suspected disability.

■All tests and materials included those tailored to assess specific areas of educational need.

■All assessments were selected and administered so as not to be discriminatory on racial, cultural, or

sexual bias.

■Each instrument was used for the purpose for which it was designed and is valid and reliable.

■Each instrument was administered by trained and knowledgeable personnel.

■Each instrument was given in accordance with the test instructions provided by the producers of the

assessments.

■All tests were selected and administered to best ensure that they produce results that accurately

reflect the student’s abilities, not the student’s impairments, including impaired sensory, manual, or speaking skills. Explanation or ant of the above that are not checked:___________N/A_____________________ PREVIOUS TESTING: An initial psychoeducational assessment was performed in March 2010. The results are as follows: KABC-2

SUBTEST Scaled Score Age Equivalent Range

Story Completion 3 5:4

Triangles 11 9:0

Block Counting 7 6:6

Pattern Reasoning 7 6:9

Hand Movements 5 4:6

NONVERBAL INDEX 76 Below Average

BVAT-NU

CLUSTER/Test Standard Score %ile

Bilingual Verbal Ability 72 3

English Language Proficiency 70 2

Picture Vocabulary 80 9

Oral Vocabulary 82 11

Verbal Analogies 78 7

Comprehensive Test of Phonological Processing (CTOPP): Date 3/18/10 Age 8-2

SS

Phonological Awareness 88

Elision 7

Sound Blending 9

8

CONFIDENTIAL

Phonological Memory 94

Memory for Digits 6

Nonword Repetition 12

Rapid Naming 112

Rapid Digit Naming 12

Rapid Letter Naming 12

Developmental Test of Visual-Motor Integration – Fifth Edition (VMI-5): Date 3/11/10 Age 8-2

Standard Score 89

Percentile 23

Test of Visual Perceptual Skills – Third Edition (TVPS-3): Date 3/18/10 Age 8-2

Standard Score

Visual Discrimination 7

Visual Memory 2

Visual-Spatial Relationships 5

Visual Form Constancy 5

Basic 74

Visual Sequential Memory 12

Sequencing 110

Visual Figure-Ground 5

Visual Closure 9

Complex 85

Overall 82

9

CONFIDENTIAL

Conners’ Parent Rating Scale – Third Edition: Long Version Date 3/18/10 Age 8 Completed by: parent (Spanish translation and transcribed into English form by psychologist) * Scores over 70 are significant *

T Score Range

Oppositional 70 Markedly Atypical

Cognitive Problems/Inattention 72 Markedly Atypical Hyperactivity 72 Markedly Atypical Anxious-Shy 79 Markedly Atypical Perfectionism 52 Average

Social Problems 64 Mildly Atypical

Psychosomatic 67 Moderately Atypical

Conners ADHD Index 79 Markedly Atypical

Conners’ Global Index: Restless/Impulsive 68 Moderately Atypical

Conners’ Global Index: Emotional Lability 65 Mildly Atypical

Conners’ Global Index: Total 69 Moderately Atypical

DSM-IV: Inattentive 76 Markedly Atypical DSM-IV Hyperactive-Impulsive 78 Markedly Atypical DSM-IV: Total 79 Markedly Atypical Conners’ Teacher Rating Scale – Third Edition: Long Version Date 3/18/10 Age 8 Completed by: Lorraine Epstein * Scores over 70 are significant *

T Score Range

Inattention 53 Average

Hyperactivity/Impulsivity 63 Mildly Atypical

Learning Problems/Executive Functioning 62 Mildly Atypical

Learning Problems (subscale of LE) 73 Markedly Atypical

Executive Functioning (subscale of LE) 49 Average

Aggression 51 Average

Peer Relations 41 Slightly atypical

Conners 3 Global Index Total 53 Average

DSM-IV-TR ADHD Inattentive 53 Average

DSM-IV-TR ADHD Hyperactive-Impulsive 61 Mildly Atypical

DSM-IV-Conduct Disorder 56 Average

DSM-IV-TR Oppositional Defiant Disorder 42 Slightly Atypical

10

CONFIDENTIAL

CURRENT RESULTS OF ASSESSMENT/PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND RELATED DEVELOPMENTAL NEEDS: Standard Score Scaled Score Qualitative Descriptor

130 and above 16-20 Very Superior

120-129 14-15 Superior

110-119 12-13 High Average

90-109 8-11 Average

80-89 6-7 Low Average

70-79 4-5 Borderline

69 and below 0-3 Intellectually Deficient

TEACHER REPORT: Susan Pease, General Education 4th Grade Teacher Distractibility: Moderate - Extreme~ short attention span, lack of concentration, tunes in and out Perceptual Problems: Moderate~ difficulty in accurately duplicating letters: “has a strong font when

writes…not readable” Conceptual Problems: Extreme~ difficulties in remembering ideas and concepts, written words, arithmetic processes; limited vocabulary; difficulty in expressing self Emotionality: Moderate~ excessive anxiety Social Problems: None~ has a great smile and sense of humor SOCIAL-EMOTIONAL/BEHAVIORAL FUNCTIONING: For is family drawing, XXXXX drew a picture of himself with his mother, father, and sister. He drew himself and his sister, sitting on the couch, watching television. He drew his mother in the kitchen, cooking, and his father sitting at a desk working on the computer. For his school drawing, XXXXX drew a picture of himself at recess playing soccer on the field. XXXXX reported to feel happy at school.

11

CONFIDENTIAL

XXXXX was also given the Sentence Completion Task. His sentences reflect a happy child who enjoys school. Some of his sentences were:

When I go to bed…I read a book.

Boys…are my friend.

My mother…is happy.

I feel…happy.

I can’t…play games on school days.

Reading…is fun.

I need…to get better.

I am best when…I play soccer.

I hate…work.

School…is fun.

I like…soccer.

I am happy when…I am in school.

I am very…happy in school.

I…can play sports.

When it is dark…I pray.

My teacher…is very nice with me. The Piers-Harris 2 was administered to assess XXXXX’s self-concept. On this measure, XXXXX responded that he “is a happy person”, is “smart, a leader in games and sports, is well behaved in school, is strong, and likes who he is”. XXXXX also responded “yes” to the statement “My parents expect too much of me”. XXXXX appears to have answered the questions honestly, as the Inconsistency Index and Response Bias Index were within the average (interpretable) range. XXXXX appears to have a good self-concept. Piers-Harris Children’s Self-Concept Scale – Second Edition: Date 9/8/11 Age 9 “T” scores below 40 are regarded as a serious indicator of low self-esteem.

T Score

Behavioral Adjustment 46

Intellectual/School Status 51

Physical Appearance and Attributes 52

Freedom from Anxiety 51

Popularity 50

Happiness and Satisfaction 51

Total 49

12

CONFIDENTIAL

The Conners 3 is an assessment tool used to obtain observations about a student’s behavior in the school and in the home setting. This instrument is designed to assess ADHD and its most common co-morbid problems in children and adolescents. XXXXX’s teacher and parents completed the Conners-3. On the teacher form, scores on the Validity scales do not indicate a positive, negative or inconsistent response style. The T -score: Learning Problems (subscale) (T = 72) was very elevated indicating many more concerns than are typically reported. The teacher reported that XXXXX’s problems seriously affect his functioning very frequently (rating = 3) in the academic setting. Based on the teacher’s ratings, the Conners 3 ADHD Index score is borderline (58% probability of an ADHD classification). Conners 3 - Teacher: Date 9/7/11 Age 9 Completed by: Susan Pease (4th grade teacher) T Score

Inattention 60 High Average

Hyperactivity/Impulsivity 43 Average

Learning Problems/Executive Functioning 60 High Average Learning Problems 72 Very Elevated

Executive Functioning 49 Average

Defiance/Aggression 44 Average

Peer Relations 50 Average

ADHD Predominantly Inattentive Type 51 Average

ADHD predominantly Hyperactive Type 43 Average

Conduct Disorder 45 Average

Oppositional Defiant Disorder 44 Average

Conners 3GI: Restless/Impulsive 51 Average

Conners 3GI: Emotional Lability 44 Average

Conners 3GI: Total 49 Average

Conners 3 - Parent: Date 9/1/11 Age 9 Completed by: Hugo YYYYY (father) *Caution should be used when interpreting this parent report, as the Inconsistency Index indicates that responses to similar items showed a possible inconsistent responses style. The T-scores for the following Conners 3-P Content scales were very elevated (i.e., T-score = 70), indicating many more concerns than are typically reported: Inattention (T = 87) and Learning Problems (T = 90). The Symptom Count was probably met and the T-score was elevated or very elevated (i.e., T-score = 65) for the following DSM-IV-TR Symptom scale: ADHD Predominantly Inattentive Type (T = 73). The parent reports that XXXXX YYYYY’s problems seriously affect his functioning very frequently (rating = 3) in the academic setting, and often (rating = 2) in the home setting.

13

CONFIDENTIAL

Based on the parent’s ratings, further investigation was suggested/recommended for issues with anxiety. Based on the parent’s ratings, further investigation was suggested/recommended for issues with Depression.

T Score

Inattention 87 Very Elevated

Hyperactivity/Impulsivity 53 Average

Learning Problems 90 Very Elevated

Executive Functioning 54 Average

Defiance/Aggression 59 Average

Peer Relations 44 Average

ADHD Predominantly Inattentive Type 73 Very Elevated

ADHD predominantly Hyperactive Type 54 Average

Conduct Disorder 44 Average

Oppositional Defiant Disorder 56 Average

Conners 3GI: Restless/Impulsive 48 Average

Conners 3GI: Emotional Lability 54 Average

Conners 3GI: Total 50 Average

14

CONFIDENTIAL

PRE-ACADEMIC/ACADEMIC SKILLS: Wechsler Individual Achievement Test – Third Edition (WIAT-III):

Date 10/20/11 Age 9-9

Age Norms Reported Given by Joan Shayer, Learning Center Teacher

XXXXX’s academic achievement was evaluated by Joan Shayer, Learning Center Teacher, with the WIAT-III. This test focused on the areas of reading, math, and written language. XXXXX’s scores are compared to age level peers nationally.

Composite Standard Score Percentile Rank Range

Oral Language 78 7 Below Average

Listening Comprehension 79 8

Oral Expression 82 12

Reading

Word Reading 79 8

Reading Comprehension 72 3

Written Expression 84 14 Below Average

Sentence Composition 83 13

Essay Composition 96 39

Spelling 83 13

Mathematics 86 18 Average

Math Problem Solving 84 14

Numerical Operations 90 25

Math Fluency-Addition 101 53

Math Fluency-Subtraction 90 25

Math Fluency-Multiplication 85 16

Math Fluency 91 27 Average

15

CONFIDENTIAL

Overall, academic testing shows that XXXXX has low average skills in the areas of math and math fluency. Oral language and written expression skills fall within the below average range. Basic reading skills (word reading) falls within the below average range, while reading comprehension skills fall within the well below average range. OVERALL SUMMARY AND RECOMMENDATIONS ___________________________________________________ This assessment was conducted due to parent’s request and as part of an early triennial evaluation. Continued special education eligibility is being considered. SUMMARY OF ASSESSMENT: Current results indicate …..

Cognitive abilities: most likely fall within the below average range. Nonverbal IQ: 76

Academic skills levels as demonstrated by standard scores:

a. Reading – well below average to below average b. Math – average c. Written Expression – below average

Academic Skills as demonstrated by classroom performance/grades/group test scores:

In the general education setting, XXXXX performs well below grade level peers in the areas that involve reading comprehension. In math calculation, he performs slightly below grade level or at grade level.

STAR results from 3rd grade indicate Far Below Basic skills in English Language Arts and Basic skills in Math

Social-emotional functioning: XXXXX is a sweet child who puts forth good effort. He has a strong desire to do well in school. He can at times present as anxious and nervous. His attention and distractibility, although much improved, continue to significantly impact his ability to access the general education curriculum, most specifically in the area of Language arts.

Speech/Language functioning: Current testing shows deficits in auditory memory and word relationships. Some of his expressive skills are within the average range. Please refer to Speech/Language assessment report.

Processing Delays are most likely exhibited in the following areas:

attention

No severe discrepancies between measured cognitive ability and academic achievement are evident at this time.

16

CONFIDENTIAL

Other: XXXXX has a diagnosis of ADHD. Although improvement in attention and focus has been noted since he has been prescribed Vyvanse, he continues to struggle with accessing the general education curriculum in the area of reading, specifically reading comprehension and basic reading skills.

Second language factors: XXXXX is an English Language Learner.

SUMMARY OF ASSESSMENTS, INCLUDING FACTORS AFFECTING EDUCATIONAL PERFORMANCE: Previous results indicate that XXXXX’s nonverbal cognitive functioning falls within the below average range. Current academic assessment results indicate significant weakness in the areas of reading comprehension and written expression. XXXXX presents as a student with significant attention difficulties. His inability to remain on task for required length of time significantly impacts his ability to access the general education curriculum. RECOMMENDATIONS TO ENABLE STUDENT TO BE INVOLVED IN AND PROGRESS IN GENERAL EDUCATION CURRICULUM:

Optimize seating arrangement (away from windows and doorways, near front)

Provide a quiet environment

Acknowledge attention deficits as a component of student’s learning profile

Provide external cueing to maintain attention

Provide instruction in short blocks (5 to 15 minutes)

Reward on-task behaviors

Provide for individual or small group instruction

Preview or “Frontload” activities purpose and anticipated timeline.

Instruct student to:

Watch the instructor

Sit where least distracted

Pay attention to established cues

Work at a study carrel or other low distraction area “personal office”

Have something to squeeze to release stress

Communicate with teacher when feeling extremely distractible

ELIGIBILITY:

17

CONFIDENTIAL

■Indicators of possible disability or continuing disability:

Other Health Impairment:

Federal

P.L. 105-17 (IDEA), Title 34, CFR, 300.7(c)(9)

Other health impairment means having limited strength, vitality or alertness, including a heightened

alertness to environmental stimuli, that results in limited alertness with respect to the educational

environment, that –

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or

attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead

poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and

(ii) Adversely affects a child’s educational performance.

2. State

CCR, Title 5, Section 3030(a)

A pupil has limited strength, vitality or alertness, due to chronic or acute health problems, including

but not limited to a heart condition, cancer, leukemia, rheumatic fever, chronic kidney disease, cystic

fibrosis, severe asthma, epilepsy, lead poisoning, diabetes, tuberculosis and other communicable

infectious diseases, and hematological disorders such as sickle cell anemia and hemophilia which

adversely affects a pupil’s educational performance. In accordance with Section 56026(e) of the

Education Code, such physical disabilities shall not be temporary in nature as defined by Section

3001(v). Currently, a severe discrepancy does not exist between previously tested cognitive ability and current academic functioning. However, at this time, XXXXX appears to meet the eligibility requirements for special education services under the eligibility criteria of Other Health Impaired (OHI). A secondary eligibility of Speech/Language disability may need to be considered. It is the examiner's recommendation that speech designated instructional services continue to be provided and that the team consider specialized academic instruction in the areas of reading and written language in the Learning Center. The IEP team will need to determine if this disability adversely affects his educational performance and functioning cannot be corrected without continued special education and related services.

■Possible special education and related services needed or additions or modifications to current

services needed to meet goals and participate in general curriculum/appropriate activities (include basis for determination of need): The IEP team will need to determine how XXXXX's educational needs can best be met and if special education services continue to be required in order for him to be successful at school. The IEP team will meet to discuss assessment results as well as to discuss educational planning and placement, which may include special education. All test results from the multi-disciplinary team members’ assessment will be considered before a conclusion can be reached regarding whether student’s needs require special education and related services, which cannot be provided with modification of the regular school program. The purpose of this report is to provide information to assist the team in making that decision. Need for specialized services and equipment (required for low incidence):__No____

18

CONFIDENTIAL

Person completing this report: ______________________ __________________ Elizabeth Farley, M.S. Date School Psychologist Other assessors contributing to this report:

Name Title

Joan Shayer Special Education Teacher

Martha Vaughan Speech/Language Pathologist