dyslexia checklist
Dyslexia in PCSSD Quick-Reference Sheet
Checklist for Referral for Dyslexia Level II Screening & Services Step One: Initial Screening in ALL six components according to PCSSD Assessment Protocol K-5 Assessments
Circle Yes or NO
Considerations
6-12 Assessments
Circle Yes or NO
Considerations
STAR Reading
Yes or NO
If no, stop and administer
STAR Reading
Yes or NO
If no, stop and administer
Developmental Spelling Analysis (DSA)
Yes or NO
If no, stop and administer
Developmental Spelling Analysis (DSA)
Yes or NO
If no, stop and administer
DIBELS & AR Rapid Naming
Yes or NO
If no, stop and administer
Writing Sample
Yes or NO
If no, stop and administer
Writing Sample
Yes or NO
If no, stop and administer
AR Rapid Naming
Yes, NO or NA Only if students have not been assessed in K-2
Step Two: Response to Intervention Process
CHECK POINT: ALL tasks in Step 2 should be completed before moving to Step 3 Please circle Yes or No for each descriptor
❏ Discussed significant deficits across assessments with grade-level or content-level RtI team
Yes or No
❏ Response to Intervention forms completed by referring teacher and filed with RtI coordinator
Yes or No
❏ Intervention provided no less than 9wks. 18 weeks recommended for intense intervention
Yes or No
❏ Student progress monitored bi-weekly using STAR or EARLY STAR
Yes or No
❏ RtI team met to review progress and determine next steps
Yes or No
Meeting Date ______
❏ RtI team met to make determination regarding interventions
Yes or No
Please check box for RtI decision ❏ Option 1: Continue Interventions Meeting Date _______ ❏ Option 2: Modify Interventions Meeting Date _______ ❏ Option 3: Referral for to School RtI Team Meeting Date _______ CHECK POINT: If Option 3 is chosen, continue to Step Three (3). If not, stop here and continue RtI interventions
Arkansas Dyslexia Resource Guide http://tinyurl.com/he3a6k5
Dyslexia in PCSSD Quick-Reference Sheet
Step Three:
School RTI team meets to complete Level I Screening “Data Gathering” CHECK POINT: RtI forms should be complete and indicate intervention at the classroom level. If not, go back to Step Two.
Please circle Yes or No for each descriptor ❏ Classroom teacher gathers data and presents student results to school-level RTI Team Yes or No ❏ Next steps completed by team based on screening, intervention and progress monitoring data Yes or No ❏ Option 1: Modify Intervention plan Meeting Date _______ ❏ Option 2: Refer student for Level II Screening Meeting Date _______ ❏ Parental Consent is obtained using form in RtI Manual Yes or No ❏ Provide parent with copy of the Basics about Dyslexia Fact Sheet. Yes or No ❏ Fact sheet can be downloaded from this site: http://tinyurl.com/jl5xajy
CHECK POINT: Do not proceed to Step Four without parental consent or RtI file with documentation.
Step Four:
Referral for Level II screening submitted to Program Administrator
❏ RTI records are made available to District Dyslexia Lead ❏ District Program Administrator for elementary literacy confirms need for Level II Screening ❏ Referral sent to Program Administrator Referral Date _______ ❏ Level II screening is administered by district designee ❏ If eligible, student receives intense intervention using dyslexia program ❏ RTI team and Dyslexia Therapist reviews student progress quarterly Note: Parent requests also follow the same process. Start at step one.
Yes or No Yes or No Yes or No Yes or No
FastTrack Dyslexia Intervention Services
Students that have a diagnosis for characteristics of dyslexia are eligible for intervention services upon receipt of diagnosis.
Dyslexia Screening Levels Level of Screening Initial Screening
Administered by Classroom Teacher
Level I Screening “Data Gathering”
Completed by Classroom Teacher
K-5 ❏ ❏ ❏ ❏
STAR Test DSA DIBELS WRITING SAMPLE
Review: Initial Screening Gather: work samples
6-8 ❏ ❏
STAR Test WRITING SAMPLE
9-12 ❏ ❏
STAR Test WRITING SAMPLE
Review: Initial Screening Review: Initial Screening Gather: work samples Gather: work samples
Administered by District Designee
Level II Screening
Battery of Norm-referenced Diagnostic Assessments
Interventions
By Whom? Trained Dyslexia Interventionists
Arkansas Dyslexia Resource Guide http://tinyurl.com/he3a6k5
Checklist for Referral for Dyslexia Level II Screening & Services Step One: Initial Screening in ALL six components according to PCSSD Assessment Protocol K-5 Assessments
Circle Yes or NO
Considerations
6-12 Assessments
Circle Yes or NO
Considerations
STAR Reading
Yes or NO
If no, stop and administer
STAR Reading
Yes or NO
If no, stop and administer
Developmental Spelling Analysis (DSA)
Yes or NO
If no, stop and administer
Developmental Spelling Analysis (DSA)
Yes or NO
If no, stop and administer
DIBELS & AR Rapid Naming
Yes or NO
If no, stop and administer
Writing Sample
Yes or NO
If no, stop and administer
Writing Sample
Yes or NO
If no, stop and administer
AR Rapid Naming
Yes, NO or NA Only if students have not been assessed in K-2
Step Two: Response to Intervention Process
CHECK POINT: ALL tasks in Step 2 should be completed before moving to Step 3 Please circle Yes or No for each descriptor
❏ Discussed significant deficits across assessments with grade-level or content-level RtI team
Yes or No
❏ Response to Intervention forms completed by referring teacher and filed with RtI coordinator
Yes or No
❏ Intervention provided no less than 9wks. 18 weeks recommended for intense intervention
Yes or No
❏ Student progress monitored bi-weekly using STAR or EARLY STAR
Yes or No
❏ RtI team met to review progress and determine next steps
Yes or No
Meeting Date ______
❏ RtI team met to make determination regarding interventions
Yes or No
Please check box for RtI decision ❏ Option 1: Continue Interventions Meeting Date _______ ❏ Option 2: Modify Interventions Meeting Date _______ ❏ Option 3: Referral for to School RtI Team Meeting Date _______ CHECK POINT: If Option 3 is chosen, continue to Step Three (3). If not, stop here and continue RtI interventions
Arkansas Dyslexia Resource Guide http://tinyurl.com/he3a6k5
Dyslexia in PCSSD Quick-Reference Sheet
Step Three:
School RTI team meets to complete Level I Screening “Data Gathering” CHECK POINT: RtI forms should be complete and indicate intervention at the classroom level. If not, go back to Step Two.
Please circle Yes or No for each descriptor ❏ Classroom teacher gathers data and presents student results to school-level RTI Team Yes or No ❏ Next steps completed by team based on screening, intervention and progress monitoring data Yes or No ❏ Option 1: Modify Intervention plan Meeting Date _______ ❏ Option 2: Refer student for Level II Screening Meeting Date _______ ❏ Parental Consent is obtained using form in RtI Manual Yes or No ❏ Provide parent with copy of the Basics about Dyslexia Fact Sheet. Yes or No ❏ Fact sheet can be downloaded from this site: http://tinyurl.com/jl5xajy
CHECK POINT: Do not proceed to Step Four without parental consent or RtI file with documentation.
Step Four:
Referral for Level II screening submitted to Program Administrator
❏ RTI records are made available to District Dyslexia Lead ❏ District Program Administrator for elementary literacy confirms need for Level II Screening ❏ Referral sent to Program Administrator Referral Date _______ ❏ Level II screening is administered by district designee ❏ If eligible, student receives intense intervention using dyslexia program ❏ RTI team and Dyslexia Therapist reviews student progress quarterly Note: Parent requests also follow the same process. Start at step one.
Yes or No Yes or No Yes or No Yes or No
FastTrack Dyslexia Intervention Services
Students that have a diagnosis for characteristics of dyslexia are eligible for intervention services upon receipt of diagnosis.
Dyslexia Screening Levels Level of Screening Initial Screening
Administered by Classroom Teacher
Level I Screening “Data Gathering”
Completed by Classroom Teacher
K-5 ❏ ❏ ❏ ❏
STAR Test DSA DIBELS WRITING SAMPLE
Review: Initial Screening Gather: work samples
6-8 ❏ ❏
STAR Test WRITING SAMPLE
9-12 ❏ ❏
STAR Test WRITING SAMPLE
Review: Initial Screening Review: Initial Screening Gather: work samples Gather: work samples
Administered by District Designee
Level II Screening
Battery of Norm-referenced Diagnostic Assessments
Interventions
By Whom? Trained Dyslexia Interventionists
Arkansas Dyslexia Resource Guide http://tinyurl.com/he3a6k5
