Durham Public Schools

1. Durham Public Schools Case Study: Early Intervention School Year 2010-2011 Time Frame: August 2010 through January 2011 (~5-6 months)

2. Case Description Initially Presenting Risk Factor Data 2010: • Child was referred to DPS due to concerns about his learning abilities, speech, and behavior, by his mom and through several community professionals including a Child Service Coordinator, a physician at a Community Health Center, and a community SLP. • Child’s mother was highly concerned about his aggressive behavior towards her at home and his excessive language delays. • Child’s Service Coordinator expressed concerns about his attention seeking behaviors, delays in communication (i.e., not using words), short attention span, and delay in fine motor skills. She noted that he was very challenging to assess in the home setting. • Child’s family spoke Spanish in the home.

3. Baseline Data at Commencement of Intervention Speech challenges • Child received a speech-language screening in 1/2010 by a community SLP.  Child was given the Preschool Language Scale-4th Edition, Spanish Version.  Results were as followed: • Auditory Comprehension-Standard Score: 68; • Expressive Communication-Standard Score: 70; • Total Language Score: 69. More at Four/Title I • Child was placed in a DPS More at Four / Title I classroom in August 2010 • Initial scores (Dial 3): • Motor: 5 • Concepts: 3 • Language: 4 • Total: 12

4. First Few Months at School • Student used little to no words in English or Spanish and it was “EXTREMELY difficult to understand” what he was saying for both adults and students • Student was unable to trace or copy letters when written/modeled for him. • Student exhibited difficulty grasping writing and eating utensils. • Student demonstrated aggressive behaviors with both adults and students. “He would hit, spit at, kick, push, both peers and adults as well as turn over chairs, shelves, and tables in the class. At times he would present danger to himself by running away from adults throughout the school. Student would have melt-downs throughout the day when things didn't go his way or he was asked to do something he didn't want to do. These things would include transitioning, cleaning up, lining up, sharing, etc.  During large group time he would have to be removed from the area, because he was unable to longer than 2-3 minutes without verbally and physically disturbing his peers.  It was very difficult for Student to have friends, because most students would be afraid of his aggressive behaviors. During meals, Student eats little to no food. He wouldn't drink or eat anything, sometimes throwing his food on the floor in the trashcan. He became very aggressive when others encourage him to eat or being praised for eating.”

5. Tier I and II Strategies Tier I • Visual Supports • Behavior Chart (made with actual pictures of him doing each activity and transitioning) • Using more visuals/pictures of daily activities, group activities, etc. instead of words • Implementation of “Cool Down Time” • Ignoring negative behaviors • Praising positive behaviors • Simple Communication: using 1-2 words to communicate • Using a “Buddy System” (having a peer to assist him) • Environmental adaptations: Instead of sitting in circle, he sat near the circle time group while cutting paper (i.e. shapes). • Student was given classroom jobs (more than 1 sometimes) and often assisted adults. • Academic coaching Tier II • Behavioral observations and consultations with preschool psychologist • BSA out in place: November 8th-January 10th • At the same time, Tier III intervention process began (referral for testing)

6. Fast Forward January 2011

7. DPS Preschool Assessment Team (DPS-PAT) Child was assessed in early January of 2011 by the DPS-PAT (Tier III). Speech and Language Results: The Preschool Language Scale-4th Edition (PLS-4) Spanish Version was administered by a Spanish-speaking interpreter.  • On the Auditory Comprehension subtest, Student earned a score of 92, which reflects skills within normal/functional limits.    • On the Expressive Language subtest, Student earned a score of 87, which reflects skills in the Average range.  • Student’s Total Language standard score was an 89, which is indicative of age appropriate and functional language skills.    • Student’s functional use and understanding of language was reported as very appropriate and effective. 

8. PAT Results • Cognitive scores fell in the Average range. • DAS-II • Verbal Reasoning Standard Score: 81 (Below Average) • Non-verbal Reasoning: 99 (Average) • Spatial Reasoning: 112 (Above Average) • GCA: 96 (Average) • Special Non-verbal Composite: 106 (Average)

9. PAT Results • Age appropriate (Average) academic functioning. • Age-appropriate motor skills (PDMS-2 FMQ: 95). • Adaptive skills, via parent and teacher rating scales indicated daily living skills in the Borderline to Low range, with weaknesses in communication and self-care. • We expect Student’s adaptive functioning to catch up and improve as his other skills have done. • VAST improvements in behavior and in classroom functioning.

10. PAT Results Further Occupational Evaluation Results Self Care Skills: • Able to feed himself, but he doesn’t like to eat. Needs lots of encouragement and assistance to eat lunch at school, mom reports this is true at home as well. • Able to dress and undress himself. • Able to wash his hands independently. • Potty trained, including clothing management. • Able to manage personal belongings at school. Student Role/Interaction Skills: • Able to put out his cot. • Difficulty with transitions to non-preferred or non-routine tasks. • Able to walk in a line with adult support.

11. PAT Results Continued: Learning, Pre-academic Skills: • Able to complete puzzles. • Knows every student’s number of their cot, and can set the cots up independently for rest time. • Sorting objects by color. • Able to write his first name. • Able to draw prewriting shapes. • Able to cut along lines and cut out shapes. • Enjoys arts and crafts. • Counting with 1-1 correspondence to about 3. Play Skills: • Able to get along with peers in the classroom, now that he has intensive behavioral support. • Able to run, jump, scale playground structures, and can sit on a swing without pumping.

12. Comment by DPS PAT SLP “This illustrates the power and possibility of outcomes from exposure and experience for children who are English Language Learners. ”

13. Qualitative Differences Student’s Teacher reports: “Student is now able to write his name without looking at it, while forming each letter appropriately. He is the only student in the classroom who can write his name from memory and recognize the letters. He recognizes all of his peers' (assigned) numbers and names. He now uses his manners without reminders most of the time. When entering the school each morning he speaks to all adults by saying "Good morning" in English! He is also transitioning much better. Some reminders are needed, but not as many as a few months ago. He understands classroom rules and helps friends understand them as well. For example, he washes his hands using all of the appropriate steps. Student uses self-help skills without reminders and assists peers in using them as well.  He now participates appropriately in large group time; He enjoys morning music and movement and specifically ask for a certain song. He also enjoys small group activities. He uses spoken language more. For example, he attempts to say words in English and repeats adults and peers frequently. Moreover, Student hasn't acted aggressively at all over the past three months. Recently when he has become angry he has sat down by himself to calm down.”

14. Parent Report Student’s mother has reported the following to teacher: “Mom reports that she has seen much improvement in Student being in school, both academically and socially. She sees that he is now learning to get along better with his peers and is learning more English. She is excited about the progress that he has made!”

15. And…. This success story is still in progress…..