CONTRACTORS LETTERHEAD

SPEECH & LANGUAGE ASSESSMENT REPORTS FOR HEAD START

I. Student Data Name Date of Birth Gender Chronological Age Home Language Student Language Head Start Agency / Site Head Start Enrollment Date Date signed assessment plan received II. Evaluation Data

Date of Evaluation (Include any missed or cancelled appointments) Date of Report Name of Evaluator(s) Evaluation was conducted in Assessments Completed: Preschool Language Assessment (PLA) Preschool Language Scale -Fourth Edition (PLS-4) PLS-Articulation Screener SAM Goldman Fristoe Arizona Assessment of Phonological Processes Oral Peripheral Exam Preschool Team Assessment Experimental III (PTA) Parent Interview Teacher Interview Observation _______________________________ (other) III. Reason for Referral Indicate who initiated the referral and why. English Spanish ________________

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IV. V. VI.

Head Start Interventions/Modifications Report on the strategies implemented prior to the referral and the outcome. Background Information Include basic information about family history and home language Hearing/Vision/Health Indicate date and outcome of hearing and vision screenings. Include additional health information that may be relevant to this assessment. Significant health information that may be considered confidential should not be reported here. Child Engagement/Program Include description of classroom environment, activities and childs engagement/performance. Child Engagement/Evaluation Include description of evaluation environment and childs level of engagement during process. IX. Communication Results Use parent/teacher friendly language; define terms such as phonological process, oral peripheral; avoid words such as compliant/noncompliant. Use objective language and present facts related to the areas below. Include a description of tools used.
Example: The PLS-4 is a standardized tool that measures language development of children birth to 6 years of age. The Auditory Comprehension Subscale provides information about the childs understanding of vocabulary and concepts, and interpretation of meaning based on word order and subtle differences. The Expressive Communication Subscale evaluates a childs ability to communicate socially, provide information, apply word and sentence rules and to express complex ideas. Results may be indicated in: Standard Scores, 76 or below may meet eligibility criteria; Percentile Ranks, 6% or below may meet eligibility criteria; Standard Deviations, 1.5 and above may meet eligibility criteria; and Age Equivalents.

VII. VIII.

Receptive Language Report scores, including Standard Deviation. Include examples of childs functional level, assessed strengths and assessed needs. Support with information from observation, existing classroom assessments and parent/teacher interview. Only if the results appear to meet the eligibility criteria established in the CA Ed. Code, include a statement that indicates what age level skills the child may not be able to achieve due to this delay. Ex: B/Gs receptive language delays will impact his ability to participate in class discussions, answer questions and follow directions. Expressive Language Report scores, including Standard Deviation. Include examples of childs functional level, assessed strengths and assessed needs. Support with information from observation, existing classroom assessments and parent/teacher interview. Only if the results appear to meet the eligibility criteria established in the CA Ed. Code, include a statement that indicates what age level skills the child may not

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be able to achieve due to this delay. Ex: B/Gs expressive language delays will impact his ability to be understood when expressing thoughts and ideas and participating in class discussions. Language Sample Use Language Sample template (attached). Provide a language sample and analysis of 50 utterances using Browns criteria. Note sentence complexity, mean length of utterance, pronunciation and percentage of intelligibility. If 50 utterances are not provided include rationale. Within the report include a sample of 5 utterances (minimum) indicating how language was collected; response to questions, retelling a story, spontaneous comments, imitation. The Language Sample should reflect childs pronunciation and English translation, if applicable. Pragmatics Include a definition. Ex: Pragmatics refers to the use of language in social contexts and includes skills such as verbal turn-taking, staying on topic, response time and how the child relates to others. Describe the childs functional ability in this area. Articulation Identify the measure used and how the responses were elicited. Report findings. Indicate which sounds are within developmental norms and which sounds are delayed based on chronological age, primary language, speech and language of primary caregivers and any other factor that may impact phonological development. If assessment of phonological processes was completed include developmental criteria and definitions. Always report childs ability to imitate modeled sounds and percentage of intelligibility. Oral-Peripheral Include a statement that reports the childs ability to imitate typical oral motor movements and sound sequences and implications for speech production. Voice Include a statement that reports the appropriateness of childs quality, pitch and loudness. Fluency Include a statement that reports the appropriateness of flow, rate and rhythm of childs speech. If the referral was based on concerns related to fluency this area must be evaluated using norm referenced criteria. Include information regarding percentage of dysfluent utterances, type(s) of dysfluency and secondary characteristics.

X.

Summary Restate name, age, reason for referral. Recap strengths, needs and supporting scores. Only if the results appear to meet the eligibility criteria established in the CA Ed. Code, repeat your statement that indicates what age level skills the child may not be able to achieve due to this delay. Do not include recommendations in the report.

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