CONTRACTOR’S 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 ________________

September 2007

IV. Head Start Interventions/Modifications Report on the strategies implemented prior to the referral and the outcome. including Standard Deviation. Include examples of child’s functional level. Expressive Language Report scores. existing classroom assessments and parent/teacher interview. include a statement that indicates what age level skills the child may not be able to achieve due to this delay. and interpretation of meaning based on word order and subtle differences. Significant health information that may be considered confidential should not be reported here. The Expressive Communication Subscale evaluates a child’s ability to communicate socially. define terms such as phonological process. provide information. and Age Equivalents. The Auditory Comprehension Subscale provides information about the child’s understanding of vocabulary and concepts. Results may be indicated in: Standard Scores. Include additional health information that may be relevant to this assessment. Standard Deviations. V. Example: The PLS-4 is a standardized tool that measures language development of children birth to 6 years of age.5 and above may meet eligibility criteria. VIII. apply word and sentence rules and to express complex ideas.  Receptive Language Report scores. Only if the results appear to meet the eligibility criteria established in the CA Ed. Child Engagement/Program Include description of classroom environment. Use objective language and present facts related to the areas below. answer questions and follow directions. Include examples of child’s functional level. activities and child’s engagement/performance. Background Information Include basic information about family history and home language Hearing/Vision/Health Indicate date and outcome of hearing and vision screenings. VI. Code. Child Engagement/Evaluation Include description of evaluation environment and child’s level of engagement during process. oral peripheral. assessed strengths and assessed needs. including Standard Deviation. 76 or below may meet eligibility criteria. Only if the results appear to meet the eligibility criteria established in the CA Ed. existing classroom assessments and parent/teacher interview. assessed strengths and assessed needs. Communication Results Use parent/teacher friendly language. Percentile Ranks. 1. Support with information from observation. Ex: B/G’s receptive language delays will impact his ability to participate in class discussions. IX. Support with information from observation. 6% or below may meet eligibility criteria. avoid words such as compliant/noncompliant. include a statement that indicates what age level skills the child may not  September 2007 . Code. Include a description of tools used. VII.

Fluency Include a statement that reports the appropriateness of flow. response time and how the child relates to others.be able to achieve due to this delay. Indicate which sounds are within developmental norms and which sounds are delayed based on chronological age. Oral-Peripheral Include a statement that reports the child’s ability to imitate typical oral motor movements and sound sequences and implications for speech production. age. Articulation Identify the measure used and how the responses were elicited. reason for referral. Do not include recommendations in the report. if applicable. Recap strengths. Note sentence complexity. Ex: Pragmatics refers to the use of language in social contexts and includes skills such as verbal turn-taking. Describe the child’s functional ability in this area. repeat your statement that indicates what age level skills the child may not be able to achieve due to this delay. If the referral was based on concerns related to fluency this area must be evaluated using norm referenced criteria. Within the report include a sample of 5 utterances (minimum) indicating how language was collected. spontaneous comments. pitch and loudness. Include information regarding percentage of dysfluent utterances. needs and supporting scores. Always report child’s ability to imitate modeled sounds and percentage of intelligibility. Provide a language sample and analysis of 50 utterances using Brown’s criteria.      X.  Language Sample Use Language Sample template (attached). speech and language of primary caregivers and any other factor that may impact phonological development. September 2007 . Only if the results appear to meet the eligibility criteria established in the CA Ed. Code. Ex: B/G’s expressive language delays will impact his ability to be understood when expressing thoughts and ideas and participating in class discussions. If 50 utterances are not provided include rationale. response to questions. Summary Restate name. primary language. Pragmatics Include a definition. rate and rhythm of child’s speech. Voice Include a statement that reports the appropriateness of child’s quality. pronunciation and percentage of intelligibility. type(s) of dysfluency and secondary characteristics. mean length of utterance. imitation. staying on topic. The Language Sample should reflect child’s pronunciation and English translation. If assessment of phonological processes was completed include developmental criteria and definitions. retelling a story. Report findings.

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