Michigan Severity Rating Scales:

Michigan Severity Rating Scales:
The Michigan Severity Rating Scales: Tools Supported by Data We’re very pleased to be here today to share this exciting new data with you. Sue and I have both worked on this project from the beginning and want to thank AER for this opportunity to share it with you. The information we’re sharing with you today is the result of over 15 years work by VI professionals in Michigan. We first started presenting on the scales in 2007; started being urged in 2008 to gather better data; presented at AER 2008; Cleveland 2010; AER webinar in Cleveland October 2010 We approached the Department of Blindness and Low Vision Studies at Western Michigan University to guide us in gathering the data that would show that these tools are reliable in suggesting service times for Orientation & Mobility services to students in public schools. We’re grateful to Dawn and Rob for their hard work in this project. Michigan Severity Rating Scales: Solving the Puzzle of Service Delivery Time

Michigan Severity Rating Scales Tools Supported by Data
Orientation and Mobility Severity Rating Scale (O&MSRS) Orientation and Mobility Severity Rating Scale for Students with Additional Needs (O&MSRS+) Vision Services Severity Rating Scale (VSSRS) Vision Services Severity Rating Scale for Students with Additional Needs (VSSRS+) Susan L

Michigan Severity Rating Scales History and Development
Adapted from the Montgomery County, Pennsylvania model beginning in 1995 Published and disseminated by the Michigan Department of Education – Special Education Services in 1996 Sue B.

First versions – 1996 and supported by the Michigan Department of Education – Special Education Services Michigan Department of Education-Low Incidence Outreach (MDE-LIO) created and sponsored committees beginning in 2007 to revise the three existing scales and develop the O&MSRS+

Web search indicated the Scales were being used and referenced in documents in several other states Referred to in O&M university preparation programs Internationally recognized Sue B.

Michigan Severity Rating Scales
What they are: Data collection tools A guide based on best practices Guideline for IEP team service discussion Susan L The Michigan Severity Rating Scales What they are: First, As a data collection tool that helps the service provider analyze the various factors that go into deciding how much time will be required to provide the amount of service needed. Second, As a Guide Based on Best Practice *This has been somewhat informally determined even though we gathered data and reached a consensus. We recognize that a more formal determination of the validity and reliability of the tools needs to be established. We are in the beginning stages of getting assistance from those knowledgeable in research to guide us through the steps of determining this. Third, As a Guideline for IEP team service discussion: *The manner in which these tools are used for IEP Team discussion is up to the service provider *Some service providers fill out the scale at the IEP with all team members providing input *Other providers fill it out ahead of time and use the information and the data collected as the basis for the recommendation of service time and then keep it in the student’s working file

Michigan Severity Rating Scales
What they are not: Not an assessment Not a severity of disability but a severity of student’s need for services Not a pre-determiner of service Not the only data source Susan L The Michigan Severity Rating Scales: What they are not: They’re not an assessment *We need to emphasize that these are not normed assessments and should not be used as an assessment tool even though you go through an assessment process in order to determine the severity of need score in each category They’re not used to determine the severity of the disability but severity of the student’s need for services *There was objection to the use of the word severity throughout the tool, but the committees decided to keep the name since it has become internationally recognized. *The phrase “severity of need” was inserted throughout the scales to keep the user focused on what the purpose of these tools is. They’re not a pre-determiner of service, but a suggestion of what may be an appropriate level of service And they’re not the only data source This is only one of the sources of data that should be considered

Michigan Severity Rating Scales The Surveys
2011 – MDE-LIO partnered with the Department of Blindness and Low Vision Studies – WMU Dr. Robert Wall-Emerson & Dr. Dawn Anderson oversaw the development of the surveys Surveys administered by MDE-LIO and sent to listserves in early 2012 Susan L talk about survey process

Number of respondents in the national survey O&MSRS / O&MSRS+ 125 complete or partial VSSRS / VSSRS+ 103 complete or partial Susan L

Survey questions included: O&M, TCVI or Dual service provider Previous experience with the scales When the Scale is completed & with whom Are the Scales used for caseload analysis and how important of a role do they play? Susan L

Respondents read scenarios and answered questions based on student profiles How well are areas of concern covered? How well do contributing factors address adding or subtracting from service time? How well do service times match instructional needs? What are the reasons if recommended service time can’t happen? Susan L

Reliability (precision) Respondents overwhelmingly identified the scales as measuring the significant factors to be considered in determining service time for O&M and Vision Services Validity (accuracy) O&MSRS above 90% O&MSRS % VSSRS % VSSRS % Susan L

Orientation & Mobility Severity Rating Scale
Sue B

Fill out the student information on the Severity of Need Profile Sue B

The numbers attached to each severity of need are considered part of a continuum. Sue B

Each of the Severity of Need categories is structured in terms of impact on independent travel skills as it relates to the student's age appropriate needs Sue B

Severity of Need Categories Refers to the student's distance vision and/or peripheral vision as reported by an eye care specialist Sue B

Severity of Need Categories Refers to the student's ability to use vision for all travel tasks Sue B For students who have mastered age or developmentally appropriate travel skills (cane travel, echolocation), score a 0 even if the visual impairment impacts the ability to use vision for travel.

Severity of Need Categories Refers to the student’s need for use and skill level of a white cane or alternative mobility device Sue B

Severity of Need Categories Refers to possible situations when a discrepancy exists between the student’s actual functioning in travel skills and the projected level of independence based on the O&M Specialist’s professional judgment Sue B

Severity of Need Categories Refers to the student’s ability to travel safely and proficiently in a familiar environment (i.e., school, neighborhood) based on current literature of age appropriate travel levels and expectations Sue B

Severity of Need Categories Refers to the student’s conceptual understanding and how O&M progress is affected Sue B

Severity of Need Categories Refers to the type of environment in which instruction is required (i.e., business district, new school, neighborhood) Sue B

Severity of Need Categories Refers to whether the student has the opportunity to use O&M skills in the community, at home, etc. outside of O&M instructional time Sue B

Total the right hand column to obtain a “Severity of Need Score” at the bottom Sue B

Severity of Need Summary Sue B

Severity of Need Summary If appropriate, fill out the Contributing Factors to Service Delivery on the Student Performance Summary by adding or subtracting .5 points Sue B

Severity of Need Summary Locate the range which contains the Final Severity of Need Score to determine the frequency of service Sue B

Completion of the O&MSRS Sam is an 8th grade student in general education classes. He has a diagnosis of ocular albinism and a recent low vision examination indicated a visual acuity of 20/200 OU. He has excellent orientation to his community and can describe routes from his house to many destinations including the names of streets in his description. He has experience using public transportation with family and friends. He rarely has access to a computer except during directed class time and has little experience using internet mapping sites for route planning or to preview unfamiliar destinations. Sue B

Discussion Sue B

Orientation & Mobility Severity Rating Scale +
Severity of Need Categories The Level of Vision (Medical) is identical to the O&MSRS Sue B

Severity of Need Categories Refers to the student's ability to use vision for all travel tasks (i.e. movement within the classroom, school building and community) as reported by the Orientation & Mobility Instructor Add functional vision Add cane skills

Severity of Need Categories Refers to the student's need for use and skill level of a white cane or alternative mobility device Add Cane skills

Severity of Need Categories Refers to the ability of the student to communicate with the O&M Specialist and benefit from instruction. Students with little ability to communicate with the O&M Specialist may not benefit from a high level of direct O&M service Sue B

Severity of Need Categories Refers to the impact of the additional needs on the instructional process. Students whose additional needs prevent progress in travel skills may not benefit from a high level of direct O&M service Sue B

Severity of Need Categories Refers to the supervision needed to maintain the safety of the student during travel Sue B

Severity of Need Categories Refers to the impact that the student’s level of concept development has on progress in travel skills Sue B

Severity of Need Categories Refers to the amount of time needed to manage the student’s behavior so that learning can take place Sue B

Severity of Need Score As with the O&MSRS, total the right hand column to obtain a “Severity of Need Score” at the bottom Severity of Need Summary Fill out the student information on the second page Sue B

Severity of Need Summary If appropriate, fill out the Contributing Factors to Service Delivery on the Student Performance Summary by adding or subtracting .5 points Sue B

Severity of Need Summary Locate the range which contains the Final Severity of Need Score to determine the frequency of service Sue B

Completion of the O&MSRS+ Rochelle is a severely multiply impaired student in a center based program. Her visual acuity is estimated at 20/100 in both eyes. There is no suspected field loss. She is able to use a power chair for independent mobility, however, she frequently refuses to operate the joystick and waits for staff to drive her to her destination. When motivated, she is able to negotiate around furniture and through doors, but at a very slow speed. She has little expressive language other than some inconsistent ability to point to symbols on a communication board to indicate basic wants and needs. She is dependent on others for transfers and all activities of daily living. Sue B

Discussion Sue B

Vision Services Severity Rating Scale
Susan L These are the scales that are used to determine the need for services from a Teacher Consultant or Teacher of the Visually Impaired. They are intended *to assist the IEP Team in the selection of a vision services delivery model for existing as well as newly identified visually impaired students. *The VSSRS and VSSRS+ will also be used to document change of frequency of services for existing visually impaired students This slide shows the grid for the Vision Services Severity Rating Scale (VSSRS). This scale is intended for use with students identified as visually impaired and is primarily intended for use with students in general education settings although it may be applicable for some students with additional mild impairments.

Each of the eight categories listed on the VSSRS, Severity of Need Profile is structured in terms of the impact on vision functioning as it relates to the student's educational program Susan L The VSSRS Severity of Need Categories Each of the eight categories listed on the VSSRS, Severity of Need Profile is structured in terms of the impact on vision functioning as it relates to the student's educational program. When using the VSSRS, criteria provided within each of the categories is not all inclusive and many criteria overlap from one severity level to the next. Additional factors may influence the selection of the severity of need level by the teacher

Severity of Need Categories Level of Vision (Medical) is identical to the O&M Scales Susan L The first two severity of need categories are identical to the O&M Scales and are obtained by using the medical report from an optometrist or ophthalmologist

Severity of Need Categories Refers to the student’s level of functional near vision as determined by the TCVI or TVI (Appendix A) Susan L The rest of the categories are specific to the services provided by the TCVI or TVI Category 3, Functional Vision, refers to the student’s level of functional near vision as determined by the TCVI or TVI and uses an appendix that is included with the VSSRS.

Susan L Here is Appendix A which gives the Approximate Equivalent Visual Acuity according to the Distance Snellen and Jaeger charts as well as metric and point font sizes. It also gives the type of reading matter that would be equivalent for most of the sizes from bible font to newspaper headline font.

Severity of Need Categories Refers to the student's primary mode of learning (i.e., braille, print, print modifications, auditory, or combination) Susan L Category 4, Reading medium, refers to the student’s primary mode of learning, for example braille, print, print modifications, auditory, or a combination.

Severity of Need Categories Refers to the student's need for and use of low vision devices and technology to facilitate maximum participation in the general education curriculum Susan L Category 5, low vision devices and technology refers to the student’s need for and use of low vision devices and technology to facilitate maximum participation in the general education curriculum.

Severity of Need Categories Refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student's participation in their educational program Susan L Category 6, Material preparation refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student’s participation in their educational program Additional material preparation may be completed by a Teaching Assistant/Paraprofessional/Braillist, but is not to be considered for this rating scale.

Severity of Need Categories Refers to instruction in skills such as auditory and tactile efficiency, awareness of body in space, social skills, activities of daily living, etc. Susan L Category 7, Compensatory Skills refers to instruction in skills such as auditory and tactile efficiency, awareness of body in space, social skills, activities of daily living, etc.

Severity of Need Categories Refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program. Susan L Category 8, Communication with student’s team and pertinent individuals refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program.

Severity of Need Score As with the O&M Scales, total the right hand column to obtain a “Severity of Need Score” at the bottom Severity of Need Summary Fill out the student information on the second page Susan L

Severity of Need Summary Contributing factors are different so as to address the additional needs of students receiving Vision Services. Add or subtract .5 points. Direct Curriculum Instruction may receive more points If appropriate, fill out the Contributing Factors to Service Delivery on the Student Performance Summary by adding or subtracting .5 points. Contributing Factors include: Age of student Attendance Availability of materials/equipment Expanded Core Curriculum: Prep / Instruction / Coordination Progressive condition Recent vision loss School staff need for support Student cooperation Training of Paraprofessional / Teaching Assistant / Braillist Transition to new school/building Travel time Numerous accommodations provided by TCVI / TVI Direct Curriculum Instruction (add 1 to 4 points) Committee members felt that those students receiving direct curriculum instruction such as in math or reading should receive up to 4 additional points which are added to the final score There is a line for “Other (explain)”

Severity of Need Summary Locate the range which contains the Final Severity of Need Score to determine the frequency of service Susan L 0-2 Service not indicated times / year times / semester times / month minutes each times / week minutes each or more times/week 45 or more minutes each

Completion of the VSSRS Ashley is an 11 year girl with a history of retinopathy of prematurity according to an ophthalmology report. She has no light perception. Ashley has received TCVI services since enrolled in Early Intervention Home Based Service. She is transitioning to Middle School and is enrolled in general education classes for much of her day. She will have access to a generic special education resource room for pull out services. Ashley is a fluent Braille reader and reads often for pleasure. She struggles with math and has not mastered basic math concepts. The TCVI will provide significant follow-up to Ashley’s general education math class. Susan L Ashley is an 11 year girl with a history of retinopathy of prematurity according to an ophthalmology report. She has no light perception. Ashley has received TCVI services since enrolled in Early Intervention Home Based Service. She is transitioning to Middle School and is enrolled in general education classes for much of her day. She will have access to a generic special education resource room for pull out services. Ashley is a fluent Braille reader and reads often for pleasure. She struggles with math and has not mastered basic math concepts. The TCVI will provide significant follow-up to Ashley’s general education math class.

Completion of the VSSRS cont. She is demonstrating an aptitude for using the braillenote and continues to improve in use of it. Use of the computer is challenging for her and she knows approximately half of the alphabet keys. She can type 8 words a minute with 60% accuracy. She is being introduced to JAWS. A certified braillist is housed at the elementary school and materials for middle school which are given ahead of time can be prepared by this person. It is anticipated that some regular material preparation / adaption will be required of the TCVI during middle school. A paraprofessional will be available for Ashley in Middle School and will be assigned to provide assistance in classes such as Science and Physical Education and others to be determined. Susan L She is demonstrating an aptitude for using the braillenote and continues to improve in use of it. Use of the computer is challenging for her and she knows approximately half of the alphabet keys. She can type 8 words a minute with 60% accuracy. She is being introduced to JAWS. A certified braillist is housed at the elementary school and materials for middle school which are given ahead of time can be prepared by this person. It is anticipated that some regular material preparation / adaption will be required of the TCVI during middle school. A paraprofessional will be available for Ashley in Middle School and will be assigned to provide assistance in classes such as Science and Physical Education and others to be determined.

Discussion

Vision Services Severity Rating Scale+
Susan L Vision Services Severity Rating Scale for Students with Additional Needs (VSSRS+) is used with students identified as visually impaired and for whom the VSSRS does not seem to meet the needs. The student does not necessarily have to have visual impairment as the primary certification. It is an informal tool primarily intended for use with students in special education settings, but could include some students in general education settings.

Severity of Need Categories Category 1 refers to the student's level of distance vision as reported by an eye care / low vision specialist and category 2 refers to the student's ability to apply visual skills to the educational setting Susan L Category 1 refers to the student's level of distance vision as reported by an eye care / low vision specialist and category 2 refers to the student's ability to apply visual skills to the educational setting We recognize that an adequate eye report may not be available for all students. The functional vision assessment that can be conducted by a TCVI or TVI can be used instead. Suggested methods for non-verbal students include use of Teller Acuity Cards, LEA Vision Assessment Materials, etc.

Severity of Need Categories Refers to the impact of these delays on the student’s ability to benefit from services from the TCVI / TVI Susan L The next three categories took a great deal of time to develop. The committee wanted to be sure that students weren’t just being written off because they had additional needs. We also wanted to be sure that there was some justification for not providing intense direct services for students who were so severely multiply impaired that there was little chance of improvement of skills Category 3 Impact of Developmental / Communication Delays refers to the impact of these delays on the student’s ability to benefit from services from the TCVI / TVI As in the OMSRS+, significant additional needs may impact the student’s ability to benefit from a high of level of service, so the more impact the delays have, the lower the severity of need score will be and less service time will be suggested

Severity of Need Categories Refers to the ability of the student to respond to stimulation and/or instruction Susan L This is another category where the more delays, the less likely that vision services will make an impact on the education of the student.

Severity of Need Categories Refers to the level of independence in skills of daily living Susan L Category 5 Level of Skill in Activities of Daily Living refers to the level of independence in skills of daily living

Severity of Need Categories Refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student's participation in their educational program Susan L Category (6) Need for Material Preparation by the TCVI / TVI refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student's participation in their educational program and is scored exactly like the VSSRS

Severity of Need Categories Refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program Susan L The 7th category Need for communication with student's team / pertinent individuals by the TCVI / TVI refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program and is scored exactly like the VSSRS, also.

Severity of Need Summary Contributing factors are different so as to address the additional needs of these students. Add or subtract .5 points. Age of student and Direction Curriculum Instruction may receive more points. Susan L The severity of need summary is completed as in the O&M scales and the VSSRS by determining the severity of need score and considering the contributing factors. Note that the age of the student and Direct curriculum instruction may receive up to 4 points each Committee members felt that a very young child with additional needs may not receive a high enough score to merit enough service time without these extra points. The same is true of direct curriculum instruction in a content area such as math or reading. It is up to the discretion of the TCVI / TVI or team filling out the scale whether additional points should be added. Other Contributing factors are the same as some of the factors in the VSSRS Attendance Availability of materials / equipment Consultation and coordination of Expanded Core Curriculum Activities Progressive condition Recent vision loss School staff need for support Student cooperation Teaching of Paraprofessional / Teaching Assistant / Braillist Transition to new school / building Other

Severity of Need Summary Locate the range which contains the Final Severity of Need Score to determine the frequency of service Susan L

Completion of the VSSRS+ Clark is a 3 year old with a history of trauma during delivery. He has an undiagnosed visual impairment and began a school program at the beginning of this school year in a program for students with severe multiple impairments. He does not have a blink reflex, but parents feel that he recognizes their faces and he passed a vision screening to the one month developmental level with an early intervention teacher who is not a vision services specialist. Clark did not receive services from a Teacher of the Visually Impaired prior to enrolling in school. He has extremely low tone and is unable to participate in activities of daily living. He fusses when he is not held and is difficult to quiet. Clark is in a classroom where several other children receive consultation from the TCVI. Susan L

Discussion Susan L

Michigan Severity Rating Scales Survey Findings
Reliability (precision) Respondents overwhelmingly identified the scales as measuring the significant factors to be considered in determining service time for O&M and Vision Services Validity (accuracy) O&MSRS above 90% O&MSRS % VSSRS % VSSRS % Sue B

Michigan Severity Rating Scales Caseload Analysis
Service information from the Michigan Severity Rating Scales Additional hours per week needed for support Hours per week for travel Tools for caseload analysis Sue B

Contact Information Sue B

Michigan State Board of Education
John C. Austin President Casandra E. Ulbrich Vice President Nancy Danhof Secretary Marianne Yared McGuire Treasurer Richard Zeile NASBE Delegate Kathleen N. Straus Daniel Varner Eileen Lappin Weiser Sue B Rick Snyder, Governor Michael P. Flanagan Superintendent of Public Instruction

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