Examining How Health Impacts Learning: Using Root Cause Analysis to Drive Instruction Robert Frantum-Allen, MA Colorado Association of School Nurses March 2014

The Trouble with Handouts  Paper on Specially Designed Instruction and Root Cause Analysis Today’s Presentation Sample Root Cause Analysis in Reading on 6 students Blank Templates for Root Cause Analysis

Mystery! A sailor goes into a restaurant. His hands are tanned except for where a watch and wedding ring once belonged. He orders albatross, eats one bite which reminds him of something. He goes outside and kills himself.

Mystery! Bob and Carol and Ted and Alice all live in the same house. Bob and Carol go out to a movie, and when they return, Alice is lying dead on the floor in a puddle of water and glass. She has multiple lacerations all over her entire body. It is obvious that Ted killed her but Ted is not prosecuted or severely punished.

Outcomes 1.Developing an understanding that learning, specifically Reading, is a physiological activity 2.Understanding that cognitive processing is impacted by health and processing disorders can be the root to academic learning problems 3.Gain a deeper understanding of how a Root Cause Analysis drives your instruction 4.Participate in a sample Root Cause Analysis

What would this body of evidence indicate? Sneezing Stuffy or running nose Sore throat Coughing Watery eyes Mild headache Mild body aches

What would this body of evidence indicate? High number of dis-phonetic errors on a spelling test (spells lump lup) Receptively identify rhyme but not expressively generate a rhyme Inability to segment and blend sounds Poor results on an elision test “Say smack. Now say it without the /m/”

Playing Darts in the Dark

Specific Learning Disability Definition: Specific Learning Disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

Psychological Processor

Cognitive Sweat She had a large piece of birthday cake. I would love to have a slice of cake. The first slice was very little. Is there a chance I could talk to the person in charge? The house mouse also likes to eat cake. Where are you going with that cake?

Why is there a silent e? 1. Cake, Slice 2. Love, Have 3. Large, Piece, Charge, Chance, Slice 4. Little 5. House, Mouse 6. Where, Are

Executive Functioning

Reasoning

Reading Processors

Brain Images Comparing 9-Year-Old Average Reader and 9-Year-Old Un-remediated Poor Reader

Changes in Brain Activation Patterns in Response to Instruction p. 63

Processing Speed rapid retrieval accuracy

Language Processing

Medical Conditions, Medicines and Cognitive Processing Albutero l Asthma uncontrollable shaking of a part of the body nervousness headache Nausea vomiting cough throat irritation muscle, bone, or back pain Executive Functioning ReasoningPhonological Processing OrthographicContext and Meeting Processing Speed Language Processing

Medical Conditions, Medicines and Cognitive Processing InsulinDiabetes Hypoglycemia Confusion Nausea, hunger, tiredness Heart palpitations Blurred vision Irritability Executive Functioning ReasoningPhonological Processing OrthographicContext and Meeting Processing Speed Language Processing

Medical Conditions, Medicines and Cognitive Processing Amoxicillin Infections Skin Rash Breathing Problems Blistering Seizures Diarrhea Difficult y urinating Weak or tired Dizziness Headache Trouble sleeping Executive Functioning ReasoningPhonological Processing OrthographicContext and Meeting Processing Speed Language Processing

Medical Conditions, Medicines and Cognitive Processing Methylphenidate ADD/ADHD Nervousness, Insomnia Loss of Appetite Sleep problems Dizziness, Involuntary Movement Psychosis Tics Depression Glaucoma Executive Functioning ReasoningPhonological Processing OrthographicContext and Meeting Processing Speed Language Processing

Working Memory and ADD/ADHD Executive Functioning Short Term Visual Sketch pad Short Term Auditory Memory Retrieval from Long Term Memory

Medical Conditions, Medicines and Cognitive Processing Anticonvulsant Seizure Prolonged Fever Rash Severe Sore Throat Mouth Ulcers Easy Bruising Pinpoint Bleeding Weakness Excessive Fatigue Lack of Appetite Executive Functioning ReasoningPhonological Processing OrthographicContext and Meeting Processing Speed Language Processing

ROOT CAUSE ANALYSIS

Fishbone diagram is used when…. … a team needs to study a problem/issue to determine the root cause. … a team wants to study all the possible reasons why a process is beginning to have difficulties, problems, or breakdowns. … a team needs to identify areas for data collection. … a team wants to study why a process is not performing properly or producing the designed results.

1) Draw the fishbone diagram 2) List the problem in the head of the fish 3) Label each bone with categories to be studied 4) Identify the factors within each category that maybe affecting the problem 5) Continue until you no longer get useful information 6) Analyze the results

ACADEMIC FISHBONE

● Background Knowledge ● Vocabulary Knowledge ● Language Structures ● Verbal Reasoning ● Literacy Knowledge ● Phonological Awareness ● Decoding (and Spelling) ● Sight Recognition SKILLED READING: fluent execution and coordination of word recognition and text comprehension. LANGUAGE COMPREHENSION WORD RECOGNITION increasingly automatic increasingly strategic Reading is a multifaceted skill, gradually acquired over years of instruction and practice. Reading: Scarborough's Rope

Fluency/naming speed and language comprehension Phonology and fluency/naming speed Phonology and language comprehension All three issues Subtypes of Reading Disability

Phonological Awareness (Blevins, Rosner and Words their Way) Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness) Vocabulary and Comprehension (DRA/SRI, Core Vocabulary and Critchlaw) Fluency (ORF, Fry and RAN) Rhyme: Oddity Task: Oral Blending: Oral Segmentation: Phonemic Manipulation: Alphabet Skills: Reading and Decoding: Spelling Skills: Morphology: # of Orthographic errors on spelling: Site Words: ORF Rate: ORF Accuracy: # of phoneme errors on spelling test: Color naming RAN: Reading Level: Oral Language Vocabulary: Name: ________________ Executive Functioning Skills: Reasoning Skills: Other: Rosner Auditory Analysis: Reading Vocabulary: Reading Fishbone Analysis

CASE STUDY: ANGELA

Case Study K-2 Reached Benchmarks 3 rd Grade CSAP Satisfactory 4 th Grade CSAP P. Proficient 5 th Grade CSAP Unsatisfactory Currently 6 th Grade at a K-8 School SRI Lexile- 498 or 2 nd grade

Case Study Student Intervention Team Academic Detectives Read Naturally for 2 days a week Guided Reading Plus for 3 days a week Progress Monitoring Oral Reading Fluency – no progress after 6 weeks.

Special Education GORT- showed she is at the 21%ile Program Manager Called the program manager and not sure what to do Review indicated a very poor BOE A BOE was developed Case Study

Phonological AwarenessAlphabetic Principle Vocabulary and Comprehension Fluency Reading Level: SRI 498 GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark (spring 2010) PP DRA Level 40 MAZE Passage: 38%ile Angela is struggling with reading

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Phonological Awareness (Blevins, Rosner and Words their Way) Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness) Vocabulary and Comprehension (DRA/SRI and Critchlaw) Fluency (ORF, Fry and RAN) Rhyme: 11/12 Oddity Task: 12/12 Oral Blending: 12/12 Oral Segmentation: 23/24 Phonemic Manipulation: 12/12 Phoneme/Grapheme: Short vowels: 21/21 Consonant Blends w/ short vowels: 15/15 Short vowels, digraphs, and trigraph: 15/15 R-Controlled vowels:13/15 Long vowels spellings: 13/15 Variant Vowels: 10/15 Low frequency vowel /consonant spellings: 8/15 Multisyllabic words: 14/24 Morphology: Structural analysis 1/12 Inflectional Morphemes 11/12 Derivational Morphemes 0/12 Site Words: San Diego 5 th grade level ORF Rate: 93.8 Below Average ORF Accuracy: 92% Below Average # of phoneme errors on spelling test: 57% Color naming RAN: 6 th grade level Reading Level: GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark PP DRA 40 (5 th grade level) MAZE Passage: 38%ile Oral Language Vocabulary: Rosner Auditory Analysis: 1 st Grade Level Reading Vocabulary: GORT Fluency: 16%ile 7 th Grade Level 5 th grade level Executive Function: excellent focus, initiates tasks, can shift in midstream; no concerns with executive functioning Reasoning : excellent verbal and non-verbal reasoning Other: English is first language; no family history of reading problems; older sibling have no issues with academics; engaged family; no sig medical concerns No concern Slight Concern Serious Concern

Is there evidence to suggest difficulty with executive functi oning? Is there evidence to suggest difficulty with Language Processing ? Is there evidence to suggest difficulty with reasoning ? Root Causes of Reading Difficulty Student has the ability to sustain focus when basic skills are automatic Is there evidence to suggest difficulty with processing speed? Student is able to learn through various methods (mastery, inquiry) yes no Is there evidence to suggest problems with phonological processing? Is there evidence to suggest problems with orthographic processing? yes no yes no yes no yes no yes no Prioritize the concerns 1._____Basic Phonological_________ 2._____Basic Orthographic _________ 3.______________________________ 4.______________________________ 5.______________________________ 6.______________________________ Executive Functioning Concerns Reasoning Concerns Reading Comprehension Concerns Reading Fluency Concerns Basic Reading Phonological Concern Basic Reading Orthographic Concern Create the Treatment Plan Name: ___________Angela ________________

RESULTS: TWO STORIES

Literacy Focus Schools

Case Study Diagnostic/ Root Cause Analysis Treatment PlanProgress Monitoring Evaluation -Informal Measures -20 Minutes -As many people to participate as possible - Collaborative -Based on building resources -Fidelity to IEP -All children receive core -Treatment based on the deficit -IEP Driven -Quick -After each 5 hours of treatment -Check in -Mentoring, Coaching and Collaboration

Near North East Year One 13 E. S. Mostly SPED and SLP Teachers 3 rd grade CSAP status of P or PP grew 25% for a total of 43% of Special Education Students were P or PP on CSAP Sustained these levels in year two with less support

West Side Literacy Focus Year Two 18 E. S. Mostly SPED and SLP Teachers Largest ELL Population in the district When doing root cause-introduced the concepts of errors of transfer for ELL 3 rd grade CSAP status of P or PP grew 14% for a total of 26% of Special Education Students were P or PP on CSAP

Green Valley Ranch Turn Around School New Leadership New Curriculum

Green Valley Ranch 60 4 th and 5 th Graders Scoring Unsatisfactory Screening data indicated 40 needed word level reading 15 needing phonological awareness work 12 needed language 8 needed comprehensive intervention

Green Valley Ranch Word Level Reading (40)Language (12)Comprehensive (8) Grapheme Work (25) -Writing Road to Reading 1 hour daily Phoneme Work (15) -Writing Road to Reading with Phonological Awareness work daily Vocabulary and Oral Language work with leveled (LLI) and decodable text (text from the Core) Language!

Green Valley Ranch 48 have returned to the general education classroom Remaining 12 had a deeper root cause analysis completed 9 will continue intervention that focuses more on multi-syllable word work and morpheme instruction 3 have been referred to special education

What was one take away?