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 http://rcause.wikispaces.com • 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 • Developing an understanding that learning, specifically Reading, is a physiological activity • Understanding that cognitive processing is impacted by health and processing disorders can be the root to academic learning problems • Gain a deeper understanding of how a Root Cause Analysis drives your instruction • 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/”
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.
Cognitive Sweat • She had a largepiece 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 housemouse also likes to eat cake. • Whereare 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
Reasoning VERBAL NONVERBAL
Reading Processors context run semantic /r/ /ŭ/ /n/ orthographic phonologic
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
What role do we play in helping to determine the processing disorder?
Medical Conditions, Medicines and Cognitive Processing Asthma Albuterol • uncontrollable shaking of a part of the body • nervousness • headache • Nausea • vomiting • cough • throat irritation • muscle, bone, or back pain
Medical Conditions, Medicines and Cognitive Processing Diabetes Insulin • Hypoglycemia • Confusion • Nausea, • hunger, • tiredness • Heart palpitations • Blurred vision • Irritability
Medical Conditions, Medicines and Cognitive Processing Infections Amoxicillin • Skin Rash • Breathing Problems • Blistering • Seizures • Diarrhea • Difficult y urinating • Weak or tired • Dizziness • Headache • Trouble sleeping
Medical Conditions, Medicines and Cognitive Processing ADD/ADHD Methylphenidate • Nervousness, • Insomnia • Loss of Appetite • Sleep problems • Dizziness, • Involuntary Movement • Psychosis • Tics • Depression • Glaucoma
Working Memory and ADD/ADHD Retrieval from Long Term Memory Executive Functioning Short Term Visual Sketch pad Short Term Auditory Memory
Medical Conditions, Medicines and Cognitive Processing Seizure Anticonvulsant • Prolonged Fever • Rash • Severe Sore Throat • Mouth Ulcers • Easy Bruising • Pinpoint Bleeding • Weakness • Excessive Fatigue • Lack of Appetite
data data data data data data data data data data constipation
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.
3) Label each bone with categories to be studied 2) List the problem in the head of the fish 4) Identify the factors within each category that maybe affecting the problem 1) Draw the fishbone diagram 5) Continue until you no longer get useful information 6) Analyze the results
LANGUAGE COMPREHENSION ● Background Knowledge ● Vocabulary Knowledge ● Language Structures ● Verbal Reasoning ● Literacy Knowledge SKILLED READING: fluent execution and coordination of word recognition and text comprehension. increasingly strategic WORD RECOGNITION ● Phonological Awareness ● Decoding (and Spelling) ● Sight Recognition increasingly automatic Reading: Scarborough's Rope Reading is a multifaceted skill, gradually acquired over years of instruction and practice.
Subtypes of Reading Disability Phonology and language comprehension Fluency/naming speed and language comprehension Phonology and fluency/naming speed All three issues
Fishbone Analysis Phonological Awareness (Blevins, Rosner and Words their Way) Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness) Morphology: Name: ________________ # of phoneme errors on spelling test: Alphabet Skills: Reading and Decoding: Spelling Skills: Rosner Auditory Analysis: Rhyme: Oddity Task: Oral Blending: Oral Segmentation: Phonemic Manipulation: # of Orthographic errors on spelling: Reading ORF Rate: Reading Level: ORF Accuracy: Oral Language Vocabulary: Color naming RAN: Site Words: Reading Vocabulary: Executive Functioning Skills: Reasoning Skills: Other: Vocabulary and Comprehension (DRA/SRI, Core Vocabulary and Critchlaw) Fluency (ORF, Fry and RAN)
Case Study • K-2 Reached Benchmarks • 3rd Grade CSAP Satisfactory • 4th Grade CSAP P. Proficient • 5th Grade CSAP Unsatisfactory • Currently 6th Grade at a K-8 School • SRI Lexile- 498 or 2nd 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.
Case Study Special Education Program Manager • Called the program manager and not sure what to do • Review indicated a very poor BOE • A BOE was developed • GORT- showed she is at the 21%ile
Phonological Awareness Alphabetic Principle Angela is struggling with reading Reading Level: SRI 498 GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark (spring 2010) PP DRA Level 40 MAZE Passage: 38%ile Fluency Vocabulary and Comprehension
Clues table tibl tabl tebl
Phonological Awareness (Blevins, Rosner and Words their Way) Alphabetic Principle (Core Phonics, Words their Way, LETRS Morphological Awareness) No concern Morphology: Structural analysis 1/12 Inflectional Morphemes 11/12 Derivational Morphemes 0/12 Slight Concern # of phoneme errors on spelling test: 57% Serious Concern Angela is struggling with reading Rosner Auditory Analysis: 1st Grade Level 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 Rhyme: 11/12 Oddity Task: 12/12 Oral Blending: 12/12 Oral Segmentation: 23/24 Phonemic Manipulation: 12/12 Reading Level: GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark PP DRA 40 (5th grade level) MAZE Passage: 38%ile ORF Rate: 93.8 Below Average ORF Accuracy: 92% Below Average Color naming RAN: 6th grade level Site Words: San Diego 5th grade level Oral Language Vocabulary: GORT Fluency: 16%ile 7th 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 Reading Vocabulary: 5th grade level Vocabulary and Comprehension (DRA/SRI and Critchlaw) Fluency (ORF, Fry and RAN)