Evaluation of Preschool Special Education Practices Efficacy Study

APPENDIX H

teacher-child reports

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OMB No.: 1850-0916

Expiration Date: XX/XX/XXXX

Teacher-Child Report

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0916. The time required to complete this information collection is estimated to average 25 minutes, including the time to review instructions, search existing data sources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.

INSTRUCTIONS

• Enclosed please find 2 [or 3] instruments that you need to complete for the child listed on the upper right hand corner of the previous page.

• Once you have completed the instruments, please return them to your school coordinator.

• The instruments will take about 25 minutes to complete.

• If you are unsure how to answer a question on any instrument, please give the best answer you can rather than leaving it blank.

• Your answers will be completely confidential; no information that identifies you, your school, or your students will be reported. Information collected for this study comes under the confidentiality and data protection requirements of the Institute of Education Sciences (The Education Sciences Reform Act of 2002, Title I, Part E, Section 183). Responses to this data collection will be used only for statistical purposes. The reports prepared for the study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.

• Your participation in the study is voluntary, but your response is critical for producing valid and reliable data. There are no direct risks or benefits to participating. All information you provide will be kept private to the extent permitted by law. Neither your name nor the child’s name will be attached to any information you give us; and it will not be shared with others. This study has received IRB approval from Health Media Labs. If you have any questions about the study or your rights as a research volunteer, please contact Brian Roff at Mathematica toll free by phone at (833) 741-0984 or by email at EPSEP@mathematica-mpr.com.

Description of Instruments That Would Be Enclosed

1. Social Skills Improvement System (SSIS; Gresham & Elliott, 2008; 76 items)

Teachers will complete the Social Skills (46 items) and Problem Behaviors (30 items) sections of the SSIS. For each item, they will circle how often the child displays each behavior (never, seldom, often, or almost always). For each of the social skills items, they will circle how important the behavior is for success in their classroom (not important, important, or critical).

The SSIS is a proprietary instrument.

2. Clinical Evaluation of Language Fundamentals Preschool 2 (CELF P2; Wiig et al., 2004) Descriptive Pragmatics Profile (26 items)

Teachers will complete the Nonverbal Communication Skills (7 items), Conversational Routines and Skills (12 items), and Asking for, Giving, and Responding to Information (7 items) sections of the CELF P2 Descriptive Pragmatics Profile. For each item, they will circle how often the child demonstrates the skill (never, sometimes, often, or always).

The CELF P2 is a proprietary instrument.

3. ABILITIES Index (Simeonsson & Bailey, 1991; 9 items) (Fall only)

Each ability is rated on a scale of 1 to 6 with 1 indicating normal ability and 6 indicating extreme or profound lack of ability. Teachers will indicate the child’s ability level on Audition; Behavior and social skills; Intellectual function; Limbs; Intentional communication; Tonicity; Integrity of physical health; Eyes; and Structural status by placing an ‘x’ next to the appropriate space on the form.

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