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 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

VERBAL NONVERBAL

Reading Processors

orthographic phonologic

semantic

context

/r/ /ŭ/ /n/

run

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

What role do we play inhelping to determine the

processing disorder?

Medical Conditions, Medicines and Cognitive Processing

AlbuterolAsthma • uncontrollable shaking of a

part of the body• nervousness• headache• Nausea• vomiting• cough• throat irritation• muscle, bone, or back pain

Executive Functioning

Reasoning Phonological Processing

Orthographic Context 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

Reasoning Phonological Processing

Orthographic Context and Meeting

Processing Speed

Language Processing

Medical Conditions, Medicines and Cognitive Processing

AmoxicillinInfections • Skin Rash• Breathing Problems• Blistering• Seizures• Diarrhea• Difficult y urinating• Weak or tired• Dizziness• Headache• Trouble sleeping

Executive Functioning

Reasoning Phonological Processing

Orthographic Context and Meeting

Processing Speed

Language Processing

Medical Conditions, Medicines and Cognitive Processing

MethylphenidateADD/ADHD • Nervousness, • Insomnia• Loss of Appetite• Sleep problems• Dizziness, • Involuntary Movement • Psychosis• Tics• Depression• Glaucoma

Executive Functioning

Reasoning Phonological Processing

Orthographic Context and Meeting

Processing Speed

Language Processing

Working Memory and ADD/ADHD

Executive Functioning

Short Term Visual Sketch

pad

Short Term

AuditoryMemory

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

Reasoning Phonological Processing

Orthographic Context and Meeting

Processing Speed

Language Processing

ROOT CAUSE ANALYSIS

datadatadatadata

data

data

datadatadata

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.

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

increasinglystrategic

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:PhonemicManipulation:

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 • 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 TeamAcademic Detectives

Read Naturally for 2 days a weekGuided 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 doReview indicated a very poor BOEA BOE was developed

Case Study

Phonological Awareness Alphabetic 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

Clues

tabletibltabltebl

Clues

Clues

Clues

Clues

Clues

Total number of seconds

Grade level

>111 < K

111-95 K

94-76 1st grade

75-67 2nd grade

66-64 3rd grade

63-59 4th grade

58-52 5th grade

51-49 6th grade

48-45 7th grade

45-40 8th grade

<40 9th grade +

Angela is struggling with reading

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: 11/12Oddity Task: 12/12 Oral Blending: 12/12Oral Segmentation: 23/24PhonemicManipulation: 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 11/12Derivational Morphemes 0/12

Site Words: San Diego 5th grade level

ORF Rate: 93.8 Below Average ORF Accuracy: 92% Below Average

# of phoneme errors on spelling test: 57%

Color naming RAN: 6th grade level

Reading Level: GORT: 21%ile CSAP: Unsatisfactory DPS Benchmark PP DRA 40 (5th grade level) MAZE Passage: 38%ile

Oral Language Vocabulary:

Rosner Auditory Analysis: 1st Grade Level

Reading Vocabulary:

GORT Fluency: 16%ile

7th Grade Level

5th 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

functioning?

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

1.

2.

3.

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

noyes

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 Plan Progress 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 • 3rd 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 • 3rd 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 4th and 5th 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!

September to December 2012

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?