Report for Consideration for Language Outreach Team



To be completed by the SENCO and Current Speech and Language Therapist (SLT)

|Name of Pupil: |DOB: |School: |

|Address: |

|SENCO (please print): |Community/SST/EY SLT (please print): |Parent (please print): |

|Signed: |Signed: |Signed: |

|Date: |Date: |Date: |

Pupils in Trafford Mainstream Primary Schools can be considered for the Language Outreach Service once the following criteria have been satisfied, and evidence supplied (essential items in bold):

|Criteria |Evidence supplied |Please tick: |

|This pupil has had 3 terms of ‘specialist’ intervention from the School |Summary of previous speech and language targets with outcomes (SLT plans | |

|Support Team or (for reception children) ‘specialist’ intervention from the |with outcomes and/or individual provision map/pupil profile/IEP/annotated | |

|EY SLT Team, or for pupils with speech sound disorders 3 blocks of clinic |graduated approach document) | |

|based intervention. | | |

|This pupil has TOMS (Therapy Outcome Measures) scores of 2 or below – please|TOMS scores from the Speech and Language Therapist | |

|include pre- and post- intervention measures. | | |

|This pupil has severe and complex language needs (language scores on 5th |Recent language scores from SLT assessment | |

|centile or lower in more than one language area). |Summary of EY Tracking/ ‘Red flags’ for Developmental Language Disorder | |

|This pupil has language needs which are persisting despite intervention. |School assessment/report reflecting how language needs are continuing to | |

| |impact on access to the curriculum and learning (e.g. school report, EP | |

| |report, pupil tracking data, foundation stage profile). | |

|School and current SLT have identified how school will use the Language |A school summary/report of the anticipated outcome of further SLT | |

|Outreach SLT time to support the pupil to achieve specific, measurable |intervention from the Language Outreach team – including what you think | |

|learning outcomes. |school staff will be able to do with the SLT extra support. | |

Please complete the form below regarding the child’s most recent EYFS tracking results. If you don’t have this information then please describe the child’s performance in each area.in the last column.

Age in months when EY tracking completed: Date completed:

|Early Learning Goal |E, W or S |Age level achieved (in months i.e. 8-20) |

| | |Otherwise provide a description. |

|Personal social and |Making relationships | | |

|emotional development | | | |

| |Self-confidence and | | |

| |self-awareness | | |

| |Managing behaviour | | |

| | | | |

|Physical Development |Moving and handling | | |

| | | | |

| |Health and self-care | | |

| | | | |

|Communication and language |Listening and attention | | |

| | | | |

| |Understanding | | |

| | | | |

| |Speaking | | |

|Literacy |Reading | | |

| | | | |

| |Writing | | |

| | | | |

|Mathematics |Numbers | | |

| | | | |

| |Shape and measure | | |

| | | | |

| | | | |

|Knowledge of the world |People and communities | | |

| | | | |

| |The world | | |

| | | | |

| |Technology | | |

| | | | |

|Expressive arts and design |Exploring a using media and | | |

| |materials | | |

| |Being imaginative | | |

| | | | |

Please circle the level of attention skills that you have observed as typical of this child within the past 3 months-present date.

|Looking and Listening Skills |

| | | |

|Level 1: 0-1 year: Can pay fleeting attention, |Level 3: 2-3 years: attention is still single channeled. Can |Level 5: 4-5 years: Can perform activity |

|but any new event will distract. Attention held |concentrate by looking or listening. Can attend to adult’s choice of |whilst listening to instructions. Dual |

|very briefly on current focus. |activity for short periods, with frequent prompts |attention. Can look and listen and do for |

| | |short periods |

| | | |

|Level 2: 1-2 years |Level 4: 3-4 years: Starting to be able to control own focus of |Level 6: 5-6 years: attention skills now |

|Will attend to own choice of activity, but may |attention. Can concentrate on looking or listening. Can attend to |flexible and sustained for long periods. Can |

|not like the adult joining in. Can’t focus on |adult’s choice of activity for longer periods, with less frequent |look and listen and do. Can easily integrate |

|more than one thing at a time. |prompts. |visual and auditory information. |

Please circle the level of play skills that you have observed as typical of this child within the past 3 months-present date.

|Play Skills |

| | | |

|Level: 1-1 ½ years |Level: 1 ½ - 2 years |Level: 2 - 2 ½ years |

|Solitary or onlooker play – self play |Parallel play – plays near others but not with them |Parallel play predominates |

|• Continual walking activities |• Talks to self as he/she plays |• Arranges doll furniture into meaningful |

|• Begins running- still and awkward |• Little social give and take – little interest in |groups and uses doll figures to act out simple themes |

|• Scribbles spontaneous with crayons |what others say or do but hugs, pushes, |from own experience |

|• Can remove mittens, socks, hat, unzips zipper |pulls, snatches, grabs, defends rights by |• Aligns three or more cubes to make train; pushes |

|• Puts objects in and out of container |pulling hair and kicking |train |

|• Can figure out ways of overcoming some |• Does not ask for help |• Builds tower of six to seven blocks |

|obstacles (opening doors, reaching high |• Strings beads |• Imitates drawing of vertical line |

|places) |• Transports blocks in a wagon rather than |• Sequences related action in play such as preparing |

|• Imitates many things (sweeping, combing |just building |food for doll, feeding it, wiping its mouth |

|hair – self use) |• Relates action to object or another person –washes, | |

|• Pulls toys, carries or hugs dolls, teddy bear |feeds, combs doll in addition to | |

|• Very rapid shifts in attention – especially expressed|self | |

|by gross motor skills |• Likes to play with flexible materials such as clay, | |

| |pat, pinches, and fingers | |

| |• Less rapid shifts in attention | |

| | | |

|Level: 2 ½ -3 years |Level: 3 -3 ½ years |Level: 3 ½-4 years |

|Dramatization and imagination begin to |Builds bridge from model |Increase in dramatization of play |

|enter play (make believe and pretend) |• Cooperative play begins |• Complicated ideas but unable to carry out |

|• Beginning interest in cooperative play – plays with |• Organizes doll furniture accurately and |in detail; no carryover from day to day |

|others in small groups |begins to use in genuinely imaginative ways |• Prefers to play in group of two to three |

|• Interest in combining play things |• Draws two or more strokes for a cross-on |children; chooses companion of own sex |

|• Is willing to wait his/her turn |imitation |• Suggests turns, but often bossy in directing |

|• Will put toys away with some supervision |• Beginning to share |others |

|• Watches cartoons on TV |• Re-enacts experienced events such as birthday |• Often silly in play and may do things |

|• Names own drawing |party, baking cookies |wrong purposely |

|• Builds tower of nine blocks |• Uses one object to represent another (stick =phone or|• Puts toys aware |

|• Puts together four-part nesting toy |fence |• Likes to dress up |

|• Stacks five or more rings on a peg in order of size | |• Draws a human with two parts. Adds three |

|• Draws horizontal line in imitation | |parts to incomplete human |

|• Imitates drawing a circle | |• Builds structures/buildings with blocks |

| | |• Assumes the role of another person in play |

| | |(becomes a teacher, animal, parent) |

| | |

|Level: 4 - 4 ½ years |Level: 4 ½- 5 years |

|Make cube gate from model |Likes cutting out and pasting |

|• Identifies parts missing in two pictures |• Likes working on projects – may carry |

|• Shows off dramatically |over from day to day |

|• Copies square |• Definite interest in finishing what he/she |

|• Much self-praise |Starts |

|• Uses dolls and puppets to act out scripts |• Plays in groups of two to five – friendships |

|• Good imaginative play |becoming stronger |

| |• Spurred on by rivalry in activity – |

| |competition |

| |• Interested in going on excursions |

| |• Draws unmistakable human with body, arms, legs, feet, nose and eyes |

| |• Copies a triangle |

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