Name: School Year:
DOMAIN 1: PLANNING AND PREPARATION // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 1a
Demonstrates knowledge and skill in the therapist’s discipline / Therapist demonstrates little or no knowledge and skill in their discipline; does not maintain necessary license
☐ / Therapist demonstrates basic knowledge and skill in their discipline; maintains necessary license
☐ / Therapist demonstrates thorough knowledge and skill in their discipline; maintains necessary license
☐ / Therapist demonstrates extensive knowledge and skill in their discipline; therapist is considered a resource in their discipline; maintains necessary license
☐
Component 1b
Establishes goals for therapy services appropriate to the setting and the students served / Therapist has no clear goals for therapy services, or they are inappropriate to either the situation or the age of the students
☐ / Therapist’s goals are rudimentary and are only partially suitable to the situation and the age of the students
☐ / Therapist’s goals are clear and appropriate to the situation in the school and to the age of the students
☐ / Therapist’s goals are highly appropriate to the situation in the school and to the age of the students Goals have been developed following consultations with administrators and teachers
☐
Notes:
DOMAIN 1: PLANNING AND PREPARATION // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 1c
Demonstrates knowledge of special education regulations and guidelines / Therapist demonstrates little or no knowledge of special education laws and procedures, therapy standards of practice
☐ / Therapist demonstrates basic knowledge of special education laws and procedures and therapy standards of practice
☐ / Therapist demonstrates thorough knowledge of special education laws and procedures and therapy standards of practice
☐ / Therapist’s knowledge of special education laws and procedures and therapy standards of practice are extensive; therapist takes a leadership role in reviewing and revising LADSE/department policies
☐
Component 1d
Collects information; writes reports / Therapist neglects to collect important information on which to base recommendations; reports are inaccurate or not appropriate to the audience
☐ / Therapist collects most of the important information on which to base recommendations; reports are accurate but lacking in clarity or not always appropriate to the audience
☐ / Therapist collects all the important information on which to base recommendations; reports use sound clinical reasoning, define technical terminology, are clear and appropriate to the audience
☐ / Therapist is proactive in collecting important information, reports demonstrate advanced clinical reasoning, are articulate and analyze critical aspects of student performance, balancing technical terminology with explanations for lay audience
☐
Notes:
DOMAIN 1: PLANNING AND PREPARATION // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 1e
Develops therapeutic intervention plans appropriate to the setting and school program in order to meet the needs of individual students / Therapist has missed components of the intervention plan, or they are inappropriate to either the situation or the students; plan does not relate to student goals
☐ / Therapist’s intervention plan is rudimentary or only partially suitable to the situation and to the students; only parts of the plan relate to student goals
☐ / Therapist’s intervention plans are clear and appropriate to the situation and student; use sound clinical reasoning based on assessment information and PLOP/PLAFP
☐ / Therapist’s intervention plans are comprehensive with detailed information using advanced clinical reasoning; are based on assessment data and PLOP and have been developed following consultation with LADSE school team
☐
Component 1f
Develops a plan to evaluate effectiveness of therapeutic intervention and student progress / Therapist’s data-management system is either nonexistent or in disarray; it cannot be used to monitor student progress or to adjust intervention when needed
☐ / Therapist has developed a rudimentary data-management system for monitoring student progress that is used inconsistently and occasionally uses it to adjust intervention when needed
☐ / Therapist has developed a relevant data-management system for accurate monitoring student progress and uses it to adjust intervention when needed
☐ / Therapist has developed a highly effective data-management system that accurately monitors student progress and uses it to adjust intervention when needed; Therapist uses the system to communicate with teachers and parents
☐
DOMAIN 1: PLANNING AND PREPARATION
OVERALL RATING – DOMAIN 1 / q UNSATISFACTORY / q BASIC / q PROFICIENT / q DISTINGUISHED
Notes:
Name: School Year: Evaluator: Date:
DOMAIN 2: ENVIRONMENT /
/ Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 2a
Creates an environment of respect and rapport with students / Therapist’s interactions with students are negative or inappropriate; students appear uncomfortable interacting with therapist
☐ / Therapist’s interactions are a mix of positive and negative; the therapist’s efforts at developing rapport are partially successful
☐ / Therapist’s interactions with students are positive and respectful; students appear comfortable interacting with the therapist
☐ / Therapist’s interactions with students evoke a high degree of comfort and trust from the students
☐
Component 2b
Manages workload effectively/Organizes time effectively / Therapist does not organize time and schedule efficiently, is often late for meetings/therapy sessions or paperwork deadlines, does not communicate schedule changes
☐ / Therapist is inconsistent with organization of time and schedule; not always effective communicating schedule changes; inconsistently meets paperwork deadlines
☐ / Therapist organizes time and schedule efficiently and flexibly; prioritizes time and communicates schedule changes, completes reports/ paperwork in timely manner
☐ / Therapist is highly organized, efficient and flexible with time and schedule; effectively negotiates schedule and changes, and proactively communicates schedule/ changes, diligently completes reports/ paperwork ahead of required dates
☐
Notes:
DOMAIN 2: ENVIRONMENT // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 2c
Establishes and maintains clear procedures for referrals / Therapist has not communicated procedure for referrals to team members Team is unclear how to refer a student for therapy
☐ / Therapist established procedures for referral; process is not clear and easily followed
☐ / Procedures for therapy referrals, meetings and consultations with parents and administrators are clear to everyone
☐ / Procedures for all aspects of therapy referral and testing protocols are clear to everyone, and have been developed in consultation with parents, teachers, and administrators
☐
Component 2d
Establishes standards of student conduct / No standards of conduct have been established and therapist disregards or fails to address negative student behavior during evaluation or treatment
☐ / Standards of conduct appear to have been established in testing and treatment; Therapist attempts to monitor and correct student negative behavior during evaluation and treatment are partially successful
☐ / Standards of conduct have been established in testing and treatment; Therapist monitors student behavior against those standards; response to students is appropriate and respectful
☐ / Standards of conduct have been established in testing and treatment; Therapist’s monitoring of students is subtle and preventive, and students engage in self-monitoring of behavior
☐
DOMAIN 2: ENVIRONMENT
OVERALL RATING – DOMAIN 2 / q UNSATISFACTORY / q BASIC / q PROFICIENT / q DISTINGUISHED
Notes:
Name: School Year: Evaluator: Date:
DOMAIN 3: DELIVERY OF SERVICE /
/ Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 3a
Collaborates with building or program teams at systems level to incorporate RtI approach for universal strategies (Tier 1) / Does not identify building or program needs, does not respond to requests for universal strategies in the classroom
☐ / Provides suggestions for universal strategies or in-services to teams only upon request
☐ / Works collaboratively to identify building/program needs and develops
in-services or appropriate materials to build capacity of teachers to meet student needs
☐ / Proactively identifies building/program needs for universal strategies and develops resources and instruction for school teams; provides ongoing monitoring and collaboration to build capacity of teachers to meet needs of all students
☐
Component 3b
Responds to all IEP and non-IEP (problem solving) referrals and evaluating student needs / Therapist fails to respond to referrals or makes hasty assessments of student needs
☐ / Therapist responds to referrals when pressed and makes adequate assessments of student needs
☐ / Therapist responds to referrals and makes thorough assessments of student needs
☐ / Therapist is proactive in responding to referrals and makes highly competent assessments of student needs
☐
Notes:
DOMAIN 3: DELIVERY OF SERVICE // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 3c
Implements therapeutic intervention to maximize student success / Therapeutic intervention consists of a random collection of unrelated activities lacking coherence or an overall structure
☐ / Therapist’s intervention has a guiding principle and includes a number of worth-while activities, but some of them don’t fit with the team priorities
☐ / Therapist’s intervention includes appropriate strategies aligned to overall goals, some of which are evidence based, preparatory and/or purposeful; strategies are partially embedded across school day
☐ / Therapist’s intervention is highly coherent and comprehensive utilizing a wide variety of preparatory and purposeful strategies is evidence based, and serves to support students across the school day
☐
Component 3d
Demonstrates flexibility and responsiveness of therapeutic intervention / Therapist adheres to intervention plan, in spite of evidence of its inadequacy
☐ / Therapist makes modest changes in the therapeutic intervention when confronted with evidence of the need for change
☐ / Therapist makes revisions in the therapeutic intervention when they are needed using some data to support changes
☐ / Therapist continually seeks ways to improve the therapeutic intervention and uses clinical reasoning to make changes as needed in response based on data and in response to student, parent, or teacher input
☐
Notes:
DOMAIN 3: DELIVERY OF SERVICE // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 3e
Collaborates and communicates with IEP teams and professional peers / Therapist is not available to staff for questions and planning and declines to provide background material when requested
☐ / Therapist is available to staff for questions and planning and provides background material when requested
☐ / Therapist initiates contact with IEP teams to confer regarding individual cases
☐ / Therapist is proactive seeking out IEP teams, outside agencies and other professionals to confer regarding cases, soliciting their perspectives on individual students
☐
Component 3f
Communicates with families / Therapist fails to communicate with families or communicates in an insensitive manner
☐ / Therapist’s communication with families is partially successful but there are occasional insensitivities to cultural and linguistic traditions
☐ / Therapist communicates with families in an effective and respectful manner, sharing information on student performance and needs; is sensitive to cultural and linguistic traditions
☐ / Therapist communicates in a highly effective and empathetic manner on current student performance, collaboratively identifying/prioritizing needs; Therapist is sensitive to cultural and linguistic traditions; Therapist reaches out to families of students to enhance trust
☐
DOMAIN 3: DELIVERY OF SERVICE
OVERALL RATING – DOMAIN 3 / q UNSATISFACTORY / q BASIC / q PROFICIENT / q DISTINGUISHED
Notes:
Name: School Year: Evaluator: Date:
/ Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 4a
Reflects on practice and professional growth / Therapist does not use reflection to guide decisions, unaware of professional growth needs, or reflections are inaccurate or self-serving
☐ / Therapist’s reflection on practice is moderately accurate and objective without citing specific professional growth needs
☐ / Therapist’s reflection on practice is accurate and objective, citing positive and negative characteristics; uses to guide professional development activities
☐ / Therapist’s reflection is highly accurate and perceptive, citing specific examples that have not been successful; uses reflection to make future decisions and guide professional growth needs
☐
Component 4b
Engages in a professional community / Therapist’s relationships with colleagues are negative or self-serving; therapist avoids being involved in LADSE, school and district events or projects
☐ / Therapist’s relationships with colleagues are cordial; therapist participates in LADSE, school or district events or projects when specifically asked to do so
☐ / Therapist participates actively in LADSE, school and district events or projects and maintains positive and productive relationships with colleagues
☐ / Therapist makes a substantial contribution to LADSE, school and district events or projects and assumes a leadership role with colleagues
☐
Notes:
DOMAIN 4: PROFESSIONAL RESPONSIBILITIES // Level of Performance /
/ UNSATISFACTORY / BASIC / PROFICIENT / DISTINGUISHED /
Component 4c
Participates in professional development / Therapist does not participate in profes-sional development activities, even when such activities are clearly needed for the development of skills
☐ / Therapist’s participation in professional development activities is limited to those that are convenient or are required
☐ / Therapist seeks out opportunities for professional development based on an individual assessment of need
☐ / Therapist actively pursues professional growth opportunities and makes a substantial contribution to the profession through such activities as mentoring colleagues
☐
Component 4d
Shows professionalism, including integrity, advocacy, and maintaining confidentiality / Therapist displays dishonesty in interactions with colleagues, students, and the public and violates principles of confidentiality
☐ / Therapist is honest in interactions with colleagues, students, and the public; plays a moderate advocacy role for students; does not violate norms of confidentiality
☐ / Therapist displays high standards of honesty, integrity and confidentiality in inter-actions with colleagues, students and the public; advocates for students when needed
☐ / Therapist can be counted on to hold the highest standards of honesty, integrity and confidentiality and to advocate for students, taking a leadership role with colleagues
☐
DOMAIN 4: PROFESSIONAL RESPONSIBILITIES
OVERALL RATING – DOMAIN 1 / q UNSATISFACTORY / q BASIC / q PROFICIENT / q DISTINGUISHED
Notes:
Name: School Year: Evaluator: Date:
Attendance