Services

The services of Literacy Care are two fold. They are:

1. The Diagnostic Literacy Assessment (Very Thorough and Well Reported On)
2. Treatment and Management  (Highly Individualised and Very Successful)

Diagnostic Assessment Process

The assessment process is the most important of all. It consists of three one hour consultations.

• Initial Interview (30 minutes for parent interview and 30 minutes of testing with child)
• Assessment Interview (One Hour Testing with child Only)
• Feedback Interview (One Hour with Parents Only)

 The Initial Interview is essential for the following reasons:

• To provide information about how the entire assessment process works.
• To determine how Literacy Care can specifically assist your child before making a decision to do any testing - in some cases a child may have already completed a considerable amount of assessment and you may feel that further assessment is unnecessary.
• To provide opportunity for previous reports to be viewed and commented on before a decision about further testing is made.
• To collect and evaluate relevant background and history on the child and family
• To commence some testing as is desirable.

Usually about 30 minutes is taken to interview parents and 30 minutes is set aside to perform some testing with the student.

The following areas and information must be collected and considered at the Initial Interview

History

As in all cases in medicine the history and background is the most important and therefore is afforded the most respect (Shaywitz 2003). History involves the recording of information from the following areas:

General Medical History

This includes:

• Biomedical and Psychoemotional Information

Developmental History

This includes:

• Milestones
• Gross/Fine Motor Ability
• Speech/Language Ability
• Strengths/Talents

Educational History

This includes:

• General Academic Progress as well as Specific Scholastic Difficulties

Family (Genetic) History

This includes:

• Diagnosed conditions and similar difficulties that have been experienced by members of the child's family.

Phonological and Orthographic Processing Difficulties

This is one of the most important areas of consideration. It covers essential processing and cognitive skills such as rapid naming, phonological memory and phonemic awareness. It also measures visual analysis, visual memory and sequencing ability. This information very often determines the nature and type of learning disability and gives essential prognostic information on how to formulate an appropriate treatment.

Neurosensory Status

This is information about the child's vision and hearing. These areas are not the underlying causes of specific learning difficulties but they may serve to complicate the problems if left unattended. Because difficulties in these areas are easy to find than testing should be done as a matter of routine.

Existing Reports

If the child has had other tests administered relative to their learning problems then the reports should be made available to the testing practitioner. If there is a considerable amount of data on the child then this should be brought to the initial interview so as the professional can review these reports with the child's carer and make a decision as to the necessity of a full diagnostic literacy assessment.

Reports and assessment information from the following sources may have already been collected:

• Medical - this could include information about existing conditions and medications
• Psychoeducational - this could include information about verbal and non verbal performances, IQ and emotional stability
• Speech and Language - this will be information provided by a Speech Language Pathololgist
• Occupational Therapy - this will be information provided by an Occupational Therapist
• Ascertainment/Appraisal - this will be information provided by the child's school
• School Reports

Standardized Scores

Numerical data is important in order to establish a set of baseline measures from which future measures can be compared. This allows measurable goals to be set within predetermined time frames. It also gives an insight into the extent of the learning delay. Further scores can be taken throughout intervention and the rate and strength of progress can be plotted on a graph. These scores are usually compared to the child's age and year of schooling.

Such standardized numerical data usually includes:

• Functional Reading Accuracy Age
• Word Processing Age
• Reading Comprehension Age
• Word per Minute Rate
• Written Spelling Age

Assessment Interview - One Hour

The child generally works alone with the practitioner.  During this time a range of test instruments are administered.  This testing time is in addition to the 30 minutes of testing at the initial interview.  The tests cover the following diagnostic areas.

• Word Processing Accuracy (Single Word, Single Sentence, Paragraph, Short Story)
• Decoding Skills
• Developmental Reading Stages (Frith Model)
• Literal Comprehension (Oral/Literal Retelling)
• Fluency
• Wording Processing Rate (Word Per Minute Rate)
• Whole Word Spelling
• Encoding (Synthetic and Analytical Phonics)
• Visual Analysis
• Phonological Processing (Phon. Awareness, Phon Memory, Auto Rapid Naming)
• Handwriting
• A Dyslexia Screening Instrument
• A Scotopic Sensitivity Screening Instrument (Oral Screen Only)

Evidence

The goal of this aspect of the testing is to gather sufficient evidence to answer the following questions:

• Is there a learning disability?
• If so, what is it?
• What is the best way to describe the problem?
• What is the extent or degree of the disability?
• Are there coexisting problems like attention and concentration difficulties, anxiety, cognitive difficulties or other psychoemotional problems that are impacting on learning or that will prevent effective remediation?
• What type of intervention is needed?
• How long will intervention take and what goals will be achieved?
• Are there other professionals that need to be involved in the intervention?

Remember: Tests and Assessment instruments DO NOT DIAGNOSE - PEOPLE DO.

What Happens After Assessment

After assessment the student can be successfully identified and a type of service organised. A detailed report is prepared and formal plan is designed. Within each plan there are phases of work.

The plan shows:

• Number of Phases in the Intervention
• Number of Visits Within Each Phase
• Frequency of Visits Within Each Phase
• Nature of Visit (e.g. In office, Telephone, Internet, Email)
• Predetermined Dates of Review
• Whether a Second Plan will be Necessary

• All Necessary Intellectual Property and all Physical Resources
• Appropriate Time
• Predetermined Reviews and Retesting
• Progress Results and Reports
• Feedback to School
• Email and Telephone Contact with School and Other Professionals as Requested and/or Required

Feedback Interview - One Hour

The final meeting is is usually between the specialist and parents only.  It is the time when the diagnostic literacy report and treatment plan are presented and discussed.  The answers to the above questions are given and a range of other information based documents are presented.

Treatment and Management

The highly specialized work that Literacy Care provides within the Child Development Network allows for the provision of an equally specific set of treatment pathways. Over 90% of children who utilize our services are identified in 5 ways. Identification is important for two reasons:

1. It expresses the fact that we understand the child's unique set of difficulties and can accurately provide a specific and prescriptive treatment and management plan.
   
   
2. It provides for an outcome driven approach where clinical visits and payment are linked to short and long term gains and overall achievement.

Each Identity Corresponds to a Type of Service Offered

Identities and Services

1.  Type 1 Literacy

These students are assigned a Type 1 identity because their particular case is relatively uncomplicated in terms of our ability to understand how to treat. Secondly, the long term outcome is reasonably predictable. Their difficulties could range from mild to significant.

Example: A child who may be several years behind in their reading and spelling ability but who have no other significant difficulties such as high anxiety or attention control problems.

2.  Type 2 Literacy

These students are assigned a Type 2 identity because their case is complex relative to treatment requirements and the long term outcome cannot be accurately predicted until some intervention has been accomplished. Example: A child who may be several years behind in their reading and spelling ability but who also have other difficulties or diagnosed conditions that make the process of remediation more complicated.

3.  Guided Literacy

These students have been so identified because they live too far away from clinical services to make regular visits viable. Therefore a special kit has been formulated that delivers literacy services in the form of physical, telephone and internet/email based resources. Students must live over an hour away in normal travelling time to qualify.

4.  Early Literacy Intervention

This identity and service is reserved for students who for whatever reason are not considered eligible for the other categories of treatment. The most frequent reasons are:

The child is considered too young or too immature for the demands of an intense literacy intervention but who are still of sufficient age to learn to read

The child's predicament is so unpredictable (such as is the case with treatment resistors) that it is decided that some significantly modified work done in the home will assist in identifying needs and goals better

Students who are waiting to engage in intervention and would like to commence some meaningful work at home in the meantime

5.  Study Skills

This identity and service covers students who are in senior primary, middle school and high school. It is a calculated mix of written comprehension, writing and study skills. It also includes actual assignment and exam preparation techniques.

Explaining the Five Types of Services

1.  Type 1 Literacy - Two Phase Intervention

Phase One:     6 Consultations

Phase Two:     22 – 26 Consultations

Retesting and reporting on results occurs every six consultations or every 8 weeks. Expected goals and outcomes are described before intervention commences.

2.  Type 2 Literacy – Three Phase Intervention

Phase One:     6 consultations

This period is designed to treat the difficulties but also to further elucidate the difficulties diagnostically so a more detailed plan and set of goals can be formulated.

The first phase concludes with reassessment and the formulation of the plan.

Phase Two:     Processing and Cognitive Training

Phase Three:   Multisensory Literacy Intervention

It includes:

• A prediction now of what can be achieved and how to do it
• Number of consultations
• Predetermined Reviews and Retesting
• Predetermined dates of review
• Final Goals and Outcomes

3.  Guide Literacy Intervention – Three Phase Intervention

Phase One:     Start Up Consultation and First Two Weeks

It includes:

• Three hour in office Start Up Consultation
• Two Email Tutorials (one at end of first week and one at the end of the second week)
• Two Phone Tutorials (one at end of first week and one at the end of the second week)

Phase Two:     Next Four Weeks of Lessons

It includes:

• Four Email Tutorials (one at end of each week)
• Two Phone Tutorials (two weeks apart)

Phase Three:   Ongoing “Steady State” Instruction

It includes:

• Six Weekly In-Office Retesting
• Fortnightly Email Tutorials
• Phone Tutorials by Arrangement

4.  Early Literacy Intervention – Three Phase Intervention

Phase One:     Start Up Consultation and First Two Weeks of lessons (performed by a parent at home)

It includes:

• One Hour Start Up In-Office Consultation
• One Phone Tutorial at the End of Two Weeks

Phase Two:     One Month of Lessons (performed by a parent at home)

It includes:

• Two Email Tutorials Two weeks apart
• One Hour In Office reassessment at the end of the month

Phase Three

This phase will be planned after the review at the end of the month. It may involve a complete conclusion to work, an extension of phase two or a conversion to a full intervention.

5.  Study Skills– Three Phase Intervention

Phase One:     6 Consultations in 6 Weeks

Phase Two:     6 Consultations in 6 weeks

Phase Three:   6 Consultations in 6 Weeks

Each phase represents a composite area of skill. Each composite area is made up of a number of sub skills that translate into student activity.

Literacy Care, The CDN and Networking

The Literacy Care service is located within the Child Development Network at The Mater Hospital. As such it is probably a unique service relative to educational consultancy.  It also means that the treatment provided for the child can be (as needed) the outcome of a highly collaborative process involving the other members of the Child Development Network team.

Literacy Care's core service is to work closely with the child's parents to develop an individualized goal driven intervention that will directly address the child's literacy problems given that he or she is either generally delayed or has an actual diagnosed Learning Disability.