# APP E N D IX E FOURTH - GRADE SPECIAL EDUCATION TEACHER QUESTIONNAIRES

Ear l y Ch il dho od Long it ud i n al St u d y , K i nd er g a rten Cl a ss o f 2 0 1 0 - 11 (E CL S - K : 2011) 

# Spring Fourth - Grade National Data Collection and Fifth - Grade Recruitment
O M B C le a ra n ce P acka g e #1850 - 0750 v.1 6

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# Spring 2015 Special Education Teacher Questionnaire A

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR OR AN ECLS‐K:2011 STAFF MEMBER. DO NOT MAIL THIS QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING. Use a black or blue ball point pen to complete this questionnaire.

National Center for Education Statistics by: Prepared for the U.S. Department of Education

Westat Rockville, Maryland



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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850‐XXXX. Approval expires XX/XX/XXXX. The time required to complete this survey is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Early Childhood Longitudinal Study, National Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006‐ 5574. The collection of information in this survey is authorized by 20 U.S. Code, Section 9543. Participation is voluntary. You may skip questions you do not wish to answer; however, we hope that you will answer as many questions as you can. Your responses are protected from disclosure by federal statute ﴾20 U.S. Code, Section 9573﴿. All responses that relate to or describe identifiable characteristics of individuals may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law. Data will be combined to produce statistical reports. No individual data that links your name, address, telephone number, or identification number with your responses will be included in the statistical reports. 15 Draft

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### Dear Special Education Teacher/Related Services Provider, This questionnaire is an important part of a major longitudinal study of children's early educational experiences beginning with kindergarten and continuing through grade 5. The Early Childhood Longitudinal Study, Kindergarten Class of 2010‐11 ﴾ECLS‐K:2011﴿ is collecting information from the special education teachers/related service providers of sampled children who have Individualized Education Programs ﴾IEPs﴿ to investigate the relationship between the children's academic progress and various school, classroom, teacher, and home characteristics. This questionnaire collects information about your background and your work in this school with children with disabilities. Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you do not want to answer. However, only you can provide this information. Although we realize you are very busy, we urge you to complete this questionnaire as completely and accurately as possible. The information you provide is being collected for research purposes only and will be protected from disclosure to the fullest extent allowable by law ﴾Education Sciences Reform Act of 2002, 20 U.S.C. § 9573﴿. Information from multiple individuals will be combined to produce statistical reports; no information that identifies you will be included in any reports or provided to students, their parents, or other school staff.

THANK YOU VERY MUCH FOR YOUR HELP. Draft

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1. What is your gender? MARK ONE RESPONSE.

2. In what year were you born? WRITE IN YEAR BELOW.

3. Are you Hispanic or Latino? MARK ONE RESPONSE.

Male Female

Yes No 4. Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO BE.

5. What is the highest level of education you have completed? MARK ONE RESPONSE.

Did not complete high school High school diploma or equivalent/GED Some college or technical or vocational school Associate’s degree Bachelor's degree Master's degree An advanced professional degree beyond a master’s degree ﴾for example, Ph.D., MD﴿ American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White YEAR 

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8. Counting this school year, how many total years have you been working with children in any school, including years in which you worked part time? This would include other assignments such as teaching in a regular classroom or otherwise providing services to children. WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR, WRITE "1."

Year﴾s﴿ 7. Counting this school year, how many total years have you been working with children receiving special education or related services in any school, including years in which you worked part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR, WRITE "1."

Year﴾s﴿ 6. Is this school year the first year you have worked with children in this school? MARK ONE RESPONSE. Yes No Draft

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9. Which of the following credentials, licenses, or certificates do you have for working with children with disabilities? DO NOT INCLUDE ACADEMIC DEGREES, SUCH AS A BACHELOR'S DEGREE, MASTER'S DEGREE, OR PH.D. MARK YES OR NO ON EACH ROW. a. Emergency credential b. Provisional or temporary credential c. Disability‐specific credential or endorsement d. Special education credential or endorsement ﴾for more than one disability category﴿ e. General education credential f. Speech/language therapy state license or certification g. Physical therapy state license or certification h. Occupational therapy state license or certification i. Social work license or certification

m. Other professional license, credential, or endorsement ﴾PLEASE SPECIFY﴿ l. Certificate of Clinical Competence k. Clinical psychology license or certification j. School psychology license or certification Yes No

10. Have you taken the exam for National Board for Professional Teaching Standards certification? MARK ONE RESPONSE. Not taken Taken and passed Taken and have not yet passed Taken and awaiting test results Not applicable Draft

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* Including the condition formerly classified as mental retardation 11. Have you ever taken a college course in the following areas? MARK YES OR NO ON EACH ROW. Yes No a. Early childhood education b. Early childhood special education c. Elementary education d. Child development e. English as a Second Language ﴾ESL﴿ or teaching English language learners f. General special education g. Learning disabilities h. Intellectual disability * i. Orthopedic impairments

l. Blindness and vision k. Deafness and hearing j. Serious emotional disturbance

m. Communication disorders n. Infants and toddlers with disabilities
o. Physical therapy p. Occupational therapy q. School psychology r. Classroom management Draft

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12. Have you ever taken a college course that addressed issues related to the following? MARK YES OR NO ON EACH ROW.

13. Which of the following best describes your current position in this school? MARK ONE RESPONSE.

Special education teacher Special education teacher consultant General education teacher Special education classroom aide Speech‐language pathologist Physical therapist Physical therapy assistant or aide Occupational therapist Occupational therapy assistant or aide School psychologist School counselor School social worker Other ﴾PLEASE SPECIFY﴿ Yes No a. Using published research evidence to identify and select effective interventions and supports for students b. Using formal assessment data to inform the choice of READING interventions and supports for students c. Using formal assessment data to inform the choice of MATH interventions and supports for students d. Using data to inform the choice of behavioral interventions and supports for students Draft

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14. How do you classify your main assignment at this school, that is, the activity at which you spend most of your time during this school year? MARK ONE RESPONSE. Regular full‐time teacher/service provider Regular part‐time teacher/service provider Itinerant teacher/service provider ﴾that is, your assignment requires you to provide Long‐term substitute ﴾that is, your assignment requires that you fill the role of a
Teacher aide Other ﴾PLEASE SPECIFY﴿ instruction/related services at more than one school﴿ teacher on a long‐term basis, but you are still considered a substitute﴿

15. During this school year, where have you worked with children with IEPs? INCLUDE ONLY CHILDREN WHO ATTEND THIS SCHOOL. MARK YES OR NO ON EACH ROW. Yes No a. In a general education classroom b. In a special education classroom c. In a non‐classroom space ﴾for example, office, therapy room, small work space, mobile van, etc.﴿ d.In a location outside of the school setting ﴾for example, a child's home, a private clinic, etc.﴿ e.Other ﴾PLEASE SPECIFY﴿ Draft

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17. During the school year, how many children with IEPs have you worked with or provided services for, on average, each week ? ﴾Include children you work with directly, as well as children for whom you consult with the general education teacher and/or another special education teacher/service provider.﴿ MARK ONE RESPONSE. 16. Please indicate the extent to which you agree or disagree with each of the following statements. MARK ONE RESPONSE ON EACH ROW.

1‐10 11‐20 21‐40 More than 40 Don't know
18. Date questionnaire completed: Strongly disagree Disagree Neither disagree nor agree Agree Strongly agree
b. I am certain I am making a difference in the lives of the children I work with. c. If I could start over, I would choose this career again. d. I am satisfied with my class size/caseload. a. I really enjoy my present job.



# THANK YOU FOR YOUR COOPERATION! MONTH DAY YEAR



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# Spring 2015 Special Education Teacher Questionnaire B Child Level

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR OR AN ECLS‐K:2011 STAFF MEMBER. DO NOT MAIL THIS QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING. Use a black or blue ball point pen to complete this questionnaire.

Rockville, Maryland Westat National Center for Education Statistics by: Prepared for the U.S. Department of Education



### S_ID T_ID C_ID 

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C

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850‐XXXX. Approval expires XX/XX/XXXX. The time required to complete this survey is estimated to average 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Early Childhood Longitudinal Study, National Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006‐ 5574. The collection of information in this survey is authorized by 20 U.S. Code, Section 9543. Participation is voluntary. You may skip questions you do not wish to answer; however, we hope that you will answer as many questions as you can. Your responses are protected from disclosure by federal statute ﴾20 U.S. Code, Section 9573﴿. All responses that relate to or describe identifiable characteristics of individuals may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law. Data will be combined to produce statistical reports. No individual data that links your name, address, telephone number, or identification number with your responses will be included in the statistical reports. 15 Draft

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### Dear Special Education Teacher/Related Services Provider, This questionnaire is an important part of a major longitudinal study of children's early educational experiences beginning with kindergarten and continuing through grade 5. The Early Childhood Longitudinal Study, Kindergarten Class of 2010‐11 ﴾ECLS‐K:2011﴿ is collecting information from the special education teachers/related service providers of sampled children who have Individualized Education Programs ﴾IEPs﴿. We are gathering information from these children's regular classroom teachers as well. Our purpose is to investigate the relationship between the children's academic progress and various school, classroom, teacher, and home characteristics. This questionnaire collects information on the special education/related services received by the child identified on the cover of this questionnaire. Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you do not want to answer. However, only you can provide this information. Although we realize you are very busy, we urge you to complete this questionnaire as completely and accurately as possible. You may find at least some of the information we are asking for in the child's IEP. All information you provide is being collected for research purposes only and will be protected from disclosure to the fullest extent allowable by law ﴾Education Sciences Reform Act of 2002, 20 U.S.C. § 9573﴿. Information from multiple individuals will be combined to produce statistical reports; no information that identifies you will be included in any reports or provided to students, their parents, or other school staff.

THANK YOU VERY MUCH FOR YOUR HELP. Draft

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3. In what capacity or capacities do you teach or provide services to this child? MARK YES OR NO ON EACH ROW. a. Provide instruction directly to the child b. Provide related services directly to the child c. Provide consultation services directly to the child d.Provide indirect consultation services ﴾for example, consultation to the child's teacher﴿ e. Provide case management f. Other ﴾PLEASE SPECIFY﴿

4. When was this child first determined eligible for special education or related services? MARK ONE RESPONSE. Before kindergarten During kindergarten During first grade During second grade During third grade During fourth grade Other ﴾PLEASE SPECIFY﴿

Don't know 1. Is this child currently receiving gifted/talented services through an IEP, or has the child received such services during this school year? MARK ONE RESPONSE.

2. Is this child currently receiving special education services through an IEP due to a disability or has the child received such services during this school year? MARK ONE RESPONSE. Yes No

﴾SKIP TO Q 34﴿ Yes No

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7. To what extent were you involved in planning the transition from last year's special education program to this year's special education program for this child? MARK ONE RESPONSE. Not at all Somewhat Extensively 5. Is this the first school year that the child has been receiving special education services? MARK ONE RESPONSE. Yes No 6. When did this child first start receiving special education or related services? MARK ONE RESPONSE.

8. To what extent did you communicate with the person﴾s﴿ who provided special education for this child last year? MARK ONE RESPONSE. Not at all Somewhat Extensively I provided special education for this child last year. Before kindergarten During kindergarten During first grade During second grade During third grade Other ﴾PLEASE SPECIFY﴿

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* Including the condition formerly classified as mental retardation 9. Have you reviewed this child's records related to special education services provided before this school year? MARK ONE RESPONSE. Yes No, I don't have access to the records. No, I have access to the records, but have not reviewed them. No, I provided special education to this child last year.

10. What is this child's primary disability as identified on the child's IEP? PLEASE SELECT THE CATEGORY BELOW INTO WHICH THE CHILD'S PRIMARY DISABILITY FITS BEST. MARK ONE RESPONSE. Speech or language impairments Specific learning disabilities Emotional disturbance Intellectual disability * Developmental delay Visual impairments ﴾including blindness﴿ Hearing impairments ﴾including deafness﴿ Orthopedic impairments Other health impairments Autism Traumatic brain injury Deaf‐blindness Multiple disabilities ﴾children included in this category should be those who have more than No classification is given one primary disability which do not include deaf‐blindness or developmental delay﴿ Draft

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11. During this school year, for which of the following disabilities has this child received special education or related services, whether for the child's primary disability or another of his/her disabilities? MARK YES OR NO ON EACH ROW.

12. During this school year, has this child received any special education or related services because of a diagnosed Attention Deficit Disorder ﴾ADD﴿ or Attention Deficit Hyperactivity Disorder ﴾ADHD﴿? MARK ONE RESPONSE. Yes No

* Including the condition formerly classified as mental retardation a. Speech or language impairments b. Specific learning disabilities c. Emotional disturbance d. Intellectual disability * e. Developmental delay f. Visual impairments ﴾including blindness﴿ g.Hearing impairments ﴾including deafness﴿ h. Orthopedic impairments i. Other health impairments

l. Deaf‐blindness k. Traumatic brain injury j. Autism

m. Multiple disabilities ﴾children included in this category should be those who have more than one primary disability which do not include deaf‐blindness or developmental delay﴿ n. No classification given THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD'S SPECIAL EDUCATION EXPERIENCE DURING THE CURRENT SCHOOL YEAR .

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13. During this school year, which of the following describe﴾s﴿ the IEP goals for this child? MARK YES OR NO ON EACH ROW. Academics

Speech and language a. Reading b. Mathematics c. Language Arts d. Science

Social

Life skills
Physical/Mobility

Other e. Auditory processing f. Listening comprehension g. Oral expression h. Voice/speech articulation i. Language pragmatics
j. Social skills k. General appropriateness of behavior

l. Adaptive behavior or self‐help skills

m. Fine motor skills n. Gross motor skills o. Orientation and mobility
p. Other ﴾PLEASE SPECIFY﴿ Yes No Draft

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14. During this school year, which of the following related services have been provided through the school to this child? MARK YES OR NO ON EACH ROW. a. Audiology b. Counseling services
c. Occupational therapy d. Physical therapy e. Psychological services f. Health services g. Social work services h. Special transportation i. Speech or language therapy j. Orientation services

m.Other ﴾PLEASE SPECIFY﴿ l. Rehabilitation services k. Mobility services Yes No Draft

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15. During this school year, has this child received any of the following? MARK YES OR NO ON EACH ROW.

16. During this school year, has this child's primary placement been a general education classroom? MARK ONE RESPONSE. Yes No a. Adaptive physical education b.Assistance from classroom aides ﴾for example, teacher aide, behavioral assistant, special education aide﴿ c. Interpreter for the deaf or hard of hearing ﴾oral or sign﴿ d. Teacher used Braille to provide instruction e. Child was taught how to use Braille f. Teacher used American Sign Language to provide instruction g. Child was taught how to use American Sign Language h. Teacher used Manual English to provide instruction i. Child was taught how to use Manual English j. Teacher used Cued Speech to provide instruction

m. Tutoring/remediation from special education teacher l. Mental health services, personal/group counseling, therapy, or psychiatric care provided to the child k. Child was taught how to use Cued Speech

n. Training, counseling, and other supports/services provided to this child's family Yes No Draft

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17. During this school year, approximately how many hours per week of direct special education and related services ﴾that is, service provided directly to the child, from a teacher or another adult﴿ has this child received? WRITE NUMBER IN BOX.

Hours per week 18. Of the hours of direct special education and related services reported above, approximately how many of those hours per week were the instruction/services provided outside of a general education classroom but within the school setting? WRITE NUMBER IN BOX.

Hours per week

19. During this school year, what teaching practices and methods have you and/or other special education service providers used with this child? MARK ONE RESPONSE ON EACH ROW.

a. One‐on‐one instruction b.Small‐group instruction c. Large‐group instruction d.Co‐teaching ﴾see definition above﴿
e. Cooperative learning f. Peer tutoring g. Computer‐based instruction h. Direct instruction i. Cognitive strategies j. Self‐management k. Behavior management Don't know Yes No

l. Instruction received through a sign interpreter PLEASE NOTE THE FOLLOWING DEFINITION THAT IS RELEVANT TO QUESTION 19 BELOW: Co‐teaching is when a general education teacher and a special education service provider share the teaching responsibility, with the special education service provider providing specialized differentiated lessons for students with special needs. The two teachers participate in lesson or activity planning together and work together in the same classroom to instruct both students with and without disabilities. Draft

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20. During this school year, which of the following best describes the curriculum materials used with this child in the general education classroom? MARK ONE RESPONSE. General education curriculum materials were used without modification General education curriculum materials were used with some modifications General education curriculum materials were used with substantial modifications Specially‐designed commercial materials were used Teacher‐designed materials were used Child not in this setting Don't know

General education curriculum materials were used without modification General education curriculum materials were used with some modifications General education curriculum materials were used with substantial modifications Specially‐designed commercial materials were used Teacher‐designed materials were used Child not in this setting Don't know 21. During this school year, which of the following best describes the curriculum materials used with this child in the special education classroom/program? MARK ONE RESPONSE.

22. During this school year, has this child had the assistance of a service animal while at school? A service animal is any guide dog, signal dog, or other dog individually trained to provide assistance to an individual with a disability. Service animals can be used full time or in‐school only as part of a program such as animal assisted therapy ﴾AAT﴿. Yes, this child has been assisted by his/her own service dog at school Yes, this child has been assisted by a service dog provided by a school program No, this child has not been assisted by a service dog at school Draft

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23. During this school year, which of the following assistive technologies and devices has this child used? MARK YES OR NO ON EACH ROW. Mobility aids a. Vans, vehicles b. Wheelchair c. Walker d. White cane

e. Electronic with voice output ﴾for example, Touch Talker﴿ f. Electronic without voice output ﴾for example, device with visual display or printed speech output﴿ g. Non‐electronic ﴾for example, manual printing board﴿ Communication aids

Hearing assistance

Visual aids

Learning aids ﴾non‐computer﴿ r. Tape recorder s. Calculator t. Electronic spelling devices h. Hearing aids i. FM loops j. TTYs/TDDs k. Cochlear implants l. Real‐time captioning

m. Braille texts n. Electronic Braille devices o. Digital texts q. Close‐captioned television ﴾CCTV﴿ p. Magnifying devices Yes No Draft

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23. ﴾CONTINUED﴿ During this school year, which of the following assistive technologies and devices has this child used? MARK YES OR NO ON EACH ROW.
Yes No

24. Does this child have a computer, laptop, or word processing device assigned to him/her for use full time this school year? MARK ONE RESPONSE. Yes No 25. During this school year, on average, how often have you met with general education teacher﴾s﴿ to discuss this child's program or progress? MARK ONE RESPONSE. w. Reading x. Writing y. Mathematics Other assistive technologies or devices z. Other ﴾PLEASE SPECIFY﴿ Computer software designed for children with disabilities Computer hardware designed or adapted for children with disabilities ﴾for example, alternate keyboards, switch interface﴿ u. Used solely by individual child v. Shared with other children

Not applicable because I am the child's general education teacher Not applicable to my work with this child Every day or several times a week Once a week or several times a month Once a month A few times over the school year Once during this school year Never during this school year ﴾SKIP TO Q 27﴿ ﴾SKIP TO Q 27﴿ ﴾SKIP TO Q 27﴿ Draft

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27. During this school year, approximately how often have you communicated with this child's parents about this child's program or progress ﴾by phone, in person, or in writing, including e‐mail﴿? MARK ONE RESPONSE. Every day or several times a week Once a week or several times a month Once a month A few times over the school year Once during this school year Never during this school year

28. During this school year, has this child received formal individual evaluations in any of the following areas for purposes of developing IEP goals? MARK YES OR NO ON EACH ROW. 26. On average, how long were the meetings with the general education teacher﴾s﴿ to discuss this child's program or progress? MARK ONE RESPONSE. 1 to 15 minutes 16 to 30 minutes 31 to 45 minutes 46 to 60 minutes More than 60 minutes

a. Psychological b. Speech/language c. Vision d. Hearing e. Learning style f. Motor skills g. Academics h.Other ﴾PLEASE SPECIFY﴿ Yes No Draft

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29. To what extent is this child expected to achieve the same general education goals as other children at his/her grade level this school year? MARK ONE RESPONSE.

30. What percentage of this child's current IEP goals have been met or nearly met at this point in the school year? MARK ONE RESPONSE. 76 to 100 percent 51 to 75 percent 26 to 50 percent 1 to 25 percent 0 percent 31. Which of the following best expresses the likelihood that this child will continue to receive some level of special education services ﴾through an IEP﴿ in the next school year? MARK ONE RESPONSE. Child is expected to attain grade level achievement for all of the academic content standards. Child is expected to attain grade level achievement for some of the academic content Child is expected to attain grade level achievement for only a few of the academic content Child is not expected to attain grade level achievement for any of the academic content There are no academic content standards at this grade level. Don't know standards. standards. standards.

not continue in special education ﴾will be dismissed from services﴿ Definitely will continue in special education Very likely to continue in special education Rather likely to continue in special education Rather unlikely to continue in special education Very unlikely to continue in special education Definitely will Draft

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32. During this school year, to what extent has this child participated in any grade‐level assessment administered as part of the school's testing program? MARK ONE RESPONSE.

33. Did this child receive special accommodations to participate in the school's regular testing or assessment program this school year? MARK ONE RESPONSE. Yes No Don't know 34. In which grade is this child enrolled? MARK ONE RESPONSE.

Kindergarten First grade Second grade Third grade Fourth grade Fifth grade or higher This child is in an ungraded classroom 35. Date Questionnaire Completed:



# THANK YOU FOR YOUR COOPERATION! MONTH DAY YEAR



## 2015 Child did not participate in the school's testing or assessment program. Child participated in alternate assessments and no regular assessments. Child participated in some alternate assessments and some regular assessments. Child participated fully in the school's regular testing or assessment program. There is no testing or assessment program at this grade level. Don't know ﴾SKIP TO Q 34﴿ ﴾SKIP TO Q 34﴿

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