Chapter 6: The Pre-Referral Process

Contents
Chapter Overview 74
Definition and Importance of a Pre-Referral Process 74
Collecting Student Background Information 75
Educational History 75
Current English Language Skills and Progress 76
First Language Skills and Use 76
Student and Family Factors 77
Current Educational Environment 78
Who Carries Out the Pre-referral Process? 78
Questions to Consider During Pre-Referral 79
Resources 80
Tools 82
Endnotes 112

Chapter Overview
The pre-referral process is a preventative approach that can help address English learners’ (ELs’) academic and
behavioral challenges in the classroom. A thorough pre-referral evaluation process can help ensure that the role
of factors like second language learning and acculturation are considered before a special education evaluation
is conducted. This chapter identifies information that should be collected for ELs and discusses several tools to
support the collection of critical background information. The chapter also clarifies which students are to be
included in the pre-referral process, who carries out the process, and when it occurs. The chapter concludes
with suggestions about making the decision to refer an EL for evaluation to determine eligibility for special
education services.

Definition and Importance of a Pre-Referral Process

A pre-referral process is a preventative approach intended to address struggling students’ academic or
behavioral challenges in the classroom. All students who need extra support should participate in interventions
designed to meet their specific needs. Often, these interventions take place as part of a Multi-Tiered System of
Support (MTSS; see Chapter 7) if the school uses such a problem solving system. The pre-referral process is not a
part of a special education evaluation. i Some students who experience continued academic or behavioral

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difficulties, even after participating in appropriate interventions, may be referred for a special education
evaluation.

There are several recommended steps in a thorough pre-referral process, many of which provide information for
the creation of a student profile to inform decision-making. These include: (a) defining the specific concern; (b)
collecting current data and student work samples highlighting the specific concern; (c) reviewing student
records; (d) talking to relevant people familiar with the student (e.g., the student, previous teachers, parents or
guardians, the principal (h) seeking help from other staff and a school’s intervention team, if one exists; (e)
implementing multiple interventions, (j) documenting instructional strategies, interventions used, and the
results of interventions; (k) sharing results of intervention data with other team members. iiCompleting a
thorough pre-referral process can help to minimize over referrals to special education for ELs and students from
some racial and ethnic backgrounds. iii In Minnesota, schools are required to carry out at least two documented
pre-referral interventions before referring a student for a comprehensive special education evaluation. iv

Minnesota law requires that school carry out at least two documented pre-referral interventions prior
to referring a student for a comprehensive special education evaluation. v

For more about interventions that are part of an MTSS system, see Chapter 7. This chapter will address
important background information to collect when carrying out a pre-referral process.

Collecting Student Background Information

Educators should collect student background information during the pre-referral process because it can shed
light on the nature of a student’s difficulties. vi,vii Further, background information can provide educators with
ideas for possible changes to make in the general school program or the approach to instruction that will
improve the student’s likelihood for success.

To give important context to pre-referral interventions for ELs, five types of information should be gathered:

• Educational history.
• Current English language skills and progress.
• First language development, use, and current skills.
• Student and family factors.
• Current educational environment.

Each of the five types of information is described in more detail below.

Educational History

An EL’s educational history has a direct impact on current learning. viii A thorough review of a student’s
educational history should include examination of transcripts from other schools, interviews with family
members, and collection of anecdotal information from previous teachers.

Refugee and immigrant students may or may not have records of previous schooling. Family interviews can fill in
gaps in their formal school records. An EL’s educational history may provide clues that the student had trouble
in school before coming to the U.S. Here are some clues to look for:

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 • Student was retained one year or more.
• Student was sent to a special school or special class.
• Student was asked to stop attending school because he or she could not learn.
• Student attended school but was not expected to do the same work as classmates.
• Student changed schools frequently.

Current English Language Skills and Progress

An initial determination that the student’s problems are not primarily caused by limited English proficiency is
essential in determining the actions to take for a struggling EL. ix The student’s current skills and progress in
learning English should be compared with peers of similar language, culture and instructional background. x

Information on English language skills in each of the four modalities (listening, speaking, reading, and writing)
may be gathered by examining results from the following sources of information:

• Formative assessments of English proficiency.

• Progress data and work samples from teacher files.
• Existing data from standardized assessments used to establish eligibility for English language
development services (e.g., WIDA Access Placement Test [W-APT]xi).
• Existing data from the WIDA Access 2.0, the state annual English proficiency assessment (for more
information see Chapter 4).

Schools should use a variety of measures and should collect English proficiency information in different
contexts.xii Some measures of language proficiency should be collected at the time of the student’s participation
in pre-referral interventions. The non-standardized measures in Chapter 4 can be used on an ongoing basis to
document student progress and establish whether a student’s progress or learning patterns are different from
those of peers with similar instructional opportunities. Documenting that a student’s language development
differs from peers with similar backgrounds and experiences is needed if an EL is referred for a special education
evaluation at a later date. This information will establish that the student may be experiencing difficulties that
are not primarily due to second language acquisition or cultural differences.

For additional information on assessing English language acquisition, see Chapter 4.

First Language Skills and Use

Information on first language skills is needed as part of the pre-referral process for several reasons. xiii First,
understanding a student’s native language skills provides information on whether a struggling EL lacks certain
language skills in that native language that need to be addressed. For example, if an EL is experiencing difficulty
with learning to read in English, collecting information on whether the student can read in the native language
gives educators an idea of what type of reading intervention may be needed.

If a student is referred for a special education evaluation, information about the student’s native language
proficiency can help to determine whether academic difficulties are due to language learning or to something
else. For example, if a struggling EL has a high degree of proficiency in the native language and is new to the
U.S., it is possible that the student is experiencing temporary problems associated with learning English. A
special education referral would not be appropriate in this situation. As another example, certain disabilities,

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such as speech-language impairments or intellectual disabilities, will affect development of native language skills
as well as English. Learning that a student is impaired in his or her first language, despite many opportunities to
acquire that language, may indicate a potential disability and the need for more thorough evaluation.

Information on native language skills in each of the four modalities (listening, speaking, reading, and writing)
should be gathered from a variety of sources including:

• Parent or guardian interviews.

• Record reviews of existing information (e.g., cumulative file, Minnesota Language Survey).
• Observations of the student’s native language use.
• One-on-one interaction with the student using either standardized or informal procedures.
• Existing data from standardized native language proficiency assessments, when possible and
appropriate to the student’s situation (e.g., LAS and Woodcock-Munoz Spanish-language editions).

As with English proficiency documentation, it is important to gather multiple sources of information about a
student’s native language use in different contexts. An interpreter or bilingual staff member should assist with
conducting parent or guardian interviews, and may need to help with record reviews if information is provided
in other languages. It is also preferable to involve a bilingual staff member in native language observations, but
even English-speaking staff can gather important information. For example, English-speaking staff may observe
the student’s preferred language when interacting with native language peers and whether the student’s native
language communication is understood by other native language speakers at school.

When a standardized native language assessment is given, teachers must consider whether the whole test, as
well as each specific subtest, is appropriate for a given student. For example, does the student speak the dialect
of the language that is used in the assessment? Has the assessment been normed on bilingual speakers of the
same dialect represented by the student? Has the student learned to read and write in the native language? If
not, the reading and writing subtests may not provide useful information to teachers.

In the Resources section of this chapter there is a link to the Native Language Literacy Assessment (NLLA)
developed for newcomer adolescent ELs who have limited English literacy. The Tools section provides tools to
gather information on a student’s native language education, current language use patterns in the home, and
native language literacy. See Chapter 4 for additional information on assessing ELs’ use of their native language.

Student and Family Factors

As part of the pre-referral process, it would be useful to gather, if possible, information on language, family, and
cultural factors that may have an impact on the student’s education. A tool such as the EL Student and Family
Background Form (Tool 6.4) can be used to interview family members and gather information about the
student’s language development and use of language in the home as well as other home issues that may affect
student learning. Not all sections or items of this tool need to be administered for every student.

Before talking with the family, the person gathering information should decide which questions are appropriate
given the student’s presenting problems. For example, there are some items related to family changes or
stresses that may be asked if it is suspected that these may be issues. If the student is experiencing behavior

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problems, some of the questions in the sections on “Student Interests” and “Family and Cultural Issues” may be
helpful.

Ideally, family information will be gathered during a face-to-face conversation, but in some cases a telephone
interview may be appropriate. The person gathering the information should either be proficient in the family’s
native language or work with an experienced interpreter. It is important to establish rapport and ensure the
family’s comfort in the interview. The family should be made to feel like an invaluable partner with school staff
in helping the student to become English proficient and to acquire the academic content necessary to succeed in
school. Learning ahead of time about the family’s culture will make the interview go more smoothly.

A family interview may be conducted in school, during a home visit, or at another location. In some cases, a
neutral location familiar to the family (e.g., public library, coffee shop, community center) is preferable. In
addition, teachers may be able to gather initial information during regularly scheduled parent-teacher
conferences.

Current Educational Environment

When conducting a pre-referral process, information should be collected on the student’s opportunity to learn
both grade-level content and English language skills in the classroom. xiv Key aspects of providing a student with
access to instruction include:

• The type of instructional methods and strategies currently used in both general education and EL or
bilingual education settings.
• How instruction has been differentiated for ELs of varying English proficiency levels.
• Student progress and performance on classroom tasks and assessments.
• What types of interventions have been tried, student response to those interventions, and how student
performance during interventions has been monitored over a period of several weeks.
• Whether instruction and interventions are appropriate for linguistically and culturally diverse students.
• How EL services or bilingual education is delivered and the amount of language development instruction
per day.
• How much and what type of content instruction is missed for services like EL instruction, Title 1
instruction, academic interventions, etc.

Related tools at the end of this chapter include the Observation Checklist for Teacher Behaviors with ELs (Tool
6.5) and Working with ELs: The Interventionist’s Self-Evaluation Checklist (Tool 6.6).

Who Carries Out the Pre-referral Process?

A team approach to pre-referral is an effective way to reduce inappropriate special education evaluations for
ELs. xv Implementing pre-referral interventions is the responsibility of general education staff in consultation with
EL or bilingual education staff and others such as school psychologists. General educators and parents play a role
in the collection of student background information. If the school has an interpreter or bilingual home-school
liaison, that person will also be an important part of a pre-referral team if the parents/guardians do not speak
English well. If the school does not have an interpreter on staff who speaks the student’s first language, the
school may need to contract with someone for this purpose (see Chapter 5 for information on interpreters).

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Questions to Consider During Pre-Referral
As the team reviews the student information collected during the pre-referral process, a profile of the student
should be created based on answers to several key questions:

1. Is current content and English language development instruction accessible to the student? Is
instruction appropriately differentiated so that the EL’s English proficiency is not a barrier to
participation?
2. Have teachers tried appropriate interventions and accommodations? What was the result?
3. Has the school helped the student to learn about the climate and expectations for learning and
behavior?
4. Has the student had prior instruction in the native language or in the home culture?
5. What observations have the parents or guardians made about:
• The student’s use of the native language at home and in the community?
• The comprehensibility of the student’s native language interactions?
• How the student’s native language development compares to that of siblings or native language
peers?
• Reasons for any academic or behavioral difficulties the student experiences?
6. Is the student’s rate and manner of learning English substantially different from peers of similar
background?
7. Can the student use the native language for: (a) expressing his or her basic needs; (b) performing more
complex listening/speaking or reading/writing tasks in the native language?
8. How do the student’s native language skills compare to his or her English language skills?xvi Are there
any difficulties that the student has using both languages?
9. Does the student have any risk factors that may make learning more difficult (e.g., recent arrival to the
U.S., level of acculturation, limited or interrupted formal education, current or prior health problems,
stress or mental health concerns, war-related trauma). What has been done to support the student?xvii
10. Were any learning problems identified in prior English-language schools or native language schools?

Based on the review of background information and discussion of the questions listed above, a team, or the
parents, may consider referring a student for a formal special education evaluation if he or she has not been
successful with interventions during the pre-referral process. The steps in that referral vary by school because
schools may identify different teams as responsible for reviewing referrals (e.g., child study team, special
education referral team). The referral must take place in a timely way so that children who may need additional
services are not delayed in receiving them because of an overly long pre-referral process. xviii

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Resources
• Bateman, D. F., & Cline, J. L. (2016). A teacher’s guide to special education. Alexandria, VA: ASCD.

This book provides a guide to special education laws and processes for non-special education teachers.
It includes a section on the pre-referral process.

• Blatchley, L., & Lau, M. (2010). Culturally competent screening and special education referral: A
systematic approach. Communique Handout, National Association of School Psychologists, 38, 1-7.

This document provides a description of culturally competent approaches to the pre-referral screening
process. It lists questions for educators to consider as they collect and review student information.

• Brown, J. E., Klingner, J., & Lamker, D. (2012, September 20). English learners who struggle in school:
Strategies for response to intervention (RTI), referral to special education and academic evaluation
[Webinar]. Retrieved from https://education.mn.gov/MDE/dse/sped/div/el/049273

This webinar series was created to help schools answer the following questions: (1) What are
considerations in designing and implementing tiered intervention programs for English learners (ELs)?
(2) When and how can teams make the decision to refer an EL for a formal special education evaluation?
(3) What are recommended procedures for assessing academic skills as part of a comprehensive special
education evaluation?

• Collier, C. (2007). What every administrator & educator should know: Separating difference from
disability. Retrieved from: http://www.center-
school.org/esl/documents/whateveryeducatorshouldknow.pdf

This whitepaper describes what school staff need to know in order to determine whether an EL should
be referred for a special education evaluation.

• Hart, J. (2009). Strategies for culturally and linguistically diverse students with special needs.
Preventing School Failure: Alternative Education for Children and Youth, 53:3, 197-208, DOI:
10.3200/PSFL.53.3.197-208

This article contains recommendations for informal assessments that can be used with ELs during the
pre-referral process.

• King, K., & Bigelow, M. (2016). Native language literacy assessment. Retrieved from:
https://drive.google.com/file/d/0B64uvB4u-xaVaFh2QXhzLXUxSzQ/view

This native language literacy assessment was collaboratively developed by the University of Minnesota,
Wellstone International High School, The New Family Center, and the Minneapolis public schools. It is
designed for adolescent newcomer ELs who have limited English literacy skills and who score at a level 1
or 2 on the W-APT. The test is available in Amharic, Arabic, English, Oromo, Somali, Spanish, and Swahili.

• Klingner, J., & Harry, B. (2006). The special education referral and decision-making process for English
language learners: Child study team meetings and placement conferences. Teachers College
Record, 108(11), 2247.

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 The implications sections of this research study describes ways to improve the pre-referral stage for ELs
and how multi-tiered systems of support can be a way to provide meaningful pre-referral strategies.

• Ortiz, A., Wilkinson, C., Robertson-Courtney, P., & Kushner, M. (2006). Considerations in
implementing intervention assistance teams to support English language learners. Remedial and
Special Education, 27(1), 53-63.

This article discusses things to consider (e.g., team membership, needed knowledge, design of
interventions, keeping records) when intervention assistance teams (IATs) are implemented for ELs. IATs
help teachers design and implement general education interventions to improve the academic
performance of ELs who are experiencing difficulties at school.

• Rinaldi, C., & Samson, J. (2008). English language learners and Response to Intervention: Referral
considerations. Teaching Exceptional Children, 40(5), 6.

This article suggests considerations for pre-referral and referral processes with ELs who participate in a
multi-tiered system of support like Response to Intervention. It provides a case study of a student
showing the assessments given and the decisions made.

• Roseberry-McKibbin, C (2014). Multicultural students with special language needs (4th ed.).
Oceanside, CA: Academic Communication Associates.

A book that includes information about cultural groups, their customs, and the issues important to
consider in assessment and program planning for culturally and linguistically diverse students with
language disorders and other special learning needs. Research and practical information is included to
help professionals work more effectively with ELs.

• Salvia, J., Ysseldyke, J., & Witmer, S. (2017). Assessment: In special and inclusive education (13th ed.).
Belmont, CA: Cengage Learning.

This resource provides comprehensive information on a variety of forms of assessment measures

including observations and other informal measures, and progress monitoring assessments. Sections of
the book address pre-referral interventions and referrals for special education evaluations. ELs are
addressed.

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Tools
• Tool 6.1: Pre-Referral Checklist for ELs – to document background information in five areas (educational
history; current English language skills and progress compared to peers; first language development and
current skills; family and cultural background, basic health and developmental history; current
educational environment and issues).
• Tool 6.2: EL Sociocultural Checklist – to obtain more information about sociocultural factors that might
affect the student’s academic performance.
• Tool 6.3: EL Educational History – to document the student’s educational history.
• Tool 6.4: EL Student and Family Background Form – to document language use in the family; language
development; health and early development; student interests and feelings; cultural issues; and how the
student learns at home.
• Tool 6.5: Observation Checklist for Teacher Behaviors with ELs – list of teaching behaviors effective with
groups that include ELs, to be used by an external person observing how a teacher works with ELs.
• Tool 6.6: Working with ELs: The Interventionist’s Self-Evaluation Checklist – to provide a personal
reflection on classroom practices.

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Tool 6.1: Pre-Referral Checklist for ELs
This checklist will usually be used by EL teachers, general education teachers, bilingual staff or others who are
involved in making referrals for special education evaluation.

Area 1: Educational history

Significant findings: Check if completed: ☒

Area 2: Current English language skills and progress

Significant findings: Check if completed:☐

Area 3: First language development, use and current skills

Check if completed: ☐

Info Source: Parents ☐ Bilingual staff ☐ Direct assessment ☐ Other ☐

Significant findings:

Area 4: Student and family factors

Significant findings: Check if completed: ☐

Area 5: Current educational environment

Significant findings: Check if completed: ☐

Interventions and results:

Recommended actions:

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 Tool 6.2: EL Sociocultural Checklist
Using your knowledge of this student obtained through observations, record review, and parent contacts,
complete the Sociocultural Checklist by placing a check by all statements that apply. When completed, consider
whether (a) additional interventions should be attempted based on the information; or (b) whether evaluation
procedures should be modified based on the information.

Student Information Respondent Information

Name Name

Date of Birth Age Grade Date Position

School Agency/School

Race, Culture and Acculturation Factors

 1. The student has been in a refugee camp or was forced to leave his/her home because of war.

 2. The student recently moved from another town, city, state or country.

 3. The student is having difficulty acculturating to his/her new environment.

 4. The student is a racial or religious minority in this school.

 5. The student seldom interacts with peers or staff of other racial/cultural backgrounds or has poor
relations with peers and staff of other racial/cultural backgrounds.
 6. There are conflicts over acculturation within the student’s family.

Socioeconomic Factors

 7. The student is currently homeless or lacks adequate housing, clothing, and/or nutrition.

 8. The student’s parents or caregivers do not have a high school diploma or GED.

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Resiliency Factors

 9. The student has special strengths, talents, or interests. Describe:

 10. The student is involved in school and/or community activities. Describe:

 11. The student has a mentor or a positive adult role model.

 12. The family has a support network. Describe:

Life Change Factors

 13. The student’s family is very mobile (has moved more than once during the current school year or
has a pattern of moving at least once a year over several years).
 14. The student’s previous education has been sporadic, limited, or very different from the current
school.
 15. The school and the student’s family have a history of negative communication or interactions.

 16. The student is separated from his/her immediate family or the primary caregiver has
changed
within the last year.
 17. The student has recently experienced a crisis or trauma.

 18. The student expresses or displays a sense of stress, anxiety, isolation, or

alienation.

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Tool 6.3: EL Educational History

Student’s name

School

Grade

Age

First Language

Reason for referral

Person completing the

record review

Date of record review

Please answer the following questions.

 Yes
1. Are records from other schools available (both in and
outside the United States)?  No

2. If the answer is yes, where are the records from?

3. How old was the student when he/she first attended

school?
4. Did the student attend a formal preschool or head start
program? (list the name of the school or program if
available)

5. Circle each age the student was in school outside the Age: 3 4 5 6 7 8 9 10 11 12 13
United States 14 15 16 17 18 19

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  Yes
6. Did the student learn to read in the native language?
 No

 Yes
7. Is the student literate in more than one language? (please
list all languages)  No

 Yes
8. Did the student pass classes in math, science, and other
subjects?  No

 Yes
9. Was the student ever held back a grade or level?
 No

10. How long has the student been in the current school?

11. Circle each age the student has been in schools in the Age: 3 4 5 6 7 8 9 10 11 12 13
United States 14 15 16 17 18 19

 Yes
12. Have records been obtained from schools attended prior
to this one?  No

13. How long has the student received EL or bilingual

program services?

14. Has the student received any other special services?  Yes
(please list the services and how long the student was
served)  No

 Yes
15. Was the student’s attendance in other United States
schools regular?  No

 Yes
16. Was the student’s attendance in schools outside the
United States regular?  No

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  Yes
17. Are there any notes about behavior or discipline
problems in the record? (describe any information)  No

Please list any tests the student has taken and the test dates and scores.

Test Test Date Scores

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Please describe any other information included in the student’s records that may be helpful (examples of
classroom or homework, alternative assessments, teacher notes, parent notes, extracurricular activities, special
awards)

It is helpful to construct an educational history / time line for the student and identify breaks in education when
the student moved or was unable to attend school. Fill in as much of the following time line as possible.

Student’s School Attended Hours per Language of Moves or Significant

Age (name, grades, country) Day Instruction Events

*Some information may not be available and may be acquired later

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Tool 6.4: EL Student and Family Background Form
Be Selective

Choose sections and items from EL Student and Family Background Form that make the most sense for
the unique needs of the individual student. The interview is divided into seven sections. Each section is
subdivided into basic information (for pre-referral) and follow-up information (for more detailed data
collection needed for a special education evaluation).

1. General Information: The majority of this section is devoted to identifying who lives with the student and
what languages the student speaks with these individuals.
2. Language Use in the Home: This section addresses current language use patterns in the home, including
differences in language use among adults and siblings. The follow-up items gather information on how
language is used for various activities. This allows you to learn whether the student is exposed to formal or
academic language or whether the native language is primarily used for concrete tasks or informal
conversation.
3. Language Development: This section includes questions about the student’s acquisition and use of his or
her first language. The primary emphasis of this section is whether or not they acquired the language at
developmentally appropriate ages and in the developmentally appropriate sequence. Follow-up questions
are designed to collect information about the student’s fluency, word choice, rate of speech, and other
elements of language.
4. Health and Early Development: This section includes questions about the student’s vision, hearing, and
other basic health conditions. The follow-up items address more specific ailments as well as birth and early
development.
5. Student’s Interests and Feelings: This section asks a variety of questions about the student’s feelings toward
school, about friends, and about activities the student enjoys. The basic information items can be useful in
planning pre-referral interventions. The follow-up items address more sensitive topics related to family
problems, trauma, and the parent’s or guardian’s perception of the child. Teachers are advised to review
these questions with their interpreter to decide how best to gather information in this area.
6. Cultural Issues: The basic information items in this section address the family’s motivation for coming to
Minnesota and acculturation issues that the student or family may be facing. The follow-up section probes
whether the student’s behavioral or academic problems may be related to cultural differences with the
school or to cross-cultural conflicts within the family.
7. How the Student Learns at Home: This section addresses study habits at home and also asks whether other
family members have had trouble in school. Each section is subdivided into basic information (for pre-
referral) and follow-up information (for more detailed data collection needed for a special education
evaluation)

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Make Use of Information from Record Review or Other Sources

You may already have information about some items based on knowledge of the student or record
review. If so, make a note of this information as you review the form. Flag these items so that you can
double-check the information with family members.

Connect this Form with the EL Educational History

If you do the EL Educational History first, you can use that information to choose the areas of the EL
Student and Family Background Form to complete.

For example, if the student has never attended formal school in his/her native country, you need to find
out more about why. The student may have been a refugee in a place where formal schooling was not
available. In that case, you will want to complete the General Information section and the Cultural and
Racial Issues section to identify additional information about the family’s situation in their native
country. They may have been a member of an ethnic or religious group that was persecuted. They may
have been able to educate their children at home or in a religious setting. This kind of information will
help focus on student needs and identify student strengths.

Be Sensitive to Family Concerns and Cultural Issues

If any items may cause the parents or guardians discomfort, consider rephrasing those items or not
administering them. Working with the interpreter or a school staff member who is a member of the
culture, identify sensitive items in advance and decide on the strategy you will use with regard to those
items. If any essential questions are missing, add them. Remember that you are collecting information
that will make a difference in the student’s life and educational future.

Some important questions are hard to ask. To help you, many sections include Tips for Interviewers and
Interpreters. Both you and the interpreter should be familiar with these tips.

Some items also have two or three alternate phrasings: allow your interpreter to select the most
appropriate version.

Address Families Correctly

When talking with students and family members, be sure to use address people appropriately and
pronounce names as correctly as possible. If you are not sure how to address someone, ask.

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I. EL Student and Family Background Information

Interview Information

Name of Interviewer

Interview Format
 Face to Face  Telephone  Other
(check all that apply)

Language of Interview  English  Native language:

Interpreter Used  Yes  No

Date of Interview

Location of Interview

General Information

Information about the student Information about the informant

Child’s Name: Name:

Date of Birth: Relationship to Child:

Age: Years of Formal Education:

Grade: Employment:

School: Date Completed:

Parent(s): Have you always been the primary caretaker of the

student?

First Language: First Language:

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People the Student Currently Lives With: (check all that apply)

 Mother  Father  Siblings

 Grandparents  Other Relatives  Foster Parents

 Friends  Independent / Self  Other: (describe)

Basic Health Information:

 Vision Screening Date: Results:

 Hearing Screening Date: _________ Results:

 Health Information from Nurse:

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II. Language Use in the Family

Tips for Interviewers

• Try to identify if anyone new has been added to the household in the past six months.
• Consider asking, “What percentage of the time do various family members speak the native language? And
English?” This helps the school to determine how much English the student is exposed to on a daily basis.

Basic Information
1. How many people live in the household?

2. What languages do the adults in the family speak to each other? To children?

3. What languages do the children in the family speak?

4. What languages does (student’s name) speak with important adults in the family? In school? In the
community?

5. What languages does (student’s name) use with the other children in the family?

6. What adults does (student’s name) spend a lot of time with? What language do they speak?

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Follow-up Information
1. List everyone living with (student’s name) and the languages they speak together.

Name Age Relationship to Child Language the child and this person use
together

 English  Other

 Both

 English  Other

 Both

 English  Other

 Both

 English  Other

 Both

 English  Other

 Both

 English  Other

 Both

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 2. What language does (student’s name) use for these activities?

Activity First Language English Both

Listening to music   

Watching TV   

Playing games   

Playing cards   

Using the computer   

Reading books and magazines   

Playing sports   

Dance, other lessons   

At church, temple, mosque, etc.   

Going shopping   

Other community activities   

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III. Language Development

Tips for Interviewers

• Families have different cultural expectations about how young children learn and different ways of
remembering when children learned to do things.
• Families from different cultural backgrounds may not keep track of these kinds of details.

Basic Information
1. What language did (student’s name) first learn to speak?
2. How old was (student’s name) when he/she first said words?
3. In native language _________ In English ________
4. What language did (student’s name) first hear?
5. Does (student’s name) speak as much as other children in the family?
6. Do you (parents) have any concerns about (student’s name)’s language development?
7. When did (student’s name) start talking compared with your other children (or other children that you
know):
a. At the same time as other children __________
b. Earlier (younger) than other children __________
c. Later (older) than other children __________
8. Does (student’s name) talk like other children his/her age?
In native language _________ In English
9. Does (student’s name) understand your questions and directions?
In native language _________ In English ________

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Follow-up Information (Choose which questions to ask)
1. Does (student’s name) often repeat sounds or struggle to get words out?
2. Does (student’s name) ever talk about something that doesn’t make sense?
3. Does (student’s name) use mostly one and two word sentences?
a. Alternate: Does (student’s name) usually say only one or two words at one time or does he/she say a
lot of words at one time?
4. Does (student’s name) use longer sentences without difficulty?
In native language _________ in English ________
5. Can (student’s name) talk about complex or abstract ideas? For example, can he/she tell complicated
stories or tell you about difficult things that he/she is studying in school?
In native language _________ in English ________
6. Does (student’s name) switch between your language and English in the same sentence?
7. When (student’s name) switches back and forth between your language and English, does it make
sense?
8. Does (student’s name) speak in complete sentences?
In native language _________ in English ________
9. Does (student’s name) use correct grammar in your language?
10. Does (student’s name) pronounce sounds correctly in your native language?
11. Does (student’s name) speak at a normal rate of speech in his/her native language?
a. Alternate: Does he/she speak faster or slower than other children
12. Does (student’s name) speak as smoothly and fluently as other children of the same age? Does he/she
hesitate more than other children or repeat sounds over and over?
13. Does (student’s name) use the same types of words that other children do in your language?
a. Alternate: Does (student’s name) know as many words as other children do in your language?
b. Alternate: Does (student’s name) often not know the word for something or use the wrong word?
14. Does (student’s name) put words in the same order as other children of similar age?
15. Do you ever ask (student’s name) to do several different things in a series? (E.g. carry groceries from the
car, put them in the cupboard, take a bath). Can (student’s name) follow several directions in a row?
16. Did anyone else in (student’s name)’s family have trouble learning to speak? If yes, please tell us about
those problems.

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IV. Health and Early Development

Basic Information

Tips for Interviewers

• Different cultures use different words to describe health problems. For that reason, several words are given
to describe some conditions.
• In some cultures, the father may provide all information even when the mother’s input is needed. A female
interpreter and female teacher may be able to gather the information needed directly from the mother.
1. Does (student’s name) have any health problems that may have an effect on learning?
 vision or eye problems  wears glasses
 hearing problems  wears hearing aid
 ear infections (How often? At what ages? Did the student have surgery to correct it?)
2. Has (student’s name) ever had any serious illnesses or accidents? If yes, please tell me about what
happened and when it happened.

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Follow-up Information (Choose which questions to ask)

Tips for Interviewers

• For Item 1, you do not need to go through every health problem listed. Ask just about suspected areas of
concern or give two or three examples.
1. Does (student’s name) have any health problems that may have an effect on learning?
 Asthma, breathing problems
 Allergies to food, animals, etc.
 Head injury (if yes, ask if (student’s name) had convulsions or was unconscious)
 Diabetes
 Epilepsy, seizures, convulsions
 Mental health problems, depression, sadness, tired and anxious all the time
 Fevers (if yes, ask if (student’s name) had convulsions or was unconscious)
 Serious infections (if yes, ask if (student’s name) had convulsions)
 Malaria
 Tuberculosis
 Other (please describe)
2. How much did (student’s name) weigh when he/she was born?
a. Alternate: Was (student’s name) the same size as other babies when he/she was born?
b. Alternate: Were there any complications during pregnancy or birth?
3. In comparison with other children that you know, did (student’s name) learn to do things at the same age?
Did he/she sit, walk, eat solid food, and say words, etc., at the same age as other children?

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V. Student’s Interests and Feelings

A. Basic Information

Tips for Interviewers

• It may also be appropriate to ask the student some of these questions.
1. What are (student’s name)’s favorite after-school activities?
a. Alternate: What does (student’s name) like best to do after school?
2. What types of things does (student’s name) do around the house or in the community that he/she is
particularly good at?
a. Alternate: Please tell us about some things that (student’s name) is good at. For example, is he/she
good at sports, dancing, or taking care of younger children?
3. Does (student’s name) like to read or look at books? What are his/her favorites?
a. Alternate: Does (student’s name) like to read on his/her own?
b. Alternate: Does (student’s name) like when people read or tell him/her stories?
4. Does (student’s name) tell you how he/she feels about school? What does he/she say about school?
5. Does (student’s name) have friends that he/she plays with regularly?
6. Does (student’s name) understand how to share toys and belongings?
7. How does (student’s name) get along with children his/her own age?

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Follow-up Information (Choose which questions to ask)

Tips for Interviewers

• These questions may be uncomfortable for families of different cultures, but it is important for the school to
know about traumatic events that may cause the student to be angry, sad or withdrawn. These feelings may
cause the student to have problems in school.
• Explain to families that problems in school are often related to changes in a student’s life at home. These
problems may be temporary, but it is helpful for the school to know about them.
1. Can you think of anything that has happened in your family that might explain why (student’s name) is
having trouble in school?
a. Alternate: Has anything happened at home that might help us understand why (student’s name) is
having trouble in school? (Give two or three examples from the list below)
 Divorce or separation
 Death of a family member
 Parent’s job loss
 Drug or alcohol problems
 Family member in drug or alcohol treatment
 Family member’s illness or hospitalization
 Birth of new baby
 New person living with family
 Problems with other children in the neighborhood
 Family legal problems
 Housing problem, change in living situation or homelessness
 Fire, flood or other event that damaged home
 Violence or sexual abuse in family
 Family member leaves home
 Family needs help with winter clothing
 Family doesn’t have enough food
2. Are you concerned about any emotional trauma or stress that (student’s name) may have experienced?
3. Do you feel that (student’s name) is sadder or angrier than other children his/her age?

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Optional Parent Questionnaire

Please rate how you see your child’s behavior and feelings. Tell me whether you think the statement is “very
much like my child,” “somewhat like my child,” “not very much like my child,” or “not like my child at all.” If you
are not sure, use your best judgment. We want to find out how you see your child’s strengths and problems.

Not very
Very much Somewhat Not like my
My child… much like my
like my child like my child child at all
child

A. Thinks that school is important    

B. Spends enough time on homework
assignments
   
C. Needs help with homework
assessments
   
D. Has difficulty completing school
assignments
   

E. Has trouble making and keeping friends    

F. Is someone who willingly cooperates
with others
   

G. Is often hurtful to others    

H. Is often hurtful to self    

I. Respects the property of others    

J. Is moody and uncooperative    

K. Gets in trouble in the neighborhood    

L. Is liked by other adults living in the
neighborhood
   

M. Cares about doing well in school    

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VI. Cultural Issues

Tips for Interviewers

• It may also be appropriate to ask the student some of these questions.
• You may not think that there are problems of this nature in the school, but it is important to find out if the
student or family thinks that there are racial or cultural problems.

Basic Information
1. How did you and your family come to Minnesota?
a. Alternate: Why did you and your family decide to move here?
2. How does (student’s name) feel about being here?
a. Alternate: Has (student’s name) had any problems adjusting to living here? Can you tell me about
those problems?
3. Do you think (student’s name) has problems in school because of his race or cultural background? Can
you tell me about those problems?
a. Alternate: Do you think (student’s name) has problems with teachers or other students because he
is _________________ (name of cultural group)? Can you tell me about those problems?
4. What kind of cultural activities does your family take part in?
5. Do you think that the teachers and students in school understand your culture?
6. Do you have any ideas about how we can help your son/daughter?
Follow-up Information (Choose which questions to ask)

Tips for Interviewers

• It may also be appropriate to ask the student some of these questions.
• Explain to parents that sometime students act differently at school than at home because teachers and
parents discipline children differently. That is why the school wants to find out how parents discipline their
children when they do something wrong.
• It is important to find out if the student or family thinks that there are racial or cultural problems. Those
perceived problems need to be discussed.
1. What disciplinary strategies do you use at home?
a. Alternate: What do you do at home when (student’s name) does something wrong?
2. Sometimes (student’s name) does things he/she is not supposed to do in school. (Give an example if
appropriate.) What would you like us to do if he/she does something wrong?
3. Do you like (student’s name) to act more like American students or do you like him/her to behave more
traditionally?
4. Do you and (student’s name) ever argue about whether he/she should act more like an American student or
more traditionally? Do you think this is connected to the problems he/she is having in school?
a. Alternate: When families come to the U.S., sometimes it is difficult because the children want to be just
like American students, but their parents and grandparents want them to be more traditional. Do you

104
 have problems like this with your child? Do you think this is connected to the problems he/she is having
in school?
5. The school is going to do some tests of (student’s name)’s behavior and how he/she learns. Think about your
family’s cultural background and heritage. What would you like the school staff to know so that they can
better understand your child and do a better job when they test him/her?

105
VII. How the Student Learns at Home

Basic Information

Tips for Interviewers

• Explain to the family that teachers appreciate when parents do certain things in order to help their children
do better in school, but they know that some parents are very busy and cannot help their children. Teachers
also expect that students will study at home. Explain that since (student’s name) is having problems, you
want to find out more about how he/she studies and learns at home.
1. Does (student’s name) need help at home to perform daily tasks? For example, does he/she need help
dressing, eating, or helping with household chores?
2. Does (student’s name) have a place at home to keep his/her school books and papers and to do
homework?
3. Do you ask (student’s name) to show you his/her homework?
4. Does someone in the family help (student’s name) with homework?
5. Does (student’s name) do his/her homework before watching TV or playing?
6. Does someone in your family read to (student’s name)?
In native language _________ In English ________
7. Has anyone else in your family had problems learning how to read or do math?
8. How do you think (student’s name) does in school compared with his/her brothers and sisters?

106
Follow-up Information

Tips for Interviewers

• Children learn how to do lots of things at home: they learn how to cook, how to play games, how to do
housework, how to tell stories. Explain to parents that the teachers want to know if (student’s name) has
trouble learning things at home.

Please rate how you see your child on various learning style characteristics listed below. Place a check in the box
that best describes your child, ranging from Good to Poor. If you are not sure about an item, just use your best
judgment. The purpose of this activity is to help us determine what areas, if any, you see as a problem.

How does your child. . . Good OK Poor N/A

Follow directions with two or three steps?    

Remembers things?    

Organize toys, books, clothes, etc.?    

Plan how to do tasks or activities?    

Understand what he/she reads?    

Understand what he/she sees?    

Understand what he/she hears?    

Learn a new game?    

Recall events from the school day?    

Recall details from a special event?    

Read aloud?    

107
How does your child. . . Good OK Poor N/A

Carry on a conversation?    

Write by hand?    

Solve problems or figure out how to do things?    

Explain something he/she has learned?    

Put things together or repair things?    

Draw or paint?    

Do basic math?    

108
Tool 6.5: Observation Checklist for Teacher Behaviors with ELs
Before the lesson begins, the teacher… Notes
 prepares and distributes materials Grade:
 ensures he/she has students’ attention Number of students:
 reviews previous lesson Number of ELs:
 asks about prior student experiences Class / topic:
 includes heterogeneous group (EL and non-EL) Time observed:
 previews the upcoming lesson, builds context
 lists new vocabulary (may be done during)
During the lesson, the teacher…
 speaks slowly
 enunciates clearly
 uses simple language
 exaggerates intonation to emphasize key words
 pauses to allow for thought processing
 checks for understanding (asks questions)
 repeats information using different words
 elicits student participation
 calls on different students (EL and non-EL)
 uses visuals
 uses manipulatives
 uses facial expression, dramatization, gestures
 relates lesson to student experiences
 uses concrete examples
 uses student’s language as appropriate
 gives students the opportunity to practice
 answers questions
 uses different instructional techniques
visual/verbal
visual/nonverbal
auditory
kinesthetic
tactile
total physical response (TPR)

109
 After the lesson, the teacher…
 encourages discussion
 provides the opportunity to share, practice
 lets students use manipulatives
 reviews key points of lesson
 answers questions
 encourages students to take risks
 offers alternatives to demonstrate knowledge
 provides positive feedback

Source: Beta Group, Judith Wilde (Albuquerque, New Mexico)

110
Tool 6.6: Working with ELs: The Interventionist’s Self-Evaluation Checklist
Almost
Do I… Sometimes Very Rarely Never
Always

Use a multi-modal approach to teaching material?    

Review previous material?    

Make input comprehensible by slowly down, pausing,
speaking clearly?
   

Rephrase and restate information?    

Check frequently for comprehension?    

Focus on teaching meaning rather than focusing on
correct grammar?
   

Avoid putting students on the spot by demanding they

talk immediately?
   

Give extra time for processing information?    

Attempt to reduce students’ anxieties and give them
extra attention when possible?
   

Encourage students’ use and development of their

primary language?
   

Encourage students to interject their own cultural

experiences and backgrounds into learning situations?
   

Expose all my students to multicultural activities and

materials on a regular basis?
   

Include parents and community members from different

cultural backgrounds in my teaching?
   

Use visuals, hands-on, cooperative learning, and

guarded vocabulary to make input comprehensible?
   

Avoid using worksheets and seat work for crowd

management and busy work?
   

Source: Roseberry-McKibbin, C (1995). Multicultural students with Special Language Needs. Oceanside, CA:
Academic Communication Associates

111
Endnotes

i
The IRIS Center, (n.d.) The Pre-referral process: Procedures for supporting students with academic and behavioral concerns.
Retrieved from: http://iris.peabody.vanderbilt.edu/module/preref/challenge/#content; Elementary and Middle Schools
Technical Assistance Center. (n.d.) Disproportionality: The disproportionate representation of racial and ethnic minorities in
special education. Retrieved from: http://www.emstac.org/registered/topics/disproportionality/researchhighlights/Pre-
referral.htm

ii
Bateman, D. F., & Cline, J. L. (2016). A teacher’s guide to special education. Alexandria, VA: ASCD.

Elementary and Middle Schools Technical Assistance Center. (n.d.) Disproportionality: The disproportionate representation
iii

of racial and ethnic minorities in special education. Retrieved from:

http://www.emstac.org/registered/topics/disproportionality/researchhighlights/Pre-referral.htm

iv
Minnesota Statute section 125A.56. Retrieved from: https://www.revisor.leg.state.mn.us/statutes/?id=125A.56

v
Minnesota Statutes section 125A.56 (2017). Retrieved from: https://www.revisor.leg.state.mn.us/statutes/?id=125A.56

vi
Brown, J., & Doolittle, J. (2008). A Cultural, Linguistic, and Ecological Framework for Response to Intervention with English
Language Learners. Teaching Exceptional Children, 40(5), 66.

Blatchley, L., & Lau, M. (2010). Culturally competent screening and special education referral: A systematic
vii

approach. Communique Handout, National Association of School Psychologists, 38, 1-7.

Brown, J., & Doolittle, J. (2008). A Cultural, Linguistic, and Ecological Framework for Response to Intervention with English
viii

Language Learners. Teaching Exceptional Children, 40(5), 66; Collier, C. (2010). RTI for diverse learners. Thousand Oaks, CA:
Corwin.

ix
Collier, C. (2010). RTI for diverse learners. Thousand Oaks, CA: Corwin.

x
Blatchley, L. & Lau, M. (2010). Culturally competent screening and special education referral: A systematic
approach. Communique Handout, National Association of School Psychologists, 38, 1-7.

Minnesota Department of Education. (2011). English learner education program guidance: WIDA Access Placement Test
xi

(W-APT) Guidance. Retrieved from https://www.wida.us/membership/states/MN/W-APT_FAQ_2011_Minnesota.pdf

Hart, J. (2009). Strategies for culturally and linguistically diverse students with special needs. Preventing School Failure:
xii

Alternative Education for Children and Youth, 53:3, 197-208, DOI: 10.3200/PSFL.53.3.197-208; Hart, J. (2009). Strategies for
culturally and linguistically diverse students with special needs. Preventing School Failure: Alternative Education for Children
and Youth, 53:3, 197-208, DOI: 10.3200/PSFL.53.3.197-208.

xiii
Collier, C. (2010). RTI for diverse learners. Thousand Oaks, CA: Corwin.

xiv
Collier, C. (2010). RTI for diverse learners. Thousand Oaks, CA: Corwin

xv
Ortiz, A.A., Wilkinson, C.Y., Robertson-Courtney, P., & Kushner, M. (2006). Considerations in implementing intervention
assistance teams to support English language learners. Remedial and Special Education, 27(1), 53-63.

Hart, J. (2009). Strategies for culturally and linguistically diverse students with special needs. Preventing School Failure:
xvi

Alternative Education for Children and Youth, 53:3, 197-208, DOI: 10.3200/PSFL.53.3.197-208

112
 Hart, J. (2009). Strategies for culturally and linguistically diverse students with special needs. Preventing School Failure:
xvii

Alternative Education for Children and Youth, 53:3, 197-208, DOI: 10.3200/PSFL.53.3.197-208

Ryder, R. (2016, April). A Response to Intervention Process Cannot Be Used to Delay-Deny an Evaluation for Preschool
xviii

Special Education Services under the Individuals with Disabilities Education Act [Memorandum]. Washington, DC: U.S.
Department of Education, Office of Special Education Programs. Retrieved from:
http://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/oseprtipreschoolmemo4-29-16.pdf

113