Form Wtw 18 - Learning Needs Screening Page 2
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4STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
LEARNING NEEDS SCREENING
Directions for County Worker (Continued):
4. Ask the client each question in sections I, II, III, and IV on page 3.
a. Record the client’s responses by checking “YES” or “NO.”
b. Count the number of “YES” responses in each section, then multiply by the number indicated in the section.
For example, multiply the number of “YES” responses obtained in Section III by 3. Then enter the result after
the equal sign as the subtotal.
c. To obtain a total, add the subtotals from sections I, II, III and IV.
d. If the total from sections I, II, III and IV is 12 or more, refer the client for a learning disabilities evaluation and
document the referral in the case file.
5. Ask the client each of the supplemental questions on page 4 regardless of the score.
a. Record the client’s responses by checking “YES” or “NO” and filling in the blanks, where appropriate.
b. Ask the client to provide any record of a previous learning disabilities evaluation, attendance in special
education, or medical conditions. If the client appears to have problems obtaining the information, the county
will assist the client. The client will sign the appropriate document to grant permission to obtain the
information.
c. With the client’s written consent (WTW 20: Permission to Release Learning Disabilities Information), forward
the records to the learning disabilities evaluator for consideration.
d. Refer the client, as appropriate, to a medical or service provider(s) to address any potential health concerns
identified on page 4.
Note: The Learning Needs Screening tool is not intended to determine the existence of a learning disability. It is only the
first step in the evaluation process.
WTW 18 (4/16) COVERSHEET - REQUIRED FORM - NO SUBSTITUTES PERMITTED
PAGE 2 of 4
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