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R o c h e s t e r P u b l i c S c h o o l s : T o t a l S p e c i a l E d u c a t i o n S y s t e m M a n u a l

CHAPTER 3: EVALUATION AND REEVALUATION STANDARDS

Table of ContentsDate of Last

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Chapter 3: Evaluation and Reevaluation StandardsEvaluation Notice, Consent and Timelines 6 Procedural Safeguards 6 Evaluation Plan / Prior Written Notice for Evaluations (Effective January 2009) 6 Parental Consent for Evaluation or Reevaluation 7 Infant and Toddler Initial Evaluation 7 Independent Educational Evaluation 8Evaluation and Reevaluation Procedures 9 Initial Evaluation Procedures 9 Reevaluation Procedures 11 Review of Existing Data 11 Parent Involvement 12 Evaluation Team 12 Nondiscriminatory Evaluation 13 Evaluation Materials and Procedures 14 Braille Skills Inventory 14 Secondary Transition Evaluation 14 Transition Areas to Evaluate 15 Infant and Toddler Evaluation 18 Evaluation Report 18 Disproportionality 19Procedures for Determining Eligibility and Placement 20 Determining the Child is a Child with a Disability 20 Determining the Student is Not a Student with a Disability 21 Infants and Toddlers with Disabilities 21ECSE Criteria Crossover Assessment 22Documentation Links: Test Protocols 23List of Cultural Liaisons 9/08 23List of Available Assessment Tools 6/08 24List of Available Interpreters 9/08 27 List of Qualified Staff (2008-2009) 10/08 28Guidelines for Independent Educational Evaluations 34 Samples of Prior Written Notice for Evaluations (effective January 2009) Effective 1/09 36Use of Existing Data for ReevaluationsMatrix of Existing Data Sources 38Hints for Conducting the Classroom Observation 39Matrix: Selecting an Observation 40

Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-1

Duration Recording Form 41Example: Duration Recording Form 42Latency Recording Form 43Example: Latency Recording Form 44Interval Observation Recording Form 45Example: Interval Observation Recording Form 46Event/Frequency Observation Recording Form 48Example: Event/Frequency Observation Recording Form 50Permanent Product Recording Form 51Example: Permanent Product Recording Form 52A-B-C Observation Sheet 53

Guidelines for Team Override Eligibility Decisions 54Procedures for Exiting Students from Special Education 55Procedures for Exiting Students through Graduation 57Guidelines for Writing a Graduation Report – Summary of Performance 58Graduation Exit Report – Summary of Performance 59

Guidelines on Access and Storage of Test Protocols 61Guidelines for Writing the Evaluation Report 65Chapter 3A: Autism Spectrum Disorders (ASD) Documentation 67 State Guidelines: Autism Spectrum Disorders 68 Patterns of Qualitative Impairment/Possible Behavioral Indicators 68 Autism Spectrum Disorders (ASD) Criteria Checklist 69 Example: Autism Spectrum Disorder Evaluation Report 71Chapter 3B: Specific Learning Disabilities (SLD) Documentation 72 State Guidelines: Specific Learning Disabilities (SLD) 80 Specific Learning Disabilities (SLD) Criteria Checklist 80 Guidelines for Conducting Evaluations for SLD Students 82 Matrix for Developing an SLD Evaluation 83 Record Review for Learning Disabilities Evaluation 85 Information Processing: Teacher Interview 86 Information Processing: Student Interview 87 Example: Specific Learning Disability (SLD) Evaluation Report 89Specific Learning Disability (SLD) Manual Link: http://education.state.mn.us/mdeprod/groups/specialed/documents/manual/001529.pdf

91

Chapter 3C: Speech or Language Impairment Documentation State Guidelines: Speech or Language Impairment (S/L) 100 Speech or Language Impairment (S/L) Criteria Checklist 100 Guidelines for Conducting Evaluations for Speech or Language Report 102

Example Speech / Language Report: 103Chapter 3D: Other Health Disability (OHD) Documentation 104 State Guidelines: Other Health Disabilities (OHD) 108 Other Health Disabilities (OHD) Criteria Checklist 108


http://education.state.mn.us/mdeprod/groups/specialed/documents/manual/001529.pdf


School Service Options for Students with Chronic and Acute Health Conditions 110 Students with Health Conditions- Identifying Education Needs 111Other Health Disability (OHD) Terminology Within Criteria 112Matrix for Developing a Other Health Disability (OHD) Evaluation Report 114Example: Other Health Disability (OHD) Evaluation Report 115Systematic Interview/Observation Worksheet 117Parent/Guardian Interview 126Sample Cover Letter for Organizational and Independent Work Skills Checklist 129Instructions: Organizational and Independent Work Skills Checklist for School Staff 131Organizational and Independent Work Skills Checklist: Pre-Kindergarten - Kindergarten 132Organizational and Independent Work Skills Checklist: Elementary 133Organizational and Independent Work Skills Checklist: Middle School and High School 135Sample: Health Condition Documentation Form 137Sample: Systematic Parent Interview 139Guide for Completing an Evaluation and Writing Goals for Students with Health Conditions 140Additional Goals and Objectives for Students with Health Conditions 144Other Health Disabilities (OHD) Companion Manual Link: http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf

154

Fact Sheet about Disorders often Associated with Other Health Disabilities (OHD) Link: http://education.state.mn.us/MDE/Learning_Support/Special_Education/Categorical_Disability_Information/Other_Health_Disabilities/Disability_Fact_Sheets/index.html

Chapter 3E: Traumatic Brain Injury (TBI) Documentation State Guidelines: Traumatic Brain Injury (TBI) 155 Traumatic Brain Injury (TBI) Criteria Checklist 155 Matrix for Developing a Traumatic Brain Injury (TBI) Evaluation Plan 158 Traumatic Brain Injury (TBI) Manual Link: http://education.state.mn.us/mdeprod/groups/specialed/documents/manual/001755.pdf

159

Chapter 3F: Vision Impaired (VI) Documentation State Guidelines: Visually Impaired (VI) 160 Visually Impaired (VI) Criteria Checklist 160 Matrix for Developing a VI Evaluation Plan 161CHAPTER 3G: Early Childhood Special Education (ECSE) Documentation : 162 State Guidelines: Early Childhood Special Education (ECSE) 163 Early Childhood Special Education (ECSE) Criteria Checklist 163Flowchart: Referral for Child Younger than Age 2 165Flowchart: Referral for Toddlers Age 2 and Older 167Decision Tree: Eligibility for Transition from Part C to Part 168




http://education.state.mn.us/MDE/Learning_Support/Special_Education/Categorical_Disability_Information/Other_Health_Disabilities/Disability_Fact_Sheets/index.html



http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf

http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf

BExample: ECSE Evaluation Report (Ages B-2) 169Example: ECSE Evaluation Report (Ages 3-6) 170

Chapter 3H: Developmental Cognitive Disabilities (DCD) Documentation 177 State Guidelines: Developmental Cognitive Disability (DCD) 188 Developmental Cognitive Disability (DCD) Criteria Checklist 188 Guidelines for Conducting Evaluation for Developmental Cognitive Disability (DCD) 190 Matrix for Developing a Developmental Cognitive Disability (DCD) Evaluation 192Example: Developmental Cognitive Disability (DCD) Evaluation Report 194Developmental Cognitive Disabilities (DCD) Manual Link: http://education.state.mn.us/mde/groups/specialed/documents/manual/001499.pdf

195

Chapter 3I: Emotional or Behavior Disorders (EBD) Documentation State Guidelines: Emotional or Behavioral Disorders (EBD) 205 Emotional or Behavioral Disorders (EBD) Criteria Checklist 205Matrix for Developing an Emotional / Behavior Disability (EBD) Evaluation Plan 208 Example: Emotional Behavior Disability (EBD) Evaluation Report 210Functional Behavioral Assessment (FBA) Definition 211Rochester FBA Form Instructions 243Example: Rochester FBA Form 224Example: Functional Behavioral Assessment Report (FBA) 227Behavior Intervention Plan (BIP) Outline 231Example: Behavior Intervention Plan (BIP) 239

Chapter 3J: Deaf- Blind Documentation 240 State Guidelines: Students with Blindness 241 State Guidelines: Deaf-Blindness 241 Deaf-Blind Criteria Checklist 242 Chapter 3K: Deaf and Hard of Hearing Documentation 243 State Guidelines: Deaf and Hard of Hearing (D/HH) 244 Deaf and Hard of Hearing (D/HH) Criteria Checklist 244 Chapter 3L: Severe Multiple Impairment 246 State Guidelines: Severely Multiply Impaired (SMI) 247 Severely Multiply Impaired (SMI) Criteria Checklist 247 Chapter 3M: Physically Impaired (PI) Documentation 248 State Guidelines: Physically Impaired (PI) 249 Physically Impaired (PI) Criteria Checklist 249 Physical Impairment (PI) Manual Link: http://ecsu.k12.mn.us/programsservices/specialeducation/documents/mnpimanual2002.pdf

250

Chapter 3N: Developmental Adaptive Physical Education Documentation State Guidelines: Developmental Adapted Physical Education (DAPE) 251


http://ecsu.k12.mn.us/programsservices/specialeducation/documents/mnpimanual2002.pdf

http://ecsu.k12.mn.us/programsservices/specialeducation/documents/mnpimanual2002.pdf

http://education.state.mn.us/mde/groups/specialed/documents/manual/001499.pdf

http://education.state.mn.us/mde/groups/specialed/documents/manual/001499.pdf

Developmental Adapted Physical Education (DAPE) Criteria Checklist 251 Assistive Technology 252 Sample of Assistive Technology Devices 274 Steps for Considering Assistive Technology 275 Assistive Technology Status Log 279 Case Manager Considerations for Student, Environment and Tasks Worksheet

281

Parent and Student Assistive Technology Worksheets 282 Assistive Technology Group Planning Template 286 Assistive Technology Planning and Implementation Summary

289

Request for Assistive Technology Trial 290 Assistive Technology Equipment Request 269 SETT Framework 270Students Determined to be Medically Fragile 297Procedure for Determining Services for Students Identified as Medically Fragile 302Do Not Resuscitate/Do Not Intubate – Sample Board Policy 302Forms in Native Languages Other than English Link to MDE 304

Start Chapter

Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6Identification

System Standards Referral StandardsEvaluation and Reevaluation

Standards IEP/IFSP Planning

StandardsInstructional Delivery of Program Standards Staffing Standards

Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12Facilities

StandardsDue Process Procedural

Safeguards/Parental Involvement

Considerations

Personnel Development

StandardsInteragency and

Community Relations Standards

Transportation Standards

Coordination With Other Educational

Programs Standards

Chapter 13 Chapter 14 Chapter 15 Appendix A Appendix B Appendix C

Fiscal Resources and Reporting

StandardsGovernance Standards

Discipline Considerations for

Students with Disabilities

Conservatorship and Guardianship

English Language Learners

Response to Intervention (RtI)


Total Special Education System Manual Chapter Links

http://education.state.mn.us/MDE/Learning_Support/Special_Education/Evaluation_Program_Planning_Supports/Cultural_Linguistic_Diversity/Due_Process_Forms/index.html


EVALUATION NOTICE, CONSENT AND TIMELINESDistricts and public agencies will provide notice to the parents of a child with a disability that describes any evaluation procedures proposed.

P R O C E D U R A L S A F E G U A R D SA copy of the procedural safeguards must be given to parents a minimum of one time each school year. Parents must also be given a copy at the following times:

1) upon initial referral or parent request for evaluation;2) upon receipt of the first MDE complaint and upon receipt of the first due process

complaint in a school year;3) on the date the district decides to change the placement of a student with a disability

for a violation of the district discipline policy (in the event of a manifestation determination); or

4) upon request by parent.

Rochester Public Schools uses its own Procedural Safeguards Notice (found on the r-school SSS website under forms) which includes all of the required contents prescribed in Federal IDEA. For infants and toddlers, the Rochester Public Schools uses the Infant and Toddler Intervention Procedural Safeguards Notice provided by the Minnesota Department of Education

E V A L U A T I O N P L A N / P R I O R W R I T T E N N O T I C E F O R E V A L U A T I O N S

An Evaluation Plan and Prior Written Notice will be provided to a parent when the District proposes or refuses to initiate an evaluation or change the identification to a child suspected of having a disability. The Evaluation Plan includes information about if the evaluation is an initial or reevaluation, factors relative to the evaluation, adaptations needed to conduct the evaluation, areas and procedures proposed for the evaluation, and where the evaluation will take place.

The Prior Written Notice includes the following:1) a description of the action proposed or refused by the district;2) an explanation of why the district proposed or refused to take the action;3) a description of each evaluation procedure, assessment, record, or report the district

used as a basis for the proposed or refused action;4) a description of other options that the IEP team considered and the reasons why those

options were rejected;5) a description of other factors that are relevant to the district’s proposal or refusal;6) a statement that the parents of a child with a disability have protection under the

procedural safeguards and how to obtain the procedural safeguards; and7) sources for parents to contact to obtain assistance in understanding these provisions.


P A R E N T A L C O N S E N T F O R E V A L U A T I O N O R R E E V A L U A T I O N

A district proposing an initial evaluation must obtain informed consent before conducting the evaluation. The district must make reasonable efforts to obtain the informed consent from the parent. The district must not proceed with the initial evaluation, the initial placement of a child in a special education program, or the initial provision of special education services for a child without the prior written consent of the child’s parent. A district may not override the written refusal of a parent to consent to an initial evaluation or reevaluation.

A district proposing a reevaluation must obtain informed parental consent prior to conducting the reevaluation. The informed parental consent is not required if the district can demonstrate that it made a reasonable effort to obtain such consent and has documented its attempts to do so, and the child’s parent has failed to respond. The district must wait 14 calendar days before proceeding with the reevaluation.

Parental consent is not required before reviewing existing data as part of an evaluation or a reevaluation. The student’s evaluation team determines whether additional assessments are needed beyond the existing data. An evaluation plan must be sent for parental consent whether the team has chosen to use just existing information or if additional assessments are needed. Parents have the right to request assessments beyond existing information.

Parental consent is not required before administering a test or other evaluation that is administered to all children unless, before administration of that test or evaluation, consent is required of parents of all children.

For initial evaluations only, if a child is not residing with the child’s parent, the district is not required to obtain informed consent from the parent to determine whether the child is a child with a disability if:

1) despite reasonable efforts to do so, the district cannot discover the whereabouts of the parent of the child;

2) the rights of the parent(s) of the child have been terminated in accordance with State law; or

3) the rights of the parent(s) to make educational decisions have been removed by the courts and consent for an initial evaluation has been given by an individual appointed by the judge to represent the child.

For information regarding appointment of a surrogate see Guidelines Regarding Appointment and Training of Surrogate Parents.

I N F A N T A N D T O D D L E R I N I T I A L E V A L U A T I O N S

Prior to conducting an initial evaluation and providing early intervention services, the district must obtain written parental consent. If consent is not given, the district will make reasonable efforts to ensure that the parent is fully aware of the nature of the evaluation and the services


that might be available to their child and understands that the child will not be able to receive the evaluation or services unless they provide written consent.

I N D E P E N D E N T E D U C A T I O N A L E V A L U A T I O N

An Individual Educational Evaluation (IEE) is an evaluation conducted by a qualified examiner who is not employed by the district responsible for the education of the child in question.

Independent Educational Evaluation at Public ExpenseA parent has the right to an IEE at school district expense if the parent disagrees with an evaluation completed by the district. If the district does not believe an IEE is necessary, the district must ask a hearing officer to determine the appropriateness of its evaluation. If the hearing officer determines the district’s evaluation is appropriate, a parent still has the right to an independent evaluation, but not at public expense. A hearing officer may also order an IEE of a child at school district expense during a due process hearing. A district may ask a parent why he or she objects to the district evaluation, but they may not require the parent to provide an explanation and may not unreasonably delay either providing the IEE or requesting a due process hearing to show that its evaluation is appropriate.

If a parent requests an IEE the district must provide to parents its criteria for selection of an independent examiner and information about where an IEE may be obtained. Districts may not impose conditions or timelines related to obtaining an IEE.

Independent Educational Evaluation at Private ExpenseIf a parent obtains an IEE at private expense and chooses to share the results of the IEE with the district, the results of the evaluation must be reviewed and considered by the district.



EVALUATION AND REEVALUATION PROCEDURES

I N I T I A L E V A L U A T I O N P R O C E D U R E S

Either a parent or a district may initiate a request for an initial evaluation to determine if the child is a child with a disability. Parents requesting an evaluation may do so verbally or in writing.

The school district will conduct a comprehensive evaluation to determine whether the child is a student with a disability that adversely affects the student’s educational performance and needs special education and related services, and to determine the educational needs of the student. Written parental consent is needed before the child may be evaluated. Once parental consent is received, the evaluation team has 30 school days to complete the evaluation report. For initial evaluations the school psychologist (or vision teacher, speech / language pathologist / dhh teacher /ECSE Teacher) is responsible for writing the synthesized report. Special education teachers and related services staff are responsible for administering tests, completing observations, reporting test scores and interpreting test results. In order to allow the school psychologist enough time to synthesize the information into the final summary, evaluation related information needs to be completed by the 20th day after parental consent is received.

Note: the 20/30 day hence calendar is available on the Student Support Services webpage under forms.

Evaluation Guidelines for Students Who Transfer In and Out of State

- When a student who is receiving special education services enrolls from within the state of Minnesota with a current evaluation (within the last 3 years), a re-evaluation is not necessary.

- If an out-of-state transfer student receiving special education moves into the district, in order to continue receiving special education services the student must meet initial Minnesota Criteria. The evaluation team must decide if A) a new evaluation is required to determine if the child meets Minnesota eligibility criteria, or B) the student meets all components of initial criteria based on existing information. If the team is considering B) the evaluation team must complete the criteria checklist for all all areas considered for eligibility. The checklist documenting the student has met Mn eligibility must be attached to an evaluation plan documenting that no additional testing is necessary to determine eligibility.

- There will be cases where a student has previously qualified under Minnesota special education criteria, and subsequently moves out of state, and then returns to Minnesota with no new evaluation completed. In this case the evaluation team may choose to accept the previous Minnesota evaluation as long as the Minnesota evaluation is less than 3 years old and the team agrees the information is current and valid. If the student moves back to Minnesota with a more recent evaluation from another state, a reevaluation must be initiated and the student must meet initial Minnesota criteria.

Re s p o n s i b i l i t i e s C h a r t


Steps in Evaluation/ReevaluationPerson of Responsibility:

Steps Initial Evaluation ReevaluationSet up Evaluation Plan meeting to obtain parent input

Psych IEP Manager

Develop and Finalize Evaluation Plan

Psych IEP Manager

**NOTE: Evaluation Plan must be reviewed by psych before finalized

Write Report Psych PsychArrange Evaluation Report/IEP meeting

IEP Manager IEP Manager

Lead/Facilitate E.R.Meeting

Psych IEP Manager

File Evaluation Paperwork appropriately

Psych IEP Manager

Rochester Public Schools shall ensure that, at a minimum, the following requirements are met:

The Notice of Educational Evaluation Plan for an initial evaluation should be completed by the school psychologist.

For initial evaluations, the evaluation may not begin until the parent/guardian has provided signed permission to evaluate.

Evaluations will be nondiscriminatory on a racial or cultural basis and conducted in the student’s native language.

Materials and procedures used to evaluate a child who is an English Language Learner (ELL) must ensure that they measure the extent to which the student has a disability and needs special education, rather than measuring the student’s English language skills.

A variety of evaluation tools will be used to gather information about the student, including information provided by the parent and information regarding the student’s involvement and progress in the general education curriculum (and for a preschool child, to participate in appropriate preschool activities).

The evaluation will be administered by trained and knowledgeable personnel. For students with impaired sensory, physical, or verbal skills, a description of

modifications to the standard conditions of test administration must be included in the evaluation report.

The tests and other evaluation methods should be tailored to evaluate specific areas of educational concern.

No single procedure will be used as the sole criterion for determining a disability and developing an educational program.

The student will be evaluated in all areas related to the suspected disability. The testing instruments used will be technically sound, research based and specific to

the individual student. The Notice of Educational Evaluation Plan for a re-evaluation should be completed by

the IEP manager and reviewed by the school psychologist.Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-10

A re-evaluation of a student currently on an IEP must be conducted within 3 years unless the parent and the school district agree otherwise.

A parent has 14 calendar days to respond to the plan in writing. If the evaluation manager does not receive permission to evaluate, he/she needs to document at least 2 attempts of parent contact before beginning testing. If the parent has not objected in writing within 14 calendar days after receipt of the Notice of Re-evaluation, the District may proceed with the re-evaluation.

Re-evaluations must be completed before three years if the student’s parents or the IEP team request a re-evaluation. It cannot be “postponed” while a team waits for medical information, clinical testing etc.

To add or remove a service (i.e. SLP, OT or PT), a comprehensive evaluation must be completed, except when the sole purpose is to complete a Functional Behavioral Assessment or to evaluate Transition needs.

A comprehensive evaluation is not required when the sole purpose is to complete a Functional Behavioral Assessment. All other evaluations must be comprehensive in that they address all pertinent evaluation areas, educational needs that derive from the disability and criteria.

An exit evaluation is not required when dismissing from a secondary disability (such as dismissing from speech and language services for a student also identified EBD).

R E E V A L U A T I O N P R O C E D U R E S

A reevaluation is completed every three years to determine if the student continues to be a student with a disability. Students must have met initial eligibility criteria for the primary area of disability initially, or the criteria for a proper override were met through documentation that all four steps in the override criteria were followed. Reevaluation reports must document that all eligibility criteria have been addressed, though the student may not meet the strict criteria under initial evaluation.

The IEP team and other qualified professionals, as appropriate, will, on the basis of review and input from the student’s parents, determine what additional data is needed to:

determine whether the student continues to have a disability; the present levels of performance and educational needs of the student; whether the student needs special education and related services; and any additions or modifications to services that are needed to enable the student to meet

the measurable annual goals and to participate in the general curriculum.

Determination of what additional data is needed for the re-evaluation does not require a meeting

R E V I E W O F E X I S T I N G D A T AThe evaluation team may, in certain cases, determine that no additional data is needed to determine whether the student continues to be a student with a disability. When this is the case, the district will document this decision by notifying the student’s parents of the evaluation team’s determination and the reasons for it, and the right of parents’ to request an evaluation.


P A R E N T I N V O L V E M E N T

The parents of a child with a disability must be afforded the opportunity to: inspect and review all educational records with respect to the identification, evaluation,

and educational placement of their child; and participate in meetings with respect to the identification, evaluation, educational

placement, and provision of FAPE to their child.

Upon completion of an evaluation, parents and other IEP team members will determine if the child is a student with a disability. Parents will be given a copy of the evaluation report and the documentation of determination of eligibility.

E V A L U A T I O N T E A M

The evaluation must be conducted by a multidisciplinary team. At a minimum, this team must be comprised of: Special Education Teacher with licensure in suspected areas of disabilityRegular Education Teacher of the studentParentBuilding AdministratorOther Special Education Licensed Staff

The evaluation team should include licensed special education staff and others as appropriate to conduct the evaluation, including licensed special education staff and others who may have the responsibility for implementing the educational program for the student.

Specific Learning Disability Evaluation TeamThe determination of whether a child is a student suspected of having a specific learning disability is made by the child’s parents and a team of professionals that must include:

1) the child’s regular teacher or a regular classroom teacher qualified to teach a child of his/her age;

2) for a child of less than school age, an individual qualified to teach a child of his/her age; and

3) at least one person qualified to conduct individual diagnostic examinations such as a school psychologist, speech-language pathologist, or SLD teacher.

Secondary Transition Evaluation TeamBefore the end of the student’s 9th grader year, an evaluation of secondary transition needs for students with disabilities must occur. To appropriately evaluate a plan for a student’s transition, additional IEP team members may be necessary. These may include vocational education staff members and other community agency representatives as appropriate.

Multidisability Team Teaching ModelA team member licensed in the student’s disability will be a member of the evaluation / reevaluation team and participate in the development, review, and revision of the IEP. Consultation and indirect services must be provided to the general or special education Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-12

teacher providing instruction if not licensed in the disability. The IEP team will determine the frequency and amount of time for these services, which need to be documented on the service grid.

Interagency ServicesIf at the time of initial referral for an educational evaluation or a reevaluation, the school district determines that a child with disabilities age Birth-21 may be eligible for interagency services, the district may request that the county of residence provide a representative to the initial assessment or reassessment team meeting or first IEP team meeting following the evaluation in order to facilitate coordination between the district and county provided services. Upon request from the district, the county will provide a representative to assist the IEP team in determining the student’s eligibility for existing health, mental health, or other support services provided by the county. An interagency plan (IEP, or Individual Service Plan, IFSP) may be developed for the eligible student and the student’s family to coordinate services. The parent must consent to the participation of interagency representatives and the sharing of information.

N O N D I S C R I M I N A T O R Y E V A L U A T I O N

Districts will ensure that testing and evaluation materials and procedures utilized for the purposes of classification and placement of children with a disability are selected and administered so as not to be racially or culturally discriminatory. Tests and other evaluation materials will be provided and administered in the student’s native language or other mode of communication unless it is clearly not feasible to do so.

E V A L U A T I O N M A T E R I A L S A N D P R O C E D U R E S

Districts will ensure that: evaluation teams use tools and strategies that provide relevant information to determine

educational needs of the student; if an assessment is administered to a child with impaired sensory, manual, or speaking

skills, the assessment results accurately reflect the child’s aptitude or achievement level or whatever other factors the test measures, rather than reflecting the child’s impaired sensory, manual, or speaking skills (unless those skills are the factors the test is measuring);

materials and procedures used to evaluate a student with limited English proficiency are selected and administered to ensure that they measure the extent to which the student has a disability and needs special education and related services, rather than measure the child’s English language skills;

tests and other evaluation materials include those tailored to evaluate specific areas of educational need and not merely those that are designed to provide a single general intelligence quotient;


any standardized tests that are given have been validated for the specific purpose for which they are used, are administered by trained and knowledgeable personnel, and are administered in accordance with any instructions provided by the producer of such tests;

in evaluating a student with a disability, the evaluation is comprehensive in order to identify all of the child’s special education and related services needs, whether or not commonly linked to the disability category in which the student has been classified;

technically sound instruments that are designed to assess the relative contribution of cognitive and behavioral factors, in addition to physical or developmental factors are used;

the student is evaluated in all areas of suspected disability, including, if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities;

a variety of evaluation tools and strategies are used to gather relevant functional and developmental information, including information from the parent;

the team does not use any single procedure as the sole criterion for determining whether a child is a student with a disability or determining an appropriate education program for the student;

information from a variety of sources is considered, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the student’s physical condition, social or cultural background, and adaptive behavior;

if an evaluation is not conducted under standard conditions, a description of the extent to which it varied from standard conditions is included in the evaluation report; and

if a student transfers from one school building to another school building within the district while an evaluation is taking place, staff from both buildings will work cooperatively to ensure prompt completion of the evaluation

B R A I L L E S K I L L S I N V E N T O R YIn developing an IEP for each blind student the presumption must be that proficiency in Braille reading and writing is essential for the student to achieve satisfactory educational progress. The assessment required for each student with blindness must include a Braille skills inventory, including a statement of strengths and deficits. Braille instruction and use are not required if IEP team members concur that the student’s visual impairment does not affect reading and writing performance commensurate with ability. The exclusive use of Braille is not required if other special education services are appropriate to the student’s educational needs. Instruction in Braille reading and writing must be available for each blind student for whom the IEP team has determined that reading and writing is appropriate.

S E C O N D A R Y T R A N S I T I O N E V A L U A T I O NEvery district shall ensure that all students with disabilities are provided the special instruction and services which are appropriate to their needs. The student’s needs and the special education instruction and services to be provided shall be agreed upon through the development of an individual education plan. The plan will address the student’s need to develop skills to live and work as independently as possible within the community. During grade 9, the plan will address the student’s needs for transition from secondary services to post secondary education and training, employment, community participation, recreation and leisure, and home living. The plan must include a statement of the needed transition services, including a statement of the interagency responsibilities or linkages or both before secondary services are concluded.


For each student, the district will conduct a multidisciplinary evaluation of secondary transition needs and plan appropriate services to meet the student’s transition needs. Areas of evaluation and planning must be relevant to the student’s needs and may include work, recreation and leisure, home living, community participation, and post secondary training and learning opportunities. To appropriately assess and plan for a student’s secondary transition, additional IEP team members may be necessary and may include vocational education staff members and other community agency representatives as appropriate.

Secondary transition evaluation results must be documented as part of the student’s evaluation plan. Current and secondary transition goals, and instructional and related services to meet the student’s secondary transition needs must be considered by the team with annual needs, goals, objectives, and services documented on the student’s IEP.

At least 2 different assessment procedures with 2 different sources must be utilized when evaluations include secondary transition.

Transition planning must go beyond preparing for the world of work to include a full spectrum of independent living activities within the community. Although work preparation is important, developing recreation and leisure skills, managing a budget, taking part in community activities, developing friendships, and planning for personal health care, for example, are of equal importance for a quality adult life.

IEP/Transition Planning TeamDuring the student’s 9th grader year, all students receiving special education must have an IEP that focuses on transition. Individuals who can assist and support students in their adult lives are invited to join the existing IEP team to plan for the future. When selecting people to assist students with their plans for the future, the team should first consider the types of services and supports the student may need to meet his or her adult goals.

A student’s IEP/transition planning team should be convened by the IEP manager in consultation with the student and family. The student and parent(s) may identify key individuals who are already involved in their lives (i.e., relatives, county case manager, mental health counselor, or parole officer). Students and their parents should be given information about available post-school services and community resources so that they can make informed decisions about the individuals they want on the team.

Non-School ParticipantsWhen inviting non-school participants to the IEP/transition planning meeting, the IEP manager should clearly explain why the person is being invited and what role the person is expected to assume at the meeting. For example, a person may be invited to provide information about services, or to negotiate shared service provision. When choosing new members for the team, consider inviting representatives from agencies who might be valuable in supporting a student in attaining his or her anticipated post-school outcomes.

In general, involvement of non-school participants should be requested at least two years before the student will leave high school. If the IEP manager is in doubt about when to invite a non-school service provider, contact the provider to discuss the request for involvement.

T R A N S I T I O N A R E A S T O E V A L U A T EFive transition areas must be assessed and annually addressed in the IEP/transition planning process for all students with special education needs age 14 years and older. Teams need to


administer more than one procedure when gathering information related to transition. These transition areas are:

1. Home Living: Developing necessary skills to live as independently as possible. A. Financial/Income

1. Earned Income2. Unearned Income (gifts/dividends)3. Insurance (life, annuities)4. General Public Assistance5. Food Stamps6. Supplemental Security Income (SSI)7. Social Security Benefits8. Trust/Will or similar income9. Minnesota Supplemental Assistance10. Commodities11. Meals on Wheels/Home Delivery Meals12. Medical Assistance

B. Personal/Family Relationships1. Counseling2. Health Aide/Home Attendant3. Support Group4. Respite Care5. Tax Deduction for Developmentally Disabled Individuals who reside at home6. Visiting arrangements7. Churches8. Minnesota Family Subsidy9. County Human Services

C. Develop personal care skills including hygiene, health, private and public behaviorD. Develop housekeeping and cooking skillsE. Develop budgeting skillsF. Identify who to call and what to do in emergency situationsG. Explore possible living arrangements

1. With family2. Adult Foster Care3. Shelter Care Group Home4. Specialized Shelter Care Group Home (training)5. Semi-independent (supervised) Living Services6. Share Living (roommate)7. Independent Living (own house, apartment)8. Low Income Housing9. Shared Ownership (Supportive Living Services, etc.)

2. Recreation and Leisure: knowing about and experiencing social and free time activities;A. Develop an array of specific and affordable recreation and leisure skillsB. Develop spectator or audience member skillsC. Identify activities through community education classesD. Identify acceptable dress behavior for a variety of situationsE. Arrange social activitiesF. Establish exercise routinesG. Identify possible social supports from family & community (church, clubs, etc.)

3. Community Participation: accessing community resources including people, places, and activities in the community;

A. Develop shopping skillsRochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-16

B. Assess vulnerability statusC. Open and learn to use a bank accountD. Register for military selective serviceE. Register to vote and vote in a local precinctF. Learn to schedule appointmentsG. Learn to order and dine at restaurantsH. Access medical services

1. Medical Care: Intermittent Care Daily-Long-Term Care2. Medical Services: General medical services (check-ups, etc.)3. Medication Supervision, Dental Care4. Medical/Accident Insurance5. Financial Resources, Group Policy, Available Individual Policy, Medicaid, other6. TTY/TTD (Communication for Hearing Impaired)7. Medical Assistance

I. Transportation1. Independence (own car, bicycle, etc.)2. Public transportation (bus, taxi, train)3. Specialized transportation (electric wheelchair, etc.)4. Ride-Share5. Community Volunteers6. Car pooling

J. Advocacy/Legal Services1. Guardianship, Conservatorship2. Wills/Trusts, other3. Self-Advocacy4. Legal Aid5. PACER, ARC,

4. Jobs and Job Training: developing employment/vocational skills; A. Participate in work responsibilities (chores) at home.B. Visit possible employment sites and "shadow" employees.C. Become aware of career opportunities and interest.H. Receive vocational training within the community.I. Develop interpersonal skills necessary to maintain employment.J. Participate in summer employment.K. Identify people and agencies that can assist in job search.L. Apply for support from the Division of Rehabilitation Services.M. Identify and check eligibility requirement for other job supports.N. Identify and apply for day training and habilitation services.O. Identify and arrange for transportation to and from work.

5. Postsecondary Education and Training: developing skills to access life-long learning opportunities.

A. Identify personal learning styles.B. Become aware of career interests and options.C. Become aware of post-secondary enrollment options.D. Visit post-secondary institutions.E. Register and take college entrance exams.F. Develop a resume and request letter of recommendation.


G. Identify and apply to post-secondary institutions.H. Identify supports needed at post-secondary sites.I. Identify and check eligibility requirements for adult support.J. Check courses and credits toward high school graduation.K. Apply for financial aid, scholarships, etc.

L. Arrange for transportation and housing, if necessary.

For more information on Transition-related assessment, please visit the RCTIC site at:http://www.rochester.k12.mn.us/se3bin/clientgenie.cgi then click Community, then RCTIC

I N F A N T A N D T O D D L E R E V A L U A T I O N

The evaluation and assessment of each referred child must:1) be conducted by personnel trained to utilize appropriate methods and procedures;2) be based on informed clinical opinion;3) include a review of pertinent records related to the child’s current health status and

medical history;4) include an evaluation of the child’s level of functioning in the developmental areas of

cognitive development, physical development including vision and hearing, communication development, social or emotional development and adaptive development;

5) include an assessment of the unique needs of the child in terms of each of the developmental areas, including the identification of services appropriate to meet those needs; and

6) use nondiscriminatory evaluation and assessment procedures.

A family assessment to determine the strengths, resources, priorities, and concerns of the family and services necessary to enhance the family’s capacity to meet the developmental needs of the child will be conducted if the family voluntarily agrees to the assessment. This assessment will be conducted by personnel trained in appropriate methods and procedures. Information will be provided by the family through a personal interview.

An assessment will be completed and delivered to the parents within 45 calendar days of receiving the referral.

E V A L U A T I O N R E P O R TEvaluation teams will interpret evaluation data for the purpose of determining if a child is a child with a disability and the educational needs of the child. Teams will:

draw upon information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the child’s physical condition, social or cultural background, and adaptive behavior; and


http://www.rochester.k12.mn.us/se3bin/clientgenie.cgi

ensure that information obtained from all of these sources is documented and carefully considered.

An evaluation report will be completed and delivered to the student’s parents within 30 school days of receiving parent consent for evaluation. The evaluation report will include, at a minimum:

A. a summary of all evaluation results;

B. documentation of whether the student has a particular category of disability, or in the case of a reevaluation, whether the student continues to have such a disability;

C. the student’s present levels of performance and educational needs that derive from the disability;

D. whether the student needs special education and related services, or in the case of a reevaluation, whether the student continues to need special education and related services; and whether any additions or modifications to the special education and related services are needed to enable the student to meet the measurable annual goals set out in the student’s IEP and to participate, as appropriate, in the general curriculum.

Secondary transition evaluation results will be documented as part of the evaluation report. Current secondary transition needs, goals, and instructional and related services to meet the student’s secondary transition needs will be considered by the team with annual needs, goals, objectives, and services documented on the student’s IEP.

D I S P R O P O R T I O N A L I T YDistricts will provide the needed information to the Minnesota Department of Education to determine if significant disproportionality based on race and ethnicity is occurring in the district. If it is determined that a significant disproportionality with respect to the identification of students as students with disabilities, or the placement in particular educational settings of these children, districts will:

1. review and revise the identification or placement procedures and practices of the district;

2. use federal funds to provide comprehensive coordinated early intervening services to students in those groups that were significantly over identified; and

3. publicly report on the revision of identification and placement practices and procedures.



PROCEDURES FOR DETERMINING ELIGIBILITY AND PLACEMENTEvaluation data used for the purpose of determining if a child is a student with a disability and identifying the educational need of the child will be drawn from a variety of sources including:

aptitude and achievement parent input teacher recommendations physical condition social or cultural background, and adaptive behavior

D E T E R M I N I N G T H E C H I L D I S A C H I L D W I T H A D I S A B I L I T Y

After administering assessments and other evaluation measures, a group of qualified professionals and the parent of the student determine whether the student is a student with a disability, and identifies the educational needs of the child. The school district will provide a copy of the evaluation report and the documentation of determination of eligibility to the parent.

A student must not be determined to be a student with a disability if the determination factor for that determination is:

lack of appropriate instruction in reading or math; or Limited English proficiency; and the student does not otherwise meet eligibility criteria.

Every child who meets eligibility for: Deaf and Hard of Hearing; Blind-Visually impaired; Speech or Language Impairment Physical Impairment Other Health Disability; Developmental Cognitive Disability; Emotional/Behavioral Disorder; Autism Spectrum Disorder; Traumatic Brain Injury; Severely Multiply Impaired; Deaf-Blind; Developmental Delay Specific Learning Disability

and needs special instruction and services as determined by State standards, is a child with a disability. In addition, every child under age three, and from age three to age seven, who needs special instruction and services because the child has a substantial delay, or a diagnosed physical or mental condition or disorder with a high probability of resulting in developmental delay is a child with a disability.

DETERMINING THE STUDENT IS NOT A STUDENT WITH A DISABIL ITY

A district must evaluate a student with a disability before determining that the student is no longer a student with a disability. An evaluation is not required before the termination of a student’s eligibility due to graduation from high school. The district will provide the student with a summary of the student’s academic achievement and functional performance and recommendations on how to assist the student in meeting his/her postsecondary goals.A child with a short-term or temporary physical or emotionally illness or disability, is not a child with a disability.A guardian or adult student can request to be removed from special education. When this occurs the District should offer and evaluation to determine eligibility. If the guardian / adult student declines this offer the District will create a Prior Written Notice noting that the guardian or adult student is requesting services be discontinued and that the District stands ready to provide services.

INFANTS AND TODDLERS WITH DISABIL IT IESInfants and toddlers with disabilities means individuals from birth through age two who need early intervention services because they:

1. are experiencing developmental delays, as measured by appropriate diagnostic instruments and procedures in one or more of the following areas:

cognitive development; physical development including vision and hearing; communication development; social or emotional development; adaptive development;

OR

2. has a diagnosed physical or mental condition or disorder known to have a high probability of resulting in developmental delay.

Every child who has a hearing impairment, visual disability, speech or language impairment, physical disability, other health impairment, cognitive disability, emotional or behavioral disorder, specific learning disability, autism, traumatic brain injury, multiple disabilities, or deaf/blind disability and needs special instruction and services, is a child with a disability. In addition, every child under age three who needs special instruction and services because the child has a substantial delay or a diagnosed physical or mental condition or disorder that has a high probability of resulting in developmental delay is a child with a disability.


ECSE CRITERIA CROSSOVER ASSESSMENT

ECSE Criteria Crossover Tool

Subitem B Language From Rule

Interpretation for Students Prior to Kindergarten Yes/No

1 Excessive absenteeism Child is frequently absent from child care or other natural environments

2 Specialized health care procedures during the school day

Child receives specialized health care procedures during hours that other children are typically at school

3 Medications that adversely affect learning and functions

Interpreted as written

4 Limited physical strength resulting in decreased capacity to perform school activities

Limited physical strength resulting in decreased capacity to perform developmentally appropriate tasks

5 Limited endurance resulting in decreased stamina and decreased ability to maintain performance


6 Heightened or diminished alertness resulting in impaired abilities (i.e., prioritizing environmental stimuli, maintaining focus, sustaining effort or accuracy)


7 Impaired ability to manage and organize materials and complete classroom assignments within routine timelines

Impaired ability to manage and organize materials used in developmentally appropriate activities and complete developmentally appropriate tasks within routine timelines

8 Impaired ability to follow directions or initiate a task


OHD evaluation procedures for children prior to kindergarten entrance:A. An individually administered, nationally normed standardized evaluation of student’s

developmental performance1;B. Documented, systematic interview conducted by a licensed special education teacher

with the student’s parent or guardian and child care provider, if appropriate;C. One or more documented, systematic observations in the (1) home or (2) child care or

other learning environment by a licensed special education teacher;D. A review of the student’s health history, including the verification of a medical diagnosis

of a health condition; andE. Records review.

List of additional evaluation activities is appropriate as written.

1 Refer to Early Childhood Special Education Assessment Instruments: A Selected Review for Use in Minnesota (1997) for a description of possible tools.

D O C U M E N T A T I O N

TEST PROTOCOLSTest protocols are considered part of the special education file and therefore are filed in the special education file of the student.

CULTURAL LIAISON CONTACT INFORMATION

2008-2009

Minority Parent/ Student Liaison ProgramJohn AdamsAden Hassen285-8845

Kellogg Middle SchoolAbdi Nur285-8701

Century High SchoolPaul Malone328-5174

John Marshall High SchoolVaughn Thompson328-5246

Mayo High SchoolMulugeta Haileab328-5521

Friedell/District Wide Juan Vasquez285-8877

Willow CreekNicole Bryant328-5900

GageMaryam Nur328-3386

Zelda Collins-MooreDistrict Coordinator358-8628

LIST OF AVAILABLE ASSESSMENT TOOLSAs of 6/08

Achenbach System of Empirically Based AssessmentAdaptive Behavior Assessment System - Second Edition (ABAS-II)Arizona Articulation Scale-Third Edition (AAPS-3)Autism Diagnostic Interview - Revised (ADI-R)Autism Diagnostic Observation Schedule (ADOS)Battelle Developmental InventoryBattelle Developmental Inventory-2Bayley Scales of Development-Third Edition-Cognitive (Bayley III)Bayley Scales of Development-Third Edition-Communication (Bayley III)Bayley Scales of Development-Third Edition-Motor (Bayley III) Bayley Scales of Development-Third Edition-Social-Emotional (Bayley III)Behavior Assessment System for Children - Second Edition (BASC-2)Behavior Disorder Identification Scale - Second Edition (BDIS-2)Behavior Evaluation Scale - Third Edition (BES-3)Behavior Rating Inventory of Executive Function(BRIEF) Behavior Rating Profile - Second Edition (BRP-2)Boehm Test of Basic Concepts-Third Edition: Preschool VersionBracken Basic Concept ScaleBracken Basic Concept Scale-RevisedBrigance Comprehensive Inventory of Basic Skills-Revised (CIBS-R)Brigance Inventory of Early Development - Second Edition (IED-2)Brigance Inventory of Early Development-Second Edition (IED-II)Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2)Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2) Fine MotorCareer Occupational Preference System-Second Edition (COPS-II)CELF-4 Observation Rating ScaleCELF-PRE:2 Pragmatic ProfileCELF-PRE:2 Observation Rating ScaleChild Development Inventory (CDI) Children's Autism Rating Scale (CARS)Clinical Evaluation of Language Fundamentals- Preschool: Second Edition (CELF-PRE:2) Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) Clinical Evaluation of Language Fundamentals-Fourth Edition: Spanish Version (CELF-4:Spanish) Comprehensive Assessment of Spoken Language (CASL)Comprehensive Test of Nonverbal Intelligence (CTONI)

Conners Rating ScaleDevelopmental Test of Visual Perception (DTVP-2)Differential Ability Scales - Second Edition (DAS-II)Enderle Severson Transition Rating Scale (ESTR-Form J)Expressive One-Word Vocabulary Test (EOWPVT)Expressive Vocabulary Test (EVT)Functional Vision Assessment Gilliam Asperger's Disorder Scale (GADS)Gilliam Autism Rating Scale - Second Edition (GARS-2)Goldman Fristoe Test of Articulation-Second Edition Hughes Basic Gross Motor Assessment (BGMA)Infant/Toddler Sensory ProfileInfant/Toddler Sensory ProfileKaufman Adolescent & Adult Intelligence Test (KAIT) Kaufman Assessment Battery for Children - Second Edition (KABC-2)Kaufman Speech Praxis Test For Children Kaufman Test of Educational Achievement - Second Edition (KTEA-II)KeyMath-RevisedLanguage Processing Test-Elementary: Third Edition (LPT-3)Language Sample:Leiter International Performance Scale - Revised (Leiter-R)Lindamood Auditory Conceptualization Test-Third Edition (LAC-3)Listening Comprehension Test: Second Edition Listening TestMeadow-Kendall Social-Emotional Assessment Inventory for Deaf & Hearing Impaired StudentsMinnesota Handwriting Screening Motor-Free Visual Perception Test-Third Edition (MVPT-3)Mullen Scales of Early LearningOral and Written Language Scale (OWLS)Oral and Written Language Scales (OWLS): Oral Language ScalesPeabody Developmental Motor Scales-Second Edition Gross Motor (PDMS-2)Peabody Developmental Motor Scales-Second Edition (Fine Motor) (PDMS-2)Peabody Picture Vocabulary Test- Third Edition (PPVT-III) Pediatric Evaluation of Disability Inventory (PEDI)Phonological Awareness Test (PAT) Photo Articulation Test- Third Edition (PAT-3) Piers-Harris Children's Self-Concept Scale - Second Edition (PHCSCS-2)Preschool Language Scale- Fourth Edition (PLS-4)Preschool Language Scale-Fourth Edition: Spanish Edition (PLS-4)Receptive-Expressive Emergent Language Test- Third Edition (REEL-III) Reynolds Adolescent Depression Scale - Second Edition (RADS-2)Reynolds Child Depression Scale (RCDS)Rossetti Infant-Toddler Language Scale Scales of Independent Behavior - Revised (SIB-R)School Functional Assessment (SFA)

Screening Instrument for Targeting Educational Risk (SIFTER)Sensory ProfileSensory Profile School Companion Sensory Profile-Adolescent/AdultSensory Profile-Infant/Toddler Sequenced Inventory of Communication Development-Revised (SICD-R)Social Communication Questionnaire (SCQ)Social Skills Rating Scales (SSRS)Spanish Preschool Articulation Test (SPAT)Structured Phonographic Expressive Language Test-III (SPELT-III) Stuttering Severity Instrument- Third Edition (SSI-3) Teaching Age-Appropriate Purposeful Skills (TAPS) Temperament and Atypical Behavior Scale (TABS)Tennessee Self-Concept Scales Test For Auditory Comprehension of Language- Third Edition (TACL-3) Test of Auditory Comprehension (TAC)Test of Auditory Processing Skills - Third Edition (TAPS-3)Test of Auditory Reasoning and Processing (TARPS)Test of Early Math Ability-Third Edition (TEMA-III)Test of Early Reading Ability-Third Edition (TERA-III)Test of Early Written Language-Second Edition (TEWL-II)Test of Language Development-Intermediate: Third Edition (TOLD-I:3)Test of Language Development-Primary: Third Edition (TOLD-P:3)Test of Pragmatic Language (TOPL)Test of Problem Solving-Third Edition: Elementary (TOPS-3)Test of Problem-Solving: Adolescent (TOPS:A)Test of Visual Motor Skills-Revised (TVMS-R)Test of Visual Perception Skills-Third Edition (TVPS-3)Test of Word Finding: Second Edition (TWF-2) Test of Written Language-Third Edition (TOWL-III)The SKI*HI Language Development ScaleToken Test For Children: Second Edition(TTFC-2)Transition Planning Inventory (TPI)Universal Nonverbal Intelligence Test (UNIT)Vineland Adaptive Behavior Scales - Second Edition (Vineland-II)Wechsler Adult Intelligence Scale - Third Edition (WAIS-III)Wechsler Individual Achievement Test-Second Edition (WIAT-II)Wechsler Preschool and Primary Scale of Intelligence - Third Edition (WPPSI-III) Wisconsin Behavior Rating Scale (WBRS) Woodcock Reading Mastery Tests-RevisedWoodcock-Johnson Tests of Achievement - Third Edition (WJ-III) Woodcock-Johnson Tests of Cognitive Abilities (WJ-III COG)Young Child Achievement Test (YCAT)

LIST OF AVAILABLE INTERPRETERS

The district employs bilingual specialists who speak the following languages:

BosnianCambodianHmongLaoSomaliArabicSpanishVietnameseKhmerAmharicFrenchJapaneseKoreanChineseAmerican Sign Language

In addition, on call bilingual specials are available who speak several other languages not listed above

Please call 328-4237 if you need the services of an interpreter

LIST OF QUALIFIED STAFF (2008-2009)

Last Name First Name

Position

Adams Karen ECSEAdler Joan AutismAlcott Mary DCD-MMAlexander Sharon SpeechAlexander Sharon SpeechAndersen Emily ECSEAnderson Linda DCD-MMArendt Rita DCD-SPArneson Dianne EBDArnold Sue DCD-SPAsprey Smith Maureen SpeechBagniewski Amanda LDBakken Renee ECSEBakken Karl TechnologyBalsum Amy ECSEBarry Meghan Mental

HealthBatzner Martha SpeechBauch Adele ECSEBaumgardner Jennifer SWBennett Andrea DAPEBernatz Jody SpeechBeyer Michelle PsychBielen Kathy LDBoles Amber EBDBoyd Mary Lou DAPEBradley Mary LDBrannan LeeAnn MultiBraun Tara Mental

HealthBresnahan Jane DHHBreza Julia DCD-SPBrytowski Kelly SpeechBurdick Katia SpeechByron Pat DCD-MMCampbell LTS

Kelly EBD/LD

Caples Jean VisionCarlin Stena LDCarter Diana EBD/ECSECastro Shannon DCD-MMChase Laura SWChase Jerry EBDChonis Jenny SWClark Hilary BISClark Annette SWCourts Anita SpeechCraven Pam DCD-MMCrowley Sheri DHHDahl Kris DHHDankbar Sandy PTDaul Judy PsychDayland Tonya DCD-SPDieter Wendy SpeechDion Hillary LDDodge Susan SpeechDrossel Sarah SpeechDuchateau Nick LDDurst Alesha SpeechEagen Marla SpeechEdell Rosemary OTEdmonds Karen ECSEEdwards Kris EBDEllsworth Angie SWEmeott Carla WE

Engstler Lori ECSEErickson Leann SpeechErickson Bonnie SpeechFarley Colleen LDFarlow Courtney LDFelton Shawna DCD-MMFerns Lisa AutismFirl Janelle DCD-SPFlaharty Nancy SpeechFlanders Gail DCD-MMFloerke Katie DCD-SPForsyth Kathy SWGedicke Cindy EBDGerak-McEligot

Julia Psych

Glessing Jeff SpeechGoerss Theresa DCD-MM/WEGoetz Brant EBDGora Melissa LDGordon Pat EBDGore Stephanie PTGosse John EBDGrimsrud Koni SpeechGroth Abbey DCD-SPGruben Mark Aut/EBDHagstrom Jessica DCD-SPHallock Maggie SWHammel Melody OTHanrahan Mary DCD-MMHanson Bonnie PsychHanson Trish DCD-MMHaselhorst Sue SpeechHauan Jill ECSEHeiderscheit Terry EBDHemmesch Henri SWHenning Jody PsychHeruth Chris EBDHilleshiem Jill DCD-MMHinds Amber DCD-SPHolland Dixie DCD-SPHolthorf-Jewell

Marian LD

Horlitz Megan LDHuegel Joanna LDIhrke Jennifer MultiIlle Steve DAPEJacobson Joyce SpeechJahnke Sandy WEJensen Martha ECSE

Jirsa Claudia LDJohnson Steve EBDJohnson Joanne MultiJones Kathy EBDKane Pat SWKerl Scott SWKester Deb LDKnott Kathy DHHKohler Renee AutismKoster Dawn DCD-MMKram Amy SpeechKram Jason EBDKreidermacher

Lois SW

Kroening Kim DCD-MM/SPKuisle Rita EBD/LDKumerow Erika PsychKuramoto Natalie DHHLambert Mary ECSELangsdale Matt DAPELaPlante Christie LDLaqua Stephanie DCD-SPLarson Sarah ECSELea Dana DCD-SPLenz Dawn EBDLindquist Guy EBDLindquist Heather EBDLindsey Jane OTLivingstone Sheila LDLovhaug Trisha DCD-MMLucca Gina EBDLucido Clif EBDLyons Rosemary EBDMacDonald Scott EBDMartin Mandy EBDMayerle Kris LDMcGuire Ann DCD-MMMeyers Britney SWMilene Theresa EBDMiller Nancy DCD-MMMoody Denise 3rd partyMuch Kerry DCD-SPMuehe Deb DCD-MMNaylor Sandy SpeechNelson Nancy OTNickelotti Kristi DCD-SPNorby Robyn PsychNordine Don EBD/LDNovotny Kathy LD

Olson Cami LDOlson Scott EBDOsowski Char DCD-SPOtterness Chad EBDOwens Marie EBD/LDParker Jessica PsychPolson Jennie AT/PIQuinn Kathy PsychRadtke Melissa ECSEReddinger Jessica ECSERein Justin LDReiter Connie ECSERenstrom Bethany SpeechResman Deb OTRiester Danielle SWRiles Steve EBDRing Kori AutismRobertson Cindy DCD-MMRobinson Becky LDRoelofs Lisa EBDRoggow Juiann ECSERyan LTS Erin DCD-MMSanderson Rita VisionSchaaf Lisa DCD-MMSchellhammer

Kathy OT

Schemmel Amy SpeechSchmidt Bryan PsychSchmitz Jan DCD-SPSchollmeier Tammie LDSchuller Judi DHHSchuster LTS Tonya LDScott Theresa AutismSenst Jessica DCD-SPShaft Pam DCD-MMShepard Janice DHHShimak-Hanson

Kim EBD

Simcox Patty AutismSmith Deb DCD-SPSmith Rebecca LDSolheim Scott PsychSonnabend Mike EBDSpencer Molly LDSprinkle Christilee PsychSteege Teresa ECSEStejskal Joli SWStephans Jennifer LDStreyle Sarah ECSE

Strusz Sheri ECSESuter Jim LDSweeney Colette ECSESweeney Shannon ECSETennis Deb ECSETessum Kay EBDThatcher Laura SpeechThiesmann Rebecca LDThomas Colin EBD/SLDThompson Anne WEValioukevitch Deb DCD-MMVeiseth Cassandra SpeechVerna Michelle DCD-MMWalter David EBDWalters-Smith

Deb Audiologist

Weis Tessa EBDWelsh Kim ECSEWheeler Becky ECSEWiest Cindy SpeechWilliams Elizabeth SpeechWindhorst Beth DHHWipperling Linda ECSEWoodworth Diane DCD-MMWroblewski Jessica DHHZincke Becky DCD-MM

R o c h e s t e r P u b l i c S c h o o l s : T o t a l S p e c i a l E d u c a t i o n S y s t e m M a n u a l D o c u m e n t a t i o n

GUIDELINES FOR INDEPENDENT EDUCATIONAL EVALUATIONSParent(s) of a student with a disability have the right to obtain an independent educational evaluation (IEE) at public expense if the parent(s) disagree with an evaluation completed by the school district or a State hearing officer orders an independent assessment. The district is entitled to first evaluate the student in the particular area(s) of concern before the district will be required to pay for an independent educational evaluation of the same issue(s). The parent may request from the district information about where an independent educational assessment can be obtained. The district may refuse the parent’s request for independent assessment at public expense and then must initiate conciliation and/or due process hearing if necessary.

Independent educational evaluation means an evaluation conducted by a qualified examiner who is not employed by the district. Public expense means the school district either pays for the full cost of the evaluation or evaluation components or ensures that the evaluation or evaluation components are otherwise provided at no cost to the parent.

If the parent requests an independent educational evaluation, the district may ask the parent why they object to the district’s evaluation. However, the explanation by the parent may not be required and the district may not unreasonably delay either providing the independent educational evaluation at public expense or initiating a due process hearing to defend the district’s evaluation.

Pursuant to Minnesota Rule (Minn. R. 3525.3300D.(3)), when an independent evaluation is at public expense, the criterion under which the evaluation is obtained, including the location of the evaluation and the qualifications of the examiner, must be the same as the criteria the district uses when it initiates an evaluation.

It is helpful if evaluators are experienced in providing educational recommendations and understand criteria for disability services in schools. Independent evaluators may not have financial or business or personal interest in the outcome, results, or recommendations of the evaluation. Also, the evaluator must be independent of the parent and student. The evaluator must not have a treating relationship with any member of the student’ family. If a parent(s) uses an evaluator of their choice, he/she must submit proof the evaluator complies with district standards, including documentation of a license to perform the type of evaluation being considered. Evaluators not sanctioned as complying with these standards will not be paid for the costs of the independent evaluation.

If the district agrees to pay for an independent evaluation, an evaluation plan will be developed specifying the areas to be evaluated and who will complete each assessment. The district will request to meet with the parent and the independent evaluator(s) to help plan the scope of the independent evaluation and a Notice of Educational Evaluation will be completed for that purpose. This is to help ensure that information obtained is helpful, that the purposes for the evaluation are clear, and that there is a framework for the ultimate report and recommendations.

In any circumstance where an independent educational evaluation at public expense is undertaken, the district requires that the evaluator have full access to school records and that the parent authorize in writing that the evaluator may have conversations with any school employee who has provided service or evaluated the student. The parent must provide authorization for the independent evaluator to have access to all school records. Just as a school evaluator would, the independent evaluator must seek and utilize school and parental

input or any other input or data provided by the school or the parent. The parent will provide the district with written authorization to exchange information with the evaluator. The district will be entitled to a copy of the evaluator’s report at the same time it is provided to the parent and will be given written permission to have discussions with the evaluator. Both school district employees and parents or parent representatives may provide information to the independent evaluator. However, any information shared must be provided to the other side by the independent evaluator. The evaluator must be available to discuss and interpret the results of the evaluation with district staff by participating in the evaluation meeting with the parents and the IEP Team.

Evaluation procedures will include the use of norm-referenced instruments that possess the technical adequacy for their intended purpose. Instruments, which involve surveys and/or questionnaires, must include teacher or school staff input. Evaluations may be required, when appropriate, to be completed in the current educational setting as opposed to a clinical setting. Evaluation is to be completed in a timely manner and within 30 school days.

Evaluation results are to be included in a written report that addresses the disability eligibility criteria established by the State of Minnesota.

Transportation costs for evaluation are not reimbursed.

Evaluation costs must not exceed prevailing and established rates in the community. As part of the contracted evaluation, independent evaluators must agree to release their evaluation information and results directly to the school district prior to the receipt of payment for services.

The district will consider the results of the independent evaluation in making decisions in the team setting regarding the student’s program. This does not, however, mean that outside recommendations will be adopted or followed.

If privately obtained evaluations do not satisfy federal and state law provisions; parents are not entitled to reimbursement for the evaluations. Also, parents are not entitled to reimbursement for evaluations completed by unqualified individuals.

Please contact your Student Support Services Supervisor if you receive a request for an Independent Educational Evaluation.


SAMPLE#1: PRIOR WRITTEN NOTICE FOR EVALUATIONProposal to Initiate an Evaluation

1. A description of the action proposed or refused by the district.The district is proposing to conduct a three year reevaluation. Specific data to be reviewed and assessments to be conducted are documented in the attached evaluation plan

STOP2. An explanation of any other options the district considered and the reasons

why those were rejected.Example 1: The classroom teacher had concerns regarding the student’s articulation.Example 2: Scores on the Stanfords demonstrate that the student ranked far below

other aged peers.Example 3: The student has been suspended 15 times in a three month period for

fighting.

3. A description of any other options the district considered and the reasons why those were rejected.The district conducted two pre-referral interventions (describe them here and explain that they were not successful).

4. Description of each evaluation test record, or report the district used as a basis for the proposed or refused action.Stanford scores, MCA scores, CBM probes, classroom records (including grades, attendance, discipline referrals, etc.).

5. Description of any other factors that is relevant to the proposal or refusal.There were no other factors.


SAMPLE#2: PRIOR WRITTEN NOTICE FOR EVALUATIONProposal to Initiate an Evaluation

1. A description of the action proposed or refused by the district, (if not shown on attached IEP, IFSP or IIIP).The district has proposed a special education evaluation to determine if Raymond is a

student with a disability, specifically an Emotional or Behavioral Disorder.

2. An explanation of why the district proposes or refused to take the action.The district proposed the evaluation in response to a documented history of discipline referrals which occurred between October, 2004 and March, 2005. The student’s discipline report dated March 10, 2005 shows eight referrals for not following rules and directions, three referrals for disrespect, and four referrals for inappropriate behavior/actions. 12 of these violations occurred in other settings within the school. The consequences for these behaviors include eight Remedy Plans, one parent conference, five days of out-of-school suspension, five periods of in-school suspension, and one consequence unknown. On March 20, Raymond was removed from his classroom for not following directions and insubordination. This referral resulted in a CPI team escort to the in-school suspension room and a five day suspension. Based on this history of behavioral concerns, the district proposed an evaluation to determine if Raymond is a student with a disability.

3. A description of any other options the district considered and the reasons why those options were rejected.Since Raymond was not identified as a student with a disability at the time of the incident on March 7, 2005, the district considered discipline in keeping with district policy and behavioral guidelines for a regular education student. After a discussion with teaching staff, it was determined that because of Raymond’s pattern of behavior, the district should rule out the presence of an Emotional or Behavioral Disorder before determining further disciplinary actions.

4. A description of each evaluation procedure, tests, record, or report the district used as a basis for the proposed or refused action.The district considered the information provided in the Student Discipline Report dated March 10, 2005, and documented information from the incident that took place on March 7, 2005.

5. A description of any other factors that is relevant to the district’s proposal or refusal.There were no other factors that were relevant to the district’s evaluation proposal.


USE OF EXISTING DATA FOR REEVALUATIONSUSE OF EXISTING DATA FOR REEVALUATIONS

For a special education reevaluation the team needs to gather information to satisfy four components:

1. confirm the continuing existence of a disability, 2. update the student’s current level of performance and educational needs,3. confirm whether the student continues to need special education services,4. determine any changes needed to enable the student to meet IEP annual goals and

participate in the general education curriculum.

Essentially, all evaluations are a combination of existing and new data. When existing data are sufficient to address the four components listed above, there is no need for gathering new data. For reevaluations, some existing data will be used from the previous evaluation(s). Other existing data may be found from a variety of sources (see Matrix of Existing Data Sources for Reevaluation).

Prior to reevaluation case managers must first determine what data are currently available and then determine if existing data are satisfactory to satisfy the 4 components listed above. It will be helpful to consider the data in terms of the four components, as well as the areas for the evaluation report which are listed below:

1. Intellectual Functioning2. Academic Performance3. Social, Emotional, Behavioral4. Communication5. Motor Ability6. Functional Skills7. Physical Status8. Sensory Status9. Transition, including Vocational.

After the existing data are assembled and viewed within the above context, the case manager should contact the student’s parent(s) for their input. The summary of existing data and the input from parents is reviewed with the evaluation team. The evaluation team should assist the case manager in developing an evaluation plan. Even if no additional data need to be collected, a Notice of an Educational Evaluation/Re-evaluation must be completed, which includes Prior Written Notice and Parent Consent/Objection Form. Parents must provide consent prior to the gathering of new data unless reasonable attempts were made to obtain parent consent. Even if the reevaluation used only existing data (and no new information was gathered through typical testing procedures), an evaluation report must be written which documents findings to satisfy the four components listed above.

In developing a reevaluation plan, care should be given to assess the value of administration/readministration of standardized testing, such as cognitive tests, achievement tests, and various norm referenced rating scales. These decisions are best made with the gathered expertise of the Evaluation Team. The school psychologist must review the final reevaluation plan. All service providers (i.e. DAPE, OT, PT, Audiologist, Sp/L) must be consulted and have an opportunity to provide input on the reevaluation plan.




MATRIX OF EXISTING DATA SOURCES FOR REEVALUATION

Matrix of Existing Data Sources for Reevaluation

DATA SOURCES Component 1

Component 2

Component 3

Component 4

Evaluation and Information Provided by Student/Parent(s)

Interview/Questionnaire/Rating Scales completed by parent(s)

x x

Interview/Questionnaire/Rating Scales completed by student

x x

Outside reports (medical/psychological evaluations) x xSchool Records - Cumulative File/Special Education

RecordsIndividual norm-referenced achievement xIndividual norm-referenced cognitive xNorm-referenced rating scales (social/emotional, adaptive, etc.)

x

Criterion-referenced rating scales (academic, adaptive, behavior)

x x

Cumulative folder review (report card, attendance, discipline, etc.)

x

Group achievement (e.g., Stanfords, PLAN) xState assessments (MCAS, Graduation Standards) x xVocational skills inventories (required for age 14 and older)

x x x

Longitudinal study of educational progress x xCurrent Classroom Based Assessments and

ObservationsClassroom observations x x x xCurriculum-based assessments (AIMS-WEB, DIBELS) x x xCriterion-referenced inventories (Informal Reading Inventory)

x x x

Information from Teachers and Related Service Providers

Interview/Questionnaire/Rating Scale completed by teacher(s)

x x x x

Portfolio assessments x x xCurrent progress on IEP/IFSP goals/objectives x x xCurrent involvement/progress in mainstream x x x

Components requiring documentation from existing data sources:Component 1: confirm the continuing existence of the student's disability

Component 2: update the student's present levels of performance and pertinent educational needs

Component 3: confirm whether the student continues to need special education and related services

Component 4: determine any changes in service needed to enable the student to meet IEP/IFSP annual goals and participate in the general curriculum



HINTS FOR CONDUCTING THE CLASSROOM OBSERVATIONThe classroom observation is typically done before the child knows the person conducting the observation so that the child will not be aware that the person is watching him. It is very important (and required by the federal law) that the child be observed in the regular classroom by someone other than the classroom teacher. Since the testing environment is not a natural setting, it is especially important for the observer to see how the child behaves and performs in her regular environment.

The time of day that the child is observed depends upon why he was referred. Therefore, the observer wants to see that child in the subject area of concern or, if the problem includes a behavioral concern, during a time when these behaviors would most likely occur. The kinds of behaviors or skills typically noted during an observation are some of the following:

The child's attentiveness and activity level. The child's ability to persist on an activity or assignment. How the child relates to classmates. How the child reacts and relates to authority figures, such as teacher, classroom

paraprofessional or principal. How long it takes the child to complete work in comparison to other children in the class. The child's fine and gross motor coordination. The child's academic skills in relation to classmates' performance.

The observer typically spends one class period observing. This, of course, can vary, depending upon what is being taught and at what grade level. Usually it is important to observe the child for at least forty minutes to one hour. Certainly, if the problem behaviors or skills are not apparent during that first observation, it may be necessary to come to the classroom on a different day or to gather samples of the child's work in the problem area(s).

The observational format selected will determine the manner in which the data is collected with a structured momentary time sampling procedure providing the soundest basis for addressing subject to peer comparisons on the behaviors and skills listed above. By combining the momentary time sample observational format with a narrative format it is possible to note how the student’s behavior is influenced by various settings, instructional formats etc,. The primary purpose of the observation is to document the degree to which the student is able to benefit from instruction provided in a mainstream setting. If the student has a learning disability the observation provides crucial information for the team in deciding whether or not the severe underachievement can only be corrected through the provision of special education services.

The checklist for rating processing disorders can be completed at the end of the formal observation. It is also advisable to check with the classroom teacher to determine if the behavior observed is representative of the student’s day-to-day functioning.



MATRIX: SELECTING AN OBSERVATION

Matrix: Selecting an Observation

Duration Latency Interval EventPermane

nt Product

ABC

Opportunities to Respond XAcademic

Engagement in Silent Reading

X X

Out of Seat X X XNumber of Correct

Responses X

Teacher Praise XSwearing X X

Asking for Help X XWriting X X X

Following Directions X X

Tantrums or Outbursts X X X

Vocalizing X XFidgeting X X



DURATION RECORDING FORMRochester Public Schools DURATION RECORDING FORM

Student:

Person completing this form:

Location:

Date(s):

Duration Recording – Description, Procedures, & ExampleIf you are interested in measuring how long a behavior lasts you can do that by using the Duration Recording method. However, in order to do so, you need to make sure that the behavior that you are looking at has a clear beginning and a clear ending so that you can tell exactly when the behavior starts and when it finishes. You will also need some timing instrument such as a wall clock, wristwatch, or stopwatch.Examples of behaviors that you might want to measure the length of include crying, being out of the classroom, being in a particular location, engaging in a particular activity.Procedures Write down the behavior that you will be looking for and its definition. Make sure that you have your timing instrument available prior to beginning your observation. Each time that you are observing for the behavior, write down the date and time. Each time the behavior occurs:

o Write down the time when the behavior begano Write down the time when the behavior stoppedo Calculate the length of time that the behavior lasted and write it in minutes and/or seconds. (This is what

you graph).

Behavior Definition (in specific, observable, measurable terms):

Date Time Enter time when the behavior began

Enter time when behavior stopped

Length of time that the behavior lasted for



EXAMPLE: DURATION RECORDING FORMRochester Public Schools DURATION RECORDING FORM

Student:


Location:

Date(s):

Duration Recording – Description, Procedures, & ExampleIf you are interested in measuring how long a behavior lasts you can do that by using the Duration Recording method. However, in order to do so, you need to make sure that the behavior that you are looking at has a clear beginning and a clear ending so that you can tell exactly when the behavior starts and when it finishes. You will also need some timing instrument such as a wall clock, wristwatch, or stopwatch.Examples of behaviors that you might want to measure the length of include crying, being out of the classroom, being in a particular location, engaging in a particular activity.Procedures Write down the behavior that you will be looking for and its definition. Make sure that you have your timing instrument available prior to beginning your observation. Each time that you are observing for the behavior, write down the date and time. Each time the behavior occurs:

o Write down the time when the behavior begano Write down the time when the behavior stoppedo Calculate the length of time that the behavior lasted and write it in minutes and/or seconds. (This is what

you graph).

Behavior Definition (in specific, observable, measurable terms):Behavior: Working individually. Behavior Definition: Sitting at desk, with an assignment on the desk, looking at assignment, not talking to peers. Once student looks up (not looking at assignment any more), the behavior has stopped. If student begins talking to peers while looking at assignment, behavior has stopped.

Date Time Enter time when the behavior began

Enter time when behavior stopped

Length of time that the behavior lasted for

11/5/06 9:30-10:30 a.m. 9:55 a.m. 10:06 a.m. 11 minutes

11/6/06 9:30-10:30 a.m. 9:43 a.m. 9:51 a.m. 8 minutes

11/6/06 9:30-10:30 a.m. 10:19 a.m. 10:28 a.m. 9 minutes

11/7/06 9:30-10:30 a.m. 10:04 a.m. 10:19 a.m. 15 minutes



LATENCY RECORDING FORMRochester Public Schools LATENCY RECORDING FORM

Student:


Location:

Date(s):

Latency Recording (i.e., Time to Respond) – Description, Procedures, & ExampleIf you are interested in measuring the time that it takes for the person to respond, you can measure just that by using the Latency Recording (Time to Respond) method. However, in order to do so, you need to make sure that the behavior that you are looking at has a clear beginning so that you can tell exactly when the behavior starts. To measure how long it takes to respond you will need some timing instrument such as wall clock, wristwatch, or stopwatch.Examples of behaviors where you might want to measure latency include how long it takes to go sit at one’s desk, how long it takes to take out materials, how long it takes to begin writing…Procedures Write down the behavior that you will be looking for and its definition Make sure that you have your timing instrument available prior to beginning your observation. Each time that you are looking for or expecting the behavior to occur write down the date and timeo Write down the time when the instruction to do the behavior is given.o Write down the time when the behavior starts.o Calculate the length of time (i.e., latency) that it took for the behavior to begin and write it in minutes and/or

seconds (This is what you graph).

Behavior Definition (in specific, observable, measurable terms):

Date Time Enter time when the instruction began

Enter time when behavior starts

Length of time for the behavior to start



EXAMPLE: LATENCY RECORDING FORMRochester Public Schools

LATENCY RECORDING FORMStudent:


Location:

Date(s):

Latency Recording (i.e., Time to Respond) – Description, Procedures, & ExampleIf you are interested in measuring the time that it takes for the person to respond, you can measure just that by using the Latency Recording (Time to Respond) method. However, in order to do so, you need to make sure that the behavior that you are looking at has a clear beginning so that you can tell exactly when the behavior starts. To measure how long it takes to respond you will need some timing instrument such as wall clock, wristwatch, or stopwatch.Examples of behaviors where you might want to measure latency include how long it takes to go sit at one’s desk, how long it takes to take out materials, how long it takes to begin writing…Procedures Write down the behavior that you will be looking for and its definition Make sure that you have your timing instrument available prior to beginning your observation. Each time that you are looking for or expecting the behavior to occur write down the date and timeo Write down the time when the instruction to do the behavior is given.o Write down the time when the behavior starts.o Calculate the length of time (i.e., latency) that it took for the behavior to begin and write it in minutes and/or

seconds (This is what you graph).

Behavior Definition (in specific, observable, measurable terms):Behavior: Time it takes to start working. Behavior Definition: Time it takes for the student to begin writing on assignment paper after instruction to start working on assignment is given to the whole class.

Date TimeEnter time when the instruction

beganEnter time when behavior starts

Length of time for the behavior to start

11/5/06 8:30-9:30 a.m. 8:46 a.m. 8:52 a.m. 6 minutes

11/5/06 1:30-2:30 p.m. 1:46 p.m. 1:48 p.m. 2 minutes

11/6/06 8:30-9:30 a.m. 8:32 a.m. 8:35 a.m. 3 minutes

11/6/06 1:30-2:30 p.m. 1:41 p.m. 1:46 p.m. 5 minutes

11/7/06 8:30-9:30 a.m. 8:55 a.m. 9:02 a.m. 7 minutes




INTERVAL OBSERVATION RECORDING FORM (PART A)Rochester Public Schools INTERVAL OBSERVATION RECORDING

FORM(Part A)

Student:


Location:

Date(s):

Directions:Off/On Task measures are sampled at the onset of each 30 second interval. Every 30 seconds look up and record a mark if the student is not looking at or toward the directed educational stimulus. Physical, Vocal/Noise, and Out-of-Place are recorded as they occur across each 30-second interval. Record each discrete response occurring within each interval or mark a single response in each box when the response occurs continuously across two or more consecutive intervals.

KEYPhysical: Inappropriate contact or hurling of objects, damage to property, or inappropriate motor behavior: Inappropriate is a function of context, duration of context, duration of intensity.Vocal/Noise: Inappropriate acoustic responses not listed otherwise as physically inappropriate: Inappropriate is a function of context, duration or intensity.Place: Out of explicitly or implicitly defined locations.Compliance: Is a measure of student responses per opportunity to respond. Each time a group or individual directive is given, mark below the diagonal line of the box for the interval in which the directive is given. Mark above the diagonal line of the box for the interval in which compliance with the directive occurs. The total number above the diagonal represents compliance responses and the total number below the diagonal represents opportunities.

Target = T Peers = POBS 1

Setting:________Date: __________Time:__________

OBS 2Setting:________Date: __________Time:__________

OBS 3Setting:________Date: __________Time:__________

Median Greater median#Smaller

median#

Discrepancy

On TaskT

P

________

________

________

________

________

________

_______

___________ ____ = ________

PhysicalT

P

________

________

________

________

________

________

_________

___________ ____ = ________

Vocal/Noise

T

P

________

________

________

________

________

________

_______

___________ ____ = ________

PlaceT

P

________

________

________

________

________

________

_______

___________ ____ = ________

Compliance

T

P

________

________

________

________

________

________

_______

___________ ____ = ________


Use Part B for recording observation data



INTERVAL OBSERVATION RECORDING FORM (PART B)Student: School: Grade:Observer: Teacher: Setting:Date: Time observed from ________________to ___________________ Intervals are 30 seconds

See Interval Observation: Directions and Summary FormTARGET 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Total RPM= Rate per Min.

RPH= Rate per Hour

On-Task ____ 20 x100

= __%

Physical ____RPM RPH

10 ___ x60____Vocal/Noise ____ 10 ___ x60____Place ____ 10 ___ x60____Compliance ____ R0=______%

PEER M/F 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Total RPM= Rate per Min. RPH= Rate per Hour

On-Task ____ 20 x100

= __%

Physical ____RPM RPH

RPH10 ___ x60____Vocal/Noise ____ 10 ___ x60____Place ____ 10 ___ x60____Compliance ____ R0=______%

Behavioral Comments:Off/On-TaskPhysical/ContactVocal/NoisePlaceComplianceGeneral Comments




EXAMPLE: INTERVAL OBSERVATION RECORDING FORM (PART A)Rochester Public Schools

INTERVAL OBSERVATION RECORDING

FORM(Part A)

Student:

John Doe Person completing this form:

Johnson

Location:

Mayo High School Date(s):

11/5/06

Directions:Off/On Task measures are sampled at the onset of each 30 second interval. Every 30 seconds look up and record a mark if the student is not looking at or toward the directed educational stimulus. Physical, Vocal/Noise, and Out-of-Place are recorded as they occur across each 30-second interval. Record each discrete response occurring within each interval or mark a single response in each box when the response occurs continuously across two or more consecutive intervals.

KEYPhysical: Inappropriate contact or hurling of objects, damage to property, or inappropriate motor behavior: Inappropriate is a function of context, duration of context, duration of intensity.Vocal/Noise: Inappropriate acoustic responses not listed otherwise as physically inappropriate: Inappropriate is a function of context, duration or intensity.Place: Out of explicitly or implicitly defined locations.Compliance: Is a measure of student responses per opportunity to respond. Each time a group or individual directive is given, mark below the diagonal line of the box for the interval in which the directive is given. Mark above the diagonal line of the box for the interval in which compliance with the directive occurs. The total number above the diagonal represents compliance responses and the total number below the diagonal represents opportunities.

Target = T Peers = POBS 1

Setting: Math 7Date: 11/5/06Time: 9:00-9:20

OBS 2Setting:________Date: _________Time:__________

OBS 3Setting:________Date: _________Time:__________

Median Greater median#Smaller

median#

Discrepancy

On TaskT

P

75%

85%

________

________

________

________

_______

___________ ____ = ________

PhysicalT

P

12%

6%

________

________

________

________

_________

___________ ____ = ________

Vocal/Noise

T

P

12%

6%

________

________

________

________

_______

___________ ____ = ________

PlaceT

P

12%

6%

________

________

________

________

_______

___________ ____ = ________

Compliance 100% ________ ________ _______Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-52

T

P100% ________ ________ _______

____ ____ = ________

Use Part B for recording observation data



EXAMPLE: INTERVAL OBSERVATION RECORDING FORM (PART B)Rochester Public Schools

INTERVAL OBSERVATION RECORDING FORM (PART B)Student: John Doe School: Mayo High School Grade: 7Observer: Johnson Teacher: Cook Setting: MathDate: 11/5/06 Time observed from 9:00 a.m. to 9:20 a.m. Intervals are 30 seconds

See Interval Observation: Directions and Summary FormTARGET 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Total RPM= Rate per Min.

RPH= Rate per Hour

On-Task √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ __15__ 20 x100 = 75 %

Physical √ √ __2__RPM RPH

10 .2 x 60 12

Vocal/Noise √ √ __2__10 .2

x 60 12

Place √ √ __2__10 .2

x 60 12

Compliance √√

√√ __2/2__ R0 = 100%

PEER M/F 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Total RPM= Rate per Min. RPH= Rate per Hour

On-Task √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ _17_ 20 x100

= 85%

Physical √ __1_RPM RPH

RPH10 .1 x 60 6 Vocal/Noise √ __1_ 10 .1 x 60 6 Place √ __1_ 10 .1 x 60 6 Compliance √

√√√ _2/2_ R0 = 100%

Behavioral Comments:Off/On-TaskPhysical/ContactVocal/NoisePlaceCompliance


General Comments



EVENT/FREQUENCY OBSERVATION RECORDING FORMRochester Public Schools

EVENT/FREQUENCY OBSERVATION

RECORDING FORMStudent:


Location:

Date(s):

When the behavior that you are looking at can be easily counted, Event/Frequency Recording may be the best method to use. A behavior can be easily counted when:

The behavior has a clear beginning and end, and It does not happen at such a high rate that it is hard to keep track of.

Some examples of behaviors that you can measure by event/frequency recording include leaving one’s seat, raising one’s hand, yelling out an answer, asking to go to the bathroom, being on time, opportunities to respond, teacher praise, number of correct responses, etc.The use of tally marks is probably the easiest and most accurate technique to use to keep track of behaviors as they occur.Procedures for use:

Write down the behavior that you will be looking for and its definition. During each observation period:

o Write down the dateo Write down the timeo Make a tally mark each time the behavior occurs (enter “0”) if the behavior

does not occur)o When the observation is complete, total the number of tally marks for that day

and graph.

Behavior Definition (in specific, observable, and measurable terms):

Date Class Time Tally when behavior occurs:

Total number of times behavior occurred:

Notes/Comments:Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-56



EXAMPLE: EVENT/FREQUENCY OBSERVATION RECORDING FORMRochester Public Schools

EVENT/FREQUENCY OBSERVATION

RECORDING FORMStudent:

John Doe Person completing this form:

Johnson

Location:

John Marshall High School Date(s):

11/5/06

When the behavior that you are looking at can be easily counted, Event/Frequency Recording may be the best method to use. A behavior can be easily counted when:

The behavior has a clear beginning and end, and It does not happen at such a high rate that it is hard to keep track of.

Some examples of behaviors that you can measure by event/frequency recording include leaving one’s seat, raising one’s hand, yelling out an answer, asking to go to the bathroom, being on time, opportunities to respond, teacher praise, number of correct responses, etc.The use of tally marks is probably the easiest and most accurate technique to use to keep track of behaviors as they occur.Procedures for use:

Write down the behavior that you will be looking for and its definition. During each observation period:

o Write down the dateo Write down the timeo Make a tally mark each time the behavior occurs (enter “0”) if the behavior does

not occur)o When the observation is complete, total the number of tally marks for that day

and graph.

Behavior Definition (in specific, observable, and measurable terms):Behavior: Leaving seat during class time. Behavior Definition: Being at least one foot away from desk/seat during class, anytime after tardy bell rings. This includes when John asks permission to leave seat.

Date Class Time Tally when behavior occurs: Total number of times behavior occurred:

11/5/06 Math 7 8:50-9:35 / / / / / 6

11/6/06 Social 7 1:10-1:55 / / / / 4

11/7/06 English 2:15-3:00 / / / / / / 7

Notes/Comments:



PERMANENT PRODUCT RECORDING FORMRochester Public Schools

PERMANENT PRODUCT RECORDING

FORMStudent:


Location:

Date(s):

Permanent Product Recording – Description, Procedures, & ExampleWhen the behavior that you are looking at results in a lasting product, Permanent Product may be the best method to use because you don’t have to be “on the lookout” for the behavior to happen, as you can measure it afterwards by looking at its product. However, you do have to be careful that only the target person’s target behavior, and not someone else’s or some other behavior, results in the product that you have chosen to look at.Examples of lasting products to look at include having a bed made, having a clean room, written assignments, papers thrown on the floor, items left on the table, the way someone is dressed. In these examples, the behaviors that you might be looking for could be, cleaning, answering questions correctly, number of completed assignments, number of assignments turned in, dressing skills, and self-help skills.Procedures: Write down the permanent product that you will be looking at. Write down the behavior that you will be looking for in that permanent product, and its definition. For each permanent product that you look at:o Enter the date when the permanent product was completed.o If the permanent product that you are looking at could occur several times during the day, also enter the

time.o If there are different types of permanent products that you are looking at, enter the label of that permanent

product.o If the behavior that you are measuring could occur more than once in that permanent product (ex. you are

looking at correct answers in homework assignments), write down: The number of times that the behavior occurred. The number of opportunities in which the behavior could have occurred. If the behavior did not occur, make sure to enter “0” – zero.

o Calculate the Total Percent of number of times that the behavior occurred per day (This is what you graph).


Date Time Permanent Product Label

No. of Times Behavior Occurred (# correct

answers)Number of

OpportunitiesTotal % of Times

Behavior Occurred




EXAMPLE: PERMANENT PRODUCT RECORDING FORMRochester Public Schools

PERMANENT PRODUCT RECORDING

FORMStudent:


Location:

Date(s):

Permanent Product Recording – Description, Procedures, & ExampleWhen the behavior that you are looking at results in a lasting product, Permanent Product may be the best method to use because you don’t have to be “on the lookout” for the behavior to happen, as you can measure it afterwards by looking at its product. However, you do have to be careful that only the target person’s target behavior, and not someone else’s or some other behavior, results in the product that you have chosen to look at.Examples of lasting products to look at include having a bed made, having a clean room, written assignments, papers thrown on the floor, items left on the table, the way someone is dressed. In these examples, the behaviors that you might be looking for could be, cleaning, answering questions correctly, number of completed assignments, number of assignments turned in, dressing skills, self-help skills.Procedures: Write down the permanent product that you will be looking at. Write down the behavior that you will be looking for in that permanent product, and its definition. For each permanent product that you look at:o Enter the date when the permanent product was completed.o If the permanent product that you are looking at could occur several times during the day, also enter the time.o If there are different types of permanent products that you are looking at, enter the label of that permanent

product.o If the behavior that you are measuring could occur more than once in that permanent product (ex. you are

looking at correct answers in homework assignments), write down: The number of times that the behavior occurred. The number of opportunities in which the behavior could have occurred. If the behavior did not occur, make sure to enter “0” – zero.

o Calculate the Total Percent of number of times that the behavior occurred per day (This is what you graph).


Behavior: Answering questions correctly on homework assignments turned in. Behavior Definition: Answers on homework questions are complete and accurate (excludes partially answered items). Excludes any written assignments performed in class. Permanent Product Looked At: Homework assignments turned in.

Date Time Permanent Product Label

No. of Times Behavior Occurred (# correct

answers)

Number of Opportunitie

s

Total % of Times Behavior Occurred

11/5/06 2 p.m. Homework Section I 12 20 (12/20) x 100 = 60

11/6/06 2 p.m. Homework Section II 4 10 (4/10) x 100 = 40

11/7/06 2 p.m. Homework Section III 25 40 (25/40) x 100 = 63




A-B-C OBSERVATION SHEETRochester Public Schools

PROBLEM IDENTIFICATIONA-B-C OBSERVATION SHEET

Important: Please fill out after EVERY incident of problem behaviorStudent:

Observer: Target Behavior:

ABC/Anecdotal Data Recording: An ABC Chart is a direct observation tool that can be used to collect information about the events that are occurring within a student’s environment. “A” refers to the antecedent, or the event or activity that immediately precedes a problem behavior. The “B” refers to observed behavior, and “C” refers to the consequence, or the event that immediately follows a response. For example, a student who is drawing pictures instead of working on his class assignment may react by cursing or throwing his pencil when his teacher tells him to finish the task. The teacher may discover that verbal requests to work and other demands are antecedents that trigger problem behavior. Common antecedents include critical feedback from others absence of attention, and specific tasks or activities. The consequence may be that the teacher sends the student to the office every time he curses and throws his pencil. Over several observation sessions, it may become clear that the student is engaging in problem behavior to escape from his class assignment.An ABC Chart is used to organize information over several observation sessions by recording the types of behaviors observed and the events that precede and follow the behavior. Observing and recording ABC data assists the team in forming a hypothesis statement and gathering evidence that the function maintaining a problem behavior has been identified.

DateTime

Person present when

behavior occurred

Which predictors were present?

1. He/She was tired.2. He/She was hungry.3. He/She was bored.4. He/She was sick.5. There was a change in his schedule.

Where did the problem occur?

(example: kitchen, yard, mall)

Describe specifically and completely the PROBLEM behavior (example: yelling,

pushing, screaming at X)

Describe specifically and completely what

happened 30 minutes BEFORE the

problem behavior (example: I ask

him/her to take a shower).

Describe specifically and completely what happened during the

30 minutes FOLLOWING the

problem behavior including your intervention

(example: I asked what was wrong)

Hypothesized function




GUIDELINES FOR TEAM OVERRIDE ON ELIGIBILITY DECISIONS

Documentation Required A team may determine that a student is eligible for special education and related services (even though the student does not meet the specific requirement in law) if they believe the student has a disability and needs special instruction. If the team is considering an override, they must contact their SSS Supervisor prior the meeting. Any overrides must be sent to the Director of Student Support Services, In order to do this the team must include the documentation in the student’s special education record in accordance with items A, B, C, and D.

A. The student’s record must contain documents that explain why the standards and procedures, used with the majority of students, resulted in invalid findings for this student.

B. The record must indicate what objective data were used to conclude that the student has a disability and is in need of specialized instruction. These data include, for example, test scores, work products, self-reports, teacher comments, medical data, previous testing, observational data, ecological assessments, and other developmental data.

C. Since the eligibility decision is based on a synthesis of multiple data and not all data are equally valid, the team must indicate which data had the greatest relative importance for the eligibility decision.

D. The team override decision must be signed by the team members agreeing to the override decision. For those team members who disagree with the override decision, a statement of why they disagree and their signature must be included.

Evaluation ProceduresEach public agency shall ensure, at a minimum, that the following requirements are met:(a) (1) Tests and other evaluation materials used to assess a child under Part B of the Act:

(i) are selected and administered so as not to be discriminatory on a racial or cultural basis; and

(ii) are provided and administered in the child’s native language or other mode of communication, unless it is clearly not feasible to do so; and

(2) Materials and procedures used to assess a child with limited English proficiency are selected and administered to ensure that they measure the extent to which the child has a disability and needs special education, rather than measuring the child’s English language skills.

(b) A variety of assessment tools and strategies are used to gather relevant functional and developmental information about the child…

(c) (1) any standardized tests that are given to a child –(i) have been validated for the specific purpose for which they are used; and (ii) are administered by trained and knowledgeable personnel in accordance with

any instructions provided by the producer of the tests.(2) if an assessment is not conducted under standard conditions, a description of the

extent to which it varied from standard conditions (e.g., the qualifications of the person administering the test, or the method of test administration) must be included in the evaluation report.

Determination of eligibility(a) Upon completing the administration of tests and other evaluation materials –


(1) a group of qualified professionals and the parent of the child must determine whether the child is a child with a disability; and

(2) the public agency must provide a copy of the evaluation report and the documentation of determination of eligibility to the parent.

(b) A child may not be determined to be eligible under this part if:(1) the determinant factor for that eligibility determination is:

(i) lack of instruction in reading or math; or (ii) limited English proficiency…

Procedures for determining eligibility and placement(a) In interpreting evaluation data for the purpose of determining if a child is a child with a

disability and the educational needs of the child, each public agency shall:(1) draw upon information from a variety of sources including aptitude and

achievement tests, parent input, teacher recommendations, physical condition, social or cultural background, and adaptive behavior…

Native language(a) As used in this part, the team native language, if used with reference to an individual of

limited English proficiency, means the following:(1) The language normally used by that individual, or, in the case of a child, the

language normally used by the parents of the child, except as provided in paragraph (a)(2) of this section.

(2) In all direct contact with a child (including evaluation of the child), the language normally used by the child in the home or learning environment.

(b) For an individual with deafness or blindness, or for an individual with no written language, the mode of communication is that normally used by the individual (such as sign language, Braille, or oral communication).


R o c h e s t e r P u b l i c S c h o o l s :

T o t a l S p e c i a l E d u c a t i o n S y s t e m M a n u a l D o c u m e n t a t i o n

PROCEDURES FOR EXITING STUDENTS FROM SPECIAL EDUCATIONThere are times when a student exits special education for reasons other than graduation or aging out. Case managers must follow these procedures for exiting students.

1. Write a Notice of Educational Evaluation/Reevaluation Plan and send it with the Notice of Proposed Action / Denial for parent consent.

2. Evaluate the student using procedures listed on the evaluation plan.3. Write a draft Evaluation Report summarizing the evaluation results.4. Meet as an IEP team to review the evaluation and determine if the student continues to

be a student with a disability.5. Complete a Notice of Proposed Services stating that the student is no longer a

student with a disability. Be sure to answer all of the following questions: A description of the action proposed or refused by the district; An explanation of why the district proposes or refused to take the action; A description of each evaluation procedure, test, record, or report the district used

as a basis for the proposed or refused action; and A description of any other factors that is relevant to the district’s proposal or

refusal.Send the Prior Written Notice, a copy of the Evaluation Report, and a Notice of Proposed Action / Denial to parents for their consent.


R o c h e s t e r P u b l i c S c h o o l s :T o t a l S p e c i a l E d u c a t i o n S y s t e m M a n u a l D o c u m e n t a t i o n

PROCEDURES FOR EXITING STUDENTS THROUGH GRADUATIONStudents with disabilities who leave high school with a regular diploma or by reaching maximum age of eligibility are provided a Graduating Exit Report-Summary of Performance. The following procedures will be followed:

1) Write a Summary of Performance just prior to the student leaving the high school setting. This is a separate document from the IEP. There does not need to be a reevaluation prior to exiting special education through graduation.Schools have no obligation to provide assessment solely for the identification or eligibility for other agencies or services not related to K-12 education.If a special education student drops out, no Summary of Performance is required.

2) Graduation is a change of placement. Notice of Proposed Action /Denial must be completed and signed by the parent or student, if age 18 or older.



GUIDELINES FOR WRITING A GRADUATION REPORT – SUMMARY OF PERFORMANCE

Graduation ExitIDEA 04 requires that for a student whose eligibility terminates through graduation with a diploma or aging out, the district must provide the student with a summary of the student’s academic achievement and functional performance that includes recommendations on how to assist the student in meeting postsecondary goals.Federal law also requires that the district plan for a student’s graduation. Inform parents in the fall of the year the student is expected to graduate, the district’s intent to graduate/exit the student. Graduation or aging-out is a change of placement. Therefore, it is necessary to also provide a Notice of Proposed Action indicating the student’s dismissal due to graduation, along with the Graduation Exit Summary of Performance Report.

Summary of PerformanceFor which student is the Summary of Performance required and when should a Summary of Performance be provided?Students who are receiving special education services when leaving high school and who are leaving due to receiving a regular diploma or by reaching the maximum age of eligibility are required to have a Summary of Performance. The Summary of Performance should ideally be provided to the student just prior to leaving the high school setting. Completion of the Summary too far in advance of graduation of leaving high school may result in incomplete records, recommendations, and summarizations of both academic achievement and functional performance.

Do students who receive a GED require a Summary of Performance?NO, only those students who leave high school with a regular diploma or be reaching maximum age of eligibility require a Summary of Performance.

Do students who have been staffed out of special education during their senior year prior to graduation or who have dropped out require a Summary of Performance?No, if special education services have ended prior to the student leaving the high school setting with a diploma or by reaching the maximum age of eligibility, no Summary of Performance is required. If the special education student drops out, no Summary of Performance is required.

Is the Summary of Performance part of the IEP?No, the Summary of Performance is NOT a part of the IEP; it falls under the section of IDEA 2004 that determines the need for reevaluation prior to exiting special education.

Can the student’s current IEP be the Summary of Performance?No, as stated above, the Summary of Performance is not regarded as the IEP and is clearly identified as a separate process from the IEP. If the summary were intended to be part of the IEP, it is likely the reauthorization would have included it in the section of IDEA 2004 pertaining to IEP content. It is the current interpretation by our department that this must be a separate document from the IEP.


Who needs to be present when reviewing the Summary of Performance with a student and his/her family?The primary service provider (case manager), the student and the parent are the only people required to review the Summary of Performance. This does not need to be a formal meeting, but documentation that the Summary has been provided should be obtained. This can be done by collecting signatures on the Summary of Performance.

Are new assessments required to complete the Summary of Performance?No, IDEA 2004 clearly indicates that schools have NO obligation to provide assessment solely for the identification or eligibility for other agencies or services not related to K-12 education.

If a student has not met all their IEP goals and objectives, does this influence the Summary of Performance?No, the Summary of Performance is provided when the student approaches the termination of his/her Free and Appropriate Public Education (FAPE) and therefore is based on the attainment of the diploma or the reaching of maximum age of eligibility (the student’s progress on IEP goals and objectives is not a factor).

What is the process for students who receive a Certificate of Completion, a modified diploma, or leave high school without documentation and do so prior to reaching the maximum age of eligibility?Students who leave high school under the circumstances above must have an eligibility review meeting to establish the change in placement. A student may continue to qualify for special education, but refuse to continue services and therefore leave the high school setting. It is important to note that for these students FAPE has not ended and they may return to continue special education or regular education services until age 21.

Is a Summary of Performance required for students who are expelled?No, students who are expelled and have an IEP are still entitled to FAPE and therefore shall not receive a Summary of Performance until they have either received a diploma or reached the maximum age of eligibility.



GRADUATION EXIT REPORT – SUMMARY OF PERFORMANCE ROCHESTER PUBLIC SCHOOLSSUMMARY OF PERFORMANCE

Part 1: Student Information

Student Name: ________________________________ Date of Birth: _____________ Year of Graduation/Exit: ___________

Address: ___________________________________________________________________________________________________ (street) (town, state) (zip code)

Current School: ____________________ Student’s primary disability: __________ Student’s secondary disability: _________

Name and phone number of person completing this form: __________________________________________________________

Date Summary was completed: __________ Date of most recent IEP: __________________

Please check off and include the most recent copy of evaluation reports that you are attaching that address or identify the student’s disability and/or that will assist in postsecondary planning:

□ Psychological/cognitive □ Response to Intervention (RTI)□ Neuropsychological □ Language proficiency assessments□ Medical/physical □ Reading assessments□ Achievement/academics □ Communication□ Adaptive behavior □ Behavioral analysis□ Social/interpersonal skills □ Classroom observations□ Community-based assessment □ Career/vocational/transition□ Self-determination □ Assistive technology□ Other: _______________________________________________________

Part 2 – Student’s Postsecondary Goal(s)


1.

2.

3.

If employment is the primary goal, the top three job interests:

Part 3 – Summary of PerformanceACADEMIC CONTENT AREA Present Level of

Performance(grade level, standard scores, strengths, weaknesses)

Essential accommodations/modification and/or assistive technology utilized in high school

Reading (Basic reading/decoding; reading comprehension; reading speed)

Math (Calculation skills, math problem solving)

Page 2 of 5

Language (Written composition, written and oral expression, spelling)

Learning Skills (class participation, note-taking, keyboarding, organization, homework management, time management, study skills, test-taking skills)

COGNITIVE AREAS Present Level of Performance Essential accommodations/modification and/or assistive technology utilized in high school

General Ability and Problem Solving (reasoning/processing)


Attention and Executive Functioning (energy level, sustained attention, memory functions, processing speed, impulse control, activity level)

Communication (speech/language, augmentative communication)

Additional Relevant Factors (other cognitive strengths/weaknesses, conducive learning environments, effective learning strategies, etc.)

FUNCTIONAL AREAS Present Level of Performance Essential accommodations/modification and/or assistive technology utilized in high school

Career/Vocational/Transition (Career interests, career exploration opportunities, job training opportunities)

Page 3 of 5

Social Skills and Behavior (Interactions with teachers/peers, level of initiation in asking for assistance, responsiveness to services and accommodations, degree of involvement in extracurricular activities, confidence and persistence as a learner, emotional or behavioral issues related to learning and/or attention)Independent Living Skills (Self-care, leisure skills, personal safety, mobility, transportation, banking, budgeting)

Self-Determination/Self-Advocacy Skills (Ability to identify and articulate learning strengths and weaknesses, ability to ask for assistance with independence)

Additional important considerations that can assist in making decisions about disability determination and needed accommodations (e.g., medical problems, family concerns, sleep disturbance, etc.)

Part 4 – Recommendations to assist student in meeting post secondary goals

What are the essential accommodations, modifications, assistive technology or general areas of support that students will need to be successful in the following post-high school environments:

Higher Education or Vocational Training:

Employment:

Independent Living:

Community participation:


Page 4 of 5

Part 5 – Student Input (Optional)

SUMMARY OF PERFORMANCE: STUDENT PERSPECTIVE

A. How does your disability affect your school work and school activities (such as grades, relationships, assignments, projects, communication, time on tests, mobility, extra-curricular activities)?

B. In the past, what supports have been tried by teachers or by you to help you succeed in school (aids, adaptive equipment, physical accommodations, other services)?

C. Which of these accommodations and supports has worked best for you?

D. Which of these accommodations and supports have not worked?

E. What strengths and needs should professionals know about you as you enter the college or work environment?

I have reviewed and agree with the contents of this Summary of Performance.

Student Signature: ________________________________________ Date: ____________

Page 5 of 5



GUIDELINES ON ACCESS AND STORAGE OF TEST PROTOCOLSUnder the Family Educational Rights and Privacy Act (FERPA), a district must permit parents of a student with a disability to inspect and review educational records about their child. A district must respond to such a request within ten business days and must comply with the request before an IEP team meeting or due process hearing is held and within 45 calendar days. Test data is part of the educational record.

Test Protocols as Educational DataTo determine whether the test protocols contain educational data and to what extent before releasing them to the parents, use the following guidelines provided by the Family Policy Compliance Office (FPCO), the federal office responsible for implementation of FERPA.

1. If the test questions and answers are both personally identifiable to the student (that is, if the answers appear on the same sheet as the questions, and are identified by the student’s name), the parents have a right to inspect both the questions and answers.

2. If the questions are separate from the answers, and only the answers are personally identifiable to the student, the parent has the right of access to the answers only. However, since 34 C.F.R. § 99.10 also requires an agency to respond to a reasonable request for explanation or interpretation of the record, the agency would have to inform the parent of the questions, if so requested, in order to explain the answers to the questions.

See Letter to Thomas, 211 IDELR 240 (FPCO 1986).

If schools maintain copies of a student’s test answer sheets (an ‘education record’), the parent would have a right under Part B [of IDEA] and FERPA to request an explanation and interpretation of the record. The explanation and interpretation by the school district could entail showing the parent the test question booklet, reading the questions to the parent, or providing an interpretation for the responses in some other adequate manner that would inform the parent. 34 C.F.R. § 300.562 (discussion).

Providing Copies of Test Protocols and Educational DataThe district is not unequivocally obliged to distribute copies of test protocols containing educational data to the parents unless failure to do so would effectively prevent the parents from exercising their right to inspect and review. 34 C.F.R. § 300.562(b)(2). In other words, if parents are physically unable to inspect and review the educational data about their child, the district must provide copies of the data to them. The U.S. Department of Education has interpreted this to mean that a parent shall receive copies of the records when he or she lives too far from the school district to see the records in person. Letter to Anonymous, 213 IDELR 188 (OSERS 1989) and Letter to Kincaid, 213 IDELR271(OSERS 1989). The parent might also be prevented from exercising the right to inspect and review for other reasons, such as a disability, lack of transportation, etc. Representatives from the district may use their own judgment regarding whether a parent is effectively denied access, but should take the above examples into consideration when making this determination.


In Letter to Thomas, the FPCO determined that “an educational agency or institution makes fair use of copyrighted material when the agency or institution provides a copy of test questions and a student’s answers to those questions to the parents of the students.” 211 IDELR 420 (FPCO 1986). However, to reduce the risk of test security violations, the FPCO also counseled: “[Districts] mark the documents with appropriate language informing the party to whom it is released that the test instrument is copyrighted.” Even though this approach will not alleviate all test security concerns, a district must balance those concerns with a parent’s right, guaranteed by federal law, to inspect and review his or her child’s educational data.

Rights of a Parent Representative The IDEA regulations diverge from FERPA by allowing a parent representative access to inspect and review special education data on behalf of the parent; however, nothing in FERPA, IDEA or its implementing regulations allows a parent representative to obtain copies of the child’s educational data directly from the district, even if the district has parental consent. See 34 C.F.R. § 300.562(b)(3) and 34 C.F.R. § 99.10(d).

Nothing in that EHA-B3 provision gives a parent representative the right to obtain a copy of an education record of a student, even if failure to provide the copy would effectively prevent the representative from inspecting and reviewing the record. Therefore, while a school district is not required to give copies of education records to a parent representative, a parent could obtain copies of records, if he or she has a right to them, and provide them, in turn, to a representative.Letter to Longest, 213 IDELR 173 (OSEP 1988).



GUIDELINES FOR WRITING THE EVALUATION REPORTThe Evaluation Summary Report (ER) should include:1. Reason for Referral- Summarize the information that led to the referral2. Background Information (including Review of Existing Information,

Language/Racial/Cultural Factors, and Information from Parents)- Summarize relevant information in the student’s file, information about the student’s background and how that impacts the evaluation, as well as information shared by parents. Include concerns and information that would help the team make decisions about special education eligibility and identify student educational needs.

3. Evaluation Results and Interpretation- All tests, evaluations and assessments must be listed on the evaluation plan signed by the parent. List and describe the evaluations conducted and summarize pertinent test scores that relate to any eligibility categories being considered. Summarize existing data such as current classroom-based evaluation and observations, district and state assessments, curriculum based measurements, and information from prior evaluations. Describe the student’s current levels of functioning for skills and behavior. Do not just list scores. Be sure to interpret the test scores and results. Parents should be able to understand the results from the information you have provided.

4. Present Level of Performance- Based on existing data and evaluation results write a comprehensive summary of the student’s functioning. If the student qualifies for special education, this statement should flow with the educational needs and the Present Level of Performance statement and goals in the student’s IEP.

5. Eligibility Determination- Summarize the team’s interpretation of all the evaluation results and the team’s judgment regarding eligibility, addressing all criteria components. Write a narrative summary synthesizing the evaluation results and data from all team members. The data should support the team’s decision concerning eligibility or continuing need for special education services. The interpretation of the team synthesized the evaluation results and relates the data to the eligibility criteria to support the team’s decision regarding eligibility. Merely stating the components or checking off the components on a checklist is not sufficient. The eligibility statement must include the supporting documentation to verify each criteria component. All criteria components must be addressed for both initial evaluation and reevaluation. When no additional data are needed, summarize the existing data that supports continued eligibility and need for service.

6. Educational Needs that Derive from the Disability- State the educational needs of the student. Educational needs are individually determined, student-based skills or behavior that requires specialized instruction in skill and/or behavior areas and compensatory strategies. Education needs do not refer to materials, methods, or types of special education services. It is important that all recommendations brought to the meeting by the team members are discussed and synthesized into needs statements which will generate the goals on the IEP.



CHAPTER 3A: Autism Spectrum Disorders (ASD) Documentation


STATE GUIDELINES: AUTISM SPECTRUM DISORDERS (ASD)Definition. “Autism spectrum disorders (ASD)” means a range of pervasive developmental disorders that adversely affect a student’s functioning and result in the need for special education instruction and related services. ASD is a disability category characterized by an uneven developmental profile and a pattern of qualitative impairments in several areas of development: social interaction, communication, or restrictive repetitive and stereotyped patterns of behavior, interests, and activities, with onset in childhood. Characteristics can present themselves in a wide variety of combinations from mild to severe, as well as in the number of symptoms present, for example Autistic Disorder, Childhood Autism, Atypical Autism, Pervasive Developmental Disorder: Not Otherwise Specified, Asperger’s Disorder, or other related pervasive developmental disorders.

Criteria. The multidisciplinary team shall determine that a student is eligible and in need of special education instruction and related services if the student demonstrates patterns of behavior consistent with those in item A and fulfills the requirements in item B.

A. An educational evaluation must address all three core features in subitems (1) to (3). For eligibility purposes, there must be documented evidence the student demonstrates the specific patterns of behavior described in at least two of these subitems, one of which must be subitem (1). The eligibility determination must be supported by information collected from multiple settings and sources.

Behavioral indicators of these core features must be atypical for the student’s developmental level. Documentation of behavioral indicators must include the use of at least two of these methods: structured interviews with parents, autism checklists, communication and developmental rating scales, functional behavior assessments, application of diagnostic criteria from the current Diagnostic and Statistical Manual (DSM), informal and standardized evaluation instruments, or intellectual testing.

(1) Qualitative impairment in social interaction, as documented by two or more behavioral indicators, such as: limited joint attention and limited use of facial expressions directed toward others; does not show or bring things to others to indicate an interest in the activity; demonstrates difficulties in relating to people, objects, and events; a gross impairment in ability to make and keep friends; significant vulnerability and safety issues due to social naiveté; may appear to prefer isolated or solitary activities; misinterprets others’ behaviors and social cues.

(2) Qualitative impairment in communication, as documented by one or more behavioral indicators, such as: not using finger to point or request; using others’ hand or body as a tool; showing lack of spontaneous imitation or lack of varied imaginative play; absence or delay of spoken language; limited understanding and use of nonverbal communication skills such as gestures, facial expressions, or voice tone; odd production of speech including intonation, volume, rhythm, or rate; repetitive or


idiosyncratic language or inability to initiate or maintain a conversation when speech is present.

(3) Restricted, repetitive, or stereotyped patterns of behavior, interest, and activities, as documented by one or more behavioral indicators, such as: insistence on following routines or rituals; demonstrating distress or resistance to changes in activity; repetitive hand or finger mannerism; lack of true imaginative play versus reenactment; overreaction or under-reaction to sensory stimuli; rigid or rule-bounding thinking; an intense, focused preoccupation with a limited range of play, interests, or conversation topics.

B. The team shall verify that an ASD adversely affects a student’s present level of performance and that the student is in need of special education and related services. This verification is completed through the multidisciplinary team evaluation and summarized in the student’s evaluation report. Documentation must be supported by data from each of the following components:

(1) The evaluation must identify the student’s present level of performance and educational needs in each of the core features identified by the team in item A. In addition, the evaluation process must give consideration to all other areas of educational concern consistent with the IEP process.

(2) The student’s need for instruction and services must be documented and supported by evaluation and observations in two different settings, on two different days.

(3) A developmental history which summarizes developmental information and behavior patterns.

Team membership. At least one professional with experience and expertise in the area of ASD must be included on the team determining eligibility and educational programming, due to the complexity of this disability and the specialized intervention methods. The team must include a school professional knowledgeable of the range of possible special education eligibility criteria.

Implementation. Students with various educational profiles and related clinical diagnoses may be included as eligible if they meet the criteria of ASD. However, a clinical or medical diagnosis is not required to be eligible for special education services. Due to the wide variation in characteristics and needs, students with different educational profiles or a specific clinical diagnosis must also be determined as eligible following the criteria. Following this eligibility determination process is essential to identify and document individual strengths and weaknesses and the student’s unique educational needs so that an effective individual educational program may be planned and implemented.

PATTERNS OF QUALITATIVE IMPAIRMENT/POSSIBLE BEHAVIORAL INDICATORS

The criteria describe the three core features that must be considered in an educational evaluation for Autism Spectrum Disorders. It provides descriptions of each core feature and list some behaviors that may help discriminate between Autism Spectrum Disorders and other categories. As teams review the criteria, the following expanded list of behavioral indicators may be helpful. Note that a student should demonstrate patterns of behavior in the core features identified.


These examples have been summarized from the following diagnostic and assessment tools: DSM-IV, Autism Diagnostic Observation Schedule, Autism Diagnostic Interview-Revised, Gilliam Autism Rating Scale, and Childhood Autism Rating Scale.

These examples should not be used as discrete items in a check-off list, but as possible behavioral indicators that must be viewed as patterns or clusters of behaviors.

Core Feature 1: Qualitative impairment in social interactionIn addition to those behavioral indicators listed as examples on the criteria checklist, consider the following:• lack of emotional or social reciprocity• limited insight into social relationships• limited empathy/comments on others’ emotions• unusual eye contact; limited shared enjoyment in interaction• reduced quality of social overtures and responses• lack of social smiling; impairment in group play with peers• reduced imitative social play• lack of interest in or response to other children• doesn’t give affectionate responses (e.g., hugs and kisses)• looks through people (i.e., shows no recognition that a person is present)

Core Feature 2: Qualitative impairment in communicationIn addition to those behavioral indicators listed as examples in the rule, consider the following:• reduced amount of social communication• limited frequency of vocalization directed to others• echolalia• inappropriate questions or statements• pronominal reversal• repeats words or phrases over and over• looks away or avoids looking at speaker when name is called• avoids asking for things he or she wants• fails to initiate conversations with peers or adults• repeats unintelligible sounds (babbles) over and over

Core Feature 3: Restricted, repetitive, or stereotyped patterns of behaviorIn addition to those behavioral indicators listed as examples in the rule, consider the following:• persistent preoccupation with parts of objects• excessive interest in highly specific topics or objects• compulsions/rituals• licks, smells or sniffs inedible objects (e.g., person’s hand, toys, books)• spins objects not designed for spinning (e.g., saucers, cups, glasses)• rocks back and forth while seated or standing• makes rapid lunging, darting movement when moving from place to place• flaps hands or fingers in front of face or at sides• responds negatively or with temper tantrums when given commands, requests, or directions• lines up objects in precise, orderly fashion and becomes upset when the order is disturbed



AUTISM SPECTRUM DISORDERS (ASD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_______________________________________________Student ID#:________________________________Grade:_______________ School:_________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is considered eligible for special education when the student meets criteria in items A and B.

A An educational evaluation must address all three subitems listed below. For eligibility purposes, a student must meet criteria in subitem 1 AND either/both subitem 2 or 3.

Circle One

1. Qualitative impairment in social interactions: (two or more behavioral indicators) Yes No___limited joint attention___limited use of facial expressions directed toward others___does not show or bring things to others to indicate an interest in the activity___demonstrates difficulties in relating to people, objects, and events___a gross impairment in ability to make and keep friends___significant vulnerability and safety issues due to social naiveté___may appear to prefer isolated or solitary activities___misinterprets others’ behaviors and social cues___other__________________________________________

2. Qualitative impairment in communication: (one or more behavioral indicators) Yes No___not using finger to point or request___using others’ hand or body as a tool___showing lack of spontaneous imitation or lack of varied imaginative play___absence or delay of spoken language___limited understanding and use of nonverbal communication skills such as gestures, facial

expressions, or tone of voice___odd production of speech including intonation, volume, rhythm or rate___repetitive or idiosyncratic language or inability to initiate or maintain a conversation when

speech is present___other________________________________________

3. Restricted, repetitive or stereotyped patterns of behavior, interest, activities: (one or more behavioral indicators)

Yes No___insistence on following routines or rituals___demonstrating distress or resistance to changes in activity___repetitive hand or finger mannerism___lack of true imaginative play versus reenactment___overreaction or under-reaction to sensory stimuli___rigid or rule-bounding thinking___an intense, focused preoccupation with a limited range of play, interests, or conversation topics___other________________________________________

Behavioral indicators in item A must include the use of at least two of the methods below: Yes No___structured interview with parents___autism rating scales or checklist(s)___communication and developmental scales___functional behavior evaluation___application of DSM-IV diagnostic criteria___informal and standardized evaluation instruments___intellectual testing

In Item A, did student meet criteria in subitem 1 AND either or both subitem 2 or 3?

YES

NO

AND B Verification that an ASD adversely affects the student’s present educational

level of performance; data from each of these:Circle One

1. Educational needs in each core feature identified in A Yes Noand

2. Observation in two different settings on two different days Yes Noand

3. Historical summary of developmental information and behavior patterns Yes NoRochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-81

In Item B, did student meet criteria in subitems 1 and 2 and 3? YES NO




EXAMPLE: AUTISM SPECTRUM DISORDER EVALUATION REPORT

REASON FOR REFERRAL Julian was referred for mandatory three-year reevaluation to determine continued eligibility for special education.

BACKGROUND INFORMATION

REVIEW OF EXISTING INFORMATION: Julian was initially evaluated by the early childhood assessment team in 12/02. He qualified for special education with a primary disability of Developmental Delay and a secondary disability of Speech/Language Impaired and has been receiving early intervention services since that time. Julian was initially diagnosed with Autism in October, 2003 at the Mayo Clinic. He was subsequently educationally reevaluated and in a report dated 1-15-04, Julian was identified with a primary disability of Autism Spectrum Disorders and a secondary disability of Speech/Language Impaired.

Prior assessment results from the 2003 Mayo Clinic report included an ADOS (Module 1) score of Communication = 4, Social Interaction = 11, Communication plus Social Interaction = 15, Play = 4, and Stereotyped Behaviors and Restricted Interests = 3. Julian's most recent evaluation at Mayo Clinic was in 4/06. On 4-10-06, Julian obtained the following results: DAS General Conceptual Ability of 78 (7th percentile) with difficulties noted in following verbal instructions that become increasingly more difficult and a Leiter-R Brief IQ of 87. Julian's performance on the Leiter-R was lower than prior performance (no score mentioned) and that was attributed to Julian's reported difficulty with sustained attention during the testing. On the CDI, Julian obtained a General Development Score of 3 years, 9 month. He earned a CARS Total Score of 30 which is in the mild to moderately autistic range.

Julian currently attends half-day kindergarten with support from the early childhood kindergarten combination program, speech language, occupational therapy, and autism consult services. Julian's first quarter report card indicates that his language arts and writing skills are secure as Julian knew all upper and lower case letters and was at a writing level 5 on a scale of 1-8. His listening comprehension was rated at a beginning level given that he correctly responded to 2 of 5 picture questions. School attendance is satisfactory.

LANGUAGE/RACIAL/CULTURAL FACTORS: Julian is Caucasian from a family whose only language is English. There are no known language/racial/cultural factors that would negatively impact this evaluation.

INFORMATION FROM PARENTS: Parents reported Julian's strengths to be his academic math and reading skills. He has a sense of humor and likes to be silly. Julian will show sympathy toward others. His preferred play activities include computer games, Play Station, and movies. Parents reported Julian will rewind and watch particular parts of movies repeatedly if they let him. Parents continue to be concerned with Julian's needs to develop his social interactions with peers and to improve his reading comprehension.

In regard to additional services and activities, Julian attends the Rochester Austim Center approximately 20 hours per week and has been receiving services there for approximately the past 3 years. He previously received S/L services at Stanley Jones. Julian has successfully participated in the Adaptive Park & Recreation's Rideability and Soccer programs.


INFORMATION FROM TEACHERS:Teachers identified Julian's strengths to be his academic knowledge and his ability to follow through on tasks he is given. Julian does need verbal prompts to complete tasks. His ability to sit and listen in a large group has increased considerably. There is concern with Julian's social reasoning and lack of judgment in being able to distinguish between appropriate and inappropriate social interactions. He will often follow the behaviors of peers that are making poor choices and he doesn't realize that what they are doing is inappropriate.

EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior.

ACADEMIC PERFORMANCE: Z, Special Education TeacherInformal Inventory/Checklists

Date: December 19, 2006

Interpretation: Julian is able to identify all upper and lowercase letters and is able to produce all letter sounds. Julian writes most upper and lowercase letters with correct formations and is able to read all sight words learned in class including several others he is able to read on own. He is able to read and write simple sentences. Julian identifies numbers 0-100 and is able to write them randomly. He identifies all shapes. Julian is able to state personal information about himself (name, age, parent names, and sibling information). Academically, Julian performs at or above his peers.

COMMUNICATION: Z, Speech/Language Pathologist Peabody Picture Vocabulary Test- Third Edition (PPVT-III) The PPVT-III is intended as a measure of listening comprehension for spoken words in standard English and a screening for verbal ability for children 2 years 6 months old through 90 years of age. The individual is asked to point to a picture, from a group of four, when presented with a single word.

PPVT-III Form: A Date:12/18/2006

Score Range Standard Deviation Difference

TOTAL TEST 93 Average -.46 Interpretation: Julian's receptive vocabulary knowledge is within the average range for a child his age.

PRESCHOOL LANGUAGE SCALE- Forth Edition (PLS-4)The Preschool Language Scale-4 measures auditory comprehension and expressive communication in children birth through 6 years 11 months of age.

PLS-4 Date: 12/15/2006 Score Range Standard Deviation

Difference Auditory Comprehension 86 low average -.93 Expressive Communication 86 low average -.93 TOTAL LANGUAGE 85 low average -1.0

Interpretation: Julian's language skills on this test are within the low average range. In the area of expressive language he was successful in naming items that fit into categories (food, animals), completes similes, counting items and giving correct number, defining words, repairing grammatical errors, segments words, telling a story in sequence. He had more difficulty telling a story with an introduction, sequence and conclusion, rhyming words, repairing semantic absurdities (The boy sleeps on a bicycle.) In the area of receptive language, Julian was able to demonstrate his ability to understand time/sequence concepts (first, last), identify initial sounds, understands quantitative concepts, adds, and subtracts numbers, time concepts. He had more difficulty understanding rhyming words. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-84

Comprehensive Assessment of Spoken Language (CASL)The Comprehensive Assessment of Spoken Language (CASL) is a norm-referenced oral language assessment test for children and young adults ages 3 through 21. Each of the CASL tests is individually administered and is based on a well-defined theory of language. The battery is designed to measure the processes of comprehension, expression, and retrieval in the four language categories of lexical/semantics, syntax, supralinguistics, and pragmatics.

CASL Date: Score Range Standard Deviation

Difference PRAGMATIC JUDGMENT 65 Far Below Average -2.33

Interpretation: Julian's pragmatic judgment skills are far below average for a child his age. Many times, he would describe the picture in the test booklet and miss the meaning of the question. For instance, the correct answer required Julian to use a sentence to request help to carry books. Julian's response was "He is carrying books." Also, Julian tended to try to answer many of the questions with "I don't know."

Language Sample

Date: 12/15/06

Interpretation: In a sampling of language gathered during spontaneous conversation with the examiner, Julian exhibited structures ranging from one word to longer more complex structures of 6-8 words in length. He was able to use pronouns, (I, we, my, he), past tense, present progressives, plurals and auxiliary verbs in the sample. He did have difficulties using the pronoun "she" consistently and correctly in the sample. In addition, Julian did answer some of the questions that were asked of him. Frequently in the sample, the speech/language pathologist needed to gain Julian's attention and ask the question again. This inattention to the speaker did occur throughout the sample. He also would answer many questions asked of him with "I don't know." When prompted to give an answer (2-3 times) Julian then would typically then provide an answer. Additionally, Julian gave minimal eye contact throughout the sample. It was also noticed that Julian would turn his entire body away from the speaker when he was speaking and when he was being talked to. He also had difficulties initiating new topics and staying on topic for more the 1-2 turns. He did not make further comments or ask questions of his conversational partner. It should also be noted that Julian tended to speak to himself with a quieter voice. When asked what he said, Julian tended to answer with "Ah, nothing." Overall, Julian's grammatical and syntactical features in the sample are age appropriate for a child his age. However, his conversation skills (eye contact, initiating, maintaining) are not typical for a child his age.

HEALTH/PHYSICAL STATUS: Z, Licensed School Nurse Health Status: Julian is a kindergarten student in general good health. He has no known allergies and no activity restrictions. Julian has a history of ear infections. There were no other ongoing health concerns noted.SENSORY STATUS: T. Haugen, Licensed School Nurse

Review of Records: Julian's health records were reviewed on 12/19/06. Julian had a normal hearing exam at Mayo Clinic. There were no concerns noted in his file with hearing or vision. Julian has not had a formal screening done at school. If concerns are noted, a screening can be performed.

FINE MOTOR:

Fine Motor ObservationDate: 1-3-2007Time: 1:30Observed by: Z, OT


Julian's fine-motor skills were assessed informally by the occupational therapist during structured activities in a 1:1 setting in a quiet classroom at Gage East. Julian appeared to enjoy a variety of fine-motor activities, and seemed to be trying hard to complete the tasks to the best of his ability. He concentrated well on individual tasks, and was able to stick with tasks lasting several minutes without prompting. He would frequently lose his focus in-between items, but was easily able to be redirected to the next task. Julian demonstrated a right-handed preference for all skilled fine-motor tasks, and used a variety of appropriate grasp and manipulation patterns. These included good 2- and 3-finger grasps on small items, and a functional 3- or 4-finger pencil grasp. He wrote 22/26 lower-case letters legibly with no visual model available, and appeared to know upper-case as well. He was able to align his letters fairly well, and there were only 2 reversals in this sample (b and d). He copied a 3-word sentence using good letter formation and alignment on single-line (baseline) paper. When coloring, he appeared to have adequate control to color very small areas, but often chose to color rapidly and with long strokes, compromising the quality of the finished product.

He was able to use both hands together in a coordinated manner for activities such as stringing small beads, using scissors, and using clothing fasteners. With regular kindergarten scissors, he was able to cut simple irregular shapes on or within 1/4" of the line. He also used his left hand appropriately to hold and turn the paper while cutting. Julian was able to independently use buttons and snaps of varying size and resistance, was able to start a jacket zipper, and was able to tie a bow with relative ease.Julian's general upper extremity strength and tone seemed to be somewhat decreased, but within an average range. It did appear, however, that when he was having difficulty with some of the more resistive clothing fasteners, that the main issue was decreased hand and finger strength. He also may have a very slight hand tremor, as very mild shakiness was noted in each hand (left more than right). However, this was noted toward the beginning of the session, and it is possible that he was uncomfortable in an unfamiliar setting, and/or was putting excessive effort into the initial tasks. He tried to stack 12 small blocks, but only got to 8 before the tower fell. On his second attempt, he held the stack with one hand when it got fairly high, and then continued to stack the blocks, succeeding in stacking all 12. He was also able to imitate block constructions of six blocks with a model, but not from memory. He was able to correctly sequence a thumb-to-finger touching task with each hand individually, and with both hands simultaneously, but this required his total visual concentration.

Julian was asked to draw several simple figures, and was able to make a recognizable person (with 10+ body parts), house, and tree. He also drew two dogs that were recognizable as some type of animal. Although somewhat immature, these drawings were done with relative ease and were representative of the figures that he intended to portray.

SOCIAL/BEHAVIORAL: Z, School Psychologist

Gilliam Autism Rating Scale – Second Edition (GARS-2)The GARS-2 is a norm referenced test designed to evaluate and diagnose children with unique behavioral problems who may have autism. It is designed for use with children aged 3 through 22, and is useful in estimating the severity of the disorder.

Subtest scores reported are scaled scores which have a mean of 10 and a standard deviation of 3. Higher scores are indicative of concern.

GARS-2 Date: 12-13-06 Parents School Staff

Stereotyped Behaviors 8 5 Communication 10 6 Social Interaction 8 6 AUTISM INDEX 91 72

Interpretation: Julian's parents and school staff completed the GARS-2. Parent ratings are more elevated than staff ratings of Julian's behavior. The Autism Index obtained from parent ratings


indicates the probability of autism to be very likely and the Autism Index obtained from teacher ratings is in the possible range of probability. In the area of stereotyped responses, parents reported Julian frequently avoids eye contact and stares at objects for at least 5 seconds and he sometimes eats specific foods, makes rapid darting movements when moving , and walks on tiptoes. School staff reported Julian avoids eye contact and stares some of the time. In the communication area, parents observe Julian frequently repeating (echoing words), repeating words out of context, and repeating words/phrases over and over. They also reported Julian sometimes does not initiate conversations, uses pronouns inappropriately, and repeats unintelligible sounds over and over. School staff reported Julian sometimes does not initiate conversations.

In the area of social interaction, parents indicated Julian frequently does certain things repetitively, lines up objects in precise order and becomes upset when the order is disturbed. He sometimes avoids eye contact, withdraws in group situations, shows no recognition that a person is present, becomes upset when routines are changed, and responds negatively when given commands, requests or directions. School indicated Julian sometimes avoids eye contact, stares of looks unhappy or unexcited when praised or humored, does not imitate other people when imitation is required (eg. games or learning activities) and behaviors in an unreasonably fearful manner.

FUNCTIONAL: Z, School Psychologist

Adaptive Behavior Assessment System – Second Edition (ABAS-II)The ABAS-II is a comprehensive, norm-referenced assessment of the functional skills of individuals ages birth to 89 years. The adaptive skills measured correspond to the specification identified by the American Association on Mental Retardation and the DSM-IV. The ABAS-II has forms for daycare providers, teachers, parents/primary caregivers, and a self-report adult form. Adaptive skills in domains are reported as scaled scores which have a mean of 10 and a standard deviation of 3. The Composite Scores are standard scores.

ABAS-II Date: 12-13-06

Parent

Teacher Communication 4 3 Community Use 2 9 Functional Academics 5 7 Home/School Living 5 5 Health and Safety 1 2 Leisure 5 3 Self-Care 5 4 Self-Direction 6 4 Social 3 6 GENERAL ADAPTIVE COMPOSITE (GAC)

63 70

GCA PERCENTILE RANK 0.7 2.3

Interpretation: Julian's parents and school staff rated his adaptive behavior in the home and school settings. Julian's functional skills are well below age expectancy in the home and school settings with General Adaptive Composites at or below the 3rd percentile. Independent functional skills that would be expected at Julian's age vary greatly in regard to consistency. It appears that many of Julian uses many of his skills only some of the time when needed rather than performing them consistently. He needs prompts to apply some of his skills.


OBSERVATIONS

Date: December 11, 2006Time: 2:00-2:30Observed by: ZSetting: Kindergarten Classroom

The observation took place during literacy centers. Julian wrote his name on a book and told his teacher "thank you" when she told him he did a nice job. Julian was instructed to point to words in sentences as he read. He did not point, but did read each word in each sentence accurately and ahead of rest of class. He was told to color in book while he waited his turn. He colored with markers and looked at observer and said " I can color with markers." While coloring, he did a lot of self-talk and made various noises with mouth. He used only the black marker to color. He sat quietly for his turn to read. He put his book away and came back and sat at table. Julian went to next group area when asked after 1st time told and he knew to get marker, board, and sock without any prompts. He read sight words correctly when they were presented and said sorry once when he spoke out of turn and teacher pointed it out. The group was then told to write some words and he had to be prompted several times before he began. He followed along with the rest of group for the remainder of the lesson. When asked to write sentence, "I am (their name)." He only wrote "Julian" and needed 4-5 prompts to get him to erase it and write the complete sentence. He used upper and lowercase letters appropriately in most instances. Julian put all materials away and pushed chair in when asked. He then stepped back and helped the para finish cleaning the rest of table before he continued to line up with his classmates.

Date: 1-3-07Time: 1;15 - 1:35pmObserved by: Z, School PsychologistSetting: Kindergarten -combination small group language activity

Julian was observed during a small group activity that involved social interaction, turn-taking, verbal requesting, direction-following with some sets of colored paper mittens. When Julian entered the classroom, he immediately sat down on the floor with the group and put his head down and rubbed his hair repetitively. When the speech clinician asked if Julian was excited to be at school and if he liked snow, Julian replied, "No" to both questions. He folded his arms, pulled his knees up, and lay his head on his knees. When the clinician asked if the children wore mittens, Julian responded, "Z, can you stop that?!" in a high-pitched voice that sounded agitated. When the teacher directed the group to stand, Julian said, "I can't" and looked unhappy. The clinician gave Julian an individual prompt to stand and Julian replied, "I want to sit." As the clinician gave each student 2 different color mittens she explained they were to go around and ask each other what color mittens they had and try to match them. When the clinician approached Julian he replied, "Z, I can't." He then went on to match a pair of mittens with a peer and exchange mittens without using any verbal requests. Julian proceeded to go to the edge of the room and repetitively dropped his mittens on the floor. When the clinician twice asked Julian "what do you have?" he responded "Nothing" as he rubbed the mittens together repetitively. The clinician made three specific verbal prompts before Julian matched an orange mitten with her. As the teacher gave the group directions to do things with the mittens (eg. , hold them above their heads.), Julian was playing with his mittens and covering his eyes with them. He stood by the clinician rather than with the group of students. When the clinician put the mitten behind her back and instructed the students to do the same, Julian put his mitten behind the clinician's back rather than his own. Julian stood for the next few minutes looking at a computer screen (turned off) and flapping his mittens and did not participate in the rest of the direction-following activity. He repeatedly placed the mittens on a chair and pushed them off. Julian put a mitten up his shirt sleeve and one inside his shirt and smiled at no one in particular. He proceeded to hum/sing and played with the mittens in many different ways. Julian gave his pair of mittens to the clinician after receiving an individual prompt. He then used a high pitched voice to say, "I want to go back to class." Throughout the observation Julian did not show any interest or spontaneous interaction with peers. He frequently needed individual prompts and then often responded negatively. He separated himself physically from the group for some of the time and engaged in repetitive play. The paraprofessional Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-88

indicated Julian was the teacher helper that day and was not happy about leaving the classroom to go to group.

Date: 1-4-07Time: 2:30-3:15pmObserved by: Z, School PsychologistSetting: Kindergarten Classroom - Snack/centers/group time Julian was observed in his kindergarten classroom during snack/centers/group time. When the teacher asked Julian if he was having a snack today, he replied, "No." The teacher asked the question three times and Julian replied each time, but his response was so soft she did not hear him the first two times. Julian immediately went to the water table where 4 boys were playing. He played in the water with his hands for 30 seconds and then went to play computer. As Julian was starting the game, a female peer went over and put her arm around Julian briefly and helped him start the computer game. He tolerated that interaction but offered no response. Julian selected and played a time-telling game where he moved the hands on a face clock to match a digital time. He played the game successfully for 15 minutes. He turned around every 5 minutes and looked at the water table area briefly. When the teacher announced it was time to pick up, a female peer went over and took Julian's headphones off his head. He did not react, but wandered away from the area and the peer logged off the computer game and turned the monitor off. Julian went to his assigned seat (front of the group near the teacher) on the carpet for group time. He had his fingers in his mouth and appeared to be pulling on his lip. As the teacher read a book on solids and gases to the class and asked questions to the group, Julian did not participate. He had his fingers in his mouth, head down, and rarely looked up. Julian made some verbal comments aloud that the observer could not entirely hear, but they did not appear to be related to the class discussion. He then turned to a female peer and said, "want to go home." Julian proceeded to flap his hands and arms. The shared paraprofessional that works with Julian was across the room throughout the observation. He turned and looked at her 3 times during the 25 minute group time. In summary, when given free choice, Julian momentarily chose an activity that involved peers and then moved on to a solitary computer activity. When two female peers approached Julian separately in a "helper" way in two separate instances, Julian tolerated the interaction but did not engage with the girls. Julian followed the class routine. He did not participate in the class discussion and paid little visual attention to the book being read to the group. Julian engaged in repetitive flapping and made some off-task verbal comments toward the end of group time. VALIDITY Were the evaluations administered valid for the student? Yes Were the evaluations administered valid for the purpose to which they were intended? Yes

Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? No A lack of appropriate educational instruction in math? No Limited English proficiency? No

PRESENT LEVEL OF PERFORMANCE Julian is a 6 1/2 year old kindergarten student who receives the following services through special education: early childhood kindergarten combination program, speech language, occupational therapy, and autism consultation. Julian was previously identified with a primary disability of Autism Spectrum Disorders and a secondary disability of Speech/Language Impaired.

Results of intellectual assessment at Mayo Clinic dated 4/06 yielded below average scores which likely provide a minimal estimate of Julian's true ability level. Scores at that time included a Leiter Brief IQ of 87 and a DAS General Conceptual Ability Score of 78 and Nonverbal Score of 83. These scores are lower than would be expected given Julian's strong academic achievement. Julian's academic performance is at or above kindergarten expectations. He is able to read and write simple sentences and identifies numbers 1-100 and is able to write them randomly. In the area of fine motor skills, in a 1:1 setting, Julian can write upper and lower case letters, with about 85% of them being easily legible, and others being close approximations. He can draw somewhat immature, but recognizable simple figures, can cut simple irregular shapes generally on or within 1/4" of the line, and can manipulate all clothing fasteners independently (including tying a bow.) Julian's functional skills are well below age Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-89

expectancy in the home and school settings. Independent functional skills that would be expected at Julian's age vary greatly in regard to consistency. It appears that many of Julian uses many of his skills only some of the time when needed rather than performing them consistently. He also needs prompts to apply some of this skills. Julian's receptive and expressive language skills are within the average range for a child his age. The language sample also demonstrated that Julian's grammatical and syntactical skills are age appropriate for his age. However, the sample also highlighted Julian's difficulty with his pragmatic language skills. He had difficulties with initiating a conversation, initiating a new topic , maintaining topics, eye contact, answering questions and body language. Julian continues to have significant difficulty with social interaction. He continues to avoid eye contact, does not initiate conversations, stares off, engages in repetitive behaviors (repeating words/phrases and actions), withdraws in group situations, and may become upset if routines are changed. Staff who worked with Julian last year note that he has made gains in social awareness and interaction.

ELIGIBILITY DETERMINATION Autism Spectrum Disorders (ASD)According to Minnesota Special Education rules, a student is eligible for special education and related services when the student meets criteria items A below, a student must meet number 1 and either number 2 or number 3.

Julian's evaluation documents: A) (1) Qualitative impairment in social interactions based on the following indicators: limited use of facial expressions toward others, gross impairment in ability to make friends, appears to prefer isolated or solitary activities, misinterprets others' behaviors and social cues, and difficulty relating to people. (2) Qualitative impairment in communication is documented based on the following indicator(s): early delay of spoken language, inability to initiate or maintain conversation, showing lack of spontaneous imitations/lack of varied imaginative play, and repetitive, idiosyncratic language. (3) Restricted, repetitive or stereotyped patterns of behavior, interests, and/or activities are documented based on the following indicator(s): repetitive hand or finger mannerisms, demonstrating distress or resistance to change, over-reaction to sensory stimuli, and insistence on following routines or rituals. The above behavioral indicators are atypical for the student’s development level. B) The student’s present levels of performance and educational needs in each core feature have been identified and are included under the Present Levels of Performance and Educational Needs sections of this report. Observations across settings and days support the above findings and a summary of the student’s developmental history and behavior patterns was obtained on 1-3 and 1-4-07.

In summary, based on the results of this evaluation, Julian meets eligibility criteria for an Autism Spectrum Disorder.

Language Disorder EligibilityAccording to Minnesota Special Education rules, a student has a Language Disorder and is in need of speech or language services when the student meets the criteria described in items A and B and either C or D.

Julian's evaluation documents: A) A language pattern that does interfere with communication as judged by an educational speech-language pathologist and Mrs. Bakken B) An analysis of the llanguage sample has demonstrated that Julian's language behavior is inconsistent and different from expectations based on age, developmental level or cognitive level. C) Peabody Picture Vocabulary Test-3 A and the Preschool Language Scale-4 were administered and resulted in standard deviation scores of 93 and 85, respectively. These scores are not 2.0 or more standard deviations below the mean. The Comprehensive Assessment of Spoken Language Pragmatic Judgment was administered to Julian. He obtained a standard score of 65. OR D) NA Technically adequate norm referenced language tests are not available to provide evidence of a deficit of 2.0 standard deviations below the mean in the area of language, but two documented measurement procedures indicate a substantial difference from what would be expected based on age, developmental level, or cognitive level.Therefore, based on the results of this evaluation, Julian does not meet criteria for Language Disorder.


This disability adversely affects Julian's performance in the general education setting as evidenced by the following:

The student performs substantially below that of peers.

The resources necessary to support the student to participate and progress in the general education curriculum are beyond those available in the general education curriculum.

The student will not make expected progress at the rate commensurate with peers in the general education classroom.

The student requires specially designed instructional methods that are not available in the general education classroom.

EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITY

Areas of specially designed instruction needed:

Communication: Julian needs to improve his pragmatic language skills to be able to have meaningful interactions with peers and adults within the educational setting.

Social Behavior Skills: Julian needs to improve his social interaction skills, social reasoning, and social judgment.

Coping Skills/Problem Solving: Julian needs to develop better coping skills to use when he is in stressful situations. This includes learning to cope with changes in routine or schedule.

Independent Work Skills: Julian needs to develop independent task completion skills and decrease his prompt dependency.



CHAPTER 3B: Specific Learning Disabilities (SLD) Documentation


STATE GUIDELINES: SPECIFIC LEARNING DISABILITIES (SLD)"Specific learning disability" means a condition within the individual affecting learning relative to potential.

A. A specific learning disability is manifested by interference with the acquisition, organization, storage, retrieval, manipulation, or expression of information so that the individual does not learn at an adequate rate when provided with the usual developmental opportunities and instruction from a regular school environment.

B. A specific learning disability is demonstrated by a significant discrepancy between a student's general intellectual ability and academic achievement in one or more of the following areas: oral expression, listening comprehension, mathematical calculation or mathematics reasoning, basic reading skills, reading comprehension, and written expression.

C. A specific learning disability is demonstrated primarily in academic functioning, but may also affect self-esteem, career development, and life adjustment skills. A specific learning disability may occur with, but cannot be primarily the result of: visual, hearing, or motor impairment; mental impairment; emotional disorders; or environmental, cultural, economic influences, or a history of an inconsistent education program.

Note: IDEA criteria for determining the existence of a specific learning disability is incorporated into the state criteria.

The team shall determine that a student has a specific learning disability and is in need of special education and related services when the student meets the criteria described in items A through C. Information about each item must be sought from the parent and included as part of the evaluation data. The evaluation data must confirm that the disabling effects of the student's disability occur in a variety of settings.

1. The student must demonstrate severe underachievement in response to usual classroom instruction. The performance measures used to verify this finding must be both representative of the student's curriculum and useful for developing instructional goals and objectives. The following evaluation procedures are required at a minimum to verify this finding:

A. evidence of low achievement from sources such as cumulative record review, class work samples, anecdotal teacher records, formal and informal tests, curriculum based evaluation results, and results from instructional support programs such as Title I and Assurance of Mastery; and

B. at least one team member other than the student's regular teacher shall observe the student's academic performance in the regular classroom setting. In the case of a child


served through an Early Childhood Special Education program or who is out of school, a team member shall observe the child in an environment appropriate for a child of that age.

2. The student must demonstrate a severe discrepancy between general intellectual ability and achievement in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematical calculation, or mathematical reasoning. The demonstration of a severe discrepancy shall not be based solely on the use of standardized tests. The team shall consider these standardized test results as only one component of the eligibility criteria.

A. The instruments used to assess the student's general intellectual ability and achievement must be individually administered and interpreted by an appropriately licensed person using standardized procedures.

B. For initial placement, the severe discrepancy must be equal to or greater than 1.75 standard deviations below the mean of the distribution of difference scores for the general population of individuals at the student's chronological age level.

3. The team must agree that it has sufficient evaluation data that verify the following conclusions:

A. the student has an information processing condition that is manifested by behaviors such as: inadequate or lack of expected acquisition of information, lack of organization skills, memory, expression, and motor control for written tasks such as pencil and paper assignments, drawing, and copying;

B. the disabling effects of the student's information processing condition occur in a variety of settings; and

C. the student's underachievement is not primarily the result of: visual, hearing, or motor impairment; mental impairment; emotional or behavioral disorders; or environmental, cultural, economic influences, or a history of an inconsistent education program.

S L D E V A L U A T I O N R E P O R T

1. The team shall prepare a report of the results of the evaluation. The report must include a statement of:A. whether the child has a specific learning disability;B. the basis for making the determination;C. the relevant behavior noted during the observation of the child;D. the relationship of that behavior to the child's academic functioning;E. the educationally relevant medical findings, if any;F. whether there is a severe discrepancy between achievement and ability that is not

correctable without special education and related services; andG. the determination of the team concerning the effects of environmental, cultural, or

economic disadvantage.

2. Each team member shall certify in writing whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the team member must submit a separate statement presenting his or her conclusions.



SPECIFIC LEARNING DISABILITY (SLD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:________________________________________Student ID#:_________________________________ Grade:_______School: __________________________________________________Date of Meeting:___________________________________________

The team shall determine that a student has a specific learning disability and is in need of special education and related services when the student meets the criteria described in Items A through C.

ITEM

A

The student demonstrates severe under achievement in response to usual classroom instruction.

CIRCLE1. supported by the following

sources/procedures:_______________________________________ YES NO

2. at least one team member other than the student's regular teacher shall observe the student's academic performance in the regular classroom setting.

YES NO

Have all criteria in ITEM A been met? YES

NO

AND

ITEM

B

The student demonstrates a severe discrepancy between general intellectual ability and achievement in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, mathematical calculation, or mathematical reasoning (for initial placement, the severe discrepancy must be equal to or greater than 1.75 standard deviations below the mean of the distribution of difference scores for the general population of individuals at the student's chronological age level).

List area(s) Discrepancy score___________________________ ________________________________________________ ________________________________________________ ________________________________________________ _____________________

YES NO

Have all criteria in ITEM B been met? YES

NO

AND

ITEM

C

The team agrees that sufficient evaluation data exists to verify the following conclusions:

YES NO

1. the student has an information processing deficit; YES NO2. the information processing deficit occurs in a variety of settings; and YES NO3. the student's underachievement is not primarily the result of: visual, hearing, or

motor impairment; mental impairment; emotional or behavioral disorders; or environmental, cultural, economic influences, or a history of an inconsistent education program.

YES NO

Have all criteria in ITEM C been met? YES

NO

Have the criteria for SLD been met in Items A through C ? YES

NO




GUIDELINES FOR CONDUCTING EVALUATIONS FOR SPECIFIC LEARNING DISABILITIES (SLD)

I N T R O D U C T I O NEvaluation of Specific Learning Disabilities (SLD) must be based upon multiple sources of information and includes four phases: prereferral, evaluation determination, evaluation process and evaluation report. An effective evaluation process should provide sufficient information to make eligibility determination, as well as gather information to guide intervention.

P R E R E F E R R A LAs with all special education evaluations, at least two documented interventions must be conducted prior to a referral for evaluation for SLD. Prereferral documentation must include a definition of the problem, review of appropriate records, samples of classroom work, and the documented interventions. The prereferral process will vary slightly from building to building.

E V A L U A T I O N P L A NThe Evaluation Plan provides a foundation to ensure that adequate information is gathered to meet due process requirements for eligibility determination. Teams should refer to the Matrix for Developing a SLD Evaluation Plan to consider possible data sources. Items preceded by a bullet are required for all SLD evaluations conducted within RRSEC member districts’ schools. State criteria can be divided into three areas and the matrix identifies the area under which each data source may contribute toward an eligibility decision.

For published tests, professional ethics require that evaluations be administered and interpreted by personnel with training commensurate with the requirements listed by the test publishers. Standardized instruments such as the Woodcock-Johnson Psycho-educational Battery-Revised must be administered and interpreted by professionals who have been adequately trained. Please consult with your supervisor if you are not sure about the training requirements for specific evaluation procedures.

E V A L U A T I O N P R O C E S SA multidisciplinary team is required for all special education evaluations, and the SLD evaluation process must include a teacher licensed in the area of SLD, a school psychologist, and others as determined by the individual circumstances of the referral concern. Evaluation information will be provided by parents, teachers and direct evaluation of the child. Structured interviews, questionnaires, and rating scales are primary methods of gathering information from parents and teachers. Direct observation of the child in naturalistic settings can be conducted by the SLD certified teacher, school psychologist or others who have received adequate training in the use of the observational format. Classroom observations should be performed as unobtrusively as possible.

E V A L U A T I O N R E P O R TThe Evaluation Report (ER) should present all relevant and significant evaluation results and integrate these findings in a manner that systematically addresses the state eligibility criteria.

Prior to the evaluation meeting, the person responsible for writing the evaluation report should gather evaluation data from all those involved in the evaluation process and synthesize that information into one comprehensive report. The written report needs to be available to the parents within 30 days of when the evaluation plan is signed. However, after the evaluation meeting, changes / additions may need to be made in order to finalize the report.


At the evaluation conference, the team will present and discuss evaluation results in order to make a special education eligibility determination. As information is shared, additions can be made to the ER report. The ER can also be amended to include the recommendations of the team. Once completed, the ER must be signed by all team members, including a teacher who is licensed in SLD.

If the evaluation team wishes to override the criteria, they must comply with the Team Override Guidelines and complete and attach the Team Criteria Override Decision Form . A copy of all team overrides must be given to the Director of Special Education.

MDE Policy: Intellectual Functioning Standard Scores Below 75The Minnesota Department of Education has clarified their policy for students with overall cognitive ability scores of less than 75. The policy and rationale is explained below: "The Minnesota Regression Table may not be used with standard scores on measures of general intellectual ability of less than 75 for two reasons. First, there is general concern in the field that the correlation between tests and the reliability of individual tests is low at a level greater than two standard deviations from the mean, making the statistical comparison difficult.

Second, the effects of mental impairment on achievement must be discussed and ruled out as the primary reason for a student's under achievement (see SLD Companion Manual-Section 8: Exclusionary Factors). The IEP team must discuss general academic expectations for a student with low ability. Ruling out of the effects of a mental impairment on achievement is difficult. IEP teams may not extend the Minnesota Regression Table to include lower scores. The scores on the Minnesota Regression Table are computed using a regression formula (see Appendix C of the SLD Companion Manual). Scores of 75 or lower require an override."

Broad Scores vs. Cluster scoresWhen using the WJ-III to obtain standardized achievement scores, teams can use either Broad or Cluster scores to establish the significant discrepancy portion of SLD eligibility.



MATRIX FOR DEVELOPING AN SLD EVALUATIONNote: Though some evaluation information listed below may have been obtained through the prereferral process, parental permission should be obtained for all information used during the formal evaluation process.

Item A: Severe underachievement

Item B: Severe discrepancy between ability and achievement

Item C: Evidence of a processing disorder

DATA SOURCES Item A Item B Item C Classroom Observation x x

Information Processing Questionnaire Parent x x Teacher x xStudent x x

Student History Questionnaire Parent (for initials) x x x

Standardized Norm Referenced Evaluations Individual achievement x x x Individual intellectual (include observations of test behavior)

x x

School Records x x Cumulative folder review (including report card, attendance, etc.) x xWork samples x x Current academic progress x xGroup achievement (e.g., Stanfords, MCA II) xAnecdotal Records xCurriculum-Based Assessment x xInformal Assessment (e.g., reading inventory) x xOutside Evaluations/Reports (medical/psychological evaluations)

x x

Sensory Status x x xVocational Skills inventories (required for 14 and older)

Required components for all SLD Evaluations



RECORD REVIEW FOR LEARNING DISABILITIES EVALUATION

After the evaluation team has received the signed referral, information about the child’s school history is gathered by reviewing the school records. It is in these records that the professional can find a wealth of information about the child. This information is vital for addressing the severe underachievement component of the SLD criteria and addressing the exclusionary factors. These records:

Describe where the child has gone to school in the past.

Tell with whom the child lives; his parents and siblings.

Show the child’s progression or retention through the grades.

Contain report card comments and grades from past teachers.

Give group achievement or group intelligence test scores of this child.

Indicate any significant health problems of the child.

Report the results of any vision or hearing screenings the child has had.

Indicate any special programs that have been tried with the child.

Contain any other evaluations that have been completed.

Show the child’s attendance patterns.

Show demographic information; parents’ education, occupations, etc.



INFORMATION PROCESSING: TEACHER INTERVIEW

Student’s Name ________________________________ Grade _________ Birth Date ________________General Education Teacher ______________________________________ Date _____________________Assessor _______________________________________________________________________________Directions: Please rate the student on the following behaviors that might indicate the presents of an information processing condition. Each section represents one component of information processing. Additional information may be recorded on a separate sheet of paper or on the back of this form.

Storage Almost always

Frequently

About ½ the time Seldom

Hardly ever

Not observe

dFollows two to three-step directions Immediately recalls information Retains sequences Grasps simple word meanings Recognizes or recalls information over time

Organization Almost always

Frequently


Hardly ever

Not observe

dHands assignments in on time Has an organized locker or desk Completes assignments Uses planning skills Aligns work spatially Sequences information

Acquisition Almost always

Frequently


Hardly ever

Not observe

dLinks new information to that previously learned

Obtains information by hearing Obtains information by seeing Obtains information by reading Obtains information by touching Obtains information through multi-sensory approach

Can discriminate visually Can discriminate auditorily

Retrieval Almost always

Frequently


Hardly ever

Not observe

dResponds in acceptable amount of time Develops strategies to help recall information Can name and label


Recalls sounds associated with letters and words

Counts and calculates automatically Recalls sequential steps for tasks


Expression Almost always

Frequently


Hardly ever

Not observe

dDemonstrates oral fluency Demonstrates reading fluency Demonstrates writing fluency Responds appropriately to nonverbal communication

Asks questions/gives answers related to content

Participates in class activities

Manipulation Almost always

Frequently


Hardly ever

Not observe

dApplies learned information to new situations Infers information Summarized information Interprets information Writes sentences of varying length and complexity

Analyzes and solves problems of varying complexity

Interprets social cues Differentiates details from key concepts



INFORMATION PROCESSING: STUDENT INTERVIEW

Student’s Name ________________________________ Grade _________ Birth Date ________________General Education Teacher ______________________________________ Date _____________________Assessor _______________________________________________________________________________Directions: Which word best describes you? (Read items to student and modify as needed).

1. After hearing new information, I learn it by saying it again to myself. (S)

Usually Sometimes

Seldom

2. I spell words by seeing the word in my mind. (S) Usually Sometimes

Seldom

3. I spell words by sounding out the letters. (S) Usually Sometimes

Seldom

4. I turn my assignment in on time. (O) Usually Sometimes

Seldom

5. My locker and desk are in order. (O) Usually Sometimes

Seldom

6. I run out of space when I am writing. (O) Usually Sometimes

Seldom

7. When I write papers, I get information before I begin writing. (O)

Usually Sometimes

Seldom

8. I make notes or an outline before I write. (O) Usually Sometimes

Seldom

9. I edit or change my writing at least once before handing my paper in to the teacher. (O)

Usually Sometimes

Seldom

10.

When I do a math story problem, I think about the information before I do the work. (O)

Usually Sometimes

Seldom

11.

I can tell a story in the right order. (O) Usually Sometimes

Seldom

12.

I know how to study for a test. (O) Usually Sometimes

Seldom

13.

I remember things without having to have them repeated. (A)

Usually Sometimes

Seldom

14.

I learn new things easily. (A) Usually Sometimes

Seldom

15.

I understand what I read. (A) Usually Sometimes

Seldom

16.

I understand what someone tells me. (A) Usually Sometimes

Seldom

17.

I understand my class work. (A) Usually Sometimes

Seldom

18.

I know my basic addition facts. (R) Usually Sometimes

Seldom

19.

I know my basic multiplication facts. (R) Usually Sometimes

Seldom

20.

I use pictures when I do a math problem. (R) Usually Sometimes

Seldom

21.

I remember things from the past. (R) Usually Sometimes

Seldom


22.

I remember the specific information I have studied for a test. (R)

Usually Sometimes

Seldom

23.

I like to play games that are timed. (R) Usually Sometimes

Seldom

24.

I do things at a fast rate of speed. (R) Usually Sometimes

Seldom

25.

I can tell you how to get around the building. (E) Usually Sometimes

Seldom

26.

I like to: read aloud (E) Usually Sometimes

Seldom

draw (E) Usually Sometimes

Seldom

give oral reports (E) Usually Sometimes

Seldom

do an experiment (E) Usually Sometimes

Seldom

show how to do something (E) Usually Sometimes

Seldom

write (E) Usually Sometimes

Seldom

do math problems (M) Usually Sometimes

Seldom

27.

I can find more than one way to answer a question. (M) Usually Sometimes

Seldom

28.

I can explain what I learn to my parents. (M) Usually Sometimes

Seldom

Write your answers to these questions:29.

Name two things that are alike and tell why. (M,E) 1) ______________ 2)______________

30.

Name two things that are different and tell why. (M,E) 1) ______________ 2) ______________

31.

How do you remember new information such as spelling words, a friend’s phone number, etc.? (S,O,E)

32.

What are the names of all of your teachers including phy-ed, music and art? (S,O,E)

____________________________ ____________________________ ________________________________________________________ ____________________________ ________________________________________________________ ____________________________ ____________________________

S = Storage, O = Organization, A = Acquisition, R = Retrieval, E = Expression, M = Manipulation of information



EXAMPLE: SLD EVALUATION REPORT

REASON FOR REFERRAL Julian was referred to the Child Study Team by his mother because of her concerns about his struggling with the first grade expectations in reading.

BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: Julian is currently a first grader at St. Pius school. He also attended kindergarten at St. Pius. There was some discussion of the end of his kindergarten year about having Julian repeat kindergarten. Before school ended, his teacher noted that he was doing so well, that she did not think he should be held back. Julian had some help with a tutor over the summer, and the tutor told Julian's mom, that he was making nice progress. Julian was previously referred by his mother, for speech and language concerns in May of 2004, at age three years two months due to his mispronunciation of sounds. The evaluation revealed that he was not eligible for speech and language services at that time. Julian score on the above the Preschool Developmental Inventory was above the cutoff score, indicating that further evaluation was not warranted. LANGUAGE/RACIAL/CULTURAL FACTORS: There are no known language/racial/cultural factors that would negatively impact this evaluation.

INFORMATION FROM PARENTS: Julian lives at home with his mother. There were not complications during the pregnancy or birth of Julian. Julian was hearing impaired as a result of multiple ear infections from age 9 months to 17 moths and he was delayed in his speech development. Some events changes in Julian's life include the fact that his parents were divorced in 2006 and his father remarried in 2007. His step-sister joined his family. Julian's current problems in school are with reading, motivation, and independence. These problems were first apparent in kindergarten. Julian's mother thinks these problems may be due to a lack of interest on Julian's part. INFORMATION FROM TEACHERS: Information from teachers will be forthcoming in this evaluation.


INTELLECTUAL: Woodcock-Johnson Tests of Cognitive Abilities (WJ-III COG) by Z, School PsychologistThe WJ-III COG provides a measure of general intellectual abilities and specific cognitive abilities. It can be used with individual from 2 through 90+ years. It has both a standard battery (including 10 subtests) and an extended battery (an additional 10 subtests.)

WJ-III COG Date: Score Range Verbal Ability 78 (66-91) Below AverageThinking Ability 93 (88-98) Average


Cognitive Efficiency 86 (80-91) Low AverageGENERAL INTELLECTUAL ABILITY (GIA) 88 (84-91) Low Average

Interpretation: During the evaluation Julian was cooperative but appeared fidgety and restless at times. He was often distracted and needed to be redirected to the tasks. Julian appeared to be comfortable with the evaluator. At times, it is believed he responded too quickly to items and he attempted items, but would give up easily. Due to some distraction, this sore may be an underrepresentation of his true abilities. Julian's Verbal Ability (acquired knowledge and language comprehension and ability to express himself verbally) was within the below average rage when compared to others his age level. The Verbal Ability Scale is composed of four subtests and provides a measure of language development that includes the comprehension of individual words as well as the relationship among words. Julian's Thinking Ability (intentional cognitive processes) is in the average range and is an area of strength for Julian. The Thinking Ability Scale represent a sampling of different thinking processes that may be used when information in short-term memory cannot be processed automatically. It is designed to test four thinking abilities including a) long term retrieval, b) visual spatial thinking, c) auditory processing, and d) fluid reasoning.) Julian's Cognitive Efficiency (automatic cognitive processing) was in the low average range . The Cognitive Efficiency Scale is a measure that represents a sampling of two different factors of automatic processing or the process of the cognitive system to process information automatically. It includes a processing speed test (Visual matching) and one short term memory test (Numbers Reversed). Julian's General Intellectual Abilities scale which was in the Low Average ranges. The General Cognitive Abilities Score combines the Verbal Ability, Thinking Ability and Cognitive Efficiency scales. The General Intellectual Ability is considered the best single-score predictor of global criteria such as overall school achievement or other life outcomes that have a relationship to cognitive ability. ** Note: Cognitive tests or IQ tests are measures of only a part of the competencies involved with intelligent behavior. Information obtained from intelligence tests is useful, but limited. IQ tests are best used as estimates of likely school performance and are a reflection of the extent to which children have mastered middle class cultural symbols and broad culturally rooted facts, concepts and problem solving strategies. IQ tests do not reflect innate genetic capacity and IQ scores can vary. Some individuals will demonstrate significant increases or decreases in their measured intellectual abilities. ACADEMIC by Z, Special Education TeacherWoodcock-Johnson Tests of Achievement - Third Edition (WJ-III) The WJ-III is an individually administered, broad-based, nationally normed achievement test. It provides information about reading, math, written language and oral language.

WJ-IIIForm: ADate: November 2007

Score Range

Basic Reading 87 Low Average Reading Comprehension 76 Low Math Calculation 81 Low Average Math Reasoning 85 Low Average


Written Expression 81 Low Average Oral Expression 90 Average Listening Comprehension 96 Average

Interpretation: The Basic Reading Skills cluster is a combination of the Letter-Word Identification and the Word Attack tests and provides a measure of the basic reading skills through letter identification, decoding sight vocabulary, phonics skills and structural analysis. For Letter-Word Identification, the student is asked to read a list of letters/words out of context. Julian's score of 87 is low average. Julian was able to identify and name upper case and lower case letters and correctly identify the words cat and car. He was very distractible during this task. For Word Attack, the student is asked to read lists of nonsense words. Julian's score of 89 is low average. He was able to identify the sounds of p, k, and n. He was not able to read any of the words. Instead he named letters. His overall Basic Reading Skills score of 87 is in the low average range. Julian needs to increase his phonics skills and reading of short vowel words and high frequency words. The Reading Comprehension cluster consists of the Passage Comprehension and Reading Vocabulary subtests. They provide a measure of comprehension, vocabulary, and reasoning. For the Passage Comprehension subtest, the student may identify symbols, read word phrases, read a passage and fill in the missing word. Julian's score of 75 is in the low range. Julian was able to identify symbols for chair, book, dog, and cat. He was also able to associate the words "yellow bird" with a picture of a yellow bird. For the Reading Vocabulary subtest, the student identifies synonyms, antonyms, and analogies. Julian's score of 0 does not provide a standard score. He was not able to read the provided words or name their synonyms or antonyms. His overall Reading Comprehension score of 76 is in the low range. The Math Calculation cluster consists of the calculation and math fluency subtests. These measure computational skills and automaticity of basic math skills and basic math facts. On the Calculation subtest, basic math problems are given for the student to solve. Julian's score of 78 is low. He was able to correctly solve two problems. The Math Fluency subtest consists of basic math facts given as a timed test. Julian's score of 91 is average. Julian correctly answered 11 problems including some addition, subtraction, and multiplication. For other problems he added when he should have subtracted. His overall Math Calculation score of 81 is in the low average range. The Math Reasoning cluster consists of Applied Problems and Quantitative Concepts subtest. These provide a measure of problem solving, analysis, reasoning, and vocabulary. The Applied Problems subtest asks the student to solve a variety of story problems read aloud by the test administrator. Julian's score of 94 is average. He was able to identify the number of objects in pictures such as the number of ducks in the water and so forth. Quantitative Concepts deals with math patterns and vocabulary. Julian's score of 79 is low. He was able to identify some shapes, numbers of objects, largest and smallest, last and middle. On the task that required Julian to count from 1 to 10 he was not able to do this, however when asked to count by two's Julian counted by ones. His overall Math Reasoning score of 85 is in the low average range. The Written Expression cluster consists of Writing Fluency and Writing Samples. These provide a measure of meaningful written expression and fluency. The Writing Fluency subtest is a timed test where the student writes sentences with the three provided words. Julian's score is 0 as he was not able to complete the sample items therefore the subtest was discontinued. On the sample items, Julian wrote a series of letters and included one period. He then asked the test administrator to read what he had written. The administrator asked Julian to read his writing. He read his sentences as follows: "This pig is not fat he is cool." "This ball is so huge" and "This bell is so cool we really, really, really like it." The Writing Samples subtest consists of Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-107

sentence writing with prompts from the test administrator. Julian's score of 87 is low average. Julian correctly wrote his name and the word cat. For the other prompts he wrote a variety of upper case and lower case letters in isolation. His overall Written Expression score of 81 is in the low average range. The Oral Expression cluster consists of Story Recall, Understanding Directions, Picture Vocabulary, and the Oral Comprehension subtest. For Story Recall, the student listens to a story on a cassette tape and is asked to retell the story. Julian's score of 111 is high average. The Understanding Directions subtest requires the student to look at a picture and then point to various items in the pictures based on a prompt from a cassette tape. The directions begin with one step and gradually increase to multi-step directions. Julian's score of 95 is average. For Picture Vocabulary, the student is shown various pictures and is asked to name the picture. Julian's score of 84 is low average. For the Oral Comprehension subtest, the student listens to a prompt from a cassette tape and is asked to finish the prompt. For example, "Candy tastes ____." Julian's score of 99 is average. His overall Oral Expression score of 90 is in the average range. His overall Listening Comprehension score of 96 is average. Minnesota Information Processing Checklist: Information processing refers to the acts of receiving, recalling, and using information to function in the environment. Minnesota rule states that a specific learning disability is manifested by the following: storage (using memory, rehearsing, and relating information), organization (arranging, planning, and labeling information), acquisition (receiving, linking, gaining, and comprehending information), retrieval (locating, recognizing, and searching for information), expression (reconstructing, demonstrating, and sharing information), and manipulation (evaluating, integrating, and translating information).

Home Information: Based on an interview with Z, Julian's mother, the major area of concern is with reading, motivation and independence. Angela believes that Julian's slower progress with reading may be due to his lack of interest. Angela has tried helping Julian at home by reading aloud to him and helping him with his homework. Angela believes that other people believe Julian is well behaved when he is not around her. Julian was almost retained in kindergarten, but he began making some nice progress at the end of the year, and parents were told it was alright for Julian to move to first grade. In Angela's opinion, the school staff can be most helpful to Julian now by realizing he is unique and allowing him to be unique. Some strengths about Julian are that he is creative, thoughtful and enjoys hands on tasks. Julian learns best when he is given rewards. Angela reports that in the last three months they have used flash cards, guided reading, and worked on numbers correctly. Julian has had difficulties writing letters, and works in the correct case. Angela would like to know Julian's areas of strengths and weaknesses and ideas to help him progress to second grade. Julian currently does homework for 2-3 days a week for approximately 30 minutes to 1 hour. He needs assistance to complete the homework. If he didn't have so much homework, family life would be less frustrating in the evening. Storage: Julian almost always requires parental assistance in organizing and planning skills. Acquisition: In the areas of acquisition, Julian almost always requires assistance in understating what he reads, understanding what he sees, and in learning a new game. Retrieval: In the area of retrieval, Julian almost always requires parental assistance in reading aloud. Manipulation: In the area of manipulation, Julian always requires parental assistance in problem solving and in explaining something he learns. Teacher Information:


Date: November 8, 2007Interpretation: The Information Processing Teacher Interview was completed by Julian's first grade teacher Ms. Z. Ms. Z noted Julian's strengths as physical games and activities as well as adding and subtracting one digit numbers under 12. She is concerned about his challenges with reading, phonics, decoding, and comprehending. Other concerns are noted as follows: Storage: Julian hardly ever follows two to three step directions, immediately recalls information, retains sequences, or recalls information over time. About half of the time Julian is able to grasp simple word meanings. Organization: Julian hardly ever uses planning skills, aligns work spatially, or sequences information. He frequently hands in assignments on time and has an organized locker and desk. Acquisition: Julian hardly ever links new information to that which was previously learned. He hardly ever obtains information by reading. About half of the time, Julian obtains information by hearing, seeing, or through a multi-sensory approach. About half of the time he can discriminate visually or auditorily. Retrieval: Julian hardly ever recalls sequential steps for tasks. He seldom recalls sounds associated with letters and words or counts and calculates automatically. About half the time Julian responds in an acceptable amount of time. Julian can frequently name and label things. Expression: Julian hardly ever demonstrates reading or writing fluency. About half of the time he responds appropriately to nonverbal communication and participates in class activities. Frequently, Julian demonstrates oral fluency and asks questions or gives answers related to content. Manipulation: Julian hardly ever applies learned information to new situations, infers, summarizes, or interprets information. He hardly ever writes sentence that vary in length or complexity. He hardly ever solves problems or analyzes problems of varying complexity or differentiates details from key concepts. About half of the time he interprets social cues.

HEALTH/PHYSICAL: Z Licensed School Nurse (LSN)Health Status: A school health update filled out by Julian's parents on Sept. 27, 2007 indicated that they had no health concerns for Julian.

SENSORY: Review of Records: by Z, Licensed School NurseMathew passed a hearing screening within normal limits. He also passed a vision screening within normal limits, his visual acuity was 10/12.5 in both his right and left eye. FINE MOTOR: by Z, Occupational TherapistBruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2) Fine MotorThe BOT2 is an individually administered measure of fine motor skills used for assessing children ages 4 through 21. Scaled Scores have a mean of 15 and a standard deviation of 5, and Standard Scores have a mean of 50 and standard deviation of 10. Average scaled scores range from 11 to 19 and average standard scores range from 41-59:

BOT2Date: 11/30/07

Score Range

Fine Motor Precision 11 average


Fine Motor Integration 9 below average TOTAL FINE MANUAL CONTROL 38 below average Manual Dexterity 14 average

Interpretation: Julian was administered the fine motor subtests of the BOT2. The Fine Motor Precision and Fine Motor Integration subtests consist of tasks that encompass the control and coordination of the hands and fingers, especially for grasping, writing and drawing. The Manual Dexterity subtest is a series of timed activities encompassing the control and coordination of the arms and hands, especially for object manipulation. Julian was very enthusiastic and energetic, and seemed to be trying to do well on the test items. He was extremely fidgety, somewhat impulsive in his performance, and quite rapid in his execution of many of the items. He was not particularly distracted by stimuli in the environment (visual or auditory), but frequently drew himself off task with conversation, movement, and a desire to control the testing situation. Julian obtained average scores on the first and third subtests, and a slightly below average score on the second subtest. The subtest on which he received the lower score was one consisting totally of design copying. Even though this is not a timed test, he tended to execute the items quite rapidly. This score is probably a minimal estimate of his actual abilities, because, had he gone more slowly, the chances are that his score would have been somewhat higher, quite possibly in the average range. However, it seemed to be a valid representation of what Julian was able to bring to the testing situation on this day. Observations: Julian used his left hand as his preferred hand, and demonstrated a variety of appropriate grasp and manipulation patterns on test materials, including a functional 3-finger pencil grasp. He generally rested his arm appropriately on the table as he wrote, and stabilized the paper well with his right hand. His general muscle strength, tone and stability were within a typical range.

Handwriting: In addition to his name, he was asked to copy a sentence of nine words. Of the 37 letters in this sentence, only 4 would have been difficult to decipher had they been out of context. Several letters were formed incorrectly, but this did not generally compromise their legibility. Spacing (both within and between words) was somewhat problematic, as was letter size consistency, and, to a lesser degree, alignment on the single-lined (baseline) paper. Information from classroom teacher:Julian's classroom teacher reported that Julian fidgets all the time. He also picks at erasers and crayons frequently. His writing is often "all over the place", with little spatial awareness of alignment or where to place letters, but the letters themselves are usually legible. She mentioned that he does a satisfactory job in other fine motor activities such as art, but generally needs the help of a peer to keep him on track and finish the project. He performs functional/self-care tasks, such as dressing and using clothing fasteners, independently. Summary/Present Levels:Julian's scores on the Bruininks test suggest an average to slightly below average level of fine motor skills. However, due to his fidgeting behavior and impulsive task execution, this is quite possibly a minimal estimate of his actual abilities. On observation, he had good dexterity and grasp patterns on a variety of test items and general materials. His muscle strength and tone were average, and it appeared that motor planning ability (mentally planning, and then effectively executing a novel motor task) was adequate, as well. Julian needs to slow down when doing fine motor tasks, particularly complex tasks like writing. If he does not rush through tasks, and attends to the smaller, relevant details, his fine motor performance will probably improve. Also, a variety of types of handwriting paper might be tried to see which ones elicit the best results. Single-lined paper (rather than unlined paper or Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-110

the typical 3-lined handwriting paper) seemed to work well for him during this testing session. Double-lined paper (like HWT paper) was not tried during testing, but may also help to improve his legibility.

OBSERVATIONS:

Date: December 4, 2007Time: 9:15-9:35Observed by: Z, Special Education TeacherSetting: Reading Teacher's Classroom Julian was observed during a small group reading class with the reading teacher. He and four other students were seated at a small table with the teacher. First the group reviewed what they had done the previous day. The students then reviewed color words by using the magic pointer to point to the word the teacher said. Julian's word was blue and he took a lot of time to process the information before pointing. Julian sounded out the b at the beginning of the word blue. He initially pointed to the word purple and then to other words before pointing to blue with teacher assistance. The next turn he was to point to the word green. Another student said the sound /g/ before Julian had a chance to do this. It again took a while for him to point to the word. The other students were quicker at this task. The group was then instructed to whisper read a book. Julian was turned to the "hairy monster" to read. He was able to read the book on his own specifically the repeated sentence "I can see". He was the first to finish reading and stated that he was done. The group then rotated and Julian read with the teacher. He had trouble with the sentences that started differently than "I can see", for example "Can you see fish?" was challenging for him. He needed a lot of prompting to be guided to read the words rather than just repeat the sentences. The group finished one more rotation and discussed What was your favorite fish in the book. Julian stated his favorite was the "shark" but was reminded that there was no shark in the book. The group then wrote in their journals about the story. They were instructed to write two sentences about fish. Julian said "can we write zero?". The students were told to write the title of the book and then write the sentence starter "I can see". Julian needed help writing the word fish and required more teacher assistance than the other students. One of his sentences as prompted by the directions was "I can see a green" however green was not spelled correctly.

Academic Areas: Both basic reading and reading comprehension were a problem for Julian. He needed assistance for both decoding words and for understanding what was read. Written expression was also challenging for Julian. He also demonstrated some problem with oral expression and listening comprehension in that he repeated some sentences, stated "Me want one" and he was directed to listen to directions.

Behavior: Julian was observed to have some problem with distractibility and hyperactivity. He was moving a lot in his seat and also pretended to use his hands as a camera at the beginning of the lesson.

Information Processing: Julian was observed to have some problem with remembering visual and auditory material, having classroom materials (he did not have his writing journal), understanding visual material, comprehending information, recalling information, responding in a timely manner, using strategies to recall, writing legibly, demonstrating fluency iin speech, and applying information.

VALIDITY Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-111

Were the evaluations administered valid for the student? YesWere the evaluations administered valid for the purpose to which they were intended? Yes

Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? NoA lack of appropriate educational instruction in math? NoLimited English proficiency? No

PRESENT LEVEL OF PERFORMANCE

Julian is currently a first grader at St. Pius School. Julian also attended kindergarten at St. Pius. Julian's overall ability is within the low average. Julian demonstrates an individual strength in tasks that involve hand-eye coordination and nonverbal ability wilt scores in the average range. Julian's verbal ability score was within a below average range whereas his thinking ability score was within an average range. Julian's cognitive efficiency score was also in the low average range, but this lower score may have been affected by his distractibility. Julian's academic achievement scores were all in the average range on the oral expression and the listening comprehension sections. On the Reading Comprehension test they were in the low range and in the Basic Reading, Math Calculation, Math Reasoning, and Written Expression, they were in the low average range. Julian demonstrates some information processing deficits in both the home and school setting in the areas of storage, organization, acquisition, retrieval, expression and manipulation. Julian's scores on the Bruininks test suggest an average to slightly below average level of fine motor skills. However, due to his fidgeting behavior and impulsive task execution, this is quite possibly a minimal estimate of his actual abilities. On observation, he had good dexterity and grasp patterns on a variety of test items and general materials. His muscle strength and tone were average, and it appeared that motor planning ability (mentally planning, and then effectively executing a novel motor task) was adequate, as well. Julian needs to slow down when doing fine motor tasks, particularly complex tasks like writing. If he does not rush through tasks, and attends to the smaller, relevant details, his fine motor performance will probably improve. Also, a variety of types of handwriting paper might be tried to see which ones elicit the best results. Single-lined paper (rather than unlined paper or the typical 3-lined handwriting paper) seemed to work well for him during this testing session. Double-lined paper (like HWT paper) was not tried during testing, but may also help to improve his legibility. Julian is reported to be a healthy boy with vision and hearing within a normal range. ELIGIBILITY DETERMINATION Specific Learning Disability:According to Minnesota Special Education rules, a student has a Specific Learning Disability and is in need of special education and related services when the student meets the criteria described in items A, B, and C.

Julian's evaluation documents: A) Severe underachievement in the area of reading based on his performance in the classroom according to his classroom teacher. B) Based on a comparison of an overall intellectual ability score of 88 on the Woodcock-Johnson Tests of Cognitive Abilities (WJ-III COG) and academic achievement scores of 87 In Basic Reading, 76 in Reading Comprehension, 81 in Math Calculation, 85 in Math Reasoning and 81 in Written Expression on the Woodcock-Johnson Tests of Achievement - Third Edition (WJ-III) a severe discrepancy is not established according to the Minnesota SLD Regression Table. A standard score of 72 or below is needed in order to establish this severe discrepancy and all of Julian's scores were higher than this. C) Information processing deficits are evident, based on Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-112

information obtained by parent and school staff, in the areas of Storage, Acquisition, Retrieval, Expression and Manipulation. Storage: At home, Julian almost always requires parental assistance in organizing and planning skills Organization: Julian hardly ever uses planning skills, aligns work spatially, or sequences information. Acquisition: In the areas of acquisition, Julian almost always requires assistance in understating what he reads, understanding what he sees, and in learning a new game. Julian hardly ever links new information to that which was previously learned. He hardly ever obtains information by reading. Retrieval: Julian hardly ever recalls sequential steps for tasks. He seldom recalls sounds associated with letters and words or counts and calculates automatically. Expression: Julian hardly ever demonstrates reading or writing fluency. Manipulation: Julian's teacher reports that Julian hardly ever applies learned information to new situations, infers, summarizes, or interprets information. He hardly ever writes sentence that vary in length or complexity. He hardly ever solves problems or analyzes problems of varying complexity or differentiates details from key concepts. At home, Julian always requires parental assistance in problem solving and in explaining something he learns

In summary, based on the results of this evaluation, Julian does not meet eligibility criteria for a Specific Learning Disability due to a lack of a large enough discrepancy between ability and achievement.

EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITY At this time, Julian does not meet criteria for special education services and his needs can be best met in the regular educational classroom with some modifications. Julian will benefit from repeated exposure to the material in different formats using different modalities. Since Julian likes to work for rewards, a individualized reward plan may benefit Julian. It may also benefit Julian if tasks were broken down into small, attainable parts for individualized seat work. Julian will likely require additional help to complete tasks, especially in the area of reading.



CHAPTER 3C: Speech or Language Impairment Documentation


STATE GUIDELINES: SPEECH OR LANGUAGE IMPAIRMENTF L U E N C Y D I S O R D E R

"Fluency disorder" means the intrusion or repetition of sounds, syllables, and words; prolongation of sounds; avoidance of words; silent blocks; or inappropriate inhalation, exhalation, or phonation patterns. These patterns may also be accompanied by facial and body movements associated with the effort to speak. Fluency patterns that can be attributed only to dialectical, cultural, or ethnic differences or to the influence of a foreign language should not be identified as a disorder.

The team shall determine that a student has a fluency disorder and is eligible for speech or language special education when the student meets the criterion in both items A and B:

A. the behavior interferes with communication as judged by a teacher of communication disorders and either another adult or the child; and

B. dysfluent behaviors occur during at least five percent of the words spoken on two or more speech samples.

V O I C E D I S O R D E R"Voice disorder" means the absence of voice or presence of abnormal quality, pitch, resonance, loudness, or duration. Voice patterns that can be attributed only to dialectical, cultural, or ethnic differences or to the influence of a foreign language should not be identified as a disorder.

The team shall determine that a student has a voice disorder and is eligible for speech or language special education when the student meets the criterion in both items A and B:


B. achievement of a moderate to severe vocal severity rating is demonstrated on a voice evaluation profile administered on two separate occasions, two weeks apart, at different times of the day.

A R T I C U L A T I O N D I S O R D E R"Articulation disorder" means the absence of or incorrect production of speech sounds that are developmentally appropriate. Articulation patterns that can be attributed only to dialectical, cultural, or ethnic differences or to the influence of a foreign language should not be identified as a disorder.


The team shall determine that a student has an articulation disorder and is eligible for speech or language special education when the student meets the criterion in item A and either B, C, or D:


B. test performance falls 2.0 standard deviations below the mean on a technically adequate, norm-referenced articulation test; or

C. performance on a pressure consonant test indicates problems in nasal resonance; or

D. a student is nine years of age or older and a sound is consistently in error as documented by two three-minute conversational speech samples.

L A N G U A G E D I S O R D E R"Language disorder" means a breakdown in communication as characterized by problems in expressing needs, ideas, or information that may be accompanied by problems in understanding. Language patterns that can be attributed only to dialectical, cultural, or ethnic differences or to the influence of a foreign language should not be identified as a disorder.

The team shall determine that a student has a language disorder and is eligible for speech or language special education services when the student meets the criterion in items A and B and either item C or D:


B. an analysis of a language sample or documented observation of communicative interaction indicates the student's language behavior falls below or is different from what would be expected given consideration to chronological age, developmental level, or cognitive level; and

C. the student scores 2.0 standard deviations below the mean on at least two technically adequate, norm-referenced language tests if available; or

D. if technically adequate, norm-referenced language tests are not available to provide evidence of a deficit of 2.0 standard deviations below the mean in the area of language, two documented measurement procedures indicate a substantial difference from what would be expected given consideration to chronological age, developmental level, or cognitive level. These procedures may include additional language samples, criterion-referenced instruments, observations in natural environments, and parent reports.



SPEECH OR LANGUAGE (S/L) IMPAIRMENT CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________Student ID#:__________________________________ Grade:_______School: ___________________________________________________Date of Meeting:____________________________________________

In order for a student to be eligible for special education and related services under the category of speech or language impairment they must meet the following criterion.

A. F

LUEN

CY

The team shall determine that the student meets the criterion in both of these areas: CIRCLE1. the behavior interferes with communication as judged by a teacher of

communication disorders and either another adult or the child; andYES

NO

2. dysfluent behaviors occur during at least five percent of the words spoken on two or more speech samples.

YES

NO

Have all criteria in ITEM A been met? YES

NO

B. V

OICE

The team shall determine that the student meets the criterion in both of these areas: CIRCLE1. the behavior interferes with communication as judged by a teacher of


NO

2. achievement of a moderate to severe vocal severity rating is demonstrated on a voice evaluation profile administered on two separate occasions, two weeks apart, at different times of the day.

YES

NO

Have all criteria in ITEM B been met? YES

NO

C. A

RTIC

ULAT

ION

The team shall determine that the student meets criterion in: CIRCLE1. the behavior interferes with communication as judged by a teacher of


NO

2. test performance falls 2.0 standard deviations below the mean on a technically adequate, norm-referenced articulation test; or

YES

NO

3. performance on a pressure consonant test indicates problems in nasal resonance; or

YES

NO

4. a student is nine years of age or older and a sound is consistently in error as documented by two three-minute conversational speech samples.

YES

NO

Have all criteria in ITEM C been met? YES

NO

D. L

ANGU

AGE

The team shall determine that the student meets criterion in: CIRCLE1. the behavior interferes with communication as judged by a teacher of


NO

2. an analysis of a language sample or documented observation of communicative interaction indicates the student's language behavior falls below or is different from what would be expected given consideration to chronological age, developmental level, or cognitive level; and

YES

NO

3. the student scores 2.0 standard deviations below the mean on at least two technically adequate, norm-referenced language tests if available; or

YES

NO

4. if technically adequate, norm-referenced language tests are not available to provide evidence of a deficit of 2.0 standard deviations below the mean in the area of language, two documented measurement procedures indicate a substantial difference from what would be expected given consideration to chronological age, developmental level, or cognitive level. These procedures may include additional language samples, criterion-referenced instruments, observations in natural environments, and parent reports

YES

NO


Have all criteria in ITEM D been met? YES

NO



GUIDELINES FOR CONDUCTING EVALUATIONS FOR SPEECH OR LANGUAGE IMPAIRMENT

Evaluation of Speech or Language Impairment (S/L) must be based upon multiple sources of information and includes four phases: prereferral, evaluation determination, evaluation process, and evaluation report. An effective evaluation process should provide sufficient information to determine eligibility, as well as, gather information to guide future intervention.

P r e r e f e r r a lAs with all special education evaluations, at least two documented interventions must be conducted prior to a referral for evaluation for language concerns. Prereferral documentation must include a definition of the problem, review of appropriate records, samples of classroom work, and the documented interventions. The prereferral process will vary slightly from building to building.

E v a l u a t i o n P l a nThe Evaluation Plan provides a foundation to ensure that adequate information is gathered to meet due process requirements for eligibility determination. Parents must have input to determine how to proceed with the evaluation; several possible data sources should be considered. For published tests, professional ethics require that evaluations be administered and interpreted by personnel with training commensurate with the requirements listed by the test publishers. A speech/language clinician must be involved in this process.

E v a l u a t i o n P r o c e s sA multidisciplinary team is required for all special education evaluations, and the S/L evaluation process must include a clinician licensed in the area of S/L and others as determined by the individual circumstances of the referral concern. Evaluation information may include information provided by parents, teachers as well as direct evaluation and observation of the student.

E v a l u a t i o n Re p o r tThe Evaluation Report (ER) should present all relevant and significant evaluation results and integrate these findings in a manner that systematically addresses the state eligibility criteria.

Prior to the evaluation meeting, the person responsible for writing the evaluation report should gather evaluation data from all those involved in the evaluation process and synthesize that information into one comprehensive report. The written report needs to be available to the parents within 30 days of when the evaluation plan is signed. However, after the evaluation meeting, changes / additions may need to be made in order to finalize the report.

At the evaluation conference, the team will present and discuss evaluation results in order to make a special education eligibility determination. As information is shared, additions can be made to the ER report. The ER can also be amended to include the recommendations of the team.



EXAMPLE: SPEECH/LANGUAGE EVALUATION REPORT

REASON FOR REFERRAL Dylan was referred for this evaluation by his kindergarten teacher who noticed difficulty trying to understand Dylan in the regular classroom environment. His teacher also noticed difference in his language development as compared to same age peers. His mother agreed to the evaluation as she had noticed the same difficulties at home. It was noted on his Early Childhood Screening in April of 2006, that Dylan should be further examined for a speech delay.

BACKGROUND INFORMATION Dylan is a 5yr 6 month old male who attends Kindergarten at Sunset Terrace Elementary. He lives with his mother and father and older brother in Rochester Minnesota.LANGUAGE/RACIAL/CULTURAL FACTORS: Dylan is Caucasian and his family speaks only English in the home. There are no known language/racial/cultural factors that would negatively impact this evaluation. INFORMATION FROM PARENTS: Dylan's mother reports that she has difficulty understanding him and that he does not seem to put sentences together as well as other children his age. She is worried that this will affect his ability to reach his academic potential in the regular educational classroom.

INFORMATION FROM TEACHERS: His regular education kindergarten teacher reports that Dylan is able to identify letters and number and count at a level commensurate with his peers. She notes he is able to get along with others and communicates with them, although at times it is difficult for his peers to understand him. She does note that Dylan has not made gains in regard to being able to match written letters with their sound.


COMMUNICATION From Z, (Speech/Language Pathologist): Clinical Evaluation of Language Fundamentals- Preschool: Second Edition (CELF-PRE:2) The CELF-PRE:2 is an evaluation of expressive and receptive language skills for students 3 years 0 months through 6 years 11 months of age. Subtests include: Concepts and Following Directions, Word Structure, Expressive Vocabulary, Recalling Sentences, Sentence Structure, Basic Concepts, Recalling Sentences in Context, Word Classes and Phonological Awareness.

Subtest scores are reported as scaled scores which have a mean of 10 and a standard deviation of 3. A scaled score range of 7 to 13 represents the average language skills in each individual subtest.

CELF-PRE:2 Date: Score Range Standard Deviation

Difference Sentence Structure 10 Avg. --- Word Structure 8 Avg. --- Expressive Vocabulary 8 Avg. --- Concepts & Following Directions --- Recalling Sentences --- Basic Concepts --- Word Classes Receptive ---


Word Classes-Total --- TOTAL CORE LANGUAGE 92 Average -.5

Interpretation:

Dylan's language skills as measured on the CELF-preschool 2 appear to be in the average range. He is able to understand and use language in an adequate manner. Photo Articulation Test- Third Edition (PAT-3) The PAT-3 is a standardized tool that provides a systematic method for eliciting all English speech sounds from children 3 years 0 months through 8 years 11 months of age. Photographs are presented to the student, who is asked to name the pictures.

PAT-3 Date: Score Range Standard Deviation

Difference TOTAL 30 Far below Avg. -2.0

The following errors were documented at the word level: Sound Initial Medial Final p m w h b d n y k t t t g d d t f ng j sh s th l w w zh s v b b b ch t s sh s bl f s s z l bl bw sl voiced th d d v r bl bw tr sr voiceless th n f s r w TOTAL 12 10 8

Interpretation:


Dylan has difficulty with sounds which are usually developed by his chronological age. These sounds include: "k,g. and l". He also has difficulty with sound clusters such as "sp, sk, st, bl, and cl,br, kr, and tr". These errors impact his ability to be understood by peers and adults in the regular education setting. His score on this measure of 70 is deemed educationally significant.Structured Phonographic Expressive Language Test-III (SPELT-III) The SPELT-III measures a child's generation of specific morphologic and syntactic structures. It is intended for ages 4.0 to 9-11. Children verbally respond to both visual and auditory stimulus in a specific manner in order to determine their use of certain grammatical structures.Date: 11/08/2006Interpretation: Dylan received a standard score of 87 which falls in the low average range on this measure. He displayed difficulty with subject verb agreement when creating sentence from the picture stimulus. Irregular and copula verbs also were difficult for Dylan. His use of "is" and "are" verbs needs to improve. However, Dylan's overall syntactic skills do fall within normal limits and therefore he does not require direct intervention to improve his syntax according to Minnesota state guidelines.

Speech/Language Sample: Speech Sample:A speech sample is a recall of a student’s speech, often during a spontaneous conversation with the examiner. The speech sample is used in order to analyze functional speech skills in the areas of articulation, voice and fluency.

Date:11/30/2006Interpretation:Dylan participated in a 15 minute speech sample to determine his ability and needs as they relate to articulation skills. Dylan's error pattern mirrored that which was found on the Photo Articulation Test given on 11/08/2006. He has difficulty with /k/ /g/ and /l/ sounds. These sounds should be developed by his current age. He shows cluster reduction of sounds such as /sp/ and /tr/. Dylan also reduces the amount of syllables in words especially if they are not regularly occurring in his everyday speech. His voice quality and fluency skills seem to be functional.

Date:11/30/2006Language Sample:During a 15 minute language sample, Dylan interacted with the Speech-Language Pathologist in the therapy room. Dylan's sentences, while containing grammatical errors, were functional and descriptive in nature. His mean length of utterance was more the 5.0. During the interaction he displayed adequate concept knowledge and understanding of simple directions. He did show some difficulty with opposites, and rhyming during game play with the examiner. While it does not appear that Dylan's language skills are impaired according to state educational guidelines, it is of note that he has abnormal and delayed syntax skills. As he continues to progress from grade to grade this may be an area of concern.

HEALTH/PHYSICAL STATUS: From Z, Licensed School NurseDylan appears to have no physical or health problems. According to his Early Childhood Screening, dated 4-05-06, Dylan may have an allergy to ibuprofen and does suffer from seasonal allergies. No other health concern were noted.

SENSORY STATUS: From Z, Licensed School Nurse Hearing Screening:Date: 11/14/06Interpretation:Dylan's hearing was screened at school and results were found to be within normal limits.

Vision Screening:Date: 11/14/06Interpretation:Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-121

Dylan's vision was screened at school and results were found to be within normal limits.

VALIDITY Were the evaluations administered valid for the student? YesWere the evaluations administered valid for the purpose to which they were intended? Yes

Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? NoA lack of appropriate educational instruction in math? NoLimited English proficiency? no

PRESENT LEVEL OF PERFORMANCEDylan has difficulty with articulation skills. He is able to produce most articulation sounds, but has difficulty with /k/, /g/, /l/ and blend sounds. His language skills although below age level expectations are not educationally significant according to state guidelines. Dylan's language skills should be monitored for further progress. His grammar skills could be addressed at home and by the classroom teacher by using appropriate language models as well as positive reminders for using appropriate grammatical structures.

ELIGIBILITY DETERMINATION Language Disorder EligibilityAccording to Minnesota Special Education rules, a student has a Language Disorder and is in need of language services when the student meets the criteria described in items A and B and either C or D.

Dylan's evaluation documents: A) A language pattern that does not interfere with communication as judged by an educational speech-language pathologist and the classroom teacher B) An analysis of the language sample has demonstrated that Dylan's language behavior is not below expectations based on age, developmental level or cognitive level. C) The SPELT-3 and the CELF-4 were administered and resulted in standard deviation scores of 87 and 92 respectively. These scores are not 2.0 or more standard deviations below the mean. In summary, based on the results of this evaluation, Dylan does meet eligibility criteria for a Language Disorder.

Articulation Disorder EligibilityAccording to Minnesota Special Education rules, a student has an articulation disorder and is in need of speech or language special education services when the student meets the criteria as described below. A student who falls within this range must meet the criteria in item A and either Item B or C below.

Dylan's evaluation documents: A) A speech pattern that does interfere with communication as judged by an speech-language pathologist, the classroom teacher and the parent. B) For ages 0-8 yrs 11 mo PAT-3 was administered and resulted in a standard deviation score of 70. Criteria C is not relevant due to age.In summary, based on the results of this evaluation Dylan does meet eligibility criteria for an Articulation Disorder.

This disability adversely impacts Dylan's performance in the general education setting as evidenced by the following: The presenting problem or behaviors of concern have not been responsive to general education interventions.






EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITY Areas of specially designed instruction needed: Speech Articulation in making the sounds of /k/, /g/, and /l/


CHAPTER 3D: Other Health Disabilities (OHD) Documentation


STATE GUIDELINES: OTHER HEALTH DISABILITIES (OHD)"Other health disabled" means having limited strength, endurance, vitality, or alertness, including a heightened or diminished alertness to environmental stimuli, with respect to the educational environment that is due to a broad range of medically diagnosed chronic or acute health conditions that adversely affect a student’s educational performance.

PART I - The team shall determine that a student is eligible and in need of special education instruction and services if the student meets the criterion in item A and three or more of the criteria in Item B.

Item A: There is:(1) Written and signed documentation by a licensed physician of a medically diagnosed

chronic or acute health condition; or(2) In the case of a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity

Disorder (ADD or ADHD), there is written and signed documentation of a medical diagnosis by a licensed physician. The diagnosis of ADD/ADHD must include documentation that DSM-IV criteria in items A to E have been met. DSM-IV criteria documentation must be provided by either a licensed physician or a mental health or medical professional licensed to diagnose the condition.

Item B: In comparison with peers, the health condition adversely affects the student’s ability to complete educational tasks within routine timelines as documented by three or more of the following:Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-123

(1) excessive absenteeism linked to the health condition, for example, hospitalizations, medical treatments, surgeries, or illnesses;

(2) specialized health care procedures that are necessary during the school day;(3) medications that adversely affect learning and functioning in terms of

comprehension, memory, attention, or fatigue;(4) limited physical strength resulting in decreased capacity to perform school activities; (5) limited endurance resulting in decreased stamina and decreased ability to maintain

performance;(6) heightened or diminished alertness resulting in impaired abilities, for example,

prioritizing environmental stimuli; maintaining focus; or sustaining effort or accuracy;(7) impaired ability to manage and organize materials and complete classroom

assignments within routine timelines; or(8) impaired ability to follow directions or initiate and complete a task.

PART II – Evaluation: The health condition results in a pattern of unsatisfactory educational progress as supported by current or existing data from items A through E.

A. An individually administered, nationally normed standardized evaluation of the student’s academic performance.

B. Documented, systematic interviews conducted by a licensed special education teacher with classroom teachers and the student’s parent or guardian.

C. One or more documented, systematic observations in the classroom or other learning environment by a licensed special education teacher.

D. A review of the student’s health history, including the verification of a medical diagnosis of a health condition; and

E. Records review.The evaluation findings may include data from: an individually administered, nationally-normed test of intellectual ability; an interview with the student; information from the school nurse or other individuals knowledgeable about the health condition of the student; standardized, nationally-normed behavior rating scales; gross and fine motor and sensory motor measures; communication measures; functional skills checklists; and environmental, socio-cultural, and ethnic information reviews.For initial evaluations, all medical documentation must be dated within the previous 12 months.



OTHER HEALTH DISABILITIES (OHD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_____________________________________________Student ID#:___________________________________Grade: __________School: _______________________________________________________Date of Meeting:________________________________________________

"Other health disabled" means having limited strength, endurance, vitality, or alertness, including a heightened or diminished alertness to environmental stimuli, with respect to the educational environment that is due to a broad range of medically diagnosed chronic or acute health conditions that adversely affect a student’s educational performance.

PART I - The team shall determine that a student is eligible and in need of special education instruction and services if the student meets the criterion in item A and three or more of the criteria in Item B.Item A: There is:

(1) Written and signed documentation by a licensed physician of a medically diagnosed chronic or acute health condition; or(2) In the case of a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD or ADHD), there is written and signed documentation of a medical diagnosis by a licensed physician. The diagnosis of ADD/ADHD must include documentation that DSM-IV criteria in items A to E have been met. DSM-IV criteria documentation must be provided by either a licensed physician or a mental health or medical professional licensed to diagnose the condition.Does the student meet the criterion in Item A? Ye

sNo

ANDItem B: In comparison with peers, the health condition adversely affects the student’s ability to complete educational tasks within routine timelines as documented by three or more of the following:


(1) excessive absenteeism linked to the health condition, for example, hospitalizations, medical treatments, surgeries, or illnesses;(2) specialized health care procedures that are necessary during the school day;(3) medications that adversely affect learning and functioning in terms of comprehension, memory, attention, or fatigue;(4) limited physical strength resulting in decreased capacity to perform school activities; (5) limited endurance resulting in decreased stamina and decreased ability to maintain performance;(6) heightened or diminished alertness resulting in impaired abilities, for example, prioritizing environmental stimuli; maintaining focus; or sustaining effort or accuracy;(7) impaired ability to manage and organize materials and complete classroom assignments within routine timelines; or(8) impaired ability to follow directions or initiate and complete a task.Does the student meet the criterion in Item B? Ye

sNo

PART II - Evaluation. The health condition results in a pattern of unsatisfactory educational progress as supported by current or existing data from items A to E.

A. An individually administered, nationally-normed standardized evaluation of the student’s academic performance.B. Documented, systematic interviews conducted by a licensed special education teacher with classroom teachers and the student’s parent or guardian.C. One or more documented, systematic observations in the classroom or other learning environment by a licensed special education teacher.D. A review of the student’s health history, including the verification of a medical diagnosis of a health condition; andE. Records review.The evaluation findings may include data from: an individually administered, nationally-normed test of intellectual ability; an interview with the student; information from the school nurse or other individuals knowledgeable about the health condition of the student; standardized, nationally-normed behavior rating scales; gross and fine motor and sensory motor measures; communication measures; functional skills checklists; and environmental, socio-cultural, and ethnic information reviews.For initial evaluations, all medical documentation must be dated within the previous 12 months.Does the student meet the eligibility criteria? Ye

sNo


Develop 504 Plan


SCHOOL SERVICE OPTIONS FOR STUDENTS WITH CHRONIC/ACUTE HEALTH CONDITIONS

Medical information: A licensed physician has diagnosed a medical condition. The physician may prescribe medical treatment, consisting of medication, special health care procedures, or health monitoring. The physician may discuss educational issues based on parent concerns and medical evaluation. The physician may use words such as learning disability, respiratory disorder, heart condition, nonverbal learning disorder, auditory processing disorder, sensory integrative dysfunction, or mental health disability. These may not meet the definition of a chronic or acute health condition. This information is considered by the educational staff as they determine the student’s needs within the educational setting.

* Please note that all medical diagnoses are not chronic or acute health conditions.

A licensed physician has diagnosed a medical condition.

Parent shares information about a health condition with school staff. Licensed School Nurse documents health condition in the health record. Licensed School Nurse may develop an Individualized Health Plan (IHP) or Emergency Health Plan (EHP). Licensed School Nurse or parent informs the teachers and staff about the health condition. School staff may or may not note educational deficit or presenting problems.

or or


NO SUPPORT NEEDEDChild and family manage condition without accommodation or support in the educational setting. Child maintains academic progress.Example:Child has medical diagnosis by a licensed physician of ADHD and is taking medication at home.Child broke a leg in an accident. Family and child are managing medical needs. Child will remain out of regular PE until leg heals and may use school elevator. No support is needed from the school at this time.Child has diagnosed allergies to certain pollens, dust, and other substances. Family and child manage medical needs by using prescribed medications when symptoms increase.

Parent and/or nurse presents to school staff, re: academics and functional concerns and teacher makes accommodations within the classroom. Child is successful.

WHEN SUPPORTS MAY BE NEEDED IN THE EDUCATIONAL SETTINGPotential Outcomes and Levels of Support within Educational Setting

Student is presented to Child Study Team after 2 documented interventions have been completed.

Intervention strategies implemented and student is successful.

504 Evaluation Considered

Follow district 504 procedure within the general education setting.

Eligible

504 Plan

Not Eligible

Special Education Evaluation Considered

Medical diagnosis is written and signed by the licensed physician.

Evaluation for Special Education is completed.

EligibleNot EligibleIf student is not eligible, consider 504 Evaluation

IEPIEP Team determines service based on students needs.

Student is not successful.


STUDENTS WITH HEALTH CONDITIONS- IDENTIFYING EDUCATIONAL NEEDS

PurposeThe purpose of this document is to serve as a guide for practitioners in identifying the educational needs of students with chronic or acute health conditions who may be eligible for service under the area of Other Health Disabilities (OHD). This information will assist teams in determining the scope of educational needs, and in linking the presenting learning problems to the chronic or acute health diagnosis. The Other Health Disabilities Manual:http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf provides a framework for gathering the necessary data and establishing a link between the presenting chronic or acute health conditions and educational needs in order to address criteria.

State Definition“Other Health Disability” means having limited strength, endurance, vitality, or alertness, including a heightened or diminished alertness to environmental stimuli, with respect to the educational environment that is due to a broad range of medically diagnosed chronic or acute health conditions that adversely affect a student’s educational performance.

BackgroundMedical and educational teams often consider all medical diagnoses as chronic or acute health conditions and, therefore, may inaccurately assume that all such diagnoses are eligible for specially designed instruction, related services and accommodations under the OHD category label.There are students with medical diagnoses in each and every one of the special education categories. A comprehensive educational evaluation describing the student’s presenting problems and possible eligibility for special education must be completed to determine which category (if any) best describes the student and his needs.It is the responsibility of the evaluation team to determine what effect, if any, the chronic or acute health condition as on the student’s ability to access and make progress in his or her educational program.Students who are medically diagnosed with chronic or acute health conditions present themselves in a variety of ways. Even students with similar health conditions can present with very different needs, depending on the manner and the severity in which the condition affects the student. Once the characteristics of the student’s condition have been identified and documented according to state OHD criteria, the team must be able to establish links between the child’s difficulties in school and the identified health condition to determine eligibility for OHD services.Once links have been verified, services may be implemented that address the aspects of the health condition that have been found to prevent the student from accessing and making progress in his or her educational program. Services provided are based on individual needs not solely on the diagnosis of a chronic or acute health condition.Remember:Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-128

http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf%20%20

http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Publication/001683.pdf%20%20

A medical diagnosis alone is insufficient to determine eligibility for special education services.

All students with medical diagnoses are not automatically to be considered for eligibility for Other Health Disabilities. Teams are advised to focus on the presenting problems in conjunction with a comprehensive evaluation to determine the appropriate disability category.

Students with some medical diagnose may demonstrate educational concerns that may lead teams to consider them eligible for other special education categories.

Services and accommodations may be provided through a 504 plan, an Individual Health Plan (IHP), or through district level supports.

When determining eligibility for children birth through age six who have been diagnosed with a syndrome or condition known to hinder normal development, please see Minnesota law for Early Childhood Special Education.

Students who have a physician diagnosed health condition may need an education evaluation if they are experiencing inadequate academic progress. In order to qualify for services under OHD eligibility, the health condition must adversely affect the student’s ability to complete educational tasks within routine timelines, as documented in three or more of the following areas:

1. excessive absenteeism linked to the health condition, for example, hospitalizations, medical treatments, surgeries, or illnesses;

2. specialized healthcare procedures that are necessary during the school day;3. medications that adversely affect learning and functioning in terms of comprehension,

memory, attention, or fatigue;4. limited physical strength resulting in decreased capacity to perform school activities;5. limited endurance resulting in decreased stamina and decreased ability to maintain

performance;6. heightened or diminished alertness resulting in impaired abilities, for example,

prioritizing environmental stimuli; maintaining focus; or sustaining effort or accuracy;7. impaired ability to manage and organize materials and complete classroom

assignments within routine timelines; or8. impaired ability to follow directions or initiate and complete a task.


OHD TERMINOLOGY WITHIN CRITERIA

Clarification of Terminology within Criteria

Chronic Health Condition: One that is long term and is either not curable or has residual features that result in limitations in functions of daily living requiring special assistance or adaptations, OR, a disease or disorder that develops slowly and persists for a long time – often the remainder of the life span. Examples are epilepsy, sickle cell anemia, leukemia, or diabetes or some autoimmune diseases.

Acute Health Condition: A disease or disease symptom that begins abruptly and with marked intensity then subsides after a relatively short period of time. Examples would be Crohn’s disease, kidney diseases or conditions that require an organ transplant, OR, a health condition with rapid onset, severe symptoms, and a short course. Sequelae, however, may be short-term or persistent. (Sequelae are conditions that follow and result from a disease. For example, a child who has had meningitis may suffer from sequelae such as motor problems and cognitive impairment).

Heightened or Diminished Alertness: Inability to maintain awareness, vigilance, mindfulness, or attentiveness. This may be caused by external stimuli in the environment or an internal inability to maintain focus.

Limited Strength: Lack of durability, energy or vigor that result in decreased capacity to perform school activities.

Limited Endurance: The inability to maintain effort caused by lack of resilience or stamina.

Inadequate Academic Progress: Inadequate progress in comparison to peers as measured by these outcomes and which are directly linked to the chronic/acute health condition:

Grades, test scores, and daily work: Academic work is consistently in the poor-to-failing range.

Poor work completion: Failure to consistently complete work in a timely manner and results in poor-to-failing academic performance.

Decrease or change in work output: There is a documented and consistent decrease or change in the amount of work produced that results in poor-to-failing academic performance.

Decrease or change in independent functioning or organizational skills: There is a documented and consistent decrease in student’s independent functioning or organizational skills that results in poor-to-failing academic performance.

Systematic Interview: Objective and organized means of gathering data from parents and teachers to confirm or validate criteria.

Systematic Observation: An objective and organized means of gathering data to confirm or validate the criteria.



MATRIX FOR DEVELOPING AN OHD EVALUATION PLANNote: Though some evaluation information listed below may have been obtained through the prereferral process, parental permission should be obtained for all information used during the formal evaluation process. For initial evaluations, all medical documentation must be dated within the previous 12 months.

D A T A S O U R C E S

Criterion Components

Normed, Standardize

d Evaluation

Interviews

Observation

Health History

Record Review

Licensed

Physician

Diagnosis

Date:______

Licensed

Physician

Diagnosis of

ADHD Date:___

__Written and signed documentation by a licensed physician of a medically diagnosed chronic or acute health condition

x x x

Absenteeism linked to health condition

x x x xSpecialized Health Care procedures necessary during school day

x x x x x

Medications that adversely affect learning and functioning

x x x x x

Limited physical strength (performance)

x x x x x xLimited endurance (maintaining effort)

x x x x x xHeightened or diminished alertness (focus)

x x x x x xManage/organize materials/Complete assignments

x x x xFollow directions/initiate and complete a task

x x x x x


PURPOSE OF DATA

Gives a picture of underlying academic

skills of the student

Gives teacher/parent a report of

the student’s

day to day educational function

Gives “snapshot in time” of ability to

function in educational

settings

Gives overall

picture of health

concern’s impact on performan

ce and education

Gives overall

picture of educationa

l performan

ce and attendance for each

grade completed

Gives current medical diagnosi

s and any

associated

conditions or

health issues

Gives current medical diagnosi

s of ADHD and

comorbid

conditions

The health condition results in a pattern of unsatisfactory educational progress as supported by current or existing data from items A to E.

A. An individually administered, nationally normed standardized evaluation of the pupil’s academic performance.

B. Documented, systematic interviews conducted by a licensed special education teacher with classroom teachers and the pupil’s parent or guardian.

C. One or more documented, systematic observations in the classroom or other learning environment by a licensed special education teacher.

D. A review of the pupil’s health history, including the verification of a medical diagnosis of a health condition; and

E. Records review

The evaluation findings may include data from: an individually administered, nationally normed test of intellectual ability; an interview with the pupil; information from the school nurse or other individuals knowledgeable about the health condition of the pupil; standardized, nationally normed behavior rating scales; gross and fine motor and sensory motor measures; communication measures; and functional skills checklists.



EXAMPLE: OTHER HEALTH DISABILITY (OHD) EVALUATION REPORT

REASON FOR REFERRAL Riley was referred by her mother due to her concerns regarding her academic achievement and how her ADHD may be affecting her learning rate. BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: Riley has been at Lincoln since Kindergarten. Her attendance over the years has been good. Typically she missed no more than 5 days of school, although in 1st grade she missed 9. At the end of kindergarten she obtained 119/160 objectives, or the 16th percentile. In First grade, Riley's DIBELS assessment was notable for being Deficit in non-sense word fluency, and being At-Risk in oral fluency. In 2nd grade, Riley continued to have difficulty in reading fluency. She met some grade level expectations in writing, reading, and math. On the Stanford Achievement Test (SAT)she scored at the low end of the Average range (25% NPR). In 3rd grade on the MCA's Riley did not meet standards. On the DIBELS oral fluency, she was At-risk, and on the SAT, her NPR dropped to 4 % in reading, 5% in math, and 10% in language. She met some grade level expectations in writing and reading. In 4th grade, Riley's SAT scores were 14% in reading, 10% in math, and 6% in language. On her Otis-Lennon School Abilities test, she received a score in the 1st% in verbal and 2nd % in non-verbal. In terms of behavioral expectations over the years comments on report cards included the following; K-hard to wait her turn, distracted, and impulsive, 1st grade- needs reminders to stay on task, 2nd grade-interacts well with others, does not always turn in homework, does not always complete work, 3rd grade-has attention problems, easily distracted, and does not turn in work. LANGUAGE/RACIAL/CULTURAL FACTORS: Riley is Caucasian and from a family whose primary language is English. There are no known language/racial/cultural factors that would negatively impact this evaluation. INFORMATION FROM PARENTS and Developmental History: Riley lives with her mother and step father along with her siblings and step siblings. Her father has also remarried and she has a step mother and 1/2 sisters who live with her father. She gets to see them as well. She was born at about 40 weeks gestation and there were no concerns at time of birth or after. She reached developmental milestones within normal limits and ranges, if not a little early. There is a family history of dyslexia and ADHD in 2 family members. For more information see parent interview in the academic section. INFORMATION FROM TEACHERS: See teacher interview. EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-133

INTELLECTUAL: Z, School Psychologist Behavioral Observations During Testing Riley came to the testing situation appropriately dressed and groomed. She appeared to be of average height and weight for a girl her age. She participated in the testing activities willingly. Her articulation was understandable to the examiner. Attending skills were age appropriate, but at times she had a long response time when retrieving words from her memory. Riley seemed motivated to do well. Rapport was easily established. Given Riley's good attending ability and that rapport was established, this evaluation is seen as providing a reasonable estimate of her current level of functioning. Woodcock Johnson Test of Cognitive Abilities-III (WJ-III) COGThe WJ-III COG provides a measure of general intellectual abilities and specific cognitive abilities. It can be used with individual from 2 through 90+ years. It has both a standard battery (including 10 subtests) and an extended battery (an additional 10 subtests.)

WJ-III COG Date: 3/17/2008 Score % Range Verbal Ability 86 17 Low Average Thinking Ability 109 74 Average Cognitive Efficiency 105 62 Average Phonemic Awareness 121 92 Superior GENERAL INTELLECTUAL ABILITY (GIA) 99 48 Average

Interpretation: On the WJ-III cognitive, Riley received a General Intellectual Ability of 99 (48 %) in the Average range of intellectual functioning. There is a 90 % chance that Riley's true GIA is between 97 and 102. Riley was able to perform solidly in the Average range in the areas of Thinking Ability and Cognitive Efficiency. Thinking ability measures different thinking processes that may be invoked when information in short-term memory cannot be processed automatically. The Cognitive Efficiency Scale measures automatic cognitive processing, processing speed and short-term memory. She showed most difficulty in the area of Verbal Ability, her score falling in the Low Average range. This is a measure of language development that includes comprehension of relationships among words as well as understanding of individual words. Riley was also given the subtests that measured her Phonemic Awareness. On this cluster she received a score of 121 (92nd%), in the Superior range. This measures knowledge and skills related to analyzing and synthesizing speech sounds. This contrasts sharply with her weak reading skills. This is a statistically significant weakness compared to other children her age. Riley had most difficulty with the Verbal Comprehension subtest. It was difficult for her to name synonyms for words such as begin, we, and car. On all other subtests, Riley scored solidly in the Average range. In general, Riley presents with overall Average cognitive skills. Verbal skills are weaker in the Low Average range. Riley lacks some understanding of typical language concepts. Nonverbal skills and automatic skills are solidly Average. ACADEMIC: Z & Z, Special Education Teachers Woodcock-Johnson Tests of Achievement - Third Edition (WJ-III) The WJ-III is an individually administered, broad-based, nationally normed achievement test. It provides information about reading, math, written language and oral language.

WJ-III Score Range Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-134

Form: A Date: 3/6/08 Basic Reading 92 90-94 Reading Comprehension 99 96-102 Math Calculation 89 85-92 Math Reasoning 98 95-101 Written Expression 91 87-96 Listening Comprehension 93 89-96

Interpretation: Riley came willingly with the examiner for this test. She was friendly and appeared to work hard when she had to solve the more difficult problems. Riley's highest score was in the area of reading comprehension. On this test, she took her time to think through possible answers before deciding on a correct answer. In the area of math calculation, Riley also took time to think through how to solve the equations. In this area though, Riley often used an incorrect process for solving the problem and then answered incorrectly. For example, one problem required her to multiple 22 x 6. Riley set up a subtraction problem instead (22 - 6), and came up with 24 for the answer. Riley had difficulty with all problems related to adding and subtracting money with regrouping. She also struggled with counting coins ( Which coins add up to 55 cents? - 4 quarters and 2 dimes). Riley was able to solve some subtraction problems correctly (48-19=29), but others were incorrect (89-18=65). During the timed math test, Riley misread the signs for the equations (added instead of subtracted), which resulted in errors. This resulted in a low average score for Riley. On the writing tests, Riley appeared to work hard and scored in the low average range. The only area of difficulty were the times she was given the first and third sentences, and she had to think of a good second sentence. Riley was not able to write a sentence for this type of writing. SOCIAL-EMOTIONAL: Z, Special Education Teacher Behavior Assessment System for Children - Second Edition (BASC-2)The BASC-2 is a general rating scale used to evaluate the social/emotional/behavioral levels of children. Rating scales include the Parent Rating Scales (PRS), Teacher Rating Scales (TRS), and Self-Report of Personality (SRP). Scores are reported in T-Scores, which have a mean of 50 and a standard deviation of 10. Borderline significant problem scores are indicated with a "B". Clinically significant problem scores are indicated with a "C".

BASC-2 PRS/TRS Date: 3/3/08-3/6/08 Mother Classroom

Teacher Clinical Scales: Hyperactivity 84 C 70 C Aggression 84 C 44 Conduct Problems 68 B 46 Anxiety 62 B 41 Depression 60 B 42 Somatization 58 42 Attention Problems 69 B 72 C Learning Problems -- 79 C


Atypicality 55 47 Withdrawal 49 50 Adaptive Scales: Adaptability 40 47 Social Skills 57 41 Leadership 39 B 43 Activities of Daily Living 37 B -- Study Skills -- 27 C Functional Communication 44 34 B

BASC-2 SRPDate: 3/24/08 Student Clinical Scales: Attitude to School 41 Attitude to Teachers 57 Atypicality 53 Locus of Control 59 Social Stress 55 Anxiety 55 Depression 48 Sense of Inadequacy 54 Attention Problems 73 C Hyperactivity 57 Adaptive Scales: Relations with Parents 26 C Interpersonal Relationships 40 Self Esteem 53 Self-Reliance 37 B

Interpretation: Riley's mom (Lori) and her teacher (Megan) reported borderline and significant concerns in the areas of hyperactivity and attention problems. Riley reported significant concerns about her attention problems. Lori also reported concerns in the areas of aggression, conduct problems, anxiety, depression, leadership, and activities of daily living. Megan reported concerns in the areas of functional communication, learning problems, and study skills. Megan reported no concerns for the critical items. Lori reported concerns for critical items as: eats too much - almost always; is easily annoyed by others - sometimes; bullies others - sometimes; hits other children - sometimes; threatens to hurt others - often; and falls down - sometimes. Riley's concerns for critical items are: other kids hate to be with me - sometimes; no one understands me - sometimes; I feel sad - sometimes; I hear voices in my head - sometimes; other people make fun of me - sometimes. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-136

Parent Interview: Parents of Riley were asked to fill out a Home and Family Interview that was completed on March 3. 2008. Changes that have occurred in Riley's life have included a new brother, moving to a new home, and the separation of her parents which is when they started noticing major behavior issues becoming more apparent. Parents noticed Riley's struggles began at age 2 and a half when she was observed to have difficulty paying attention. At age 8 her difficulty to retain information also became noticed. Riley is currently diagnosed with ADHD and is on medication for this. There is a family history on her mother's side of ADHD and dyslexia in her maternal grandmother. Parents attempt to help Riley with her academics and she attends RAP to receive extra help. At home they review flash cards and use a positive reward system in place for her reading. Mom spends many hours working on homework to assist Riley in retaining her information, but a lot of that time is spent guessing at the answers. Mom is unsure of how Riley learns and feels because Riley just doesn't "get it" that constant adult supervision or assistance is needed. Mom feels Riley has a big heart, loving, motherly, and likes to take care of everyone. Her mother she feels others view her to be overbearing. Riley easily learns games, yet struggles with learning math and reading. Her mother was asked to rate Riley's performance at home or in the community. She feels that Riley is able to follow 2-3 step directions, demonstrate artistic abilities, recall specifics from a special event, carry on a conversation, and handwrites very well. Riley is observed to occasionally require adult assistance in remembering, organization, reading aloud, understanding what she sees and hears, recalling events from the school day, solving problems, and explaining something she learns. Her mother's biggest concerns are how she uses her planning skills, whether she understands what she reads, and knowing her basic math facts. Mom is looking for assistance in finding ways to help Riley start moving forward in her learning. Her mother feels that at home the family would be more at ease if they could find a way to better help Riley in her schooling. Teacher Interview: Riley's teachers report her to be happy and enjoys coming to class. They observe Riley to be sweet and seeks approval from others. She is very sensitive to what others think. Riley usually tries very hard, but despite her effort still struggles to do many things. Riley understands class routines and expects them to be maintained by everyone. Riley's teachers were given an interview on her information processing skills. The areas reported on were storage, organization, acquisition, retrieval, expression, and manipulation. She was rated on a frequencies of almost always, frequently, about half the time, seldom, and hardly ever. It was reported that in the area of storage Riley frequently grasps simple word meanings, however, overall Riley struggles with following two to three step directions, and recalling information over time. In the area of organization Riley does show to align her work spatially, and will half of the time turn in assignments in time, however, the work she is turning in is seldom complete. Riley hardly ever uses planning skills. In the area of acquisition Riley obtains information by touching and through a multi sensory approach about half of the time. She seldom to hardly ever obtains information by hearing, seeing, and reading. She hardly ever links new information to that was previously learned. In area of retrieval, Riley frequently can name and label. About half the time she can recall sounds associated with letters and words, and can count and calculate automatically. Riley hardly ever develops strategies to recall information and hardly ever responds in an acceptable amount of time. In the area of expression, Riley frequently demonstrates oral fluency and participates in oral class activities. Riley hardly ever demonstrates reading and writing fluency. In the area of manipulation Riley seldom to hardly ever summarizes information, applies learned information to new situations, infers information, interprets information, writes sentences of varying length and complexity, Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-137

interprets social cues, and differentiates details from key concepts. Overall, there are a number of concerns in the areas of storage, organization, acquisition, retrieval, expression, and manipulation with manipulation being of the biggest concern. HEALTH/PHYSICAL: Z, Special Education Teacher Review of Medical Information: Dr. Z, of the Zumbro Valley Mental Health clinic in Rochester, MN, responded to the request for written medical verification for Riley. Dr. Z completed and signed the DSM-IV criteria sheet and the health condition documentation form both dated March 10, 2008. Dr. Z diagnosed Riley with ADHD-Combined Type (314.01). Dr. Z stated that Riley is currently being prescribed Focalin XR and Strattera to assist with her ADHD symptoms. These medications are being taken at home and they may cause some stomachaches. Riley's medical diagnosis may have acquired some possible educational implications. Due to her health condition, Riley may have difficulties with attention, organization, impulsive behaviors, and/or concentration. Riley may fail to pay close attention to details within instructions that are given to her verbally or in writing. This may cause her to make careless mistakes within her work. She may have a difficult time sustaining her attention for lengthy periods of time. She may not follow through with directions given to her. She may easily lose her materials and/or forget where she may have placed them. She may be easily distracted by extraneous stimuli. She may be forgetful within her daily activities. Riley may talk excessively, blurt out answers, and/or interrupt others around her. She may appear 'on the go.' She may get out of her assigned seat at inappropriate times. Riley's medical condition would indicate that instructional strategies and/or classroom accommodations are warranted. She may need preferential seating away from distractions. She may need a verbal or visual cue between her and her teachers in order to regain her focus to the task at hand. She may need to learn how to utilize checklists to assist her with organizing her projects and daily routines. She may need to have color coded folders that correspond to a designated folder. Riley may need lengthy projects broken down into smaller parts and graded on each part. She may need to be on an incentive plan that reinforces appropriate classroom functioning skills. SENSORY: Z, Licensed School Nurse, Hearing Screening :Date: 3/14/08Interpretation: Riley's hearing was screened at school and was found to be within normal limits. Vision ScreeningDate: 3/14/08Interpretation: Riley's vision was screened at school and was found to be within normal limits. OBSERVATIONS: Z & Z, Special Education Teachers Date: Thursday, April 17, 2008Time: 9:12-9:32 amObserved by: ZSetting: homeroom class Riley was observed by Z, special education teacher, on Thursday, April 17 during morning activities using the Deno-Merkins observation method. This interval recording method requires the rater to observe the designated child for 30 seconds, and then observe a same gender peer for 30 seconds. Observed behaviors are rated as: Noise (any noise that distracts the teacher or peers), Out of Place (any movement beyond the designated boundaries), Physical Contact (any contact with another person or their belongings which is unacceptable Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-138

to that person), Off Task (any movement off the task which is not covered in the above categories), On Task (appropriate behavior for the task at hand), Other (behaviors specific to the student or situation).

During this observation, the students were working on typical morning activities which involved answering two math questions, one reading question, and correcting the errors in two sentences. The students were allowed to talk quietly with others sitting near them. The teacher moved about the room handing out awards to students who were done prior to the 9:15 bell. Riley did not receive an award this day. After a few more minutes, the teacher called on students to provide the correct answers. Sometimes a brief discussion followed when there were questions from students. The morning broadcast came on three minutes into the correcting time, so the class stopped correcting and watched the broadcast from their seats. After the broadcast ended, the class resumed their correcting. When they were done correcting, they read a blog account written by another teacher as a class. Riley was working on her morning work as the observation began, but stopped when I entered the room. When another adult came into the room, Riley stopped working and talked with that adult, then she did not return to her work until the teacher reminded her to do so. When the class began their correcting, Riley was not yet done, but she followed along while the teacher called on other students for answers. One time, Riley called out without raising her hand (the only student in the class to do so during this observation). After the broadcast finished and the class resumed correcting, Riley put her work away and did not get it out again during the remaining time, even though the student next to her was correcting her work. Riley was quiet during the time they were reading and discussing the blog. Overall, Riley was on task for 60% of this observation. Her peers were on task 85%. She made noise 10% and was otherwise off task 30%. Her peers made noise 5% and were otherwise off task 10%. During this observation, it appeared as though Riley paid attention to too many things - each time an adult entered the room, when the teacher was near her, and other students near her. Date: March 12, 2008Time: 2:00-2:30Observed by: Z Setting: Math class Riley was observed in her math class. Riley was sitting at a circular table with five other peers. For the first half of the observation Riley was taking a math test. During the math test she was up and down in her chair, pointing to things on her classmate’s papers, turning around talking to peers, and just overall distracted. Riley's peers were completed with their test as she was one of the last three remaining to complete hers. They were working on workbook pages as Riley continued to work. After ten minutes, Riley completed her test and picked up her workbook that happened to be in the observer’s hands. She is unaware of who the observer is and she began asking the observer (a stranger) about what she needed to complete in her workbook. The teacher then stepped in and asked her to let her see her book. Riley was verbally told what pages needed to be completed and the teacher wrote it on a post it note to show her visually. Riley walked over to a friend to see how many pages she had to do and walked away seemingly happy she only had two to do. Riley then sat down again and took about five minutes to get started in her workbook. Peers were distracting her and she was distracting other peers. Riley also took off her shoes and replaced them before beginning to work in her workbook. Riley then started to find the page she needed to do and started to work. Another student was sitting next to her laughing and pointing at her work a lot and Riley responded by laughing back. Riley worked for about five minutes then put her Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-139

book away as the teacher explained they would play a game with cards that they needed to make math problems to get the answer of the one card they draw. (ex. If you get a 0 for the answer card and four cards with a 4, 5, 7, 0, you could take 5 +7- 4 x 0 = 0) Riley did not listen to directions closely as she was talking with peers. When it came time to play the game she asked that the teacher to explain it to her again. The teacher then explained it and she continued to ask similar questions. Riley was able to give an example with her cards. It was observed that Riley is well liked by her peers, that she is socially able to connect with peers, she asks questions when she doesn't understand, and makes genuine effort to do well. It was observed that Riley does not always respond in a timely manner, that she is distractible, has difficulty beginning tasks promptly, and at times can be disruptive in a group. VALIDITY Were the evaluations administered valid for the student? YesWere the evaluations administered valid for the purpose to which they were intended? Yes Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? NoA lack of appropriate educational instruction in math? NoLimited English proficiency? No PRESENT LEVEL OF PERFORMANCE In general, Riley presents with overall Average cognitive skills. Verbal skills are weaker in the Low Average range. Riley lacks some understanding of typical language concepts. Nonverbal skills and automatic skills are solidly Average. In the Academic area, Riley was able to score in the Average range in reading and writing on an individually administered test in a quiet setting. She had difficulty in the math calculation area because she did not always pay attention to the calculation sign. She still does not have her math facts straight and struggles even in the one on one testing. In her school work, Riley is receiving Not meeting grade expectations for any reading skills, her fluency is very low compared to what is expected for 4 grade. Her performance in the class does not match individualized testing. In terms or organization and information processing, Riley rarely is organized, does not turn her work in on time, or if she does turn it in, it is not complete. She has a hard time getting started on tasks, or completing them. She seems distracted by the social things occurring in the classroom. She has difficulty retrieving information and planning ahead. In the social emotional area, Riley scored in the clinically significant range in attention problems, hyperactivity, learning problems at school and home. At home Riley also has some difficulty with aggression and following directions. Her time on task is lower than other female peers in her class even on medication for her ADHD. Her vision and hearing are within normal limits. She is diagnosed with ADHD and is taking Straterra and Focalin daily. ELIGIBILITY DETERMINATION Other Health Disabilities:According to Minnesota Special Education rules, a student is eligible for special education instruction and services when the student meets the criteria of A and B. Riley's evaluation documents: A) Riley has been diagnosed with Attention Deficit and Hyperactivity Disorder. The health condition documentation forms (including DSM-IV criteria for ADHD) were signed by Dr. Z, of Resorte Valley Mental Health, and dated 3-10-2008. B) In comparison with peers, the health condition adversely affects Riley's ability to complete educational tasks within routine timelines as documented by the following: limited endurance to complete tasks, diminished alertness, impaired ability to manage and organize material, Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-140

and impaired ability to initiate and complete a task. The evaluation team has established and documented that the health condition results in a pattern of unsatisfactory educational progress as documented through: individually administered, nationally normed standardized evaluation of Riley's academic performance; systematic interviews conducted by a licensed special education teacher with Riley's teachers and parents; one or more systematic observations in the classroom or learning environment by a licensed special education teacher; review of Riley's health history; and records review. In summary, based on the results of this evaluation, Riley meets eligibility criteria for Other Health Disabilities. This disability adversely impacts Riley's performance in the general education setting as evidenced by the following:

The student performs substantially below that of peers. The resources necessary to support the student to participate and progress in the

general education curriculum are beyond those available in the general education curriculum.


EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITYAreas of specially designed instruction needed:

Math Calculation: Riley needs to improve her knowledge of basic math and her attention to math processes and what is required of problems.Basic Reading: Riley needs to improve her reading fluencyOrganization: Riley needs to improve the organization of her materials, homework, and work.Independent Work Skills: Riley needs to improve her ability to start a task and complete a task during class work instead of distracting peers.



SYSTEMATIC INTERVIEW/OBSERVATION WORKSHEET

Student’s Name ________________________________ DOB __________ School ____________________

Medical Diagnosis _____________________ Physician ________________ Date of Diagnosis ___________

Interview Date ___________________________________________ Observation Date(s) _________________________________Person(s) Interviewed _____________________________________ Observation Setting _________________________________________________________________________________________ __________________________________________________Completed by ____________________________________________ Completed by _______________________________________Title ____________________________________________________ Title ______________________________________________

Information must be gathered from both interview (I) and Observation (O). For each item place the appropriate number in the box: 1) adequate 2) adequate with accommodations 3) areas of concern Documentation should be determined to be significantly discrepant from peers. This documentation should include descriptive, narrative examples of the educational concern, and list any current accommodations.

Physical Ability (Document significant discrepancies from peers) I O Limited physical strength resulting in decreased capacity to perform school activities.

Limited endurance resulting in decreased stamina and decreased ability to maintain performance.

Level of pain results in decreased ability to perform or maintain performance.

Alertness Heightened or diminished alertness resulting in impaired abilities. (Document significant discrepancies from peers).

I O Prioritizing environmental stimuli:

Maintaining focus/sustaining effort:

Accuracy of completed task:

Organization Skills (Document significant discrepancies from peers and if this is an area of concern complete Organization and Independent Work Skills Observation Interview Worksheet for Elementary, Secondary or Preschool)

I O Materials: (Has materials when needed, physical organization of space and materials).

Written Work: (Organized on page in sequential manner, i.e., name at top, items in logical Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-142

order, capitalization, paragraphs, etc.)

Thoughts: (Tells thoughts or stories sequentially – beginning, middle, and end, stay on topic).

Work Completion Within Routine Timelines (Document significant discrepancies from peers).

I O Self-Initiates: (Ability to independently begin a task).

Displays On-Task Behavior: (Ability to continue working on a task).

Follows Directions: (Can follow directions given to the entire class without individual assistance).

Homework: (Independently keeps track of assignments, completes them and hands them in on time).

Participates in Group Activities:

Number of Assignments Given ___ Assignments Turned In ___ Assignments Late ___

Work completion: (Unassisted, adult assisted, peer assisted).

Independence (Document significant discrepancies from peers).I O Movement Through School Environment: (Gets to destination without support needed due to

strength, endurance, behavior, or attention).

Clothing/Bathroom/Lunchroom: (Can manage these self care activities without assistance).

Motoric Management of Materials: (Uses computer, books, notes, pencil, scissors, desk, locker).

Level of Self-Advocacy: (Requests help, can tell others about disability and needed accommodations and modifications).



Functional Level of Academic Performance (Daily classroom performance in relation to peers).

I O Reading:

Comprehension Fluency Decoding

Math: Computation Reasoning

Written Language: Math Language

Other:

Peer Interaction (Document significant discrepancies from peers).I O Student with Peers: (Does the student initiate and interact appropriately?).

Peers with Student: (Do others include student and interact appropriately?).

Interfering Behaviors (Document significant discrepancies from peers).I O Distracting to Self or Others:

Impulsive Behavior:

Main StrengthsI O Parents:

General Education Teacher/Other Staff:

Main ConcernsI O Parents:

General Education Teacher/Other Staff:



PARENT/GUARDIAN INTERVIEW

1. What are your child’s strengths?

2. What are your concerns for your child while at school?

3. Are there special considerations that the school needs to be aware of?

Medical:

Health:

Safety:

4. What are your priorities for the staff and your child to work on at school?

5. How much does your child know about his/her medical diagnosis?

6. Do you want school staff to provide an inservice to your child’s classmates?

Would you like to participate in the inservice?

Do you want your child to be present at the inservice?


7. How would you like to communicate with school staff about your child and the medical condition?

Do you prefer one contact person?

8. Have you talked to the school nurse about medications or health concerns?

9. Share examples of how your child organized themselves at home to things like: chores, getting ready for school in the morning and room cleaning.

10. How much time does your child typically spend on homework each evening?

How much assistance do you need to provide?

What strategies have worked at home?

11. Does your child have friends in your neighborhood? Same age, older or younger?



SAMPLE COVER LETTER FOR ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST

Date: ___________________________

To: _____________________________

Regarding Student: __________________________________________

From: _____________________________________________________

The attached checklist, “Organizational and Independent Work Skills in the Classroom”, will assist staff in determining if a student meets OHD criteria, may serve as part of an educational re-assessment and provide classroom teachers information to help identify student needs in organizational and independent work skills that are related to a variety of disabilities.

The following guidelines are suggested when completing the worksheet:

Definition of categories:

Independent: Performance in skill area meets or exceeds classroom expectations.

Areas of Concern/ Needs Assistance: Performance in skill area does not meet classroom expectations.

Current Adaptations/ or Comments: Student is currently being provided with adaptations to curriculum or environment such as an organizational system, or provided with assistance (i.e., paraprofessional).

Comments should always be made whenever an area of concern is noted.

Please note strengths when appropriate.

Thank you for your time and assistance.

Please return to: _________________________________

Or _____________________________________________



INSTRUCTIONS: ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST FOR SCHOOL STAFF

Pre-kindergarten-KindergartenElementary

Middle School and High School

These three checklists are designed to assist teachers or other related professional in the identification of needs in the area of organizational and independent work skills in the classroom. These checklists provide an observational and interview tool to address deficits in education that are related to organization and working independently. They are not required but are a suggested way to address this section of the criteria. The checklists can also be used as a format for student interviews.

Each skill area should be rated and/or described as follows:

Independent – student is able to complete the skill or tasks at a quality or rate similar to their peers.

Area of Concern/Needs Assistance – student is not able to complete the skill or task at a quality or rate similar to their peers.

Adaptations/Comments – clarification of student’s skills, noting current adaptations.


ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST: PRE-K INDERGARTEN - K INDERGARTEN

Student’s Name: ______________________________ Grade: ______________________________

School: _____________________________________Setting: ______________________________

Date: _______________________________________Completed by: _________________________

Independent

Areas of Concern/ Needs Assistance

CurrentAdaptations/Comments

Organization and Work SkillsFollows classroom routines Rules SchedulesFollows 1-2 step directionAttends to group instructionBegins task/activityFinishes task/activity within the time allottedKnows when task/activity is completeCorrects mistakes given verbal feedbackTransitions from one activity/setting to another within the allowed time with needed materials and suppliesUses free time appropriately (chooses an activity/playmate, plays)Participates actively in group activities/projectsSeeks adult/peer help appropriatelyMotor – related to strength/endurance/pain managementMoves through natural school environment in a safe and timely manner (including emergency evacuation)Demonstrates stability at table, on chair, or floorParticipates in learning movement activities similar to peersUtilizes all natural school environments (i.e., lunchroom, playground, bathroom stage)Meets personal needs (eating, dressing, toileting) in natural environment at schoolStabilizes paper while using pencils, crayons, and markersPicks up/holds, turns pages of booksManipulates educational materials (puzzles, blocks)Uses school supplies (markers, scissors, eraser, paste/glue, paints)Manages back packRochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-150

Stores/retrieves materials in an orderly and timely mannerOperates standard computer/mousePage 2; Organizational and independent work skills checklist continued.

Do you have any concerns regarding this student’s behavior? Yes No

Do you have any concerns regarding this student’s attendance? Yes No

Does this student get along socially with peers? Yes No

Does this student’s disability impact peer acceptance? Yes No

Please list any accommodations or modifications you routinely make for this student.

What other issues or concerns do you have for this student?


ORGANIZATIONAL AND INDPENDENT WORK SKILLS CHECKLIST: ELEMENTARY


School: _____________________________________Setting: ______________________________


Independent



Organization and Work SkillsFollows classroom routines Rules SchedulesFollows verbal directionsFollows written directionsFollows multi-step directions in sequenceListens and works without distractionBegins work/tasksFinishes work/tasks within time allottedKnows when work is completeCorrects mistakes and edits workTurns in work on timeTakes notices and appropriate materials home to complete homeworkReturns completed homework within time allottedTransitions from one classroom activity/setting to another within the time allotted with needed materials and suppliesUses free time appropriatelyParticipates actively in class discussions/group activities/projectsRequests help appropriately (teacher/support staff/peer) to clarify classroom requirements or meet personal needsMotor – related to strength/endurance/pain managementMoves through natural school environment in a safe and timely manner (including emergency evacuation)Demonstrates stability at table, on chair, or floorParticipates in physical education classUtilizes all natural school environments (i.e., lunchroom, playground, bathroom stage)Meets personal needs (eating, dressing, toileting) at schoolProduces written work that is legible and completed within time lines, without Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-152

fatigueUses school supplies (markers, scissor, eraser, paste/glue/paints)Manages books, materials, and backpackStores/retrieves materials in an orderly and timely mannerOperates standard computer/mouse








ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST: MIDDLE SCHOOL AND HIGH SCHOOL


School: _____________________________________Setting: ______________________________


Independent



Organization and Work SkillsFollows daily class scheduleUses and follows assignment book/plannerOrganizes and studies course materialsListens and works without distractionBegins and completes work within time allottedUnderstands assignment expectationsTurns in work on timeCompletes testsObtains and completes makeup assignments when absentTransitions from one classroom activity/setting to another within the time allotted with needed materials and suppliesUses independent time appropriatelyParticipates actively in class discussions/group activities/projectsAdvocates for self to clarify classroom requirements or meet personal needsMotor – related to strength/endurance/pain managementMoves through natural school environment in a safe and timely manner (including emergency evacuation)Participates in physical education classUtilizes all natural school environments (i.e., lunchroom, playground, bathroom stage)Meets personal needs (eating, dressing, toileting) within the daily scheduleProduces written work that is legible and completed within time lines, without fatigueManages school materials and belongings in a timely mannerOrganizes school materials, folders, lockerOperates standard computer/mouse


Page 2; Organizational and independent work skills checklist continued;









SAMPLE: HEALTH CONDITION DOCUMENTATION FORM

Date:

From:

To:

For: ______________________________________ _____________________________(Child’s Name) (Date of Birth)

This child is in the process of being evaluated for special education services. Thank you for your assistance in identifying health conditions that may affect the child’s educational performance as the school district makes a determinations of eligibility for special education services. Attached you will find a signed copy of our release of information.

Please list all medical diagnoses that would affect the child in the school setting.

Please identify any activity limitations or restrictions related to the above mentioned diagnoses.

Will the above mentioned diagnoses impact school attendance?

Is this child currently receiving medications and/or undergoing specialized health care procedures that are necessary during the school day?

Will any of the medications taken by this child adversely affect school performance?

________________________________________ ______________________________Physician’s Signature Date

Please submit any evaluation data that you believe would assist us in our eligibility determination.

If this child has been diagnosed with Attention Deficit Hyperactive Disorder, please complete the attached two sided Medical Documentation Form for Attention Deficit/Hyperactivity Disorder.

Please return this information to the address identified on the release of information.




SAMPLE: SYSTEMATIC PARENT INTERVIEWDear Family Member:The purpose of this form is to gather information about your child and other issues that may affect your child’s school performance. The information you provide must be included as part of the assessment for your child. Your ideas and concerns are important to the assessment process and will be summarized in the Evaluation Report. Use additional paper if more room is needed when answering these questions.Student’s Name: Grade: Birth Date:General Education Teacher: Date:School:Form Completed by:Parent(s):

Complete this section only if this information was gathered through an interview:Who conducted the interview and recorded the family member’s response?How were questions communicated? Personal interview with: _____________ Phone interview with: ______________

Student lives with: Persons living in the student’s home: Parent(s) Foster parent Relative Peers On Own Other

Name Relationship to child Age

Family members not present in the home:Name Relationship to child Age

1. Does your child have any medical, physical or psychological conditions? Please check all that apply even if they are not currently present. For items checked, please provide explanation. Indicate medication if applicable.

Medication Explanation Vision Hearing Attention Deficit Disorder Head Injury Asthma Allergies Diabetes Depression Cerebral Palsy Seizures Other

2. Does anyone in your family have a history of medical or physical problems? Yes No If Yes, please explain:


3. Has anyone in your family had academic or educational problems? Yes No If yes, please explain:

4. Were there any unusual complications during the pregnancy or birth of this child? Yes No If yes, please explain:

5. Were the development stages such as walking, sitting, etc. for this child within normal ranges? Yes No If Yes, please explain:

6. Many learning problems in childhood are temporary and may be brought on by changes in the life of a child and his or her family. Indicate which of the following events have occurred in your family. (Check all that apply).

Year Describe Move to a new home How many times in the year stated?

How many times total? Change of school Repetition of grade Serious illness in family Death in family Divorce/separation of parents Change in hours parent(s) are home Loss of job Parent began work out of home Brother or sister left home New person joined family Who? Neighborhood concerns Chemical or alcohol use When? Ongoing? Homelessness Foster home placement Court placement Involvement with the law Family member in counseling


Other Ongoing?


7. What are your child’s current school problems?

When did you first notice them?

What do you think caused them?

8. Do you feel your child’s school problem(s) is (are) the result of a cultural or other misunderstanding? Yes No If Yes, please explain:

9. Have you tried anything to help your child at home such as reading aloud, sitting with your child at homework time, etc.? Yes No If Yes, please explain:

10. In your opinion, what can the school staff do to be most helpful to your child at this time?

11. Share the strengths and special abilities of your child.

12. Describe the way you’ve seen your child learn best. Give an example?


13. Describe something your child had difficulty learning in the last three months.

14. What information would you like from this assessment?

15. How many days a week does your child have homework? __________ How many days a week does your child do homework? __________ How long does he or she spend on homework each day? __________

(minutes or hours) Does your child complete homework independently, or does your child need your assistance?

16. Rate your child’s performance at home or in the community on the following items:

Doe

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Pare

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Assi

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Follows two to three-step directions (S) Remembers (S) Organization Skills (O) Uses planning skills (O) Understands what he or she reads (A) Understands what he or she sees (A) Understands what he or she hears (A) Learns a new game (A) Recalls events from the school day (R) Recalls specifics from a special event (R) Reads aloud (R) Carries on a conversation (E) Handwriting (E) Problem solves (M) Explains something he or she learns (M) Assembles or repairs things (M) Demonstrates artistic ability (M) Knows basic math facts (R) S = Storage, O = Organization, A = Acquisition, R = Retrieval, E = Expression, M = Manipulation of information



GUIDE FOR COMPLETING AN EVALUATION AND WRITING GOALS FOR STUDENTS WITH HEALTH CONDITIONS

The examples provided are based on practice in the field and will assist teams to develop goals related to the needs determined by a comprehensive evaluation. The examples describe students with a variety of health disabilities and often multiple needs. In the examples there are goals that address productivity, health and academic progress. Teams struggle to write goals for students with OHD because they believe they must write only academic goals and are unsure of how to document and include data about productivity and health that impact academic performance.Teams need to consider: HEALTH – how the health condition manifests itself (pain, frequent medical treatments,

medication and side effects, inconsistent wellness, strength or endurance or focus); PRODUCTIVITY – write goals that will diminish the impact the health disability has on

learning (amount of work, completion of work, inconsistent output); and ACADEMIC – provide accommodations, modifications and specially designed instruction to

allow the student to access the learning environment (length of assignments, alternate curriculum or testing options).

1. ATTENDANCEAttendance – excessive absenteeism linked to the health condition. Student is noted to have consistent or intermittent absences that interfere with academic progress and participation in school activities. Absences must be the result of hospitalizations, medical treatments, surgeries, or illnesses. This may also be considered for students who are present at school, but miss an excessive amount of classroom instruction due to their health condition (i.e. are often in the health office for nebulizer treatments).Notes:

There is no “typical” minimum or maximum amount of absences to be considered excessive.

Documentation must describe the effects of the absences. Excessive absenteeism is based on comparison with peers and effects on learning. Intermittent, as well as cumulative absences must be considered, as each may impact

learning. Excessive absences, for the purposes of OHD may not be due to refusal to attend

school, school phobia, truancy, or non-medically prescribed or health-condition related procedures (i.e., vision therapy).

Excessive absences, for the purposes of OHD, may not be due to a manifestation of an emotional or behavioral disorder. For example, in a case where a student misses school due to an anxiety disorder, the team should consider whether that student demonstrates a disability in another category (i.e., E/BD).

Example Evaluation Data:Jose has been diagnosed with leukemia. He had been absent from school intermittently for six months with symptoms related to leukemia before he was diagnosed. During the first two weeks of chemotherapy, Jose has been absent for nine days. An additional three rounds of chemotherapy are scheduled, in which further absences are anticipated. Additionally, Jose currently misses half-days of school when overly fatigued. Prior to receiving this diagnosis, Jose was performing at a level similar to his peers. Since the onset of these absences, he has been unable to maintain adequate academic progress in math when compared to his peers.Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-162

Educational Needs Statement:Jose needs to improve his multiplication skills.

Corresponding PLEP Statement:Due to Jose’s health-related absences, he has experienced gaps in his instruction. Jose’s health condition results in excessive absences from school for frequent hospitalizations and interferes with his ability to maintain satisfactory academic progress in comparison to peers. Jose is absent on an average of 2-3 days per week, compared to an average peer of absence of one day per month. As a result, Jose has missed instruction of skills related to single-digit multiplication. On the last timed multiplication test, Jose was able to correctly answer 42/100 problems in a five-minute probe when peers answered 95/100. Jose was not able to correctly answer problems that included 4’s, 7’s, and 9’s.

ACADEMIC Goal Statement:Jose will increase his multiplication skills from 42/100 to 95/100 on five-minute timed single-digit mixed multiplication problems as measured by school staff by June 5th 2009.

Objectives:1) Presented with multiplication flashcards for 4’s, 7’s, and 9’s, Jose will correctly answer 19 out of 20 facts in 1 minute on 4/5 probes as measured by school staff on a flashcard chart.

2) Given a 5-minute timed single-digit mixed multiplication probe, Jose will accurately complete 75 of 100 problems as measured by school staff on a graph.

3) Given a 5-minute timed single-digit mixed multiplication probe, Jose will accurately complete 95 of 100 problems as measured by school staff on a graph.


2. HEALTH CARE PROCEDURESHealth Care Procedures – specialized health care procedures that are necessary during the school day. This area should be considered when a student currently (or it is anticipated) needs nursing care during the school day as prescribed by the student’s licensed physician. These procedures require training for the individual who performs them. Examples include catheterization, gastric tube feeding, postural drainage, tracheotomy care, oxygen administration, ostomy care, and the administration of medications: oral, inhaled, injected or IV. (NOTE: The link must still be made on the impact that these procedures are having on the student’s ability to make adequate progress).

Notes: IEP goals and objectives are educationally based. School nurses are not usually

required to write educational goals and objectives on the IEP unless a student is learning a behavior, or task, related to his or her health condition (i.e., self-catheterization, asthma self-cares such as a nebulization procedure, diabetic self-cares).

When students at school need ongoing nursing management, a documented plan of care is essential. An Individual Health Care Plan (IHP) should be written that documents the information from the nursing assessment and includes the student goals and outcomes that are to be achieved. The IHP would include more detail than the IEP and should be attached to the IEP.

Medication administration pertains to lengthy procedures that remove the child from the learning setting. This does not include simple medication administration, or monitoring procedures such as blood-sugar levels, blood pressure check, and/or administration of oral medication

Example Evaluation Data for an academic goal:Rachel, a second grader with a diagnosis of Immune Deficiency Disorder, requires immunoglobulin (IVIG infusions) every two weeks. These treatments are one hour in duration. These regularly scheduled treatments occur during reading and language instruction. Due to the time away from instruction, Rachel is not meeting reading milestones at a rate comparable to the majority of her peers.

Educational Needs Statement:#1:Rachel needs to increase her reading fluency skills.

Corresponding PLEP Statement:Due to Rachel’s requirement for specialized health care procedures (IVIG infusions) during the school day, Rachel has missed significant amounts of reading and language instruction. Poor performance on classroom tests, as well as a one-year lag in standardized, 1:1 academic assessment results, indicates that Rachel needs to increase her reading fluency skills.

ACADEMIC Goal:

Rachel needs to improve her reading fluency from 11 wpm at the second grade level to 60 wpm at the second grade level with 90% accuracy as measured by teacher-administered running record by June 8th 2009 .

Objectives:1) Using 2nd grade reading materials, Rachel will increase her reading fluency to 30 wpm with 90% accuracy on 75% of the probes as measured by a teacher reading record.2) Using 2nd grade reading materials, Rachel will increase her reading fluency to 60 wpm with 90% accuracy on 75% of the probes as measured by a teacher reading record.

3. MEDICATIONMedication – medications that adversely affect learning and functioning in terms of comprehension, memory, attention, or fatigue. Concerns in this area should be considered when a student is taking medications during the school day to manage his/her health/medical needs.

Notes: The evaluation must demonstrate documented evidence of memory, attention or

fatigue issues related to the prescribed medication. Best practice is to collaborate with medical professionals regarding the effects of

medications administered to the student. Students taking a prescribed medication may not experience all the known possible

side effects. The team should determine if any possible side effects are actually affecting the student’s educational performance.

Example Evaluation Data: Sarah is a survivor of childhood leukemia and has received multiple invasive treatments and medications including: Prednisone PO, Vincristine IV, Cytatrabine (intrathecal), Methotrexate Laparaginase, Thioguanine PO, Intrathecal Triples (Methotrtexate, Cyhtarabine, Hydrocortisone), Doxorubicin IV, Cyclophosphamide IV, Cytarabine IV, Methtrexate PO, Mercaptopurine PO, and Dexamethasone PO. Intrathecal treatments, specifically, have been demonstrated to result in sequelae involving reduced cognitive and attention abilities over time (Journal of Developmental and Behavioral Pediatrics (1990), 11:6, 301-305). Although Sarah is not currently on any medication, her present levels of cognitive performance, her inattentiveness in class, and her impaired ability to grasp concepts when compared with peers are consistent with these effects. Sarah continues to experience chronic effects from the sequelae resultant of her past medical treatments demonstrated through information gathered through interviews and observations.

Educational Needs Statement:Sarah needs to improve her work completion skills.

Corresponding PLEP Statement:Sarah’s reduced cognitive ability as a result of chemotherapy treatments impacts her ability to progress at a level similar to peers. Sarah’s rate of work is significantly slower than her peers. When given independent work time, Sarah is able to complete one assignment in the time her peers are able to complete three. She requires frequent repetition of directions and prompts to get back to work. Sarah needs to increase her independent work skills in order to maintain focus and grasp basic concepts within the mainstream curriculum.

PRODUCTIVITY Goal:

Sarah will increase her work completion skills from needing directions repeated five times during independent work time to needing directions repeated two or fewer times as monitored by school staff by June 8, 2009.

Objectives:1) Given a worksheet with the directions highlighted, Sarah will read the highlighted directions and verbally state the directions in the correct order on 4/5 trials as monitored by school staff using a data sheet.2) Given instruction on how to identify key details in a set of directions and a worksheet, Sarah will independently highlight the key details with 90% accuracy on 4/5 trials as monitored by school staff using a data sheet.3) Given a worksheet with the directions highlighted, a need to have the directions repeated, and a verbal prompt by her teacher to check her directions, Sarah will independently check the highlighted directions and continue working on 4/5 trials as monitored by school staff using a data sheet.

4. PHYSICAL STRENGTHPhysical strength – limited physical strength resulting in decreased capacity to perform school activities. This area should be considered when a student’s health condition limits ability to handle materials, transition within the building, and participate in recreational or leisure playground activities.

Notes: Documentation must be linked to treatment or etiology and describe the effects on

learning. This includes modifications and accommodations necessary during P.E., recess, field trips, and school transitions.

Overall weakness permeates the child’s school day. Limited strength may impact the quality and quantity of work, including homework.

Example Evaluation Data:Doris has limited physical strength associated with her Juvenile Rheumatoid Arthritis. She experiences swelling of her hand joints, as well as hand pain. These symptoms result in her inability to use typical writing utensils for any extended period. Alternate methods of work output have been provided to Doris in order to increase here work output and lessen fatigue. Her limited ability to perform written language tasks in the classroom has prevented her from practicing and mastering sentence construction, syntax, and other basic writing skills. Work samples, as well as standardized 1:1 assessments and group tests reflect inadequate academic progress in the area of written language when compared with a majority of her peers.

Educational Needs Statement:Doris needs to improve her sentence writing skills.

Corresponding PLEP Statement:Since Doris’ condition of JRA inhibits her ability to perform written language tasks at a level commensurate with peers, Doris is lacking many sentence writing skills. Doris omits correct punctuation 50% of the time on classroom writing samples. She uses correct capitalization 60% of the time at the beginning of a sentence, but only 30% of the time when her writing includes proper nouns. Writing samples document that Doris uses correct subject/verb agreement 50% of the time. Currently Doris is provided with adult assistance to complete written language tasks. As a result, she has not mastered using writing mechanics independently.

ACADEMIC Goal:Doris will improve her capitalization skills from using correct capitalization 60% of the time on a five sentence paragraph, to using correct capitalization 80% of the time on a five sentence paragraph as measured by special education staff by June 8th, 2009.

Objectives:1) Given 10 sentences, Doris will correctly identify capitalization errors with 80% accuracy on 8/10 trials as measured by special education staff using a data sheet.2) Given a topic, Doris will write a 5 sentence paragraph using correct capitalization with 80% accuracy on 8/10 trials as measured by special education staff using a data sheet.

5. ENDURANCE AND STAMINAEndurance and Stamina – limited endurance resulting in decreased stamina and decreased ability to maintain performance. This area should be considered when a student fatigues easily, experiences chronic pain and inconsistently performs in the classroom setting.

Notes: Students may do well at the beginning of the day and show a declined performance by

the end of the day. The team should keep that in mind when developing an educational program.

Example Evaluation Data:The effects of Robert’s Bronchopulmonary Dysplasia (BPD) make it laborious for him to breathe. He expends excessive effort in taking normal breaths. This has resulted in excessive fatigue and in an inability to fully participate in classroom activities. Classroom observations indicate that Robert requires frequent rest breaks and therefore his access to regular-classroom academic instruction is fragmented and inconsistent.

Educational Needs Statement #1: Robert needs to improve his multiplication skills.

Corresponding PLEP Statement:The frequent need for rest breaks associated with Robert’s diagnosed condition of BPD has and continues to prevent him from full participation in mainstream math class. This has resulted in fragmented and inconsistent exposure to basic math skills. Robert has missed over 40% of math class because it is held in the afternoon. Robert is completing his assignments with less than 60% accuracy when working independently. Robert knows his basic multiplication facts, but is unable to multiply two 2-digit numbers independently.

ACADEMIC Goal:Given a worksheet of 20 problems, Robert will increase his multiplication skills of 2-digit numbers from 60% accuracy to 90% accuracy as measured by special education staff by June 8th, 2009.

Objectives:1) Presented with 2-digit whole numbers and verbal prompts, Robert will be able to correctly multiply the numbers presented with 90% accuracy on 8/10 trials as measured by special education staff using data sheets.2) Presented with 2-digit whole numbers and a visual cue, Robert will be able to correctly multiply the numbers presented with 90% accuracy on 8/10 trials as measured by special education staff using data sheets.

Educational Needs Statement #2:Robert needs to improve his self-monitoring skills.

Corresponding PLEP Statement:Robert requires frequent rest breaks due to fatigue associated with his diagnosed condition of BPD. Robert seldom asks to take a break. His teachers notice when he is showing signs of fatigue and suggest that he take a rest break. Robert often works to the point of exhaustion. This results in frequent illnesses and absences from school.

6. HEIGHTENED OR DIMINISHED ALERTNESSHeightened or diminished alertness – heightened or diminished alertness resulting in impaired abilities, for example, prioritizing environmental stimuli, maintaining focus, or sustaining effort or accuracy. This area should be considered for students who appear to become overactive or shutdown, are off-task, complete fewer assignments than peers, have difficulty listening and/or have poor work quality.

Notes: Students require frequent redirection. Students may be distracted and/or unable to filter out visual, auditory or tactile stimuli

in their environment. Students experiencing pain or fear related to a condition may be unable to focus and

perform efficiently.

Students are not intentionally choosing not to participate or perform a task. There must be evidence of the need for specific academic instruction vs.

accommodations or instruction due to off-task behaviors. For example, if a student achieves average scores on an individually administered 1:1 test, but fails on classroom tests and does not turn in work within routine timelines, the student may require assistance in developing independent work skills vs. direct academic instruction.

Example Evaluation Data:Susan’s diagnosis of Attention Deficit Hyperactivity Disorder-Inattentive type manifests itself in an inability for her to sustain attention during typical instructional activities. Observation data gathered during her ability-grouped reading class describes Susan as being on task 30% of the time, when compared with a random sample of peers, who were on task 62% of the time. When redirected by her teacher, Susan returns to work, but 90% of the time is found to be off task within three minutes of the last redirection.

Educational Needs Statement:Susan needs to improve her independent work skills.

Corresponding PLEP Statement:Observational data documents that Susan is on task 30% of the time. Susan responds appropriately to redirection by her teacher. It is found that Susan understands the directions given in her assignments. She is able to repeat them when asked to do so. When an assignment is given, Susan begins working within one minute. She is able to sustain independent work for up to three minutes with most tasks.

PRODUCTIVITY Goal:Susan will improve her ability to remain on task from 30% of the time to 60% of the time as monitored by special education staff by June 8, 2009.

Objectives:1) Given a classroom assignment and a prompt to begin working, Susan will begin working within ten seconds on 8/10 trials as monitored by special education staff using a data sheet.2) Given a classroom assignment and independent work time, Susan will work independently for five minutes on 8/10 trials as monitored by special education staff using a data sheet.7. MANAGING AND ORGANIZING MATERIALSManaging and organizing materials – impaired abilities to manage and organize materials and complete classroom assignments within routine timelines. This area should be considered for students who consistently complete fewer assignments than peers and/or whose assignments are often not completed within routine timelines even after regular methods of organizing have been implemented.

Notes: There must be evidence of the need for specific academic instruction vs.

accommodations or instruction due to organizational issues. For example, if a student achieves average scores on an individually administered 1:1 test, but fails on classroom tests and does not turn in work within routine timelines, the student may require assistance in developing independent work skills or assignment modifications vs. direct academic instruction.

Organizational difficulties may present academically and may require specially designed instruction to remediate. In math, for example, this may include difficulties in setting up equations and/or following the steps towards completion of them.

Example Evaluation Data:Gennifer has been diagnosed with Neurofibromatosis Type 1, which results in a pronounced difficulty in her ability to attend to classroom instruction and follow classroom routines. Gennifer’s teacher reports that she is unable to independently plan for her homework at the end of the day, and that she requires repeated prompts to turn in completed assignments. When assignments are turned in, they are seldom finished. During the last grading period, records indicate that Gennifer turned in 40% of her assignments on time as compared to 80% for her peers. This has resulted in failing grades. Gennifer is able to correctly record her assignments in her planner.

Educational Needs Statement:Gennifer needs to improve her organizational skills.

PRODUCTIVITY Goal:Gennifer will improve her organizational skills from needing adult assistance 100% of the time when gathering her homework materials to gathering her homework materials independently 100% of the time as measured by teacher checklist by June 8, 2009.

Objectives:1) Given the completion of a role modeling activity with an adult, Gennifer will verbally review the assignments written in her planner with an adult and place the needed homework materials in her bag on 5/5 trials as monitored through a teacher generated checklist.2) Given the successful completion of verbal rehearsal activities, Gennifer will independently review the assignments written in her planner and place the needed homework materials in her bag 5/5 trials as monitored though a teacher generated checklist.

8. FOLLOWING DIRECTONS AND TASK COMPLETIONFollowing directions and task completion – impaired ability to follow directions or initiate and complete a task. This area should be considered for students whose level of distractibility and/or impulsivity interferes with ability to attend during a lecture, start work and remain on task, focus and complete activity-based classroom projects in comparison to peers.

Notes: There must be evidence of the need for specific academic instruction vs.

accommodations or instruction due to issues related to independent work skills. For example, if a student achieves average scores on an individually administered 1:1 test, but fails on classroom tests and does not complete tasks or initiate tasks independently in the day to day routine classroom situation, the student may require instruction in developing independent work skills vs. direct academic instruction.

Students who have suffered a brain injury or other neurologically based conditions may not present with educational difficulties in earlier grades. The student may experience increasing difficulties in maintaining academic progress, as requirements for executive functioning (i.e., task management, focus, organization, and independent work skills) increase in upper grades.

In order to establish a pattern, it is important for the team to thoroughly examine the student’s academic history when determining the student’s current need for academic support.

Example Evaluation Data:Denise’s medical records document a sustained in utero stroke in the frontal lobe region. Due to the focus of stroke damage, there is a reason to suspect that Denise’s performance has been negatively impacted. Denise requires frequent adult redirection in order to initiate and complete routine classroom tasks. Observation data documents that Denise requires two prompts per minute, as compared to peers requiring no prompts, to remain on task during a written assignment. When asked to repeat the directions of an assignment, Denise was only able to verbalize one of the four steps required when peers were able to verbalize all steps. Observations indicate that when asked to work in a group, Denise required five redirections, compared with no redirections required of her peers. Denise’s teacher reports that this is typical of Denise’s performance in day-to-day classroom situations.

Educational Needs Statement:Denise needs to improve her ability to work in cooperative groups.

Corresponding PLEP Statement:When assigned to a cooperative group, Denise is able to join the group when asked to do so. When the task directions are given to the group, Denise is able to restate 25% of the directions that are given. At this time, Denise does not ask her teacher or her peers to restate the directions. When she is unsure of the task assigned, Denise exhibits off task behaviors such as talking with her peers, wandering around the work area, or playing with her materials.

PRODUCTIVITY Goal:Denise will improve her ability to work in a cooperative group from needing 5 prompts to complete her work to needing 1 or fewer prompts to complete her work as monitored by special education staff by June 8, 2009.

Objectives:1) When in a cooperative group, Denise will join the group when asked to do so with 1 verbal prompt on 2/3 opportunities as monitored by special education staff using a data sheet.2) When provided with directions in a cooperative group, Denise will verbal restate the directions that are given with 100% accuracy on 2/3 opportunities as monitored by special education staff using a data sheet.

A D D I T I O N A L G O A L S A N D O B J E C T I V E S F O R S T U D E N T S W I T H H E A L T H C O N D I T I O N S

Please see Student Plans for other possible examples of goals and objectives for students with health conditions. These are located in the goal bank under the Social, Emotional, Behavioral and Functional areas


CHAPTER 3E: Traumatic Brain Injury (TBI) Documentation


STATE GUIDELINES: TRAUMATIC BRAIN INJURY (TBI)"Traumatic brain injury" means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that may adversely affect a child's educational performance and result in the need for special education and related services. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as: cognition, speech/language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, and information processing. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma.

The team shall determine that a student is eligible and in need of special education and related services if the student meets the criterion in item A and the criteria in items B and C as documented by the information gathered according to item D:

A. There is documentation by a physician of a medically verified traumatic brain injury.B. There is a functional impairment attributable to the traumatic brain injury that adversely

affects educational performance in one or more of the following areas: intellectual-cognitive, academic, communication, motor, sensory, social-emotional-behavioral, and functional skills-adaptive behavior. Examples of functional impairments which may adversely affect educational performance area:1. intellectual-cognitive, such as, but not limited to, impaired:

a) attention or concentration;b) ability to initiate, organize, or complete tasks;c) ability to sequence, generalize, or plan;d) insight/consequential thinking;e) flexibility in thinking, reasoning, or problem-solving;f) abstract thinking;g) judgment or perception;h) long-term or short-term memory;i) ability to acquire or retain new information;j) ability to process information;

2. academic, such as, but not limited to:a) marked decline in achievement from pre-injury levels;b) impaired ability to acquire basic skills;c) normal sequence of skill acquisition which has been interrupted by the trauma as

related to chronological and developmental age;3. communication, such as, but not limited to:

a) impaired ability to initiate, maintain, restructure, or terminate conversation;b) impaired ability to respond to verbal communication in a timely, accurate or efficient

manner;c) impaired ability to communicate in distracting or stressful environments;d) impaired ability to use language appropriately;

e) impaired ability to use appropriate syntax;f) impaired abstract or figurative language;g) perseverative speech;h) impaired ability to understand verbal information;i) impaired ability to discriminate relevant from irrelevant information;j) impaired voice production/articulation;

4. motor, such as, but not limited to, impaired:a) mobility;b) fine or gross motor skills;c) speed of processing or motor response time; d) sensory/perceptual motor skills;

5. sensory, such as, but not limited to, impaired:a) vision;b) hearing;

6. social-emotional-behavioral, such as, but not limited to:a) [impaired] ability to initiate or sustain appropriate peer or adult relationships;b) impaired ability to perceive, evaluate, or use social cues or context appropriately;c) impaired ability to cope with over-stimulating environments, low frustration

tolerance;d) mood swings or emotional [instability];e) impaired ability to establish or maintain self-esteem;f) denial of deficits affecting performance;g) poor emotional adjustment to injury;h) impaired ability to demonstrate age-appropriate behavior;i) impaired self-control;j) intensification of preexistent maladaptive behaviors or disabilities;

7. functional skills-adaptive behavior, such as, but not limited to, impaired:a) ability to perform developmentally appropriate daily living skills in school, home,

leisure, or community setting; b) ability to transfer skills from one setting to another;c) orientation;d) ability to find rooms, buildings, or locations in a familiar environment;e) ability to respond to environmental cues;f) ability to follow a routine;g) ability to accept change in an established routine;h) stamina that results in chronic fatigue;

C. The functional impairments are not primarily the result of previously existing:1. visual, hearing, or motor impairments;2. emotional-behavioral disorders;3. mental retardation;4. language or specific learning disabilities;5. environmental or economic disadvantage;6. cultural differences.

D. Information/data to document a functional impairment in one or more of the areas in item B must, at a minimum, include one source from Group One and one source from Group Two:1. GROUP ONE:

a) checklists;b) classroom or work samples;c) educational/medical history;d) documented, systematic behavioral observations;

e) interviews with parents, student, and other knowledgeable individuals.

2. GROUP TWO:a) criterion-referenced measures;b) personality or projective measures; c) sociometric measures;d) standardized evaluation measures: academic, cognitive, communication,

neuropsychological, or motor.


TRAUMATIC BRAIN INJURY (TBI) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:_______________________________________Grade:____________ School:_____________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is in need of special education and related services when the student meetsthe criterion described in Items A and in Items B and C as documented by information gathered according to D.

Circle OneA

.There is documentation by a physician of a medically verified traumatic brain injury? Yes No

Does the student meet the criterion in Item A? Yes NoAND

B. There is a functional impairment attributable to the traumatic brain injury that adversely affects educational performance in one or more of the following areas:

Yes No

____ intellectual/cognitive____ communication____ social/emotional/behavioral____ academic

____ sensory____ functional skills/adaptive behavior____ motor

Does the student meet the criterion in Item B? Yes NoAND

C. The functional impairments are not primarily the result of previously existing:

Yes No

____ visual, hearing, motor impairments____ environmental or economic disadvantage____ language or specific learning disability

____ mental retardation____ emotional/behavioral disorders____ cultural differences

Does the student meet the criterion in Item C? Yes NoAND

D. Information/data to document a functional impairment in Item B must, at a minimum, include one source from #1 and one source from #2:

Yes No

1. ____ checklists____ documented, systematic behavioral observations____ interviews with parent, student, and other knowledgeable individuals____ classroom or work samples____ educational/medical history

AND2. ____ criterion referenced measures

____ sociometric measures____ personality or projective measures____ standardized evaluation measures (academic, cognitive, communication,

neuropsychological, or motor)

Does the student meet the criterion in Item D? Yes No


MATRIX FOR DEVELOPING A TBI EVALUATION PLANNote: Though some evaluation information listed below may have been obtained through the prereferral process, parental permission should be obtained for all information used during the formal evaluation process.

DATA SOURCESCriterion

Components

ChecklistsStandardized assessment measures

Sociometric measures

Classroom or work samples

Educational/Medical History

Observations InterviewsCriterion

Referenced Measures

Personality Measures

Written and signed documentation by a licensed physician of a medically diagnosed TBI

X

Functional impairment attributable to the TBI in the area of intellectual/cognitive

X X X

Functional impairment attributable to the TBI in the area of academics

X X X X X X X

Functional impairment attributable to the TBI in the area of communication

X X X X X X

Functional impairment attributable to the TBI in the area of motor

X X X X X X

Functional impairment attributable to the TBI in the area of sensory

X X

Functional impairment attributable to the TBI in the area of social-emotional-behavioral

X X X X X X X

Functional impairment attributable to the TBI in the area of functional skills-adaptive behavior

X X X X X X

Documentation of a functional impairment in one or more of the areas above must, at a minimum, include one source from Group One and one source from Group Two:

Group One: Group Two:(a) checklists; (a) criterion-referenced measures;(b) classroom or work samples; (b) personality or projective measures;(c) education/medical history; (c) sociometric measures;(d) documented, systematic behavioral observations; (d) standardized assessment measures

(academic, cognitive, communication, neuropsychological, or motor)


CHAPTER 3F: Vision Impaired (VI) Documentation


STATE GUIDELINES: VISUALLY IMPAIRED (VI)"Visually impaired" means a medically verified visual impairment accompanied by limitations in sight that interfere with acquiring information or interaction with the environment to the extent that special education and related services may be needed.

The team shall determine that a student is eligible as having a visual impairment and in need of special education if the student meets one of the criteria in item A and one of the criteria in item B.

A. There is medical documentation of a diagnosed visual impairment by a licensed eye specialist establishing one or more of the following conditions:1) visual acuity of 20/60 or less in the better eye with the best conventional correction;

estimation of acuity is acceptable for difficult-to-test students;2) visual field of 20 degrees or less, or bilateral scotomas; or 3) a congenital or degenerating eye condition including, but not limited to, progressive

cataract, glaucoma, retinitis pigmentosa, albinism, or nystagmus.

B. A functional evaluation of visual abilities conducted by a licensed teacher of the visually impaired determines that:1) the student has limited ability in visually accessing program-appropriate educational

media including, but not limited to, textbooks, photocopies, ditto copies, chalkboards, computers, or environmental signs, without modification;

2) the student has limited ability to visually access the full range of program-appropriate educational materials and media without accommodating actions including, but not limited to, changes in posture, body movement, focal distance, or squinting;

3) the student demonstrates variable visual ability due to environmental factors including, but not limited to, lighting, contrast, weather, color, or movement, that cannot be controlled; or

4) the student experiences reduced ability due to visual fatigue.


VISUALLY IMPAIRED (VI) CRITERIA CHECKLIST Initial Evaluation Reevaluation


A student is eligible for special education and related services when the student meets one of the criteria in A and one of the items in B.

Circle OneA.

Documentation of visual impairment by a licensed eye specialist in at least one area:

Yes No

____ Visual acuity of 20/60 or less in better eye with best conventional correction

____ Visual field of 20 degrees or less or bilateral scotomas____ Congenital or degenerating eye condition:

_____________________________Does the student meet the criteria in Item A? Yes No

ANDB. Documentation of functional visual abilities evaluated by a teacher

of the visually impaired in at least one area Yes No

____ Limited ability in visually accessing program-appropriate educational media and materials without modifications

____ Limited ability to visually access full range of program-appropriate materials or media without accommodating actions (changes in posture, squinting, focal distance, etc.).

____ Variable visual ability due to environmental factors (lighting, contrast, color, movement, or weather) that cannot be controlled.

____ Reduced or variable visual ability due to visual fatigue or other factors common to the eye condition.

Does the student meet the criteria in Item B? Yes No


MATRIX FOR DEVELOPING A VI EVALUATION PLANNote: Though some evaluation information listed below may have been obtained through the prereferral process, parental permission should be obtained for all information used during the formal evaluation process.

Item A= Medical documentation of a diagnosed visual impairmentItem B= Functional evaluation of visual abilities conducted by a licensed teacher of the visually impaired

DATA SOURCES Item A Item BMedical

Medical vision examination x Clinical low vision evaluation x Health history review x x

Interview/survey Parent/care giver x Teacher x Child/student x

Observation Educational environment x Home/community environment x

School Records Progress in general education curriculum (grades and tests)

x

Work samples x Review of IEP goals x

Standardized Norm Referenced Evaluations Individual achievement x Individual cognitive x

Expanded Core Curriculum Functional vision assessment x Learning media assessment x Assistive technology x Communication (Braille, print), listening, concepts, language x Non-academic areas (social/personal, daily living, leisure, career) (required for 14 and older)

x

Orientation and mobility x

Required components for all VI evaluation


CHAPTER 3G: Early Childhood Special Education (ECSE) Documentation


STATE GUIDELINES: EARLY CHILDHOOD SPECIAL EDUCATION (ECSE)

"Early childhood special education" must be available to students from birth to seven years of age who have a substantial delay or disorder in development or have an identifiable sensory, physical, mental, or social/emotional condition or impairment with a high probability of resulting in developmental delay.

Criteria for Children from Birth through Two Years and 11 MonthsThe team shall determine that a child from birth through the age of two years and 11 months is eligible for early childhood special education if:

A. The child meets the criteria of one of the disability categories;Or

B. The child meets one of the criteria for developmental delay in subitem (1) or the criteria in subitem (2):

1. the child has a diagnosed physical or mental condition or disorder that has a high probability of resulting in developmental delay regardless of whether the child has a demonstrated need or delay;

2. the child is experiencing a developmental delay that is demonstrated by a score of 1.5 standard deviations or more below the mean, as measured by the appropriate diagnostic measures and procedures, in one or more of the following areas:a) cognitive development;b) physical development, including vision and hearing;c) communication development;d) social or emotional development; ore) adaptive development.

Criteria for Children from Three through Six Years and 11 MonthsThe team shall determine that a child from the age of 3 years through the age of 6 years and 11 months is eligible for early childhood special education when:

A. The child meets the criteria of one of the disability categories; or

B. The child meets one of the criteria for developmental delay in subitem (1) and the criteria in

subitem (2):1. The child:

a) has a diagnosed physical or mental condition or disorder that has a high probability of resulting in developmental delay; or

b) has a delay in two or more of the areas of: cognitive development;

physical development, including vision and hearing; communication development; social and emotional developments; or adaptive development

that is verified by an evaluation using one or more technically adequate, norm-referenced instruments. The scores must be at least 1.5 standard deviations below the mean in each area.

2. The child’s need for special education is supported by:a) at least one documented, systematic observation in the child’s daily routine setting

by an appropriate professional. If observation in the daily routine setting is not possible, the alternative setting must be justified.

b) A developmental history; andc) At least one other evaluation procedure in each area of identified delay that is

conducted on a different day than the medical or norm-referenced evaluation; which may include criterion-referenced instruments, language samples or curriculum-based measures.


EARLY CHILDHOOD SPECIAL EDUCATION (ECSE) CRITERIA CHECKLIST

Birth to 6 Years 11 Months Initial Evaluation Reevaluation


Birth Through Two YearsA child is in need of special education and related services in Early Childhood Special Education when the child meets the criteria described in Item A, or Items B, C, and D.

Circle OneA

.Meets disability criteria in one of the other disability categories Disability category ___________________

Yes No

Does the student meet the criterion in Item A? Yes NoOR

B. Documentation in report of medical condition or developmental delay

Yes No

1. Medically diagnosed physical or mental condition or disorder that has high probability of resulting in developmental delay regardless of whether the child has a demonstrated need or delay.

OR2. Developmental delay demonstrated by a score of 1.5 standard

deviations or more below the mean in one or more of the following areas:a)cognitive development;b) physical development including vision and hearing;c) communication;d) social or emotional development; ore) adaptive development.Test Name ___________________________________________________________________Area(s) of Developmental Delay __________________________________________________Scores ______________________________________________________________________ (subtest of instruments are not acceptable)

Yes No


C. Supported by systematic observation in routine setting and documented in evaluation report

Yes No


D. Documentation in evaluation report of corroboration of the developmental evaluation or medical diagnosis from:

Yes No

____ Developmental history____ Evaluation procedure conducted on another day____ Other: ________________________________________________________ (parent report, behavior checklist, childcare agency, etc.)


Three Through Six Years

A child is in need of special education and related services in Early Childhood Special Education when the child meets the criteria described in Item A, or Items B, C, and D.

Circle OneA

.Meets disability criteria in one of the other disability categories Disability category ___________________

Yes No


B. Meets one of the following criteria for developmental delay Yes No1. Medically diagnosed physical or mental condition or disorder that has

high probability of resulting in developmental delay.OR2. Delay of 1.5 SD below mean in two or more developmental areas.

Subtests of instruments are not acceptable.Yes No


C. Supported by systematic observation in routine setting and documented in evaluation report

Yes No


D. Documentation in evaluation report of corroboration of the developmental evaluation or medical diagnosis from:

Yes No

____ Developmental history____ Evaluation procedure using at least one other evaluation procedure in each area of identified delay conducted on another day____ Other: ________________________________________________________ (parent report, behavior checklist, childcare agency, etc.)



FLOWCHART: REFERRAL FOR CHILD YOUNGER THAN AGE 2

*Evaluation cannot proceed without appropriate signed consent

10B2: Services end by age 3.

8B1: Meet all requirements of transition from Part C to Part B:Document transition steps/services in IFSPConvene transition conference (between 2-years 3 months and 2 years 8 months, 30 days).

Seek parental consent for an initial evaluation to determine eligibility under Part B.

9A/11B1: IEP is developed & implemented by the child’s 3rd birthday.

9B: Written Consent for Initial Part B Evaluation Received.

7A: Serve eligible child and family through IFSP(s).

8A: Meet all requirements of Part C to Part B transition: Document transition steps/services in IFSPConvene transition conference not less than 90 days but not more than 9 months prior to the child’s 3rd birthday for children potentially eligible under Part B.

7.5B: Team decides if child is potentially eligible under Part B.

7B: Serve eligible child and family through IFSP(s).

8B2: IFSP documents transition steps. Service coordinator makes reasonable effort to convene a conference with parents and providers of appropriate service for children not eligible for services under Part B.

5B: Multidisciplinary team conducts timely, comprehensive evaluation of the child’s developmental functioning in all five developmental domains and applies the information to eligibility criteria.

6B2: Evaluation results indicate the child meets eligibility for Developmental Delay or any categorical disability.

5A: Multidisciplinary team conducts timely, comprehensive evaluation of the child’s functioning in all five domains as required under Part C. The evaluation also addresses specific requirements of any suspected categorical disability. Information is applied to criteria.

6A1 & 6B1: Child is not eligible for services.

6A3: Evaluation results indicate the child meets eligibility for Developmental Delay.

6A2: Evaluation results indicate the child meets eligibility for S/L, ASD, OHD, or other categorical disability.

4A: Written consent received for Part C and Part B evaluations.

4B: Written consent received for Part C evaluation.

3A: Team seeks written parental consent for concurrent Part C and Part B evaluation.*

3B: Team seeks written parental consent for Part C evaluation.*

2A: Team suspects the child may ultimately be categorically eligible.

1. Referral is received for a child younger than age 2 2B: Team believes that the child’s

only potential disability category is DD.

NO

YES

NOYES

10B1: Conduct Initial Part B evaluation as per prior written notice.Has eligibility been established?

11B2: Services end by age 3.

NO

YES


FLOWCHART: REFERRAL FOR TODDLERS AGE 2 AND OLDER

NO

1A: Referral is received for a child between age 2 and 2 years 10 months & 16 days.

1B: Referral is received for a child who is within 45 days of 3rd birthday.

2A: Written parental consent sought and received for concurrent Part C and Part B evaluations.

2B: Written consent sought and received for Part B evaluation only.

3A: Multidisciplinary team conducts timely, comprehensive evaluation of the child’s functioning in all five developmental domains as required under Part C. The evaluation also addresses specific requirements of any suspected categorical disability. Information is applied to criteria.

3B: Team conducts an evaluation adhering to all applicable Part B standards including timeline and requirement to evaluate in all areas related to the child’s suspected disability.

7A/9C1: IEP is developed and implemented by the child’s 3rd birthday. Parents provide written consent for the initial provision of Part B services.

8C1: Conduct Initial Part B evaluation as per prior written notice. Apply information to criteria.Has eligibility been established?

7C: Written Consent for Initial Part B Evaluation received.

6C1: IFSP documents transition steps. Service coordinator provides parents with appropriate services / resources for children not eligible for services under Part B. Part C Services end.

6A: Meet all requirements of Part C to Part B transition:Document transition steps/services in IFSPConvene transition conference not less than 90 days but not more than 9 months prior to the child’s 3rd birthday for children potentially eligible under Part B (may have been initial IFSP team meeting).

5.5C: Team may choose to reevaluate child for potential eligible under Part B.

4A1 & 4B1: Evaluation indicates the child is not eligible for services.

4A2: Evaluation results indicate the child meets eligibility for S/L, ASD, OHD, or other categorical disability or DD in 2 or more areas.

4A3: Evaluation results indicate the child meets Part C eligibility for DD due to delay in one domain.

5B: Develop and implement IEP following all applicable Part B standard(s).

5C: Serve Part C eligible child and family through IFSP.

5A: Serve eligible child and family through IFSP.

4B2: Evaluation results indicate the child meets eligibility for 3-6 DD (2 or more areas) or a categorical disability.

6C2: Meet all requirements of transition from Part C to Part B:Document transition steps/services in IFSPConvene transition conference not less than 90 days but not more than 9 months prior to the child’s 3rd birthday. See parental consent for an initial Part B evaluation.

9C2: Services end by Age 3.

8C2: Services end by age 3.

YES

YES

NO

YES NO


DECISION TREE: ELIGIBILITY FOR TRANSITION FROM PART C TO PART B

Part B Eligible

Is this child served under Part C and nearing age 3potentially eligible

for ECSE services under Part B?Convene transition conference between 2y3m & 90 days prior to child's 3rd

Birthday. IFSP must document steps taken to transition the child to Part B service

or other appropriate services.

YES Has the child already been

determined eligible for Part B through an evaluation process that included parents providing informed consent specifically to an initial evaluation for Part B?

Conduct an initial evaluation for eligibility under Part B following all applicable Part B standards. Because this is an initial evaluation, parents must provide informed consent in writing.

Review the child's status prior to their third birthday to ensure that the child still meets the eligibility requirements for Part B.

IEP is developed and

implemented by the child's 3rd

birthday. Parents provide written consent

for the initial provision of Part

B services.

IFSP documents transition steps.

Service coordinator makes reasonable effort

to convene a conference with

parents and providers of appropriate services for children not

eligible for services under part B.

Services end byAge 3

YES

NO

NO

Team believes child is not eligible for Part B

Part BEligible

Not Part B Eligible

Part B Eligible

Conduct a reevaluation following all applicable Part B standards. Parents must be given prior written notice and be afforded 14 days to object to the district's proposal.

Not Part B eligible


EXAMPLE: ECSE EVALUATION REPORT (AGE B-2)

REASON FOR REFERRAL Ronald was referred to the Rochester Intake Team on 11/9/2007 by Dr. Barbaresi, Mayo Clinic, with concerns in regard to Ronald's overall development. Ronald underwent a heart transplant at 6 weeks of age and a medical report dated 11/8/2007 stated that with the heart transplant Ronald has a chronic medical condition that puts him at risk for global developmental delay. A developmental history was obtained through parent interview and an evaluation plan was discussed. The Bayley Scales of Development III (Cognitive, Motor, and Communication Scales) were administered by an early childhood special education teacher and a physical therapist. In addition, the Ages and Stages 14 Month Questionnaire's: A Parent-Completed, Child Monitoring System was reviewed, an observation was conducted, and Ronald's medical records were examined. Ronald was 15 month and 20 days at the time of the evaluation. BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: Ronald was born at full term to a teenage mother in the Twin Cities area and placed for adoption with Luke and Jessie Brown. In utero Ronald was diagnosed with congenital heart disease that ultimately required a heart transplant at the age of 6 weeks. Subsequent to the cardiac transplant Ronald developed disseminated cytomegalovirus and posttransplant lymphoproliferative disease. Both conditions have since been treated. Ronald's medical history indicated that he had three grand mal seizures a year ago while he was in the hospital. He was started on phenobarbital that was ended in 1/07 with no recurrence of seizures. Ronald has also had a Nissen procedure with gastrostomy tube insertion for surgeries. Currently the G-tube is used only for giving medication. Ronald is being followed by a medical team at Mayo Clinic to monitor ongoing heart concerns, infectious disease issues and developmental progress. Ronald's primary doctor is Dr. Driscoll, Mayo Clinic. Ronald's medications include 40 mg Cyclosporin t.i.d. and .2 mg Prednisone both via G-tube twice a day to prevent rejection, .4 mg Amlodipine via G-tube once a day for hypertension, ml Bactrim via G-tube three days per week, and 5 ml Claritin via G-tube once daily for possible allergies. Parent's stated that Ronald has been healthy and has not had any other hospitalizations. They are unsure whether he has allergies because Ronald has a chronic runny nose and therefore is on Claritin. LANGUAGE/RACIAL/CULTURAL FACTORS: Ronald is Caucasian and from a family whose only language is English. There are no known language/racial/cultural factors that would impact this evaluation. INFORMATION FROM PARENTS: Parent's describe Ronald as an almost normal kid with concerns in regard to Ronald's communication skills and gross motor skills (that have since the referral improved considerably). Parent's also shared that Ronald eats well. He consumes table foods, finger feeds, and holds his bottle. He is working on using a sippy cup. Parent's stated that Ronald sleeps well. He goes to bed at 7:30pm, sleeps until 11:00pm, wakes up for a bottle, and goes back to sleep until 7-8:00am. Ronald takes 1 to 2 naps a day. Parent's shared that they work opposite shifts in order for someone to stay at home with Ronald and they are careful about exposing him to any illness. EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are

Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior. COGNITIVE SKILLS: by Z, Special Education TeacherBayley Scales of Development-Third Edition-Cognitive (Bayley III)The Bayley Scales of Development are designed to measure a child's cognitive skills in the areas of sensorimotor development, exploration and manipulation of objects, concept formation and memory.

Bayley III Date: 11/30/2007

Composite StandardScore

Standard DeviationDifference

Cognitive 85 -1.0 SD (Mean is 100/SD=15)

Interpretation: Information regarding cognitive skills were collected through parent report on the Ages and Stages Questionnaires: A Parent-Completed Monitoring System (ASQ)-Problem Solving Section, observation, and through the administration of the Bayley Scales of Development III (Cognitive Scale). On the ASQ, parent's noted that Ronald was able to put a small toy into a bowl or box, drop two small toys one after the other into a container, and was starting to drop several small toys into a container. On the ASQ Ronald received a Problem Solving score of 25 that indicated he appears to be doing well at this time. Ronald was assessed using the Bayley Scales of Development in his home with his father present. He was alert, happy, cooperative, and interested in most of the objects that were presented to him throughout the session. Ronald was 15 months and 20 days at the time of the evaluation. Based on the results of the Bayley Ronald's cognitive skills are in the low average range. Ronald was able to focus on pictures with interest or recognition. Ronald demonstrated sensorimotor and manipulation skills by grasping and retaining two blocks, one in each hand, while visually attending and attempting to secure a third block. He was also able to take one block out of a cup and able to place 4 blocks in a cup. Ronald was able to isolate his index finger to "poke" in the holes on a peg board. Ronald demonstrated imitation skills and appropriate play by pushing a car so that all the wheels stayed on the table, and by squeezing a squeeze toy. The concept of object permanence was evident when Ronald found a toy that was hidden under a cloth and when he looked into an empty cup for blocks. Problem solving skills were observed when Ronald was able to retrieve an object through the open end of a box within 20 seconds, obtain a ring by the string and suspended it without touching the table, and by attempting to remove a cheerio from a bottle.

SOCIAL SKILLS: from Z, Special Education TeacherInformal Inventory/ChecklistsSocial skills were obtained through parent report, observation and the information parent shared on the ASQ-Personal -Social Section. On the ASQ Ronald was able to help with dressing and roll a ball back and forth. He received a score of 20 that indicated his skills may be slightly delayed. Observations indicated that Ronald is very aware of new people and that he prefers familiar adults. Parents also shared that Ronald responds to his mirror image and enjoys "peek-a-boo". Ronald waves and gets upset when he is left alone. Ronald is generally a happy baby. COMMUNICATION SKILLS: from Z, Special Education Teacher

Bayley Scales of Development-Third Edition-Communication (Bayley III)The Bayley Scales of Development are divided into two parts, receptive and expressive communication. The receptive communication subtest addresses vocabulary, such as identifying objects and pictures, how children reference others socially, and verbal comprehension. The expressive communication subtest addresses preverbal skills, vocabulary, and the use of two word utterances, plurals, or verb tense.

Bayley III Date: 11/30/2007 Score Standard Deviation

Difference COMMUNICATION TOTAL 71 -1.93 SD

Interpretation: Information in regard to Ronald's communication skills were collected through parent report on the ASQ-Communication section, observation, parent report, and the Bayley communication scale. On the ASQ parent's indicated that Ronald sometimes uses one word in addition to "mama" and "dada". Sometimes Ronald shakes his head when he means no or yes. Ronald does point to, pat, or try to pick up pictures in a book. On the ASQ Ronald received a communication score of 20 that indicated there may be concerns in this area. Parent's also reported that Ronald cries in a special way when he is hungry, makes a variety of sounds, babbles, laughs out loud, responds to voices and his name. He also says "dada" and is starting to imitate sounds that parent's make. He is starting to understand "no no" and shakes his head "no." Observations noted that Ronald used inflections, said 'oh oh", and could "pant" when referring to the family dogs. He is starting to wave bye bye. Ronald's communication skills on the Bayley were administered in his home with his father present. He was happy, alert, imitative, responsive, and interested in toys and activities. According to the Bayley Language Scale Ronald's communication skills are in the below average range of development. Ronald was 15 months and 20 days at the time of the evaluation. On the Bayley Scales Receptive Communication Subtest Ronald received a scaled score of 5. He demonstrated suspended play with with objects, responded to his name, and looked up briefly during play when his name was called. He stopped reaching for a toy in response to "no no" and maintained attention for at least 60 seconds during a play routine. Ronald's father shared that Ronald waves bye bye inconsistently. On the Bayley Scales Expressive Communication Subtest Ronald received a scaled score of 5. Ronald uses at least two gestures to make needs known (reaching for toys and waving). Ronald imitates at least one repetitive consonant-vowel combination-"oh oh." Ronald actively participates in at least one play routine (rolling a ball back and forth)and he produces at least one vocalization that contains inflections. Ronald's father stated that sometimes Ronald imitates repetitive consonant-vowel sounds including "dada" and "oh oh", and that Ronald produces many beginning and ending sounds.

MOTOR SKILLS: from Z, Physical TherapistBayley Scales of Development-Third Edition-Motor (Bayley III) The Bayley Scales of Development are divided into two sections, fine motor and gross motor. The fine motor potion of the test addresses skills related to visual tracking, reaching, object manipulation and grasping. The gross motor portion of the test addresses positioning (sitting, standing), locomotor, coordination, balance, and motor planning. The fine and gross motor scores are reported as scaled scores with a mean of 10 and a standard deviation of 3. The composite motor score is reported as a standard score with a mean of 100 and standard deviation of 15.

Bayley III Scaled Standard Standard

Date: 11/30/2007 Score Score Deviation

Fine Motor Scaled score 7 ---

Gross Motor Scaled score 2 ---

Composite Motor score --- 68 -2.1 SD

Interpretation: Ronald was assessed at home with his dad present. He was very cooperative during testing.

Fine motor: Ronald's fine motor skills are at the edge of the low normal range. He picks up blocks with palmar grasp with thumb opposition. He can transfer blocks from hand to hand but does not build a 2 block tower. Banging blocks together is an emerging skill. He uses a three finger pincer grasp to pick up cereal with either hand. He turns pages of a book. He picks up a crayon using a palmar grasp and will tap the paper imitating the examiner but does not imitate strokes or scribble on the paper. He could pull apart 2 Duplos but not the stack of Duplos. I did not attempt having him put pennies in a bank as he is mouthing anything he picks up.

Gross motor: Ronald's gross motor skills are far below average. Ronald displays normal patterns of movement. Rotating in and out a variety of positions. His main means of mobility is crawling on hands and knees which parents note is a new skill. He crawls with good control and speed. He is moving in and out of sitting in a variety of ways and is pulling to kneel and to 1/2 kneel but not to stand. He will stand at the couch when placed but is not yet walking sideways along furniture. He will take forward steps with hands held and will stand momentarily if you take away support.

Ronald's combined motor score is 68 which places his skills at 2.1 standard deviations below the mean which qualifies him for early intervention services. The State of Minnesota requires a score of 1.5 SD below the mean in one area to qualify for early intervention services. FUNCTIONAL SKILLS: Child Development Inventory (CDI ) The CDI is a screening instrument used to measure the global general development as reported by parent observation in the areas of self-help, gross motor, fine motor, and language.

Date: 11/14/2007Interpretation: Social: Ronald makes eye contact, has a social smile, and shows interest in his mirror image. He recognizes familiar adults and reacts differently towards strangers. Ronald gets upset when he is left alone and reaches for familiar people. Ronald plays "peek-a-boo" and gets into things. He is starting to wave. Self-Help: Ronald is alert and interested in objects. Ronald reaches for objects and looks for objects after they disappear from sight. Ronald feeds himself a cookie, insists on independent feeding, and is starting to lift a cup to his mouth to drink. Ronald anticipates being lifted by raising his arms up and he helps a little with dressing.

Gross Motor: Ronald pivots on his tummy and rolls over in both directions. He sits alone steady and crawls. Ronald is starting to pull to stand and props on his knees. He transitions from a crawling position to a sitting position and back again. Fine Motor: Ronald holds objects in both hands and transfers objects from hand to hand. Ronald puts toys in his mouth and uses his forefinger to poke, push, or roll small objects. Ronald holds two objects, one in each hand, at the same time and brings two objects together. Ronald puts objects in containers and turns pages in a book one at a time. HEALTH/PHYSICAL: from Z, Special Education TeacherReview of Medical RecordsIn a medical report from Mayo Clinic dated 11/8/2007 it was noted that Ronald was born at term after an uncomplicated pregnancy to a teenage mother in the Twin Cities. He was diagnosed with congenital heart disease in utero. Initially it was planned for Ronald to have an operable aortic coarctation, however, it was later determined that he had hypoplastic left heart syndrome that required transplantation. Ronald was hospitalized for 3 months and at 6 weeks of age he under went a heart transplant. After several months Ronald developed a further complication of posttransplant lymphoproliferative disorder. Ronald has had several admissions in regard to treatment of both cardiac rejection and posttransplant lymphoproliferative disorder. Both conditions have since been treated. Ronald is followed by Dr. Driscoll with Mayo Pediatric Cardiology and he is currently on cyclosporine and prednisone to prevent rejection and on amlodipine for hypertension, Bactrim prophylaxis, and Claritin. Ronald is also followed by Dr. Boyce, Pediatric Infectious disease, because he developed CMV pneumonitis and CMV hepatitis after transplantation in addition to posttransplant lymphoproliferative disease. Ronald received treatment for posttransplant lymphoproliferative disease and the condition has cleared completely with a negative PET scan after treatment. Ronald's medical history indicated that he had three grand mal seizures a year ago while he was in the hospital. He was started on phenobarbital and phenobarbital that was stopped in 1/07 with no recurrence of seizures. Ronald has also had a Nissen procedure with gastrostomy tube insertion for surgeries. Currently the G-tube is used only for giving medication. Ronald recently received his 2 month immunizations and he has been healthy. Ronald is scheduled to have his 4 month immunizations in December 2007. Ronald was seen in Developmental and Behavioral Pediatrics for a developmental evaluation. Dr. Z of Mayo Clinic noted in the medical report that "Ronald manifests significant, global developmental delay" with concerns particularly in the areas of communication and gross motor. It was also stated that "Ronald has a medical condition that places him at extraordinarily high risk for long-term developmental problems" based on documented cases of children who underwent neonatal heart transplantation and were at risk for developmental delay. Ronald is scheduled for a reassessment in six months to reevaluate his developmental level. SENSORYReview of Medical Report- by Z, Special Education TeacherRonald passed the newborn hearing screen. Ronald appears to see and respond to the toys and people in his environment. Medical reports have indicated no concerns in regard to vision at this time. OBSERVATION

Date: 11/27/2007Time: 12:30pmObserved by: Z, ECSE TeacherSetting: Ronald's home When the observer arrived Ronald was playing on the floor and his father was at home with him. Ronald became quiet and very still when he saw the observer and physical therapist. He moved closer to his father while he kept an eye on the new people. After a little while Ronald resumed play with the toys that were on the floor around him. He was observed to shake, bang, and move toys according to their function. When a toy dropped out of his hand Ronald looked for it. Ronald started babbling and used a variety of sounds including "da da" and "oh oh." He also used inflections in his speech. When his dad said his name Ronald looked up. Ronald imitated facial expressions and smiled in response to simple familiar games such as "peek-a-boo". He also participated in rolling a ball back and forth. Throughout the visit Ronald was able to move around and explore in his environment by crawling, propping on his knees, sitting, and pulling to stand with assistance. VALIDITYWere the evaluations administered valid for the student? Yes Were the evaluations administered valid for the purpose to which they were intended? Yes Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? NoA lack of appropriate educational instruction in math? NoLimited English proficiency? No PRESENT LEVEL OF PERFORMANCE Cognitive: Ronald actively and appropriately explores objects and toys in his environment. He exhibits memory, problem solving and object permanence skills. Communication: Ronald responds to his name and imitates facial expressions and some sounds. He babbles and is beginning to use more consonant vowel sounds. He is also starting to understand "no no" and shakes his head "no." Social: Ronald recognizes familiar adults and is wary of strangers. He waves "bye bye" and reaches for familiar adults. Ronald has a social smile and enjoys simple familiar games and reciprocal activities such as rolling a ball back and forth. Fine Motor: Ronald picks up blocks using a palmar grasp with thumb opposition. He can also transfer blocks from hand to hand and is starting to bang blocks together. Gross Motor: Ronald displays normal patterns of movement. He rotates in and out a variety of positions. His main means of mobility is crawling on hands and knees. Ronald is moving in and out of sitting in a variety of ways and is pulling to kneel and to 1/2 kneel but not to stand. He will stand at the couch when placed but does not cruise. Functional: Ronald has established a sleeping and eating pattern. He assists with dressing and eats table foods. Ronald finger feeds and holds his own bottle. He is working on using a sippy cup. Health/Sensory: Ronald's sensory and health needs are closely monitored by his medical team. ELIGIBILITY DETERMINATION Early Childhood Special Education:A child is eligible for special education and related services when the child meets the criteria described in items A OR B. Ronald's evaluation documents: A) Ronald meets criteria for Developmental Delay. On the Bayley Scales of Development III (Motor Scale) Ronald received a composite score of 68 that translated to a standard deviation of -2.1. On the Bayley Communication Scale Ronald received a composite score of 71 that translated to a standard deviation of -1.93. B) Ronald also meets criteria because he has a diagnosed physical condition that has a high probability

of resulting in developmental delay as documented in a medical report dated 11/8/2007. To qualify for services Ronald needs to have a medical condition that has a high probability of resulting in developmental delay or a score 1.5 standard deviations below the mean in one or more of the following areas: cognitive development, physical development, communication, social or emotional development, adaptive development. Documentation is supported by a systematic observation in Ronald's home and corroboration from a developmental history, information form the ASQ, medical reports, and the Child Development Chart-First 21 Months. In summary, based on the results of this evaluation, Ronald meets eligibility criteria for Early Childhood Special Education.This disability adversely impacts Ronald's performance in the general education setting as evidenced by the following:

Ronald demonstrates a learning rate that is below that of peers in gross motor and communication. Based on the heart transplant Ronald is a risk for overall developmental delay, therefore, early intervention is recommended.

EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITYRonald needs to learn to pull to stand and walk along furniture and with hands held and to ultimately let go, stand independently and walk independently. He needs to learn to move to stand midfloor and squat to pick up toys. His fine motor skills need to be monitored as they are at the edge of the low normal range. Ronald also needs to develop his communication skills in order to express his needs (by the use of gestures or signs/vocalizations/consonant-vowel combinations/words) and respond to others (demonstrating understanding of common names and objects/following simple familiar directions, etc). Finally, Ronald's overall development needs to be monitored to assure age appropriate progress.


EXAMPLE: ECSE EVALUATION REPORT (AGE 3-6)

Reason for Referral Walter is a 4 year 7 month old boy who was referred by his teacher at Rainbow Nursery School because of concerns with his learning, problem solving and logical thinking. There were also concerns with his communication and fine motor skills. A second referral was made by Preschool Screening for communication concerns. BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION LANGUAGE/RACIAL/CULTURAL FACTORS: There are no known language/racial/cultural factors that would negatively impact this evaluation. INFORMATION FROM PARENTS: DEVELOPMENTAL HISTORY: An interview and Developmental History were completed by Amy, Walter's mother, indicating the following information. Walter was born at 38 weeks. During the pregnancy Walter would rest on Mom's venacava and she would pass out, but the delivery was uncomplicated and there were no difficulties following the birth. There is no history of hospitalizations or seizure activity. Developmental milestones were achieved at age appropriate times. Walter babbled as a baby, sat alone at 5-8 months and walked at 11-15 months. However, he did not use his first words until after 14 months. He was slow to put words together which happened at about age three. He eats a variety of foods but can be picky. Walter sleeps 9 hours at night and does not take a nap. He enjoys matchbox cars, jumping on a trampoline and playing with the dog at home. He stays with activities for 1/2 hour and longer if it is with his cars. Walter has two older sisters and 4 older brothers, but not all of them live at home. Amy also completed a Preschool Developmental Inventory. The information from that inventory yielded a score of 33. The cut off for his age is 42, indicating a need for generalized testing. The following information was given from the PDI and Developmental History: Health: Walter is considered to be healthy. He does not have any allergies and is not on any medications. Immunizations are up to date. Sensory: Vision and hearing have not been formally assessed. Walter has 1-2 ear infections between 6 months and 2 years of age. Walter is not overly sensitive to touch, sound or movement. Motor: Walter climbs easily on playground equipment. He is not yet pedaling a tricycle or pumping himself on a swing. He is right handed and is able to scribble and draw or copy a circle. He is not yet printing his name or drawing recognizable pictures. Scissor skills are also not developed as yet. Cognitive/Communication: Walter correctly refers to himself as a boy or girl but does not do so with others. He counts at least 3 objects and follows directions at home. He comprehends concepts such as "bigger" , "long/short", "same/different" and "half". Sentences are his main means of communication and he is understood by Mom and Dad about 75% of the time and 50% of the time by others. Walter uses pronouns, questions words ('who', 'what', 'where'- but not 'when', 'how', 'why') and some descriptor words (loud/soft, heavy, fast/slow). There are no concerns with voice quality or fluency. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-196

Self-help: Walter is toilet trained for bladder and bowel control and is able to care for his own needs in the bathroom. He washes and dries his hands himself and is independent for undressing and dressing, including fasteners. Social: Walter has the opportunity to be with peers at daycare and at preschool and seems to enjoy these times. He can compete in simple games, tattle, give directions to others and offer to help others. He is not clingy or dependent when separated from his mother, is not frequently angry or aggressive and is not fearful or worried a lot. He does seem overly active at times at home. INFORMATION FROM OTHERS: Early Childhood Screening 1-7-08 Early Screening Inventory Preschool: score = 15 which is a passing score, Walter copied simple block designs, could copy simple forms and draw a person. He was able to complete a visual sequence of three pictures but failed in the number concepts. He could name and use descriptor words for objects, completed verbal analogies and repeat back a series of three numbers. Gross motor skills were good for standing on one foot for balance but he could not hop. Walter failed the hearing screening for his right ear. Ages and Stages Questionnaire: Social Emotional: Score= 25, cutoff =70 indicating no concerns in this area. EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior. COGNITIVE ABILITIES From: Z, School Psychologist Behavioral Observations During Testing:Walter came to the testing situation appropriately dressed and groomed. He appeared to be of average height and weight for a his age. He participated in the testing activities willingly. His articulation was difficult to understand, even when context was known. Attending skills were very good given his age. Walter, seem a little reserved, but seemed motivated to do well. Rapport was easily established. Given Walter's good attending ability and that rapport was established, this evaluation is seen as providing a reasonable estimate of his level of functioning. Differential Ability Scales - Second Edition (DAS-II)The DAS-II measures general cognitive abilities. The general conceptual ability score is comprised of the following possible clusters: verbal, nonverbal reasoning and spatial. There is also a special nonverbal composite that can be obtained. The DAS-II can be used with preschool and school aged children.

DAS-II Date:3/6/2008 Score % Range


Verbal 89 23 Low Average Nonverbal Reasoning 83 13 Low Average Spatial 94 34 Low Average Special Nonverbal Composite 88 21 Low Average GENERAL CONCEPTUAL ABILITY (GCA) 86 (-.93=SD) 18 Low Average

Interpretation: The DAS-2 measures general conceptual ability. On the DAS-2, Walter received a GCA score of 86(18th %), in the Low Average range of functioning. There is a 90% chance that Walter's true GCA falls between 81 and 92. The Verbal Ability measures acquired verbal concepts and knowledge such as language comprehension, vocabulary, and expressive skills. Walter's Verbal ability fell at the high end of the Low Average range. The Nonverbal Reasoning Ability measures nonverbal, inductive reasoning and requires complex mental processing. It reflects an ability to perceive visual detail and identify rules that govern visually presented problems. Walter's score on the Nonverbal Reasoning fell in the Low Average range. The Spatial Ability score measures complex visual-spatial processing, or analysis and synthesis of visual pictures and attention to detail. Walter scored in the Average range on Spatial Ability. Walter demonstrated a statistically significant Strength on the Pattern Construction subtest. This type of strength occurs in 10-15 % of the population. This test looked at Walter's spatial orientation ability and being able to copy block patterns. A statistically significant weakness was noted in his Picture similarities score. This type of weakness occurs in 10-15% of the population. This subtest looked at Walter's ability to match pictures that have a common element. Overall, Walter demonstrated Low Average intellectual skills that were fairly evenly developed. He had a relative strength in his spatial skills, and a relative weakness in identifying similar elements in pictures. Walter's rate of learning is slightly lower than would be expected given his age.

ACADEMIC: From: Z, Special Education Teacher Testing Behavior for Academic and Communication Testing: Walter was first tested in a room down the hall from his classroom, but the second time the testing room was next to his classroom and noise carried easily. However, Walter attended well to the tasks and completed everything that was asked of him. In the testing situation, he was not distracted. Battelle Developmental Inventory-2The Battelle Developmental Inventory-2 is a developmentally integrated instrument that assesses the adaptive, social, communication, cognitive, and motor abilities of children birth through 95 months of age. It is designed to measure a child's abilities in the areas of self care, personal responsibility, adult and peer interaction, self-concept and socialization, receptive language (assesses the child's understanding of spoken language), and expressive language (assesses the child's ability to use speech to communicate and express ideas , gross motor (assessing the large muscle planning and control), fine motor (assessing fine motor planning and control), perceptual motor (assessing coordination between what is seen and what is written), attention and memory (assessing visual concepts), reasoning and academic and perception and concepts. The Domain and BDI Total Scores are reported as Developmental Quotients which have a mean of 100 and a standard deviation of 15. The Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-198

Subdomains are reported as Scaled Scores which have a mean of 10 and a standard deviation of 3.

BATTELLE DEVELOPMENTAL INVENTORY-2 Dates: 3-4 &11-08

Scaled Score

Developmental Quotient

Standard Deviation

Domain/Subdomain Motor Perceptual Motor 10 0 Cognitive 77 -1.5 Attention and Memory 4 -2.0 Reasoning and Academic Skills 7 -1.0 Perception and Concepts 6 -1.33

Interpretation: Walter's did very well in the perceptual motor area. He had a 5 fingered grasp to start but was quite shaky as he wrote. So he switched to a whole hand grasp with his thumb up and was more controlled. He also switched from his right hand to his left, but primarily stayed with his right. He could copy a circle and a cross and the letter "T". Walter also drew a person with at least 6 parts. Drawing within a designated area was something Walter could do but when curves were added, it became more difficult. He could snip with a scissors but had to be shown to put his fingers in the holes. In the Attention and Memory area Walter showed good persistence for finding pictures within a larger picture. He could also recall an object taken away from three and could repeat back 3 and 4 numbers in a series. Walter had more difficulty attending to an oral story and answering questions from the story. He is also easily distracted when in a group situation. Reasoning and Academics were a higher area for Walter. He knew his colors, could find missing parts of a picture and could answer questions about common actions ( "What flies?") but not logic questions that involve "why". Opposite analogies were difficult as were completing instructions with two steps. In the Perception and Concepts area Walter had some good base skills for recognizing differences among similar shapes and numerals, comparing sizes of familiar objects not in view and identifying objects by feel. However, he could not identify the picture that did not belong. Some organizational items were difficult like assembling a 6 piece puzzle of a boy and concepts of sequence like first, middle, last. The overall cognitive score was 77, which is -1.5 standard deviations from the norm and is a qualifying score.

COMMUNICATION From: Z, Speech Pathologist Photo Articulation Test- Third Edition (PAT-3) The PAT-3 provides a systematic method for eliciting all English speech sounds from children aged 3-0 through 8-11.

PAT-3 Date: 3/11/08

Raw Score

Standard Score Range

Standard Deviation

Difference Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-199

TOTAL 48 <60 69 and below - far below average <-2.66

The chart below can be read as follows: blank space (sounds that were produced correctly), omit (sounds that were left out by the child), other sounds noted (sounds that were substituted for the target sound), dashed line (sounds that were not tested). The following errors were documented at the word level:

Sound Initial Medial Final p m w - h - - b d n y t - k t t t g d d d t f p p ng - n n j d t sh t l w omit ou zh - z v b b b ch t t ts s t ch s bl p / sp t / sk t / st z d d l bl bw / bl tw / kl b / fl voiced th d d p r bl bw / br tw / kr tw / tr voiceless th p f f


r w w er - - "uh" or /I/

Interpretation: Walter was able to produce several early developing sounds at the word level including: "p,b,m,h,w,t,d,n." Several other sounds were inconsistently produced indicating that they might be emerging. These included: "y,f,s,z,j,zh." Other sounds that were consistently in error included: "k,g,ng,v,l,ch,th,r" and all consonant blends. Errors were characterized mainly by substitution of "stop" sounds for target sounds and by reduction of consonant blends. Preschool Language Scale- Fourth Edition (PLS-4)The Preschool Language Scale-4 measures auditory comprehension and expressive communication in children birth through 6-11.

PLS-4 Date: 3/4/08 & 3/11/08 Standard Score Range Standard Deviation

Difference Auditory Comprehension 83 80-89 - low average --- Expressive Communication 91 90-109 - average --- TOTAL LANGUAGE 86 80-89 - low average -0.93

Interpretation: Walter was able to demonstrate understanding of several language concepts including: colors, shapes, inferences (implied meaning), categorization (grouping like items), picture analogies ('You sleep in a bed, you sit in a __'), number concepts (more, most, 3, 5), expanded sentences, and describing words (tall, long). Walter was also able to name pictures of common items, combine words into sentences, answer questions (where, logical, hypothetical), complete verbal analogies, name an object being described, name categories, use some describing words (long, short, red), describe how things are similar, give simple definitions of words and complete similies ('It is as hot as a __'). Next steps for Walter would include understanding and use of spatial concepts (under, in front, in back, next to), expansion of describing words, identifying an item that does not belong to a group, ordering and sequencing (largest to smallest, first/middle/last), responding to more abstract questions, using more grammatically correct sentences and increasing his average sentence length.

Structured Phonographic Expressive Language Test-III (SPELT-III) This test measures a child's generation of specific morphologic and syntactic structures through structured visual and auditory stimuli.

SPELT-III Date: 3/13/08

Standard Score Range Standard Deviation

Difference 75 70-79 - below average -1.66

Interpretation: Walter was able to correctly use several early developing parts of speech including: conjunction (because), spatial concepts (under, on, behind), plural and possessive nouns ('s' ending), and present progressive verbs ('ing' ending). Walter had more difficulty in using later developing parts of speech: pronouns (his/her, himself), negative (doesn't), spatial concept (next to), auxiliary verb forms (is, are, was, were, will), regular past tense verbs ('ed' ending), irregular past tense verbs, and a variety of question forms (who, do, does, would). Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-201

Speech/Language Sample: A speech/language sample is a recall of a student's speech and language, often during spontaneous conversation with the examiner. The speech/language sample is used in order to analyze articulation, voice and fluency as well as functional language skills in the areas of content, form and use. Mean Length of Utterance (MLU) and pragmatic skills are also noted. Date: 3/4/08 & 3/11/08Interpretation: Walter's speech/language skills were observed during his evaluation at Rainbow Nursery School. Speech skills appeared to be within the norm in terms of voice, rate, resonance and fluency. Articulation errors in conversation were similar to those observed during formalized testing. Walter's language sample was based on 32 spontaneous utterances. Mean Length of Utterance (MLU or "average sentence length") was equal to 3.62. Mean for his age was 5.02 with one standard deviation to 1.164. This score places Walter approximately -1.3 standard deviations below the mean in terms of MLU. Sentence structure observed included the use of common nouns, verbs, pronouns (I, my, they), conjunction (and), describing word (red), negatives (no, don't), number concept (one), spatial concepts (on, off), plural nouns ('s' ending), present progressive verbs ("ing" ending), and question form (where). Some parts of speech were either inconsistently or incorrectly used including: pronoun (he), articles (a, the) and auxiliary verbs (is, are, am, can, does, have, has). Use of past tense verbs and possessive nouns ("s" ending) was not observed. Some sentences were up to 5-7 words in length, however; structure was somewhat immature (i.e. "Where this one go?" or "I going drive like this" or "I play this one now.") Pragmatic language skills appeared to be within normal limits. Walter had appropriate eye contact, use of facial expression and gesture. He used his language to greet, initiate, comment, request and question. MOTOR SKILLS: From: Z, Special Education Teacher Fine motor skills were screened with the Battelle Developmental Inventory. Walter had a score that was well within normal limits. He could copy simple shapes and snipped with a scissors. He is more comfortable with a whole hand grasp for control but is able to start and try with a more mature 5 fingered grasp. He can draw a person and is starting to print his name. HEALTH/PHYSICAL STATUS : reported in Information from Parents earlier in this report SENSORY STATUS : From: Z, AudiologistHearing Screening: Date: March 6, 2008 Walter's hearing was screened utilizing conditioned play audiometry in a quiet room at Zumbro Lutheran Rainbow Nursery School. Otoscopic inspection revealed clear ear canals bilaterally. He passed the hearing screen bilaterally at the 20 dB hearing level (HL) across the frequency range of 500 - 4000 Hz in both ears.

Interpretation: Walter's hearing is adequate for access to normal conversational speech in typical environments. SELF HELP/FUNCTIONAL: From: Z, School Psychologist Vineland Adaptive Behavior Scales - Second Edition (Vineland-II)The Vineland-II is a norm-referenced assessment of adaptive and maladaptive behavior. It has Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-202

a variety of parent and teacher interview/rating options. The content and scales of Vineland-II were organized within a three domain structure: Communication, Daily Living, and Socialization. In addition, Vineland-II offers a Motor Skills Domain and an optional Maladaptive Behavior Index to provide more in-depth information.

VINELAND-II Date: 3/11 & 3/3/2008 Parent %

Teacher %

Communication Domain 85 16 84 14 Daily Living Skills Domain 103 58 73 4 Socialization Domain 101 53 98 45 Motor Skills Domain 78 7 72 3 ADAPTIVE BEHAVIOR COMPOSITE 90 (-.66=SD) 25 80 (-1.33=SD) 9

Interpretation: The Vineland is a measure of personal self-sufficiency in various environments. It examines whether a person has skills as well as if they use them when required. According to parents, on the Vineland-2, Walter received an Adaptive Behavior Composite of 90, 25th% in the Average level of functioning. There is a 90 % chance that Walter's true Adaptive level is between 96 and 94. Daily Living Skills and Socialization skills both fell in the Average range. Communication skills were in the Low Average range. Motor skills fell in the Below average range. Both fine and gross motor skills were weaker than expected. Communication skills were average for receptive language. Expressive language skills were a relative weakness. Walter's articulation difficulties may effect how often he speaks in that it is difficult for other's to understand him. According to his teacher, on the Vineland-2, Walter received an Adaptive Behavior Composite of 80, 9th % in the Low Average level of functioning. There is a 90 % chance that Walter's true Adaptive level is between 76 and 84. At school Walter demonstrates Average social skills. Communication and skills fall in the Low Average range. Written communication skills are a relative weakness. Daily living skills and motor skills fell in the Below Average range. At school Walter is having difficultly with some pre-academic skills. Walter's gross and fine motor skills are weaker than expected given his age. Overall, Walter's adaptive/functional skills are in the Low Average to Average range. He does better at home than he does at school. Social skills are a relative strength in that Walter gets along with peers. Communication is effected by his articulation difficulties. Motor skills seem to be a little weak. Daily living skills vary depending on the environment. OBSERVATIONS From: Z, Special Education Teacher and Z, School Psychologist Date: 2-6-08 Observed by: Z Setting: Rainbow Nursery School Time: 2:30 Walter was in a classroom with 10 other children. He was first observed in the gym with his class around a large parachute. The teacher was giving directions on what they were to do with quiet and large movements. Walter was watching the teacher carefully and imitating the movements she requested. He smiled when the group made the parachute have big waves. When the teacher gave a series of directions to follow around in the circle, Walter followed what the rest of the group did very well. The teacher then had the group run across the gym Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-203

and Walter's running was smooth and coordinated. When told to line up, he did so and followed the group up the stairs back to the classroom. The teacher gave an instruction that said they had crosses to paint but that they didn't have to and could choose to play instead. Most of the class chose to paint the crosses but Walter and two other boys chose to play. Walter told his teacher, "I don't have to paint a cross." He chose to play with the wind up cars with two other boys. He said, "When I'm not going that way, I'm going back to ____." He did not say this to anyone in particular and did not make eye contact with anyone. Other things he said were: "whoa, what happened?", "He has to go across the bridge." and "whoa, look at where he goes." Again, none of these responses were directed at anyone. When told it was not his turn by another peer, he ignored him and did not respond, but continued with his actions. Walter said, "I don't want the green car" when he had a red one. The teacher asked him what color a certain car was. Walter responded, "I don't know." She told him it was yellow. He said, "It's like the sun." Then Walter let go of one of his cars and said "whoa, he went my way." And looked up at a peer and smiled. The peer said, "I'm sorry if I'm stopping your car." Walter did not respond. But later he said, "I'm not going to go that way, though." Walter watched as another child entered the play. He had good fine motor skills for winding the cars. When they did not work he would pick them up and try again. He said, "Get out of my way" playfully to another child. He stayed with activities for 10 minutes at a time. Walter then got out an electronic book. The teacher assisted him in getting started. He poked at the buttons but did not follow the instructions. He did something right and said, "I did it!" to the teacher and kept poking the same button over and over, looking to the teacher for a reaction. At clean up time Walter helped with clean up. He came to the circle and followed directions for clapping and quiet. He attended to a story well but as soon as the teacher was talking about something without a visual cues, Walter was looking around and easily distracted. Interpretation: Walter follows simple directions especially if they are within a routine. With more complex directions Walter will look to see what others are doing to get cues. His interactions with peers are present but fairly simple. It appears that he lacks some language skills to interact more fully. In the circle time Walter attends well when there are visual stimuli to hold his attention. He is distracted by other activity in the classroom in the large group period. Date: 3/6/2008Time:2pm-2:30pmObserved by: ZSetting: Rainbow preschool Walter was observed in his preschool classroom. He was eating snack with his class. He sat down and was able to pour himself a drink form a pitcher into a small paper cup. He ate with his right hand and finished his snack and drink. He asked for more drink by stating, " More juice please." Articulation errors were noted. He nodded in response to the teacher when asked if he wanted more cookies. During snack, Walter watched peers and smiles, but did not join any conversations or make comments to peers. After snack they had some free play time. Walter at first watched the peers before he chose an area. He decide to play with some a car on a car mat. He was mostly playing by himself. Another peer joined him for some time. Walter made some comments including, "I can drive it like this", "I going drive like this", "I trying to drive", and "get out of my way". That peer left. Soon another peer came. They tossed a car toward Walter, and then took his in a trade. Walter had not asked to trade, the peer had just wanted Walter's car. Walter did not say Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-204

anything or do anything. An adult intervened on Walter's behalf. The peer needed a number of comments before they would give it back to Walter. In summary, Walter presented as a quiet , well behaved boy. He followed classroom routines and was polite. He did not defend himself, when a peer took advantage of him. The teacher stated that this is typical. VALIDITY Were the evaluations administered valid for the student? yesWere the evaluations administered valid for the purpose to which they were intended? yes Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? noA lack of appropriate educational instruction in math? noLimited English proficiency? no PRESENT LEVEL OF PERFORMANCE Walter is a sweet little boy who appears to enjoy being in the social environment at school. He follows the routines of the classroom and when he does not comprehend the direction, he looks to others to help with his compliance. Walter demonstrated Low Average intellectual skills that were fairly evenly developed. He had a relative strength in his spatial skills, and a relative weakness in identifying similar elements in pictures. Walter's rate of learning is slightly lower than would be expected given his age. In the preacademic area Walter is able to match pictures, shapes and letters and recognizes differences in numbers and letters. Attending is a major problem for Walter but when there are visuals, he does much betters. He shows good memory skills for objects and pictures but when he has to remember auditory information without a visual cues, it is more difficult. However, Walter could answer some beginning complex questions ("What flies?") but not logical questions (why).Walter knew colors and counted to 4 in a rote fashion. He could 1:1 count to 3. Speech skills appeared to be within the norm in terms of voice, rate, resonance and fluency. In terms of articulation development, Walter was able to produce several early developing sounds at the word level including: "p,b,m,h,w,t,d,n." Other sounds were emerging or not yet developed included: "y,k,g,ng,f,v,l,s,z,j,ch,sh,zh,th,r" and all consonant blends. In the area of language development, Walter's skills were in the "low-average" to "average" range. He was able to demonstrate understanding of several language concepts including: colors, shapes, inferences, categorization, picture analogies, number concepts, expanded sentences, and describing words. Walter was also able to name pictures of common items, combine words into sentences, answer questions, complete verbal analogies, use some describing words, name an object being described, name categories, describe how things are similar, give simple definitions of words and complete similies. Walter's average sentence length was "low-average" for his age. While some sentences were well constructed, others were grammatically immature. In terms of pragmatic (social) language development, Walter's skills were found to be within normal limits. He was able to used his language to greet, initiate, comment, request and question. Socially, Walter enjoys playing with other children, although his interactions are fairly simplistic. It appears that Walter's language skills prevents more interactive or cooperative play. Motor skills appear to be generally within normal limits, however Walter could use more exposure or practice in the fine motor area to increase these skills for kindergarten readiness. Walter's adaptive/functional skills are in the Low Average to Average range. He does better at home than he does at school. Social skills are a relative strength in that Walter gets along with peers. Communication is effected by his articulation difficulties. Motor skills seem to be a little weak. Daily living skills vary depending on the environment. Health and sensory areas are of no concern for Walter. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-205

ELIGIBILITY DETERMINATION A child is eligible for Early Childhood Special Education when the child meets the criteria described in items A OR B. Walter's evaluation documents: B) Walter has a developmental delay. Walter received a standard deviation score of -1.5 and -1.66 on the Battelle-2 and the SPELT respectively. Documentation is supported by a systematic observation in the preschool and corroboration from a developmental history and other evaluation procedures in each area of developmental delay conducted on a different day than the medical or norm-referenced evaluation. Other evaluation procedures that were relied upon included parent report, language sample, criteria and developmental checklist. In summary, based on the results of this evaluation, Walter meets eligibility criteria for Early Childhood Special Education. Language Disorder Eligibility:According to Minnesota Special Education rules, a student has a Language Disorder and is in need of speech or language services when the student meets the criteria described in items A and B and either C or D. Walter's evaluation documents: A) A language pattern that does interfere with communication as judged by an educational speech-language pathologist and special education teacher. B) An analysis of the language sample/observation has demonstrated that Walter's language behavior is below average compared to expectations based on age. C) The PLS-4, the SPELT, and MLU were administered and resulted in standard deviation scores of -.93, -1.66, and -1.3, respectively. These scores are not)2.0 or more standard deviations below the mean. In summary, based on the results of this evaluation Walter does not meet eligibility criteria for a Language Disorder. However given his -1.66 on the SPELT, Walter could receive related services for language. Articulation Disorder Eligibility:According to Minnesota Special Education rules, a student has an articulation disorder and is in need of speech or language special education services when the student meets the criteria as described below. A student who falls within this range must meet the criteria in item A and either Item B or C below. Walter's evaluation documents: A) A speech pattern that does interfere with communication as judged by an educational speech-language pathologist and special education teacher. B) The Goldman Fristoe was administered and resulted in a standard deviation score of greater than -2.66. In summary, based on the results of this evaluation Walter meets eligibility criteria for an Articulation Disorder. This disability adversely impacts Walter's performance in the general education setting as evidenced by the following: -The presenting problem or behaviors of concern have not been responsive to general education interventions.

-The resources necessary to support the student to participate and progress in the general education curriculum are beyond those available in the general education curriculum. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-206

-The student requires specially designed instructional methods that are not available in the general education classroom.

EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITY Areas of specially designed instruction needed:

Communication:Speech Articulation: Walter needs to increase his articulation skills in the correct production of "y,k,g,ng,f,v,l,s,z,j,ch,sh,zh,th,r" and all consonant blends. Since some of these sounds develop earlier than others, sound may be added to his objectives as they become appropriate.

Speech/Language: Walter needs to increase his understanding and use of language concepts beginning with: spatial concepts, describing words, identifying an item that does not belong to a group, ordering and sequencing, responding to more abstract questions, using more grammatically correct sentences (including pronouns, articles, auxiliary verbs and past tense verbs), and increasing his average sentence length. Cognitive: Walter has needs in the area developing preacademic concepts starting with counting to ten and 1:1 counting to five. He also requires work with organizational concepts starting with categorization, sequencing and retaining information to answer questions.



CHAPTER 3H: Developmental Cognitive Disabilities (DCD) Documentation


STATE GUIDELINES: DEVELOPMENTAL COGNITIVE DISABILITY (DCD)

“Developmental Cognitive Disability (DCD)” refers to students with significantly below average intellectual functioning and concurrent deficits in adaptive behavior that require special education instruction and related services.

The team shall determine that a student is eligible as having a developmental cognitive disability (DCD) and is in need of special education instruction and service if the student meets the criteria in items A and B.

A. Adaptive Behavior The student demonstrates below average adaptive behavior in school and home, and, if appropriate, community environments. Below average means:

1. a composite score at or below the 15th percentile on a nationally normed, technically adequate measure of adaptive behavior; and

2. documentation of needs and the level of support required in at least four of the seven adaptive behavior domains across multiple environments. Systematic observations and parent input must be included as sources to document need and level of support. All of the following domains must be considered:a) daily living skills and independent living skills;b) social and interpersonal skills;c) communication skills;d) academic skills;e) recreation and leisure skills;f) community participation skills; andg) work and work-related skills.

Other sources of documentation may include checklists, classroom or work samples, interviews, criterion-referenced measures, educational history, medical history, or student self-report.

B. Cognitive FunctioningThe student demonstrates significantly below average general intellectual functioning that is measured by an individually administered, nationally normed test of intellectual ability. Significantly below average means:

1. mild-moderate range: an intelligence quotient of 70 or lower (plus or minus 1 standard error of measurement); or

2. severe-profound range: an intelligence quotient of 55 or lower (plus or minus 1 standard error of measurement).

Intellectual functioning must be verified through a written summary of results from at least two systematic observations with consideration for culturally relevant information, medical and educational histories, and one or more of the following: supplemental tests of specific Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-208

abilities, criterion-referenced tests, alternative methods of intellectual assessment, clinical interviews with parents, including family members, or observations and analysis of behavior across multiple environments.



DEVELOPMENTAL COGNITIVE DISABILITY (DCD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:________________________________________Student ID#:__________________________________ Grade:______School: __________________________________________________Date of Meeting:___________________________________________

The team shall determine that a student qualifies for services under Developmental Cognitive Disability and is in need of special education services and/or related services when the student meets criteria described in items A and B.

A A d a p t i v e B e h a v i o r CIRCLE ONE

1. A composite score at or below the 15th percentile (plus or minus 1 Standard Error of Measurement*) on a nationally normed, technically adequate measure of adaptive behavior, in the student’s school; and

YES NO

2. in the student's home, and, if appropriate community environment; and

YES NO

3. documentation of need and the level of support required in at least 4 of the seven domains:

YES NO

daily/independent living skills

academic skills work and work-related skillssocial and interpersonal

skillsrecreation and leisure skillscommunication skills community participation skillsItem A: Does student meet all of the criterion outlined

above?YES\\\\\\

NOAND

B C o g n i t i v e F u n c t i o n i n g CIRCLE ONE

1. Significantly below average intellectual functioning as indicated by a general intellectual ability score 2 standard deviations below the mean (70 or lower) for mild to moderate and 3 standard deviations below the mean (55 or lower) for severe to profound (plus or minus 1 Standard Error of Measurement*) on an intelligence test that is standardized, nationally normed, technically adequate, and individually administered by a trained professional. This must be verified by at least 2 systematic observations

YES NO

2. The current cognitive evaluation is consistent with previous evaluation(s) of the student’s cognitive ability.

YES NO

Item B: Does student meet all of the criterion outlined above?

YES

NOO

DCD Eligibility:Does student meet all of the criteria listed in A and B?

YES

NO

* The Standard Error of Measurement should only be used when there is evidence (previous cognitive/adaptive evaluations(s), test behavior) to suggest that the student’s “true” ability/adaptation is best reflected when considering the “plus” or “minus”. When in doubt, consider additional evaluation.



GUIDELINES FOR CONDUCTING EVALUATIONS FOR DEVELOPMENTAL COGNITIVE DISABILITY (DCD)

Evaluation of Developmental Cognitive Disability (DCD) must be based upon multiple sources of information and includes four phases: prereferral, evaluation planning, evaluation process and Evaluation Report (ER). An effective evaluation process should provide sufficient information to determine eligibility and guide intervention. Since the long and short-term consequences of special education labels are serious, the team must carefully consider how the evaluation information will be gathered and interpreted.

P R E R E F E R R A LAs with all special education evaluations, at least two documented interventions must be conducted prior to a referral for evaluation for DCD. Prereferral documentation must include a definition of the problem, review of appropriate records, samples of classroom work, and the documented interventions. The prereferral process will vary slightly from building to building.

D C D C R I T E R I AAccording to Minnesota state eligibility criteria, evaluation of a developmental cognitive disability (DCD) must be based upon multiple sources of information across multiple settings (school and home, and, if appropriate, community environments). Based on the state criteria, a student is considered to have a DCD and eligible for services when evaluation information indicates significantly below average intellectual functioning resulting in, or associated with, concurrent deficits in adaptive behavior that may require special education and related service. The evaluation team must gather information on adaptive and intellectual functioning through the use of standardized, nationally normed, technically adequate measures. Results of norm-referenced adaptive behavior and intellectual evaluation must be supported by written evidence drawn from at least 2 systematic observations and parent input to document need and level of support necessary. Other sources of documentation may include: checklists, classroom or work samples, interviews, criterion-referenced measures, educational history, medical history, or pupil self-report. Adaptive skills are evaluated in the student's typical environment across all aspects of their life and must include evaluation of adaptive behavior in the school and home, and, if appropriate, community environments.

A student with limits in intellectual functioning who does not have limits in adaptive skill areas may not be meet the critiera as having a developmental cognitive disability. The adaptive behavior needs to be evaluated in the school and home, and, if appropriate, community to ensure that the student’s difficulty in meeting the demands of their environment are not limited solely to an academic, home or community setting.

E V A L U A T I O N P L A NAn evaluation plan provides a foundation to ensure that adequate information is gathered to meet state due process requirements for eligibility determination. When the team meets to plan an evaluation, they should refer to the Matrix for Developing a DCD Evaluation Plan to consider possible data sources. Shaded items are required for all DCD evaluations. State criteria can be divided into two areas and the matrix identifies the area under which each data source may contribute toward an eligibility decision.

The adaptive behavior evaluation should be carefully planned to answer questions about the student’s functioning and service needs. To meet state criteria, the student’s adaptive functioning should be evaluated in both the school and in the home, and, if appropriate, community environments. Consequently, the team should consider which adaptive behavior evaluation scales are most appropriate and provide information about the student’s functional Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-211

strengths and challenges. Careful consideration of the various adaptive evaluation tools (norm-referenced and alternative methods of evaluation) should allow for eligibility decisions and to determine priorities for adaptive skill goals. Alternative methods of evaluating adaptive behavior may be useful in determining priorities for adaptive skills, planning transition to a vocational plan, or evaluating problem behaviors that may be interfering with the attainment of skills.

For published tests, professional ethics require that evaluation tools be administered and interpreted by personnel with training commensurate with the requirements indicated by the test publishers. For example. standardized instruments such as the Scales of Independent Behavior-Revised (SIB-R), Vineland ABS, Adaptive Behavior Evaluation Scale-Revised, etc. must be interpreted by professionals with appropriate training.

A functional behavioral assessment (FBA) must be completed when behavior impedes the student’s learning and/or the learning of others. A functional behavioral assessment identifies environmental events, antecedents, and consequences of the target behaviors which allows the team to develop more effective interventions. The Rochester Schools Guidelines on the Use of Behavioral Interventions requires a functional behavioral assessment prior to the use of a conditional procedure. Any information on past or present behavioral interventions should be included in the evaluation report.

E V A L U A T I O N P R O C E S SA multidisciplinary team is required for all special education evaluations, and the DCD evaluation process must include a teacher licensed in the area, a school psychologist, and others as determined by the individual circumstances of the referral concern. Evaluation information will be provided by parents, teachers, and direct evaluation of the student. Structured interviews and rating scales are primary methods of gathering information from parents and teachers.

At least 2 direct observations of the student can be conducted by the DCD certified teacher, school psychologist or others who have received adequate training in the use of observation techniques. Classroom observations should be performed as unobtrusively as possible.

Determination of the least restrictive environment requires an interdisciplinary team to determine needed supports across various environments. It is recommended that the evaluation information be translated into levels of support: intermittent, limited, extensive, and pervasive.

1. Intermittent support refers to support on an "as needed basis." An example would be support that is needed in order for a person to find a new job in the event of a job loss. Intermittent support may be needed occasionally by an individual over the lifespan, but not on a continuous daily basis.

2. Limited support may occur over a limited time span such as during transition from school to work or in time-limited job training. This type of support has a limit on the time that is needed to provide appropriate support for an individual.

3. Extensive support in a life area is assistance that an individual needs on a daily basis that is not limited by time. This may involve support in the home and/or support in work. Intermittent, limited and extensive supports may not be needed in all life areas for an individual.

4. Pervasive support refers to constant support across environments and life areas and may include life-sustaining measures. A person requiring pervasive support will need assistance on a daily basis across all life areas.


While it is not necessary to translate evaluation results into these levels of support, it provides a useful framework for teams to determine appropriate levels of educational services and supports across the student’s various environments.

E V A L U A T I O N R E P O R TThe Evaluation Report (ER) should present all relevant and significant evaluation results and integrate these findings in a manner that systematically addresses the state eligibility criteria. See Evaluation Reports for examples of Reevaluation of DCD ER and/or DCD Evaluation Report with Transition. Prior to the evaluation meeting, the person responsible for writing the evaluation report should gather evaluation data from all those involved in the evaluation process and synthesize that information into one comprehensive report. The written report needs to be available to the parents within 30 days of when the evaluation plan is signed. However, after the evaluation meeting, changes / additions may need to be made in order to finalize the report. This process can be simplified by using the DCD Criteria Checklist.




MATRIX FOR DEVELOPING A DEVELOPMENTAL COGNITIVE DISABILITY (DCD) EVALUATION

DATA SOURCES Adaptive

Intellectual

Standardized Norm Referenced Evaluations xAchievement (Individual, Group) x Adaptive Behavior (school and home and, if appropriate, community)

x

Intellectual xSocial Skills xSpeech and Language xMotor x

2 Systematic Observations Classroom Settings x xNon academic xFunctional Evaluation of Behavior x

School RecordsCumulative File Review (required for initial evaluation) x xEducational History (required for initial evaluation) xReview of Goals and Objectives on Current IEP x

Interviews Information from Parent (survey, checklist, conversation)

x

Child xTeacher (survey, checklist) x

Outside Evaluations/ReportsMedical x xPsychological x xDevelopmental xSensory Status

Criterion Referenced EvaluationsAcademic xSocial xAdaptive xSociometric x

Transition (required for age 14 and older)Parent Interview x xStudent Interview x xTransition Checklists x

Required components for all DCD evaluations



EXAMPLE: DEVELOPMENTAL COGNITIVE DISABILITY (DCD) EVALUATION REPORT

REASON FOR REFERRAL Eliza was referred for mandatory three-year reevaluation to determine continued eligibility for special education. BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: Review of Records: Eliza suffered severe grand mal seizure at the age of 2 1/2 months. Eliza was subsequently referred for early childhood special education assessment. Eliza has been receiving special education services since infancy. Eliza is a student who requires complete care for her self-care, ambulation, and safety needs. She currently receives the following supports through special education: DCD-SP services, physical therapy, and occupational therapy. Prior test results in Eliza's school records were reviewed. On 10-15-97, the Bayley Scales of Infant Development was administered. Eliza was functioning at less than a one month level compared to chronological age of 2 1/2 months at the time. The established Mental Development Index was 42. On 2-23-98, the Bayley Scales of Infant Development-II was administered. Eliza obtained a raw score of 27 which did not correlate to a Mental Development Index (which means it was less than 50). She obtained an age equivalent score of 2 months at the chronological age of 6 3/4 months. LANGUAGE/RACIAL/CULTURAL FACTORS: There are no known language/racial/cultural factors that would impact this evaluation. INFORMATION FROM PARENTS: Parents indicated that Eliza is very sensitive to sounds and voices. She is very aware of the presence of her mom, and will often cry if she is near Mom and cannot sit in her lap. When Eliza hears a crying baby she may respond by vocalizing and crying. Mom reports that sometimes it appears that Eliza receptively understands some familiar phrases. For example she may respond to hearing "We're going home" with excitement. This is not consistent though. Eliza enjoys family gatherings and events with many people and sounds. Parents feel the school programming is very appropriate. Given Eliza's medical and personal care needs, gross motor positioning needs, and developmental level , parents are concerned about the transition to middle school. Parents feel Eliza needs continued opportunities to have a wide variety of stimulating experiences. They believe that the Severely Multiply Impaired disability is descriptive of Eliza. EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior. INTELLECTUAL and FUNCTIONAL: Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-215

Given Eliza's severely limited response capabilities in regard to formal testing, Eliza's intellectual functioning was generally assessed using the Wisconsin Behavior Rating Scale and observation of her overall functioning. The WBRS also provides an estimate of Eliza's functional skills. Wisconsin Behavior Rating Scale (WBRS) The WBRS is a criterion-based and norm-reference assessment used to assess the functioning levels of individuals of all ages who are functioning at a developmental level under approximately 3 years. It was standardized on a random sample of severely/profoundly impaired individuals who were in residential settings. It assesses developmental skills in 11 areas, and is sometimes used to estimate an individual's general intellectual abilities, when other more traditional means are not appropriate. Percentile ranks are based on institutionalized individuals who function below the developmental level of 3 years and Age Equivalent scores are reported in months.

WBRS Date: 2-28-08

Age Equivalent (in months)

(Parent, Teacher) Gross Motor 2, 2 Fine Motor 4, 2 Expressive Language 5, 2 Receptive Language 6, 3 Play Skills 4, 3 Socialization 5, 6 Domestic Activity <5, <5 Eating <1, <1 Toileting 10, 10 Dressing <8, <8 Grooming <16, 12 TOTAL SCALE 3.9, 2.7 Behavioral Age (in months)

Interpretation: The WBRS was completed by Eliza's parents and special education teacher. The scale provides age equivalent scores in adaptive behavior. Eliza's overall adaptive behavior age equivalent in months is 3. 9 by parent rating and 2.7 by teacher rating. Compared to her chronological age of 10 years, 7 months, the current WBRS scores rank below the 1st percentile. Previous WBRS results included Behavioral Age Equivalents of 2.3 months (by parent and teacher) in 2/05. Informal Inventory/Checklists Date: Various Dates in February In the classroom Eliza is observed to laugh, turn and shake her head in response to certain music and favorite voices. She will reach out to hit at the red switch 2/5 opportunities. The switch needs to be brought into her line of vision, placed within close reach or her left hand, and then she may need several minutes of wait time before she attempts to reach. She will hit Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-216

at the switch with a tapping/banging motion. When presented with noisy toys Eliza will turn toward the sound. Eliza has been observed to transfer a long toy from her right hand to her left hand. She is very motivated to bring items to her mouth to chew. Eliza has a strong need to suck and chew, and will suck her thumb or bite on her fingers if given the opportunity to do so. She bites on her finger with a good amount of force and has a calloused red area on the first finger of her left hand. Eliza is offered a variety of sensory stimulation items each day. She will look at toys presented to her, and may reach out to the item, but this is not always consistent. She will often hold on to the item once it is placed in her grasp. Eliza may respond to some tasting activities (licks of a sucker, pudding, etc) by occasionally sticking her tongue out for more, but on other days may not appear interested. Eliza was observed to more easily reach out for toys when positioned on the mat and propped into a long legged sitting position. ( Objects of stimulating color were placed in front of her at chest level. Eliza consistently reached out to bat at the objects). Eliza is very content during the school day and rarely cries. COMMUNICATION: Review of Records:

Date: 2/07 Eliza began receiving consultation services from a speech-language pathologist during a play group in September, 1999. Eliza was vocalizing and clearly indicating pleasure versus displeasure. By November, 1999, Eliza was initiating turn-taking with sounds and demonstrating anticipatory excitement. In 2000, Eliza was working on activating switches during play and continuing her interactions with people through simple turn-taking activities and vocal play. Switches were introduced to activate toys. An Interagency Intervention Plan was written in November, 2001. Speech services continued on an indirect bases. Eliza was demonstrating enjoyment of being in close proximity with her peers. She frequently responded by smiling or laughing. A reevaluation was completed in March, 2002. Eliza vocalized and imitated some sounds adults made and attempted to gain an object by making vocalizations. Eliza babbled for pleasure and engaged in vocal play. She responded appropriately to different vocal tones. Services remained indirect. In 2003, indirect services were discontinued and consultation services were provided as needed. In 2005, a reevaluation placed Eliza's receptive skills in the 0-6 month range with scattered skills in the 6-8 month range. Expressive language skills fell within the 0-4 month range. Eliza was able to quiet, show excitement, recognize familiar people and attend to speakers for a short period of time. She was able to cry, gurgle, coo, laugh, and squeal. She discriminated between pleasure and pain. Eliza did not follow simple requests, attend to spoken communication, or look at simple pictures/objects when named. She did not imitate babbling or participate in vocal play. She did not use gestures or signals to indicate needs. Language skills were comparable to cognitive ability. Informal Inventory/Checklist: Date: 2/07 According to a receptive and expressive communication checklist completed by the parents, Eliza's receptive language skills fall within the 0-6 month range, with a few scattered skills evident in the 6-8 month range. Eliza quiets when picked up and can awaken or quiet to the voice or touch of her caregiver. She inspects her surroundings either visually or by touch. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-217

Eliza shows anticipatory excitement. She recognizes her parents and other family members and seems to know the difference between familiar persons and strangers. Eliza seems to be aware of the sight, sound, and tactile properties of objects. She distinguishes between friendly, comforting voices or handling versus angry noncomforting voices and handling. Eliza will stop crying when someone attempts to communicate. Eliza will watch or feel the speakers face and will react to facial expressions and voice intensity. She looks/feels/listens for familiar toys/people/objects when the are present. Eliza does not respond to simple requests, attend to spoken communication, or recognize people/objects/toys by name or signs. Expressively, parents report scattered skills in the 0-4 month range. Eliza has been observed making non-cry noises such as grunts, hiccups, and sucking sounds. Cries are produced with both a strong and weak voice and used to communicate pain or discomfort. Eliza will gurgle, coo, laugh, or squeal at pleasurable things. She will repeat her own actions or gestures that she finds pleasurable. Eliza will vocalize to social stimuli. She will imitate some gestures and vocalizations. Eliza will vocalize feelings of pleasure or displeasure. With the exception of reacting to facial expressions and looking for familiar toys/objects/people, Eliza's special education teacher reported similar receptive language skills being observed in the classroom environment. Expressive language skills were scattered within the 0-4 month range. The special education teacher has not observed Eliza imitating gestures or vocalizations. MOTOR: Motor Observation Date: 2/28/2008Time: 12:45pmSetting: Special education classroom

Eliza was observed sitting in her wheelchair in her special education classroom setting. She is able to move and use both of her arms to some degree. Her passive range of motion in both of her arms appears to be close to within functional limits. It appears that her range of motion has actually improved in her right arm as compared to when she was evaluated three years ago. Eliza wears a splint on her right wrist to keep it in a neutral position which she wears most of the time. She also has a new mitten splint for her right wrist and hand with the primary function of this splint to be placed on an as needed basis when Eliza is biting her finger to prevent her from hurting herself. She also has a blue splint to wear on her left hand as needed. When she bites her left thumb, she also tends to put her index finger up near her eye and the concern is there that she may hurt her eye as well. The blue splint appears to minimize her biting this hand. Eliza has limited use of her right hand to play with objects. She will loosely hold onto an object when it is placed into her right hand, and then often will reach over with her left hand to remove the object from the right hand. She will make an attempt to reach up to obtain an object with her left hand, and the teacher reports that she did a lot more of this when she was in supported sitting on the floor and working with the vision teacher. She will retain an object in her left hand for longer periods than in the past and likes to bring toys up to her mouth to chew on them. She has several soft toys that are appropriate for chewing including a few chewy tubes that are even flavored. Eliza enjoys when staff assist her with hand over hand activities and will make an attempt to clap her hands together. She can push on a switch to operate a toy, but may end up banging on it instead of just pushing it and then releasing it. Eliza is provided with several position changes during her day at school. She has a new wheelchair which she sits well in. She is in the gait trainer and stander for 20-30 minutes every day. She is also on her back on the mat for her Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-218

stretching exercises each day and spends about 30 minutes in a prone position over the wedge. She is able to remain in this position with her head up for a much longer duration than when she was evaluated three years ago. She has not worked on mobility on the floor such as rolling since she had hip surgery. Staff are currently using a two person lift for all transfers, but there is a hoyer lift available for use if necessary. Eliza shows obvious joy with so many activities at school. She enjoys sensory rich activities including play with toys that have high visual and auditory interest. Staff use the vibrator and music to interest her. She also takes small tastes at times for some gustatory stimulation although she does not eat food orally. But Eliza's favorite part of school appears to be her strong interest in favorite people in her environment and she certainly shows a reaction to certain people such as her mom or one of the paras that works in her classroom. Eliza is dependent for all of her self-cares at school and is tube fed.

Motor Observation Date: 2/13/2008Time: 9:30 AMSetting: Classroom and Hallway

Eliza arrived to school in her manual wheelchair, which is customized to provide her optimal positioning. She wore bilateral AFOs and per parent report will be getting a new pair in the near future. Eliza required maximal assistance for all transfers. She was transferred into a Rifton gait trainer with assist of two and securely positioned using forearm prompts and chest and pelvic supports. Staff stood behind Eliza throughout the duration of the activity and assisted with forward propulsion, directional control, and provided appropriate feedback for motivation. During the observation, Eliza demonstrated the ability to alternate her feet but there was increased in-toeing noted bilaterally (greater on left LE) as compared to the past few weeks, which at times hindered her ability to step through. She took a maximum of 13 consecutive steps before stopping and requiring encouragement and/or light physical cuing to resume and completed a total of 50 feet. It should be noted that her performance during this activity does fluctuate. At the time of her last progress report Eliza averaged 29 consecutive steps during ambulation attempts, completing a minimum of 13 consecutive steps on 91% of trials, with the lower number being 10 consecutive steps and the highest number 82 consecutive steps. Eliza also fluctuated in the total distance completed, ranging from less than 80 feet to 165 feet, depending upon her mood and also the amount of distraction in the hallway. Following ambulation, Eliza was transferred with assist of two onto a floor mat. While in supine, Eliza's' muscle tone and asymmetry were noted with her lower extremities taking a windswept position to the right (right hip externally rotated and left hip internally rotated). She was then positioned into a supported prone on forearm position with pillow support at her trunk.

Although not observed, Eliza continues to utilize a supine stander for 30 minutes 1x/day and tolerates this without difficulty. She also receives daily range of motion activities to bilateral upper and lower extremities and overall has not demonstrated resistance to this activity. HEALTH/PHYSICAL: Review of Records: Eliza has a history of severe global developmental delays. She also has a history of seizures which have been well controlled. She is no longer taking any daily meds for Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-219

seizures and her mother Nancy states that her last seizure was in approximately 2001. Eliza does have a seizure care plan in place at school. Eliza has a gastrostomy tube in place for primary nutrition. The tube feeding is done by a pump. There are emergency care plans in place to address potential dislodgement of the G-tube or for leakage around the G-tube. Eliza does have problems with reflux and constipation. She is currently taking medications to help with these issues. UTI's have been a constant problem and Eliza does take medication to help alleviate this problem. On April 11th, 2008 Eliza is scheduled to have a Mitrofanoff procedure done. This procedure will allow Eliza to be catheterized through a small opening on her abdomen. During the surgery Eliza is also scheduled to have a hysterectomy. Eliza has been receiving shots to help stop her early onset of puberty and this will help with this issue. The doctors estimate that Eliza will be out of school four to six weeks following the surgery.

SENSORY: Review of Records: Nancy stated that Nicole had recently been to the doctor to have her vision tested. Nancy said that Eliza's vision is normal and Eliza's hearing seemed to be fine.

OBSERVATIONS: Date: 3/3/2008Time: 1:10-1:40Setting: Special Education Classroom Eliza was positioned in her stander during circle time. She laughed and moved her head back and forth in response to the music. Eliza was sucking on the thumb of her left hand. The paraprofessional removed the hand splint and placed a noise making toy in her hand. Eliza needed assistance at her wrist to shake the toy, but she independently maintained her grasp on the toy during the activity. She did attempt to bring the toy to her mouth to chew on it, but the adult assisting her redirected her. When the activity was over, Eliza needed assistance to release the toy. When presented with the red switch and directed to touch it, Eliza appeared to look at the switch, and moved her hand, but needed assistance to touch the switch and activate the pre-recorded message. Eliza laughed in response to another child singing. She tapped her left hand on her tray. She sucked on her thumb, bringing her first finger close to her eye. The adult removed her hand from her mouth three times, then offered her a toy. When the toy was held near her, she looked and watched as it moved in front of her. She did not reach out for the toy, so the adult placed it in her hand. At the end of circle time Eliza was moved with a two person lift to the mat and positioned on her tummy with a pillow. Eliza held her head up and appeared to look at the light box placed in front of her. Eliza is responsive to the sounds of her environment. She will look at items placed near her. Eliza needs assistance to reach, grasp and manipulate objects. Eliza brings items to her mouth to suck and chew. Eliza requires adult assistance for positioning and all personal cares. Date: 2-28-08Time: 12:05-12:35pmSetting: Special education classroom Eliza was observed in the special education classroom while working with the teacher. She was content sitting in her wheelchair during her tube feeing. There were chew toys on Eliza's Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-220

tray, but she did not spontaneously use them. The teacher was talking to Eliza and when she placed a sucker on Eliza's lip, she immediately smiled. The teacher prompted Eliza with "tongue" 3 times and there was no response. Eliza had her right hand on her tray and her left hand down at her side. She spontaneously brought her left arm/hand up to the tray. When the teacher presented a squeaky, textured, light-up, sound toy, Eliza turned her head and oriented toward the toy. Eliza's head tended to be turned to the left although she would turn her head to the right given stimulation on right side. When presented with two noisy toys, Eliza gazed between the toys. She tilted her head and appeared to be be listening intently. When a white, lighted stuffed bear was presented in dim lights, Eliza looked at the bear and squealed a happy sound. When presented with a fan & switch against a black board, Eliza initially fixated on the observer sitting near her. When the teacher prompted with "make it go," Eliza raised her arm and made a repetitive arm motion in the air, but could not find the switch. She responded this way 3 of 4 times. The teacher provided hand-over-hand assistance to activate the switch. When the teacher handed Eliza a chewy toy from her tray, she held it and placed it in her mouth. The last toy presented was a vibrating, singing, stuffed animal. Eliza looked at the toy and lifted her hand. The teacher placed Eliza's hand on the toy and Eliza readily began moving her upper body and head side to side. She squealed happy sounds and laughed. Eliza clearly enjoyed the music. Overall, Eliza's functioning during the observation was consistent with an early infancy developmental level. Eliza was alert and responsive to the teacher and the sensory toys presented. She consistently oriented to sound. She did not consistently orient to visual stimulation. Eliza inconsistently reached for toys/switches and had difficulty localizing the objects. VALIDITY Were the evaluations administered valid for the student? Yes Were the evaluations administered valid for the purpose to which they were intended? Yes Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? No A lack of appropriate educational instruction in math? No Limited English proficiency? No PRESENT LEVEL OF PERFORMANCE Eliza is a 10 year old, 5th grade student. She has a well-documented history of severe global developmental delays and traumatic brain injury. Eliza is a complete care child who is nonambulatory and nonverbal. Intellectual and Functional: According to results of the WBRS, Eliza's overall adaptive behavior age equivalent is 3. 9 months by parent rating and 2.7 months by teacher rating. Compared to her chronological age of 10 years, 7 months, this indicates the presence of a severe/profound delay in her intellectual and functional skills. In regard to current performance, Eliza prefers to suck and chew on items presented to her. She will reach out for a toy, but not always consistently. Eliza expresses strong preferences/enjoyment of particular music and voices. Communication: According to information provided by Eliza's parents and her special education teacher, Eliza's receptive language skills fall within the 0-6 month range. Her expressive language skills fall within the 0-4 month range. Eliza is able to quiet, inspect her surroundings, show anticipatory excitement, recognize family, and stop crying when spoken Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-221

to. Eliza is able to gurgle, coo, and laugh. She vocalizes feelings of pain and pleasure. Eliza does not respond to simple requests, attend to spoken communication, or recognize objects/people/toys by name. No preferences have been noted when Eliza is presented with two objects to make a choice. Preferences of activities are made known by vocalizations. Eliza will laugh or smile when content. Eliza inconsistently hits a switch that is placed in front of her. Cause and effect is not noted. Eliza rarely imitates sounds or gestures. Vision: Cortical visual Impairment (CVI) is a neurological disorder which results in unique visual response to people, education materials and to the environment. When students with these visual/behavioral characteristics are shown to have loss of acuity or judged by their performance to be visually impaired, they are considered to have CVI. According to Roman CVI Resolution Scale, Eliza's resolution is within the 3-4 range to 5-6 range. She continues to focus in best on red objects. She will reach for more objects when positioned on the mat. Due to right homonymous hemianopsia, Eliza is unable to visually locate objects presented in her right fields. However, when object moves from left to right, she will follow the object to the right side. Fine Motor: Eliza is able to move and use both of her arms to some degree. Her passive range of motion in both of her arms appears to be close to within functional limits. It appears that her range of motion has actually improved in her right arm as compared to when she was evaluated three years ago. Eliza wears a splint on both hands for positioning and to protect her left hand. She will loosely hold onto an object when it is placed into her right hand, and then often will reach over with her left hand to remove the object from the right hand. She will make an attempt to reach up to obtain an object with her left hand. She will retain an object in her left hand and likes to bring toys up to her mouth to chew on them. Eliza enjoys when staff assist her with hand over hand activities and will make an attempt to clap her hands together. She benefits from opportunities to use her hands both with and without assistance throughout her day at school. Gross Motor: Eliza continues to be transported to and from school in her wheelchair and also continues to wear bilateral AFOs daily. She is dependent for all transfers and is provided with various position changes throughout her day, using a 2-person lift (although there is a hoyer lift available should staff prefer to utilize this method). Eliza tolerates being positioned in prone on forearms position with support under her trunk for periods of 20-30 minutes, extending at her upper trunk and head periodically. She also tolerates being positioned in a modified long sit position with pillow support and support either posteriorly or at her pelvis. Eliza uses a supine stander for 30 minutes 1x/day and tolerates this without difficulty. She also receives daily range of motion activities to bilateral upper and lower extremities. In addition, Eliza uses a Rifton Gait Trainer 1x/day with varying levels of performance but overall good tolerance. Once positioned using forearm prompts, chest and pelvic supports, and the thigh prompt occasionally, Eliza demonstrates the ability to reciprocate her lower extremities with staff assist for forward propulsion, directional control, and to provide verbal encouragement. Eliza averages 29 consecutive steps during attempts, completing a minimum of 13 consecutive steps on 91% of trials. In regards to total distance, Eliza fluctuates and completes from less than 80 feet up to 165 feet depending upon her mood and also the amount of distraction in the hallway. ELIGIBILITY DETERMINATION Developmental Cognitive DisabilityAccording to Minnesota Special Education rules, a student is eligible for special education and related services when the student meets the criteria in items A and B below: Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-222

Eliza's evaluation documents: A) An overall level of adaptive behavior below the 1st percentile at home and at school, as reported on the WBRS. These scores document that Eliza's adaptive behavior skills are at or below the 15th percentile in both school and home settings. Pervasive support (complete care) is needed in the following adaptive behavior domains: daily living, communication, social & interpersonal, and recreation & leisure. Educational needs identified in these domains are included in the educational needs section of this report. B) Eliza's history consistently indicates a severe/profound intellectual functioning deficit since she suffered at closed head injury in early infancy. Eliza's significant and pervasive delays in her overall functioning on the WBRS confirms the presence of a profound deficit. The student's significantly below average general intellectual functioning was verified through a written summary of two systematic observations and criterion-referenced tests. In summary, based on the results of this evaluation, Eliza meets eligibility criteria for Developmental Cognitive Disability (severe/profound).

Language Disorder According to Minnesota Special Education rules, a student has a Language Disorder and is in need of speech or language services when the student meets the criteria described in items A and B and either C or D. Eliza's evaluation documents: A) A language pattern that does interfere with communication as judged by an educational speech-language pathologist and the student's parents. B) Although an analysis of the observation has demonstrated that Eliza's language behavior is below average compared to expectations based on age, Eliza's communication skills are not below what is expected given consideration to her cognitive level. C) Formal instruments were not administered due to Eliza's cognitive level. OR D) Technically adequate norm referenced language tests are not available to provide evidence of a deficit of 2.0 standard deviations below the mean in the area of language, but two documented measurement procedures indicate a substantial difference from what would be expected based on age, developmental level, or cognitive level. Procedure #1 Receptive and Expressive Communication Checklists completed by parents: Language skills fall within the 0-6 month range. Procedure #2 Receptive and Expressive Communication Checklists completed by special education teacher: Language skills fall within the 0-6 month range. In summary, based on the results of this evaluation Eliza does not meet eligibility criteria for a Language Disorder. These disabilities adversely impacts Eliza's performance in the general education setting as evidenced by the following:

The student performs substantially below that of peers. The student demonstrates a learning rate that is substantially below that of peers The resources necessary to support the student to participate and progress in the

general education curriculum are beyond those available in the general education curriculum.




EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITY Given Eliza's level of functioning, she requires complete care for her self-care, ambulation, and safety needs. She needs a pervasive level of support to meet her functional needs.

Areas of specially designed instruction needed: Communication: In the area of communication, Eliza needs to be given opportunities to respond to stimulation, explore her environment, participate in classroom activities, and interact with objects and people. Eliza needs to continue to be involved in social experiences and given frequently reinforcement for social responsiveness. The daily interactions that occur naturally within the special education classroom will best meet these needs. Specialized instruction from a speech pathologist is not necessary to meet Eliza's current language needs. A speech pathologist will be available for consultation if needed.

Daily Living: Eliza needs full support with all daily living activities. She needs exposure to visual and verbal cues representative of daily activities. Social and Interpersonal: Eliza needs to be encouraged to explore a variety of toys. Recreation and Leisure: Eliza needs to experience a variety of sensory activities in her environment. Eliza needs to continue to improve her ability to interact with her environment. She needs to continue to use switches and be given opportunities to activate toys. Eliza needs a variety of sensory stimulation activities available to her. She needs to chew on objects, rather than her thumb or hand. Eliza needs to be encouraged to use her vision to notice things in her environment. Fine Motor: Eliza needs to continue to be provided with various position changes throughout her day and gentle range of motion exercises. She needs to be provided with a sensory rich environment for maximum stimulation. Gross Motor: Because Eliza is dependent on staff for all cares, she needs to be provided with frequent changes of position while at school. Eliza also needs to continue to improve her tolerance and ability to use a gait trainer for weight bearing, movement exercise, and trunk and head control opportunities.



CHAPTER 3I: Emotional or Behavioral Disorders (EBD) Documentation


STATE GUIDELINES: EMOTIONAL OR BEHAVIORAL DISORDERS (EBD)

“Emotional or behavior disorders” means an established pattern of one or more of the following emotional or behavior responses:

A. withdrawal or anxiety, depression, problems with mood, or feelings of self worth;B. disordered thought processes with unusual behavior patterns and atypical

communication styles; orC. aggression, hyperactivity, or impulsivity.

The established pattern of emotional or behavioral responses must adversely affect educational or developmental performance, including intrapersonal, academic, vocational, or social skills; be significantly different from appropriate age, cultural, or ethnic norms; and be more than temporary, expected responses to stressful events in the environment. The emotional or behavioral responses must be consistently exhibited in at least three different settings, two of which must be educational settings, and one other setting in either the home, childcare, or community. The responses must not be primarily the result of intellectual, sensory, or acute or chronic physical health conditions.A student is eligible and in need of special education and related services for an emotional or behavioral disorder when the student meets the criteria in items A to C.A. A student must demonstrate an established pattern of emotional or behavioral responses

that is described in at least one of the following subitems and which represents a significant difference from peers:

(1) withdrawn or anxious behaviors, pervasive unhappiness, depression, or severe problems with mood or feelings of self-worth defined by behaviors, for example: isolating self from peers; displaying intense fears or school refusal; overly perfectionistic; failing to express emotion; displaying a pervasive sad disposition; developing physical symptoms related to worry or stress; or changes in eating or sleeping patterns;

(2) disordered thought processes manifested by unusual behavior patterns, atypical communication styles, or distorted interpersonal relationships, for example: reality distortion beyond normal developmental fantasy and play or talk; inappropriate laughter, crying, sounds, or language; self-mutilation, developmentally inappropriate sexual acting out, or developmentally inappropriate self-stimulation; rigid, ritualistic patterning; perseveration or obsession with specific objects; overly affectionate behavior towards unfamiliar persons; or hallucinating or delusions of grandeur; or

(3) aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, for example: physically or verbally abusive behaviors; impulsive or violent, destructive, or intimidating behaviors; or behaviors that are threatening to others or excessively antagonistic.


The pattern must not be the result of cultural factors, and must be based on evaluation data which may include a diagnosis of mental disorder by a licensed mental health professional.

B. The pupil’s pattern of emotional or behavioral responses adversely affects educational performance and results in:

(4) an inability to demonstrate satisfactory social competence that is significantly different from appropriate age, cultural, or ethnic norms; or

(5) a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum disorders or inconsistent educational programming.

C. The combined results of prior documented interventions and the evaluation data for the pupil must establish significant impairments in one or more of the following areas: intrapersonal, academic, vocational, or social skills. The data must document that the impairment:

(1) severely interferes with the pupil’s or other students' educational performance; (2) is consistently exhibited by occurrences in at least three different settings: two

educational settings, one of which is the classroom, and one other setting in either the home, child care, or community; or for children not yet enrolled in kindergarten, the emotional or behavioral responses must be consistently exhibited in at least one setting in the home, childcare, or community; and

(6) has been occurring throughout a minimum of six months, or results from the well-documented, sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

For Learners who are Pre-Kindergarten: Children not yet enrolled in kindergarten are eligible for special education and related services if they meet the following criteria:A. A student must demonstrate an established pattern of emotional or behavioral responses that is described in at least one of the following subitems and which represents a significant difference from peers:

(1) withdrawn or anxious behaviors, pervasive unhappiness, depression, or severe problems with mood or feelings of self-worth defined by behaviors, for example: isolating self from peers; displaying intense fears or school refusal; overly perfectionistic; failing to express emotion; displaying a pervasive sad disposition; developing physical symptoms related to worry or stress; or changes in eating or sleeping patterns;

(2) disordered thought processes manifested by unusual behavior patterns, atypical communication styles, or distorted interpersonal relationships, for example: reality distortion beyond normal developmental fantasy and play or talk; inappropriate laughter, crying, sounds, or language; self-mutilation, developmentally inappropriate sexual acting out, or developmentally inappropriate self-stimulation; rigid, ritualistic patterning; perseveration or obsession with specific objects; overly affectionate behavior towards unfamiliar persons; or hallucinating or delusions of grandeur; or

(3) aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, for example: physically or verbally abusive behaviors; impulsive or violent, destructive, or intimidating behaviors; or behaviors that are threatening to others or excessively antagonistic.


B. The pupil’s pattern of emotional or behavioral responses adversely affects educational performance and results in:

(4) an inability to demonstrate satisfactory social competence that is significantly different from appropriate age, cultural, or ethnic norms; or

(5) a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum disorders or inconsistent educational programming.

C. The combined results of prior documented interventions and the evaluation data for the student must establish significant impairment in one or more of the following areas: self-care, social relations, and/or social or emotional growth. The data must document that the impairment:(1) is consistently exhibited by occurrences in at least one setting in the home, childcare, or

community; and(2) occurred throughout a minimum of six months, or resulted from the well-documented,

sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

EvaluationThe evaluation findings must be supported by current or existing data from:

(1) clinically significant scores on standardized, nationally normed behavior rating scales;(2) individually administered, standardized, nationally normed tests of intellectual ability

and academic achievement;(3) three systematic observations in the classroom or other learning environment;(4) record review;(5) interviews with parent, student, and teacher;(6) health history review procedures;(7) a mental health screening; and(8) functional behavioral assessment.

Pre-K evaluations must be supported by current or existing data from:(1) two or more systematic observations, including one in the home;(2) a case history, including medical, cultural and developmental information;(3) information on the student’s cognitive ability, social skills, and communication abilities;(4) standardized and informal interviews, including parent, teacher, caregiver, and

childcare provider; and(5) standardized adaptive behavior scales.

Functional Behavioral Assessment (FBA) means a process for gathering information to maximize the efficiency of behavioral supports. An FBA includes a description of problem behaviors and the identification of events, times, and situations that predict the occurrence and non occurrence of the behavior. An FBA also identifies:

(1) the antecedents, consequences, and reinforcers that maintain the behavior;(2) the possible functions of the behavior; and(3) possible positive alternative behaviors.

An FBA includes a variety of data collection methods and sources that facilitate the development of hypotheses and summary statements regarding behavioral patterns.



EMOTIONAL OR BEHAVIORAL DISORDERS (EBD) CRITERIA CHECKLIST

Initial Evaluation Reevaluation

Student’s Full Name:_______________________________________________Student ID#:________________________________Grade:_______________ School:_________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible and in need of special education and related services for an emotional or behavioral disorder when the student meets the criteria in items A to C below:

ITEM A. Documentation in report of established pattern of emotional or behavioral responses in at least one of the following subitems and which represents a significant difference from peers:1. Withdrawn or anxious behaviors, pervasive unhappiness, depression, severe problems with mood

or feelings of self-worth defined by behaviors:___isolating self from peers___overly perfectionistic___displaying pervasive sad disposition___developing physical symptoms related to worry or stress___displaying intense fears or school refusal___failing to express emotion___changes in eating or sleeping patterns___other__________________________________________

2. Disordered thought processes manifested by unusual behavior patterns, atypical communication styles or distorted interpersonal relationships, for example:

___reality distortion beyond normal developmental fantasy and play or talk___inappropriate laughter, crying, sounds, or language___developmentally inappropriate sexual acting out or developmentally inappropriate self-stimulation___self-mutilation___rigid, ritualistic patterning___perseveration or obsession with specific objects___overly affectionate behavior towards unfamiliar persons___hallucinating or delusions of grandeur___other________________________________________

3. Aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, for example:

___physically or verbally abusive___impulsive or violent, destructive, or intimidating behavior___behaviors that are threatening to others or excessively antagonistic___other________________________________________

Does the student meet the criteria in Item A? YES NOAND

ITEM B. Documentation of the pattern of emotional or behavioral responses that adversely affects educational performance and results in:

___inability to demonstrate satisfactory social competence that is significantly different from age, cultural or ethnic norms: OR___a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical, health, cultural or linguistic factors, illegal chemical use, autism spectrum disorders, or inconsistent educational programming.

Does the student meet the criteria in Item B? YES NOAND

ITEM C. Documentation of prior interventions and evaluation data establishes significant impairments in one or more of these areas:


___intrapersonal; or___academic; or___vocational; or___social skills. ANDData documents that the impairment:___1) severely interferes with the student’s or other students’ educational performance;___2) consistently occurs in at least three different settings, including two educational (one must be classroom), and either one home, childcare or community; and___3) occurred throughout a minimum of six months, or results from the well-documented, sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

Does the student meet the criteria in Item C? YES NO

K-12 evaluations must be supported by current or existing data from:___clinically significant scores on standardized, nationally normed behavior rating scales;___individually administered, standardized, nationally normed tests of intellectual ability and

academic achievement;___interviews with parent, student and teacher;___three systematic observations in the classroom or other learning environments;___record review;___mental health screening;___health history review procedures; ___functional behavioral assessment; or___other procedures.

For Learners Who are Pre-Kindergarten: The learner must meet criteria in areas A-B above. For criteria item C, the following must be met:ITEM C. Evaluation data in the evaluation report must establish and define developmentally

significant impairments in at least one of the following areas: ___self-care ___social relations ___social or emotional growth AND Data documents that the emotional or behavioral responses are exhibited in at least one

setting: ___home ___childcare ___community occurred throughout a minimum of six months, or resulted from the well-documented,

sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

Does the student meet the criteria in Item C? YES NO

Pre-K evaluations must be supported by current or existing data from:___two or more systematic observations, including one in the home;___a case history, including medical, cultural and developmental information;___information on the student’s cognitive ability, social skills, and communication abilities;___standardized and informal interviews, including parent, teacher, caregiver, and childcare provider;___standardized adaptive behavior scales.



MATRIX FOR DEVELOPING AN EMOTIONAL BEHAVIOR DISABILITY (EBD) EVALUATION REPORT

Note: Though some evaluation information listed below may have been obtained through the prereferral process, parental permission should be obtained for all information used during the formal evaluation process.

The three areas of the EBD criteria are as follows:Area A- Documentation of established pattern of emotional or behavioral responsesArea B- Pattern of emotional or behavioral responses that adversely affects educational performanceArea C- Documentation of prior interventions and data establishes significant impairments

DATA SOURCES Area A Area B

Area C

Classroom observation (minimum of 3) x x x Functional Behavior Assessment x x x Mental Health Screening x x x

Interview Parent x x x Teacher x x xAdministrator x x x Child/student x x x

Standardized, Norm Referenced EvaluationsGroup Achievement x xAdaptive Behavior x x x Individual Achievement x x Individual Intellectual xSocial Skills x x x Behavior Rating Scale x x x

School Records Cumulative folder review (including report card, discipline records, health history, academic history)

x x x

Transition (required for 14 and older) x

Required components for all E/BD evaluations



EXAMPLE: EBD EVALUATION REPORT REASON FOR REFERRAL Randy was referred to the Child Study Team by his classroom teacher due to behavior difficulties. Specifically, Randy has difficulty focusing and staying on task. He has difficulty managing his anger, coping with frustration, and displaying appropriate social interaction skills with peers. BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: School records indicate that Randy attended Head Start prior to kindergarten. He attended Franklin Montessori during kindergarten and repeated kindergarten at Jefferson Elementary. He attended school in Dover-Eyota during first through third grades. With the exception of kindergarten, when he missed 18 days of school, Randy's attendance record is good. He has missed 5 or fewer days of school each year since first grade. As a student of the Rochester Public Schools Randy has participated in taking a number of district and state initiated assessments, including the Stanford Achievement Test and Minnesota Comprehensive Assessments - II. A summary of his performance on these measures is as follows:

STANFORD National Percentile Ranks (NPR)

Grade 2 10/05

Grade 3 10/06

Grade 4 9/07

Total Reading 57 40 35 Total Mathematics 70 47 30 Total Language 66 3 14 Spelling 70 - - 85 Environment 86 - - - - Science - - - - 61 Social Science - - - - 32

MCA 3rd Grade April, 2007

Scale Score State Percentile Achievement Level

Reading 364 49 M - Meets Standards Mathematics 373 90 E - Exceeds Standards

A review of Randy's report cards reveals consistently strong academic skills from kindergarten through the present. Teachers have noted, however, that he does not always complete and turn in his work. Randy's third grade teacher completed a portfolio for him to be considered for Gifted and Talented Education services (GATE); Randy did not meet criteria for such services. Behavior concerns have been noted on Randy's report cards since kindergarten. Common themes include difficulty with organization and following directions, difficulty sustaining concentration, and difficulty managing his emotions and displaying self control. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-231

Randy has 11 formal discipline reports on file, documented between 9/04 and 10/07. Three reports were generated for classroom disruption, 4 for misbehavior, 1 for physical assault (kicking peer), 1 for fighting, and 2 were related to his refusal to complete his work and turn in his take home folder. All incidents resulted in detention. LANGUAGE/RACIAL/CULTURAL FACTORS: Randy is Caucasian and from a family whose only language is English. INFORMATION FROM PARENTS: Randy's parents participated in a joint interview with Z, School Psychologist, on November 12, 2007. They reported the following: Family/Background Information: Randy’s parents have been separated since 2001. Both parents expressed concerns about his behavior and his homework completion. Health/Developmental Information: According to his parents, Randy is in good physical health. However, they have concerns that Randy may have ADD/ADHD, and he has an appointment for testing on December 3, 2007 at Olmsted Medical Center. Mr. Z disclosed that he was diagnosed with ADD/ADHD when he was Randy's age. Ms. Z reported that there is also a history of bi-polar disorder and depression on her side of the family. In addition, Randy's father acknowledged that he received special education services for learning disabilities when he was a student. According to his parents, Randy achieved his early developmental milestones within the normal range (perhaps earlier than normal), and there were no complications during the pregnancy and Randy's birth. However, Randy's parents were told that he had lost about 1/4 of his hearing at age 4, but recent testing has shown that his hearing is now in the normal range. They also described his functional skills, such as feeding, dressing, brushing teeth, and knowledge of safety measures as age-appropriate. Social/Emotional/Behavior Information: Randy's parents reported that neighbors and friends may view Randy as a good kid who can be a bit quiet and shy, depending on who he is with. They also described him as a child who seems happy most of the time, but added he can be sensitive to what others say, particularly if he is teased. He has had difficulties with social skills in the past, but he seems to be doing better at the present time; however, he complains that he doesn't have friends at school, but he has friends at church and in his neighborhood. According to his parents, he seems to relate better to adults than he does to peers. Randy's parents indicated that his behaviors were more aggressive when he was at Jefferson, but he seems to be doing better this year . Mr. Rasmussen speculated that this may be due to Randy having a fresh start at a new school. While at Jefferson, he displayed behaviors such as knocking a desk over, slamming a door, and emptying a book bag into the garbage. His parents also speculated that he may be having some behavior problems at school that they're not aware of, as Randy may not be bringing information home from school. In terms of behavior at home, his father reported fewer concerns than his mother reported. Ms. Z said that Randy can have behavioral difficulties when he doesn't get what he wants, or if he is jealous of his brother. He may have tantrums and may hit the wall and his brother. He also may run away while in a store if he becomes angry. According to his parents, he displays inappropriate behavior more frequently when he is at his mother's home. He is currently seeing Dan Ryan at Family Services of Rochester for counseling. Both parents indicated that Randy has shown improvement in his behavior in recent months.


Strengths/Needs: Randy's parents describe him as "very smart and an early reader." They also said that he could tell time before he was in school. In addition, Randy draws character portraits of people that are very well done for a child of his age, and he plays the guitar. However, he has difficulty staying on task when doing anything he doesn't want to do. He avoids math, in particular. Randy's parents indicated that he could benefit from tools to help him do better in school academically and behaviorally, and that he could benefit from support in dealing with his emotions and feelings. Additional parent information is reported under the Evaluation Results and Interpretation section of this report. INFORMATION FROM TEACHERS: At the time of referral, Ms. Z reported concerns related to Randy's difficulty sustaining focus and attention, social interactions with peers, and anger management skills. Ms. Z reported no concerns with Randy's academic skill levels, although she did note that at times he refuses to do his work. Ms. Z reported very significant concern related to Randy's display of aggression, social interactions with peers, defiance and noncompliance with rules, impulsiveness, activity level, difficulty accepting responsibility for his behavior, and lack of self control. These behavior concerns are consistent with those reported by his third grade teacher at Jefferson Elementary. Several interventions have been implemented to address these concerns with limited success. In third grade interventions included utilizing a behavior plan, behavior contract, and home/school notebook. This included using a "to do" task sheet. Limited success was reported with these interventions. Since he has been at Riverside, Randy has continued to use a task completion plan that allows 10 minutes of free drawing time if requirements are met. He also uses a home/school behavior plan that goes home on a daily basis for parent signature. Randy meets weekly with the school guidance counselor and has been responsive to the strategies and skills taught during these sessions; he has not yet generalized these skills to other environments, including the classroom. Additional teacher information is reported under the Evaluation Results and Interpretation section of this report. EVALUATION RESULTS AND INTERPRETATION: Unless otherwise noted, all scores reported are standard scores, which have a mean of 100 and a standard deviation of 15. Scores of 69 or below are considered Far Below Average, 70-79 are Below Average, 80-89 are Low Average 90-109 are Average, 110-119 are High Average, 120-129 are Superior, and 130 or above are Very Superior. INTELLECTUAL: Z, School Psychologist For the current assessment Randy's cognitive functioning was evaluated with the DAS-2 during one, 50-minute session. Randy was noted to be pleasant and cooperative and put forth good effort throughout the evaluation. Midway through the evaluation he appeared somewhat fidgety and a break was provided. Following the break Randy maintained good effort and cooperation. He stood during the last two subtests administered, which did not interfere with the assessment. Results are believed to provide a valid estimate of his current cognitive functioning. Differential Ability Scales - Second Edition (DAS-II)The DAS-II measures general cognitive abilities. The general conceptual ability score is comprised of the following possible clusters: verbal, nonverbal reasoning and spatial. There is also a special nonverbal composite that can be obtained. The DAS-II can be used with preschool and school aged children.

DAS-II Score Range Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-233

Date: 11/24/07 Verbal 120 Superior Nonverbal Reasoning 92 Average Spatial 115 High Average Special Nonverbal Composite 103 Average GENERAL CONCEPTUAL ABILITY (GCA) 109 Average

Interpretation: Randy's performance on the DAS-II suggests an overall level of cognitive functioning which falls within the upper extreme of an average range. A statistically significant split is noted, however, between his Nonverbal Reasoning skills and his Verbal and Spatial reasoning skills. The magnitude of split between Randy's Verbal and Nonverbal Reasoning Reasoning skills is rare and was found in approximately 1-2% of the norming population of the DAS-II. The magnitude of split between Randy's Spatial and Nonverbal Reasoning skills occurred in approximately 2-5% of the norming population. Randy demonstrated relative strength in Verbal and Spatial reasoning skills where his performance fell within a superior and high average range, respectively. His Nonverbal Reasoning skills were significantly less developed and fell within the lower extreme of an average range. At the subtest level, Randy's performance was strongest on subtests measuring his knowledge of word meanings and visual perceptual reasoning skills. He had greater difficulty with subtests measuring his ability to recognize abstract and sequential relationships among pictures. Randy's performance on these subtests fell within an average to low average range. ACADEMIC: Z, Special Education Teacher Woodcock-Johnson Tests of Achievement - Third Edition (WJ-III) The WJ-III is an individually administered, broad-based, nationally normed achievement test. It provides information about reading, math, written language and oral language.

WJ-III Form: A Date: 11/21/07, 12/1/07

Score Range

Basic Reading 121 Superior Reading Comprehension 117 High Average Math Calculation 111 High Average Math Reasoning 112 High Average Written Expression 100 Average

Interpretation: Randy was tested in three sessions over a two day period of time. During the first session, Randy was focused and remained on task. He took his time answering the questions. When tested the second time, Randy was fidgety, off task and very quick to respond. That session was ended after two subtests due to the lack of focus. When Randy came back later that same day, he was again focused and on task. Randy's scores in reading range from the high average to superior range. He has a strong sight word vocabulary and is able to decode words with regular and irregular sound patterns. While he has strong comprehension skills, he does better with individual word meanings than with words in context. The scores Randy obtained in the area of math fall in the high average range. He applied numerous strategies to complete calculation problems as well as word problems. When timed on math facts, Randy was off task and, therefore, had a lower score. He did not do many problems, but the ones he did were accurate. Randy's writing score falls Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-234

in the average range. When timed, he was able to write complete sentences quickly. Randy completed the untimed portion during the session when he was off task. Therefore, the average score may be a low estimate of his skills in the area of written expression. SOCIAL/EMOTIONAL/BEHAVIORAL: Z, Special Education Teacher; Z, School Social Worker; Z, School Psychologist Achenbach System of Empirically Based AssessmentThe Achenbach Scales consist of the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Youth Self-Report (YSR). They provide a global measure of behavior and are designed to measure behaviors that are reportable by parents, teachers, and youth respectively. Scores reported are T-Scores which have a mean of 50 and a standard deviation of 10. Borderline significant problem scores are indicated with a "B". Clinically significant problem scores are indicated with a "C".

ACHENBACH Date: 11/30/07 Father Mother Classroom

Teacher ReadingTeacher

Anxious/Depressed 69-B 80-C 57 51 Withdrawn/Depressed 58 66-B 63 69-B Somatic Complaints 53 76-C 50 50 Social Problems 60 75-C 59 56 Thought Problems 54 64 64 50 Attention Problems 67-B 69-B 67-B 57 Rule-Breaking Behavior 60 76-C 62 66-B Aggressive Behavior 65-B 78-C 70-C 72-C

Interpretation: Ratings from Randy's father were in the borderline range in the areas of Anxious/Depressed, Attention Problems, and Aggressive Behavior. Ratings from his mother were in the clinically significant range in the areas of Anxious/Depressed, Somatic Complaints, Social Problems, Rule-Breaking Behavior, and Aggressive Behavior. His mother's ratings were in the borderline range in the areas of Withdrawn/Depressed and Attention Problems. Ratings from his classroom teacher were in the clinically significant range in the area of Aggressive Behavior and in the borderline range in the area of Attention Problems. His reading teacher provided ratings in the clinically significant range in the area of Aggressive Behavior and in the borderline range in the areas of Withdrawn/Depressed and Rule-Breaking behavior. These ratings indicate significant concerns in multiple areas across several settings both at home and at school. The area with the most consistent concerns across settings is Aggressive Behavior. Conners' Rating ScaleThe Conners' Scales are a report of a student's behavior as seen by parents and/or teachers. The scale is often used in screening or evaluating for possible attention disorders. Conners' scores are reported in T-Scores which have a mean of 50 and a standard deviation of 10. Borderline significant problem scores are marked with a "B". Clinically significant problem scores are marked with a "C".

CONNERS' Date: 12/5/07 Mother Father Classroom

Teacher Oppositional 78 C 42 >90 C Cognitive Problems/Inattention 79 C 56 49


Hyperactivity 64 50 68 B CONNERS' ADHD INDEX 76 C 56 64

Interpretation: The Conners' was completed by Randy's parents and teacher. Responses from Mr. Z revealed scores that fell within a normal range across all subscales while both Ms. Z and Ms. Z endorsed clinically significant elevations in the area of oppositional behaviors. Ms. Z also endorsed clinically significant scores in the area of cognitive problems/inattention and on the overall Conners ADHD Index, while Ms. Z noted borderline, or at risk behaviors in the area of hyperactivity. Item analysis revealed that at school, Ms. Z very frequently observes Randy displaying the following behaviors:

defiant restless in the "squirmy" sense actively defies or refuses to comply with adults' requests spiteful or vindictive leaves seat in classroom or in other situations in which remaining seated is expected fidgets with hands or feet or squirms in his seat argues with adults temper outbursts ; explosive, unpredictable behavior does not follow through on instructions and fails to finish schoolwork

At home, both parents reported that Randy frequently: fidgets with hands or feet or squirms in seat needs close supervision to get through assignments only attends if it is something he is very interested in does not follow through on instructions and fails to finish schoolwork or chores

In addition, Ms. Z also observes the following behaviors frequently: angry and resentful difficulty doing or completing homework fails to complete assignments messy or disorganized at home or school loses temper avoids, expresses reluctance about, or has difficulties engaging in tasks that require

sustained mental effort gets distracted when given instructions to do something has trouble concentrating in class leaves seat in classroom or in other situations in which remaining seated is expected


deliberately does things that annoy other people easily frustrated in efforts

Note: Items that are underlined are indicative of items frequently observed by 2 or more respondents. Interviews: Parent Interview: Parent interview data is reported under the Evaluation Results and Interpretation section of this report, under Parent Information. Teacher Interview: Randy's 4th grade classroom teacher, provided the following information on 10/31/07. Randy often avoids starting or fails to complete assignments and tasks. When redirected he frequently becomes angry and often defiant. Ms. Z, therefore, spends considerable time coaxing him through routine tasks. When he does complete his work it is often of poor quality. Randy is also often unwilling to participate in group discussions or follow along with whole group lessons. Randy will often avoid work activities by visiting the restroom, sharpening pencils, or simply refusing to get out his materials. Ms. Z believes that most of his behavior is an attempt to avoid work that is required to maintain academic progress. His open defiance and refusal to participate is often disruptive to his class. Ms. Z has used a behavior plan that provides free time for completing assigned work. She also provides significant one to one attention and assistance with work completion. She modifies many assignments to reduce the amount of work required to complete them. Despite her efforts she does not believe that Randy is making adequate progress in improving his behavior. She noted that Randy is extremely smart and creative. He reads and writes fluently, and processes information using higher order thinking skills, making connections between what he reads and what he knows. She expressed concern that he will not usually ask for help if he does not understand directions for an assignment. On occasions when he does ask for assistance he will refuse to take responsibility for not having understood and will blame other students. Ms. Z described Randy's peer interactions as inconsistent. At times his impulsive behavior may be attractive and entertaining to peers while at other times it may annoy them. She believes he doesn't pick up on social cues from peers and does not respect others' personal space. He does get along well at times, however. Ms. Z also completed an organizational and work skills checklist as part of the interview. Areas of concern or in need of improvement were: following routines, rules and schedules; following verbal, written and multi-step directions; listening and working without distraction; beginning and finishing tasks on time; knowing when work is complete; correcting or editing work; turning in work or notices on time; participating in class discussions and group activities; requesting help appropriately; and storing and retrieving materials in an orderly and timely manner. Behavior concerns noted included his ability to focus, complete classwork, comply with directions, manage anger or frustration, and interact appropriately with peers. Randy's reading teacher, was also interviewed on 11/24/07. She indicated that Randy frequently presents a negative attitude in her class. He will state that "reading is dumb" (1x/week), class activities are "stupid" (3x/week), or talk back to her (3x/week). She also reported that his writing also reflects a negative attitude in the topics he writes about. She does not understand why he presents those behaviors or what precipitates them. Attention, escape and control are possible functions. She has noted that he loves to draw and will often give him the opportunity to draw a picture of a response prior to writing about it which has


proved helpful. She has not observed any particular difficulties in relating to peers. Overall she is concerned that Randy seems to be angry and sad most of the time. Student Interview: Randy was interviewed by Ms. Z, Special Education Teacher, on 11/20/07. Despite not knowing the interviewer he was very polite and willing to participate throughout. He was first asked about his family situation. He indicated that he lives with his both his parents separately at times, and that arrangement works fine for him. He has a younger brother who lives with his mom and an older sister who lives with grandparents. He enjoys visiting his grandparents and was looking forward to Thanksgiving when he would see them and his sister. When asked who in his life he could count on for support he was unable to list anyone. When asked about school Randy stated that he didn't liked school because he would rather be playing. He does enjoy specials classes, however, such as phy. ed., art, and music, as well as recess. Math is his least favorite subject. He finds math to be the hardest subject, but said most classes are difficult. As a result he does not complete all of his assigned classwork, although he usually completes his homework. When asked if he feels he is smart he said he wasn't sure. People have told him he's smart but he fears they may be lying, as people often lie to him. Randy stated that he eats well and generally feels healthy. He goes to sleep okay, but often wakes up too early and will then watch tv. He indicated that he enjoys playing with other children and does not have difficulty making friends. He listed three boys in his class that are his friends. At recess he usually plays on the swings with a friend. He also enjoys drawing and playing hot wheels. When asked about school behavior he stated that he usually does pretty well. While at Jefferson he would get into trouble for not completing his homework, but this has not been a problem at Riverside. When pressed further he added that he does sometimes talk back to teachers. When asked what can lead to behavior problems he indicated that other students usually lie to his teacher about what he has done. He feels other kids just don't like him and will pick on him. He doesn't know why they don't like him. When asked what teachers can do to assist him through problems he indicated that he wished they would just not make him do difficult lessons like math. When asked about any problem behaviors at home he stated that he has no difficulty at home. Randy finished by saying that he generally feels happy and that is a result of being able to play at home. He enjoys art and music and is very proud of his skill for playing the guitar. He did not have any idea what he would like to do when he grows up. Functional Behavioral Assessment:Upon reviewing the data in this report which was gathered through record review, observations, interviews, rating scales, etc. the team finds the following: Target behavior: Randy displays work refusal, which includes drawing during class, sitting without working, and, if held to task, throwing tantrums that include yelling or throwing things. These behaviors occur at various times throughout the school day and vary in intensity from low (i.e. when drawing) to high (i.e. when escalating to yelling or throwing things). Behaviors also occur at home, primarily when Randy is at his mother's house. At school they occur during independent seat work, whole and small group instruction, in crowded settings, and in unstructured activities and settings. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-238

Triggers: Randy's work refusal is typically triggered by a request or demand for completing tasks. When held to task or when consequences are imposed this may escalate to tantrums that include yelling and/or throwing things. Randy is highly creative and has a strong preference for creative endeavors. When work refusal is displayed consequences to the behavior include peers and adults ignoring the behavior, providing Randy with a reprimand or warning, loss of privileges or incentives, peer attention/approval, communications home and sending Randy to the school office. Hypothesis: Given an undesired task, Randy will draw, sit or tantrum in order to avoid having to work on the task. It appears that Randy has the necessary skills to perform the tasks requested, but he fails to do so. This suggests a performance deficit rather than a skill deficit. Suggestions for positive behavioral support: Randy needs to have clear and consistent consequence for not completing work. He also needs to benefit from completing work. Rewards should be established, such as additional art or music activities, to provide additional motivation. Coordinating efforts between school and home would be highly beneficial. Mental Health Screening: Evaluation results suggest that Randy may be at risk for a number of mental health conditions. Specifically, results from interviews and checklists suggest concerns related to possible attention problems. Oppositional and aggressive behaviors are also documented as are elevated scores in the areas of anxious/depressed and withdrawn/depressed on the Achenbach. Randy was recently seen at Olmsted Medical Center for an initial consult/evaluation on 12/3/07. A consent to release information was signed by parents allowing school staff to share the results of this evaluation with staff at Olmsted Medical Center. Results will be forwarded to OMC upon completion. Randy also receives counseling from Dan Ryan of Family Services of Rochester. HEALTH/PHYSICAL: Z, Licensed School Nurse Randy's health file was reviewed on 11/30/07. Randy has no significant health conditions. He has no known allergies. He takes no routine medications. He has no physical activity restrictions. SENSORY: Z, Licensed School Nurse Hearing Screening:Date: 12/5/06Interpretation: Randy's hearing was screened at school and was found to be within normal limits. Vision Screening Date: 12/5/06Interpretation: Randy's vision was screened at school and was found to be within normal limits. OBSERVATIONS: Date: 11/20/07Time: 1:25 p.m.Observed by: Z, Special Education TeacherSetting: Classroom Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-239

At the beginning of the observation the guidance counselor was making a presentation on social skills to the class. She had students doing role plays while the rest of the class watched. Randy was standing at his desk and drawing, not watching the presentation. At one point he was singing out loud. After a few minutes the presentation ended and the teacher, a substitute who had been with the class for several days, transitioned to a social studies activity. He asked questions and guided students to find the answers. Randy stood at his desk drawing throughout most of the activity. He was extremely fidgety, swinging and dancing as he drew. At one point at girl sitting behind him commented on his dancing and Randy began shaking his rear in front of her as they both laughed loudly. Despite his ongoing off task behavior, Randy was able to chime in on a couple of occasions with correct answers to questions that had the rest of his class stumped. Randy's behavior was charted in several common problem areas and compared to randomly selected peers using 30 second alternating intervals. He showed significantly elevated levels of off task behavior due to his constant drawing. Although this observation occurred with a substitute in the room, his regular teacher has confirmed that off task behavior, often involving drawing, is a frequent and persistent concern. Randy's standing and wiggling was not recorded as inappropriate behavior as the teacher did not direct Randy to stop or otherwise indicate any concern with it. Results from the data collection follow.

Randy Peers Noise 10% 0% Out of area 5% 0% Physical 5% 0% Off task 81% 31% Noncompliance 0% 0%

Date: 11/28/07Time: 9:20-9:45 a.m.Observed by: Z, Special Education TeacherSetting: General Education Classroom Randy was observed during a morning math message in his general education classroom. He was one of 18 students in the class sitting in rows. Randy's desk is located in the front row, at the end of the row. The daily schedule was on the board and the math message was presented on the overhead. The class was working independently on five problems before going over them with the teacher. Randy was rubbing his eyes while writing on his paper. When the teacher asked if everyone was finished, Randy, along with two other students, raised his hand for more time. After a few more minutes of work time, the teacher began to go over the problems with the class. At that time, Randy turned his paper over and began drawing on the back. He stood up and continued to draw. Randy was called on to answer a question. He did not know what problem the class was discussing. When the teacher pointed out the problem, Randy gave the correct answer. The class answered the next question chorally. Randy did not respond. Randy was called on again to answer; he gave an incorrect answer but this time the teacher guided him to the correct answer. After answering the question, Randy went back to drawing on the backside of his paper. The teacher began walking around the class and stood in close proximity to Randy. She whispered to Randy that he needed to stop drawing and complete the work on the overhead. While the teacher was next to Randy, he did not write anything. When she walked away, Randy looked over his shoulder to see where the teacher was located and went back to drawing. Overall, Randy was on task 20% of the time. Date: 12/5/07Time: 10:10 - 10:30 a.m.Observed by: Z, School Social WorkerSetting: Small Group Reading Class Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-240

Randy was observed during small group reading, with Mrs. Schroeder, where the teacher: student ratio was 1:5. As the observer entered the room the students were engaged in reading a story aloud and discussing comprehension questions related to the story. During the second half of the observation the teacher gave instructions for a group activity in which students worked in groups of 2 or 3 to read a story aloud and answer comprehension questions about the story. Students were told they could either write their answers to the questions or draw them. Randy was assigned to work in a group of three and the teacher sat near them to guide the activity. He opted to draw responses to the questions, as his teacher noted he often does. Randy participated readily throughout the observation by answering questions, calling out to the teacher, and volunteering his opinions. At times his comments were on topic while at other times his comments were silly and appeared to be attention seeking in nature. Randy was also heard making noises and was frequently seen bouncing in his chair and displaying fidgety movements. He was praised 3 times for his work and was redirected to task 4 times. Throughout the observation Randy was noted to be on task 72% of the time while his peers, observed in rotating order, were on task 97% of the time. Randy was off task 28% of the time during which he was looking about the room (10%), playing with an object (10%), paging through a book (4%), out of his assigned work area (2%), and talking with peers (2%). Following the observation Mrs. Schroeder commented that his behavior was not typical of most days. She noted that his class participation often varies but that he does not typically display the fidgety behaviors or noisemaking. Randy is at times resistant to participating in class activities; generally he does not verbalize this but produces it in his drawings where he might write "this sucks" next to his drawings. VALIDITY Were the evaluations administered valid for the student? YesWere the evaluations administered valid for the purpose to which they were intended? Yes Is the lack of educational performance the result of:A lack of appropriate instruction in reading, including the essential components of reading instruction? NoA lack of appropriate educational instruction in math? NoLimited English proficiency? No PRESENT LEVEL OF PERFORMANCE Randy is a nine year old fourth grade student referred for evaluation due to behavior difficulties. This evaluation found him to have scattered intellectual functioning, with high average to superior skills demonstrated in spatial and verbal tasks, respectively. Randy's performance on nonverbal reasoning tasks was considerably less developed and fell within the lower extreme of an average range. These tasks included visual sequencing and patterning as well as abstract visual reasoning. Academically, formal testing revealed skills ranging from average to superior. Randy demonstrated a strong sight word vocabulary as well as comprehension skills. He was able to solve a variety of calculation and word problems and could produce writing with complete sentences and added detail. At times Randy's lack of attention may have interfered with his performance; particularly with respect to his math fluency and work on the written expression subtests. Parent and teacher interviews are also indicative of strong academic skills; however, it is noted that despite his apparent skill Randy often refuses to complete his work. He struggles with multi-step directions and organization skills, which may be indicative of an information processing deficit, attention difficulties, and/or behavioral issues. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-241

Social/emotional/behavioral assessment reveals significant concerns across multiple areas and settings. The area with the most consistent concerns across settings is Aggressive Behavior. Other areas of concern, ranging from borderline to clinical, include attention problems, oppositional behaviors, anxious/depressed, withdrawn/depressed, and social problems, as indicated through rating scales, observations, and interviews. A functional behavioral assessment revealed work refusal as the primary target behavior. This includes drawing, sitting without working, and when held to task, escalating behaviors that include yelling and throwing things. These behaviors occur when Randy is requested or directed to complete a task and appear to provide a means for him to avoid an undesired task. This appears to be a performance deficit for Randy. These behaviors have been noted to various degrees since kindergarten, with an escalation indicated in third grade. Randy has no identified health, medical, or sensory disorders that are known to contribute to his school difficulties. ELIGIBILITY DETERMINATION Emotional/Behavioral Disorder:According to Minnesota Special Education rules, a is eligible for special education and related services when the student meets the criteria described in items A, B, and C. Randy's evaluation documents: A) An established pattern of emotional or behavioral responses which is significantly different from peers in the area of aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, as documented by clinically significant scores on the Achenbach. B) The patterns of emotional or behavioral responses adversely impact educational performance and result in Randy's inability to demonstrate satisfactory social competence that is significantly different from age, cultural or ethnic norms and a pattern of unsatisfactory educational progress which is not primarily the result of intellectual, sensory, physical, health, cultural or linguistic factors, illegal chemical use, autism spectrum disorders, or inconsistent educational programming. This is evidenced by rating scale scores, interviews, and observations. C) Prior interventions have been unsuccessful in improving Randy's behavior. The combined results of prior documented interventions and evaluation data for the student establish significant impairments in the following areas: academic and social skills. The above documented behaviors severely interfere with Randy's or other students' educational performance, consistently occur at home and across school settings (classroom, reading class) and have occurred since kindergarten, as documented on his report cards. This evaluation included standardized, nationally normed behavior rating scales, individually-administered tests of intellectual ability and academic achievement, three systematic observations, a record review, interview with parent, student, and teacher, health history review procedures, a functional behavior assessment, and a mental health screening. In summary, based on the results of this evaluation, Randy meets eligibility criteria for an Emotional/Behavioral Disorder. This disability adversely impacts Randy's performance in the general education setting as evidenced by the following:

The presenting problem or behaviors of concern have not been responsive to general education interventions.






EDUCATIONAL NEEDS THAT DERIVE FROM THE DISABILITYAreas of specially designed instruction needed: Behavior: increase compliance with adult directives and school wide behavioral expectationsSocial Skills: increase social interaction skillsIndependent Work Skills: increase time on task, increase work completion


FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA) DEFINITIONMinnesota Rule 3525.0200, Subpart 3a. defines a functional behavioral assessment (FBA) as follows:“Functional behavior assessment means a process for gathering information to maximize the efficiency of behavior supports. An FBA includes a description of problem behaviors and the identification of events, times and situations that predict the occurrence and nonoccurrence of the behavior. An FBA also identifies the antecedents, consequences, and reinforcers that maintain the behavior, the possible functions of the behavior, and possible positive alternative behaviors. An FBA includes a variety of data collection methods and sources that facilitate the development of hypotheses and summary statements regarding behavioral patterns.”

An FBA must be written in the following circumstances:


The district continually or repeatedly uses any element of its discipline policy to respond to the child’s behavior

A regulated intervention is uses in an emergency twice within 90 days or is considered for use or before inclusion of the IEP or is used as part of the program in which a child is placed, or

A peace officer restrains or removes a child from a classroom, school building, or school grounds at the request of a school administrator or staff person during the school day twice in a 30 day period.

FBA is a process of gathering information to develop and utilize positive behavioral interventions and supports and other strategies. When a district conducts an FBA, it must prepare a written report including the following:

A description of the target behaviors and their frequency, severity, and duration A description of the events, times, and situations that predict the occurrence and

nonoccurrence of the target behaviors A description of the antecedents, consequences, and their reinforcers that maintain

the target behaviors A description of apparent functions of the target behaviors and possible appropriate

replacement behaviors Documentation that the team has considered other treatable causes for the target

behaviors, including a mental or physical health condition A description of the positive behavioral interventions and supports and other

strategies used in the past and effectiveness of each Summary statements and hypothesis about the purposes of the target behaviors that

will assist in the development of the child’s behavioral plan A description of any other evaluation data, if available, that assists in the development

of an appropriate behavioral intervention plan for the child, and An evaluation of any proposed regulated intervention to determine that it is not

contraindicated for mental or physical health reasons. The IEP team must consider the appropriateness of regulated interventions with regard to the severity of the target behavior, the effect of current medications, available medical and psychiatric history, the student’s chronological and developmental aged, physical size, and available personal history, including any history of physical or sexual abuse, in order to determine whether the regulated intervention is contraindicated.


ROCHESTER FUNCTIONAL BEHAVIORAL ASSESSMENT FORM DIRECTIONS

Prioritize one or two behavior(s) that will be the focus of the assessment and intervention plan.

Choose the behavior that most interferes with the student’s functioning in the school environment. Be specific and describe the behavior in measurable and observable terms. If two behaviors are chosen be sure to address each one on a separate form.

This form is to be completed by a member of the FBA team, and should include information from other team members. This is often filed out by the special education teacher in conjunction with general education teachers or staff.

Identifying Information Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-244

Fill out identifying information as well as summarize the concerns that have lead to the Functional Behavior Assessment.

Briefly summarize the present problems: Hayden is completing little or no school work, and no outside class work. When asked where his homework is, he often deflects the conversation to what others haven’t done or asks about a topic not related to the work. Hayden may say that it’s in his locker and will spend 20-30 minutes looking and return without the work, reporting his mother must have taken it out of his backpack. Seldom does he admit to not doing the work. In class he may sit quietly and not complete work, however when pushed he will become disruptive, storm out of the room or cry. Hayden seldom takes responsibility for the disruption and sees it as teacher’s picking on him.

Prosocial Behaviors Briefly describe what the student is doing well, include where these behaviors are occurring

and what reinforces them. Identification of Target Behaviors

Describe each behavior that interferes with the student’s functioning in the school environment. Be specific and describe the behavior(s) in measurable and observable terms. The behaviors identified will be the focus of the assessment and intervention plan. Give definition to words such as defiance, verbal aggression, etc. what does it look like for this student.

Target Behaviors: Hayden’s noncompliance is defined as refusal to comply with adult requests and directions through banter, crying, grabbing peers’ possessions, swearing, saying “no”, changing the subject and fleeing the situation. These situations are most often in response to work requests. If ignored in the classroom his noncompliance is silent and will last the entire class period if not prompted to move forward with his task.

Estimate or directly observe the frequency (how often), the intensity (high, medium, low), and the duration (for how long does the behavior last) of the target behavior. Gather anecdotal as well as data on how often the behavior takes place, where and the intensity level. Data reporting office referrals, time outs, times sent out of the classroom as well as suspension will be helpful in completing this area.

Frequency Intensity Duration 3-4 times a week; averages 2 office referrals a week and two time outs in special education setting a week

Fleeing the room has been reported three times in the last month– otherwise he remains non compliant in the classroom.

his verbal refusal usually lasts 5-8 minutes unless an adult can redirect him 1:1 sooner

Indicate where, when, and with whom the target behavior is most likely to occur:

Location(s) Time(s) Person(s) classrooms Periods 1, 2, 3, 6, 7, & 8 Teachers/paras

Successful StrategiesAn important part of the process is to determine what has been tried and what is successful or has been successful in the past. Do not discredit the success of a plan no matter how short it worked, all past information helps map where to go now.

Indicate what strategies are currently employed to prevent the target behavior: Hayden is praised for attempts at tasks and graded on work completed; he is given points hourly on a chart to provide him with frequent input on his performance and completion; Hayden also has an opportunity twice a day to earn a “reward” for his points earned, as well as frequent communication with parents via email and phone conversations.


Social Conditions/Antecedents/ConsequencesIdentify any settings or events that are already predicted to be antecedents. Often times looking at data shows patterns we hadn’t thought of, i.e. it frequently happens on Mondays before lunch.

If possible, identify any setting events that precede the target behavior (e.g., conflict with peer or adult, lack of food or sleep): teacher asking him individually where his work is or requesting he get on taskAs a team go through the list of social conditions, triggers and consequences- this is based on anecdotal information, hunches as well as data collected. Note that consequence refers to what happened as a result of and not necessarily in terms of punishment. Use the option at the end of each column for other if needed. When writing the checklist personalize the items in the list i.e. small group instruction may refer to a speech/language group or social skills group.

Social Conditions Triggers/Antecedents Consequences/Reinforcers

Function of the BehaviorIn determining the function of the behavior our form has four options for function categories,

however MDE has a longer list, and our form does have room for other. Do not feel confined by the options on the page. Possible options: Attention, Gratification, Power/Control, Self-Protection, Justice/Revenge, Acceptance, Tangible Reward, Access to objects, Avoid a task/event, Sensory Stimulation, Expression of Self, or Inadequacy/Avoidance.

Function of Behavior: From the list below, indicate possible functions of the target behavior (What is the student getting or avoiding by engaging in the behavior(s)?) Multiple motivations may be involved.

REVENGE POWER/CONTROL Get back at teacher XX Control classroom activity

Get back at peer Control adult

Get back at parent Control peer

Get back at school Control time on task/work output

Other: Other: Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-246

XX Independent seat work XX Demand/Request XX Behavior ignored Whole group instruction

XX Difficult task Reprimand/Warning

XX Small group instruction

Transition (task) XX Time-Out

Individual instruction Transition (setting) XX Loss of incentive/privileges Crowded setting Interruption in routine XX Sent to office

XX Unstructured activity Negative social interaction

Communications home

Unstructured setting Consequences imposed Removal/Suspension

Transition time Lack of social attention Peer attention/approval

O t h e r : Other: Other:

ATTENTION INADEQUACY/AVOIDANCE Gain adult attention XX Avoid demand or request

Gain peer attention XX Avoid activity or task

Gain time with preferred adult Avoid a person

Other: Escape classroom

Escape school

Other: Hypothesis Statement

It is important that the hypothesis statement includes input from all team members and considers information from parents and other evaluators. The directions on the form give you a format for such a sentence. Once a hypothesis is made it needs to be determined if it is a skill or performance deficit.

HYPOTHESIS STATEMENT: ([Student] is doing [target behavior] in order to [function].) Hayden uses noncompliance (banter, crying, verbal defiance) as a means of task avoidance and to gain power and control over his educational setting and academic tasks.

If the team indicates that the target behavior is due to a Skill Deficit (and instructional issue) then the student MUST be taught the skill set—and that should be addressed as an IEP goal.

If the team determines that the function of the behavior is a Performance Deficit (a motivational issue) then a positive behavior support needs to be set up to increase performance. This behavior can be attributed primarily to a:

Once the function and hypothesis have been established the team needs to determine what could be used to increase positive student behavior. Items from this list often translate into part of the Behavior Intervention Plan.Suggest preferred items, activities, or people that could be used as incentives in an intervention for this student (What can be used to increase positive student behavior?): On task tape to randomly reward him for time on task; modified grading on work completed, shortened outcomes, token economy system based in resource room giving daily points for work completed, time on task and independent work attempts Hayden is responsive to a visual lists of tasks to be completed and a mini-schedule may be established for particular routines and/or tasks. Hayden is also responsive to praise and adult interaction which may be used for task completion and encouragement.

What to include in the Evaluation Report:When writing the report summary be sure to include the items listed. All parts of the interview form need to be addressed in the summary and not just the A-B-Cs of the behavior. Summarize district FBA form: Prosocial Behaviors, Target Behavior, Frequency & Intensity, Setting Events (Social Conditions, Triggers/Antecedents, and Consequences/Reinforcers), Identify the Function of the Behavior, Hypothesis Statement, Skill/Performance Deficit, and Suggestions for BIP. Please remember: District


Skill deficit (This is mainly an instructional issue.)

The student does not have the necessary skill to perform desired behavior.

XX Performance deficit (This is mainly a motivational issue.)The student has the necessary skill to perform desired behavior, but fails to do so.

form is an assessment tool and should be placed in the cumulative folder with all other protocols!


EXAMPLE: ROCHESTER FUNCTIONAL BEHAVIORAL ASSESSMENT FORM

ROCHESTER PUBLIC SCHOOLSROCHESTER MN

FUNCT IONAL BEHAVIORAL ASSESSMENT

Student Name: SAMPLE Date of Birth: School: Date:

Participants:

Briefly summarize the present problems: Hayden is completing little or no school work, and no outside class work. When asked where his homework is, he often deflects the conversation to what others haven’t done or asks about a topic not related to the work. Hayden may say that it’s in his locker and will spend 20-30 minutes looking and return without the work, reporting his mother must have taken it out of his backpack. Seldom does he admit to not doing the work. In class he may sit quietly and not complete work, however when pushed he will become disruptive, storm out of the room or cry. Hayden seldom takes responsibility for the disruption and sees it as teacher’s picking on him.

Prosocial behaviors:What does the student do well?

Where does it occur?

What reinforces these positive behaviors?

Very personable with adults, interacts often and helpful-- asks how to help adults in the classroom: put down chairs, pass out papers

All classrooms except for science.

Teachers praise him for his efforts and helpfulness.

Identification of Target Behaviors: Describe each behavior that interferes with the student’s functioning in the school environment. Be specific and describe the behavior(s) in


measurable and observable terms. The behaviors identified will be the focus of the assessment and intervention plan.

Target Behaviors: Hayden’s noncompliance is defined as refusal to comply with adult requests and directions through banter, crying, grabbing peers’ possessions, swearing, saying “no”, changing the subject and fleeing the situation. These situations are most often in response to work requests.

Estimate or directly observe the frequency (how often), the intensity (high, medium, low), and the duration (for how long does the behavior last) of the target behavior:

Frequency Intensity Duration 3-4 times a week Fleeing the room has been

reported three times in the last month– otherwise he remains non compliant in the classroom.

his verbal refusal usually lasts 5-8 minutes unless an adult can redirect him 1:1 sooner

Indicate where, when, and with whom the target behavior is most likely to occur:Location(s) Time(s) Person(s)

classrooms Periods 1, 2, 3, 6, 7, & 8 Teachers/paraprofessionals

Indicate what strategies are currently employed to prevent the target behavior: Hayden is praised for attempts at tasks and graded on work completed; he is given points hourly on a chart to provide him with frequent input on his performance and completion; Hayden also has an opportunity twice a day to earn a “reward” for his points earned, as well as frequent communication with parents via email and phone conversations.

If possible, identify any setting events that precede the target behavior (e.g., conflict with peer or adult, lack of food or sleep): teacher asking him individually where his work is or requesting he get on task

From the list below indicate the social conditions when the target behavior occurs, and what triggers them (antecedents). Identify the resulting consequences that seem to be reinforcing the current behavior (Consequences may be imposed by an adult or they may naturally occur as a result of the behavior):

Social Conditions Triggers/Antecedents Consequences/Reinforcers

XX Independent seat work XX Demand/Request XX Behavior ignored Whole group instruction XX Difficult task Reprimand/WarningXX Small group instruction Transition (task) XX Time-Out Individual instruction Transition (setting) XX Loss of incentive/privileges Crowded setting Interruption in routine XX Sent to officeXX Unstructured activity Negative social interaction Communications home Unstructured setting Consequences imposed Removal/Suspension Transition time Lack of social attention Peer attention/approval Other : Other: Other:


Function of Behavior: From the list below, indicate possible functions of the target behavior (What is the student getting or avoiding by engaging in the behavior(s)?) Multiple motivations may be involved.

REVENGE POWER/CONTROL Get back at teacher XX Control classroom activity Get back at peer Control adult Get back at parent Control peer Get back at school Control time on task/work output Other: Other:

ATTENTION INADEQUACY/AVOIDANCE

Gain adult attention XX Avoid demand or request Gain peer attention XX Avoid activity or task Gain time with preferred adult Avoid a person Other: Escape classroom

Escape school Other:

HYPOTHESIS STATEMENT: ([Student] is doing [target behavior] in order to [function].)

Hayden uses noncompliance (banter, crying, verbal defiance) as a means of task avoidance and to gain power and control over his educational setting and academic tasks..

This behavior can be attributed primarily to a: Skill deficit (This is mainly an instructional issue.)

The student does not have the necessary skill to perform desired behavior.XX Performance deficit (This is mainly a motivational issue.)

The student has the necessary skill to perform desired behavior, but fails to do so.

Suggest preferred items, activities, or people that could be used as incentives in an intervention for this student (What can be used to increase positive student behavior?): On task tape to randomly reward him for time on task; modified grading on work completed, shortened outcomes, token economy system based in resource room giving daily points for work completed, time on task and independent work attempts Hayden is responsive to a visual lists of tasks to be completed and a mini-schedule may be established for particular routines and/or tasks. Hayden is also responsive to praise and adult interaction which may be used for task completion and encouragement. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-250



EXAMPLE: FUNCTIONAL BEHAVIORAL ASSESSMENT REPORT (FBA)

REASON FOR REFERRAL Mauve was referred for functional behavior assessment (FBA) given her frequent agitation and self-injurious behaviors. This report contains information relevant to the FBA. Please refer to the comprehensive evaluation report dated 2-14-08 for additional information.

BACKGROUND INFORMATION REVIEW OF EXISTING INFORMATION: Z, Special Education Teacher Review of Records: Mauve initially began receiving services in July, 2000. There is no record of behavioral concerns while in ECSE. Mauve was re-evaluated for Special Education in May 2003. Her teacher reported that Mauve did occasionally bite or pull hair of others when upset. File review from May 2004 stated that Mauve only bites others when mad. Mauve was re-evaluated in 2005 and the parents stated concern with Mauve's on-going biting and pulling hair of others at home. They also stated that Mauve engages in self-injurious wrist biting when upset. Her teacher reported that staff needs to respond to Mauve's immediate needs or she will become upset and agitated, which includes biting her wrist and vocalizing loudly. Mauve was re-evaluated for special education in 2008. The teacher stated that Mauve had episodes of agitation with sometimes aggressive behaviors towards herself and others. On these occasions Mauve became restless, vocal, and will move her body all over. When presented with a calming activity or being wrapped in a blanket and rocked, Mauve would calm down most of the time, but there were occasions that despite a variety of calming activities tried, Mauve's agitation continued and escalated to the point where mom was called to pick her up. The teacher stated when Mauve is agitated she will cry loudly, grab at others and may attempt to pull hair, bite or grab at staff's face/neck when very upset. Some days just after lunch Mauve would become very agitated. During these times of agitation Mauve is observed to burp and pass gas frequently. Her body becomes very tense and stiff and she becomes very aggressive (grabbing at adult's hair and clothing and rocking head backwards into adult's face/chest.) Mauve was observed from January 3rd- January 11th ( 7 days) for signs of stomach pain, gassiness along with aggressiveness. She was observed to have the symptoms of gas, tensing of the stomach and aggressiveness after lunch 4/7 days. Parents reported that Mauve does have problems with constipation and irregular sleep. LANGUAGE/RACIAL/CULTURAL FACTORS: Mauve is Caucasian and from a family whose only language is English. There are no known language/racial/cultural factors that would negatively impact this evaluation. PARENT INFORMATION: Z, Special Education TeacherParent Interview: Mauve's mother was interviewed on 5/21/08 by Mauve's special education teacher. Mom stated that her biggest concern with regards to Mauve's behavior in the home is her hitting herself. She would like to see Mauve stop with injuring herself and trying to injure others. Lori stated that Mauve does not bite her knuckle as often as she used to and her knuckle is healed up most of the time. Mauve has exhibited fussiness and aggression to herself or others ever since she was an infant. In her mother’s opinion, Mauve exhibits her self injurious behavior of hitting herself when she is frustrated, to get attention, or Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-252

when she is tired. Mom said they don't always do something about it, but when they do they will try and stick their hand in between her hand and her face, or put Mauve in her bed and put a blanket on her and sometimes she will fall asleep. Lori thinks the trigger with the most impact would be her tiredness. Mauve does wake up in the middle of the night or early morning and parents have heard a variety of things coming from her room including screaming, giggling, or pounding on the wall. They will usually leave her be and she eventually is quiet, but it is unsure if she has fallen back asleep or if Mauve is just being quiet in her room. Mauve’s mother stated that circumstances that underlie the behavior might be the fact that Mauve could want to be outside. Also, in the winter when Mauve can't be as active outside, she can become constipated and that issue might trigger her behavior. Lori mentioned that at home sometimes Mauve can be laughing and happy one minute and instantly she will become upset and start screaming and having behaviors, but other times Mauve slowly gets crabby, then exhibits the behaviors. She stated that Mauve goes through fazes where she will have good days at school and be fussy at home, or fussy at school all day and be fine at home. When Mauve is upset at home they use toys, singing, SpongeBob on TV, or put her in her bed to calm her down. Things that are reinforcing to Mauve at home include the radio or any type or music, the tv, a keyboard for her to play, and a special cloth rattle reindeer they have at home. TEACHER INFORMATION: Z, School Psychologist

Teacher Interview: Ms. Z, special education teacher, stated that Mauve has had episodes of agitation and engages in aggressive behaviors towards herself and others. On these occasions Mauve became restless, vocal, and will move her body all over. She will hit herself in the face with her fist, hit her face on a table, and bit her hand/wrist. Mauve will also grab at staff (hair, hands, clothing) and attempt to bite. When presented with a calming activity or being wrapped in a blanket and rocked, Mauve calms down some of the time. Data was kept on Mauve hitting herself in the face with her fist in May, 2008. During 12school days from 5-7-08 to 5-22-08, Mauve engaged in face hitting from 0 to 28 times. The behavior occurred during a range of activities and various settings. A range of activities were successful in calming Mauve, but not consistently calming. Activities that had a calming effect included music, toys, clapping, fan with lights, rocking (held in rocking chair by adult), walking her around in her wheelchair, and feeding. EVALUATION RESULTS AND INTERPRETATION INTELLECTUAL: Z, School Psychologist Date: 2-12-08 The Bayley is a measure of early development and was used to evaluate Mauve's cognitive development in 2/08. While Mauve exceeded the chronological age range of the Bayley, the measure was used informally to obtain an estimate of her cognitive functioning. Mauve demonstrated a mental development age level of 6 months on a 2-12-08 administration of the Bayley Scales of Infant Development-3. . She was visually, auditorily, and physically responsive to items presented during the assessment. Mauve would look, turn, and immediately reach for items. She consistently picked up objects that were presented. Items of interest she typically banged repeatedly on the table (up to 10 seconds) or explored them orally. Mauve readily pushed or dropped items of lesser interest onto the floor. A prior Bayley estimate obtained on 4-7-05 also placed Mauve's cognitive development at a mental age equivalent of 6 months. Review of Records: COMMUNICATION: Z, School Psychologist According to a receptive and expressive communication checklist completed by the parents, Mauve's receptive language skills fall within the 0-6 month range, with a few scattered skills evident in the 6-10 month range. Mauve quiets when picked up and can awaken or quiet to the voice or touch of her caregiver. She inspects her surroundings either visually or by touch. Mauve shows anticipatory Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-253

excitement. She recognizes her parents and other family members and seems to know the difference between familiar persons and strangers. Mauve seems to be aware of the sight, sound, and tactile properties of objects. She distinguishes between friendly, comforting voices or handling versus angry noncomforting voices and handling. Mauve will stop crying when someone attempts to communicate. Mauve will watch or feel the speakers face and will react to facial expressions and voice intensity. She looks/feels/listens for familiar toys/people/objects Review of Records: FUNCTIONAL: Z, School Psychologist The Wisconsin Behavior Rating Scale was completed by Mauve's parents and special education teacher on 1-24-08. Mauve obtained overall adaptive behavior age equivalents of 10.4 by parent rating and 7.1 by teacher rating. Results indicate that Mauve's general adaptive functioning is significantly below her chronological age of 8 years, 0 months HEALTH: Z, Licensed School Nurse (LSN) Health Status: Mauve records indicate that Dr. Whiteman had diagnosed Mauve with autosomal chromosome abnormality, unbalanced chromosome translocation and partial trisomy 15q plus partial momosomy 18q. Hypotonia is considered a prominent feature of the partial monosomy 18q as is evidenced in Mauve.. Mauve exhibits craniofacial dysmorphism that is also characteristic of this genetic condition. Urogenital abnormalities are common which would explain Mauve's vesicoureteric reflux. Ocular malformations such as nystagmus, optic atrophy can also be included. Mauve has a history of having constipation. According to her mother Mauve is taking medication daily to help with this but in a phone conversation on 09/12/08 mom stated that Mauve has not had a BM all week. Mauve does have a history of seizures and has an emergency care plan in place at school. As of the written of this report Mauve's last known seizure according to mom was June 29th. During a medical exam this summer Mom stated that Mauve's doctors found some "spiky" activity and that the doctors think that Mauve may be having migraines or night terrors. Her seizure medication was increased to see if this would help. Mom took Mauve to the doctor on 09/11/08 because she felt that Mauve had been just laying on her side and that she wasn't responding as usual. The doctor prescribed an antibiotic. SENSORY: Z, Occupational Therapist; Z, School Psychologist Review of Records: Mauve has been seen by Dr. Z from the Mayo Clinic Ophthalmology Department. His report dated December 21, 2005, states that Mauve diagnosis: coloboma which is a keyhole defect of the iris in both eyes; myopia (nearsightedness) which is a refractive error where the image of a distant object is formed in front of the retina and cannot be seen distinctly; and congenital nystagmus which is involuntary rhythmic eye movement. She was prescribed corrective lenses but no acuity was given on this report. The doctor recommended a check up in 2 years from visit. Report dated, December 17, 2003 by Dr. Z, states that her acuity is around 20/200. Medical History: Mauve diagnoses are coloboma, congenital nystagmus, and myopia. Overall, Mauve has a moderate to severe vision loss, which affects the distance from which she can see details and identify printed symbols and objects. Mauve uses a slight head tilt with her right eye focused on the stimuli most of the time. Her near distance is most functional at 12" for objects at midline and/or right side. Presenting objects at near to her left side, she would not locate unless auditory or light stimuli was used. Mauve's distance viewing is most functional at 3-4 feet. Mauve appeared most comfortable with objects that were bright and/or reflective, 4" in size at near, 11" at far. Informal Inventory/Checklist: Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-254

Date: 5/12/2008 Interpretation: A sensory checklist was sent home for Mauve's parents to complete to get a more accurate picture of the types of activities that they see her liking and disliking. In the area of touch, Mauve likes being touched, hugged and cuddled. She kind of likes getting her hands messy with paint, glue, food, lotion and so on. She also kind of likes grooming tasks such as face washing, tooth brushing and enjoys taking a bath. For proprioception, Mauve likes roughhousing, jumping, bouncing, and other types of active play. She likes crunchy or chewy foods and also smooth foods as well. For vestibular sensations, she likes swings, but has mixed reactions to less stable surfaces such as grass, snow, sand and so on. She also kind of likes riding in the car. For auditory, Mauve likes watching TV and listening to music. She has mixed reaction to loud voices, conversations, people singing or a lot of background noise. For visual, Mauve enjoys looking at shiny, spinning or moving objects. She also enjoys areas that are visually stimulating such as the store or a playground. She has mixed reaction to being in bright sunshine or a very dark environment. She responds well to action packed TV, movies or video games. In the area of taste and smell, Mauve has mixed reaction to trying new foods or eating strongly flavored foods. She does well with eating familiar foods. The manner in which Mauve responds to all of these different types of stimulation appear to be the same at home as they are at school. However, Mauve probably has less periods of being upset at home than at school because the environment is easier to control at home. There are instances at school when Mauve could probably benefit from a very calm and quiet space and she might even fall asleep for a short while, but then other students return and disrupt the quiet time. Mauve then gets agitated, but the other students need to be there. Programming for Mauve needs to be based on her behavior at any given time, and also trying to prevent her becoming agitated in the first place, because once she gets upset, it is quite a challenge to help her return to being calm.

SOCIAL/EMOTIONAL/BEHAVIORAL: Z, Occupational Therapist; Z, School Psychologist; Z, Special Education Teacher Review of Records: Please refer to Background Information section of this report. Informal Inventory/Checklists:

Date: 5/8/2008

Interpretation: The Motivation Assessment Scale was completed by the Occupational Therapist and Mauve's special education teacher to try to determine why she may be doing self-abusive behavior such as hitting her chin either with her fist or hitting her chin on the table. There are four areas that are possible rationale for the behavior: Sensory, Escape, Attention and Tangible. The first area is Sensory which means that Mauve is hitting her chin for the sensory experience that it provides her. Escape refers to a student exhibiting a certain behavior to get out of certain tasks or expectations. Attention refers to the student exhibiting the behavior in order to gain attention from the parent or staff and Tangible refers to the student doing the behavior to gain something like a toy or a food item. Mauve's total scores were as follows: Sensory she scored a 7, Escape she scored a 15, Attention she scored an 8, and Tangible she scored a 16. This seems to indicate that the most likely reason that Mauve is engaging in self-abusive behavior is to either escape a situation or gain something tangible such as a toy or a food item. But there may also be times when she is also trying to gain attention or simply providing herself with experiences because of being under aroused. Often what is observed is that Mauve's behavior begins to decline right after she is finishing her lunch at around 12:30 and 1:00. It appears that this could be because of several different reasons. First, it may be that Mauve is starting to get tired at that time. She often appears to have droopy eyes and seems to be fighting falling asleep. She may be experiencing an upset stomach after eating as she often becomes very gassy after her meals. And it also appears that sometimes she is upset because she is so hungry and she is being required to try and hold the spoon and bring it up to her mouth herself. It may be that she just wants to be fed rather than have to work to get her food. At other times during the day when she is exhibiting this behavior, it seems as if she is either under or over aroused and she is trying to express frustration, provide herself with some stimulation or even to get attention from staff to provide more stimulation. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-255

OBSERVATIONS: Z, School Psychologist; Z, Special Education Teacher Date: 5-27-08Time: 12:23-12:57pm (34 minutes)Observed by: Z, School PsychologistSetting: Art class, special ed classroom

Mauve was seated in her wheelchair at an art table with a paraprofessional and three peers. The para was assisting Mauve with hand-over-hand pottery painting. Mauve was humming and tolerated the hand-over-hand painting for 2 minutes. Mauve reached to hold the para's hand and then licked the table. As the para finished the painting, Mauve attempted to bitr the para's wrist (she did not appear agitated) and then licked the table. Mauve tried to put her own hand in her mouth and when the para stopped her, Mauve quickly licked the table. Mauve held the para's hand and was calm. She turned to watch students who were moving about the room and becoming noisier. Mauve began making loud vocalizations, yelled and displayed an unhappy facial expression. Mauve continued to reach for the para's hand and repeatedly attempted to lick the table. Mauve became increasingly agitated and engaged in self-injurious/aggressive behavior during a 12 minute period of time in art. She hit her mouth with her fist 4 times, hit her chin with her fist 4 times, tried to bit the para 2 times and tried to lick or licked the table 14 times. When the para directed verbalizations to Mauve, Mauve's agitation consistently intensified (eg. she yelled louder, hit harder, etc.) Given Mauve's agitation, the para returned to the special ed room early with Mauve. Mauve calmed just leaving the art room and was content for 2 minutes watching a music toy on the floor. Mauve was assisted to a Rifton chair and presented with a light box and gel sheets. Mauve inconsistently tapped and pushed on the gel sheets. Some quiet background music was playing. After 4 minutes, Mauve became agitated and began yelling. She was assisted to the floor and scooted on her knees to sit with a para in a rocking chair. Mauve fell asleep 2 minutes into rocking while wrapped in a blanket sitting in the para's lap.. Overall, Mauve appeared to get overstimulated in the art room setting when there was more noise and activity in the class as students finished their projects. Mauve gave clear signs (vocalizations, facial expressions, and body language) that she was growing agitated. Mauve's agitated behavior consistently intensified when verbal comments were directed to her. Ignoring and redirecting Mauve's behavior was not successful. Once agitated, she did not calm until she left the setting. Date: May 28th, 2009Time: 9:30-9:50am Observed by: Z, Special Education TeacherSetting: Occupational Therapy session with OT para At the beginning of Mauve's Occupational Therapy session, the para put wrist weights on Mauve's wrist to see if Mauve would exhibit a calm response while working on a task. Immediately Mauve began biting/licking at the weights. The para assisted Mauve in taking her wrists with weights on away from her mouth two times. It was obvious that Mauve wanted the weights off. She then began hitting herself in her face and the weights on her wrist were taken off. Next, the para took out a peg board and the task was for Mauve to remove the pegs one by one from the board. Mauve would grab for a peg, but remove her hand and try to grab at the para's wrist holding the pegboard down. She tried licking the board and tray numerous times during the task. Eventually she got upset that the para was removing her face from licking the board and began hitting herself in her face. The para made Mauve remove one more peg and she was done with the task. She was reinforced after task by hand squeezes and clapping which Mauve really enjoyed and showed excitement by laughing and clapping too. She was very calm while her hands were being rubbed. Next, 2 puzzles we presented to Mauve. The para gave her prompts to make a choice on which puzzle she wanted by reaching. Mauve would not reach for a puzzle, so the para made the choice. Mauve seemed uninterested in the puzzle and began licking tray and puzzle. Mauve quickly scooped up puzzle Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-256

and threw it off the tray. Puzzle was put back on the tray and the para would slam the puzzle pieces on the tray to make a noise that caught Mauve's attention. When Mauve looked up, she was then assisted, hand over hand to grab the puzzle piece and put it in the correct spot. Mauve completed the puzzle with hand over hand assistance and received more hand massaging when the task was done. Lastly, a musical toy was presented and Mauve activated it independently and sat in a daze as she listened to the music. When the music would turn off, she would re-activate the and sit calmly, listening to the music. After about 3 minutes with the toy, she began screaming and grabbing for the para's wrist. She quickly became very agitated, so she was put on her tummy on the flat swing in the OT room. She began to laugh and laugh. She preferred a rough, unsteady, twisting action on the swing over a smoothly, steady push. She swung for about 5 minutes and ended her OT session in a calm manner. Mauve was licking all the items throughout the session, including the tray where all the tasks were placed. She was observed 16 times, licking tray/task items. She was pleased with certain items for awhile, but after a few minutes with the same task, became upset and agitated. The hand massages seemed to be the most calming activity for Mauve and she was also very content with the rough swing ride. Date: 9/2, 9/3, 9/4, 9/8 and 9/9/08Time: VariousObserved by: Z, Special Education TeacherSetting: Special ed classroom Mauve was also observed the first five days of the new school year - 9/2, 9/3, 9/4, 9/8, and 9/9 of 2008. Her behavior is consistent with what was observed last year. She does well in the morning and her fussiness is observed in the afternoon, after she has eaten. She becomes irritable, vocal, grabbing at staff, and hitting herself in the face with a fist. She seemed extremely tired, but there is so much going on in the room, she will not rest. The activity that consistently calmed her the first five days of school was to take her for a walk either around school or outside. Date: 9-12/08Time: 10:30 - 11:00am (30 minutes)Observed by: Z, School PsychologistSetting: Special Ed Classroom Mauve was kneeling on the floor mat in the the special education classroom and was clearly agitated. She was yelling, grabbing at staff members' hair and trying to bite. The teacher escorted Mauve to a bean bag chair and played a music CD that Mauve prefers (Parachutes). Mauve immediately calmed and laid back in the bean bag chair for 2 minutes. She sat up and clapped to the music for another 2 minutes. Mauve began rocking her upper body side to side to the music and clapped her hand for 2 more minutes. When the music was turned off, Mauve sat quietly for 2 minutes and waited. She grabbed at the para seated nearby and was helped to a standing position at the table. Mauve reached for a Sesame Street book that was on the table and looked at it briefly. Mauve was assisted into her wheelchair for a group story time. Mauve immediately began grabbing aggressively at a para seated next to her. When Mauve's hands were redirected she pushed herself away from the table and began hitting her mouth with her hand. The teacher moved Mauve away from the group and presented her with shaker toys. Mauve held one for a a few seconds and then tossed it. Mauve began yelling and a para began pushing Mauve's wheelchair in a circle around the classroom. Mauve continued to yell intermittently. When the para verbally responded (eg. "You're alright), Mauve consistently yelled louder. Mauve briefly cried and attempted to bit her hand while being pushed. Mauve calmed when she was taken outside with the other students for break time. In summary, Mauve was agitated during much of the observation and engaged in some aggressive behaviors. A preferred music tape had an immediate calming affect and motion (in wheelchair) was also calming to a certain degree. Verbalizations directed at Mauve when she was agitated seemed to result in more agitation. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-257

Functional Behavioral Assessment: Z, School Psychologist

Upon reviewing the data in this report which was gathered through record review, observations, interviews, rating scales, etc. the team finds the following: Mauve is a severely multiply impaired student with all aspects of her development significantly impacted. Given Mauve's level of functioning, she is a complete-care student in regard to her personal, ambulation, and safety needs. She requires a pervasive level of support throughout the school day.

Target Behavior: Mauve engages in self-injurious behavior (SIB) and aggressive behavior when agitated. Mauve will hit her face with her hand or hit her face on a table. She will attempt to grab at others (hair, arms, clothing) and bite. During a 12 school day period in May 2008, Mauve engaged in or attempted to hit herself in the face 9 of 12 school days and did not engage in the behavior 3 of the 12 days. Frequency counts range from 1 to 28 times. Daily frequency counts for face hitting were 8, 2, 0, 11, 9, 28, 0, 0, 4, 7, 3, and 19. The SIB occurred during a variety of activities as well as settings. These included opening, stander, lunch, transitions, music, playground, group time, bathroom, sensory time, walking outside, and bus line. No particular pattern was noted regarding activities or settings in the data. On the days with higher SIB occurrences, the behavior occurred during multiple activities. In general, Mauve can become more agitated if she is under-stimulated or overstimulated or does not appear to be feeling well. Function of the Behavior: Given Mauve's the severity of Mauve's multiple impairments, her agitation and behavior is her way of conveying that something is not right. Possible factors that may impact Mauve's level of agitation are the level of stimulation (too little or too much), activity level (sedentary versus motion), hunger, thirst, and possible discomfort from somatic issues (eg. gas, constipation, urinary tract infections, migraines, lack of sleep, general illnesses). Positive Behavior Supports: All staff working with Mauve should be of the understanding that Mauve's agitation is her only way of telling staff that something is not right. It is the staff's responsibility to try and figure out what is wrong and how to improve her current state of being. When Mauve is happy, she laughs out loud and shows definite pleasure. Hopefully, with a carefully planned day with a lot of stimulation built in, she can have more opportunities for laughter and enjoyment while in school and fewer periods of being agitated and unhappy. 1) Staff should try to observe Mauve's body language and determine when she is beginning to show signs of agitation. Try to figure out what she needs before her behavior escalates or it will be very challenging to get her calmed down again. 2) Allow many opportunities for Mauve to be out of her wheelchair throughout the school day. She seems to prefer being active to sitting in her wheelchair for long periods of time. 3) Provide opportunities for sensory rich activities throughout Mauve's school day. A long list of ideas can be provided to special education paraprofessionals and teachers to be implemented. The OT is available for sensory consultation. It is important to make notes on how Mauve reacts to all activities and look for patterns of activities that she responds positively to. It is likely that she may react well to an activity one day, and then act negatively to the same activity the next. It is important to be able to read Mauve's reactions and adjust activities to get positive responses. Each activity may need to be brief, but again, it depends on how she reacts. Currently, Mauve has preferred music and motion activities (swing, hammock, wheelchair walk) that have a calming effect on her. 4) According to the parent's checklist and observations at school, Mauve benefits from intense sensory input the most. She likes a lot of proprioception with pressure touch and quick movements. She also responds to visual stimulation as well. Some of the activities may be more physically demanding for staff to carry out, so having many different staff involved with her care may help ensure responsibilities are shared. For example, it may require two staff to help with putting Mauve on the swing. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-258

5) Mauve seems to begin more self-injurious behavior when having periods of inactivity or when overstimulated. Evaluate the environment and try to determine if she needs more calm and quiet time or more increased activity when she begins to exhibit these behaviors. Replace the SIB with something else, but never allow her to continue hurting herself. 6) Allowing Mauve to have a small snack in the morning may help to keep her from being so hungry at lunch that she is resistant to working on self-feeding. Perhaps more small meals throughout the day will keep her from getting an upset stomach and increased gas as well. 7) Perhaps Mauve could try eating lunch in the cafeteria. She may be so interested in what is going on around her, that she will be less agitated. So far, she has enjoyed times when she is around a lot of kids and noise. 8) Allow for more frequent time in the walker and outside time. Mauve is rarely agitated when she is outside. 9) Allow time for staff working with Mauve to meet periodically to discuss activities that are working well and those that are not. Some staff members may have ideas for calming that others are not aware of and would benefit from knowing. 10) Give praise for periods of time when Mauve is calm and quiet. 11) Mauve's schedule and day should be modified to exclude activities/settings that are clearly overstimulating/agitating to her. The schedule continues to require maximum flexibility so there are other planned options should Mauve not be tolerant of an activity on a given day. 12) Any physical symptoms should be communicated between school and home in a timely manner to ensure that any possible discomfort from somatic issues (eg. gas, constipation, urinary tract infections, migraines, lack of sleep, general illnesses) can be readily addressed. 13) Ongoing data-keeping in regard to target behaviors, Mauve's response to activities/settings, and physical symptoms/health issues may be beneficial in trying to identify a relationship between Mauve's agitation and other factors.

SUMMARY AND RECOMMENDATIONS Results of the functional behavior assessment indicate that Mauve's general level of development (severe deficit with multiple disabilities) is a factor in her behavior functioning given that her communication skills are significantly delayed. Currently, Mauve's agitation, self-injurious behavior, and aggressive behavior is her only way of conveying to staff that something is not right. As documented in the most recent comprehensive evaluation report dated 2-14-08, Mauve met eligibility criteria for both Developmental Cognitive Disability -Severe/Profound Range (DCD-SP) and Visual Impairment (VI). Given that dual identification, she met eligibility criteria for a primary disability of Severely Multiply Impaired (SMI). Please refer to the report dated for specific eligibility criteria information and needs statements.



BEHAVIOR INTERVENTION PLAN (BIP) OUTLINE

Identification of Target Behaviors - describe each behavior that interferes with the student’s functioning in the school environment. Be specific and describe the behavior(s) in measurable and observable terms. The behaviors identified will be the focus of the assessment and intervention plan.

Replacement Behavior - What behavior(s) or skill(s) do we need to directly teach the student? Is there an acceptable alternate behavior we can teach for the short term?

Instructional Procedures - How will you teach the replacement behavior(s) and skill(s)? How often? What prompts and cues will be taught?

Environmental Changes - What, if any, changes will be made to the environment in order to support the replacement behavior(s)?

Reinforced Practice - How will opportunities for practice be provided, both in class and out of class? What positive reinforcers will be used for appropriate behavior(s)?

Response to Problem Behavior(s) - What strategies will be used to reduce problem behavior (e.g. redirection, verbal warnings)? What consequences / disciplinary actions will be imposed if behavior(s) continues or escalates? Is a crisis intervention plan needed?

Implementation and Progress - Who will be primarily responsible for implementing the plan? Date of implementation. Who will be primarily responsible for monitoring progress? Describe data recording and progress monitoring procedures to be used.

Plan Evaluation - How many weeks was the intervention applied? Indicate student

progress towards identified goals. Indicate the extent to which the intervention was implemented and designed.

Plan Revisions (if necessary )- Date and reason for revisions



EXAMPLE: BEHAVIOR INTERVENTION PLAN (BIP)

IDENTIFICATION OF TARGET BEHAVIORS: Describe each behavior that interferes with the student's functioning in theschool environment. Be specific and describe the behavior(s) in measurable and observable terms. The behaviors identified will be the focus of the assessment and intervention plan.Hayden’s noncompliance is defined as refusal to comply with adult requests and directiors through banter, crying, grabbing peers possessions, swearing, and fleeing the situation. These situations are most often in response to work requests.

REPLACEMENT BEHAVIOR: What behavior(s) or skill(s) do we need to directly teach the student? Is there an acceptable alternate behavior we can teach for the short term?Hayden needs to learn how to seek out a quiet place when his emotions are out of control. Hayden will be taught how to show a picture describing his emotion to staff and talk about feelings. He needs to learn to regulate his emotions and respond accordingly. Hayden also needs to learn to respond to teacher directions with little protest or hesitation. In the short term, the staff will provide Hayden with verbal comfort until the taught skills can be applied.

INSTRUCTIONAL PROCEDURES: How will you teach the replacement behavior(s) and skill(s)? How often? Whatprompts and cues will be taught? Hayden will be presented with direct social skills instruction 3 of 5 days in a school week based on attendance. As part of this service time, Hayden will be asked to participate in role playing, discussions, peer coaching, and structured trials of ways to advocate for his academic needs; as well as manage his frustration with tasks in the general education setting. Teachers will arrange a signal with Hayden to alert him to use previously taught coping strategies. Hayden will be instructed on how to use a question card as a nonverbal indicator if he needs assistance.

ENVIRONMENTAL CHANGES: What, if any, changes will be made to the environment in order to support the replacement behavior(s)?The bean bag area will be used for self-calming for HaydenA chair will be placed in a quiet area for Hayden for time away from activitiesPeers will be removed from the room if Hayden is deemed dangerous to them or himself

REINFORCED PRACTICE: How will opportunities for practice be provided, both in class and out of class? What positivereinforcers will be used for appropriate behavior(s)?Hayden will have opportunities to practice appropriate behaviors both within the classroom and while with his peers. Hayden will be given verbal praise and high fives for participating in desired behaviors (participating in group time activities, following directions, playing appropriately with his peers). Hayden will be given desired reinforcements to encourage his participation in acceptable behaviors.

RESPONSE TO PROBLEM BEHAVIOR(S): What strategies will be used to reduce problem behavior (e.g., redirection,verbal warnings)? What consequences/disciplinary actions will be imposed if behavior(s) continues or escalates? Is a crisis intervention plan needed? The strategies that will be used will include:

1) Minor behaviors, banter and mimimal talking back to the teacher will be ignored


2) Verbal redirecting Hayden to another subject of conversation or another area within the room

3) Hayden will be given verbal time warnings and a timer will be implemented4) Hayden will be given “cool down” time when he is upset5) Hayden will be given verbal warnings if he becomes aggressive toward himself,

his peers, or staff members6) If Hayden does not calm down using the self-calming techniques, Hayden will

be given a “time away” IMPLEMENTATION AND PROGRESS: Who will be primarily responsible for implementing the plan? Date ofimplementation. Who will be primarily responsible for monitoring progress? Describe data recording and progressmonitoring procedures to be used. The IEP team will be responsible for implementing this plan. The date of implementation will be December 7, 2007. The case manager is responsible for data collection and monitoring progress through daily point sheets and incident reports.

PLAN EVALUATION: How many weeks was intervention applied? Indicate student progress towards identified goals.Indicate the extent to which the intervention was implemented as designed.


CHAPTER 3J: Deaf-Blind Documentation


STATE GUIDELINES: STUDENTS WITH BLINDNESS

“Student with blindness” means an individual who is eligible for special educational services and who:

A. has a visual acuity of 20/200 or less in the better eye with correcting lenses or has a limited field of vision such that the widest diameter subtends an angular distance of no greater than 20 degrees; or

B. has a medically indicated expectation of visual deterioration.



STATE GUIDELINES: DEAF-BLINDNESS"Deaf-blindness" means medically verified visual impairment coupled with medically verified hearing impairment that, together, interfere with acquiring information or interacting in the environment.

Both conditions (i.e., medically verified visual impairment and medically verified hearing impairment) need to be present simultaneously and must meet the criteria for both vision and hearing impairments.

Students At-Risk for Deaf-Blindness Students at-risk for deaf-blindness include, but are not limited to:

1. Those that are already identified as hearing or vision impaired and have not yet had medical or functional evaluation of the other sense (vision or hearing);

2. Those that have an identified syndrome, such as Usher Syndrome or Rubella Syndrome, that includes a potential deterioration of vision or hearing in the future;

3. Those that have a medically or functionally identified hearing impairment and a verified deficit in vision determined by a functional evaluation in the learning environment; and

4. Those that have a medically or functionally identified vision impairment and verified deficit in hearing determined by a functional evaluation in the learning environment.



DEAF-BLIND CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_____________________________________________Student ID#:_______________________________________Grade:____________ School:_____________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for special education and related services when the student meets the criteria of both visual impairment and deaf and hard of hearing or the conditions outlined in Students at Risk section. Both conditions must exist simultaneously.

Circle OneA Documentation verifies meeting criteria for both disability areas: Yes No

____ Visual Impairment____ Deaf and Hard of Hearing


B. Students at risk1. Are already identified as deaf or hard of hearing or visually impaired

but have not yet had medical or functional evaluation of the other sense.

Yes No

2. Have an identified condition that includes a potential deterioration of vision or hearing.

Yes No

3. Have a medically or functionally identified hearing loss and a verified vision loss determined by a functional evaluation in the learning environment.

Yes No

4. Have a medically or functionally identified vision impairment and verified hearing loss determined by a functional evaluation in the learning environment.

Yes No

OR5. Have an identified syndrome or condition that includes hearing and

vision loss in combination with multiple disabilities.Yes No

Does the student meet the criterion in Item B? Yes No



CHAPTER 3K: Deaf and Hard of Hearing Documentation


STATE GUIDELINES: DEAF AND HARD OF HEARING (D/HH)"Deaf and Hard of Hearing" means a diminished sensitivity to sound, or hearing loss, that is expressed in terms of standard audiological measures. Hearing impairment has the potential to affect educational, communicative, or social functioning that may result in the need for special education instruction and related services.

A student who is deaf or hard of hearing is eligible for special education instruction and related services if the student meets one of the criteria in item A and one of the criteria in item B, C, or D.

A. There is audiological documentation provided by a certified audiologist that verifies one of the following:1) a sensorineural hearing loss with an unaided pure tone average, speech threshold, or

auditory brainstem response threshold of 20 decibels hearing level (HL) or greater in the better ear;

2) a conductive hearing loss with an unaided pure tone average or speech threshold of 20 decibels hearing level (HL) or greater in the better ear persisting over three months or occurring at least three times during the previous 12 months as verified by audiograms with at least one measure provided by a certified audiologist;

3) a unilateral sensorineural or persistent conductive loss with an unaided pure tone average or speech threshold of 45 decibels hearing level (HL) or greater in the affected ear; or

4) a sensorineural hearing loss with unaided pure tone thresholds at 35 decibels hearing level (HL) or greater at two or more adjacent frequencies (500 hertz, 1000 hertz, 2000 hertz, or 4000 hertz) in the better ear.

B. The student's hearing loss affects educational performance as demonstrated by:1) a need to consistently use amplification appropriately in educational settings as

determined by audiological measures and systematic observation; or2) an achievement deficit in basic reading skills, reading comprehension, written

language, or general knowledge that is at the 15th percentile or 1.0 standard deviation or more below the mean on a technically adequate norm-referenced achievement test that is individually administered by a licensed professional.

C. The student's hearing loss affects the use and understanding of spoken English as documented by one or both of the following:1) under the student's typical classroom condition, the student's classroom interaction is

limited as measured by systematic observation of communication behaviors; or2) the student uses American Sign Language or one or more alternative or augmentative

systems of communication alone or in combination with oral language as documented Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-265

by parent or teacher reports and language sampling conducted by a professional with knowledge in the area of communication with persons who are deaf or hard of hearing.

D. The student's hearing loss affects the adaptive behavior required for age-appropriate social functioning as supported by:1) documented systematic observation within the student's primary learning environments

by a licensed professional and the student, when appropriate; and2) scores on a standardized scale of social skill development are below the average scores

expected of same-age peers.



DEAF AND HARD OF HEARING (D/HH) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:_______________________________________Grade:________________ School:_________________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for special education and related services when the student meets the criteria of item A and one in item B, C, or D.

Circle OneA. Audiological verification of hearing loss documented by certified

audiologist (one of the following): Yes No____ sensorineural hearing loss with an unaided pure tone average, speech

threshold, or ABR threshold of 20 dBHL or greater in the better ear;____ conductive hearing loss with an unaided pure tone average or speech

threshold of 20 dBHL or greater in the better ear persisting over three months or occurring at least three times during the previous 12 months as verified by audiograms with at least one measure provided by a certified audiologist;

____ unilateral sensorineural or persistent conductive loss with an unaided pure tone average or speech threshold of 45 dBHL or greater in the affected ear;

____ sensorineural hearing loss with unaided pure tone thresholds at 35 dBHL or greater at two or more adjacent frequencies (500 Hz, 1000 Hz, 2000 Hz, or 4000 Hz) in the better ear.

Does the student meet the criterion in Item A? Yes NoAND ONE OF THE FOLLOWING IN B, C, OR D:

B. Documentation in evaluation report of affecting educational performance (1 only)

1. Need to consistently use amplification in education setting as determined by audiological measures and systematic observational data;

Yes No

OR2. Achievement deficit (15%ile or at least 1.0 SD below in one area)

Test name ________________________________________________:Yes No

Basic reading skills Results ____________________Reading comprehension Results ____________________Written language Results ____________________General Knowledge Results ____________________

C. Documentation of hearing loss affecting use and understanding of spoken English

1. Systematic observation of communication behaviors that limit a student’s classroom interaction under typical conditions;

Yes No

AND/OR2. Use of ASL or one or more alternative or augmentative systems alone or in

combination with spoken English documented by parent or teacher reports and language sampling conducted by a professional with knowledge in the area of D/HH.

Yes No

D. Documentation of adaptive behavior deficit affecting social functioning (both must be present)

1. Systematic observation in primary learning environment; Yes NoAND

2. Standardized social skills evaluation (below average skills). Test name _________________________________ Results_________________

Yes No

Does the student meet the criterion in Item B, C, or D? Yes No



CHAPTER 3L: Severely Multiply Impaired Documentation

STATE GUIDELINES: SEVERELY MULTIPLY IMPAIRED (SMI)"Severely multiply impaired" means severe learning and developmental problems resulting from two or more disability conditions determined by evaluation under Minnesota Rules, part 3525.2500.

The team shall determine that a student is eligible as being severely multiply impaired if the student meets the entrance criteria for two or more of the following disabilities:

A. hearing impairmentB. physically impairedC. severe-profound developmental cognitive disabilityD. visually impairedE. emotional or behavior disordersF. autism



SEVERELY MULTIPLY IMPAIRED (SMI) CRITERIA CHECKLIST Initial Evaluation Reevaluation


A student is severely multiply impaired and is in need of special education and related services if the student meets the criterion for two or more of the following disabilities:

Circle OneDocumentation in the evaluation report to verify two or more

disability areas: Yes No____Hearing Impaired____Physically Impaired____Severe-Profound Developmental Cognitive Disability____Visually Impaired____Emotionally/Behaviorally Disordered____Autism

Does the student meet the criterion? Yes No



CHAPTER 3M: Physically Impaired (PI) Documentation


STATE GUIDELINES: PHYSICALLY IMPAIRED (PI)"Physically impaired" means a medically diagnosed chronic physical impairment, either congenital or acquired, that may adversely affect physical or academic functioning and result in the need for special education and related services.

The team shall determine that a student is eligible and in need of special education instruction and services if the student meets the criterion in item A and one of the criteria in item B.

A. There is documentation of a medically diagnosed physical impairment.

B. The student's:1. need for special education instruction and service is supported by a functional level of

organizational or independent work skills as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a special education teacher; or

2. need for special education instruction and service is supported by an inability to manage or complete motoric portions of classroom tasks within time constraints as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a special education teacher; or

3. physical impairment interferes with educational performance as shown by an achievement deficit of 1.0 standard deviations or more below the mean on an individually administered reliable, valid, and adequately normed achievement test.


PHYSICALLY IMPAIRED (PI) CRITERIA CHECKLIST Initial Evaluation Reevaluation



A student has a physical impairment and is in need of special education and related services when the student meets the criterion in Item A and one of the components in Item B.

Circle OneA

.There must be documentation of a medically diagnosed physical impairment.

Yes No

Does the student meet the criterion in Item A? Yes NoAND

B. Documentation in evaluation report of need for special education instruction and services, from one or more of the items below:1. Need for special education instruction and service is supported by a

lack of functional level in organizational or independent work skills as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a physical and health disabilities teacher;

Yes No

OR2. Need for special education instruction and service is supported by an

inability to manage or complete motoric portions of classroom tasks within time constraints as verified by a minimum of two or more documented systematic observations in daily routine settings, one of which is completed by a physical and health disabilities teacher;

Yes No

OR3. Physical impairment interferes with educational performance as

shown by an achievement deficit of 1.0 standard deviations or more below the mean on an individually administered nationally-normed standardized evaluation of the student’s academic achievement.Achievement Test ___________________________________ SD____________

Yes No



CHAPTER 3N: Developmental Adaptive Physical Education Documentation



STATE GUIDELINES: DEVELOPMENTAL ADAPTED PHYSICAL EDUCATION (DAPE)

"Developmental adapted physical education" (DAPE) means specially designed physical education instruction and services for students with disabilities who have a substantial delay or disorder in physical development. DAPE instruction for students ages 3 through 21 may include development of physical fitness, motor fitness, fundamental motor skills and patterns, skills in aquatics, dance, individual and group games, and sports.

Students with conditions such as obesity, temporary injuries, and short-term or temporary illness or disabilities are termed special needs students. Special needs students are not eligible for developmental adapted physical education. Provisions for these students must be made within regular physical education as described in Minnesota Statutes, section 126.02.

A student is eligible for developmental adapted physical education when a team determines the student has met the criteria in items A and B.

A. The student has one of the following disabilities in each respective criteria in Minnesota Rules: autism spectrum disorders, deaf-blindness, emotional or behavioral disorders, hearing impairment, specific learning disabilities, developmental cognitive disability, severely multiply impaired, other health disability, physically impaired, visually impaired, or traumatic brain injury.

B. The student is determined by the team to need specially designed physical education instruction because:1. the student's performance on an appropriately selected, technically adequate, norm-

reference psychomotor or physical fitness instrument is 1.5 standard deviations or more below the mean. The instrument must be individually administered by appropriately licensed teachers; or

2. the student's development or achievement and independence in school, home, and community settings is inadequate to allow the student to succeed in the regular physical education program as supported by written documentation from two or more of the following: motor and skill checklists; informal tests; criterion-referenced measures; deficits in achievement related to the defined curriculum; medical history or reports; parent and staff interviews; systematic observations; and social, emotional, and behavioral evaluations.

Students who are eligible for DAPE must have an identified disability but do not have to demonstrate a need in the academic area. The disability criterion is used to identify the entry into a category. Students do not have to be eligible based on the academic criteria. They need a defined disability and then demonstrate a need for service in the physical domain. EXAMPLE:

A student with a medical diagnosis of cerebral palsy who is achieving very well in the academic classroom but in the physical education class the motor involvement interferes with successful participation. When the motor needs are evaluated, it is determined that DAPE services would be beneficial to successful participation in a physical education program.



DEVELOPMENTAL ADAPTED PHYSICAL EDUCATION (DAPE) CRITERIA CHECKLIST

Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:____________________________________________Grade:____________ School:__________________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for developmental adapted physical education when the student meets the criterion described in Items A and B.

Circle OneA

.Identified disability ___________________________________________ (Not: Speech/Language or ECSE: Birth-3)

Yes No

Does the student meet the criterion in Item A? Yes No

ANDB. Documentation in evaluation report of delay from either:

1. Standardized psychomotor evaluation or physical fitness test, administered individually by an appropriate licensed teacher (1.5 SD below).

Yes No

Test SDOR2. Development or achievement and independence in school, home and

community settings is inadequate to allow success in regular PE (two or more sources of data):

Yes No

motor and skill checklistscriterion referenced measuresparent and staff interviewsinformal testsmedical history or reportssystematic observations social, emotional, and behavioral evaluationsdeficits in achievement related to the defined curriculum




ASSISTIVE TECHNOLOGYAssistive technology provides persons with disabilities devices and services to increase their independence. The Individuals with Disabilities Education Act (IDEA) as re-authorized in 1997 requires consideration of assistive technology for all students as part of the IEP process.

Assistive technology as defined in IDEA is both services and products. Specific language from the law states:

Assistive Technology Device—The term "assistive technology device" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.

Assistive Technology Service—The term "assistive technology service" means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. This term includes:

A. The evaluation of the needs of such child, including a functional evaluation of the child in the child's customary environment;

B. Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by such child;

C. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing of assistive technology devices;

D. Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;

E. Training or technical assistance for such child, or, where appropriate, the family of such child; and

F. Training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of such child.

There is a wide range of assistive technology devices, from very simple products such as pencil grips or templates through very sophisticated computer systems. The law makes it clear that the IEP team is responsible for insuring that students have access to appropriate devices and support services to insure access to a free, appropriate public education.

The Minnesota Assistive Technology Manual (http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Manual/001089.pdf)includes additional information and worksheets that will help IEP teams make decisions related to assistive technology.


http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Manual/001089.pdf

http://education.state.mn.us/mdeprod/groups/SpecialEd/documents/Manual/001089.pdf


SAMPLE OF ASSISTIVE TECHNOLOGY (AT) DEVICES


Writing


Mechanics of WritingPencil/pen with adapted gripAdapted paper (e.g. raised lines, highlighted lines)SlantboardTypewriterPortable word processorComputerAlternate Computer AccessKeyboard with easy access or accessibility optionsWord prediction, word completion, macros, abbreviation expansion to reduce keystrokesKeyguardAlternate mouse (e.g. TouchWindow, trackball,

trackpad, mouse pen)Mouse alternative with on screen keyboardAlternate keyboard (e.g. Intellikeys, Discover Board,

Tash)Mouth stick, head pointer with keyboardSwitch with Morse codeSwitch with scanningVoice recognition

Composing Written MaterialWord cards, word book, word wallPocket dictionary, thesaurusElectronic dictionary/spell check (e.g. Franklin

Bookman ) Word processor with word prediction (e.g. Co:Writer or TextHelp) to facilitate spelling and sentence

constructionMultimedia software for production of ideas (e.g. PowerPoint, Overlay Maker with talking word processor)Voice recognition software

CommunicationCommunication book/boardEye gaze boardSimple voice output product (e.g. Big Mack, CheapTalk, talking picture frame, etc.)Voice output device with levels (e.g. Macaw,CheapTalk with Levels, Digivox)Voice output with icon sequencing (e.g. AlphaTalker, Vanguard, Liberator)

Voice output with dynamic display (e.g. Dynavox,

laptop with Speaking Dynamically)Device with speech output for typing (e.g. Link, Write:Out Loud with laptop)

Reading/Studying/MathReadingChanges in text size/space/color/background colorBook adapted for page turning (e.g. with page fluffers, 3 ring binder and folders)Use of pictures with text (e.g. Picture It, PixWriter)Talking electronic devices for single words (e.g. Reading pen, Franklin Bookman)Scanner with OCR and talking word processorElectronic Books (e.g. Start to Finish)

Learning/StudyingPrint or picture scheduleLow tech aids to find materials (e.g. color tabs, colored paper or folders)Highlight text (e.g. markers, highlight tape, ruler)Voice output reminders for tasks, assignments, steps to tasksSoftware for manipulation of objects/concept development (e.g. Blocks in Motion, Thinking

Things) – may use alternate input device such as Touch Window

Software for organization of ideas and studying (e.g. PowerPoint, Inspiration, ClarisWorks Outline)Recorded materials (e.g. books on tape, recorded lectures with number coded index)

MathAbacus, Math LineCalculator/calculator with print outTalking calculatorCalculator with large keys, large displayOn screen calculatorSoftware with cueing for math computationsTactile/voice output measuring devices (e.g. clock, ruler)

Aids for Daily LivingEatingAdapted utensil/platesArm support


Automated feeding

DressingVelcro fastenersButton hookDressing aids

Recreation & LeisureAdapted toys and games (e.g. puzzles with handles)Battery interrupters and switchesAdapted sporting equipment (e.g. Velcro mitt, lighted orbeeper ball)Universal cuff to hold crayons, markers, paint brushModified utensils (e.g. rollers, stampers, scissors)Articulated forearm support (e.g. ErgoRest)Drawing/graphics computer programsMusic or games on the computer

Home LivingSwitchBattery interrupterControl unitInfrared sender/receiverX-10 unit and peripheral

TransitionWork/School to WorkAdaptations as identified to meet individual needsScheduling aids (calendars, reminders, task analysis)Switch/deviceAdapted keyboardCommunication aidKeyboard emulator

TransportationGet in and out of car as a passengerTransfer into vehicle and load mobility deviceGet into vehicle with ramp or liftIndependently arrange transportationIndependently utilize public transportation

Independently drive self with adaptationsIndependently drive selfTolerancePhysically tolerate school/work dayEmotionally tolerate full school/work dayMedically tolerate full work/school dayEnvironmentally tolerate full work/school dayTolerate with distance adaptations (internet, ITV)AdaptationsAdaptive seating/positioningElectronic communicationElectronic organizersAdapted computer inputEnvironmental control


R o c h e s t e r P u b l i c S c h o o l s : T o t a l S p e c i a l E d u c a t i o n

S y s t e m M a n u a l D o c u m e n t a t i o n

STEPS FOR CONSIDERING ASSISTIVE TECHNOLOGY

Consideration ProcessStep 1: Prior to the meeting, to aid in practical consideration of assistive technology, ateam may choose to observe the student in his customary environment to gaininformation on current activities and supports, and determine how well they work. Thisobservation may assist the team in making an informed decision regarding whetherassistive technology is already in place, what is working well, and potentially give someguidance regarding areas where any additional options may be needed. A form whichmay be useful is the Assistive Technology Status Log. The Student, Environments, and TasksWorksheet, Family and Student’s Worksheets in Section 3 can also be used to gather inputfrom team members. Team members should make a point of reporting both successesand accomplishments in addition to areas of difficulty. The Worksheets are brought to theteam meeting.

Step 2: At the team meeting, members conduct a group planning process to reviewinformation obtained from the Worksheets. It is recommended that a flip chart oroverhead be used so everyone can see all the topics from the worksheet that need to bediscussed. A template that can be used for this activity is the Assistive Technology GroupPlanning Process provided in Section 3. Note that the topics on this template directlyrelate to the information on the Worksheets. The primary objective of this group processis to identify tasks the student needs to be able to do in relation to “student” factors (e.g.,skills, abilities, functional competencies) and environmental circumstances that impactperformance. It is recommended that teams quickly move through the information onthe Student, Family, and Environments, portions of the worksheet, spending only a fewminutes per topic if the team is in general agreement with the data that has beengathered. Generally, more attention is paid to the Tasks section (i.e., the naturallyoccurring activities that take place in the environment that are critical to the student),since the team cannot generate AT solutions until those tasks have been identified. Theteam should choose from 1 to 3 critical tasks for solution generation.

Step 3: Once all aspects of the Student, Family, Environments, and Tasks Worksheet have been addressed, the team needs to generate solutions through brainstorming. The details of the solutions will vary, based on the knowledge and experience of the team members. Some team members may be able to name a specific product that they think may assist the student. Others will only be able to list features; for example “sayseverything while it is typed” or “needs to be portable” or “has only 2 messages.” Teams can use the Assistive Technology Checklist in Section 3 to review a wide range of AT devices and strategies that can be used to address student needs in such areas as writing, reading, daily living skills and transition. Also, other resources in that can be used include the Closing the Gap Directory (as updated) Trace Resource Book (as updated), or teamscan seek the advice of an AT consultant or any one of the number of state and regionalresource persons listed in the Resources for Assistive Technology section of this manual.

Step 4: This step involves “solution selection.” The team discusses solutions listed, thinking about which ones might be the most effective for the student. Team membersmay want to identify solutions that can be implemented either immediately, in the nextfew months, or in the future. At this point, the Planning and Implementation Summary can be used to list specific devices, hardware and software. Consisting of two sections,“Planning” and “Implementation,” the Planning and Implementation Summary is used to help team members consider a wide range of factors (e.g., training, cost, storage) involved in selecting and using assistive technology. Once again, if team members are uncertain aboutthe name or purpose of the devices, you can use the resources included in this manual. It isimportant to note that in some cases, a strategy rather than a device or product may be identified. Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-279

Team members gather information prior to meeting. Use Assistive Technology Status Log and Student, Environments and Tasks, Family and Student Worksheets.

Team meets and conducts group planning process, using information gathered through worksheets.

Team generates possible solutions

through brain storming. Possible solutions can be specific or more

generic. May use AT Checklist to identify

solutions.

Specific tools or strategies are selected for

implementation. Use Planning and

Implementation Summary.

Step 5: Develop implementation plan, which could include extended consideration with any identified devices or products or evaluation. Use the Planning and Implementation Summary to assign names, dates and follow-up plan and meeting. Implement the plan, collect relevant data and conduct follow-up on the planned date.


Initiate the Implementation

Plan


ASSISTIVE TECHNOLOGY STATUS LOGAssistive Technology Consideration ProcessDirections: Select instructional or access areas in the first column that are appropriate for the student. Leave blank areas that are not relevant. Specify tasks (e.g., copying assignments from the board) in each area. Indicate the manner in which the student completes these tasks in the appropriate column, specifying modifications, standard tool or AT tools. If the student is not able to complete the task with modifications, standard tools or AT tools, complete the last column.

Student Name ____________________________________ Grade ______ Date _____________________

Instructional AreaCheck and only use

relevant areas

Modifications Standard classroom tools

Current AT tools Additional solutions needed, including AT

services

Writing

Spelling

Reading

Math

Study Skills

Oral communication

Aids for Daily Living

Transition

Other

Other

Other



CASE MANAGER CONSIDERATIONS FOR STUDENT, ENVIRONMENT, AND TASKS WORKSHEET

Assistive Technology Consideration ProcessStudent Name __________________________________________ Grade _______ Date _____________

Directions: Complete information about the student, environment, and the tasks prior to the IEP meeting to obtain information about assistive technology needs. This worksheet should be completed by members of the team who are familiar with the student. Please bring this completed Student, Environment, and Tasks Worksheet to the planning meeting.

I. Student1. What does the student need to do, but is currently unable to do?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What are the student’s strengths, abilities, accomplishments, and/or motivators? Any “success stories” you would like to share?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. What are the student’s unique needs?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. What strategies or technologies have worked in the past?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. What are the student’s long-range or transition goals?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


6. What does the student need to do, but is currently unable to do?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. What strengths, learning style, coping strategies or interest should be considered by the team?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. What other issues should be discussed at the team meeting?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

II. EnvironmentWhat environments are typical for the student to complete IEP related tasks? Select up to three environments where strategies, assistive technology products, or adaptations are necessary.1. ___________________________________________________________________________________

2. ___________________________________________________________________________________

3. ___________________________________________________________________________________

Complete questions in the table below for each environment. Use additional sheets if necessary.

Environment 1 Environment 2 Environment 31. What materials are

currently available to the student?

2. What is the physical arrangement?

3. What is the instructional arrangement?

4. What supports are currently available in this environment?

5. What resources are Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-283

available to the team to support the student?


Task 1 Task 2 Task 31. What are the

naturally occurring activities (tasks) that take place in the environment that are critical to the student?

2. What are other ways of completing the tasks?

Notes:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



PARENT AND STUDENT ASSISTIVE TECHNOLOGY WORKSHEETS

PARENT WORKSHEET

Child’s Name ____________________________ Grade _____ Meeting Date ____________

Case Manager ________________________________ Phone ________________________

Directions: Please answer the following questions so we will be able to learn more about your child’s potential need for assistive technology devices or services. As a parent and a member of the planning team, you have important information that can help us in making the right decisions about what your child needs to be successful in school. If you have any questions about the Parent Worksheet please contact the Case Manager indicated above. Please bring this form with you to the planning meeting.1. What activities are most important to increase the participation or independence of your child?

____________________________________________________________________________________________________________________________________________________________________________

2. What are your child’s strengths, interests, or motivators? Do you have a “success story” you would like to share?

____________________________________________________________________________________________________________________________________________________________________________

3. Describe any current frustrations or problems your child has in completing work.

____________________________________________________________________________________________________________________________________________________________________________

4. What would be some changes in activities, approaches, or tools you think would increase your child’s learning or participation and decrease the problems and frustrations indicated above.?

____________________________________________________________________________________________________________________________________________________________________________

5. Describe any assistive technology devices (simple or complex) used successfully by your child in the home or school.

____________________________________________________________________________________________________________________________________________________________________________


6. Describe your child’s feelings about using these devices.

____________________________________________________________________________________________________________________________________________________________________________

7. How successful do you think these devices have been? Do you think your child’s needs are being met?

____________________________________________________________________________________________________________________________________________________________________________

8. What other issues should be discussed at the planning meeting?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


STUDENT WORKSHEETChild’s Name ____________________________ Grade _____ Meeting Date ____________

Case Manager ________________________________ Phone ________________________

Directions: Please answer the following questions to help us determine whether assistive technology devises and/or services might be needed in the school, home, or community. Try to answer each question as best as you can. If you need help, see the person listed above as the “Case Manager.” Please bring this form with you to the planning meeting.1. What tasks do you feel you are unable to complete at school?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Name or describe the strategies, technology devices, or assistance that could help you to complete school requirements or tasks.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Describe your feels about using technology at school, home, and/or in the community.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. What products have you tried, or have seen that you would like to try out?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. What other issues would you like to discuss at the planning meeting?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


R o c h e s t e r P u b l i c S c h o o l s : T o t a l S p e c i a l E d u c a t i o n S y s t e m M a n u a l D o c u m e n t a t i o n l

ASSISTIVE TECHNOLOGY GROUP PLANNING TEMPLATEAssistive Technology Consideration ProcessDirections: Each of the topics below should be placed on a flip chart or overhead device. Use this template only as a guide for the planning process and for summarizing the information from the Student, Family, Environments, and Task Worksheet completed by team members. The resulting information from this template can then be transferred to the Planning and Implementation Summary form.


StudentEnvironment Tasks

Strengths/Abilities/Motivators/”Success Stories”:

Needs:

Successful Strategies:

What is currently available? What is the physical arrangement? How is the student positioned in the environment? Are there any supports? Are there any barriers?

What does the student need to do? What are naturally occurring activities? Are tasks to be modified?

Options Prioritized Selections Implementation Plan

What features of a device or strategy can provide greater participation? Are there strategies to promote this? (Note-this is a brainstorming session only). At the conclusion of this session, select and highlight the top 3 options.

Discuss and prioritize the top 3 ideas from the brainstorming session. Decide if outside assistance is needed for product identification.

Trait: What product will be used and for how long? Who is responsible? What criteria will be used to assess the device or strategy? Where will the device be obtained? If assistance from outside consultant is sought, have all of the necessary release forms been signed?

Follow-up: Who and When? Set a date for the follow-up activity.


ASSISTIVE TECHNOLOGY PLANNING AND IMPLEMENTATION SUMMARY

Assistive Technology Consideration ProcessStudent Name ___________________________________ Grade _____ Date _______________________Team members (identify IEP manager) ____________________________________________________________________________________________________________________________________________Directions: The Planning and Implementation Summary is completed once the group planning process has occurred. Transfer the information compiled during the planning meeting and from Student, Family, Environment, and Tasks Worksheet to this form and maintain a copy as part of the student’s file.I. Planning Summary1. What are the devices or strategies to be tried? ________________________________________________________________________________________________________________________________________________________________________________________________________________________2. What IEP goals do these devices or strategies support? _________________________________________________________________________________________________________________________________________________________________________________________________________________3. What accommodations/supports currently exist for these goals? _____________________________________________________________________________________________________________________4. How will success be determined? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________5. What level of achievement is reasonable to expect for a trial period? _______________________________________________________________________________________________________________________________________________________________________________________________________6. What staff training will be needed/provided? __________________________________________________________________________________________________________________________________________________________________________________________________________________________7. Who will provide the training? ________________________________________________________________________________________________________________________________________________8. What is the training schedule? ________________________________________________________________________________________________________________________________________________9. Who is responsible for implementation in environment 1? ____________________________________ Rochester Public Schools Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-290

10. Who is responsible for implementation in environment 2? ___________________________________11. Who is responsible for implementation in environment 3? ___________________________________12. Who else is involved other than those listed (names and roles)? __________________________________________________________________________________________________________________________________________________________________________________________________________


II. Implementation SummaryProvide information to the following questions about the device(s) used in each environment.

Environment 1 Environment 2 Environment 31. What is the name of the

device, manufacturer and technical support number?

2. Who will order the device?

3. Is there a cost to the trial usage? If yes, who will pay? 1 (Indicate amount).

4. Who will set up, troubleshoot, and maintain ongoing support for the device?

5. Where will the device be stored when not in use?

6. How will the device be transported?

7. Who will have access to the device?

8. Who will provide training to the student and family? Who will pay for the training? 2

9. Who will provide training to the school staff? Who will pay for the training? 3

10. Who will be responsible for implementation, data collection and reporting?

11. Indicate start-up date, anticipated ending date, and follow-up meeting date.

1 Authorized signature of payer of device: ___________________________________________________2 Authorized signature of payer for student/family training: ______________________________________3 Authorized signature of payer for staff training: ______________________________________________


III. Extended Assessment LogDirections: Use the Extended Assessment Log to document the type of device that was tried, the environment, duration, and overall results. The purpose of this log is to help service providers determine whether a device met the student’s needs and to assist with future assistive technology planning.Student Name __________________________________ Grade ______ Date ______________________

Device 1 Device 2 Device 31. What is the name of the

device?

2. What environment(s) was the device used?

3. How long was the device used? (Include start and ending dates).

4. How many trials were observed?

5. What was the criteria used to judge success?

6. Was the criteria met? (Yes or No)

7. Will this device be recommended for the student? (Yes or No)

8. Other comments regarding this device?


REQUEST FOR ASSISTIVE TECHNOLOGY TRIAL

Please complete this form to request Assistive Technology (AT). This form will not be used to identify the need for Assistive Technology. The district AT coordinator will acquire the request type of technology to be used for the trial.

Date:

IEP Manager:

Student Name:

ID#:

DOB:

School:

Primary Disability:

Grade:

Please attach documentation that shows the need for Assistive technology.

Present levels of performance

IEP Goal(s)

IEP Accommodations/Modifications

Other documentation

AT requesting for trial (Describe type of device. A specific named device may not be guaranteed for use in trial).:

Person(s) responsible for collecting data:

Type of data collecting: speed accuracy spontaneity duration latency otherCriteria for success of trial:

Time needed for trial:

Trial Start Date:

Trial End Date:

Post Trial team meeting date:

The result of this trial: The trial showed the need for AT to reach IEP goals. (Attach documentation of

results.) The trial showed the need to have another AT trial. The trial showed that AT was not useful in reaching current IEP goals.


If you have questions, please contact the district AT coordinator


ASSISTIVE TECHNOLOGY EQUIPMENT REQUEST

R E Q U I S I T I O N N U M B E R : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _D A T E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

A S S I S T I V E T E C H N O L O G Y- E Q U I P M E N T R E Q U E S To n e c o m p a n y p e r s h e e t , k e e p c o p y

COMPANYADDRESS

PHONE #

D A T E S T U D E N T

D O B I D #

I E P M A N A G E R S C H O O L

P R I M A R Y D I S A B I L I T Y G R A D E

A N A . T. T R I A L W A S C O N D U C T E D

N O A . T. T R I A L W A S C O N D U C T E D

C O M M E N T S : Q U A N I T Y C AT A L O G

#D E S C R I P T I O N O F AT I T E M P R I C E

E A C HP R I C E T O T A L

Be sure to include Shipping Charges in your total.

Please send to District A.T. Coordinator (Jennie Polson @ ESC) A P P R O V E D N O T A P P R O V E D J E N N I E P O L S O N , A . T. C O O R D I N AT O R D A T E

Y E S , B I L L 3 R D PA R T Y

N O , D O N O T B I L L 3 R D PA R T Y

D E N I S E M O O D Y, 3 R D PA R T Y FA C I L I T AT O R

D A T E


A P P R O V E D N O T A P P R O V E D K AT H Y A C C U R S O , S . S . S .

S U P E R V I S O RD A T E

A P P R O V E D N O T A P P R O V E D C O R Y M C I N T Y R E , D I R E C T O R D A T E

IF NOT 3RD PARTY: CODE: IF 3RD PARty: Send to Pam Sebo @ Edison for code and ordering



SETT FRAMEWORK COLLABORATIVE CONSIDERATION OF ASSISTIVE TECHNOLOGY DEVICES AND SERVICES

SETT Cover Page and Instructions*Document can be copied and saved from the TSES manual and completed electronically

Background

The language of the Individuals with Disabilities Education Act (IDEA PL 101-476) requires that all districts address assistive technology for students who have a disability and whose learning is governed by an Individualized Education Plan (IEP). The SETT process provides a framework for arriving at decisions regarding whether a child with an identified disability requires the use of assistive technology to access their education and receive Free Appropriate Public Education (FAPE). SETT stands for Student, Environment, Tasks, and Tools.

***The student on the following attached page is currently undergoing educational evaluation for assistive technology. Please take time to complete the SETT for this child and return to


SETT Evaluation Documentation Form

Student: Date: Student Disability Area:

Setting/Initials

Student (S) Environment (E) Task (T) Tools (T)

Functional Area of Concern:

Special Needs:

Current Abilities:

Instructional Arrangement(lecture/combo): Support Available:

Materials and Equipment Used:

Access Issues:

Attitudes/Expectations:

Typical Tasks:

Tasks required for active involvement:

Can the student make reasonable progress without AT devices and services?

Suggestions for possible devices or services that would help the student make progress in your class:


Special Needs:

Current Abilities:



Access Issues:


Typical Tasks:





Setting/Initials

Student (S) Environment (E) Tasks (T) Tools (T)


Special Needs:

Current Abilities:



Access Issues:


Typical Tasks:





Special Needs:

Current Abilities:

Instructional Arrangement(lecture/combo):

Support Available:


Access Issues:


Typical Tasks:





Setting/Initials



Special Needs:

Current Abilities:


Support Available:


Access Issues:


Typical Tasks:





Special Needs:

Current Abilities:


Support Available:


Access Issues:


Typical Tasks:






Setting/Initials



Special Needs:

Current Abilities:



Access Issues:


Typical Tasks:





Special Needs:

Current Abilities:


Support Available:


Access Issues:


Typical Tasks:





Students Determined to be Medically Fragile


PROCEDURE FOR DETERMINING SERVICES FOR STUDENTS IDENTIFIED AS MEDICALLY FRAGILE

1. Referral of Student to Educational SystemA. By parent(s)/guardianB. Educational organizationC. Outside agency

2. Identify the Student's TeamA. Parent(s)/Guardian(s)B. Licensed School Nurse (LSN)C. IEP managerD. Classroom teacherE. ParaprofessionalF. County services G. PhysicianH. School administrator(s)I. Other

3. Assessment ProcessA. LSN and case manager will visit the home or the parent(s)/guardian(s) and the

student will visit the schoolB. Obtain release of information and obtain health records from parents and health

care providersC. Obtain physicians order for health procedures and equipmentD. Determine building accessibility and student space requirementE. Obtain educational records

4. Planning ConsiderationsA. Develop a transition process from previous settingB. Delegate roles and responsibilities of team membersC. Discuss safe, appropriate class placement/address attendance stipulationsD. Discuss necessary services and personnel/substitute arrangementsE. Use and care of medical equipmentF. Determine transportation needs, if necessary.

5. Develop Emergency Health Plan (LSN responsibility with team input)A. Analyze assessmentsB. Determine special health care needsC. Baseline health statusD. Medications, dietE. Use and care of medical equipmentF. Possible problems and interventionsG. Emergency plan in school and in transit as deemed necessary by team


6. Training (provided by Licensed School Nurse (LSN) or case manager)A. General training would be provided to all school personnel and peers in student’s

classroom1) Review of Emergency Health Plan (EHP)2) Emergency plan and education awareness

B. Child specificC. Health and medical procedures and emergency plan to school personnel

1) Teacher(s)2) Paraprofessional3) Health paraprofessional4) Administration

7. Direct Service Provider Entrance Into School Program (only if the above specified procedures have taken place-steps 1 through 6).

8. Ongoing Follow-up EvaluationA. Update student’s health status and review steps 1 through 6, as neededB. Document, review, and update skills trainingC. Review steps 1 through 5 and complete step 6 at transition times.

All medical cases must be directed by the Licensed School Nurse during the school year and in any school-sponsored summer school programs.



DO NOT RESUSCITATE/DO NOT INTUBATE – BOARD POLICYP U R P O S E

The purpose of this policy is to provide guidance to School District staff and parents or guardians regarding requests to implement Do Not Resuscitate / Don Not Intubate (DNR/DNI) orders and/or the withholding of emergency care of a student in the event of a life-threatening situation at school or school activities.

G E N E R A L S T A T E M E N T O F P O L I C YA. The primary mission of the School District is education. DNR-DNI orders are medical

documents. School District staff will not accept or honor requests to withhold emergency care or DNR-DNI orders. The school district will not convey such orders to emergency medical personnel.

B. School District staff will provide reasonable emergency care and assistance when a student is undergoing a medical emergency during school or school activities.

C. School District staff will activate emergency medical services (911) as soon as possible when a student is undergoing a medical emergency during school or school activities.

D. The parent(s)/guardian(s) will be notified of the emergency as soon as possible.E. Notwithstanding this school district policy, IEP and 504 teams must develop individualized

medical emergency care plans for students when indicated in keeping with state and federal law.

F. Parent(s)/guardian(s) who request that emergency care be withheld for their child or who present DNR-DNI orders, shall be advised of and shall be given a copy of this policy.


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