Special education
wog-99w4
zach_iep.pdf
Individualized Education Program (Aug 2014 revision) Page 1
School District Special Education Dept
City, State Zip
Student Name: Zach Brehm Grade: 5 Gender: DOB: 4/22/05 Age: 10
Meeting Date IEP Implementation date Projected Date when services will begin Anticipated Duration of this IEP
School Year
02/03/16 02/12/16 02/02/17 2015-2016
Student Address:
City/State/Zip:
Parent/Guardian Name (include address in section I if different that above):
Contact numbers Home Work(1) Work(2) Cell/Other Phone
County of Residence: Anticipated Year of Graduation: 2023 If consortium class or Placement: Sending District: School Building:
Current Vo-Tech Student Future Vo-Tech Student CIP Code:
Primary Disability: Secondary Disability (If applies)
Other Information: Autism, Other Health Impairment, Speech/Language Impairment
*Medical Assistance #: IEP TEAM/SIGNATURES* Signature on this IEP documents attendance, and not agreement. The Individualized Education Program (IEP) Team makes the decisions about the student’s program and placement. The student’s parent(s), the student’s special education teacher, and a representative from the local education agency are required members of this team. Signature on this IEP documents attendance, not agreement. NAME (typed or printed) POSITION (typed or printed) SIGNATURE*
Parent/Guardian/Surrogate
Parent/Guardian/Surrogate
Student*
Regular Education Teacher**
Special Education Teacher
Local Educational Agency Rep(Chair)
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Community Agency Representative
* The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate. ■ ** If the student is, or may be, participating in the regular education environment ■ *** As determined by the LEA as needed for transition services and other community services ■ **** A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted. ■ One individual listed above must be able to interpret the instructional implications of any evaluation results.
Written input received from the following members: Teachers Name Here
PROCEDURAL SAFEGUARDS NOTICE
I have received a copy of the Procedural Safeguards Notice during this school year. The Local Education Agency has informed me whom I may contact if I need more information. (Note a copy of the notice may be available on the District Web Page) Signature of Parent/Guardian/Surrogate:
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TRANSFER OF RIGHTS AT AGE OF MAJORITY For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age. REVISIONS The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as documented by: see attached IEP Revision forms
Date of Revision(s) Participants / Roles IEP Section(s) Amended
I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST ADDRESS BEFORE DEVELOPING THE IEP. ANY
FACTORS CHECKED AS “YES” MUST BE ADDRESSED IN THE IEP.
Is the Student blind or visually impaired? Yes The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team
determines, after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the student’s future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the student.
No Is the Student deaf or hard of hearing? Yes The IEP must include a communication plan to address the following: language and communication needs;
opportunities for direct communications with peers and professional personnel in the student’s language and communication mode; academic level; full range of needs, including opportunities for direct instruction in the student’s language and communication mode; and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The Communication Plan must be completed and is available at www.pattan.net.
No Does the student have communication needs? Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals,
etc.) No Does the student need assistive technology devices and/or services? Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals,
etc.) No Does the student have limited English proficiency? Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals,
etc.) No Does the student exhibit behaviors that impede his/her learning or that of others? Yes The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior
and that utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction sections of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A Positive Behavior Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net
No Other (Specify)
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II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT & FUNCTIONAL PERFORMANCE Include the following information related to the student: 1. Student’s present levels of academic achievement (e.g., most recent evaluation of the student, results of
formative assessments, curriculum based-assessments, transition assessments, progress toward current annual goals) Summative Data (i.e. PSSA)
Zach did not receive scores for the 4th grade PSSA due to refusing to participate and attempting to destroy the testing materials. PSSA results for 3rd grade were: Proficient in math and Below Basic in reading.
Benchmark (i.e. 4Sight, MAPS, DIBELS)
The following EasyCBM data has been collected from the beginning of 5th grade:
Measure Grade Season Date Raw Score Percentile
Passage Reading Fluency 5_Fall 5 Fall 9/2/2015 122 wpm 29th
CCSS Math 5_Fall 5 Fall 8/26/2015 27 63th
Reading Comprehension 5_Fall 5 Fall 9/12/2015 12 27th
Vocabulary 5_Fall 5 Fall 9/19/2015 7 2nd
CCSS Reading 5_Fall 5 Fall 8/28/2015 17/25 68% 31st
The following EasyCBM data has been collected from the middle of the year, 5th grade:
Measure Grade Season Date Raw Score Percentile
Passage Reading Fluency 5_Winter 5 Winter 1/7/2016 117 wpm 20th -9
CCSS Math 5_Winter 5 Winter 1/7/2016 25/45 60% 40th -23
Reading Comprehension 5_Winter 5 Winter 1/14/2016 8/20 40% 6th -21
Vocabulary 5_Winter 5 Winter 1/7/2016 12/20 60% 10th +8
CCSS Reading 5_Winter 5 Winter 1/8/2016 18/25 72% 26th -5
Students in 5th grade are given an EasyCBM assessment at three points in the school year; fall, winter, and spring. Students take 5 tests; Passage Reading Fluency, CCSS Math, Reading Comprehension, Vocabulary, and CCSS Reading. Given these 5 different assessments, Zach’s scores all except for Vocabulary dropped percentile categories. In Reading Fluency he went down 9 percentage points. In CCSS Math he went down 23 percentage points. In Reading Comprehension he went down 21 percentage points. In Vocabulary he went up 8 percentage points. In CCSS Reading he went down 5 percentage points. Combined, that makes for an overall loss of 58 percentage points.
Diagnostic (i.e. DRA, Running Record, baseline scores) Zach was given a 5th grade math computation probe with 4 minutes to complete 25 problems. He able to complete 4 problems (16% correct) of the 8 he attempted. When given 4th grade math computation
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probe with 4 minutes to complete 25 problems he did much better, answering 12 correct (36%) out of 12 he attempted. He did however stop working after 3 minutes and refused to do any more problems. He took a total of 3 computation probes on the 4th grade level. He averaged 12 correct on all three probes (answering 12 correct on all 3). Zach was given a 5th grade reading fluency probe with 1 minute to read quickly, fluently, and accurately. He was able to read an average of 126 words per minute with 100% accuracy. Formative (i.e. curriculum based assessments, rubrics, LFS summarizers, progress monitoring data)
SUBJECT 1st MP Letter Grade
1st MP Average
2nd MP Letter Grade
2nd MP Average
Change in average +/_
Art S S =
English U 48 U 65 +17
Health A 95 A 100 +5
Library S+ 84 S+ 85 +1
Math C 74 U 63 -11
Physical Education O 98 S+ 85 -13
Reading U 61 D 67 +6
Science/Health C 78 C 75 -3
Spelling U 54 D 71 +17
Social Studies C 79 C 81 +2
Vocal Music O 99 S+ 86 -13
Chorus U 25
Zach’s teachers and aides have done the following to ensure his success in the regular education
classroom and in the special education classroom: Introduction and lessons using “The Zones of Regulation”, Explanation of emotions with use of visual tools from “The Zones of Regulation” and, Use of a reward system using highly preferred items and a daily tracking chart for rewards earned, Positive behavior reinforcement, Use of verbal and non-verbal reminders to stay on task, Emails home to communicate behaviors of concern, Preferential seating within the classroom, Visual timer used for classroom tasks 1-1 “pep-talks” to motivate the student in the morning, Limiting distractions within the classroom environment, Avoiding known, possible behavioral triggers when possible, Frequent communication with other professionals that work with P.D. to ensure SDI’s and his behavior plan are being implemented Extended time for taking tests and in small group setting, Use of planned ignoring of small, behavior-seeking types of behavior to avoid a larger behavioral issue, Classroom visuals to help manage behavior (T.H.I.N.K., S.L.A.N.T, Small/Medium/Big Problem Poster, The Zones of Regulation Posters), Frequent review of the schools “Goals”, Reinforcement of the “Goals” with our school wide system for PBIS with “Goals”, Providing high- interest items for rewards or use during breaks Agenda sent home daily for communication between school and home, Larger spaced paper available upon request, Velcro on his desk, Extended time for writing assignments or the availability of alternative, assignments that wouldn’t include such large amounts of writing, Use of vocabulary from “The Zones of Regulation” and our school wide PBIS system of “Expected and Unexpected” with frequent reminders, Modeling of expected social skills and strategies, Repetition of directions to assure understanding, Chunking of assignments into smaller, more manageable pieces, Non-verbal reminders to not pick at himself during class, Consultation with the Autistic Support professional, Speech and Language Therapist, and the Occupational
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Therapist, Implementation and closely following the behavior-reduction strategies for de-escalation, Wait time to respond to directives, questions, and directions to return to task, Assisting in de-escalation by removing others from the room to ensure student safety, Constant reevaluation of strategies and which to use, Use of a calm speaking voice and overall manner in dealing with unexpected behaviors, Giving access to my classroom for independent work space when needed to eliminate distractions to student in class. Despite the many accommodations that we have made for Zach, many of his grades have gone down since the first marking period. There are, however, areas where he has made improvements in his grades. See the chart above for specifics.
Student’s present levels of functional performance (e.g. results from a functional behavioral assessment, results of ecological assessments, progress towards current goals).
In a structured teaching situation with an adult, Zach will complete assigned activities/tasks before gaining access to his preferred item/activity in 80% of opportunities charted for 5 consecutive days. -Zach did not make Progress towards this goal. Over the 2nd Marking period he averaged 37% work completion even though he has demonstrated that he can complete all of it with the accommodations that his teachers make for him.
During structured teaching sessions, Zach will independently use a strategy to gain the teacher’s attention (i.e. raising hand, saying, “Excuse me”) in 80% of opportunities for 5 consecutive charted days. Zach is not making progress towards this goal. He is using his strategies to appropriately gain the teacher’s attention 13% of the time.
Classroom skills (study skills, on task, homework. Etc.)
Teacher: Mr. Math Guy Subject: Math/Science Please comment on Strengths, Weaknesses and Needs in the classroom in the following areas:
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Work Completion: It is very difficult to understand exactly what Zach can and can’t complete on his own in class. Mrs. Aide is with him 100% of the time. She assists him in all his work. The decline in his math grade from marking period 1 to 2 is due to less support being given on her part. At the beginning of the year, she pretty much told him answers to get through the assignments. Now, he is actually completing them on his own more, but at a less successful rate. In the 21 days of logging that I kept track of instructional time, there were 2,520 minutes of instruction given in the classroom. He lost 1,710 minutes, 68% of the time, of instruction from either being removed from my classroom or being in my classroom not completing work or participating in the instruction. On the flip side, he was in class with or without participation 940 minutes, 37% of the time. You will notice the percentages add up to 105%. This is due to changing the tracking mechanism part way through my logging. Obviously, I am concerned. He misses large group instruction most days and participated in small group instruction around 2 out of the 21 days. If I am not able to meet his needs in either setting, how is he learning the 5th grade curriculum? Preparedness for class: Zach is always prepared for class. He has his materials. Homework completion has been 100%. On task/off task behavior: Mrs. Aide helps keep Zach on track. She usually gets him started with his assignments unless he is motivated to begin on his own. He gets a lot of positive encouragement from both of us during the lessons he is in the class for. Usually things deteriorate when I begin teaching the large group lesson. He will state that it is too hard, although most times he does not give any effort to see where he is getting stuck. This results in crawling around the floor and eventually being removed from the classroom. Homework Completion: Zach finishes his homework. General Classroom Skills: Zach has a few boys that work with him because they have known him for a few years. For the most part, he works with Mrs. Aide. She gives him work breaks when he asks. Behaviors of concern: Given the structure of the classroom, which includes large and small group instruction, and the supports Zach is receiving, I don’t think regular education math is the proper placement for him. Clearly, his grades the first marking period show that with a lot of one on one assistance, there can be some success, although I question how much of the work was being completed by just him. Now that he has worked back into doing things independently, the success is not there because some of the foundational blocks of math are not being used or shown. I honestly have very little idea what Zach can independently complete. I do know, however, that when you miss 68% of instructional time, generally, there are not real positive results. In order to help support behavior within the classroom setting, I give him an endless amount of verbal praise. I also reduce the amount of problems he has to complete on assignments. He has earned gold (Schoolwide Positive Behavior Acknowledgement System) for participating by giving answers or finishing tasks. Sometimes he earns extra technology time for completing his work. Otherwise, I support the mechanisms Mrs. Aide has in place for him. Teacher: Mrs. Social Studies Subject: Social Studies Work Completion- Zach gets his work done but usually it is not in the classroom as he rarely makes it to social studies. He completes his missing assignments for homework or the next day. His aide usually writes the answers for him in order for him to complete it. Behaviors of concern- He makes noises and crawls on the floor when he doesn’t want to work. In order to help support behavior within the classroom setting, I will tell him what he needs to do and not do. If he continues the inappropriate behavior, the aide will take him out of the room as he is being a distraction. Please note again there are many times he is not in my room at S.S. is at 2:10 and he is already gotten in trouble or is going to be a distraction. Please note sometimes the aide will take him out without being directed him because she knows he is going to be disruptive. Additional strategies used to help support behavior in the classroom include use of nonverbal cues or changes to tone of voice to prompt for expected behaviors, feedback regarding overall performance for the day; Sometimes he will give me a hug if he knows it was a good 25 minutes in my room. Homework completion- He gets it done at some point during the week but not necessarily when it is due.
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Classroom skills- He does not participate to the same extent as the other students. He does not like writing short answer responses or essays. Other- Zach had only been in class for 29 out of the first 62 days of school. When he is in class, he does not follow along in the book or pay attention to the class discussions. He will choose to look at other pages of the social studies book that interest him instead of participating. Teacher: Mrs. SPED Two Subject: English, Reading, Spelling Work Completion: On average, Zach probably completes 10-15% of his work. Usually this small percentage is with a lot of adult praise and heavy incentives. Most of the time he zones out when asked to do something, and instead of working he will pick at his skin and completely hyper focuses on that and that alone! Preparedness for class: I honestly can’t say he is ever prepared for class. Mrs. Aide, his 1-1 aide, gets everything he needs and makes sure he is prepared for class. Zach never does this on his own. On task/off task behavior: Zach has the ability to pay attention to a highly preferred activity. During class, I say he pays attention less than 20% of the time. Homework Completion: 50/50 He does have his homework completed most of the time, but usually his homework is classwork that wasn’t completed during the school day. General Classroom Skills: Zach does not interact well with other students, and he doesn’t seem to associate with a group of people like “friends”. He’s off task, disruptive, and a danger to himself and others. When he is engaged in a lesson, he very rarely will offer answers and participate in classroom instruction. If something seems too hard for him, he shuts down completely and there is nothing we can do. He often growls at other students and other students find this to be scary and threatening. Behaviors of concern: Multiple concerns. Physical outbursts, refusal to attend class and learn the content, failure to complete assignments at school, does not follow directions-even if broken down into smaller tasks or given in a different way. There have been many days that I was unable to teach my language arts lesson because Zach’s behaviors has become so bad, we were pulling the students into another room. Some of his most frequent behaviors are biting, kicking and spitting. He displays a lot of unsafe behaviors when he is struggling with his class work. In order to help support behavior across the school setting, the following strategies have been implemented:
• Introduction and lessons using “The Zones of Regulation” • Explanation of emotions with use of visual tools from “The Zones of Regulation” and • Use of a reward system using highly preferred items and a daily tracking chart for rewards earned. • Positive behavior reinforcement • Use of verbal and non-verbal reminders to stay on task • Emails home to communicate behaviors of concern • Preferential seating within the classroom • Visual timer used for classroom tasks • 1-1 “pep-talks” to motivate the student in the morning • Limiting distractions within the classroom environment • Avoiding known, possible behavioral triggers when possible • Frequent communication with other professionals that work with P.D. to ensure SDI’s and his behavior
plan are being implemented • Extended time for taking tests and in small group setting • Use of planned ignoring of small, behavior-seeking types of behavior to avoid a larger behavioral issue • Classroom visuals to help manage behavior (T.H.I.N.K., S.L.A.N.T, Small/Medium/Big Problem Poster,
The Zones of Regulation Posters) • Frequent review of the schools “ Goals” • Reinforcement of the “ Goals” with our school wide system for PBIS with “ Goals” • Providing high-interest items for rewards or use during breaks • Agenda sent home daily for communication between school and home • Larger spaced paper available upon request • Velcro on his desk
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• Extended time for writing assignments or the availability of alternative assignments that wouldn’t include such large amounts of writing
• Use of vocabulary from “The Zones of Regulation” and our school wide PBIS system of “Expected and Unexpected” with frequent reminders
• Modeling of expected social skills and strategies • Repetition of directions to assure understanding • Chunking of assignments into smaller, more manageable pieces • Non-verbal reminders to not pick at himself during class • Consultation with the Autistic Support professional, Speech and Language Therapist, and the
Occupational Therapist • Implementation and closely following the behavior-reduction strategies for de-escalation • Wait time to respond to directives, questions, and directions to return to task • Assisting in de-escalation by removing others from the room to ensure student safety • Constant reevaluation of strategies and which to use • Use of a calm speaking voice and overall manner in dealing with unexpected behaviors • Giving access to my classroom for independent work space when needed to eliminate distractions to
student in class Other functional skills (i.e. related service reports and Employment Skills)
Speech and Language Support- SPEECH Person, MS; CCC/SLP Zach has been attending the Busytown Intermediate School since August of 2014. He is currently in 5th grade. According to record review (RR dated 5-6-15), Zach’s primary disability category is Emotional Disturbance and secondary disability categories of Autism, Other Health Impairment & Speech/Language Impairment. Zach attended an out-of-district full-time emotional support classroom for Kindergarten, First and Second grade. He transferred back to The Other Elementary school in third grade. He has continued to receive Speech/Language Support services while in the Busytown School District. Zach’s speech/language goal is to improve his pragmatic language by using targeted skills. Below is his most recent progress monitoring information that was sent home for the first marking period of fifth grade. Goal Area: Pragmatic Language
Measurable Annual Goal Include: Condition, Name, Behavior, and Criteria
(Refer to Annotated IEP for description of these components)
Report of Progress
Using an expected vs. unexpected behavior(s) framework, Zach will identify and use targeted social skills, with reduced cueing/prompting required, in structured to less structured settings/opportunities 75% of the time. When presented with a social behavior/interaction scenario Zach will: -- Define/ Describe -- Contrast (expected vs unexpected) -- Predict
■ consequences/outcomes ■ feelings (his and others as related to The
Zones)
■ reactions (his and others) -- Interpret (perspective/body language) -- Modify (suggest/implement changes) (PA Standard Reference 1.6)
Marking Period S L N
1st marking period
October 2015
80% overall accuracy
2nd marking period
January 2015
74% overall
accuracy
3rd marking period
April 2015
73% accuracy
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4th marking period
June 2015
90% accuracy
Progress Report Key (extent to which progress is sufficient to meet the annual goal)
S = making sufficient progress (75% or better) L = making limited progress (65% - 74%) N = not making sufficient progress at this time (0-64%) Following is a discussion of Zach’s current speech and language skills: Social Skills Instruction: In a structured therapy setting, Zach’s performance for therapy tasks is within an average range for identifying and using the social skills targeted for each session’s lesson as long as he is prompted to respond. Notable this year has been Zach’s inability to attend group. He is not able to profit from the points of instruction that could help him be successful at school when his behavior precludes him from attending. When in attendance, he does not volunteer often but will answer if called on by the instructor. He needs to be prompted to answer “how” or “why” questions as they pertain to social situations and the topics discussed. Zach often displays unexpected behavior in our group. He begins to make screeching/high-pitched sounds and refuses to respond when he does not want to participate or do what is expected of him and his same-age peers. His peers recognize his unexpected behavior and display non-verbal signs that they are upset. His peers have also verbalized their annoyance with his unexpected behavior, in a respectful manner directly to Zach, in an effort to help him change. When this happens, Zach does not demonstrate acknowledgment of his peers’ comments, nor does it alter/change his behavior from unexpected to expected. Overall, his pragmatic language skills are below average in comparison to same-age peers.
Social skills lessons so far this school year have involved discussion and practice with the following topics:
• Expected/Unexpected behaviors
• Problem solving
• Emotions/feelings
• Perspective taking- realizing that others have thoughts about you based on: what you say; what you do; and how you look
• Flexibility of thought
It is the opinion of this examiner that Zach experiences difficulty knowing what is expected of him in specific social situations. In structured tasks, he knows and can state the expected behavior with prompting. However, when he is asked to describe and use the social behavior map to discuss behavior, he struggles to demonstrate comprehension of the fact that there are consequences to behavior, both expected and unexpected. He presents with age and grade appropriate receptive and expressive vocabulary abilities. It is recommended that Zach continue to receive Speech and Language Support. He needs to increase and improve his social pragmatic language abilities so he can be successful independently in all social interactions. The following information was reported by Mrs. PBA Person, IU 49 Consultant on 12/15/15: Consultant Visitation Summary--Autism Support to Personnel
Dates Support Provided: October, 2015 – November, 2015 Student: Zach Brehm Consultant: PBA Person Purpose/Focus of Visits: Support/suggestions for Zach’s educational programming needs
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Summary of Support provided to team: Observation of Zach in his current educational setting, supporting staff with suggestions for revision of positive behavior support plan, culmination/analysis of data collected, assessment of potential reinforcers for Zach, modeling/guided practice regarding implementation of strategies to trial, attending team meetings Reinforcers • Potential reinforcers are continually being assessed for Zach. Those that have been currently identified
though observations of the student, include: • Edibles: Parent requested that edibles not be utilized. Zach will request a red/white mint at times
throughout his school day. • Items/Activities: Earning praying mantis visuals, various books about insects, catching a grasshopper or
cricket and keeping it in a container to look at when earned as a reward • Activities on computer: Games and websites with information about insects
• A visual reinforcer menu was created for Zach containing the names of the identified reinforcing items available at school. Newly identified items/activities should continue to be added as they are identified by staff.
• Team should continue to identify additional reinforcers for Zach to expand the number and variety available throughout his day. Team should consider the features of Zach’s current reinforcers to determine potential new reinforcers. Staff should continue to work on varying reinforcers (when possible) so Zach does not satiate (get tired of) items/activities.
• Staff should continue to spend time “pairing” with Zach by engaging in reinforcing activities with him and delivering reinforcers to Zach.
Instruction/Participation (please see charts for analysis of participation data below): • The team has made offering breakfast part of Zach’s morning to avoid concerns about him beginning his day
hungry. • Data gathered have indicated that Zach will remain in his inclusion and/or special education settings at times
but does not participate in the classroom activities and/or follow directions. • Observations and analysis of the data collected for Zach’s participation skills indicate that he engages in
behaviors of concern in order to escape, postpone, avoid tasks/activities that he does not want to complete. Zach will then continue and/or increase the intensity of his behaviors in order to maintain and/or gain attention.
• Staff has had the opportunity to attempt to provide instruction to Zach in a 1:1 setting in a separate room when he is not participating in his inclusion setting and/or special education classroom setting. Staff has had success in gaining participation to complete non-academic and academic tasks/activities in this 1:1 setting.
• The team has been challenged to find reinforcers that are more powerful for Zach to earn for participation in tasks/activities than escaping the tasks and receiving attention for the behaviors of concern. However, assessment of reinforcers should continue on an ongoing basis.
• Staff should continue to chunk assignments into smaller segments to increase Zach’s ability to complete tasks.
• Staff should continue to offer alternatives to Zach writing his answers when he does not want to complete paper/pencil tasks (Ex: Zach tells staff the answer and staff write for the answer for him).
The following is the OCCUPATIONAL THERAPY EVALUATION REPORT provided by Mrs. OT Person, IU 49 Occupational Therapist, on 12/22/15:
NAME: Zach Brehm DOE: 12/8/2015
DOB: 4/27/2005 GRADE: 5th
CA: 10 years, 7 months SCHOOL: Busytown Middle
THERAPIST: Amy L. Cook, MS, OTR/L TEACHER: Math Guy/Social Studies REASON FOR REFERRAL: Zach was referred for a full scale Occupational Therapy evaluation as part of a Multi- Disciplinary Re-evaluation.
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BACKGROUND INFORMATION: Zach participated in an Occupational Therapy evaluation on 11/7/2014 and again on 4/21/15 as a present level update. Focus of this evaluation surrounded concerns regarding fine motor needs (written work excessively slow, often breaks pencil lead, difficulty coordinating eyes), gross motor (difficulty with new motor tasks), behavior (easily frustrate and distractible), and tactile needs(has difficulty interacting in a group game). Presently, Zach receives Occupational Therapy Support to School Personnel, 60 minutes per month, for self- regulation needs. OBSERVATIONS: Zach’s participation with transitions and typical educational expectations was observed on December 8, 2015. He entered the school prior to the entrance of the student body, given verbal cues to proceed to breakfast in the cafeteria. He independently went through the food line to get his tray and bag of breakfast food. He brought his tray to a half table, located in the back of the cafeteria near one of the entrances. This half table is positioned in the middle of the wall, facing away from the other tables. Zach typically sits at this location for school meals. Zach sat his tray and bag of food down, taking out a collection of permissible fine motor activities. He proceeded to work on a puzzle for the first 10 minutes of breakfast. At this time, verbal cues were used to encourage him to eat in addition to working on the puzzle. After approximately 8 more minutes, Zach’s aide arrived and joined him at the breakfast table, providing the additional verbal cues for him to eat breakfast. At this point, he ate two waffle bites, with observable mouth stuffing in 2 -3 bites, followed by drinking his beverage. When cued following the school bell, he gathered his items and threw them away. Zach did inquire about wanting to eat a few more items of his meal, but was reminded that he chose to play with the puzzle instead of eating. He was additionally cued that it was time for school/homeroom activities and that there was no longer time for eating. When transitioning from the cafeteria to his homeroom, Zach needed verbal cues to stay focused on keeping a faster pace. He stopped to inquire about dead bugs on the floor in the stairwell, needing cues to continue transitioning. His aide offered additional cues and contingencies regarding what he was allowed to have from his locker and what things were to remain in his locker. In homeroom, he sat in the back left corner of the room with his aide at an adjacent desk. While the teacher was going over a math paper with the remainder of the class, which was already in session by the time Zach arrived, Zach worked on his own math paper. He worked, answering the math questions quickly with responses. During this he continually made verbalizations to himself and to his aide, some being questions appropriate to the worksheet and some not on topic. When it was time to transition with the class to the first period special, Zach lined up beside his classmates line, at the front. At this time, he grabbed onto Mr. Math Guy’s mid-section, hugging him around the waist. Mr. Math Guy responded by acknowledging Zach verbally, patting him on the back and then releasing him from the hug. While the remainder of the class went to their special, Zach joined this therapist in a separate room for his Occupational Therapy evaluation. Also in attendance in the room were Zach’s aide and his community TSS. With regard to the actual evaluation, Zach benefitted from use of verbal cues and models for expectations (only as permitted by each standardized evaluation). When this therapist entered the cafeteria in the morning for initial observation, prior to specific assessments being administered, Zach responded by “squawking” at the therapist instead of responding with words for answers/conversation. Within 10 minutes, the squawking decreased, only surfacing again during the evaluation when requested to complete handwriting samples for analysis. During the structured, one to one evaluation, Zach benefitted from verbal cues for giving his best work, redirection if off-topic, contingencies for least desirable activities prior to desired ones or being finished, and clear choices for ways to accomplish expected outcomes. EVALUATION METHOD:
• Teacher Interview • Records Review • Clinical Observation • Handwriting Assessment • The Bruininks-Oseretsky Test of Motor Proficiency • Sensory Profile School Companion: Teacher Questionnaire • Test of Visual-Motor Skills - Revised
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EVALUATION RESULTS: Postural Control/Muscle strength/tone – Postural strength is the ability of the student to control and stabilize his trunk and neck muscles to maintain an upright posture. Zach continues to demonstrate the ability to maintain an upright sitting and standing posture and to change between postures. Ocular motor function – Ocular motor function is the ability of the child to separate the movements of his eyes from his head, maintain fixation with the eyes on an object, follow the object around the visual field (track), move the eyes back and forth between objects (saccadic eye movements), bring the eyes together (convergence) and apart (divergence). Zach continues to demonstrate the ability to perform tracking, convergence, and divergence activities. During saccadic movement, he did have difficulty, at first, maintaining a fixed eye position until directed to change. He demonstrated increased ability with this after the first two directives of where to look, fixing on the object until directed to change. Sensory processing/Self-regulation/Attention – Sensory Profile Caregiver Questionnaire information is from the initial evaluation report in November of 2014. It is considered valid assessment input for this evaluation. Sensory Profile Caregiver Questionnaire (reported November 2014): The Sensory Profile is a measure of sensory processing in daily life as assessed through the completion of 125 questions using a 5 point Likert Scale of “Never to Always”. The purpose of the Questionnaire is to evaluate the possible contributions of sensory processing to the child’s daily performance patterns, and to provide information about both the child’s tendencies to respond to stimuli and which sensory systems are likely to be contributing to or creating barriers to functional performance. The questionnaire is completed by the child’s caregiver. Summary of scores are obtained in six areas of sensory processing, five areas of modulation, and areas of behavioral and emotional responses. The areas are rated as “Typical Performance”, “Probable Difference” or “Definite Difference” when compared to a normative group. Raw scores are the results of the student’s parent’s response to the questionnaire. Areas rated as “Definite Difference” are considered to indicate sensory processing problems in those areas. The results of the Sensory Profile Questionnaire, based on the information provided by Mom, indicate a Definite Difference in the Sensory Processing Areas of Vestibular, Touch and Multisensory Processing and the modulation areas related to Endurance/Tone, Body Position, and Emotional Responses and the Behavioral and Emotional areas of Emotional/Social and Behavioral Outcomes related to his sensory processing. Based on the responses provided, Zach demonstrates a high threshold for Vestibular, indicating that he benefits from increased amounts of movement opportunities to meet his threshold levels and low threshold levels for touch processing, indicating that he reaches his threshold levels for touch processing at lower levels. The responses indicate that Zach seeks out the movement opportunities and requires increased movement to activate his body thresholds. The results indicate that Zach responds to sensory input with emotional/behavioral responses. Based on these results, recommendations for the school environment include providing increased movement opportunities (through alternative seating options including but not limited to a sit-n-move cushion or ball chair and the ability to change positions while working or in between work tasks such as walking to bathroom or to get a drink, etc.), use of a hand-fidget as a tool, continued participation in recess and physical education class. Based on the results he would also benefit from participation in movement activities outside of the school environment (participation in a variety of movement, sporting, and recreational activities). The Sensory Profile School Companion (November 2015) Additionally, the Sensory Profile School Companion: Teacher Questionnaire was completed as a current evaluation of Zach’s sensory responses in the educational environment. The Sensory Profile School Companion is a standardized assessment tool for measuring a student’s sensory processing abilities and their effect on the student’s functional performance in the classroom and school environment. It is a questionnaire consisting of 62 items organized in sensory groups: auditory, visual, movement, touch and behavior. The teacher scores each item by reporting the frequency with which the student responds to various sensory experiences (Almost Always, Frequently, Occasionally, Seldom, or Almost Never). Explanation of Scores on the Sensory Profile School Companion Teacher Questionnaire Zach’s sensory responses in the school environment fall within the Typical Performance range for the following School Factor areas: School Factor 2 (Seeking and Sensitivity)
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Zach’s sensory responses in the school environment fall within the Definite Difference range for the following School Factor areas: School Factor 1 (Seeking and Registration) School Factor 3 (Avoiding and Sensitivity) School Factor 4 (Avoiding and Registration) School Factor Scores School Factor Scores reflect the teacher’s perspective about the student within the context of the classroom, learning activities and the school day. Scores reflect the ways that student’s might learn or have barriers to learning. Each School Factor Score contains two sensory processing patterns. School Factor 1: represents the student’s need for external supports. It encompasses Seeking and Registration patterns. If scores fall in the probable/definite difference range these student’s typically need a lot of extra sensory input to activate their high thresholds in order to be prepared for learning. They will likely need supports within the learning environment to participate successfully. School Factor 2: represents the student’s awareness and attention within the learning environment. It includes Seeking and Sensitivity patterns. If scores fall in the probably/definite difference range, these student’s may be getting pulled away from learning activities because of attention to other stimuli in the environment. They will likely need adjustments within the learning environment so they can participate successfully (i.e. less stimulation). School Factor 3: represents the student’s range of tolerance for sensory input. It includes Avoiding and Sensitivity patterns. If scores fall in the probable/definite difference range, student’s may get overloaded quickly in the typical learning environments, interfering with their ability to get instructions, complete independent work or cooperate with other students in groups. The student may be seen as less tolerant, overly reactive and picky. They will need reductions in stimuli within the learning environment so they can participate successfully. School Factor 4: represents the student’s availability for learning. It includes Avoiding and Registration patterns. If scores fall in the probably/definite difference range, students are likely missing opportunities to participate and appear disinterested to the teacher. They may require less input so they can concentrate or more input so they notice what is going on. It is critical to find just the right amount of sensory input. They will need adjustments within the learning environment so they can participate successfully and strategies that the teacher can use to keep them engaged in learning throughout the day. Zach’s sensory responses in the school environment fall within the Probable Difference range for the following Quadrant areas: Quadrant 2 (Seeking) Quadrant 3 (Sensitivity) Zach’s sensory responses in the school environment fall within the Definite Difference range for the following Quadrant areas: Quadrant 1 (Registration) Quadrant 4 (Avoiding) Quadrant Scores Registration: scores in the probable/definite difference range represent students who likely miss sensory input that provide cues about what is going on in the context. The brain may not be getting what it needs to generate responses. It is hypothesized that student’s in this range have inadequate neural activation to support sustained performance and consequently may miss salient cues in the context to support ongoing responsivity. They may appear uninterested and can have a dull or flat affect. They may seem to have low energy levels and act as if they are overly tired all of the time. Seeking: scores in the probable/definite difference range represent students who tend to be active and continuously engaged in their environments. They add sensory input to every experience in daily life. They may make noises while working, fidget, rub or explore objects with their skin, chew on things and wrap body parts around furniture or people as ways to increase input during tasks. They may appear excitable or lack consideration for safety when playing.
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Sensitivity: scores in the probable/definite difference range represent students who tend to be distractible and may display hyperactivity. It is hypothesized that students in this range have over-reactive neural systems that make them aware of every stimulus that becomes available, and they do not have the commensurate ability to habituate to these stimuli. Avoiding: scores in the probable/definite difference range represent students who may engage in very disruptive behaviors hypothetically because meeting thresholds occurs too often, which is uncomfortable for the student. In order to keep the stimulation at bay, they avoid it by either withdrawing or engaging in emotional outbursts that enable them to get out of the situation. From a behavioral standpoint, the child might seem stubborn or controlling. They function best with rituals and tend to create them for their daily lives. The student is creating a situation to limit sensory input to those events that are familiar and therefore easy for the nervous system to interpret. Observations of Sensory Responses – During this current evaluation, Zach was observed to engage in the following sensory responses: munching and stuffing waffle bites in mouth during breakfast, visual distraction for dead bugs on floor in expected area of stairwell, constant verbalizations during opening math exercises in homeroom, seeking hug from homeroom/math teacher, Mr. Math Guy, seeking hug from his aide during the evaluation, multiple ‘squawkings’ and verbalizations during various portions of the evaluation, use of staccato-like robotic voice (fast-paced) when talking to therapist requiring cues for slowing down, and smelling hands when finished washing or using hand sanitizer (negative and positive reactions, respectively). Additionally, he engaged in oral activities throughout the testing, including sucking his pinky finger and picking at his nose/mouth area due to a running nose. In the structured evaluation setting, Zach did respond to cues and redirection for participating in all activities presented. Use of contingency statements and the provision of clear choices for therapist’s expected outcome also assisted him with participating. During the evaluation, his overall sensory regulation for attention and participation was in or near an optimal state for attending to, attempting, and/or completing activities, given the previous described supports. Additionally, opportunities were provided for movement on the testing side of the room. Varying seated activities with standing or large body movement also seemed beneficial to him for attention and participation. Upper Extremity Function/Hand Skills – (In-Hand Manipulation Skills) Shift: moving or “walking” fingers along the shaft of a pencil. Intact for both hands. Rotation: turning a pencil in one hand, unassisted. Intact for both hands. Translation with stabilization: moving three pennies from fingertip-to-palm and out again, individually, while maintaining others in palm. Intact for both hands. Fine motor/Perceptual motor - Handwriting – Zach uses a right quadrupod grasp with dynamic wrist motion when drawing and writing. When writing, Zach produces samples with a consistent backward slant and decreased legibility due to size, spacing, and baseline anchoring of letters. His legibility for written work was evaluated by clinical observation using the following: near point copy, far point copy, and keyboarding skills. Average Handwriting Speeds for Letters per Minute (Boys) are as follows: Grade 1 = 17 Letters per minute Grade 2 = 32 Letters per minute Grade 3 = 45 Letters per minute Grade 4 = 61 Letters per minute Grade 5 = 71 Letters per minute Near-point copy: 23 Letters per minute Letter formation – average Letter size – ½” Far-point copy: 39 Letters per minute Letter formation: 97% accuracy Baseline anchoring: 69% accuracy Letter size: 66% accuracy
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Word spacing: 44% accuracy Keyboarding skills: Timed typing test; 33 characters in one minute 6 WPM (Words per minute) 1 Error 5 WPM (adjusted speed) Zach uses the hunt/peck method for typing on a computer keyboard. He uses bilateral index fingers to strikes keys and produce typed letters. Scissor skills – Zach was able to independently use Fiskar scissors to cut around a 2” diameter circle. Visual Perception/Visual Motor Integration – Test of Visual-Motor Skills: Revised Edition [TVMS-R] Ages 3-13 years 11 months-This well-accepted, well- normed, and standardized test has been revised with the following changes: addition of new geometric forms, deletion of some original geometric forms, revised norms for subjects ages 3 years to 13 years 11 months, revised standardization, and revised method of scoring. New scoring requires each geometric form to be evaluated by visual-motor characteristics, unlike the right or wrong method. A scoring-criterion form for each test booklet is needed. Still easy to administer, the revised form of the TVMS can be administered to groups as well as to individuals. Total Raw Score: 112 Motor Age: 7 year, 0 months Standard Score: 66 Scaled Score: 3 Percentile Rank: 1 Error (Zero) Characteristics: Classification Total Error Raw Scores Standard Scores Scaled Scores Percentile Ranks 1 - Closure 9 55 1 1 2 - Angles 7 99 10 47 3 – Intersecting and/or 3 73 5 3 Overlapping Individual Lines 4 – Size of Form or Part of Form 3 61 2 1 5 – Rotation or Reversal 0 > 112 > 12 > 80 6 – Line Length 3 63 3 1 7 – Under/Over Penetration 3 55 1 1 8 – Modification of Form 3 84 7 14 Based upon evaluation results, Zach presents with visual motor strength in the areas of angle precision and rotation/reversal (not rotating or reversing the design or part of the design). His areas of need include precision with closures, intersecting and/or overlapping individual lines (unequal extensions), size of form or part of form, line length, and over-penetrating or under-penetrating the design or parts of design. Praxis/motor planning – Praxis involves the ability to develop an idea about an activity or movement, make the necessary plans to perform the activity based on both environmental factors and the knowledge of one’s body and then carry out the plan. Timing is an important aspect of praxis. R/L discrimination – Zach was able identify right and left body parts upon request; some hesitation evidenced as he paused before two of the requests. He self-corrected one of the ten without assistance, resulting in 10/10 correctly identified. Bilateral coordination – Zach was able to string beads and cut with scissors in an expected manner. Novel motor movements – Zach was able to demonstrate alternate hand flips with eyes closed and demonstrate thumb-to-finger opposition in varying patterns following an initial model. The Bruininks-Oseretsky Test of Motor Proficiency – The test is an individually administered test that assesses the motor function of children from 4 ½ to 14 ½ years of age. Raw Score Scale Score Age Equivalent Fine Motor Precision – 27 7 – Below Average 5 years, 7 months
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Fine Motor Integration – 32 9 – Below Average 6 years, 8 months Manual Dexterity - 19 6 – Below Average 5 years, 9 months Bilateral Coordination – 21 12 – Average 7 years, 11 months Gross motor/Mobility in the school – Zach is able to access and utilize his educational environment. He is able to replicate six different arm positions (using both arms). He is able to complete two jumping jacks, given a model and cues, before demonstrating decreased rhythm and coordination. Self – Help – Zach is able to independently function in the educational environment for breakfast, lunch, and using the bathroom. He benefits from adult supervision and cues for remaining on task with regard to meals. Zach is beginning to learn how to blow his nose. Strengths: Good postural control for educational environment and expectations Increased participation in structured, one-to-one evaluation setting, given adult assistance with cues, contingencies, redirection, and clear choices for expected outcomes In-hand manipulation skills Bilateral coordination for cutting Visual motor integration: angles and non-reversals or incorrect rotation Bilateral coordination emerging R/L discrimination and novel motor movements Beginning typing skills Needs: Sensory regulation/processing, particularly for Seeking/Registration, Avoiding/Sensitivity, and Avoiding/Registration Decreased legibility for written expression Visual Motor Integration: overall precision and size characteristics Fine motor: precision, integration, and dexterity SUMMARY: Zach is a 10 year, 7 month old boy who receives Occupational Therapy Support to School Personnel for sensory regulation needs in the educational environment. During this time of observation and evaluation, Zach presented with increased needs in the areas of fine motor precision, visual motor integration, and manual dexterity (greater than 25% delay). These areas of fine motor need directly impact legibility for written expression. He is beginning the use of keyboarding, using a hunt-and-peck method of typing. Zach benefits from clear models, use of visual and verbal cues, contingency statements (first ___ , then ____), and clear choices for expected outcomes. Given these supports, he participated well in the structured, one-to- one Occupational Therapy evaluation. Zach also presents with caregiver and teacher identified sensory needs, particularly in the areas of seeking input and needing movement to meet and activate threshold levels. RECOMMENDATIONS: Zach would benefit from Occupational Therapy Support to focus on fine motor and sensory regulation strategies in the educational environment. He would also benefit from Occupational Therapy Support to School Personnel to continue supporting strategies for optimal regulation with regard to participation and attention in the educational environment.
Behaviors that Impede Learning (Describe the behavior, the triggers of the behavior and the function of the behavior) Daily living/skills: (hygiene, dressing, basic consumer skills) NA
2. Present levels related to current postsecondary transition goals if the student’s age is 14 or younger if determined appropriate by the IEP team (e.g., results of formative assessments, curriculum-based assessments, progress toward current goals)
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NA
3. Parental concerns for enhancing the education of the student Parent did not share any concerns not already addressed in 1-3
4. Other Relevant Information In previous IEP’s, Zach has had an SDI to address the excessive skin picking that he does during the day. This SDI was to have pieces of Velcro on the bottom of his desk, and he was encouraged to use the Velcro instead of picking at himself. This SDI was not useful for Zach, and he was caught several times eating pieces of the Velcro. This SDI has been removed from his IEP due to the unsafe nature of having an additional non-edible within his reach. Zach has received Out of School Suspension 3 times and In School Suspension 2 times during the current 2015/2016 School year because of his dangerous or destructive behaviors.
5. How the student’s disability affects involvement and progress in the general education curriculum With Specially Designed Instruction and Program Modifications to meet his needs as a student requiring Emotional, Speech/Language and Autism Support, Zach will receive the general education curriculum when he is attending Math, ELA, Science and Social Studies in the Special Education Classroom.
6. Student’s Strengths (include interests and preferences for students who will be 16 or over during the duration of this IEP)
• Strengths: • Curriculum Based Measurement from beginning of 5th grade school year indicates average
performance in reading fluency, reading comprehension, and mathematics • Completes homework • With assistance from aide, comes prepared to class • In a structured speech therapy setting, performance for therapy tasks is in an average range when
he is prompted to respond • Age and grade appropriate receptive and expressive vocabulary abilities • History of overall Average to Low Average cognitive abilities on standardized tests administered
within school setting • History of overall High Average to Low Average academic skills on standardized tests administered
within school setting • Good postural control for educational environment and expectations • Increased participation in structured, one-to-one evaluation setting, given adult assistance with
cues, contingencies, redirection, and clear choices for expected outcomes • In-hand manipulation skills • Bilateral coordination for cutting • Visual motor integration: angles and non-reversals or incorrect rotation • Bilateral coordination emerging • R/L discrimination and novel motor movements • Beginning typing skills • Parent reports indicate adaptive strengths within the home setting in the areas of leisure skills
(ABAS-3), self-care skills (ABAS-3), health and safety skills (ABAS-3), social skills (BASC-3), and adaptability (BASC-3)
• Teacher reports indicate relative adaptive strengths within the school setting in the areas of functional academics (as rated by Mrs. Sheller and Mr Math Guy on the ABAS-3), community use (as rated by Mr. Math Guy on the ABAS-3), and self-care skills (as rated by Mr. Math Guy on the ABAS-3)
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7. Academic, Developmental, Functional Needs Related to the Student’s Disability (include transition
related needs for students who will be 16 or over during the duration of this IEP)
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• Curriculum Based Measurement from beginning of year indicated below average performance in
reading vocabulary • Teacher reports indicate that Zach is missing some basic foundational pieces in mathematics and
grade has declined since he is being asked to complete more work independently in this area • Limited progress toward IEP goals • Significant loss in instructional time due to behaviors of concern (e.g. work refusal, lack of
participation, or behaviors requiring removal from classroom such as crawling on floor and noisemaking)
• Requires constant prompting and encouragement to stay on task, but even with this dos not always pay attention and/or participate
• Limited completion of in class tasks/assignments • Picks at skin • Poor social interaction skills (growls at others, biting, kicking, spitting, etc.) • Difficulty following one-step directions • Below average pragmatic language skills • Sensory regulation/processing, particularly for • Seeking/Registration, Avoiding/Sensitivity, and Avoiding/Registration • Decreased legibility for written expression • Visual Motor Integration: overall precision and size characteristics • Fine motor: precision, integration, and dexterity • Adaptively, parent reports indicate below average communication skills (ABAS-3) and social skills
(ABAS-3) and low self-direction skills (ABAS-3) • Adaptively, teacher reports indicate significant limitations in overall adaptive functioning as
assessed on the ABAS-3 across the conceptual, social, and practical domains • Parent ratings of Zach’s social-emotional-behavioral functioning indicated elevated levels of
concern in the areas of hyperactivity/impulsivity, aggression/defiance, inattention, conduct problems, atypicality, withdrawal, leadership skills, activities of daily living, functional communication skills, learning problems, executive functioning difficulties, and peer relations.
• Teacher ratings of Zach’s social-emotional-behavioral functioning indicated elevate levels of concern in the areas of hyperactivity/impulsivity, aggression/defiance, conduct problems, anxiety, depression, atypicality, withdrawal, attention problems, learning problems, executive functioning difficulties, adaptability, social skills/peer relations, leadership, study skills, and functional communication.
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III. TRANSITION SERVICES – This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the IEP meeting, the school must take other steps to ensure that the student’s preferences and interests are considered. Transition services are a coordinated set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and functional achievement of the student with a disability to facilitate the student’s movement from school to post school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation that is based on the individual student’s needs taking into account the student’s strengths, preferences, and interests.
Transition does not apply to this student (skip this section) Postsecondary Education and Training Goal: Measurable Annual Goal
Yes/No (Document in Section V)
Courses of Study:
Service/Activity Location Frequency Projected Beginning Date
Anticipated Duration
Person(s)/Agency Responsible
Employment Goal: Measurable Annual Goal
Yes/No (Document in Section V)
Courses of Study:
Service/Activity Location Frequency Projected Beginning Date
Anticipated Duration
Person(s)/Agency Responsible
Independent Living Goal, if appropriate: Measurable Annual Goal
Yes/No (Document in Section V)
Courses of Study:
Service/Activity Location Frequency Projected Beginning Date
Anticipated Duration
Person(s)/Agency Responsible
IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS
Please check the appropriate assessment option. Information on available testing accommodations may be found in the Accommodations Guidelines available on http://www.education.pa.gov/K-12/Assessment and Accountability/PSSA/ State Assessments
Not Assessed
No statewide assessment is administered at this student’s grade level. No English proficiency assessment administered because the student is not an English Language Learner.
PSSA (Math administered in grades 3-8; Science administered in grades 4 and 8; Reading administered in grades 3-8; Writing administered in
grades 5 and 8; and ELA*)
Tested Subject
W i t h o u t
W i t h A c c
Accommodations to be provided Please consult
http://www.education.pa.gov/K-12/Assessment and Accountability/PSSA/
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A c c o m m o d a t i o n s
o m m o d a t i o n s
Math Questions read aloud(when appropriate), 1-1 testing, extended time, extra breaks
Science NA
Reading NA
Writing NA
ELA* 1-1 testing, extended time, extra breaks *ELA will replace the Reading and Writing PSSAs in 2014-2015 for grades 3-8.
Keystone Exam (Replaces the 11th grade PSSA in high school; Student must participate by 11th grade)
Tested Subject
K e y s t o n e E x a m
K e y s t o n e P r o j e c t b a s e d a s s e s s m e
V a l i d a t e d L o c a l A s s e s s m e n t * *
W i t h o u t A c c o m m o d a t i o n s
W i t h A c c o m m o d a t i o n s
Accommodations to be provided** Please consult
http://www.education.pa.gov/K-12/Assessment and Accountability/PSSA/
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n t *
Algebra 1 NA
Literature NA
Biology NA *Available when student is unable to demonstrate proficiency on a Keystone Exam or Keystone Exam Module) ** Available when selected as an option by LEA
PASA (Grades 3-8, 11 for Reading and Math, Grades 4, 8 , 11 for Science)
Student will participate in the PASA
Explain why the child cannot participate in the PSSA:
Explain why the PASA is appropriate:
Choose how the student’s performance on the PASA will be documented
Videotape (which will be kept confidential as all other school records)
Written narrative (which will be kept confidential as all other school records)
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ACCESS for ELLs (Administered in grades K-12)
Domains Without Accommodations
With Accommodations
Unable to Participate
Accommodations to be Provided or Rationale for Inability to
Participate in Selected Domains
Listening NA
Reading NA
Writing NA
Speaking NA Alternate ACCESS for ELLs (Administered in grades 1-12)
Alternate ACCESS for ELLs (Administered in grades 1-12)
☐Student will participate in the Alternate ACCESS for ELLs.
Explain why the student cannot participate in the ACCESS for ELLs:
Explain why the Alternate ACCESS for ELLs is appropriate:
Domains Without Accommodations
With Accommodations
Unable to Participate
Accommodations to be Provided or Rationale for Inability to
Participate in Selected Domains
Listening NA
Reading NA
Writing NA
Speaking NA
STUDENT PARTICIPATION – LOCAL ASSESSMENTS Student will not participate in Local assessments because there are none given during the duration of this IEP.
Student will participate in Local assessments without accommodations; or
Student will participate in Local assessments with the following accommodations: Please see PSSA Section Above; or
The student will take an alternate local assessment
Explain why the child cannot participate in the regular assessment:
Explain why the alternate assessment is appropriate:
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Complete this heading chart only when issuing these goal pages as an IEP report Card
Reporting Period: School year
Date Issued To Parent
V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately. Specially designed instruction may be listed with each goal/objective or listed in Section VI. Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be listed under Goals or Short Term Objectives.
MEASURABLE ANNUAL GOAL MEASURABLE ANNUAL GOAL
Include: Condition, Name, Behavior, and Criteria (Refer to Annotated IEP for description of these
components)
Describe HOW the student’s progress toward meeting this goal will be measured
Describe WHEN periodic reports on progress will be
provided to parents Report of Progress
When given a timed 4th grade math computation probe, Zach correct answer problems with at least 80% accuracy on 3 out of 5 trials.
Math computation probes administered at least 4 times per marking period.
Quarterly with Report cards
When given a timed 4th grade level reading fluency probe, Zach read 150 Words Correct Per Minute with at least 95% accuracy on 3 out of 5 trials.
Leveled Reading Passages administered at least 4 times per marking period.
Quarterly with Report cards
When given his assigned classroom schedule, Zach will transition to the assigned location within the allotted 5 minute time frame for 5 consecutive days.
Daily behavior logs will be used to track his progress on a weekly basis
Quarterly with Report cards
When in assigned classroom, Zach will remain in the classroom environment with no more than 1 five minute break for every 30 minutes of instructional time for 5 consecutive days.
Daily behavior logs will be used to track his progress on a weekly basis
Quarterly with Report cards
When in assigned classroom during a structured teaching situation, Zach will complete assignments before gaining access to his preferred item/activity in 80% of opportunities charted for 5 consecutive days.
Daily behavior logs will be used to track his progress on a weekly basis
Quarterly with Report cards
SHORT TERM OBJECTIVES – Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).
Short term objectives / Benchmarks
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V. GOALS AND OBJECTIVES - Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately. Specially designed instruction may be listed with each goal/objective or listed in Section VI.
Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be listed under Goals or Short Term Objectives. Student Name: Zach Brehm
Area of planned instruction: (Refer to PA Academic Standards or District Curriculum) Speech and Language Support 2016 - 2017
Measurable Annual Goal Include: Condition, Name, Behavior, and Criteria (Refer to Annotated IEP for description of these
components)
Describe HOW the student’s progress toward meeting this goal will be
measured and WHEN periodic reports on progress will be provided to
parents.
Report of Progress
Using an expected vs. unexpected behavior(s) framework, Zach will identify and use targeted social skills, with reduced cueing/prompting Required, in structured to less structured settings/opportunities 80% of the time. When presented with a social behavior/interaction scenario Zach will: -- Define/ Describe -- Contrast (expected vs unexpected) -- Predict
■ consequences/outcomes ■ feelings (his and others as related to The
Zones) ■ reactions (his and others)
-- Interpret (perspective/body language) -- Modify (suggest/implement changes) (PA Standard Reference 1.6)
Analysis of data collected during classroom activities, standardized tests, and therapy notes used to measure progress. Progress will be reported once every 9 weeks when report cards are sent home
Marking Period S L N
1st marking period
October 2016
2nd marking period
January 2016
3rd marking period
March 2016
4th marking period
May 2016
Progress Report Key (extent to which progress is sufficient to meet the annual goal) S = making sufficient progress (80% or better) L = making limited progress (70% - 79%) N = not making sufficient progress at this time (0-69%) VI. SPECIAL EDUCATION/ RELATED SERVICES / SUPPLEMENTARY AID AND SERVICES / PROGRAM MODIFICATIONS - – Include, as appropriate, for nonacademic and extracurricular services and activities.
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PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION: • SDI may be listed with each goal or as part of the table below. • Include supplementary aids and services as appropriate. • For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or
modifications to the general education curriculum, as appropriate for a student with a disability.
Due to the need for… Modification Or SDI Location* Frequency Beginning Date Anticipated Duration
Increased age appropriate
communication abilities
Daily use of agenda for home and school communication
School/Home Sent home Daily to relay
information between home
and school
02/12/16 02/02/17
Increased frequency of on
task behavior
Verbal and non-verbal reminders to stay on task During Instructional
Periods
When demonstrating
off-task behavior
02/12/16 02/02/17
An increase in completion of in
class tasks/assignments
Visual timer Regular Ed and Special
Ed Classrooms
When requested by
student/teacher
02/12/16 02/02/17
Increasing functional
communication ability
Encourage Zach to use his “boy” voice and good sounds to communicate with adults and peers.
Regular Ed and Special
Ed Classrooms
daily 02/12/16 02/02/17
An increase in the amount of work
completed
Extended time for taking tests/small group daily When off task behaviors
impede his ability to complete tests
in the given timeframe
02/12/16 02/02/17
An increase in the amount of time
student spends on task in the classroom
Low distraction area within the classroom All classroom settings
During times of instruction,
independent work, or when
otherwise necessary
02/12/16 02/02/17
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Due to the need for… Modification Or SDI Location* Frequency Beginning Date Anticipated Duration
an increase in time spent on task
during instruction, and to decrease
unexpected behaviors
*Classroom Positive Behavior Plan Change to PBSP?
All school settings
Every day 02/12/16 02/02/17
Increased age- appropriate social-
emotional- behavioral functioning
Emotional cards to express feelings Speech Classroom
1x per 6 day cycle during
social skills group
02/12/16 02/02/17
An increase in the amount of time on
task, and to provide
reinforcement
Participate in the reg. classroom behavior management plan
General Education Classrooms
During times of inclusion
02/12/16 02/02/17
legibility for written expression
Visual Motor Integration
3/4” lined primary journal to use for writing logs and math logs
Math and ELA classrooms
When a writing assignment or task is given
02/12/16 02/02/17
Addressed with a different SDI
Velcro strip attached to the bottom of desk for sensory purpose/prompts to use
See above*** 02/12/16 02/02/17
Fine motor: precision,
integration, and dexterity
Extra time for long writing assignments In class assignments
When a written assignment is
given
02/12/16 02/02/17
An increase in appropriate social
interaction skills
Preferential seating/desk away from others All areas of instruction
Always 02/12/16 02/02/17
An increase in ability to follow
single-step directions
Clear and concise explanation of directions and expectations
All areas of instruction
Whenever directions are
given
02/12/16 02/02/17
Individualized Education Program (Aug 2014 revision) Page 30
Due to the need for… Modification Or SDI Location* Frequency Beginning Date Anticipated Duration
An increase of age-appropriate social-emotional-
behavioral functioning
Model/encourage Zach to use social skills and strategies
Social Skills group, small
group setting, classroom
During social skills group, when the need arises in the classroom setting
02/12/16 02/02/17
A decrease in the amount of
picking/biting/che wing on his
skin/hair
Signal folded hands when picking skin Classroom/ hallway
When picking at self
02/12/16 02/02/17
An increase in the amount of time on
task, and to provide
reinforcement
Immediate feedback for retention of information Classroom When retention of information is
observed, as often as possible
02/12/16 02/02/17
Increase the amount of expected behaviors
Praise frequently for on-task behavior Classroom Starting out more often, with a decrease as more on-task
behavior is observed
02/12/16 02/02/17
Making progress toward current IEP
goals
Chunk work to be less overwhelming Classroom Prior to presenting to
student, as often as necessary to limit behavioral
issues
02/12/16 02/02/17
An increase in on task behavior
A 5 minute break per 30 minutes of instructional time
*Include CPAVTS in location if student is enrolled in Vo-Tech Positive Behavior Support Plan (If not needed check box )
Positive Behavior Support Plan Updated Behavior Information Summary:
Individualized Education Program (Aug 2014 revision) Page 31
Data was collected regarding the behaviors of concern which include: a) mouthing inedible objects b) biting/sucking/picking skin/hair c) verbal/nonverbal refusal behaviors. The team reported concerns the recent change in behavior from the beginning of the school year to the present time may be related to changes in medications/or changes in effectiveness of medications.
Antecedents to the behavior of concern
Behavior of concern
Consequences maintaining the
behavior of concern
Perceived function of the behavior of
concern
• Instruction/direction to individual student
• Teacher redirection • Instruction/direction to
whole group
• Biting/sucking/picking skin • Verbal/non-verbal task
refusal • Mouthing inedible objects
• Verbal prompt from teacher
• Aide/TSS prompting/redirection
To Escape • Direction To Gain • Attention
When (antecedents to the behavior of concern) given instruction/direction to individual student, teacher redirection, instruction/direction to whole group Zach (behavior of concern) will engage in biting/sucking/picking skin, verbal/non-verbal task refusal, and mouthing inedible objects in order to (perceived function of the behavior of concern) escape/avoid/postpone direction followed by trying to gain attention
PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION FOR THE POSITIVE BEHAVIOR SUPPORT PLAN:
Individualized Education Program (Aug 2014 revision) Page 32
A Antecedent (prevention) Strategies What To Avoid: • Avoid Zach being able to escape from task/activity • Avoid providing attention for behaviors of concern (unless his safety/safety of others is at risk) • Avoid access to preferred items/activities when displaying behaviors of concern • Adults should not discuss Zach’s behavior when he is able to hear their conversations Sensory Strategies/Tools:
• Continue to explore use of structured opportunities for sensory input built into the classroom routine • Increase Zach’s vocabulary of emotions and recognition of facial expressions • Use of matched stimulation to find more socially appropriate behaviors to teach Zach to replace his socially unexpected sensory seeking behaviors (i.e.:
mouthing inedible objects, biting/picking/sucking skin) • Encourage Zach to verbally to express his wants and/or needs when he is attempting to engage in unexpected sensory seeking behaviors(verbally or pointing to a
picture)
Environmental Structures and Transition: • Assessment of Zach’s reinforcers (edible items, non-edible items/activities) • Visual reinforcer menu of options for Zach to choose from to earn for participation in following directions • Visual/verbal reminders of what is next on the schedule • Use social stories and/or rules to explain behavioral expectations for specific situations • Provide a transition warning (e.g. timer, check schedule, one more minute) • Provide Zach with expectations of what is coming/transitions and warnings of changes in schedule • Give clear and concise directions • Allow Zach to make choices when possible
• Pre-correction procedures (a proactive strategy designed to prevent or interrupt predictable problem behavior from occurring and increase the likelihood of expected behavior taking place), used in conjunction with correction procedures, provide educators with a very effective and efficient method for preventing and managing a wide range of problem behavior that occurs in classroom and school settings. The combined uses of these two procedures involve seven basic steps:
Identifying the Context (trigger) and the Predictable Problem Behavior Specifying Expected Behaviors Modifying the Context Conducting Behavior Rehearsals Providing Strong Reinforcement for Expected Behaviors Prompting Expected Behaviors Monitoring the Plan
Instructional Strategies: • Errorless learning and shaping procedures when teaching new content • Gain Zach’s attention before a demand is placed upon him • Staff should model and explain to Zach what is expected when introducing instructional lessons/activities • Reduce amount of work presented at one time to increase the likelihood of assignment completion • Use clear and concise directions • When possible allow Zach to make choices appropriate to instructional activity/lesson (Ex: which one do you want to do first?) • When possible fade prompts within the instructional session to promote independent skills • Use of first/then statements when presenting activities/tasks perceived to be non-preferred/difficult to promote task completion • Use of continuous reinforcement to establish new skills • Use of a timer when appropriate • Teach Zach the expected ways to gain attention through modeling, role-playing, and the use of visual supports • Develop daily tracking form of tasks completed and preferred activities/items utilized
Individualized Education Program (Aug 2014 revision) Page 33
Communication Strategies:
• Use of behavior report between staff and parents to report positive behavioral experiences and number of tokens earned • Provide Zach with choices when given tasks/directives when possible. Talk to Zach about which task he wants to complete first and second. The goal is to
keep Zach motivated and working toward a teacher expected outcome. Allow Zach to take ownership of the task and completion of the task. Motivational Strategies:
• Conduct preference assessments with Zach – Staff will assess his interest in potential reinforcers on a daily basis • Deliver and/or change schedule of reinforcement based on Zach’s performance at the “moment” • Use promise reinforcers when transitioning from a preferred to less preferred activity • Use of continuous reinforcement when trying to establish a new skill (provide reinforcement every time Zach uses replacement behavior in his PBSP) Make
it immediate, descriptive and enthusiastic • Use of an intermittent schedule (strengthens behavior) of reinforcement for known activities/tasks • Use of a visual reinforcement system • Use a variety of reinforcement- verbal praise, high fives, tangibles, and/or non-verbal (e.g. thumbs up, pat on back) • Differential reinforcement of alternative behavior (DRA)- reinforce the alternative behaviors we want (not the interfering behavior)
Behavioral Strategies:
• At first sign that Zach’s behaviors of concern may begin (pre-cursor behaviors identified = moving around in his seat, talking faster and at a higher pitch), present Zach with a visual choice of options to try
• Staff will assist in helping Zach self-reflect to increase awareness of the effectiveness of strategies for him • Use of a clear, calm, neutral low voice • Be aware of Zach’s warning signs which can be due to a stressful events, communication, and/or overwhelming situations in which he may need to try his
identified strategies • Use close proximity when Zach is off task • Use of behavioral momentum techniques to increase participation • Use of 1:1 correspondence in earning tokens for each response Zach provides to increase his motivation to participate • Provide the student with direct instruction in replacement strategies for unexpected behaviors. Allow plenty of opportunities for
Zach to practice/role play the replacement strategy in a safe setting. When the unexpected behavior is observed in a natural setting, be sure to prompt the student to use the replacement strategy rather than simply requesting that the student terminate the unexpected behavior. The prompt used to cue the replacement behavior can be verbal or nonverbal, but should be discussed with to the student prior to use. Immediately reward the student with a high-interest incentive when the replacement behavior is used.
Individualized Education Program (Aug 2014 revision) Page 34
B Replacement Behavior (achieving the same function): • When given his assigned classroom schedule, Zach will transition to the assigned location within the allotted 5 minute time frame for 5 consecutive days.
• When in assigned classroom, Zach will remain in the classroom environment with no more than 1 five minute break for every 30 minutes of instructional time for 5 consecutive days.
• When in assigned classroom during a structured teaching situation, Zach will complete assignments before gaining access to his preferred item/activity in 80% of opportunities charted for 5 consecutive days.
ÓC Consequences (reinforcement) for when the student performs the replacement behavior:
• When delivering reinforcement it needs to be immediate, descriptive, and enthusiastic. When Zach chooses to do what is expected, give him immediate verbal praise and appropriate reinforcement (catch him being good).
• Deliver and/or change schedule of reinforcement based on Zach’s body language at the “moment” • Proactive use of sensory activities in collaboration with Zach and the staff working with him • Use a variety of reinforcement- verbal praise, high fives, tangibles, and/or non-verbal (e.g. thumbs up, knuckle bump) • Differential reinforcement of alternative behaviors (DRA)- reinforce the alternative behaviors we want (not the interfering behaviors) • Increasing the ratio of replacement behavior to reinforcement until the desired skill is more consistently established • Reevaluate reinforcers every other week and continue to add them as they are identified by staff • Teach alternative behaviors by reinforcing the replacement behaviors
Individualized Education Program (Aug 2014 revision) Page 35
ÔC Consequences (including procedures to follow) when the student performs the behavior of concern: • Do not allow Zach to escape demands (may need to interrupt the behavior with a different task/activity and then bring back the original task/activity) • Staff should withhold attention (no eye contact, do not talk to the student) when Zach engages in behaviors of concern to get adult attention. Staff should
provide a neutral, visual prompt for the replacement behavior (e.g. raise hand, say, “Excuse me.”) • Staff will remind Zach that he has strategies to use/reinforcers he is working to earn • Staff will reinforce when Zach uses his strategies or continues with activity with appropriate behavior
Behavior-Reduction Strategies (De-escalation): *Strategies are NOT meant to be followed in a hierarchical order, but use of each strategy is dependent upon level of escalation and student response to the strategy itself *To avoid multiple people giving verbal prompts at one time – select one person to give directives At the onset of the behaviors, use one of the following strategies: Strategy 1 using Communication: (use during mild signs of agitation such as moving around in his seat or talking in higher pitch)
• Staff will verbally/visually remind Zach he has strategies to use/reinforcers he is working to earn • Staff will reinforce immediately when Zach uses his strategies or continues with activity with appropriate behavior • Approach Zach maintaining a safe distance (3-5 feet) • Use Prompts to guide Zach in communicating his wants and/or needs
o Ask Zach to state what he wants. Say “What do you want? or “What do you need?”àverbally/visually cue Zach to use his words o If you think you know what Zach wants, try to help him verbalize it- Say “I want…”
• Allow 5 seconds for Zach to process the request • Repeat the prompt if necessary • If Zach makes an appropriate request, then praise him for communicating. Honor the request if possible and appropriate • When calm or back on task a staff member should debrief Zach utilizing visual supports • If signs of agitation increase, then stop and consider switching to a different strategy
Strategy 2: Prompt Strategy (incompatible behavior) (use when Strategy 1 has not been effective or not appropriate, when it is likely he will comply with request)
• Approach student maintaining a 3-5 foot distance • Prompt an incompatible behavior in a calm, neutral tone (e.g. if student is kicking, ask him to jump up and down) OR prompt a high probability behavior-
something Zach already knows how to do, a simple brief action person can do. The activity can NOT be highly reinforcing • Allow 5-10 seconds for Zach to process your request
o Praise any participation. Begin again with another incompatible or high-probability behavior (reverse the behavioral momentum) o If he responds reinforce and continue task/activity on schedule
• If non-participation occurs, identify a different incompatible or high-probability behavior and start over • If Zach engages in an incompatible behavior without being prompted- reinforce immediately • When calm a staff member will debrief with Zach utilizing visual supports • If signs of agitation increase, then stop and consider switching to a different strategy
Strategy 3: De-escalation Strategies (used for automatic reinforcement/escape)
• Staff will verbally/visually remind Zach he has strategies to use/reinforcers he is working to earn • Staff will reinforce immediately when Zach uses his strategies or continues with an activity with expected behavior • Approach Zach maintaining a safe distance (3-5 feet) • Repeat prompt if necessary • Staff will ask Zach if he wants a 2 minute or 3 minute break • Staff will check back with him • Staff will offer Zach suggestions on strategies that can be used • Praise any participation • When calm a staff member will debrief with Zach utilizing visual supports • If signs of agitation increase, stop and consider switching to a different strategy
Strategy 4: Wait Strategies: (use for attention or when other strategies appear to increase the escalation of the behavior(s) and to avoid external reinforcement of behaviors of concern)
• Staff will verbally/visually remind Zach he has strategies to use/reinforcers he is working to earn • Staff will reinforce when Zach uses his strategies or continues with the activity with appropriate behavior • When Zach is engaging in behaviors that are dangerous to himself or others, staff will utilize behavioral safety guidelines to give Zach the opportunity to de-
escalate in a quiet setting • If it is not safe to remove Zach from the area, staff should remove other students from the area
Individualized Education Program (Aug 2014 revision) Page 36
• Maintain a safe distance of 3-5 feet and position yourself to be able to monitor Zach’s behaviors while keeping movements slow and voices low-due to Zach’s body being out of control (ex: flailing arms & legs, etc.)
• Staff will use a calm, neutral tone of voice to state strategies he could use one time and then remove attention until Zach complies (offer suggestions 1 time) • Avoid reinforcing Zach’s behavior (don’t talk, give eye contact, etc.) • When Zach is showing self-regulation/emotional control (attempting to respond to teacher direction),
return him to some/all part(s) of the activity/task he was doing and then put him back on schedule (this is to avoid Zach escaping activity/task) • When calm a staff will debrief with Zach utilizing visual supports
CRISIS PLAN Note:
• The use of emergency physical intervention is considered a measure of last resort, only to be used after other less restrictive measures: including de-escalation techniques have been implemented.
• If Zach’s behavior warrants the use of emergency physical intervention due to imminent risk of serious harm to himself or others, staff will assess if there is a safe place in the room keeping Zach, other students and staff safe.
• Other students will be removed from the classroom or Zach will be removed from the classroom utilizing an appropriate behavioral safety technique
• Staff will utilize an appropriate one person behavioral safety technique to stabilize Zach • If sufficient staff present, an appropriate two person behavioral safety technique will be utilized to stabilize Zach if a one person
technique is not sufficient • Staff will then:
a. Return other students to classroom if necessary b. Notify Principal, Supervisor c. Notify parents that Zach needs to be picked up from school d. Complete incident report e. Schedule a follow-up IEP team meeting to discuss and determine action to be taken (i.e., FBA, new or revised positive behavior
support plan, etc.) If Zach’s behaviors continue to escalate and he remains in a state of crisis for more than 30 minutes, a call will be made to the following persons regarding a call to Crisis Intervention.
1. School Principal 2. Supervisor of Special Education/ Central Office/ Administration Staff 3. Parents. Mother should be called first. Her contact number is: cell 717-867-5309. If mother is not available, father should be called. His contact
number is: 717-777-8888. 4. Call to Crisis Intervention (717-888-5555) will be followed by a 911 call requesting Emergency medical response.
Individualized Education Program (Aug 2014 revision) Page 37
Individualized Education Program (Aug 2014 revision) Page 38
B. RELATED SERVICES: 1. List the services that the student needs in order to benefit from or access his/her special education program:
Service Location Frequency* Projected Beginning Date
Anticipated Duration
Speech Room 30 minutes per 6 day cycle 02/12/16 02/02/17
Home/School An average of 5 X 10 min sessions per week delivered over a total of approximately180 sessions within the IEP School Year.
02/12/16 02/02/17
02/12/16 02/02/17
School daily; during academic and nonacademic time periods
02/12/16 02/02/17
*The District and parents agree that the frequency denoted in the column above excludes the summer break (i.e the period of time between the last student day of the current school year and the first student day of the next school year) and holiday breaks when school is closed (i.e. Thanksgiving, Winter break, spring break etc.) unless specifically noted. 2. Is this Student eligible for School Based Access billing?
Yes: Please indicate services Speech, OT, Transportation, Personal Care Aide No
C. SUPPORTS FOR SCHOOL PERSONNEL – List the staff to receive the supports and the supports needed to implement the student’s IEP.
. School Personnel to
Receive Support Support Location Frequency Beginning Date Anticipated Duration
All staff who work with the student
Specially designed instruction will be distributed to staff members who work with the student
Regular school
1st week of each course.
02/12/16 02/02/17
D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY – Support services are required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education, counseling services, transportation to and from gifted programs to classrooms in buildings operated by the school district).
Support Service NA
Support Service NA
Support Service NA
Individualized Education Program (Aug 2014 revision) Page 39
EXTENDED SCHOOL YEAR – The IEP team has considered and discussed ESY services, and determined that: 1) Consideration This is the Student’s first IEP – the team has not yet had the opportunity to collect data over breaks in programming. ESY for the current school year was already reviewed on date of meeting (Note must be before February 28th if the student is identified with MR, AUT, SED) The IEP team discussed the following considerations for ESY:
Yes No Yes No
Do present education levels (Section II above) show progress on Annual goals and objectives.
Do the parents report negative changes in adaptive behaviors?
Does the student demonstrate self sufficiency & independence?
Is there data indicating that successive interruptions in educational program resulted in withdrawal from the learning process?
Are there any medical reports indicating difficulties which may be exacerbated during breaks?
Did the student receive ESY services in the Past?
2) Determination
As of 02/03/16 the IEP team has determined student is NOT in need of ESY services for the following reason(s):
The student is Eligible for ESY for the following reason(s):
3) Reasons for determination
For the IEP team to discuss at the time of the IEP meeting. Special Education teachers working with Zach recommend ESY. Zach has demonstrated severe difficulty with behavior following an extended break from school.
The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the student’s ESY Program are:
Annual Goal to Maintain Short Term Objectives
If the IEP Team has determined ESY is appropriate complete the following:
ESY Service to
be provided Location Frequency Projected Beginning
Date Anticipated Duration
Implementation of his PBSP
School-based Up to 30 hours of instruction
June 2016 August 2016
Individualized Education Program (Aug 2014 revision) Page 40
VII. EDUCATIONAL PLACEMENT A. QUESTIONS FOR IEP TEAM – The following questions must be reviewed and discussed by the IEP team prior to
providing the explanations regarding participation with students without disabilities. It is the responsibility of each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public or private institutions or other care facilities, are educated with students who are not disabled. Special classes, separate schooling or other removal of students with disabilities from the general educational environment occurs only when the nature or severity of the disability is such that education in general education classes, EVEN WITH the use of supplementary aids and services, cannot be achieved satisfactorily.
• What supplementary aids and services were considered? What supplementary aids and services were rejected? Explain why the supplementary aids and services will or will not enable the student to make progress on the goals and objectives (if applicable) in this IEP in the general education class.
• What benefits are provided in the general education class with supplementary aids and services versus the benefits provided in the
special education class?
• What potentially beneficial effects and/or harmful effects might be expected on the student with disabilities or the other students in the class, even with supplementary aids and services?
• To what extent, if any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic
activities?
Explanation of the extent, if any, to which the student will not participate with students without disabilities in the regular class. (Also explain any related services that are to be discontinued as of this IEP) In order to meet Zach's needs as a student requiring Emotional, Speech/Language and Autism Support, he will not participate with students without disabilities in the regular class when he is receiving his grade level instruction for Math, ELA, Science and Social Studies in the Special Education Classroom. He will participate with students without disabilities in the regular class for homeroom, specials, lunch, recess, assemblies and field trips
Explanation of the extent, if any, to which the child will not participate with non-disabled children in the general education curriculum: With Specially Designed Instruction and Program Modifications to meet his needs as a student requiring Emotional, Speech/Language and Autism Support, Zach will receive the general education curriculum when he is attending Math, ELA, Science and Social Studies in the Special Education Classroom.
Individualized Education Program (Aug 2014 revision) Page 41
B. Profile of Educational services High School 7.30 Middle School 7.00 Elementary 6.50
Frequency Service/Service Pull out Instructional
time in Minutes
Time in Regular Ed. in classroom (inclusion) in minutes
Daily
With Special Ed Teacher
With Aide
Math 90 Language Arts 90
Science 30 Social Studies 30
RTII 30
Weekly*
Speech 30
OT
Monthly*
Off Site
Trip Type Hours Per Month in Special Ed Setting
Hours Per Month in Community Setting
Vocational/Co- Op/Job Coach
CBI Trips Adventure Trip
Total Hours in School 6.50
Average total hours in special ed. setting per day
4.60
Average total hours inclusion with teacher per day
0.00
Individualized Education Program (Aug 2014 revision) Page 42
Average total hours inclusion with an aide per day
0.00
Total hours the student spends in the Regular Ed Setting
1.9
Percentage of Time the student spends inside the regular ed classroom
29.20%
Amount of special education professional supports
70.77%
Individualized Education Program (Aug 2014 revision) Page 43
C. Type of Support
1. Amount of special education supports
Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day
Supplemental: Special education supports and services provided by special education personnel for
more than 20% of the day but less than 80% of the school day
Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day
2. Type of special education supports
Check all that apply. Check which one is the primary support.
Autistic Support
Blind-Visually Impaired Support
Deaf and Hard of Hearing Support
Emotional Support
Learning Support
Life Skills Support
Multiple Disabilities Support
Physical Support
Speech and Language Support
D. Location of student’s program
Name of School District where the IEP will be implemented(i.e. the District in which the school building is located):
Note: for students in a program in a non-district building indicate “Program operated by Provider in the ___ School District.”
Name of School Building where the IEP will be implemented:
Is this school the student’s neighborhood school (i.e., the school the student would attend if he/she did not have an IEP)?
Yes No. If the answer is “no,” select the reason why not. Special education supports and services required in the student’s IEP cannot be provided in the neighborhood school
Individualized Education Program (Aug 2014 revision) Page 44
Other. Please explain:
Individualized Education Program (Aug 2014 revision) Page 45
VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment) To calculate the percentage of time inside the regular classroom, divide the number of hours the student spends inside the regular classroom by the total number of hours in the school day (including lunch, recess, study periods). The result is then multiplied by 100.
SECTION A: For Students Educated in Regular School Buildings with Nondisabled Peers – Indicate the percentage of time INSIDE the regular classroom for this student:
Time spent outside the regular classroom receiving services unrelated to the student’s disability (e.g., time receiving ESL services) should be considered time inside the regular classroom. Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time spent inside the regular classroom. Calculation for this Student:
Column 1 Column 2 Calculation Indicate Percentage Percentage Category
Total hours the student spends in the regular
classroom per day
Total hours in a typical school day
(including lunch, recess & study periods)
(Hours inside regular classroom ÷ hours in
school day) x 100 = % (Column 1 ÷ Column 2) x
100 = %
Section A: The percentage of time student spends inside the
regular classroom: Using the calculation result – select the appropriate percentage category
% %
INSIDE the Regular Classroom 80% or More of the Day INSIDE the Regular Classroom 79-40% of the Day INSIDE the Regular Classroom Less Than 40% of the Day
SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50% of the day – select and indicate the Name of School or Facility on the line corresponding with the appropriate selection: (If a student spends less than 50% of the day in one of these locations, the IEP team must do the calculation in Section A)
Approved Private School (Non Residential) Other Public Facility (Non Residential)
Approved Private School (Residential) Hospital/Homebound
Other Private Facility (Non Residential) Correctional Facility
Other Private Facility (Residential) Out of State Facility
Other Public Facility (Residential) Instruction Conducted in the Home
Column 1 Column 2 Calculation Indicate Percentage
Total hours the student spends in the regular classroom – per day Total hours in a typical school day (including
lunch, recess & study periods) (Hours inside regular classroom ÷ hours in
school day) x 100 = % (Column 1 ÷ Column 2) x 100 = %
Section A: The percentage of time student spends inside the regular classroom:
Example 1 5.5 6.5 (5.5 ÷ 6.5) x 100 = 85% 85% of the day (Inside 80% or More of Day)
Example 2 3 5 (3 ÷ 5) x 100 = 60% 60% of the day (Inside 79-40% of Day)
Example 3 1 5 (1 ÷ 5) x 100 = 20% 20% of the day (Inside less than 40% of Day)
For help in understanding this form, an annotated IEP is available on the PaTTAN website at www.pattan.net Type “Annotated Forms” in the Search feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.
PDE/BSE – Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009) Page 46
SCHOOL DISTRICT SPECIAL EDUCATION PROGRAM
CITY, STATE
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT PRIOR WRITTEN NOTICE (NOREP/PWN)
School Age
Parent Input (Jan 30th, 2001) Page: 47 of 53
Child's Name: Zach Brehm Date Sent 02/03/16 Name and Address of Parent/Guardian/Surrogate
For LEA Use Only Date of Receipt of Signed NOREP/PWN
July 2008 Page: 48 of 53
PDE/BSE – Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009)
This notice summarizes recommendations for your child's education program. 1. Type of action taken:
Proposes initial provision of special education and related services (For this action, the school may not proceed without your written consent in Section 8 of this document)
Refusal to initiate an evaluation (Must issue Procedural Safeguards Notice)
Proposes to change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE)
Refusal to change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE)
Change of placement for disciplinary reasons (Must issue Procedural Safeguards Notice)
Due process hearing, or an expedited due process hearing, initiated by LEA
Graduation from high school
Exiting special education
Exiting high school due to exceeding the age eligibility for a free appropriate public education (FAPE)
Extended School Year (ESY) services
Response to request for an independent educational evaluation (IEE) at public expense
Other 2. A description of the action proposed or refused by the LEA:
In order to meet Zach's needs as a student requiring Emotional, Speech/Language and Autism Support, he will not participate with students without disabilities in the regular class when he is receiving his grade level instruction for Math, ELA, Science and Social Studies in the Special Education Classroom. He will participate with students without disabilities in the regular class for homeroom, specials, lunch, recess, assemblies and field trips
3. An explanation of why the LEA proposed or refused to take the action: The IEP team has reviewed and revised the student’s IEP and feels that this placement continues to be the most appropriate setting.
PDE/BSE – Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009)
4. A description of other options that the IEP team considered and the reasons why those options were rejected. If the action proposed or refused is in regard to educational placement, options considered must begin with the regular educational environment with supplementary aids and services (information about supplementary aids and services is available on the PaTTAN website at www.pattan.net):
Options Considered Reason for Rejection
Regular Education The team feels that more services are needed than can be provided in regular ed alone.
5. A description of each evaluation procedure, assessment, record or report used as a basis for the proposed action or action refused:
6. A description of other factors that were relevant to the LEA’s proposal or refusal:
No other relevant factors were discussed.
7. The educational placement recommended for your child is (State the amount and type of special education supports, e.g., Itinerant Learning Support, Supplemental Autistic Support, Full-Time Emotional Support):
Amount of special education supports
Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day
Supplemental: Special education supports and services provided by special education
personnel for more than 20% of the day but less than 80% of the school day
Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day
Type of special education supports
Autistic Support
Blind-Visually Impaired Support
Deaf and Hard of Hearing Support
Emotional Support
Learning Support
Life Skills Support
Multiple Disabilities Support
Physical Support
Speech and Language Support
Location
PDE/BSE – Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009)
Attached are state and local resources you can consult to help you understand your rights and how the special education process works. For help in understanding this form, an annotated NOREP/Prior Written Notice is available on the PaTTAN website at www.pattan.net Type “Annotated Forms” in the Search feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.
PDE/BSE – Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009)
THE ARC OF PENNSYLVANIA 101 South Second Street Suite 8 Harrisburg, PA 17101 800-692-7258 www.thearcpa.org PARENT EDUCATION NETWORK (PEN) 2107 Industrial Highway York, PA 17402-2223 717-600-0100 (Voice/TTY) 800-522-5827 (Voice/TTY) 800-441-5028 (Spanish in PA) 717-600-8101 (Fax) www.parentednet.org PARENT EDUCATION AND ADVOCACY LEADERSHIP CENTER (PEAL) 1119 Penn Avenue Suite 400 Pittsburgh, PA 15222 412-281-4404 (Voice) 866-950-1040 (Voice) 412-281-4409 (TTY) 412-281-4408 (Fax) www.pealcenter.org HISPANICS UNITED FOR EXCEPTIONAL CHILDREN (HUNE, INC.) 202 West Cecil B. Moore Avenue Philadelphia, PA 19122 215-425-6203 (Voice) 215-425-6204 (Fax) www.huneinc.org THE MENTOR PARENT PROGRAM, INC. P.O. Box 47 Pittsfield, PA 16340 814-563-3470 (Voice) 888-447-1431 (Voice in PA) 800-855-1155 (TTY) 814-563-3445 (Fax) www.mentorparent.org DISABILITIES RIGHTS NETWORK 1414 North Cameron Street Suite C Harrisburg, PA 17103 800-692-7443 (Toll-Free Voice) 877-375-7139 (TDD) 717-236-8110 (Voice) 717-346-0293 (TDD) 717-236-0192 www.drnpa.org PENNSYLVANIA BAR ASSOCIATION 100 South Street Harrisburg, PA 17101
800-932-0311 www.pabar.org BUREAU OF SPECIAL EDUCATION’S CONSULTLINE, A PARENT HELPLINE 800-879-2301 ConsultLine personnel are available to parents and advocates of children with disabilities or children thought to be disabled to explain federal and state laws relating to special education; describe the options that are available to parents; inform the parents of procedural safeguards; identify other agencies and support services; and describe available remedies and how the parents can proceed. OFFICE FOR DISPUTE RESOLUTION 6340 Flank Drive Harrisburg, PA 17112-2764 717-541-4960 (Phone) 800-222-3353 (Toll free in PA only) 800-654-4984 (TTY) 717-657-5983 (Fax) http://ODR.pattan.net The Office for Dispute Resolution administers the mediation and due process systems statewide, and provides training and services regarding alternative dispute resolution methods. THE PENNSYLVANIA TRAINING AND TECHNICAL ASSISTANCE NETWORK (PaTTAN) Harrisburg 800-360-7282 King of Prussia 800-441-3215 Pittsburgh 800-446-5607 www.pattan.n
RESOURCES
RESOURCES
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