Chapter 3: TSES - isd4081.org · Web view... limited understanding and use of nonverbal communication skills such as gestures, facial expressions, ... eye contact; limited shared

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

CHAPTER 3: EVALUATION AND REEVALUATION STANDARDS

Revised 5/8/2023

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

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

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

complaint in a school year;3) on the date Discovery Public School of Faribault decides to change the placement of a

student with a disability for a violation of Discovery Public School of Faribault discipline policy; or

4) upon request by parent.

Discovery Public School of Faribault use the Minnesota Notice of Procedural Safeguards: Parental Rights for Public School Special Education Students which includes all of the required contents prescribed in Federal IDEA.

P R I O R W R I T T E N N O T I C E

A prior written notice will be provided to a parent a reasonable time before Discovery Public School of Faribault proposes or refused to initiate an evaluation or change the identification to a child suspected of having a disability. The written notice includes the following:

1) a description of the action proposed or refused by Discovery Public School of Faribault;2) an explanation of why Discovery Public School of Faribault proposes or refused to take

the action;3) a description of each evaluation procedure, assessment, record, or report Discovery

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

options were rejected;5) a description of other factors that are relevant to Discovery Public School of Faribault’s

proposal or refusal;6) a statement that the parents of a child with a disability have protection under the

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

Discovery Public School of Faribault Here: Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-1

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

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

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

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

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

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

1) despite reasonable efforts to do so, Discovery Public School of Faribault cannot discover the whereabouts of the parent of the child;

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

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

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

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

Independent Educational Evaluation at Public ExpenseA parent has the right to an IEE at the school’s expense if the parent disagrees with an evaluation completed by Discovery Public School of Faribault. If Discovery Public School of Faribault does not believe an IEE is necessary, Discovery Public School of Faribault must ask a hearing officer to determine the appropriateness of its evaluation. If the hearing officer


determines Discovery Public School of Faribault’s evaluation is appropriate, a parent still has the right to an independent evaluation, but not at public expense. A hearing officer may also order an IEE of a child at school expense during a due process hearing. Discovery Public School of Faribault may ask a parent why he or she objects to Discovery Public School of Faribault evaluation, but they may not require the parent to provide an explanation and may not unreasonably delay either providing the IEE or requesting a due process hearing to show that its evaluation is appropriate.If a parent requests an IEE, Discovery Public School of Faribault must provide to parents its criteria for selection of an independent examiner and information about where an IEE may be obtained. Discovery Public School of Faribault may not impose conditions or timelines related to obtaining an IEE.Independent Educational Evaluation at Private ExpenseIf a parent obtains an IEE at private expense, the results of the evaluation must be considered by Discovery Public School of Faribault.



EVALUATION AND REEVALUATION PROCEDURES

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

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

The school will conduct a comprehensive evaluation to determine whether the child is a student with a disability that adversely affects the student’s educational performance and needs special education and related services, and to determine the educational needs of the student. Written parental consent is needed before the child may be evaluated.

T E A M O V E R R I D E SDiscovery Public School of Faribault require all team overrides to be sent to the director of special education. Team overrides are discouraged as the documentation requirements are very difficult to meet.Under no circumstances is a team to use a team override on eligibility decisions without thoroughly documenting the following:1. an explanation of why the standards and procedures that are used with the majority of

students resulted in invalid finding for this student (you must involve the school psychologist in this decision);

2. the record must indicate what objective data were used to conclude that the student has a disability and is in need of specialized instruction;

3. the team must indicate which data had the greatest relative importance for the eligibility decision;

4. team members must sign-off agreeing to the override decision. Team member(s) who disagree must provide a statement of why he/she/they disagree and include his/her/their signature(s).

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

A reevaluation is completed every three years to determine if the student continues to be a student with a disability. Students must have met initial eligibility criteria for the primary area of disability initially, or the criteria for a proper override were met through documentation that all four steps in the override criteria were followed. If the student met criteria on the initial evaluation, the reevaluation must address all of the components of the eligibility criteria in the primary area of disability to determine if the student is still disabled and demonstrates continued need for service.

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

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

the measurable annual goals and to participate in the general curriculum.The review may be conducted without a meeting.

Discovery Public School of Faribault: Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-4

R E V I E W O F E X I S T I N G D A T AIf the IEP team determines that no additional data is needed to determine whether the student continues to be a student with a disability, Discovery Public School of Faribault will notify the student’s parents of that determination and the reasons for it, and the right of parents to request an evaluation (see Use of Existing Data for Reevaluations).

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

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

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

placement, and provision of FAPE to their child.

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

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

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

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

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

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

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

Multidisability Team Teaching ModelA team member licensed in the student’s disability will be responsible for conducting the student’s evaluation and participating at team meetings when an IEP is developed, reviewed, or revised. Consultation and indirect services must be provided to the general or special education teacher providing instruction if not licensed in the disability. The IEP team will determine the frequency and amount of time for these services.

Interagency ServicesIf at the time of initial referral for an educational evaluation or a reevaluation, the school determines that a child with disabilities age 5-21 may be eligible for interagency services, Discovery Public School of Faribault may request that the county of residence provide a representative to the initial assessment or reassessment team meeting or first IEP team Discovery Public School of Faribault: Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-5

meeting following the evaluation in order to facilitate coordination between Discovery Public School of Faribault and county provided services. Upon request from Discovery Public School of Faribault, the county will provide a representative to assist the IEP team in determining the student’s eligibility for existing health, mental health, or other support services provided by the county. An interagency plan of care (IIIP or other standardized written plan) will be developed for the eligible student and the student’s family to coordinate services. The parent must consent to the participation of interagency representatives and the sharing of information.

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

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

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

Discovery Public School of Faribault will ensure that: evaluation teams use tools and strategies that provide relevant information to determine

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

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

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

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

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

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

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

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

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


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

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

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

if a student transfers to another district in the same academic year while an evaluation is taking place, the Discovery Public School of Faribault work together to ensure prompt completion of the evaluation.

B R A I L L E S K I L L S I N V E N T O R Y

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

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

Every district shall ensure that all students with disabilities are provided the special instruction and services which are appropriate to their needs. The student’s needs and the special education instruction and services to be provided shall be agreed upon through the development of an individual education plan. The plan will address the student’s need to develop skills to live and work as independently as possible within the community. During grade nine, the plan will address the student’s needs for transition from secondary services to post secondary education and training, employment, community participation, recreation and leisure, and home living. The plan must include a statement of the needed transition services, including a statement of the interagency responsibilities or linkages or both before secondary services are concluded.

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

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


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

IEP/Transition Planning TeamAll students with IEPs who have reached grade 9 must have an IEP that focuses on transition. Individuals who can assist and support students in their adult lives are invited to join the existing IEP team to plan for the future. When selecting people to assist students with their plans for the future, the team should first consider the types of services and supports the student may need to meet his or her adult goals.

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

T R A N S I T I O N A R E A S T O E V A L U A T EFive transition areas must be assessed and annually addressed in the IEP/transition planning process for all students with special education needs in grades nine and later. These transition areas are:

1. Home Living, Recreation and CommunityHome Living: Developing necessary skills to live as independently as possible.

A. Financial/Income1. Earned Income2. Unearned Income (gifts/dividends)3. Insurance (life, annuities)4. General Public Assistance5. Food Stamps6. Supplemental Security Income (SSI)7. Social Security Benefits8. Trust/Will or similar income9. Minnesota Supplemental Assistance10. Commodities11. Meals on Wheels/Home Delivery Meals12. Medical Assistance

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

C. Develop personal care skills including hygiene, health, private and public behaviorD. Develop housekeeping and cooking skillsE. Develop budgeting skills


F. Identify who to call and what to do in emergency situationsG. Explore possible living arrangements

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

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

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

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

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

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

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


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

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

A. Identify personal learning styles.B. Become aware of career interests and options.C. Become aware of post-secondary enrollment options.D. Visit post-secondary institutions.E. Register and take college entrance exams.F. Develop a resume and request letter of recommendation.G. Identify and apply to post-secondary institutions.H. Identify supports needed at post-secondary sites.I. Identify and check eligibility requirements for adult support.J. Check courses and credits toward high school graduation.K. Apply for financial aid, scholarships, etc.

L. Arrange for transportation and housing, if necessary.

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

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

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

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

A. a summary of all evaluation results;


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

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

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

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



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

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

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

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

Every child who has a: hearing impairment; visual impairment; speech or language impairment physical impairment other health disability; cognitive disability; emotional/behavioral disability; autism; traumatic brain injury; severe multiple disability; deaf-blind disability; or developmental delay

“and needs special instruction and services as determined by State standards, is a child with a disability. In addition, every child under age three who has a substantial delay or has an identifiable physical or mental condition known to hinder normal development is a child with a disability and is eligible to receive early intervention services.”

DETERMINING THE STUDENT IS NOT A STUDENT WITH A DISABIL ITY

Discovery Public School of Faribault must evaluate a student with a disability before determining that the student is no longer a student with a disability. An evaluation is not required before the termination of a student’s eligibility due to graduation from high school. Discovery Public School of Faribault will provide the student with a summary of the student’s academic achievement and functional performance and recommendations on how to assist the student in meeting his/her postsecondary goals.A child with a short-term or temporary physical or emotionally illness or disability, is not a child with a disability.


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

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

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

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

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

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

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

thinking; an intense, focused preoccupation with a limited range of play, interests, or conversation topics.

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

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

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

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

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

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

PATTERNS OF QUALITATIVE IMPAIRMENT/POSSIBLE BEHAVIORAL INDICATORS

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

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

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

Core Feature 1: Qualitative impairment in social interaction

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

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

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


AUTISM SPECTRUM DISORDERS (ASD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

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

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

A Eligibility Criteria Circle One1. Social Interaction Indicators

The student must exhibit at least two of the following indicators of qualitative impairment of reciprocal social interactions:

Yes No

___limited joint attention___limited use of facial expressions directed toward others___does not show or bring things to others to indicate an interest in the activity___demonstrates difficulties in relating to people, objects, and events___a gross impairment in ability to make and keep friends___significant vulnerability and safety issues due to social naiveté___may appear to prefer isolated or solitary activities___misinterprets others’ behaviors and social cues___other__________________________________________

2. Communication and Patterns of Behavior The student must exhibit at least one indicator of qualitative impairment in communication from either of the two groups of indicators below:

Yes No

___not using finger to point or request___using others’ hand or body as a tool___showing lack of spontaneous imitation or lack of varied imaginative play___absence or delay of spoken language___limited understanding and use of nonverbal communication skills such as gestures, facial

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

OR3. The student must exhibit one or more of the behavior indicators of restricted, repetitive or stereotyped patterns of behavior, interest, activities:

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

Did student meet criteria in subitem 1 AND either or both subitem 2 or 3? YES

NO

B Verification: The student record must include documentation with supporting data in all four areas below to show verification that ASD adversely affects performance and that the student is in need of special education and related services.

Circle One

1. ___present level of performance in each core feature identified in 1 and 2 above. Yes No

2. ___educational needs in each core feature identified in 1 and 2 above. Yes No

3.

4.

___observation in two different setting on two different days

___historical summary of developmental history and behavior patterns

Yes

Yes

No

No

In Item B, did student meet criteria? YES NO


STATE GUIDELINES: STUDENTS WITH BLINDNESS

“Student with blindness” means an individual who is eligible for special educational services and who:

A. has a visual acuity of 20/200 or less in the better eye with correcting lenses or has a limited field of vision such that the widest diameter subtends an angular distance of no greater than 20 degrees; or

B. has a medically indicated expectation of visual deterioration.


STATE GUIDELINES: DEAF-BLINDNESS"Deaf-blindness" means medically verified visual impairment coupled with medically verified hearing impairment that, together, interfere with acquiring information or interacting in the environment.

Both conditions (i.e., medically verified visual impairment and medically verified hearing impairment) need to be present simultaneously and must meet the criteria for both vision and hearing impairments.

Students At-Risk for Deaf-Blindness Students at-risk for deaf-blindness include, but are not limited to:

1. Those that are already identified as hearing or vision impaired and have not yet had medical or functional evaluation of the other sense (vision or hearing);

2. Those that have an identified syndrome, such as Usher Syndrome or Rubella Syndrome, that includes a potential deterioration of vision or hearing in the future;

3. Those that have a medically or functionally identified hearing impairment and a verified deficit in vision determined by a functional evaluation in the learning environment; and

4. Those that have a medically or functionally identified vision impairment and verified deficit in hearing determined by a functional evaluation in the learning environment.


DEAF-BLIND CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_____________________________________________Student ID#:_______________________________________Grade:____________ School:_____________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for special education and related services when the student meets the criteria of both visual impairment and deaf and hard of hearing or the conditions outlined in Students at Risk section. Both conditions must exist simultaneously.

Circle OneA Documentation verifies meeting criteria for both disability areas: Yes No

____ Visual Impairment____ Deaf and Hard of Hearing

Does the student meet the criterion in Item A? Yes NoOR

B. Students at risk1. Are already identified as deaf or hard of hearing or visually impaired

but have not yet had medical or functional evaluation of the other sense.

Yes No

2. Have an identified condition that includes a potential deterioration of vision or hearing.

Yes No

3. Have a medically or functionally identified hearing loss and a verified vision loss determined by a functional evaluation in the learning environment.

Yes No

4. Have a medically or functionally identified vision impairment and verified hearing loss determined by a functional evaluation in the learning environment.

Yes No

OR5. Have an identified syndrome or condition that includes hearing and

vision loss in combination with multiple disabilities.Yes No

Does the student meet the criterion in Item B? Yes No


STATE GUIDELINES: DEAF AND HARD OF HEARING (D/HH)"Deaf and Hard of Hearing" means a diminished sensitivity to sound, or hearing loss, that is expressed in terms of standard audiological measures. Hearing impairment has the potential to affect educational, communicative, or social functioning that may result in the need for special education instruction and related services.

A student who is deaf or hard of hearing is eligible for special education instruction and related services if the student meets one of the criteria in item A and one of the criteria in item B, C, or D.

A. There is audiological documentation provided by a certified audiologist that verifies one of the following:1) a sensorineural hearing loss with an unaided pure tone average, speech threshold, or

auditory brainstem response threshold of 20 decibels hearing level (HL) or greater in the better ear;

2) a conductive hearing loss with an unaided pure tone average or speech threshold of 20 decibels hearing level (HL) or greater in the better ear persisting over three months or occurring at least three times during the previous 12 months as verified by audiograms with at least one measure provided by a certified audiologist;

3) a unilateral sensorineural or persistent conductive loss with an unaided pure tone average or speech threshold of 45 decibels hearing level (HL) or greater in the affected ear; or

4) a sensorineural hearing loss with unaided pure tone thresholds at 35 decibels hearing level (HL) or greater at two or more adjacent frequencies (500 hertz, 1000 hertz, 2000 hertz, or 4000 hertz) in the better ear.

B. The student's hearing loss affects educational performance as demonstrated by:1) a need to consistently use amplification appropriately in educational settings as

determined by audiological measures and systematic observation; or2) an achievement deficit in basic reading skills, reading comprehension, written

language, or general knowledge that is at the 15th percentile or 1.0 standard deviation or more below the mean on a technically adequate norm-referenced achievement test that is individually administered by a licensed professional.

C. The student's hearing loss affects the use and understanding of spoken English as documented by one or both of the following:1) under the student's typical classroom condition, the student's classroom interaction is

limited as measured by systematic observation of communication behaviors; or2) the student uses American Sign Language or one or more alternative or augmentative

systems of communication alone or in combination with oral language as documented by parent or teacher reports and language sampling conducted by a professional with knowledge in the area of communication with persons who are deaf or hard of hearing.

D. The student's hearing loss affects the adaptive behavior required for age-appropriate social functioning as supported by:1) documented systematic observation within the student's primary learning environments

by a licensed professional and the student, when appropriate; and2) scores on a standardized scale of social skill development are below the average scores

expected of same-age peers.


DEAF AND HARD OF HEARING (D/HH) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:_______________________________________Grade:________________ School:_________________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for special education and related services when the student meets the criteria of item A and one in item B, C, or D.Circle OneA. Audiological verification of hearing loss documented by certified

audiologist (one of the following): Yes No____ sensorineural hearing loss with an unaided pure tone average, speech

threshold, or ABR threshold of 20 dBHL or greater in the better ear;____ conductive hearing loss with an unaided pure tone average or speech

threshold of 20 dBHL or greater in the better ear persisting over three months or occurring at least three times during the previous 12 months as verified by audiograms with at least one measure provided by a certified audiologist;

____ unilateral sensorineural or persistent conductive loss with an unaided pure tone average or speech threshold of 45 dBHL or greater in the affected ear;

____ sensorineural hearing loss with unaided pure tone thresholds at 35 dBHL or greater at two or more adjacent frequencies (500 Hz, 1000 Hz, 2000 Hz, or 4000 Hz) in the better ear.

Does the student meet the criterion in Item A? Yes NoAND ONE OF THE FOLLOWING IN B, C, OR D:

B. Documentation in evaluation report of affecting educational performance (1 only)

1. Need to consistently use amplification in education setting as determined by audiological measures and systematic observational data;

Yes No

OR2. Achievement deficit (15%ile or at least 1.0 SD below in one area)

Test name ________________________________________________:Yes No

Basic reading skills Results ____________________Reading comprehension Results ____________________Written language Results ____________________General Knowledge Results ____________________

C. Documentation of hearing loss affecting use and understanding of spoken English

1. Systematic observation of communication behaviors that limit a student’s classroom interaction under typical conditions;

Yes No

AND/OR2. Use of ASL or one or more alternative or augmentative systems alone or in

combination with spoken English documented by parent or teacher reports and language sampling conducted by a professional with knowledge in the area of D/HH.

Yes No

D. Documentation of adaptive behavior deficit affecting social functioning (both must be present)

1. Systematic observation in primary learning environment; Yes NoAND

2. Standardized social skills evaluation (below average skills). Test name _________________________________ Results_________________

Yes No

Does the student meet the criterion in Item B, C, or D? Yes No


STATE GUIDELINES: DEVELOPMENTAL COGNITIVE DISABILITY (DCD)

“Developmental Cognitive Disability (DCD)” refers to students with significantly below average intellectual functioning and concurrent deficits in adaptive behavior that require special education instruction and related services.

The team shall determine that a student is eligible as having a developmental cognitive disability (DCD) and is in need of special education instruction and service if the student meets the criteria in items A and B.

A. Adaptive Behavior The student demonstrates below average adaptive behavior in school and home, and, if appropriate, community environments. Below average means:

1. a composite score at or below the 15th percentile on a nationally normed, technically adequate measure of adaptive behavior; and

2. documentation of needs and the level of support required in at least four of the seven adaptive behavior domains across multiple environments. Systematic observations and parent input must be included as sources to document need and level of support. All of the following domains must be considered:a) daily living skills and independent living skills;b) social and interpersonal skills;c) communication skills;d) academic skills;e) recreation and leisure skills;f) community participation skills; andg) work and work-related skills.

Other sources of documentation may include checklists, classroom or work samples, interviews, criterion-referenced measures, educational history, medical history, or student self-report.

B. Cognitive FunctioningThe student demonstrates significantly below average general intellectual functioning that is measured by an individually administered, nationally normed test of intellectual ability. Significantly below average means:

1. mild-moderate range: an intelligence quotient of 70 or lower (plus or minus 1 standard error of measurement); or

2. severe-profound range: an intelligence quotient of 55 or lower (plus or minus 1 standard error of measurement).

Intellectual functioning must be verified through a written summary of results from at least two systematic observations with consideration for culturally relevant information, medical and educational histories, and one or more of the following: supplemental tests of specific abilities, criterion-referenced tests, alternative methods of intellectual assessment, clinical interviews with parents, including family members, or observations and analysis of behavior across multiple environments.


DEVELOPMENTAL COGNITIVE DISABILITY (DCD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:________________________________________Student ID#:__________________________________ Grade:______School: __________________________________________________Date of Meeting:___________________________________________

The team shall determine that a student qualifies for services under Developmental Cognitive Disability and is in need of special education services and/or related services when the student meets criteria described in items A and B.

A A d a p t i v e B e h a v i o r CIRCLE ONE

1. A composite score at or below the 15th percentile (plus or minus 1 Standard Error of Measurement*) on a nationally normed, technically adequate measure of adaptive behavior, in the student’s school; and

YES NO

2. in the student's home, and, if appropriate community environment; and

YES NO

3. documentation of need and the level of support required in at least 4 of the seven domains:

YES NO

daily/independent living skills

academic skills work and work-related skillssocial and interpersonal

skillsrecreation and leisure skillscommunication skills community participation skillsItem A: Does student meet all of the criterion outlined

above?YES\\\\\\

NOAND

B C o g n i t i v e F u n c t i o n i n g CIRCLE ONE

1. Significantly below average intellectual functioning as indicated by a general intellectual ability score of 70 or lower for mild to moderate and 55 or lower for severe to profound (plus or minus 1 Standard Error of Measurement*) on an intelligence test that is standardized, nationally normed, technically adequate, and individually administered by a trained professional.

YES NO

2. The current cognitive evaluation is consistent with previous evaluation(s) of the student’s cognitive ability.

YES NO

Item B: Does student meet all of the criterion outlined above?

YES

NOO

DCD Eligibility:Does student meet all of the criteria listed in A and B?

YES

NO

* The Standard Error of Measurement should only be used when there is evidence (previous cognitive/adaptive evaluations(s), test behavior) to suggest that the student’s “true” ability/adaptation is best reflected when considering the “plus” or “minus”. When in doubt, consider additional evaluation.


STATE GUIDELINES: EMOTIONAL OR BEHAVIORAL DISORDERS (EBD)

“Emotional or behavior disorders” means an established pattern of one or more of the following emotional or behavior responses:

A. withdrawal or anxiety, depression, problems with mood, or feelings of self worth;B. disordered thought processes with unusual behavior patterns and atypical

communication styles; orC. aggression, hyperactivity, or impulsivity.

The established pattern of emotional or behavioral responses must adversely affect educational or developmental performance, including intrapersonal, academic, vocational, or social skills; be significantly different from appropriate age, cultural, or ethnic norms; and be more than temporary, expected responses to stressful events in the environment. The emotional or behavioral responses must be consistently exhibited in at least three different setting, two of which must be educational settings, and one other setting in either the home, childcare, or community. The responses must not be primarily the result of intellectual, sensory, or acute or chronic physical health conditions.A student is eligible and in need of special education and related services for an emotional or behavioral disorder when the student meets the criteria in items A to C.A. A student must demonstrate an established pattern of emotional or behavioral responses

that is described in at least one of the following subitems and which represents a significant difference from peers:

(1) withdrawn or anxious behaviors, pervasive unhappiness, depression, or severe problems with mood or feelings of self-worth defined by behaviors, for example: isolating self from peers; displaying intense fears or school refusal; overly perfectionistic; failing to express emotion; displaying a pervasive sad disposition; developing physical symptoms related to worry or stress; or changes in eating or sleeping patterns;

(2) disordered thought processes manifested by unusual behavior patterns, atypical communication styles, or distorted interpersonal relationships, for example: reality distortion beyond normal developmental fantasy and play or talk; inappropriate laughter, crying, sounds, or language; self-mutilation, developmentally inappropriate sexual acting out, or developmentally inappropriate self-stimulation; rigid, ritualistic patterning; perseveration or obsession with specific objects; overly affectionate behavior towards unfamiliar persons; or hallucinating or delusions of grandeur; or

(3) aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, for example: physically or verbally abusive behaviors; impulsive or violent, destructive, or intimidating behaviors; or behaviors that are threatening to others or excessively antagonistic.

The pattern must not be the result of cultural factors, and must be based on evaluation data which may include a diagnosis of mental disorder by a licensed mental health professional.

B. The pupil’s pattern of emotional or behavioral responses adversely affects educational performance and results in:

(4) an inability to demonstrate satisfactory social competence that is significantly different from appropriate age, cultural, or ethnic norms; or

(5) a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum disorders or inconsistent educational programming.

C. The combined results of prior documented interventions and the evaluation data for the pupil must establish significant impairments in one or more of the following areas: intrapersonal, academic, vocational, or social skills. The data must document that the impairment:

(1) severely interferes with the pupil’s or other students' educational performance; (2) is consistently exhibited by occurrences in at least three different settings: two

educational settings, one of which is the classroom, and one other setting in either the home, child care, or community; or for children not yet enrolled in kindergarten, the emotional or behavioral responses must be consistently exhibited in at least one setting in the home, childcare, or community; and

(6) has been occurring throughout a minimum of six months, or results from the well-documented, sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

For Learners who are Pre-Kindergarten: Children not yet enrolled in kindergarten are eligible for special education and related services if they meet the following criteria:A. A student must demonstrate an established pattern of emotional or behavioral responses that is described in at least one of the following subitems and which represents a significant difference from peers:

(1) withdrawn or anxious behaviors, pervasive unhappiness, depression, or severe problems with mood or feelings of self-worth defined by behaviors, for example: isolating self from peers; displaying intense fears or school refusal; overly perfectionistic; failing to express emotion; displaying a pervasive sad disposition; developing physical symptoms related to worry or stress; or changes in eating or sleeping patterns;

(2) disordered thought processes manifested by unusual behavior patterns, atypical communication styles, or distorted interpersonal relationships, for example: reality distortion beyond normal developmental fantasy and play or talk; inappropriate laughter, crying, sounds, or language; self-mutilation, developmentally inappropriate sexual acting out, or developmentally inappropriate self-stimulation; rigid, ritualistic patterning; perseveration or obsession with specific objects; overly affectionate behavior towards unfamiliar persons; or hallucinating or delusions of grandeur; or

(3) aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate, for example: physically or verbally abusive behaviors; impulsive or violent, destructive, or intimidating behaviors; or behaviors that are threatening to others or excessively antagonistic.

B. The pupil’s pattern of emotional or behavioral responses adversely affects educational performance and results in:

(4) an inability to demonstrate satisfactory social competence that is significantly different from appropriate age, cultural, or ethnic norms; or

(5) a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum disorders or inconsistent educational programming.

C. The combined results of prior documented interventions and the evaluation data for the student must establish significant impairment in one or more of the following areas: self-care, social relations, and/or social or emotional growth. The data must document that the impairment:(1) is consistently exhibited by occurrences in at least one setting in the home, childcare, or

community; and(2) occurred throughout a minimum of six months, or resulted from the well-documented,

sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

EvaluationThe evaluation findings must be supported by current or existing data from:

(1) clinically significant scores on standardized, nationally normed behavior rating scales;(2) individually administered, standardized, nationally normed tests of intellectual ability

and academic achievement;(3) three systematic observations in the classroom or other learning environment;(4) record review;(5) interviews with parent, student, and teacher;(6) health history review procedures;(7) a mental health screening; and(8) functional behavioral assessment.

Pre-K evaluations must be supported by current or existing data from:(1) two or more systematic observations, including one in the home;(2) a case history, including medical, cultural and developmental information;(3) information on the student’s cognitive ability, social skills, and communication abilities;(4) standardized and informal interviews, including parent, teacher, caregiver, and

childcare provider; and(5) standardized adaptive behavior scales.

Functional Behavioral Assessment (FBA) means a process for gathering information to maximize the efficiency of behavioral supports. An FBA includes a description of problem behaviors and the identification of events, times, and situations that predict the occurrence and non occurrence of the behavior. An FBA also identifies:

(1) the antecedents, consequences, and reinforcers that maintain the behavior;(2) the possible functions of the behavior; and(3) possible positive alternative behaviors.

A FBA includes a variety of data collection methods and sources that facilitate the development of hypotheses and summary statements regarding behavioral patterns.


EMOTIONAL OR BEHAVIORAL DISORDERS (EBD) CRITERIA CHECKLIST

Initial Evaluation Reevaluation

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

A student is eligible and in need of special education and related services for an emotional or behavioral disorder when the student meets the criteria in items A to C below:

ITEM A. Behaviors1. Withdrawn or anxious behaviors, pervasive unhappiness, depression, severe problems with mood or feelings of self-worth defined by at least one of the following:

___isolating self from peers___overly perfectionistic___displaying pervasive sad disposition___developing physical symptoms related to worry or stress___displaying intense fears or school refusal___failing to express emotion___changes in eating or sleeping patterns___other__________________________________________

OR2. Disordered thought processes manifested by unusual behavior patterns, atypical communication styles or distorted interpersonal relationships as defined by at least one of the following:

___reality distortion beyond normal developmental fantasy and play or talk___inappropriate laughter, crying, sounds, or language___developmentally inappropriate sexual acting out or developmentally inappropriate self-stimulation___self-mutilation___rigid, ritualistic patterning___perseveration or obsession with specific objects___overly affectionate behavior towards unfamiliar persons___hallucinating or delusions of grandeur___other________________________________________

OR3. Aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate as defined by at least one of the following:

___physically or verbally abusive behaviors___impulsive or violent, destructive or intimidating behavior___behaviors that are threatening to others or excessively antagonistic___Other_________________________________________

Does the student meet the criteria in Item A? YES NOANDITEM B. Patterns

___Emotional or behavioral responses that adversely affects educational performance___Inability to demonstrate satisfactory social competence that is significantly different from age, cultural or ethnic norms:

Or___Unsatisfactory educational progress that is not primarily a result of intellectual, sensory,physical, health, cultural or linguistic factors, illegal chemical use, autism spectum disorders or inconsistent educational programming.

Does the student meet the criteria in Item B? YES NO

ITEM C. Area of Impact K-12___intrapersonal___academic___vocational___social skills The area(s) identified above must meet all of the following criteria:

Data documents that the impairment:___1) severely interferes with the student’s or other students’ educational performance___2) consistently occurs in at least three different settings, including two educational (one must be classroom), and either in the home, at childcare or in the community___3) occurs throughout a minimum of six months, or results from the well-documented, sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

Does the student meet the criteria in Item C? YES NO

K-12 evaluations must be supported by current or existing data from all of the following:___clinically significant scores on standardized, nationally normed behavior rating scales___individually administered, standardized, nationally normed tests of intellectual ability and

academic achievement___interviews with parent, student and teacher___three systematic observations in the classroom or other learning environments___record review___mental health screening___health history review procedures ___functional behavioral assessment

For Learners Who are Pre-Kindergarten: Evaluation data must establish and define developmentally significant impairments in at least one of the following areas for pre-kindergarten students ___self-care ___social relations ___social or emotional growthThe area(s) defined above must meet all of the following criteria: ___Data must document that the emotional or behavioral responses are exhibited in at

least one setting including either in the home, at child care or in the community ___ Occurred throughout a minimum of six-months, or resulted from the well-documented,

sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.

Does the student meet the criteria for Pre-K? YES NO

Pre-K evaluations must be supported by current or existing data from:___two or more systematic observations, including one in the home;___a case history, including medical, cultural and developmental information;___information on the student’s cognitive ability, social skills, and communication abilities;___standardized and informal interviews, including parent, teacher, caregiver, and childcare provider;___standardized adaptive behavior scales.


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

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

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

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

Disorder (ADD or ADHD), there is written and signed documentation of a medical diagnosis by a licensed physician, an advanced practice nurse or licensed psychologist. The diagnosis of ADD/ADHD must include documentation that DSM-IV criteria in items A to E have been met. DSM-IV criteria documentation must be provided by a licensed physician, an advanced practice nurse, or a licensed psychologist qualified to make a diagnosis and determination of ADD/ADHD.

Item B: In comparison with peers, the health condition adversely affects the student’s ability to complete educational tasks within routine timelines as documented by three or more of the following:(1) excessive absenteeism linked to the health condition, for example, hospitalizations,

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

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

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

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

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

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

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

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

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

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

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


OTHER HEALTH DISABILITIES (OHD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

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

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

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

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

sNo

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

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

sNo

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

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

sNo


STATE GUIDELINES: PHYSICALLY IMPAIRED (PI)"Physically impaired" means a medically diagnosed chronic physical impairment, either congenital or acquired, that may adversely affect physical or academic functioning and result in the need for special education and related services.

The team shall determine that a student is eligible and in need of special education instruction and services if the student meets the criterion in item A and one of the criteria in item B.

A. There is documentation of a medically diagnosed physical impairment.

B. The student's:1. need for special education instruction and service is supported by a functional level of

organizational or independent work skills as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a special education teacher; or

2. need for special education instruction and service is supported by an inability to manage or complete motoric portions of classroom tasks within time constraints as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a special education teacher; or

3. physical impairment interferes with educational performance as shown by an achievement deficit of 1.0 standard deviations or more below the mean on an individually administered reliable, valid, and adequately normed achievement test.


PHYSICALLY IMPAIRED (PI) CRITERIA CHECKLIST Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:_______________________________________Grade:____________ School:_____________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student has a physical impairment and is in need of special education and related services when the student meets the criterion in Item A and one of the components in Item B.

Circle OneA.

There must be documentation of a medically diagnosed physical impairment.

Yes No

Does the student meet the criterion in Item A? Yes NoAND

B. Documentation in evaluation report of need for special education instruction and services, from one or more of the items below:1. Need for special education instruction and service is supported by a

lack of functional level in organizational or independent work skills as verified by a minimum of two or more documented, systematic observations in daily routine settings, one of which is completed by a physical and health disabilities teacher;

Yes No

OR2. Need for special education instruction and service is supported by an

inability to manage or complete motoric portions of classroom tasks within time constraints as verified by a minimum of two or more documented systematic observations in daily routine settings, one of which is completed by a physical and health disabilities teacher;

Yes No

OR3. Physical impairment interferes with educational performance as

shown by an achievement deficit of 1.0 standard deviations or more below the mean on an individually administered nationally-normed standardized evaluation of the student’s academic achievement.Achievement Test ___________________________________ SD____________

Yes No



STATE GUIDELINES: SEVERELY MULTIPLY IMPAIRED (SMI)"Severely multiply impaired" means severe learning and developmental problems resulting from two or more disability conditions determined by evaluation under Minnesota Rules, part 3525.2500.

The team shall determine that a student is eligible as being severely multiply impaired if the student meets the entrance criteria for two or more of the following disabilities:

A. hearing impairmentB. physically impairedC. moderate-severe mentally impairedD. visually impairedE. emotional or behavior disordersF. autism


SEVERELY MULTIPLY IMPAIRED (SMI) CRITERIA CHECKLIST Initial Evaluation Reevaluation


A student is severely multiply impaired and is in need of special education and related services if the student meets the criterion for two or more of the following disabilities:

Circle OneDocumentation in the evaluation report to verify two or more disability areas: Yes No

____Hearing Impaired____Physically Impaired____Moderate-Severe Mentally Impaired____Visually Impaired____Emotionally/Behaviorally Disordered____Autism

Does the student meet the criterion? Yes No


STATE GUIDELINES: SPECIFIC LEARNING DISABILITIES (SLD)Definition"Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

The disorder is:

A. manifested by interference with the acquisition, organization, storage, retrieval, manipulation, or expression of information so that the individual does not learn at an adequate rate for the child’s age or to meet state-approved grade-level standards when provided with the usual developmental opportunities and instruction from a regular school environment.

B. demonstrated primarily in academic functioning, but may also affect other developmental, functional, and life adjustment skill areas; and may occur with, but cannot be primarily the result of: visual, hearing, or motor impairment; cognitive impairment; emotional disorder; or environmental, cultural, economic influences, limited English proficiency or lack of appropriate instruction in reading or math.

CriteriaA child is eligible and in need of special education and related services for a specific learning disability when the child meets the criteria in items A, B, or C or in items A, B, and D below. Information about each item must be sought from the parent and must be included as part of the evaluation data. The evaluation data must confirm that the effects of the child’s disability occur in a variety of settings. The child must receive two interventions, as defined in Minnesota Statutes, section 125A.56, prior to evaluation, unless the parent requests an evaluation or the IEP team waives this requirement because it determines the child’s need for an evaluation is urgent.

A. The child does not achieve adequately in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, reading fluency, mathematics calculation or mathematical problem solving, in response to appropriate classroom instruction and either:

1) the child does not make adequate progress to meet age or state-approved grade-level standards in one or more of the areas listed above when using a process based on the child’s response to scientific, research-based interventions (SRBI) or:

2) the child exhibits a pattern of strengths and weaknesses in performance, achievement or both, relative to age, state-approved grade-level standards, or intellectual development that is determined by the group to be relevant to the identification of a specific learning disability. The performance measures used to verify this finding must be representative of the child’s curriculum or useful for developing instructional goals and objectives. Documentation is required to verify this finding. Such documentation includes evidence of low achievement from the following sources, when available: cumulative record reviews; class work samples; anecdotal teacher records; statewide and districtwide assessments; formal, diagnostic, and informal tests; curriculum-based evaluation results; and results from targeted support programs in general education.

B. The child has a disorder in one or more of the basic psychological processes which includes an information processing condition that is manifested in a variety of settings by behaviors such as inadequate: acquisition of information; organization; planning and sequencing;

working memory, including verbal, visual, or spatial; visual and auditory processing; speed of processing; verbal and nonverbal expression; transfer of information; and motor control for written tasks.

C. The child demonstrates a severe discrepancy between general intellectual ability and achievement in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, reading fluency, mathematics calculation or mathematical problem solving. The demonstration of a severe discrepancy shall not be based solely on the use of standardized tests. The group shall consider these standardized test results as only one component of the eligibility criteria. The instruments used to assess the child’s general intellectual ability and achievement must be individually administered and interpreted by an appropriately licensed person using standardized procedures. For initial placement, the severe discrepancy must be equal to or greater than 1.75 standard deviations below the mean of the distribution of difference scores for the general population of individuals at the child’s chronological age level.

D. The child demonstrates an inadequate rate of progress. Rate of progress is measured over time through progress monitoring while using intensive SRBI, which may be used prior to a referral or as part of an evaluation for special education. A minimum of 12 data points are required from a consistent intervention implementation over at least seven school weeks in order to establish the rate of progress. The rate of progress is adequate when the child’s:

1) rate of improvement is minimal and continued intervention will not likely result in reaching age or state-approved grade-level standards;

2) progress will likely not be maintained when instructional supports are removed;3) level of performance in repeated assessments of achievement falls below the child’s

age or state-approved grade-level standards; and4) level of achievement is at or below the fifth percentile on one or more valid and reliable

achievement tests using either state or national comparisons. Local comparison data that is valid and reliable may be used in addition to either state or national data. If local comparison data is used and differs from either state or national data, the group must provide a rationale to explain the difference.

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

In order to determine that the criteria for eligibility is met, documentation must include:

A. an observation of the child in the child’s learning environment, including the regular classroom setting that documents the child’s academic performance and behavior in areas of difficulty. For a child of less than school age or out of school, a group member must oversee the child in an environment appropriate to the child’s age. In determining whether a child has a specific learning disability, the parents and the group of qualified professionals, must:

1. use information from an observation in routine classroom instruction and monitoring of the child’s performance that was done before the child was referred for special education evaluation or:

2. conduct an observation of academic performance in the regular classroom after the child has been referred for special education evaluation and appropriate parental consent has been obtained; and

3. document the relevant behavior, if any, noted during the observation and the relationship of that behavior to the child’s academic functioning;

B. a statement of whether the child has a specific learning disability;C. the groups’ basis for making the determination, including that:

1. the child has a disorder, across multiple setting, that impacts one or more of the basic psychological processes documented by information from a variety of

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

2. the child’s underachievement is not primarily the result of visual, hearing, or motor impairment; developmental cognitive disabilities, emotional or behavioral disorders; environment, cultural, or economic influences; limited English proficiency; or lack of appropriate instruction in reading or math, verified by:

i. data that demonstrates that prior to, or as part of the referral process, the child was provided appropriate instruction in the regular education settings delivered by qualified personnel: and

ii. data-based documentation of repeated assessments of achievement at reasonable intervals, reflecting formal assessment of the child’s progress during the instruction, which was provided to the child’s parents;

D. educationally relevant medical findings, if any;E. whether the child meets the criteria, either items A, B, and C or items A B, and D; andF. if the child has participated in a process that assesses the child’s response to SRBI, the

instructional strategies used and the child-centered data collected, the documentation that the parents were notified about the state’s policies regarding the amount and nature of child performance data that would be collected and the general education services that would be provided, strategies for increasing the child’s rate of learning, and the parents right to request a special education evaluation.

VerificationEach group member must certify in writing whether the report reflects the member’s conclusion. If it does not reflect the member’s conclusion, the member must submit a separate statement presenting the member’s conclusions. Discovery Public School of Faribault’s plan for identifying a child with a specific learning disability consistent with this part must be included with its total special education system (TSES) plan. Discovery Public School of Faribault must implement its interventions consistent with that plan. The plan should detail the specific SRBI approach, including timelines for progression through the model; any SRBI that is used, by content area, the parent notification and consent policies for participation in SRBI; procedures for ensuring fidelity of implementation; and district staff training plan.The team shall determine that a student has a specific learning disability and is in need of special education and related services when the student meets the criteria described in items A through C. Information about each item must be sought from the parent and included as part of the evaluation data. The evaluation data must confirm that the disabling effects of the student's disability occur in a variety of settings.


SPECIFIC LEARNING DISABILITY (SLD) CRITERIA CHECKLIST Initial Evaluation Reevaluation

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

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

ITEM

A

The student does not achieve adequately in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematical calculation, or mathematical problem solving in response to appropriate classroom instruction and either:

CIRCLE

1. the student does not make adequate progress to meet age or state approved grade level standards in one or more of the areas listed above when using a process based on the child’s response to scientific, research-based interventions (SRBI); or

YES NO

2. the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, state-approved grade-level standards, or intellectual development, that is determined by the group to be relevant to the identification of a specific learning disability.

List area(s) Discrepancy score___________________________ ________________________________________________ ________________________________________________ _____________________

YES NO

Have all criteria in ITEM A been met? YES

NO

AND

ITEM

B

The child has a disorder in one or more of the basic psychological processes which includes an information processing condition that is manifested in a variety of settings by behaviors such as inadequate: acquisition of information; organization; planning and sequencing; working memory, including verbal, visual, or spatial; visual and auditory processing; speed of processing; verbal and nonverbal expression; transfer of information; and motor control for written tasks.

YES NO

Have all criteria in ITEM B been met? YES

NO

AND

ITEM

C

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

YES NO

Have all criteria in ITEM C been met? YES

NO

OR

ITEM

D The child demonstrates an inadequate rate of progress over time as measured through progress monitoring while using intensive scientific research-based interventions (SRBI). A minimum of 12 data points are required from a consistent intervention implemented over at least seven school weeks. Rates of progress is inadequate when:

CIRCLE


1. rate of improvement is minimal and continued intervention will not likely result in reaching age or state-approved grade-level standards;

YES NO

2. progress will likely not be maintained when instructional supports are removed; YES NO3. level of performance in repeated assessments of achievement falls below the

child’s age or state-approved grade-level standards; andYES NO

4. level of achievement is at or below the fifth percentile on one or more valid and reliable achievement tests using either state or national comparisons.

YES NO

Have all criteria in ITEM D been met? YES

NO


Have all documentation requirements been met?A. The parents and a group of qualified professionals have agreed the following

occurred and student meets above criteria:CIRCLE

1. information from an observation in routine classroom instruction and monitoring of the student’s performance was done before the child was referred for a special education evaluation;

YES NO

OR2. an observation of academic performance in the regular classroom after the

student was referred for a special education evaluation and appropriate parental consent has been obtained;

YES NO

AND3. relevant behavior, if any, was noted during the observation and the relationship

of that behavior to the child’s academic functioning;YES NO

B. Team statement of whether the child has a specific learning disability; YES NO

C. The team’s determination for making the decision included:1. the student has a disorder, across multiple settings, that impacts one or more of

the basic psychological processes that was documented by information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the student’s physical condition, social or cultural background, and adaptive behavior;

YES NO

AND2. the student’s underachievement is not primarily the result of visual, hearing, or

motor impairment; developmental cognitive disabilities; emotional or behavior disorders; environmental, cultural, or economic influences; limited English proficiency; or a lack of appropriate instruction in reading or math, verified by:a. data that demonstrate that prior to, or as part of, the referral process, the

student was provided appropriate instruction in regular education settings delivered by qualified personnel;

YES NO

ANDb. data-based documentation of repeated assessments of achievement at

reasonable intervals, reflecting formal assessment of the child’s progress during instruction, which was provided to the child’s parents;

YES NO

D. Educationally Relevant medical findings, if any. YES NO

Eligibility Determination CIRCLEthe student meets the criteria in either items A, B and C or items A, B and D; YE

SNO

ANDStudent has participated in a process that assesses the student’s response to SRBI, the instructional strategies used and the child-centered data collected, the documentation that the parents were notified about the state’s policies regarding the amount and nature of child performance data that would be collected and the general education services that would be provided, strategies for increasing the child’s rate of learning, and the parent’s right to request a special education evaluation.

YES

NO



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

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

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

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

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

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

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


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

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

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


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


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

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

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

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


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

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

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



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

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

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

A. F

LUEN

CY

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

communication disorders and either another adult or the child; andYES

NO

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

YES

NO

Have all criteria in ITEM A been met? YES

NO

B. V

OICE

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


NO

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

YES

NO

Have all criteria in ITEM B been met? YES

NO

C. A

RTIC

ULAT

ION

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


NO

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

YES

NO

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

YES

NO

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

YES

NO

Have all criteria in ITEM C been met? YES

NO

D. L

ANGU

AGE

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


NO

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

YES

NO

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

YES

NO

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

YES

NO


Have all criteria in ITEM D been met? YES

NO



STATE GUIDELINES: TRAUMATIC BRAIN INJURY (TBI)"Traumatic brain injury" means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that may adversely affect a child's educational performance and result in the need for special education and related services. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as: cognition, speech/language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, and information processing. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma.

The team shall determine that a student is eligible and in need of special education and related services if the student meets the criterion in item A and the criteria in items B and C as documented by the information gathered according to item D:

A. There is documentation by a physician of a medically verified traumatic brain injury.B. There is a functional impairment attributable to the traumatic brain injury that adversely

affects educational performance in one or more of the following areas: intellectual-cognitive, academic, communication, motor, sensory, social-emotional-behavioral, and functional skills-adaptive behavior. Examples of functional impairments which may adversely affect educational performance area:1. intellectual-cognitive, such as, but not limited to, impaired:

a) attention or concentration;b) ability to initiate, organize, or complete tasks;c) ability to sequence, generalize, or plan;d) insight/consequential thinking;e) flexibility in thinking, reasoning, or problem-solving;f) abstract thinking;g) judgment or perception;h) long-term or short-term memory;i) ability to acquire or retain new information;j) ability to process information;

2. academic, such as, but not limited to:a) marked decline in achievement from preinjury levels;b) impaired ability to acquire basic skills;c) normal sequence of skill acquisition which has been interrupted by the trauma as

related to chronological and developmental age;3. communication, such as, but not limited to:

a) impaired ability to initiate, maintain, restructure, or terminate conversation;b) impaired ability to respond to verbal communication in a timely, accurate or efficient

manner;c) impaired ability to communicate in distracting or stressful environments;d) impaired ability to use language appropriately;e) impaired ability to use appropriate syntax;f) impaired abstract or figurative language;g) perseverative speech;h) impaired ability to understand verbal information;i) impaired ability to discriminate relevant from irrelevant information;j) impaired voice production/articulation;


4. motor, such as, but not limited to, impaired:a) mobility;b) fine or gross motor skills;c) speed of processing or motor response time; d) sensory/perceptual motor skills;

5. sensory, such as, but not limited to, impaired:a) vision;b) hearing;

6. social-emotional-behavioral, such as, but not limited to:a) [impaired] ability to initiate or sustain appropriate peer or adult relationships;b) impaired ability to perceive, evaluate, or use social cues or context appropriately;c) impaired ability to cope with over-stimulating environments, low frustration

tolerance;d) mood swings or emotional [instability];e) impaired ability to establish or maintain self-esteem;f) denial of deficits affecting performance;g) poor emotional adjustment to injury;h) impaired ability to demonstrate age-appropriate behavior;i) impaired self-control;j) intensification of preexistent maladaptive behaviors or disabilities;

7. functional skills-adaptive behavior, such as, but not limited to, impaired:a) ability to perform developmentally appropriate daily living skills in school, home,

leisure, or community setting; b) ability to transfer skills from one setting to another;c) orientation;d) ability to find rooms, buildings, or locations in a familiar environment;e) ability to respond to environmental cues;f) ability to follow a routine;g) ability to accept change in an established routine;h) stamina that results in chronic fatigue;

C. The functional impairments are not primarily the result of previously existing:1. visual, hearing, or motor impairments;2. emotional-behavioral disorders;3. mental retardation;4. language or specific learning disabilities;5. environmental or economic disadvantage;6. cultural differences.

D. Information/data to document a functional impairment in one or more of the areas in item B must, at a minimum, include one source from Group One and one source from Group Two:1. GROUP ONE:

a) checklists;b) classroom or work samples;c) educational/medical history;d) documented, systematic behavioral observations;e) interviews with parents, student, and other knowledgeable individuals.

2. GROUP TWO:a) criterion-referenced measures;b) personality or projective measures;


c) sociometric measures;d) standardized evaluation measures: academic, cognitive, communication,

neuropsychological, or motor.



TRAUMATIC BRAIN INJURY (TBI) CRITERIA CHECKLIST Initial Evaluation Reevaluation


A student is in need of special education and related services when the student meetsthe criterion described in Items A and in Items B and C as documented by information gathered according to D.Circle OneA.

There is documentation by a physician of a medically verified traumatic brain injury? Yes No

Does the student meet the criterion in Item A? Yes NoAND

B. There is a functional impairment attributable to the traumatic brain injury that adversely affects educational performance in one or more of the following areas:

Yes No

____ intellectual/cognitive____ communication____ social/emotional/behavioral____ academic

____ sensory____ functional skills/adaptive behavior____ motor

Does the student meet the criterion in Item B? Yes NoAND

C. The functional impairments are not primarily the result of previously existing:

Yes No

____ visual, hearing, motor impairments____ environmental or economic disadvantage____ language or specific learning disability

____ mental retardation____ emotional/behavioral disorders____ cultural differences

Does the student meet the criterion in Item C? Yes NoAND

D. Information/data to document a functional impairment in Item B must, at a minimum, include one source from #1 and one source from #2:

Yes No

1. ____ checklists____ documented, systematic behavioral observations____ interviews with parent, student, and other knowledgeable individuals____ classroom or work samples____ educational/medical history

AND2. ____ criterion referenced measures

____ sociometric measures____ personality or projective measures____ standardized evaluation measures (academic, cognitive, communication,

neuropsychological, or motor)


Does the student meet the criterion in Item D? Yes No



STATE GUIDELINES: VISUALLY IMPAIRED (VI)"Visually impaired" means a medically verified visual impairment accompanied by limitations in sight that interfere with acquiring information or interaction with the environment to the extent that special education and related services may be needed.

The team shall determine that a student is eligible as having a visual impairment and in need of special education if the student meets one of the criteria in item A and one of the criteria in item B.

A. There is medical documentation of a diagnosed visual impairment by a licensed eye specialist establishing one or more of the following conditions:1) visual acuity of 20/60 or less in the better eye with the best conventional correction;

estimation of acuity is acceptable for difficult-to-test students;2) visual field of 20 degrees or less, or bilateral scotomas; or 3) a congenital or degenerating eye condition including, but not limited to, progressive

cataract, glaucoma, retinitis pigmentosa, albinism, or nystagmus.

B. A functional evaluation of visual abilities conducted by a licensed teacher of the visually impaired determines that:1) the student has limited ability in visually accessing program-appropriate educational

media including, but not limited to, textbooks, photocopies, ditto copies, chalkboards, computers, or environmental signs, without modification;

2) the student has limited ability to visually access the full range of program-appropriate educational materials and media without accommodating actions including, but not limited to, changes in posture, body movement, focal distance, or squinting;

3) the student demonstrates variable visual ability due to environmental factors including, but not limited to, lighting, contrast, weather, color, or movement, that cannot be controlled; or

4) the student experiences reduced ability due to visual fatigue.



VISUALLY IMPAIRED (VI) CRITERIA CHECKLIST Initial Evaluation Reevaluation


A student is eligible for special education and related services when the student meets one of the criteria in A and one of the items in B.

Circle OneA.

Documentation of visual impairment by a licensed eye specialist in at least one area:

Yes No

____ Visual acuity of 20/60 or less in better eye with best conventional correction

____ Visual field of 20 degrees or less or bilateral scotomas____ Congenital or degenerating eye condition:

_____________________________Does the student meet the criteria in Item A? Yes No

ANDB. Documentation of functional visual abilities evaluated by a teacher

of the visually impaired in at least one area Yes No

____ Limited ability in visually accessing program-appropriate educational media and materials without modifications

____ Limited ability to visually access full range of program-appropriate materials or media without accommodating actions (changes in posture, squinting, focal distance, etc.).

____ Variable visual ability due to environmental factors (lighting, contrast, color, movement, or weather) that cannot be controlled.

____ Reduced or variable visual ability due to visual fatigue or other factors common to the eye condition.

Does the student meet the criteria in Item B? Yes No



STATE GUIDELINES: DEVELOPMENTAL ADAPTED PHYSICAL EDUCATION (DAPE)

"Developmental adapted physical education" (DAPE) means specially designed physical education instruction and services for students with disabilities who have a substantial delay or disorder in physical development. DAPE instruction for students ages 3 through 21 may include development of physical fitness, motor fitness, fundamental motor skills and patterns, skills in aquatics, dance, individual and group games, and sports.

Students with conditions such as obesity, temporary injuries, and short-term or temporary illness or disabilities are termed special needs students. Special needs students are not eligible for developmental adapted physical education. Provisions for these students must be made within regular physical education as described in Minnesota Statutes, section 126.02.

A student is eligible for developmental adapted physical education when a team determines the student has met the criteria in items A and B.

A. The student has one of the following disabilities in each respective criteria in Minnesota Rules: autism spectrum disorders, deaf-blindness, emotional or behavioral disorders, hearing impairment, specific learning disabilities, developmental cognitive disability, severely multiply impaired, other health disability, physically impaired, visually impaired, or traumatic brain injury.

B. The student is determined by the team to need specially designed physical education instruction because:1. the student's performance on an appropriately selected, technically adequate, norm-

reference psychomotor or physical fitness instrument is 1.5 standard deviations or more below the mean. The instrument must be individually administered by appropriately licensed teachers; or

2. the student's development or achievement and independence in school, home, and community settings is inadequate to allow the student to succeed in the regular physical education program as supported by written documentation from two or more of the following: motor and skill checklists; informal tests; criterion-referenced measures; deficits in achievement related to the defined curriculum; medical history or reports; parent and staff interviews; systematic observations; and social, emotional, and behavioral evaluations.

Students who are eligible for DAPE must have an identified disability but do not have to demonstrate a need in the academic area. The disability criterion is used to identify the entry into a category. Students do not have to be eligible based on the academic criteria. They need a defined disability and then demonstrate a need for service in the physical domain. EXAMPLE:

A student with a medical diagnosis of cerebral palsy who is achieving very well in the academic classroom but in the physical education class the motor involvement interferes with successful participation. When the motor needs are evaluated, it is determined that DAPE services would be beneficial to successful participation in a physical education program.



DEVELOPMENTAL ADAPTED PHYSICAL EDUCATION (DAPE) CRITERIA CHECKLIST

Initial Evaluation Reevaluation

Student’s Full Name:_________________________________________________Student ID#:____________________________________________Grade:____________ School:__________________________________________________________________Date of Meeting:________________________ ELIGIBLE: Yes No

A student is eligible for developmental adapted physical education when the student meets the criterion described in Items A and B.

Circle OneA.

Identified disability ___________________________________________ (Not: Speech/Language or ECSE: Birth-3)

Yes No

Does the student meet the criterion in Item A? Yes No

ANDB. Documentation in evaluation report of delay from either:

1. Standardized psychomotor evaluation or physical fitness test, administered individually by an appropriate licensed teacher (1.5 SD below).

Yes No

Test SDOR2. Development or achievement and independence in school, home and

community settings is inadequate to allow success in regular PE (two or more sources of data):

Yes No

motor and skill checklistscriterion referenced measuresparent and staff interviewsinformal testsmedical history or reportssystematic observations social, emotional, and behavioral evaluationsdeficits in achievement related to the defined curriculum



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

- Sample #1: Prior Written Notice for Evaluation- Sample: Prior Written Notice for Parent Request to Dismiss Student from

Services- Procedures for Exiting Students through Graduation- Guidelines for Writing a Graduation Report – Summary of Performance- Graduation Exit Report – Summary of Performance- Example of evaluation reports- Example of observational forms- Notice of Special Education File Retention Policy- Health Condition Documentation Form- Sample: Medical Documentation Form for Attention Deficit Hyperactive Disorder (ADHD)- Sample: Systematic Parent Interview- Functional Behavioral Assessment (FBA) Definition- Example: Functional Behavioral Assessment (FBA)- Assistive Technology- Sample of Assistive Technology (AT) Devices- SETT Framework: Collaborative Consideration of Assistive Technology

Devices and Service


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

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

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

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

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

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

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

In any circumstance where an independent educational evaluation at public expense is undertaken, Discovery Public School of Faribault requires that the evaluator have full access to Discovery Public School of Faribault: Total Special Education System Manual—Chapter 3: Evaluation & Reevaluation Standards 3-60

school records and that the parent authorize in writing that the evaluator may have conversations with any school employee who has provided service or evaluated the student. The parent must provide authorization for the independent evaluator to have access to all school records. Just as a school evaluator would, the independent evaluator must seek and utilize school and parental input or any other input or data provided by the school or the parent. The parent will provide Discovery Public School of Faribault with written authorization to exchange information with the evaluator. Discovery Public School of Faribault will be entitled to a copy of the evaluator’s report at the same time it is provided to the parent and will be given written permission to have discussions with the evaluator. Both school employees and parents or parent representatives may provide information to the independent evaluator. However, any information shared must be provided to the other side by the independent evaluator. The evaluator must be available to discuss and interpret the results of the evaluation with district staff by participating in the evaluation meeting with the parents and the IEP Team.

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

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

Transportation costs for evaluation are not reimbursed.

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

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

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



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

1. A description of the action proposed or refused by Discovery Public School of Faribault.Discovery Public School of Faribault is proposing a special education evaluation to determine if Thomas is a student with a disability and is need of educational services. Thomas has been struggling in math and interventions have not proven successful.orDiscovery Public School of Faribault is proposing a special education reevaluation to determine if a student continues to have needs related to his Specific Learning Disability.

2. An explanation of any other options Discovery Public School of Faribault considered and the reasons why those were rejected.Example 1: The classroom teacher had concerns regarding the student’s articulation.Example 2: Scores on the NWEA demonstrate that the student ranked far below other

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

fighting.

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

4. Description of each evaluation test record, or report Discovery Public School of Faribault used as a basis for the proposed or refused action.NWEA scores, MCA scores, CBM probes, classroom records (including grades, attendance, discipline referrals, etc.).MDE IS LOOKING FOR MORE DETAIL IN THIS AREA NOW. FOR EXAMPLE: NorthWest Educational Assessments: Thomas’ scores in the area of reading were well-below those of his peers. His score of 152 is equivalent to the end of kindergarten.

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



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

1. A description of the action proposed or refused by Discovery Public School of Faribault, (if not shown on attached IEP, IFSP or IIIP).Discovery Public School of Faribault has proposed a special education evaluation to

determine if Raymond is a student with a disability, specifically an Emotional or Behavioral Disorder.

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

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

4. A description of each evaluation procedure, tests, record, or report Discovery Public School of Faribault used as a basis for the proposed or refused action.Discovery Public School of Faribault considered the information provided in the Student Discipline Report dated March 10, 2005, and documented information from the incident that took place on March 7, 2005.MDE IS LOOKING FOR MORE DETAILS IN THIS AREA

5. A description of any other factors that is relevant to Discovery Public School of Faribault’s proposal or refusal.There were no other factors that were relevant to Discovery Public School of Faribault’s evaluation proposal.



USE OF EXISTING DATA FOR REEVALUATIONSUSE OF EXISTING DATA FOR REEVALUATIONS

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

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

participate in the general education curriculum.

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

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

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

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

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

Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-64




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

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

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

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

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

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

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



MATRIX: SELECTING AN OBSERVATION

Matrix: Selecting an Observation

Duration Latency Interval EventPermane

nt Product

ABC

Opportunities to Respond XAcademic

Engagement in Silent Reading

X X

Out of Seat X X XNumber of Correct

Responses X

Teacher Praise XSwearing X X

Asking for Help X XWriting X X X

Following Directions X X

Tantrums or Outbursts X X X

Vocalizing X XFidgeting X X



DURATION RECORDING FORMDiscovery Public School of Faribault DURATION RECORDING FORM

Student:

Person completing this form:

Location:

Date(s):

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

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

you graph).

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

Date Time Enter time when the behavior began

Enter time when behavior stopped

Length of time that the behavior lasted for



EXAMPLE: DURATION RECORDING FORM

Discovery Public School of Faribault DURATION RECORDING FORMStudent:


Location:

Date(s):

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

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

you graph).

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

Date Time Enter time when the behavior began

Enter time when behavior stopped

Length of time that the behavior lasted for

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

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

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

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




LATENCY RECORDING FORM

Discovery Public School of Faribault LATENCY RECORDING FORMStudent:


Location:

Date(s):

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

seconds (This is what you graph).

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

Date Time Enter time when the instruction began

Enter time when behavior starts

Length of time for the behavior to start



EXAMPLE: LATENCY RECORDING FORM

Discovery Public School of Faribault LATENCY RECORDING FORMStudent:


Location:

Date(s):

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

seconds (This is what you graph).

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

Date TimeEnter time when the instruction

beganEnter time when behavior starts

Length of time for the behavior to start

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

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

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

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

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




INTERVAL OBSERVATION RECORDING FORM (PART A)Discovery Public School of Faribault INTERVAL OBSERVATION RECORDING

FORM(Part A)

Student:


Location:

Date(s):

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

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

Target = T Peers = POBS 1

Setting:________Date: __________Time:__________

OBS 2Setting:________Date: __________Time:__________

OBS 3Setting:________Date: __________Time:__________

Median Greater median#Smaller

median#

Discrepancy

On TaskT

P

________

________

________

________

________

________

_______

___________ ____ = ________

PhysicalT

P

________

________

________

________

________

________

_________

___________ ____ = ________

Vocal/Noise

T

P

________

________

________

________

________

________

_______

___________ ____ = ________

PlaceT

P

________

________

________

________

________

________

_______

___________ ____ = ________

Compliance

T

P

________

________

________

________

________

________

_______

___________ ____ = ________


Use Part B for recording observation data



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

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

RPH= Rate per Hour

On-Task ____ 20 x100

= __%

Physical ____RPM RPH

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

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

On-Task ____ 20 x100

= __%

Physical ____RPM RPH

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

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




EXAMPLE: INTERVAL OBSERVATION RECORDING FORM (PART A)Discovery Public School of Faribault INTERVAL OBSERVATION RECORDING

FORM(Part A)

Student:

John Doe Person completing this form:

Johnson

Location:

Milaca High School Date(s):

11/5/06

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

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

Target = T Peers = POBS 1

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

OBS 2Setting:________Date: _________Time:__________

OBS 3Setting:________Date: _________Time:__________

Median Greater median#Smaller

median#

Discrepancy

On TaskT

P

75%

85%

________

________

________

________

_______

___________ ____ = ________

PhysicalT

P

12%

6%

________

________

________

________

_________

___________ ____ = ________

Vocal/Noise

T

P

12%

6%

________

________

________

________

_______

___________ ____ = ________

PlaceT

P

12%

6%

________

________

________

________

_______

___________ ____ = ________

Complianc


eT

P

100%

100%

________

________

________

________

_______

___________ ____ = ________

Use Part B for recording observation data



EXAMPLE: INTERVAL OBSERVATION RECORDING FORM (PART B)

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

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

RPH= Rate per Hour

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

Physical √ √ __2__RPM RPH

10 .2 x 60 12

Vocal/Noise √ √ __2__10 .2

x 60 12

Place √ √ __2__10 .2

x 60 12

Compliance √√

√√ __2/2__ R0 = 100%

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

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

= 85%

Physical √ __1_RPM RPH

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

√√√ _2/2_ R0 = 100%

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


General Comments



EVENT/FREQUENCY OBSERVATION RECORDING FORM

Discovery Public School of FaribaultEVENT/FREQUENCY OBSERVATION

RECORDING FORMStudent:


Location:

Date(s):

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

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

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

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

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

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

and graph.

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

Date Class Time Tally when behavior occurs:

Total number of times behavior occurred:


Notes/Comments:



EXAMPLE: EVENT/FREQUENCY OBSERVATION RECORDING FORM

Discovery Public School of FaribaultEVENT/FREQUENCY OBSERVATION

RECORDING FORMStudent:

John Doe Person completing this form:

Johnson

Location:

Milaca High School Date(s):

11/5/06

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

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

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

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

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

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

and graph.

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

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

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

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

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

Notes/Comments: Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-85


PERMANENT PRODUCT RECORDING FORM PERMANENT PRODUCT RECORDING

FORMStudent:


Location:

Date(s):

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

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

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

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

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


Date Time Permanent Product Label

No. of Times Behavior Occurred (# correct

answers)Number of

OpportunitiesTotal % of Times

Behavior Occurred




EXAMPLE: PERMANENT PRODUCT RECORDING FORM PERMANENT PRODUCT RECORDING

FORMStudent:


Location:

Date(s):

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

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

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

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


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

Date Time Permanent Product Label

No. of Times Behavior Occurred (# correct

answers)

Number of Opportunitie

s

Total % of Times Behavior Occurred

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

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

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




A-B-C OBSERVATION SHEETPROBLEM IDENTIFICATIONA-B-C OBSERVATION SHEET

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

Observer: Target Behavior:

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

DateTime

Person present when

behavior occurred

Which predictors were present?

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

Where did the problem occur?

(example: kitchen, yard, mall)

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

pushing, screaming at X)

Describe specifically and completely what

happened 30 minutes BEFORE the

problem behavior (example: I ask

him/her to take a shower).

Describe specifically and completely what happened during the

30 minutes FOLLOWING the

problem behavior including your intervention

(example: I asked what was wrong)

Hypothesized function




GUIDELINES FOR TEAM OVERRIDE ON ELIGIBILITY DECISIONS

Documentation Required A team may determine that a student is eligible for special education and related services (even though the student does not meet the specific requirement in law) if they believe the student has a disability and needs special instruction. In order to do this the team must include the documentation in the student’s special education record in accordance with items A, B, C, and D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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



SAMPLE: PRIOR WRITTEN NOTICE FOR PARENT REQUEST TO DISMISS STUDENT FROM SERVICES

1. A description of the action proposed or refused by Discovery Public School of Faribault.At the parents’ written request, child will be dismissed from special education services at this time. He will attend at the ALC without special education support.

2. An explanation of why Discovery Public School of Faribault proposes or refuses to take action.Although Discovery Public School of Faribault has reservations regarding eliminating special education services to child, Discovery Public School of Faribault is obligated to honor a parent’s written request to revoke special education and related services. The team has agreed to work with the family to allow the student an opportunity to demonstrate appropriate social skills without special education services. Because a student will be attending the ALC, his classes will have fewer students than at the high school, and will have less seat time than required in a high school setting. Discovery Public School of Faribault team will honor the parent’s request that special education and related services be discontinued. The parent has suggested if the student is not success in the ALC environment without special education services, they will make a request for an assessment.

3. A description of any other options Discovery Public School of Faribault considered and the reasons why they were rejected.The team discussed the student attending the high school with and without special education support. The team also discussed the child attending the ALC with and without special education support. The parent felt strongly that the student had reached a point in his education where he did not benefit and, in fact, felt hindered by direct special education services. The high school placement was of concern to the family and to Discovery Public School of Faribault team because child is behind on credits and may not be able to realistically “catch up” in a time frame that would be acceptable to him. Discovery Public School of Faribault team acknowledged the child was not willing to make special education services work for him at this time. Given the parent request, the team had no recourse but o dismiss the student from services. However, Discovery Public School of Faribault team felt that given the smaller class sizes and less seat time in ALC, the student might be able to succeed without special education services.

4. A description of each evaluation procedure, test, record or report Discovery Public School of Faribault used as a basis for the proposed or refused action.The decision to dismiss the student from services was primarily based on the parent’s revocation of consent for services. Therefore, no additional assessments were conducted. The student missed a great deal of school during the spring semester when he began attending Premier High School. School records indicated that child was not successfully attending and passing classes in a traditional high school environment.


5. A description of any other factors relevant to Discovery Public School of Faribault’s proposal or refusal.If child is not successful under this current plan, the parent will request a new assessment for special education services and understands that because this becomes an initial assessment, the student will have to meet initial eligibility criteria again.



GUIDELINES FOR WRITING A GRADUATION REPORT – SUMMARY OF PERFORMANCE

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

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

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

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

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

Can the student’s current IEP be the Summary of Performance?No, as stated above, the Summary of Performance is not regarded as the IEP and is clearly identified as a separate process from the IEP. If the summary were intended to be part of the IEP, it is likely the reauthorization would have included it in the section of IDEA 2004 pertaining to IEP content. It is the current interpretation by our department that this must be a separate document from the IEP. Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-96

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

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

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

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

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



GRADUATION EXIT REPORT – SUMMARY OF PERFORMANCE

Summary of Performance

Summary of PerformanceTo be completed at exit prior to graduation or aging out.The summary of performance is most useful when linked with the IEP process and the student has the opportunity to actively participate in preparation for and at the meeting.

STUDENT INFORMATIONStudent Name:____________________________ Final IEP Manager: _____________________________Date of Birth: _______________ Age: _______ Primary Disability: _____________________________Address: __________________________ _________________, _____ _________Home Telephone: _____________________ Email Address: ________________________________Attending School/District: __________________________________ Year of Graduation/exit: _______

STUDENT’S SELF ADVOCACY STATEMENT1. My strengths are:

2. My area of Need is:

3. Accommodations that help me are:

4. My learning style is:


5. I know I can succeed when:

6. I would like people to know that:

STUDENT’S POST-SECONDARY GOALS:(This section should be completed with the student using information from the present IEP/IIIP. Unless plans have changed since the development of the most recent IEP/IIIP, the post-secondary goals may be transferred here).Employment:Write your student’s employment goal here.

Post-Secondary Education and Training:Write your student’s post-secondary goal here.

Community Participation:Write your student’s community participation here.

Recreation and LeisureWrite your student’s recreation and leisure goal here.

Home Living Skills:Write you student’s family living goal here.

ACADEMIC ACHIEVEMENT:Statewide Testing Scores Writing: _______________ Math: _______________ Reading: _______________

EFFECTIVE ACCOMMODATIONS:(A support or service that is provided to help a student fully access the general education curriculum or subject matter, does NOT change the content of what is being taught or the expectations that the student meet a performance standard applied for all students).


EFFECTIVE MODIFICATIONS:(A change to the general education curriculum or other material being taught, which alters the standards of expectations for students with disabilities).

ASSISTIVE TECHNOLOGY:(Any device that helps a student with a disability function in a given environment).

ADULT/COMMUNITY CONTACTS:(Coordination with outside agencies/personnel

HEALTH AND WELLNESS:(Information about health conditions, medications, etc. if needed).

Date Completed: __________________ Completed by: ______________________________________



NOTICE OF SPECIAL EDUCATION FILE RETENTION POLICY

In accordance with the policy adopted by the INSERT SCHOOL NAME and approved by the Minnesota Records Disposition Panel, notice is hereby being given as to the length of time that your special education file will be maintained.

The record will be retained until five years after your 21st birthday in accordance with Discovery Public School of Faribault’s retention schedule. At that time, the contents will be destroyed with the exception of the last IEP/IIIP, all evaluation reports and the Notice of Proposed Action and the following which will be maintained without time limitation: standardized and achievement test results, student’s name, address, phone number, grades, attendance and grade level completed.

By signing this notice, you are acknowledging the retention policy. No further notice will be given.

____________________________________ __________________________________Student Parent

_____________________ ____________________Date Date

____________________________________ ____________________Witness Date

----------------------------------------------------------------------------------------------------------------Student Copy

In accordance with the policy adopted by the INSERT SCHOOL NAME and approved by the Minnesota Records Disposition Panel, notice is hereby being given as to the length of time that your special education file will be maintained.

The record will be retained until five years after your 21st birthday in accordance with Discovery Public School of Faribault’s retention schedule. At that time, the contents will be destroyed with the exception of the last IEP/IIIP, all evaluation reports and the Notice of Proposed Action and the following which will be maintained without time limitation: standardized and achievement test results, student’s name, address, phone number, grades, attendance and grade level completed.

By signing this notice, you are acknowledging the retention policy. No further notice will be given.

____________________________________ __________________________________Student Parent

_____________________ ____________________Date Date

____________________________________ ____________________Witness Date



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

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

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

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

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

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

Providing Copies of Test Protocols and Educational DataDiscovery Public School of Faribault is not unequivocally obliged to distribute copies of test protocols containing educational data to the parents unless failure to do so would effectively prevent the parents from exercising their right to inspect and review. 34 C.F.R. § 300.562(b)(2). In other words, if parents are physically unable to inspect and review the educational data about their child, Discovery Public School of Faribault must provide copies of the data to them. The U.S. Department of Education has interpreted this to mean that a parent shall receive copies of the records when he or she lives too far from the school to see the records in person. Letter to Anonymous, 213 IDELR 188 (OSERS 1989) and Letter to Kincaid, 213 IDELR271(OSERS 1989). The parent might also be prevented from exercising the right to inspect and review for other reasons, such as a disability, lack of transportation, etc. Representatives from Discovery Public School of Faribault may use their own judgment regarding whether a parent is effectively denied access, but should take the above examples into consideration when making this determination. Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-102

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

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

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



GUIDELINES FOR WRITING THE EVALUATION REPORTThe evaluation Report (ER) must be one comprehensive report (not individual reports stapled together) and must include:

1. Reason for Referral/Background Information:Summarize the information that led to the evaluation.

2. Information and Concerns Reported by Parents:Summarize the information shared by parents. Include concerns and information that would help the team make decisions about special education eligibility and identify student educational needs.

3. Educationally Relevant Medical Findings:Information relevant to the student’s learning should be summarized. A copy of reports or letters from physicians or other medical personnel as appropriate, should be maintained in the student file and summarized in this section.

4. Special Considerations:Describe any adaptations in assessment procedures that need to be made based on the student’s language, cultural, economic, environmental, physical or sensory status.

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

6. Parent Input:Parent information may be integrated into one or more sections of the report including: background information, reasons for referral, health history, within the results of a questionnaire or rating scale completed by the parents, or a summary of results from an outside evaluation provided by the parents. Parent input may also be included in a separate section of the report.

7. Summary of All Evaluation Results:Results of assessment measures included on the evaluation plan must be included in the report. In addition, the report must contain a comprehensive summary of all the evaluation results. An individual summary of each assessment instrument alone is not sufficient. An overall summary must be included.

8. Present Levels of Performance: Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-104

The Present Levels of Performance must incorporate current assessment results, information on current academic and functional performance in the classroom, and input from those working with the student to get a complete and updated picture of the student. The Present Levels of Performance must include more than a list of test scores and results. Additional sources of Present Levels of Performance information include observations, work samples, curriculum-based measures, informal procedures, and progress on current goals and objectives.

9. Educational Needs:Based on existing data, evaluation results, and present levels of performance (pleps), state the educational needs of the student. Educational needs are individually determined student-based skills and behavior needs for specialized instruction in skill and/or behavior areas and compensatory strategies. Education needs do not refer to materials, methods, or types of special education services. Be specific as goals and objectives are developed from this information. It is important that all recommendations brought to the meeting by the team members are discussed and synthesized into specific needs statements which will generate the goals on the IEP.

10. Accommodations and Modifications:The report must include whether any additions or modifications to the special education and related services are needed to enable the student to meet the measurable annual goals set out in the student’s IEP, and to participate, as appropriate, in the general curriculum. The report needs to include accommodations or modifications that teams will need to detail when writing or revising the IEP.

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

Specific Learning Disability (SLD) reports must include:

1. A statement that the student’s underachievement is not primarily the result of visual, hearing, or motor impairment; developmental cognitive disabilities; emotional or behavioral disorders; environmental, cultural, or economic influences; limited English proficiency; or lack of appropriate instruction in reading or math.


2. Information from the parents about each criteria component (A, B, and C or D)

3. An observation of the student in the student’s learning environment, including the regular classroom setting that documents the student’s academic performance and behavior in the area of difficulty.

4. Documentation of inadequate achievement or a pattern of strengths and weaknesses in performance, achievement, or both relative to age, state-approved, grade level standards or intellectual development. Sources of this data include cumulative record reviews, class work samples, anecdotal teacher records, statewide and district-wide assessments, curriculum based measures, formal and informal tests, or results from targeted support programs in general education.

5. Documentation that the student has a disorder in one or more basic psychological processes that is manifested across multiple settings and is documented from a variety of sources. Sources of information include aptitude and achievement tests, parent input, teacher recommendations, or information about the student’s physical condition, social or cultural background, and adaptive behavior.

6. For Criteria C: Documentation of a severe discrepancy between general intellectual ability and achievement in one or more areas (basic reading skills, reading comprehension, reading fluency, math calculations, math reasoning, written expression, listening comprehension, or oral expression).

7. A statement of any educationally relevant medical findings.

8. Documentation of the eligibility must include whether the student meets criteria in either items A, B, and C or items A, B, and D.

9. Signatures of all team members whether in agreement with the report or not. Signatures are required for both an initial and a reevaluation.



EXAMPLE: SLD EVALUATION REPORT

Evaluation Report

Student Name: Jane Smith ID: 0759637825964 Date: 4/15/08School: Middle School Grade: 6

DOB: 2/18/96 Initial Evaluation Reevaluation

This evaluation report must include: information reported by parents summary of all evaluation results including tests and scores present level of performance statement(s) including educational needs that derive from

the disability interpretation of evaluation results and determination of eligibility by addressing criteria

components verifying the child is a child with a disability and is in need of (or continues to need) special education and related services

SLD written report components (for a child suspected of having a specific learning disability)

1) Information Reported by Parents: Jane has struggled to be academically successful at school, especially since the 2nd grade when his parents separated. His mother feels that the school has not responded to her son's increased academic needs. She feels that school staff should give her extra help to lower his frustration level. After meeting with the special education team and Jane's classroom teacher, Mrs. Smith made a written request for a formal evaluation to determine special education eligibility.

2) Review of Existing Data & Current Assessment Results: Previous testing completed on in 2nd grade at Smith Elementary on ____________ indicate that Jane’s Reading, Written Language, and Math fell within the Average range on the results of the Woodcock-Johnson Tests of Achievement III (WJ-III ACH). Scores did not indicate a discrepancy between Jane’s intellectual functioning and his achievement. He did demonstrate underachievement in response to usual classroom instruction in the areas of reading and written language. Modifications were made in grades one and two to help Jane acquire reading and writing skills. In third grade, Jane was brought to the Lincoln Elementary Student Assistance Team. Jane was referred due to his frustration with and difficulty in completing academic tasks. Jane’s teacher noted slow but adequate progress, so the SAT involvement was informational only.


Expression of Standard Scores and Percentile Ranks The standard scores reported in the following results have a mean or average of 100 and a standard deviation of 15. Standard scores between 90 and 110 would be considered average when compared to same-age peers. Percentile ranks indicate the percent of same-aged peers whose scores fall at or below the reported score. For example, a student who obtains a percentile rank of 45 on a test has scored as well as or better than 45% of same-aged peers in the comparison group. Percentile ranks between 25 and 75 fall within the average range.

A. Intellectual FunctioningThe Woodcock-Johnson Tests of Cognitive Abilities III (WJ-III COG) was administered to Jane Smith by Stevie Buckingham, the School Psychologist, on _______________. The WJ-III COG is an individually administered intellectual assessment intended to measure seven distinct cognitive abilities. Jane seemed to enjoy working on the various test activities, and he concentrated well without showing signs of fatigue. These test results should be considered a valid representation of Jane's current cognitive functioning. The Broad Cognitive Ability (GIA) which is a compilation of the seven individual tests, Jane's standard score was 107, plus or minus 7 points. The "plus or minus" information is provided to show that the chances are 90 out of 100 that his true score falls within the range of 100 to 114. Jane's GIA score would equal or exceed approximately 73 percent of children his age within a national comparison group. This score falls within the Average range.

B. Academic Functioning: The Woodcock-Johnson Tests of Achievement III (WJ-III ACH) was administered to Jane on ____________, by John Williams, the LD special education teacher at Lincoln Elementary. The WJ-III ACH is an individually administered, norm referenced, comprehensive achievement battery that is comprised of nine tests: letter-word identification, passage comprehension, calculation, applied problems, dictation, writing samples, science, social studies and humanities. These tests are combined into four broad achievement composites (each comprised of at least two subtests): Broad Reading, Broad Math, Broad Written Language, and Broad Knowledge. The table below presents the results from the four broad achievement areas as well as the discrepancy between Jane’s intellectual functioning and his broad achievement.

Test Name Standard Score Percentile Rank Discrepancy* Broad Reading 93 33rd -1.27 Broad Math 109 73rd 0.28 Broad Written Language 86 18th -1.79* Broad Knowledge 93 33rd -1.27 After completing more than half of the tests, Jane began to slouch in his chair and indicated that he had a headache. At that point testing was discontinued. Testing was completed on ___________ in the afternoon. In the area of Broad Written Language, Jane earned a score equal to or better than 18% of his same age peers. Strengths in this area are writing simple and compound sentences, the use of inventive spelling, and word usage skills. Jane struggles to form letters when writing in cursive. Other weaknesses in writing are the proper use of punctuation, capitalization, spelling skills, and paragraph writing.

3) Systematic Observations:


Jane was observed for 20 minutes in Mrs. Davis’s written language class on ______________ by John Williams, the LD teacher. The students were sitting in groups with six students per table. Students were being introduced to a unit on paragraph writing. Jane frequently spoke to the student next to her. He spent a lot of time bending the wire on his spiral notebook. When the teacher placed an overhead on the screen, Jane’s attention immediately went from the notebook to the overhead screen. He raised his hand in response to questions being asked by the teacher. During this observation, Jane was on-task 45% of the 30-second intervals while his peers were on-task 85%. Jane was observed for 20 minutes during mathematics instruction on _______________. Small groups of students worked on problems from the textbook while the teacher circulated throughout the room. Jane was on-task 80% of the time, compared to his peers who were on-task 82% of the time. Jane was observed again on __________________ for 20 minutes during social studies class. He was on-task 57% of the time, while his peers were on-task 85%. When students were expected to write sentences on a worksheet, Jane stopped working completely. Jane spent the remainder of the time chatting with students sitting near her.

4) Relevant Medical FindingsJane is in excellent physical health and has only missed 3 days of school this year. Parents reported no medical concerns at this time. According to health office records, Jane has visited the nurse’s office infrequently, during the months of February and March. During those two months, he visited the health office on 3 different occasions complaining of a headache or a stomachache. Vision and hearing screening completed on Jane in November by Discovery Public School of Faribault nurse, Sara James, reported the following: Vision: L 20/20 -- R 20/20 Hearing: Passed 5) Present Level of Educational Performance: Jane earned the following academic grades up to this point in fourth grade: 1= Outstanding Progress 2= Satisfactory Progress 3= Insufficient Progress Subject Area 1st 2nd 3rd 4thReading 3 2 1 Written Language 3 3+ 3+ Spelling 2 1 1- Math 2- 2 2

PSYCHOLOGICAL PROCESSING

Jane’s teacher reports that Jane has difficulty following instructions in the classroom. When information is presented visually, Jane seems to functions much better in the classroom. Academically, teachers report that Jane does not appear to be learning his spelling words although he is studying them at home and school. His daily work is inconsistent, sometimes neat and completed accurately, but other times very messy and incomplete. Teachers feel that Jane’s writing performance is a reflection of effort and motivation. In addition to three observation described earlier in this report, two of Jane's teachers, Jane, and her parent completed Information Processing questionnaires. These ask them to answer questions on the six areas of information processing: Storage, Organization, Acquisition, Retrieval, Expression, and Manipulation.


Janes's Science teacher, Mr. Macklay, indicated concern in 5 of 6 areas. He sees Jane's organizational skills as quite good. Of particular concern to Mr. Macklay, were the areas of Manipulation and Acquisition. He indicated that Jane is "seldom" or "hardly ever" able to apply learned information to new situations, infer information, interpret information, or analyze and solve problems of varying complexity. Also of concern to Mr. Macklay were her ability to calculate automatically, follow two and three step directions, and differentiate details from key concepts.

Jane's History teacher, Mr. Weisser, indicated concerns of less severity but many were areas of concern similar to Mr. Macklay. Mr. Weisser's concerns included: linking new information to that previously learned, recognizing or recalling information over time, inferring information, and differentiating details from key concepts.

Jane's questionnaire indicated concerns in the area of acquisition. She indicated she "sometimes" remembers things without having them repeated and "sometimes" learns new things easily. She indicated difficulty getting all her work done on time, and said she asks teachers for an extra day or two. She said she "sometimes" remembers information she has studied for a test, and indicated that she does not know her multiplication facts.

6) Educational Needs: Jane's current written language skills impair his success in academic areas that require writing. Because they believe his writing skills can be improved through intensive instruction, the team recommends that Jane receive additional instruction and practice in written language. For assignments requiring extensive writing, Jane should be allowed accommodations that compensate for his slower rate of writing. Though he should be given verbal and written feedback on spelling and punctuation errors on assignments, his grades should not be lowered due to spelling accuracy. For example, instead of reducing Jane’s grade on an assignment, he might instead be required to correct each spelling error he had made. Jane should be introduced to word processing during the next 12 months.

7) Interpretation of Evaluation Results: The team shall determine that a student has a specific learning disability and is in need of special education and related services when the pupil meets the criteria described in items A through D.

Item A The student demonstrates severe under-achievement in response to usual classroom instruction. 1. Supported by the following sources/procedures: During the fourth grade Jane has displayed "Insufficient Progress" in each rating period. 2. At least one team member other than the student's regular teacher shall observe the student's academic performance in the regular classroom setting. Three classroom observations by the LD teacher were conducted. Generally, Jane is off-task at a slightly higher rate than peers are. He is significantly off-task when a writing assignment is given. AND Item B The student demonstrates a severe discrepancy between general intellectual ability and achievement in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, mathematical calculation, or mathematical reasoning. Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-110

Current testing with the WJ-III COG and WJ-III ACH indicates a significant discrepancy of greater than –1.75 between Jane’s cognitive ability and achievement in the area of written expression. AND tem C The team agrees that sufficient assessment data exists to verify the following conclusions: The student has an psychological processing deficit.

8) Special Considerations: The team did not identify any special considerations for Jane at this time.

9) Eligibility DeterminationThe team shall determine that a student has a specific learning disability and is in need of special education and related services when the student meets the criteria described in Items A through D.The student must meet the criteria for A, B or C or A, B and D.

Item A____ The child does not achieve adequately in one or more of the following areas: oral

expression, listening comprehension, written expression, basic reading skills, reading comprehension, reading fluency, mathematics calculation or mathematical problem solving, in response to appropriate classroom instruction and either:

____ the child does not make adequate progress to meet age or state-approved grade-level standards in one or more of the areas listed above when using a process based on the child’s response to scientific, research-based interventions (SRBI) or:

____ the child exhibits a pattern of strengths and weaknesses in performance, achievement or both, relative to age, state-approved grade-level standards, or intellectual development that is determined by the group to be relevant to the identification of a specific learning disability. The performance measures used to verify this finding must be representative of he child’s curriculum or useful for developing instructional goals and objectives. Documentation is required to verify this finding. Such documentation includes evidence of low achievement from the following sources, when available: cumulative record reviews; class work samples; anecdotal teacher records; statewide and district wide assessments; formal, diagnostic, and informal tests; curriculum-based evaluation results; and results from targeted support programs in general education.

Item B____ The child has a disorder in one or more of the basic psychological processes which

includes an information processing condition that is manifested in a variety of settings by behaviors such as inadequate: acquisition of information; organization; planning and sequencing; working memory, including verbal, visual, or spatial; visual and auditory processing; speed of processing; verbal and nonverbal expression; transfer of information; and motor control for written tasks.

ITEM C____ The child demonstrates a severe discrepancy between general intellectual ability and

achievement in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, reading fluency, mathematics calculation or mathematical problem solving. The demonstration of a severe discrepancy shall not be based solely on the use of standardized tests. The group shall consider these standardized test results as only one component of the eligibility criteria. The instruments used to assess the child’s general intellectual ability and achievement must be individually administered and interpreted by an appropriately licensed person using standardized procedures. For initial


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

ITEM D____ The child demonstrates an inadequate rate of progress. Rate of progress is measured

over time through progress monitoring while using intensive SRBI, which may be used prior to a referral or as part of an evaluation for special education. A minimum of 12 data points are required from a consistent intervention implementation over at least seven school weeks in order to establish the rate of progress. The rate of progress is adequate when the child’s:

____ rate of improvement is minimal and continued intervention will not likely result in reaching age or state-approved grade-level standards;

____ progress will likely not be maintained when instructional supports are removed;____ level of performance in repeated assessments of achievement falls below the child’s

age or state-approved grade-level standards; and____ level of achievement is at or below the fifth percentile on one or more valid and reliable

achievement tests using either state or national comparisons. Local comparison data that is valid and reliable may be used in addition to either state or national data. If local comparison data is used and differs from either state or national data, the group must provide a rationale to explain the difference.


SIGNATURES

Signature Page: Evaluation Report Student Name: Jane Smith To be completed during meeting of qualified professional and parent(s)

Based on the information included in this report, the student:

Is not eligible for special education because the student did not meet state criteria in the follow areas examined:

Autism Spectrum Disorders Developmental Cognitive Disability Specific Learning Disability

Deaf & Hard of Hearing Emotional or Behavior Disorder Speech or Language Impairment

Deaf-Blind Other Health Disability Traumatic Brain Injury Developmental Delay Physically Impaired Visual Impaired

Severely Multiply Impaired

Is eligible for special education for the following reason(s): For initial evaluation, the student meets entrance criteria for the disability(ies) indicated

below.

For initial evaluation, the student qualifies through a team override decision.

For reevaluation, the student continues to have a disability and continues to demonstrate a need for special education and related services.

___ Autism Spectrum Disorders ___ Developmental Cognitive Disability ___ Specific Learning Disability

___ Deaf & Hard of Hearing ___ Emotional or Behavior Disorder ___ Speech or Language Impairment

___ Deaf-Blind ___ Other Health Disabilities ___ Traumatic Brain Injury ___ Developmental Delay ___ Physically Impaired ___ Visual

Impaired ___ Severely Multiply Impaired

SLD or Team Override SignaturesSignatures and indications of agreement with conclusions are required for SLD evaluations and for an override of any eligibility criteria. For team members not in agreement, a statement of why they disagree must be attached.

SIGNATURE OR NAME TITLE AGREEMENT

WITH CONCLUSIONS________________________ Parent Yes No________________________ Regular Education Teacher Yes No________________________ Special Education Teacher Yes No________________________ School Representative Yes No Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-113

________________________ Student (by grade nine) Yes No

SLD or Team Override SignaturesA. List documents that explain why the standards and procedures used with the majority of students resulted in invalid findings for this student:

B. Describe what objective data were used to conclude that the student has a disability and is in need of special education and related services:

C. Which data had the greatest relative importance for the eligibility decision?


EXAMPLE: SPECIFIC LEARNING DISABILITY (SLD) EVALUATION REPORT USING EXISTING DATA

Evaluation Report Using Existing Data

1. Information and Concerns Reported by Parents(Input student specific information)2. Educationally Relevant Medical FindingsHenry has not significant history of educationally relevant medical problems.3. Special Considerations (see SPED Forms Language)Henry’s language, cultural, economic or environmental background does not indicate that special adaptations in assessment procedures needed to be made. Henry’s physical or sensory status does not indicate that special accommodations needed to be made in the assessment process.4. Review of Existing Data and Current Evaluation Results and InterpretationIntellectual: (To be completed by School Psychologist)Henry is in the 7th grade at Cambridge-Isanti Middle School. He is currently receiving special education support services and is classified as having a specific learning disability (SLD). His special education records were reviewed as part of a three-year reevaluation on 1/12/06. Henry has a history of two previous cognitive evaluations.

11/00 Wechsler Intelligence Scale for Children, Third Edition (WISC-III): Full Scale IQ 94, 34 th percentile

03/03 Woodcock-Johnson Tests of Cognitive Abilities, Third Edition (WJ-III COG): General Intellectual Ability 91, 27th percentile

The most recent cognitive evaluation was in March of 2003. This assessment placed his cognitive functioning level within the average range upon peer comparison. The results were consistent with the previous evaluation. School staff does not report any observations which would suggest to this examiner these results do not continue to be valid. Therefore, another cognitive evaluation was not deemed necessary by this examiner and these results will continue to be accepted as valid.

Academic: (To be completed by Special Education Teacher)Review of past evaluation data: Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-114

2000 Woodcock-Johnson Psycho-Educational Battery-Revised, Tests of Achievement (WJ-R ACH):

Standard Score Percentile Criterion score </= 76

Broad Reading: 71 3 YES Reading Comprehension

73 4 YES

Reading Fluency 80 9 NO Basic Reading Skills 79 9 NOBroad Math: 90 25 NO Math Calculation 95 38 NO Math Reasoning 85 17 NOBroad Written Language: 74 4 YES Written Expression 64 1 YESListening Comprehension 73 3 YESOral Expression 73 4 YES

2003 Wechsler Individual Achievement Test (WIAT II):WIAT Composites Standard Score Percentile Criterion score </=

76Reading 73 3 YESMathematics 93 31 NOWritten Language 68 2 YES

Both the WJ-R ACH and the WIAT-II indicated Henry was performing below average in reading and written language when compared to his peers. A severe discrepancy was documented in the areas of reading and written language during the 2000 and 2003 evaluations.

Using the AIMS Web data collections system, timed fluency probes are being administered to track Henry’s progress on key indicators of progress in reading and written language. The goal that is indicated is based upon the 25th percentile on AIMS Web national norms.

Fall Gr 6 Winter Gr 6 Fall Gr 7Henry Goal Henry Goal Henry Goal

READING:Words ReadCorrectly

60 108 71 121 65 109

WRITING:Correct WordSequences

11 29 16 35 18 35

A current review of goals and objectives was completed. Henry is in the 7th grade and receives direct instruction in written language and reading.

Currently, Henry is working on his comprehension skills in reading. When given 100 word reading passage at his reading level he is able to answer five factual comprehension questions with 80% accuracy. When asked to retell a story including at least five details, Henry is only able to give one detail on a consistent basis. Henry also is unable to make inferences when reading a 100-word passage demonstrating only 20% accuracy.


In the area of written language, Henry is currently able to complete a simple sentence. He is beginning to write simple paragraphs using a topic sentence, supporting detail, and a concluding sentence. He needs to continue to work on adding more details to his writing. He is able to edit his work by finding the spelling errors, missing capital letters and punctuation when prompted. He needs to continue working on his editing skills to become independent.

The current data on his goals and objectives and the past evaluation data indicate Henry has made progress but continues to perform below grade level peers.

PSYCHOLOGICAL PROCESSING INFORMATION Jane’s teacher reports that Jane has difficulty following instructions in the classroom. When information is presented visually, Jane seems to functions much better in the classroom. Academically, teachers report that Jane does not appear to be learning his spelling words although he is studying them at home and school. His daily work is inconsistent, sometimes neat and completed accurately, but other times very messy and incomplete. Teachers feel that Jane’s writing performance is a reflection of effort and motivation. In addition to three observation described earlier in this report, two of Jane's teachers, Jane, and her parent completed Information Processing questionnaires. These ask them to answer questions on the six areas of information processing: Storage, Organization, Acquisition, Retrieval, Expression, and Manipulation.Janes's Science teacher, Mr. Macklay, indicated concern in 5 of 6 areas. He sees Jane's organizational skills as quite good. Of particular concern to Mr. Macklay, were the areas of Manipulation and Acquisition. He indicated that Jane is "seldom" or "hardly ever" able to apply learned information to new situations, infer information, interpret information, or analyze and solve problems of varying complexity. Also of concern to Mr. Macklay were her ability to calculate automatically, follow two and three step directions, and differentiate details from key concepts.

Jane's History teacher, Mr. Weisser, indicated concerns of less severity but many were areas of concern similar to Mr. Macklay. Mr. Weisser's concerns included: linking new information to that previously learned, recognizing or recalling information over time, inferring information, and differentiating details from key concepts.

Jane's questionnaire indicated concerns in the area of acquisition. She indicated she "sometimes" remembers things without having them repeated and "sometimes" learns new things easily. She indicated difficulty getting all her work done on time, and said she asks teachers for an extra day or two. She said she "sometimes" remembers information she has studied for a test, and indicated that she does not know her multiplication facts.

Classroom AchievementPast evaluation reports in both 2000 and 2003 indicate Henry was underachieving in the classroom in the areas of reading, math and written Language. This was documented through a record review, work samples, teacher assessments, progress monitoring, WJ-R ACH, grades, and teacher feedback.

5. Current Observation Results(Please write a current observation report)

6. Determination of Educational NeedsHenry needs to continue to improve his academic skills in the areas of reading and written language.

7. Eligibility Determination Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-116

The team shall determine that a student has a specific learning disability and is in need of special education and related services when the student meets the criteria described in Items A through D. The student must meet the Criteria for A, B or C or A, B and D.

Item AThe child does not achieve adequately in one more of the following areas: oral expression; listening comprehension; written expression; basic reading skills; reading comprehension; reading fluency; mathematics calculation or mathematical problem solving, in response to appropriate classroom and instruction and either: 1. the child does not make adequate progress to meet age or state-approved grade-level standards in one or more of the areas listed above when using a process based on the child’s response to scientific, research-based interventions (SRBI) or:2. the child exhibits a pattern of strengths and weaknesses in performance, achievement or both, relative to age, state-approved grade-level standards, or intellectual development that is determined by the group to be relevant to the identification of a specific learning disability. The performance measures used to verify this finding must be representative of the child’s curriculum or useful for developing instructional goals and objectives. Documentation is required to verify this finding. Such documentation includes evidence of low achievement from the following sources, when available: cumulative record reviews; class work samples; anecdotal teacher records; statewide and district-wide assessments; formal, diagnostic, and informal tests; curriculum-based evaluation results; and results from targeted support programs in general education. Item BThe child has a disorder in one or more of the basic psychological processes which includes an information processing condition that is manifested in a variety of settings by behaviors such as inadequate: acquisition of information; organization; planning and sequencing; working memory, including verbal, visual, or spatial; visual and auditory processing; speed of processing; verbal and nonverbal expressions; transfer of information; and motor control for written tasks.ITEM CThe child demonstrates a severe discrepancy between general intellectual ability and achievement in one or more of the following areas: oral expression; listening comprehension; written expression; basic reading skills; reading comprehension; reading fluency; mathematics calculation or mathematical problem solving. The demonstration of a severe discrepancy shall not be based solely on the use of standardized tests. The group shall consider these standardized test results as only one component of the eligibility criteria. The instruments used to assess the child’s general intellectually ability and achievement must be individually administered and interpreted by an appropriately licensed person using standardized procedures. For initial placement, the severe discrepancy must be equal to or greater than 1.75 standard deviations below the mean of the distribution of difference scores for the general population of individuals at the child’s chronological age level.

ITEM DThe child demonstrates an inadequate rate of progress. Rate of progress is measured over time through progress monitoring while using intensive SRB I, which may be used prior to a referral or as part of an evaluation for special education. A minimum of 12 data points are required from a consistent intervention implementation over at least seven school weeks in order to establish the rate of progress. The rate of progress is adequate when the child’s:


1. rate of improvement is minimal and continued intervention will not likely result in reaching age or state-approved grade-level standards;2. progress will likely not be maintained when instructional supports are removed;3. level of performance in repeated assessments of achievement falls below the child’s age or state-approved grade-level standards; and4. level of achievement is at or below the fifth percentile on one or more valid and reliable achievement tests using either state or national comparisons. If local comparison data that is valid and reliable may be used in addition to either state or national data, the group must provide a rationale to explain the difference.



EXAMPLE: OTHER HEALTH DISABILITY (OHD) EVALUATION REPORT

Evaluation Report

Student Name: Scott Johnson ID: 0001911780025 Date: 4/15/08School: Sunshine Elementary Grade: 4

DOB: 2/18/96 Initial Evaluation Reevaluation

This evaluation report must include: information reported by parents summary of all evaluation results including tests and scores present level of performance statement(s) including educational needs that derive from

the disability interpretation of evaluation results and determination of eligibility by addressing criteria

components verifying the child is a child with a disability and is in need of (or continues to need) special education and related services

SLD written report components (for a child suspected of having a specific learning disability)

Reason for Referral/Background InformationScott is a fourth grade student at Sunshine Elementary. Scott was referred for a special education evaluation by his mother, Mary Johnson. Mary is concerned about Scott’s academic progress. She has indicated that Scott has many late assignments. He is frequently off task and requires a lot of support to get his work done.

Scott enrolled at Sunshine Elementary as a kindergarten student. He had not been previously evaluated for special education services.

In kindergarten, Scott met all academic benchmarks. Teacher notes indicate that Scott required frequent prompts to stay on task.

As a first grade student, Scott continued to make satisfactory progress toward meeting academic benchmarks. Grade reports document that Scott continued to need frequent prompts to complete academic tasks. Teacher notes also document concerns related to distracting others. District level assessment data notes grade level skills in reading and skills below grade level in math.

In second grade, Scott received Title 1 support in the area of math. Scott continued to make satisfactory progress in all other academic areas. Off task behavior and distractibility continue to be noted concerns. Teacher reports also document that returning homework on time is an area of concern.

As a third grade student, Scott continued to receive Title 1 services in the area of math. Scott’s progress is other academic areas was noted to be below average to satisfactory. Off task behavior and distractibility were identified as concern areas in teacher reports. Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-119

A 504 plan was written to provide accommodations for work completion. Scott’s teacher and his mother created a communication log for daily work. Scott’s teacher would identify the assignments that needed to be finished and his mother would note what had been completed at home. According to teacher reports, the communication log did reduce the number of late assignments each week.

Scott participated in the Minnesota Comprehensive Assessments (MCA II) in the areas of reading and math. Scott met grade level standards in the area of reading. His math skills were found to be below grade level standards.

Scott is currently in the second quarter of fourth grade. He continues to receive Title 1 service in the area of math. His first quarter report card noted poor to failing work in the areas of reading, math, and social studies. Below average scores were noted in science and music. Scott is making satisfactory progress in physical education.

District level assessment data documents skills at grade level in reading and below grade level in math.

A 504 plan continues to be in place for Scott. Scott’s mother and classroom teacher use the communication log to address assignment completion. Scott is also given support with packing his backpack. According to Scott’s teacher, unless he has adult assistance, Scott is unable to complete homework tasks.

Relevant Medical InformationScott was born at 36 weeks gestation with no noted complications. He met all developmental milestones within normal limits. His medical history is significant for multiple ear infections.

An evaluation completed at the University of Minnesota dated 1/14/06 indicates that Scott has a diagnosis of Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type. He is under the care of Dr. Thomas Smith M.D. at Allina Clinic. Dr. Smith provided documentation signed on 2/21/08.

Scott is currently prescribed Concerta. He has been taking the medication for the last six months. He has not experienced any significant side effects.

Characteristics of this condition include short attention span, difficulty staying on task, difficulty blocking out unimportant stimuli in their environments, and auditory, visual, and/or internal distractibility.

Scott has passed vision and hearing screenings conducted by the school district.

Information and Concerns Reported by ParentsScott’s mother completed the Home/Family Interview with Joan Black, Special Education Teacher. Scott lives at home with his mother, father, and three siblings.

Mary is concerned about Scott’s academic progress. She has indicated that Scott has many late assignments. He is frequently off task and requires a lot of support to get his work done. Scott brings work home four to five days each week. He usually spends one to two hours on homework.


Mary sees her son as a very outgoing, energetic individual. She indicated that he will comply whenever asked to complete a chore, but he requires many prompts to finish the task. Mary feels that Scott learns best when tasks are broken down into small steps.

Existing Data, Current Evaluation Results and InterpretationINTELLECTUAL:As part of the assessment process, the Woodcock-Johnson Tests of Cognitive Abilities - Third Edition (WJ-III COG) was administered to Scott by Lisa Dash, school psychologist at Sunshine Elementary School on February 27, 2008. The WJ-III COG is an individually administered intellectual assessment intended to measure overall intellectual functioning and specific cognitive abilities. The primary purpose of this report is to describe Scott's performance as an individual at age 10 years, 2 months. Thus, interpretation is referenced to age and includes a description of performance based on relative standing of the obtained standard score results.

Scott separated easily from his teacher and classmates for testing. He responded appropriately in conversation, made good eye contact, listened attentively, and otherwise seemed comfortable with the examiner and testing process. He responded to all presented items in a prompt and careful manner. His demonstrated attention and concentration were age appropriate. Based on these observations of his testing behaviors, it was the examiner’s impression that the results of the WJ-III COG can be accepted as a valid and reliable indicator of his overall level of intellectual ability.

The standard scores reported in the following report have a mean or average of 100 and a standard deviation of 15. Standard scores between 90 and 110 would be considered average when compared to same-aged peers. Percentile ranks indicate the percent of same-aged peers whose scores fall at or below the reported score. Percentile ranks between 25 and 75 fall within the average range.

Woodcock-Johnson III Tests of Cognitive Abilities (WJ-III COG)

Standard Score PercentileVerbal Ability 104 (93-114) 60thThinking Ability 107 (99-115) 68thCognitive Efficiency 88 (81-95) 21stGeneral Intellectual Ability 97 (92-102) 42nd

The WJ-III COG is an assessment instrument which measures intellectual abilities. It includes cluster scores that represent different cognitive abilities defined as verbal ability, thinking ability, and cognitive efficiency. Scott's cognitive abilities may be described in two ways: in terms of his own individual strengths and weaknesses, and in comparison to his same aged peers.

Verbal ability is a measure of language development that includes the comprehension of individual words and the relationships among words. Scott’s Verbal Ability fell within the average range when compared to his same aged peers (60th percentile).

Thinking ability is a sampling of four different processes. These processes are long-term retrieval, visual-spatial thinking, auditory processing, and fluid reasoning. Long-term retrieval is the ability to store information and easily retrieve it later. Visual-spatial thinking is the ability to perceive and think with visual patterns, including storage and recall. Auditory processing is the ability to understand and discriminate auditory sounds; similar to Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-121

phonological awareness/processing. Fluid reasoning is the ability to reason, form concepts, and solve problems using unfamiliar or novel information or procedures. Scott’s Thinking Ability fell within the average range when compared to her same aged peers (68th percentile).

Cognitive efficiency represents the ability to process information automatically. This cluster includes a measure of processing speed and short-term memory. Scott’s Cognitive Efficiency score of 88 fell within the low average range when compared to his same aged peers (21st percentile). This suggests that Scott requires more time to complete tasks compared to other students his age.

The WJ-III COG provides a measure of General Intellectual Ability (GIA). The GIA represents a global measure of Scott's intellectual ability. Scott’s score of 97 indicates that he performed as well as, or better than 42 out of 100 students his same age on the GIA (42nd percentile). More specifically, Scott was able to complete tasks which indicate his general intellectual ability is in the average range when compared to students his same age.

Woodcock-Johnson III: Tests of Achievement (Complete)Evaluator: Joan Black, Special Education TeacherDate: 2/4/08

The Woodcock-Johnson Educational Achievement Battery - Third Edition was administered to Scott by Joan Black on 2/4/08. The average Standard Scores (SS) fall within the range of 90-109. Percentile ranks indicate the percent of same-aged peers whose scores fall at or below the reported score. The overall results that he obtained on this test are reported below:

Standard Score Percentile RankBROAD READING 99 47Reading Fluency 96 40Basic Reading Skills 108 70Letter-Word Identification 101 53Word Attack 113 82Reading Comprehension 102 56Passage Comprehension 101 52BROAD MATH 100 49Math Calculation 103 57Calculation 102 56Math Fluency 102 55Applied Problems 97 42BROAD WRITTEN LANGUAGE 95 36Spelling 108 70Written Expression 85 15Writing Fluency 80 9Writing Samples 96 40Oral Expression 102 55Story Recall 90 26Picture Vocabulary 106 65Listening Comprehension 106 65Understanding Directions 95 38Oral Comprehension 113 80

Reading


The Broad Reading cluster of the Woodcock-Johnson Tests of Achievement assesses basic letter and sight vocabulary identification skills, reading speed, and the ability to comprehend written language. Scott's skills fell within the "average" range of scores obtained by others at his age level.

Mathematics

Broad Mathematics measures basic computational skills, automaticity with basic math facts and applied mathematical problem solving. Scott's skills fall within the "average" range of scores obtained by others at his age level. His teacher notes that Scott has struggled with math skills and has worked hard to improve both his computation rate and his ability to solve basic word problems. On one item for the applied math subtest Scott needed to perform 3 steps to arrive at the answer. He confidently did all steps and accurately solved the problem.

Written Language

Broad Written Language is an overall measure of spelling, fluency of production, and quality of expression. Scott's skills within the area Broad Written Language falls within the "average" range of scores obtained by others at his age level.

While both reading and math subtest scores were all relatively in the same area written language produced a wider variance in skill proficiency. Scott's ability to spell was in the upper range of "average". His ability to write complex grammatically correct sentences also fell within the "average" range. However, Scott's ability to write sentences using a given set of words and a time limit fell within the "low average" range of scores. Scott skipped test items that appeared to be within his grasp. When encouraged to try to write a sentence he appeared discouraged and said he could not think of anything. Clearly, the pressure of producing written work with time as a factor was difficult for Scott.

COMMUNICATION: The team did not identify any concerns in the area of communication.

MOTOR: The team did not identify any significant concerns in the area of motor. Scott’s teacher did indicate that when Scott rushes through assignments his handwriting is less legible.

SOCIAL/EMOTIONAL DEVELOPMENT: FUNCTIONAL BEHAVIOR ASSESSMENT

Joan Black, Special Education Teacher, performed a functional behavioral assessment to determine the likely cause of Scott’s challenging behaviors at school. Challenging behaviors are those behaviors that interfere with Scott’s academic or social functioning. These behaviors my also interfere with the education of others. Ms. Black utilized discipline records, interviews, and direct observation as sources of information to identify the target behaviors listed below.

Scott’s most problematic behaviors were identified as talking out and noncompliance. Talking out is defined as talking or making comments at an inappropriate time. Scott was observed talking out several times in the mainstream setting and it is reported by his teachers that he often talks out during instructional time. Data collected indicates that the most likely cause for Scott’s talking out is that he is seeking attention from adults and peers. Scott needs to be taught more appropriate ways to obtain the attention of the teacher and his peers. His teacher noted that Scott is apologetic when he talks out and makes an effort to follow classroom rules related to gaining attention appropriately. Noncompliance is defined as not Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-123

following instructions given by school staff within a reasonable amount of time. Scott was observed engaging in noncompliant behavior during formal classroom observations and teachers report that noncompliant behaviors occur multiple times throughout the school day. Data collected indicate that the most likely cause for Scott’s noncompliant behavior is that he is easily distracted by stimuli in his environment. Examples of noncompliance include playing with his pencil or small toys when he should be completing assigned tasks, looking at pictures in books instead of reading the assigned material, and playing in his desk instead of taking out materials when asked to do so.

OBSERVATIONS:Date of Observation #1:2/14/2008Observer: Joan Black, Special Education Teacher Setting: Reading class

Results of observation:Scott was positioned in the middle of the classroom. He and nineteen peers were present in the classroom. At the beginning of the observation, Mrs. Peters was teaching the class how to divide words into syllables. The first three example items were completed as a large group. Mrs. Peters called on students to demonstrate the correct way to complete the task on the overhead projector. Scott voiced answers on two occasions without waiting for his teacher to call on him. For the first 15 minutes Scott's on-task behavior was measured at 15 second intervals and compared to that of a different peer during each recording time. Scott was on-task during 75% of intervals sampled. Peers were on-task 87% of time. Scott was observed looking at his materials instead of attending to the task of listening to his teacher. Scott and his peers were also observed during an independent work task. It was noted that Scott required two prompts to begin working. He completed 50% of the work done by his peers. Scott was observed looking around the room, playing with his pencil, and picking at his shirt.

Date of Observation #2:2/16/08Observer: Lisa Dash, School Psychologist Setting: Math class

Results of observation:The class format was large group with the teacher instructing at the front of the room. Scott was observed using momentary time sampling in which in each minute was split into 15-second intervals and his on-task/off-task behavior was recorded at the beginning of every interval. At the beginning of every fifth interval a randomly selected peer’s on-task/off-task behavior was recorded. Scott was observed as actively engaged in the math lesson 17% of time, while a randomly selected peer was actively engaged 25% of the time. Active engagement is defined as writing in an academic task, raising hand to answer question, talking with the teacher or student about an academic task, or reading aloud from an assigned text. Scott was observed as passively engaged 43% of time compared to 49% for a randomly selected peer. Passive engagement is defined as listening to the teacher, reading silently, looking at a worksheet, or listening to a peer respond to an academic task. Scott’s off-task behavior was recorded during each interval as well. Scott was physically off-task for 23% of the observed intervals compared to 8% for a randomly selected peer. Behaviors observed that were physically off-task included turning around in his chair, biting his pants, sliding far down in his desk and shaking his arm, and playing with his pencil sharpener and pencil shavings. Scott was verbally off-task for 18% of the intervals compared to 8% for a randomly selected peer. Verbal off-task behaviors included talking with his peers about topics unrelated to the assigned task. Scott was observed as passively off-task for 24% of the intervals compared to 33% for a randomly selected peer. Passive off-task behaviors that were observed for Scott included looking around the room or looking at peers. Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-124

FUNCTIONAL SKILLS/ADAPTIVE BEHAVIOR:A systematic interview was conducted by Joan Black, Special Education Teacher with school staff using the Elementary Organizational and Independent Work Skills Checklist. The interview was used to document areas where Scott is independent in the classroom setting and areas where assistance is needed.

Areas of Independence:**Follows classroom routines and schedules**Transitions form one classroom activity/setting to another within the time allowed**Uses free time appropriately**Participates actively in class discussions/group activities/projects**Moves through the school environment in a safe manner**Demonstrates stability at table, on chair, or floor**Participates physical education class**Utilizes all natural school environments**Uses school supplies (markers, scissors, eraser, paste/glue/paints)**Operates standard computer/mouse**Meets personal needs at school

Areas Needing Assistance:**Follows classroom rules**Begins work/tasks**Knows when work is complete**Follows verbal and written directions**Corrects mistakes and edits work**Listens and works without distraction**Finishes work/tasks within time allotted**Returns completed homework within the time allotted**Turns in work on time**Transitions form one classroom activity/setting to another with the needed materials and supplies**Requests help appropriately (teacher/support staff/peer) to clarify classroom requirements

or meet personal needs**Manages books, materials, and backpack**Stores/retrieves materials in a timely manner**Produces written work that is legible and completed with in time lines, without fatigue

The staff that completed the interview have concerns about Scott's ability to attend in class. Scott needs many reminders when completing academic tasks and needs prompts to turn in his work. He often loses his assignments. Scott also needs assistance with storing and organizing materials in his desk. His teachers noted that without the communication log being used by Scott’s teachers and parents, Scott would not be turning in any of his work. They also noted that without adult support, Scott would not pack his backpack with the materials that he needs to complete his work.

Teachers report that Scott has many friends. They have noted that at times, his peers become frustrated with his silly behavior.

There are no concerns related to Scott’s attendance.


Educational Needs:Scott needs to improve his organizational skills.

Scott needs to improve his independent work skills.

Eligibility Criteria:In order for a student to receive special education services within the category of Other Health Disabilities, he/she must meet the following criteria:

A. There is:1. Written and signed documentation by a licensed physician of a medically diagnosed chronic or acute health condition;

0R

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

An evaluation completed at the University of Minnesota dated 1/14/06 indicates that Scott has a diagnosis of Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type. He is under the care of Dr. Thomas Smith M.D. at Allina Clinic. Dr. Smith provided documentation signed on 2/21/08.

3. For initial evaluations, all documentation must be dated within the previous 12 months.

AND

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

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

2. specialized health care procedures that are necessary during the school day;

3. medications that adversely affect learning and functioning in terms of comprehension, memory, attention, or fatigue;

4. limited physical strength resulting in decreased capacity to perform school activities;

5. limited endurance resulting in decreased stamina and decreased ability to maintain performance;

6. heightened or diminished alertness resulting in impaired abilities, for example, prioritizing environmental stimuli; maintaining focus; or sustaining effort or accuracy;


Yes-Observation data and teacher reports document that Scott has difficulty sustaining focus in the classroom. He is easily distracted during both independent work time and teacher led instructional time.

7. impaired ability to manage and organize materials and complete classroom assignments within routine timelines;

Yes-Teacher reports and school records document that Scott has a history of missing and late work.

8. impaired ability to follow directions or initiate and complete a task

Yes-Teacher reports and observation data document that Scott requires frequent prompts to initiate and complete tasks.

The team determined that Scott meets eligibility criteria under the disability category of Other Health Disabilities and is in need of special education services.



SYSTEMATIC INTERVIEW/OBSERVATION WORKSHEET

Student’s Name ________________________________ DOB __________ School ____________________

Medical Diagnosis _____________________ Physician ________________ Date of Diagnosis ___________

Interview Date ___________________________________________ Observation Date(s) _________________________________Person(s) Interviewed _____________________________________ Observation Setting _________________________________________________________________________________________ __________________________________________________Completed by ____________________________________________ Completed by _______________________________________Title ____________________________________________________ Title ______________________________________________

Information must be gathered from both interview (I) and Observation (O). For each item place the appropriate number in the box: 1) adequate 2) adequate with accommodations 3) areas of concern Documentation should be determined to be significantly discrepant from peers. This documentation should include descriptive, narrative examples of the educational concern, and list any current accommodations.

Physical Ability (Document significant discrepancies from peers) I O Limited physical strength resulting in decreased capacity to perform school activities.

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

Level of pain results in decreased ability to perform or maintain performance.

Alertness Heightened or diminished alertness resulting in impaired abilities. (Document significant discrepancies from peers).

I O Prioritizing environmental stimuli:

Maintaining focus/sustaining effort:

Accuracy of completed task:

Organization Skills (Document significant discrepancies from peers and if this is an area of concern complete Organization and Independent Work Skills Observation Interview Worksheet for Elementary, Secondary or Preschool)

I O Materials: (Has materials when needed, physical organization of space and materials).


Written Work: (Organized on page in sequential manner, i.e., name at top, items in logical order, capitalization, paragraphs, etc.)

Thoughts: (Tells thoughts or stories sequentially – beginning, middle, and end, stay on topic).

Work Completion Within Routine Timelines (Document significant discrepancies from peers).

I O Self-Initiates: (Ability to independently begin a task).

Displays On-Task Behavior: (Ability to continue working on a task).

Follows Directions: (Can follow directions given to the entire class without individual assistance).

Homework: (Independently keeps track of assignments, completes them and hands them in on time).

Participates in Group Activities:

Number of Assignments Given ___ Assignments Turned In ___ Assignments Late ___

Work completion: (Unassisted, adult assisted, peer assisted).

Independence (Document significant discrepancies from peers).I O Movement Through School Environment: (Gets to destination without support needed due to

strength, endurance, behavior, or attention).

Clothing/Bathroom/Lunchroom: (Can manage these self care activities without assistance).

Motoric Management of Materials: (Uses computer, books, notes, pencil, scissors, desk, locker).

Level of Self-Advocacy: (Requests help, can tell others about disability and needed Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-129

accommodations and modifications).


Functional Level of Academic Performance (Daily classroom performance in relation to peers).

I O Reading:

Comprehension Fluency Decoding

Math: Computation Reasoning

Written Language: Math Language

Other:

Peer Interaction (Document significant discrepancies from peers).I O Student with Peers: (Does the student initiate and interact appropriately?).

Peers with Student: (Do others include student and interact appropriately?).

Interfering Behaviors (Document significant discrepancies from peers).I O Distracting to Self or Others:

Impulsive Behavior:

Main StrengthsI O Parents:

General Education Teacher/Other Staff:

Main ConcernsI O Parents:

General Education Teacher/Other Staff:



PARENT/GUARDIAN INTERVIEW

1. What are your child’s strengths?

2. What are your concerns for your child while at school?

3. Are there special considerations that the school needs to be aware of?

Medical:

Health:

Safety:

4. What are your priorities for the staff and your child to work on at school?

5. How much does your child know about his/her medical diagnosis?

6. Do you want school staff to provide an inservice to your child’s classmates?

Would you like to participate in the inservice?

Do you want your child to be present at the inservice?


7. How would you like to communicate with school staff about your child and the medical condition?

Do you prefer one contact person?

8. Have you talked to the school nurse about medications or health concerns?

9. Share examples of how your child organized themselves at home to things like: chores, getting ready for school in the morning and room cleaning.

10. How much time does your child typically spend on homework each evening?

How much assistance do you need to provide?

What strategies have worked at home?

11. Does your child have friends in your neighborhood? Same age, older or younger?


ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST: ELEMENTARY

Student’s Name: ______________________________ Grade: ______________________________

School: _____________________________________Setting: ______________________________

Date: _______________________________________Completed by: _________________________

Independent

Areas of Concern/ Needs Assistance

CurrentAdaptations/Comments

Organization and Work SkillsFollows classroom routines Rules SchedulesFollows verbal directionsFollows written directionsFollows multi-step directions in sequenceListens and works without distractionBegins work/tasksFinishes work/tasks within time allottedKnows when work is completeCorrects mistakes and edits workTurns in work on timeTakes notices and appropriate materials home to complete homeworkReturns completed homework within time allottedTransitions from one classroom activity/setting to another within the time allotted with needed materials and suppliesUses free time appropriatelyParticipates actively in class discussions/group activities/projectsRequests help appropriately (teacher/support staff/peer) to clarify classroom requirements or meet personal needsMotor – related to strength/endurance/pain managementMoves through natural school environment in a safe and timely manner (including emergency evacuation)Demonstrates stability at table, on chair, or floorParticipates in physical education classUtilizes all natural school environments (i.e., lunchroom, playground, bathroom stage)Meets personal needs (eating, dressing, toileting) at school Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-134

Produces written work that is legible and completed within time lines, without fatigueUses school supplies (markers, scissor, eraser, paste/glue/paints)Manages books, materials, and backpackStores/retrieves materials in an orderly and timely mannerOperates standard computer/mouse

Do you have any concerns regarding this student’s behavior? Yes No

Do you have any concerns regarding this student’s attendance? Yes No

Does this student get along socially with peers? Yes No

Does this student’s disability impact peer acceptance? Yes No

Please list any accommodations or modifications you routinely make for this student.

What other issues or concerns do you have for this student?


ORGANIZATIONAL AND INDEPENDENT WORK SKILLS CHECKLIST: MIDDLE SCHOOL AND HIGH SCHOOL

Student’s Name: ______________________________ Grade: ______________________________

School: _____________________________________Setting: ______________________________

Date: _______________________________________Completed by: _________________________

Independent

Areas of Concern/ Needs Assistance

CurrentAdaptations/Comments

Organization and Work SkillsFollows daily class scheduleUses and follows assignment book/plannerOrganizes and studies course materialsListens and works without distractionBegins and completes work within time allottedUnderstands assignment expectationsTurns in work on timeCompletes testsObtains and completes makeup assignments when absentTransitions from one classroom activity/setting to another within the time allotted with needed materials and suppliesUses independent time appropriatelyParticipates actively in class discussions/group activities/projectsAdvocates for self to clarify classroom requirements or meet personal needsMotor – related to strength/endurance/pain managementMoves through natural school environment in a safe and timely manner (including emergency evacuation)Participates in physical education classUtilizes all natural school environments (i.e., lunchroom, playground, bathroom stage)Meets personal needs (eating, dressing, toileting) within the daily scheduleProduces written work that is legible and completed within time lines, without fatigueManages school materials and belongings in a timely mannerOrganizes school materials, folders, locker Discovery Public School of Faribault Total Special Education System Manual — Chapter 3: Evaluation & Reevaluation Standards 3-136

Operates standard computer/mouse


Page 2; Organizational and independent work skills checklist continued;

Do you have any concerns regarding this student’s behavior? Yes No

Do you have any concerns regarding this student’s attendance? Yes No

Does this student get along socially with peers? Yes No

Does this student’s disability impact peer acceptance? Yes No

Please list any accommodations or modifications you routinely make for this student.

What other issues or concerns do you have for this student?



SAMPLE: HEALTH CONDITION DOCUMENTATION FORM

Date:

From:

To:

For: ______________________________________ _____________________________(Child’s Name) (Date of Birth)

This child is in the process of being evaluated for special education services. Thank you for your assistance in identifying health conditions that may affect the child’s educational performance as the school makes a determination of eligibility for special education services. Attached you will find a signed copy of our release of information.

Please list all medical diagnoses that would affect the child in the school setting.

Please identify any activity limitations or restrictions related to the above mentioned diagnoses.

Will the above mentioned diagnoses impact school attendance?

Is this child currently receiving medications and/or under going specialized health care procedures that are necessary during the school day?

Will any of the medications taken by this child adversely affect school performance?

________________________________________ ______________________________Physician’s Signature Date

Please submit any evaluation data that you believe would assist us in our eligibility determination.

If this child has been diagnosed with Attention Deficit Hyperactive Disorder, please complete the attached two-sided Medical Documentation Form for Attention Deficit/Hyperactivity Disorder.

Please return this information to the address identified on the release of information.



SAMPLE: MEDICAL DOCUMENTATION FORM FOR ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)

Name: _____________________________________ Birth Date: ____________________________

Directions: Please indicate the ADHD diagnostic criteria by circling or documenting those symptoms which are indicated by your evaluation.

Diagnostic Criteria for Attention Deficit Hyperactive DisorderDiagnostic and Statistical Manual of Mental Disorders

Fourth Edition(SDM-IV)

A. Either (1) or (2):

(1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities;(b) often has difficulty sustaining attention in tasks or play activities;(c) often does not seem to listen when spoken to directly;(d) often does not follow through on instructions and fails to finish schoolwork, chores, or

duties in the workplace (not due to oppositional behavior or failure to understand instructions);

(e) often has difficulty organizing tasks and activities;(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental

effort (such as schoolwork or homework);(g) often loses things necessary for tasks or activities (e.g., toys, school assignments,

pencils, books, or tools);(h) is often easily distracted by extraneous stimuli;(i) is often forgetful in daily activities.

(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:Hyperactivity(a) often fidgets with hands or feet or squirms in seat;(b) often leaves seat in classroom or in other situations in which remaining seated is

expected;(c) often runs about or climbs excessively in situation in which it is inappropriate (in

adolescents or adults, may be limited to subjective feelings of restlessness);(d) often has difficulty playing or engaging in leisure activities quietly;(e) is often “on the go” or often acts as if “driven by a motor”;(f) often talks excessively.Impulsivity(a) often blurts out answers before questions have been completed;


(b) often has difficulty waiting turn;(c) often interrupts or intrudes on others (e.g., butts into conversations or games).

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school or work and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder, and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Code based on type:314.00 Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type: if

Criterion A1 is met but Criterion A2 is not met for the past 6 months

314.01 Attention Deficit Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months

314.01 Attention Deficit Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months

Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.

Comments:

Signature of Physician (required): _________________________________________ Date: _______________

Signature of other diagnostician (if applicable; not required): ___________________ Date: _______________


*Requires parent release of information



EXAMPLE: DEVELOPMENTAL COGNITIVE DISABILITY (DCD) EVALUATION REPORT

DCD Evaluation Report

Reason for Referral/Background InformationChld is currently in 3rd grade. His last evaluation took place in kindergarten. Chld is due for his 3 year special education reevaluation at this time. Chld is in third grade this year and participates with his third grade class during specials. He is in his homeroom for social studies and science. Chld participates in the lower 2nd grade skills groups for math, reading and writing. He has a modified 2nd grade spelling list. Chld is pulled from class for a SRA reading group and for extra help in math. He is currently reading at a 2.2 reading level.

Information and Concerns Reported by Parent(s)Chld lives with his biological aunt and her family consisting of husband and 2 children ages seven and two. Chld has lived with his aunt since 1998 when his mother gave guardianship to her sister. Chld’s Aunt says his mother had difficulties learning in school. She noticed Chld’s learning difficulties when he came to live with her. She feels they began at birth. Besides being a slow learner she is concerned with Chld’s stuttering.

His Aunt says those who know Chld accept him for who he is, a very kind, easygoing boy who likes everyone. He is very much a people pleaser. Aunt feels he is doing his best in school. He enjoys math and in working very hard sounding out words and learning to read. Chld spends half an hour to an hour and a half on homework every day.

Educationally Relevant Medical InformationHEALTH UPDATE: Information obtained from school health file review and telephone interview of foster parent, Aunt, on 3-2-04. Aunt stated that Chld has lived with her since he was two years old. Aunt reports that Chld was born with club feet and went through three to four surgeries to help correct this, as well as wearing a leg cast until age two. Chld still has a yearly appointment at Gillette Childrens Hospital to monitor this condition, although Aunt reports he has not needed any further treatment since age two. Chld was also hospitalized for two days in his first year of life for treatment of gastroesophageal reflux. He was given tube feedings in the hospital, but he did not require surgery for this and the GER resolved itself with no further problems after age one. Chld had his tonsils and adenoids removed and PE tubes placed bilaterally in March of 2001. His PE tubes are out now and he has had no further problems with ear infections. Chld wears glasses full time for hyperopia (farsightedness). Aunt reports that Chld currently has no diagnosed health conditions (other than hyperopia), and he is not taking any medications. Aunt reports she has no concerns regarding Chld’s health, nor his school work. She states that he brings homework back every day and is doing fine in school. One concern she did mention was regarding Chld’s bus ride. Aunt states that he has had problems with older kids teasing him about his stuttering and also getting him to demonstrate inappropriate behaviors. Aunt has spoken to his bus driver about this and the driver has recommended that Chld sit in the front of the bus to keep contact with the older students to a minimum. Aunt describes Chld’s strengths as, " He is easy going, adapts well to any situation, is very positive and enjoys life."

Submitted by:Licensed School Nurse

Special ConsiderationsChld’s language, cultural, economic or environmental background does not indicate that special adaptations in assessment procedures needed to be made. Chld’s physical or sensory status does not indicate that special accommodations needed to be made in the assessment process.

Existing Data, Current Evaluation Results and InterpretationINTELLECTUAL:

The Woodcock Johnson Tests of Cognitive Abilities, 3rd edition (WJ III) was administered to Chld by a school psychologist, on February 24, 2004. The WJ III is a standardized, normative-referenced evaluation, which means each student is administered test items in the same manner (to ensure equal opportunity to respond correctly) and that the test was administered to a large number of students with the results compiled so that Chld’s scores can be compared to the scores received by a nationally representative group of same-age children. Tests 1-7 were administered, which yields three cluster scores: Verbal Ability, Thinking Ability, and Cognitive Efficiency. The broad measure of intellectual ability is called General Intellectual Ability (GIA). Many aspects of intelligence are not measured by intelligence tests, including motivation, curiosity, creativity and work habits. Cultural, linguistic and socioeconomic factors may also influence intelligence test performance. These factors should be taken into account when discussing the student's intelligence.

Chld remembered the examiner from previous testing and was cheerful to be working with him. He worked hard and did not appear to have any difficulty maintaining concentration to test items. On Visual-Auditory Learning, a learning task that measures long term memory, Chld got a fairly violent case of hiccups. Testing was briefly paused to enable him to get a drink. The first two stories had been administered. The examiner quickly repeated the stimuli, which may have given Chld an advantage in remembering the items. These results may be cautiously considered a valid measurement of Chld’s cognitive abilities.

Chld’s standard score on GIA, a combination of the seven individual tests, was 69. Standard scores have a mean of 100, a standard deviation of 15, and an average range of 90-110. The score is most accurately provided as a range because testing is a sample of behavior on a given day and it is not expected Chld would score exactly the same if tested again. The chances are 90 out of 100 that Chld’s true score falls within the range of 65 to 73. Chld’s General Intellectual Ability score would equal or exceed approximately 2 percent of same age peers within a national comparison group. This score falls within the low range.

Chld’s scores on the clusters were:

General Intellectual standard score= 69 percentile= 02Verbal Ability standard score= 72 percentile= 03Thinking Ability standard score= 78 percentile= 07Cognitive Efficiency standard score= 68 percentile= 02

Chld scored in the average range on Spatial Relations (visual processing task) and Sound Blending (an auditory processing task). He scored in the low range on Verbal Comprehension, Visual-Auditory Learning (a test of long term memory), Concept Formation (a test of logical problem solving), Visual Matching (a test of processing speed), and Numbers Reversed (a test of short term memory).

On testing in April 2001 with the same test (WJ COG III), his General Intellectual Ability score was 63.

ACADEMIC:

Chld was administered the Woodcock-Johnson Tests of Achievement-III by a Special Education teacher, on January 30th, 2004. The WJ-III is an individually administered, norm referenced, comprehensive achievement battery that is comprised of the following subtests: letter-word identification, reading fluency, calculation, math fluency, spelling, writing fluency, passage comprehension, applied problems, and writing samples. From the scores on these individual subtests, Broad Scores are obtained for Reading, Math, and Written Language.

Broad Reading Standard Score 68 Percentile Rank 2%Broad Math Standard Score 86 Percentile Rank 17%Broad Written Language Standard Score 64 Percentile Rank 1%

When compared to others at his age level Chld’s academic skills and fluency with academic tasks are both within the low range. His ability to apply academic skills is low average.

Chld’s performance is low average in math calculation skills; low in basic reading skills and math reasoning; and very low in reading comprehension, written language and written expression. Chld was an eager participant in the testing. In the math calculation section of the testing he tried the harder addition and subtraction problems. When he saw problems types he did not recognize he immediately knew he did not know how to do them. Writing fluency he skipped the questions when he did not know what to write and went on to the next one.

In the general education classroom, the following was observed about Chld’s academic performance:

Because School X does multi-age groupings Chld has been placed in the low 2nd grade skills groups for math reading writing and spelling. Chld's reading is below grade level according to his reading teacher he is currently in the low reading group for 2nd grade. He confuses his sight words and often uses short vowels when sounding out words. Chld is writing complete sentences and does as well as the low 1/3 of the 2nd grade group he works with according to his math teacher. In spelling he has a shortened word list and averages 60% correct. Chld is doing average to low average in the low 2nd grade math group he has been placed in according to his teacher. Chld has difficulty getting to work and not getting distracted. When he really tries he does well according to Joan Anderson, his math and writing teacher.

COMMUNICATION:

Clinical Evaluation of Language Fundamentals-IV - Administered-2-14-04 The Clinical Evaluation of Language Fundamentals-IV measures a learner’s word meanings (semantics, word and sentence structure (morphology and syntax) as well as the recall and retrieval of spoken language (memory). this measure is designed for individuals between the ages of 5 and 21.Chld reached a total language score of 64 on this assessment which is a qualifying score for speech/language services as it is more than -2.0 standard deviations below the mean and different than what would be anticipated for a student of his ability level. A breakdown of the subtest scores is as follows:

Subtest Scaled Percentile ScoreConcepts & Following Directions 6 9%Recalling Sentences 2 0.4%Formulated Sentences 1 0.1%Word Classes-Receptive 7 16%Word Classes-Expressive 7 16% Word Classes-Total 7 16%

Standard Percentile Standard Score DeviationReceptive Language Index 81 10% -1.0Expressive Language Index 59 0.3% -2.0Core Language Score 64 1% -2.0

Peabody Picture Vocabulary Test-III (PPVT-III) 1-25-2004The Peabody Picture Vocabulary Test-III measures a student’s ability to understand vocabulary at the single word level. The student is given a set of four pictures and asked to point to or say the number of the picture that best describes the word presented by the evaluator. The test is designed for individuals ages 2 through 18.Chld had a standard score of 78 on this assessment. This score is within the average range of scores for students of his age and therefore, not a qualifying score for speech and language services.

The Oral and Written Language Scales (OWLS) 3-3-2004The Oral and Written Language Scales (OWLS) measures a learner’s comprehension and expression of language in the areas of vocabulary, syntax (grammar), pragmatic (function) and higher level thinking skills. Scores are based on a mean of 100 and a standard deviation of 15, with scores of 85- 115 falling into the average range. Subtest Standard Score Percentile Standard Deviation Listening Comprehension 78 -1.0Oral Expression 62 -2.0Oral Composite 68 -2.0The results of this assessment are over 2 standard deviations below the mean. However, it is what would be anticipated for a student of his cognitive ability. Therefore, it is not a qualifying score for speech/language services.

Speech Samples:Two samples of Chld's speech were analyzed for dysfluency rates. The first sample taken on January 24,2004 yielded a dysfluency rate of 3.69% dysfluency. The second taken on January 25,2004 yielded a dysfluency rate of 3.301% dysfluency. Although these ratings indicate that Chld continues to experience dysfluency, he does not meet eligibility criterion for speech/language services in the area of dysfluency which is at 5% dysfluency.The samples were also evaluated for language content and although they contained some grammatical errors. They are consistent with what would be anticipated for a student with his cognitive level. SENSORY STATUS: Chld passed the vision and hearing screenings on 10-11-03. His visual acuity was 20/30 in the right eye and 20/25 in the left eye with his glasses on. He was able to hear each tone screened audiometrically with each ear.

OBSERVATIONS:

Date of Observation #1: 1-30-2004 Observer: Special Education TeacherSetting: General Education Classroom Direct Instruction Reading GroupResults of observation:Chld was observed using partial time interval recording during direct instruction reading between 9:55 and 10:20. Chld was seated at the front of the classroom with his teacher seated next to him. There was one other adult in the room seated with two other students. The observation began with teacher guided direct instruction then proceeded to independent work in the corresponding workbook.

During direct instruction Chld was on task 70% of the time compared to his peers 85 of the time. When doing independent work Chld was on task 50% of the time compared to his peer 78% of the time. Chld participated in the direct instruction following along with the teacher. He raised his hand to answer teacher questions. Chld's off task behaviors included watching others in the room and playing with his pencil.

Date of Observation #2: 2/21/2004 Observer: Special Education TeacherSetting: Math Skills GroupResults of observation: Chld was observed using partial time interval recording during his regular math skills group. Chld was seated alone at a table in the back of the room. Mrs. Anderson was at the front of the room instructing the whole class. Mrs. Anderson was using the chalkboard and manipulatives to demonstrate the lesson.

Chld was on task 65% of the observation time compared to 81% on task time of his peers. Chld’s main off task behavior was playing with the snack he brought with him to eat during independent work time. Chld’s other off task behaviors include talking out in class, playing with the manipulative he was given, out of seat to find a piece of paper to write on after the teacher had told the class to use a yellow sheet they each had, and watching other students in the classroom. Chld participated in class. He raised his hand to answer questions and volunteer to help the teacher.

FUNCTIONAL /ADAPTIVE BEHAVIOR: The Scales of Independent Behavior, Revised (SIB-R) were completed by Chld's foster mother and by two teachers in February 2004. The SIB-R provides a measurement of adaptive behavior, looking at his functional independence in the following clusters: Motor Skills, Social Interaction and Communication Skills, Personal Living Skills, and Community Living Skills. There is an overall measurement of adaptive behavior called Broad Independence. On the form completed by his foster mother, Chld’s functional independence is classified as "age appropriate." On this measure, his Broad Independence is comparable to that of the average individual at age 9 years 2 months. The forms completed by his teachers were significantly lower, estimating his Broad Independence in the "limited to age appropriate range" with standard scores of 71 and 61 respectively. It should be noted that there are many items on the SIB-R that teachers would be unlikely to observe directly, and as such might require a "best guess" rating.

Standard Scores for the composites are listed below:

Respondent Mom T1 T2Motor Skills 103 65 61Social Int/Comm. 104 74 66Personal Living 98 82 84

Community Living 81 81 63

The percentile rankings for the composites are listed below:

Respondent Mom T1 T2Motor Skills 59 01 0.5Social Int/Comm. 59 04 01Personal Living 45 12 15Community Living 11 11 01

In examination of these results, it seems possible that his mother's ratings overestimate his independent functioning. It also seems possible that both teachers have underestimated his motor skills. Scores on Social Interaction and Communication Skills are listed as average based upon his mother's report; however, at school the ratings produced much lower scores, indicating that at school this is an area of concern. Community Living scores are more in agreement across respondents, indicating a limited to age appropriate level of independence.

PSYCHOLOGICAL PROCESSING:

Chld’s Aunt and two of Chld’s teachers were given a survey regarding how well Chld processes information. The survey is divided into six components: storage of information, organization of information, acquisition of information, retrieval of information, expression of information, and manipulation of information.

Storage of informationAunt: Not a large concernTeachers: Some concerns

OrganizationAunt: Not a concernTeachers: Large concern

AcquisitionAunt: Not a concernTeachers: Some concerns

RetrievalAunt: Not a concernTeachers: Large concern (especially automatically retrieving information)

ExpressionAunt: Not a concernTeachers: Very much a concern

ManipulationAunt: Some concerns Teachers: Very much a concern

Both classroom teachers express concerns in all areas with the greatest concerns in the areas of retrieving, expressing and manipulating information. Aunt expresses her concerns in manipulation and storage of information.

Educational NeedsChld needs the following:

Instruction at a level that is beneficial to acquire skills. Chld is currently in the lower 2nd grade skills group and is doing as well as the students in the same group. This has been demonstrated to be an appropriate level for Chld.

Assignments modified in the areas of spelling and in other areas the classroom teacher sees a need.

The bus issue can be addressed through asking Chld daily how his bus ride was. Chld is being coached in how to react to different bus situations and to tell other students to stop when they are picking on him. Chld will also be seated at the front of the bus and the driver has been instructed to intervene if she hears Chld ask others on the bus to leave him alone more than once.

No timed tests.

Allow enough wait time for Chld to respond with answers.

Teachers and family should not interrupt his speaking and speak at a slower, calmer rate.

Eligibility Determination: Developmental Cognitive DisabilityEligibility for Developmental Cognitive Disability:The pupil needs to meet criteria in both A and B below.

Chld meets the following components of the Minnesota criteria for Developmental Cognitive Disability: Mild-Moderate:

A. Chld has a composite score at or below the 15% on a nationally normed, technically adequate measure of adaptive behavior which documents needs in the following domains (minimum 4 areas) across multiple environments, supported by systematic observation and parent input as sources to document need and level of support: ___ Daily living and independent living skills;_X__ Social and interpersonal skills; 01 %ile in Social Interaction skills of SIB-R_X__ Communication skills; 01 %ile in Social Interaction skills of SIB-R_X__ Academic skills; 01 %ile in Community Living skills of SIB-R___ Recreation and leisure skills;_X__ Community participation skills; 01 %ile in Community Living skills of SIB-R___ Work and work-related skills.

B. Chld has significantly below average general intellectual functioning as measured by an individually administered, nationally normed test of intellectual ability:_X__ an individually administered test of intellectual ability that yields an intelligence quotient 2 Standard Deviations below the mean (+ or - 1 SEM);_X__ verified by two or more systematic observations; and one or more of the following:___ supplemental tests of specific abilities:___ criterion-referenced tests: ___ alternative methods of intellectual assessment:___ clinical interviews of family members, and/or _X__ observation and analysis of behavior across environments. Woodcock-Johnson Tests of Achievement and the Scales of Independent Behavior (SIB-R)

According to the Woodcock-Johnson Test of Cognitive Abilities, Chld has a Full Scale IQ of 69 (+/- 4 (65-73)), which is at the 2%ile. This places Chld in the low range of ability.

Chld does meet the criteria for the Developmental Cognitive Disability (DCD) category.

_____________________________________________________________________________Communication Eligibility:

Chld does not meet the following components of the Minnesota criteria for Speech or Language Impairments - Fluency Disorder and is not eligible for special education: (A and B)

A. The speech pattern interferes with communication as determined by_No__ an educational speech language pathologist; and___ another adult; or___ the pupil.

B. Dysfluent behaviors occur:_No__ 5% or more of words spoken during language sample #1._No__ 5% or more of words spoken during language sample #2.

Chld does not meet the following components of the Minnesota criteria for Speech or Language Impairments - Language Disorder and is eligible for special education: (A, B and either C or D)

A. Chld’s language pattern interferes with communication as determined by:_Yes__ educational speech and language pathologist, and_Yes__ another adult, or___ the learner.

B. Language behavior is below or different from expectations based upon age, developmental level or cognitive level as demonstrated by:_No__ an analysis of language sample, or___ observation of learner.

C. Learner scores 2.0 SD or more below the mean on two technicallyadequate language tests:_Yes__ language test #1 Clinical Evaluation of Language Fundamentals-III, and_No__ language test #2-Oral Written Language Scales_No__ language test #3-Peabody Picture Vocabulary Test-III

D. If technically adequate, norm referenced instruments are not available,two procedures that indicate substantial differences from expectationsbased upon age, development or cognitive level:___ procedure #1, and___ procedure #2

Eligibility Determination: Specific Learning Disability (SLD)Eligibility Determination : Specific Learning Disability:

Eligibility is established when the student meets the criteria described in Items A, B, and C.

Chld does not meet all of the following components of the Minnesota criteria for Specific Learning Disabilities:

A. SEVERE UNDERACHIEVEMENT:

Chld does not demonstrate severe underachievement in response to usual classroom instruction. The following assessment procedures and observations verify this finding:

X___ systematic observation within the regular classroom (for preschool aged children, an environment appropriate for the age of the child), and_X__ cumulative record review;_X__ classwork samples;___ anecdotal teacher records;_X__ formal and informal tests;___ curriculum based evaluation;___ results from instructional support programs (e.g., Chapter 1, Assurance of Mastery); and/or___ other. Chld is currently placed in the lower 2nd grade skills group and is doing as well as the students in the same group. This has been demonstrated to be an appropriate level for Chld.

B. SEVERE DISCREPANCY BETWEEN ABILITY AND ACHIEVEMENT:

Chld does not demonstrate a severe discrepancy between general intellectual ability and achievement in the following area(s):___ oral expression; ___ listening comprehension; ___ written expression;___ basic reading skills;___ reading comprehension;___ mathematical calculation; and/or ___ mathematical reasoning.

According to the Woodcock-Johnson Tests of Achievement, Chld does not have a discrepancy of greater than -1.75 in any area of the testing.Chld obtained a Full Scale IQ of 69 on the Woodcock-Johnson Test of Cognitive Ability.

C. EVIDENCE OF A PROCESSING DISORDER:

The team agrees that it has sufficient evaluation data to verify that Chld has an information processing condition that occurs within a variety of settings and is manifested by the following behaviors:_X__ inadequate or lack of expected acquisition of information; Some concerns from teachers; not a large concern for foster family;_X__ lack of organizational skills (e.g., following written or oral directions); large concern of teachers and no concern of foster family;___ deficits in spatial arrangements;___ incorrect use of developmental order in relating events;___ inability to transfer of information onto paper;___ deficits in visual and auditory memory;___ deficits in verbal and nonverbal expression; foster family no concern and very much concern of teachers;_X__ inadequate motor control for written task, (e.g., writing, drawing, copying; and/or: some concern of foster family and very much of a concern of teachers;___ other:

D. EXCLUSIONARY FACTORS: The underachievement is not primarily the results of visual, hearing, or motor impairment; mental impairment; emotional or behavioral disorders; or environmental, cultural, economic influences, of an inconsistent education program; or of significant medical findings.Chld does not demonstrate underachievement when placed in appropriate level skills groups. His cognitive level is in the low range.


EXAMPLE: EBD EVALUATION REPORT

Evaluation Report

Student Name: Michael Watson ID: 12345678910 Date: 12/20/07School: Hope Elementary Grade: 3 DOB: 7/15/94 Initial Evaluation <INPUT TYPE=\ Reevaluation

This evaluation report must include: • information reported by parents • evaluation results • interpretation of evaluation results and determination of eligibility by addressing criteria components verifying the child is a child with a disability and is in need of (or continues to need) special education and related services • the educational needs of the child

Reason for Referral and Pre-referral InterventionsMichael was first referred to the Student Assistance Team (SAT) by Mrs. Jones, his 3rd grade teacher. Mrs. Jones brought Michael to SAT with concerns about his behavior. His teacher's main concerns at the time of referral were Michael's defiant, disrespectful and disruptive behavior in the classroom.

A behavioral intervention was implemented on September 2, 2007. The plan for the intervention was to allow Michael adequate time to follow directions, giving him up to 3 redirections and opportunities to follow the direction given. If he continued to refuse to follow directions, he would be directed to take a time out at his desk, if he refused that he would be asked to take an out of class time out. Also, on days when Michael's behavior was good, he would receive small incentives such as a positive note home, being the line leader, skipping a homework assignment, being first to lunch, etc. For each class during the day, if Michael had positive behavior, he would fill in a section on a game board to earn these incentives. Each day, Michael had 9 opportunities to fill in a piece of the game board.

During the 10-day intervention, Michael earned, on average, about 34% of the game board pieces he had the chance to earn. There were days when he earned as many as 7/9, but then there were days that he earned 0/9. The intervention had limited success, but Michael's behavior was still very disruptive and disrespectful. SAT members decided to implement a second intervention.

The second intervention was implemented on October 12, 2007. The second intervention was similar to the first, but with some key changes. Instead of only having the teacher rate Michael's behavior, Michael would self rate as well. Two specific goals were identified based on what Michael's most disruptive behaviors were. His two goals were appropriate language and keeping hands and feet to self. He still had the same consequences for inappropriate behavior and he still had the game board. However, instead of incentives placed intermittently on the game board, they were now on every space, even if it was just positive verbal praise, Michael got some kind of positive reinforcement for every space he filled in on the game board.

During the second 10-day intervention, Michael earned, on average, about 67% of his point possible on a daily basis. There were days that he earned 0/40 points and there were days that he earned 40/40 points. Although this intervention also had some limited success, the team did not believe it was adequate. Michael's behaviors continued to be very disruptive,

disrespectful and seemed to be increasing in intensity. The team decided to refer Michael to the Student Study Team (SST) to determine if testing for special education was warranted.

SST met on November 4, 2007 to discuss Michael. All team members present agreed that Michael should be assessed for an Emotional/Behavioral Disorder (EBD). Parent permission was received on November 29, 2007.

Information and Concerns Reported by Parent(s)At the time of Michael's referral to SAT, his teacher indicated that Michael's mother, Jenny, stated that Michael is very argumentative at home and refuses to listen. Jenny was also aware of his behavior at school. During an interview with Jenny on December 18, 2007, she indicated that Michael is both physically and verbally aggressive at home and he engages in property destruction. She believes that sometimes Michael is looking for attention. Other times she thinks he is purposefully trying to hurt the person his aggression is directed towards or he's just trying to get his anger out.

Homework is one time at home that Michael consistently acts out. Jenny indicated that "it's like a roller coaster" with Michael; his behavior is very up and down. Jenny also indicated that Michael consistently acts out around his younger brother. At the evaluation meeting on January 12, 2008, Michael's father, Jim, shared that Michael has been taking a lot of naps lately. This is something that Michael has never done before. Jim noticed this change in Michael's behavior after a recent change in medication. Jim noted that Michael tends to act out more when he is tired.

Educationally Relevant Medical FindingsMichael's parents shared that Michael was a typical infant and toddler. They had no concerns until he was about the age of 2. It was then that they started to notice Michael's defiance. He was a "mouthy" 2 year old according to his parents. When he went to preschool, Michael had trouble sharing with other students and he always wanted to be the center of attention. He was often physical with his peers. His parents believe it was when Michael was approaching 4 years old that they first visited their family doctor with concerns about Michael's behavior.

Sandy Johnson, Family Facilitator, obtained Michael's medical records from the Cambridge Medical Center. Michael's most recent visit to the doctor was on 12/24/2007. This visit was in regards to Michael's behavioral problems and for a medication check. Michael's diagnoses are Attention Deficit Disorder with Hyperactivity (ADHD), Oppositional Defiant Disorder (ODD) and Migraines.

Michael is currently taking Tenex 2 mg twice daily, Zoloft 25 mg once daily and Periactin 4 mg at bedtime.

Special ConsiderationsMichael's language, cultural, economic or environmental background does not indicate that special adaptations in assessment procedures needed to be made.

Existing Data, Current Evaluation Results and InterpretationINTELLECTUALThe Woodcock-Johnson III Tests of Cognitive Abilities (WJ III COG) were administered by John Day, school psychologist, on 12-13-07, to evaluate Michael’s current level of intellectual functioning. The WJ III COG consists of a comprehensive set of individually administered, norm-referenced tests for evaluating intellectual abilities. In addition to measuring general intellectual functioning, it assesses skills in three areas: verbal ability, thinking ability, and cognitive efficiency. Michael’s performance on the WJ III COG places him in the upper end of the “average” range of intellectual ability when compared with a national sample of students his age, at this time. His overall score of 106 fell at the 64th percentile, meaning that he did as

well as, or better than, 64% of same-age peers within the national standardization sample. There is a 90% chance that Michael’s true score falls in the range between 100 and 111. Michael’s performance across the various WJ III COG tests was somewhat variable. The majority of his scores fell in the “average” range. One score fell in the “superior” range. His results are summarized in the table below:

CLUSTER/Test Standard Score Percentile RangeGEN. INTELLECTUAL ABIL. 106 64th averageVERBAL ABILITY 93 33rd averageVerbal Comprehension 93 33rd averageTHINKING ABILITY 119 89th high averageVisual-Auditory Learning 107 68th averageSpatial Relations 102 55th averageSound Blending 128 97th superiorConcept Formation 110 74th averageCOGNITIVE EFFICIENCY 99 49th averageVisual Matching 98 45th averageNumbers Reversed 101 53rd average

The testing was completed in one session that lasted approximately one hour. Throughout that time, Michael worked cooperatively and persistently at all the tasks that were given him. The results of the testing with the WJ III COG should, therefore, be considered a valid estimate of his current intellectual functioning. Michael’s test performance suggests “average” cognitive ability, when compared to other individuals of the same age. Given his present cognitive abilities he would be expected to be quite successful in the regular classroom setting and standard curriculum.

Michael earned an “average” score on the Verbal Ability Scale. This scale provides a measure of language development that includes the comprehension of individual words and the comprehension of relationships among words. It includes subtests that required him to name pictures, provide synonyms and antonyms for words, and complete word analogies.

Michael scored at the top of the “superior” range on the Thinking Ability Scale. This cluster of four tests samples a number of thinking processes that may be invoked when information in short-term memory cannot be processed automatically. He scored in the upper end of the “average” range on Visual-Auditory Learning. This test measures learning, storage, and retrieval of new information, and required him to learn and recall a number of pictures that represented words. He earned an “average” score on Spatial Relations. This test assesses visual-spatial thinking, and required him to identify, from a group of pieces, the two or three pieces that formed a complete target shape. He scored in the “superior” range on Sound Blending, an auditory processing test that assesses skill in synthesizing language sounds (phonemes). On this test, Michael listened to a series of syllables and then was asked to blend the sounds into a word. He earned a score at the top of the “average” range on Concept Formation, a measure of fluid reasoning. On this test, he was presented with a number of logic puzzles, and required to derive the rule for each one.

Michael scored in the “average” range on the Cognitive Efficiency Scale. This cluster samples two different factors of automatic cognitive processing, or the capacity of the cognitive system to process information automatically. He earned an “average” score on Numbers Reversed, a measure of short-term memory and attentional capacity. On this test, he was required to hold a span of numbers in immediate awareness (memory) while performing a mental operation on it (reversing the sequence). His score on Visual Matching fell in the “average” range. This test evaluates perceptual speed, or the speed at which an individual can make visual symbol discriminations, and required Michael to quickly locate and circle the two identical numbers in

rows of six numbers (which increase in difficulty from single-digit numbers to triple-digit numbers) within a limited time frame (three minutes).

Summary: Michael Watson is profiled by his current earned scores on the WJ III COG as an individual with overall intellectual abilities in the upper end of the “average” range. The results of this evaluation suggest that Michael should be capable of learning most academic material at an average to above average level compared to other students his age. When the results of his academic evaluation, which was completed by Kim Wilson, special education teacher, are compared to the results of this evaluation, Michael does not demonstrate a severe discrepancy between his cognitive abilities and achievement in any area.

ACADEMICMichael's academic achievement was evaluated through file review, observation, parent/teacher reports and formally with the Woodcock-Johnson III Tests of Achievement (WJ III ACH). Kim Wilson, special education teacher, administered the WJ III ACH on 11/30/2007, 12/4/2007 and 12/5/2007. The WJ III ACH uses a standard battery of tests to assess a broad range of academic knowledge and skills. It was administered in order to gain a full understanding of Michael's academic ability.

Michael appeared to be at ease and comfortable while testing. He was cooperative throughout the testing and generally persisted with difficult tasks. He was attentive to the tasks and was slow and careful in his responses. He was on task throughout testing.

The results of the WJ III ACH are shown below. The standard score has a mean of 100 and a standard deviation of 15. Standard scores between 90 and 110 would be considered average when compared to same-age peers. The percentile rank indicates the percent of same-aged peers whose scores fall at or below the reported score. For example, a student who obtains a percentile rank of 45 on a test has scored as well or better than 45 out of 100 of his same-aged peers in the comparison group. Percentile ranks between 25 and 75 are considered to be average.

Standard Score Percentile RankBROAD READING 103 57Letter-Word Identification 104 62Reading Fluency 102 55Passage Comprehension 99 48BROAD MATH 102 56Applied Problems 112 80MATH CALCULATION 94 35Calculation 95 36Math Fluency 93 31BROAD WRITTEN LANGUAGE 100 49Spelling 103 58WRITTEN EXPRESSION 97 42Writing Fluency 94 34Writing Samples 102 57

Michael's academic performance was in the average range in all three broad achievement clusters (Reading, Math and Written Language). He also scored in the average range in Academic Knowledge.

Michael's areas of strength were applied problems, academic knowledge and understanding directions. Michael's performance on the applied problems test and the academic knowledge test was equivalent to that which would be expected from an average performing 10-2 year old student. Applied problems requires a student to analyze and solve math problems. To solve the problems, the student must listen to the problem, recognize the procedure to be

followed, and then perform relatively simple calculations. Although Michael was allowed to use paper and pencil for this portion of the test, he did all of the problems in his head. His performance on the understanding directions test was equivalent to that which would be expected of an average performing 9-9 year old student.

Michael's weaknesses were in story recall, math fluency and writing fluency. His performance on the story recall test was equivalent to that which would be expected of an average performing 7-3 year old student. The Story Recall test required Michael to listen to a short story and then retell the story with as many details as he could remember. Michael was only able to remember a limited number of details in each story. His performance on the math and writing fluency tests was equivalent to that which would be expected of an average performing 8-4 year old student.

Michael's Total Achievement score was a 102. His General Intelligence Ability (GIA) score was a 106. This suggests that Michael would be expected to learn most academic material at an average level compared to other students his age. His academic test scores and his performance in the classroom reflect this.

SENSORY STATUSMichael's vision and hearing was screened on 11/8/07. He passed both screenings. He was not wearing his glasses during the vision screening.

HELATH/PHYSICAL STATUSMichael's diagnoses are Attention Deficit Disorder with Hyperactivity (ADHD), Oppositional Defiant Disorder (ODD) and Migraines. Michael is currently taking Tenex 2 mg twice daily, Zoloft 25 mg once daily and Periactin 4 mg at bedtime.

SOCIAL/EMOTIONAL/BEHAVIORALBehavior Assessment System for Children- 2 (BASC-2)The Behavior Assessment System for Children, Second Edition (BASC-2) is a nationally-normed system for evaluating the behavior of children. The BASC-2 includes parent and teacher rating scales that gather descriptions of the child’s observable behavior. Using the ratings to over 130 key statements, the BASC-2 measures numerous aspects of behavior and personality, including positive (adaptive) and negative (clinical) dimensions. The information provided is scored so that it can be compared to the ratings received by a nationally representative group of children. This provides information regarding the degree to which the behavior is typical or problematic.

Teacher rating scales were completed for Michael by Mrs. Jones, his classroom teacher, and Mrs. Swenson, his physical education teacher. Parent rating scales were completed for him by Jenny and Jim Watson, his mother and father. Michael completed the self-report. All scales were completed in mid-December of 2007.

In the analysis of scores derived from the BASC-2, two ranges are particularly important - At-Risk and Clinically Significant. Scores in the Clinically Significant range (“CS” in the tables below) denote high levels of the maladaptive behaviors being assessed or low levels of adaptive behaviors. Scores in the At-Risk range (“ar” in the tables below) suggest the possibility of developing problems that may need to be monitored or problems that require intervention but are not severe enough to warrant formal classification or diagnosis. Scores marked with dashes (--) in the tables below indicate the Average or better range.

Teacher and Parent Rating Scales: The BASC-2 Teacher and Parent Rating Scales contain indicators, called validity indexes, for evaluating rater bias. One of these indexes, called the F index, was in the Extreme Caution range for both of Michael’s teachers and his mother. This index is intended to provide a measure of a rater’s tendency to be excessively negative in

describing the child’s behavior; however, if the majority of the raters perceive a problem, a high F index may also be a reflection of the child’s significant problems. The F index was in the Acceptable range for Michael’s father. The remaining validity indexes were in the Acceptable range for all informants.

The teacher and parent rating scales generate scores for five composite scales, based upon combinations of 16 individual scales (10 clinical scales and 6 adaptive scales). Composite scales are comprised of two or more clinical or adaptive scales, and provide indications of overall problem behaviors or adaptation. They tend to be more reliable than individual scales.

The Behavior Symptoms Index (BSI) is a composite that consists of the Hyperactivity, Aggression, Depression, Attention Problems, Atypicality, and Withdrawal scales. The BSI provides an indication of the child’s overall level of problem behavior. The results of the ratings on the BSI are summarized below:

Behavior Symptoms Index Teacher1 Teacher2 Mother FatherCS CS CS CS

The Clinically Significant ratings from all four respondents on the BSI indicate that high levels of overall problem behavior are occurring across home and multiple school settings.

The Externalizing Problems composite assesses disruptive behavior problems, such as aggression, hyperactivity, or conduct problems. The results for this composite, and the scales of which it is comprised, are summarized in the following table:

Teacher1 Teacher2 Mother FatherExternalizing Problems CS C CS CSHyperactivity CS C CS CSAggression CS C CS CSConduct Problems CS C CS CS

The Clinically Significant scores from Michael’s teachers and parents on Externalizing Problems reflect significantly high levels of disruptive behaviors across school and home settings. The Clinically Significant scores from all respondents on each of the individual scales indicate that Michael consistently tends to be overly active, rush through work/activities, and act without thinking (Hyperactivity scale), act in a hostile manner (verbal or physical) that is threatening to others (Aggression scale), and engage in antisocial and rule-breaking behavior (Conduct Problems scale).

The Internalizing Problems composite includes scales that measure depression, anxiety, and similar difficulties that are not marked by acting-out behavior. The scores provided on this composite, and its individual scales, are as follows:

Teacher1 Teacher2 Mother FatherInternalizing Problems CS ar CS CSAnxiety -- -- -- --Depression CS ar CS CSSomatization CS ar CS CS

Significant concerns are identified by three of the four respondents on Internalizing Problems, and at-risk concerns are noted by the other respondent. The scales of greatest concern, based upon these ratings, are Depression and Somatization. The high scores on the Depression scale indicate that Michael frequently tends to display feelings of unhappiness, sadness, and stress that may interfere with his ability to carry out activities and tasks. The elevated ratings on the Somatization scale reflect the tendency to be overly sensitive to and complain about relatively minor physical problems and discomforts.

The School Problems composite is found only on the teacher rating scales. It consists of the Attention Problems scale (found on both the teacher and parent rating scales) and Learning Problems scale, and reflects academic difficulties, including problems of motivation, attention, and learning and cognition. A high score on this composite is a sign that the teacher perceives behaviors that are very likely to interfere with achievement. The scores given to this composite, and its component scales, are listed below:

Teacher1 Teacher2 Mother FatherSchool Problems -- -- -- --Attention Problems -- ar CS CSLearning Problems -- --Michael’s teachers rated School Problems, along with the Learning Problems scale, in the average or better range, indicating no concerns with his ability to learn academic material. The elevated ratings from both parents and one teacher on the Attention Problems scale indicate that Michael tends to be easily distracted and unable to concentrate more than momentarily, particularly within the home setting.

The Adaptive Skills composite summarizes prosocial, organizational, study, and other adaptive skills. The results of the ratings on this composite, and the scales of which it is comprised, are summarized below:

Teacher1 Teacher2 Mother FatherAdaptive Skills ar CS CS CSAdaptability CS CS CS CSSocial Skills ar ar CS CSLeadership ar ar ar arStudy Skills ar CSActivities of Daily Living CS CSFunctional Comm. ar ar -- ar

The scores from Michael’s teachers and parents on Adaptive Skills indicate deficits in each adaptive skill area that are evident both in home and school settings. The scale of greatest concern is Adaptability. The consistently low scores on the Adaptability scale suggest that Michael does not easily adjust to changes in routine and new teachers, shift from one task to another, and share toys or possessions with other children. Along with this, the ratings indicate deficits in Michael’s skills for interacting successfully with adults and peers (Social Skills scale), skills associated with accomplishing academic, social, or community goals, including, in particular, the ability to work well with others (Leadership scale), skills that are conducive to strong academic performance, including organizational skills and good study habits (Study Skills scale), skills associated with performing basic, everyday tasks in an acceptable and safe manner (Activities of Daily Living scale), and the ability to express ideas and communicate in a way others can easily understand (Functional Communication scale).

The following individual scales are not included in a composite scale:Teacher1 Teacher2 Mother Father

Atypicality CS CS CS arWithdrawal CS ar CS ar

The high scores on Atypicality suggest that Michael behaves in ways that are immature or considered “odd” compared to same-age peers. The elevated ratings on the Withdrawal scale indicate that he tends to evade others to avoid social contact.

Student Self-Report: The Self-Report was completed by Michael on 12-18-07. The SRP has several validity indexes designed to detect the accuracy of the information. One of these

indexes, called the F index, was in the Extreme Caution range. The F index assesses the possibility that a child responded to the test items in an inordinately negative fashion. Individuals may have elevated F indexes for other reasons, as well, including reading difficulties, a failure to follow directions, random responding, or an attempt to “fake bad.”

Another validity index, called the Consistency Index, was in the Caution range for Michael. This index identifies cases where the respondent has given differing responses to items that usually are answered similarly, and may indicate that a respondent disregarded item content when completing the self-report form. Inconsistent responding may also occur if a respondent changes his or her perspective during the completion of the form, or if a respondent misunderstands the items because of poor reading ability or language comprehension. Twenty-three item pairs were identified where Michael provided differing responses to similar items.

Because these two indexes were elevated, Michael’s self-report must be interpreted carefully. Each of the remaining validity indexes was in the Acceptable range.

The SRP generates scores for five composite scales, based upon combinations of 14 individual scales (10 clinical scales and 4 adaptive scales). Composite scales are comprised of two or more clinical or adaptive scales, and provide indications of overall problem behaviors or adaptation. They tend to be more reliable than individual scales.

The Emotional Symptoms Index (ESI) is the SRP’s most global indicator of serious emotional disturbance, particularly internalized disorders. It is composed of four scales from the Internalizing Problems composite (Social Stress, Anxiety, Depression, Sense of Inadequacy) and two scales from the Personal Adjustment composite (Self-Esteem and Self-Reliance). Michael rated the ESI in the Clinically Significant range. Elevated scores on the ESI may signal the presence of serious emotional disturbance that is broad-based in its impact on the thoughts and feelings of the individual.

The School Problems composite includes the Attitude to School and Attitude to Teachers scales, and is a broad measure of adaptation to school. Elevated scores on the School Problems composite indicate a pattern of dissatisfaction with schooling, school personnel, and the structure of the educational process. Michael’s ratings on this composite, and the scales of which it is comprised, are summarized below:

School Problems Attitude to School Attitude to TeachersCS CS CS

Michael scored School Problems, as well as both of the individual scales, in the Clinically Significant range. His high rating on the Attitude to School scale indicates feelings of alienation, hostility, and dissatisfaction regarding school. The high score on the Attitude to Teachers scale reflects feelings of resentment and dislike of teachers, along with beliefs that teachers are unfair, uncaring, or overly demanding.

The Internalizing Problems composite consists of the Atypicality, Locus of Control, Social Stress, Anxiety, Depression, and Sense of Inadequacy scales. This composite can be characterized as a broad index of inwardly directed distress that reflects internalizing problems a child may be experiencing.Scores in the At-Risk range or higher deserve careful consideration. Michael’s scores on this composite and its component scales are as follows:

Atypicality Locus of Control Social Stress Anxiety Depression Sense of InadequacyCS CS __ CS CS ar

He scored Internalizing Problems, and a number of the individual scales, in the Clinically Significant range. Michael’s ratings indicate significant tendencies toward bizarre thoughts or other thoughts and behaviors considered “odd” (Atypicality scale), beliefs that rewards and punishments are controlled by external events or people (Locus of Control scale), feelings of stress and tension in personal relationships, including feelings of being excluded from social activities (Social Stress scale), and feelings of unhappiness, sadness, and dejection, and a belief that nothing goes right (Depression scale).

The Inattention/Hyperactivity composite consists of the Attention Problems and Hyperactivity scales. It measures behaviors that may be indicative of attention deficit hyperactivity disorder. Michael’s scores are as follows:

Inattention/Hyperactivity Attention Problems HyperactivityCS CS CS

He rated the composite, as well as the individual scales, in the Clinically Significant range. His high score on the Attention Problems scale indicates the inability to maintain attention and the tendency to be easily distracted from tasks requiring attention. His rating on the Hyperactivity scale reflects the tendency to report being overly active, rushing through work or activities, and acting without thinking.

The Personal Adjustment composite consists of the Relations with Parents, Interpersonal Relations, Self-Esteem, and Self-Reliance scales. Low scores indicate problematic levels of adjustment. At-Risk scores suggest problems with interpersonal relationships, self-acceptance, identity development, and ego strength. Michael’s ratings are summarized below:

Personal Adjustment Relations with Parents Interpersonal Relationsar -- --

Self-Esteem Self-RelianceCS ar

Michael rated the composite in the At-Risk range. His Clinically Significant score on the Self-Esteem scale reflect a strong lack of self-esteem, self-respect, and self-acceptance.

Summary and Interpretation of BASC-2 Results: The BASC-2 is one component of a comprehensive evaluation, and should be considered in conjunction with all other evaluation information. Michael Watson is profiled by teacher and parent ratings on the BASC-2 as a student who exhibits significantly high levels of externalizing problems, including hyperactivity, aggression, and conduct problems. These behaviors are evident across home and school settings. Along with these behaviors, Michael also demonstrates a strong pattern of depression and withdrawal, along with deficits in adaptive skills, across school and home settings. Michael’s self-ratings must be interpreted cautiously, due to concerns on two validity indexes; nonetheless, his scores suggest significant, broad-based internalized concerns.

Functional Behavior AssessmentReason for functional behavioral assessment: A functional behavioral assessment was completed as a component of Michael’s initial evaluation for special education. The information gathered from the assessment will be used to determine the function of Michael’s challenging behavior(s), to develop interventions that can be used to reduce challenging behavior(s), and to identify alternative (functional) behaviors to be taught.

Data collection: Data for this report was collected using direct observations conducted from 10/2/07-12/19/07. In addition, Michael, his classroom teacher and his mother were interviewed to gather further information. His discipline file was also reviewed.

Medical Information: This was discussed at the evaluation meeting on January 10, 2008. The team did not believe that Michael’s acting out behaviors are caused by his medical diagnoses.

Target behaviors have been identified as:1. Talking Out: talking or other vocalization that can, or does, cause a significant disruption in schoolExamples: blah, blah, blah…, “no”, mouth noises, talking when the teacher is talking.Non-Examples: answering a teacher’s questions, talking to peers during group work.

Predictors: Talking out is most likely to occur when Michael is asked to do something he doesn’t want to do, when the teacher is instructing the class and during partner activities when his partner is doing better than him. Michael also “talks back” to staff when he is redirected.

Baseline: Five incidents were documented in 2006-2007 discipline reports. Twenty-four incidents were documented so far in the 2007-2008 school year, both in discipline reports and direct observations. Most incidents resulted in peer attention, staff ignoring the behavior, staff redirection and/or removal from the activity or classroom.

Hypothesis: Talking out is most likely to occur when Michael is asked to do something he doesn’t want to do or if he is not successful in what he is doing. It is hypothesized that Michael’s behavior functions to gain peer attention and/or to avoid/escape non-preferred activities.

Replacement behaviors: Teach social skills for following directions, listening and accepting feedback.

Alternative behaviors should be taught using a teaching interaction when Michael is calm and under control using the following steps:

2. Noncompliance: not following directives from school staff that reflect school rules or planned and reasonable academic expectations within 10 seconds.Examples: refuses to follow a simple directive, refuses to begin/complete a task.Non-examples: follows the direction after one redirect, says ‘no’ but complies.

Predictors: Noncompliance is most likely to occur when Michael is in Reading and Gym. Noncompliance also occurs when Michael doesn’t want to participate in an activity/complete an academic task (math timing) and when he doesn’t understand how to do an assignment.

Michael’s challenging behavior(s) will sometimes follow a chain of responses consisting of a) saying, “No!” b) saying, “I don’t have to do this” or “the frickin’ teacher can’t make me do this” (c) throwing small pieces of paper or erasers and/or making faces (d) walking around the room bumping into other students.

Baseline: Five incidents were documented in 2006-2007 discipline reports. Twelve incidents were documented so far in the 2007-2008 school year, both in discipline reports and direct observations. Most incidents resulted staff ignoring the behavior, staff redirection or removal from the class or activity.

Hypothesis: Noncompliance is most likely to occur when Michael is given a directive to complete an academic task (Reading) or participate in a non preferred activity (Gym) or when

he doesn’t understand how to do something. It is hypothesized that Michael’s behavior functions to escape or avoid academic tasks or non-preferred activities.

Replacement Behaviors: Teach social skills for following directions, listening, requesting help and requesting a break.

3. Physical Aggression: Hitting, kicking, grabbing, biting, pinching, scratching, pulling hair and any other behavior which can or does cause physical harm to other people.Examples: slapping, hitting, kicking, grabbing, pushing, etc.Non-examples: tapping on the shoulder, high-five, shaking hands

Predictors: Physical aggression is most likely to occur when Michael is in close proximity to his peers (standing in line) and when Michael is playing games in Gym class or at recess, especially if the game is not going his way.

Baseline: Six incidents were documented in 2006-2007 discipline reports. Thirteen incidents were documented so far in the 2007-2008 school year, both in discipline reports and direct observations. Most incidents resulted in peer attention, redirection, an office referral and detention or suspension. Hypothesis: Physical aggression is most likely to occur when Michael is in close proximity to his peers or if he is playing a game and it isn’t going his way. It is hypothesized that Michael’s behavior functions to gain attention from his peers, to avoid/escape a task/activity and to express himself.

Replacement behaviors: Teach social skills for getting along with others, requesting a break and expressing feelings.

Alternative behaviors should be taught using a teaching interaction when Michael is calm and under control using the steps from above.

4. Verbal Aggression: Name calling or verbal threat of injury to another person.Examples: “Stupid”, “Dummy”, “Jerk”, “A-hole”, “Old Lady”Non-examples: “Hi, Mr. Smith!”, “Hello.”, and “How are you?”

Predictors: Verbal aggression is most likely to occur when Michael is refusing to follow directives given by staff.

Baseline: Six incidents were documented in 2006-2007 discipline reports. Seven incidents were documented so far in the 2007-2008 school year, both in discipline reports and direct observations. Most incidents resulted in staff ignoring the behavior and/or peer attention.

Hypothesis: Verbal aggression is most likely to occur when Michael is refusing to follow directives given by staff. It is hypothesized that Michael’s behavior functions to avoid/escape non-preferred activities/tasks and to gain peer/staff attention.

Replacement behaviors: Teach social skills for following directions, accepting feedback and showing respect.

Discipline RecordsDiscipline records show that Michael had 9 office referrals and 2 bus referrals in 2nd grade. Those referrals were a result of the following various behaviors: physical aggression, talking out/making noise/swearing or name calling, noncompliance and 2 incidents of sexually inappropriate behavior. Those referrals resulted in 6 noon detentions, 3 1/2 days of In School Suspension (ISS) and 3 days of bus suspension.

So far in third grade, Michael has had 5 office referrals and 1 bus referral. Those referrals were a result of the following various behaviors: talking out/swearing or name calling, physical aggression and noncompliance. Those referrals resulted in 1 noon detention, 2 days of ISS and 2 days of Out of School Suspension (OSS).

OBSERVATIONSObservations 1 and 2Michael was formally observed in the classroom for 20-minute intervals on 2 dates (December 3 and 6, 2007) by Kim Wilson, EBD teacher. He was observed in Reading and during his Christmas program rehearsal. The percentage of time that Michael and his classroom peers were on-task is shown below:

Class Michael's % On Task Peer's % On TaskReading 65 95Rehearsal 90 95

Reading began with the class correcting each other's notebooks. Michael did well during this activity. He appeared to be correcting the notebook in front of him and raised his hand appropriately to ask questions about correcting. On a couple of occasions, he was observed talking quietly to the student in front of him; he was correcting her notebook. Then, while the teacher took down scores, students were supposed to either make fix-ups or read silently; Michael did neither. He was in and out of his desk, quietly talking to peers around him and looking at an I Spy book over another student's shoulder. Although he was not following the direction he had been given, he was not being disruptive. When the teacher finished recording scores, she began instructing the class. The observer was only able to stay for the first couple minutes of instruction, but during that time, Michael was observed talking to students nearby him and following 2/3 directions that were given. During the 10 minute observation period, Michael was observed talking out 12 times; an average of 72 times per hour.

During program rehearsal, the students were standing on risers practicing songs for their Christmas program. Michael did very well for the first 10 minutes of the observation. Then he started talking out, turning around and stepping out of place. The formal observation ended after 10 minutes with Michael talking out 4 times; an average of 24 times per hour. Although the formal observation ended here, the observer stayed to the end of rehearsal. Michael continued to talk out, step out of place, grab at other students and refuse to follow directions; when the music teacher and his classroom teacher could no longer get any cooperation from Michael, the principal was called. After about 20 minutes, the principal escorted Michael back to his office, where he stayed until he was ready to follow directions and rejoin his class.

Observation 3Michael was formally observed by John Day, school psychologist, during his reading class for 20 minutes (1:30 p.m. - 1:50 p.m.) on 12-5-07. During the observation, Michael and a number of same-sex peers were observed using an alternating 30-second interval system. For example, Michael was observed for the first 30 seconds, then a male peer was observed for the next 30 seconds, then Michael was observed for 30 seconds, then another male peer was observed for 30 seconds, and so on. At the beginning of each interval, it was noted if Michael (or a peer) was not on-task (e.g., not engaged with the classroom activity). During the remainder of each interval, the following behaviors were noted if they occurred:

physical - inappropriate contact or throwing of objects, or damage to property,vocal/noise - inappropriate acoustic responses,out of place - out of the explicitly or implicitly defined location,compliance - student compliance to teacher directives.

For the first 18 minutes of the observation, Michael and his peers were seated at their desks, completing a paper-and-pencil workbook activity. The final two minutes were spent correcting their workbooks. During these activities, Michael was observed to be off-task for 60% of the time, compared to his peers who were off-task 10% of the time. When Michael was observed to be off-task, his behaviors included talking to peers, looking in his desk or around the room, being out of his seat, and making noise. The other behaviors observed are summarized in the following table (numbers represent number of occurrences, unless otherwise noted):

Michael PeersPhysical 0 0Vocal/Noise 10 4Out of Place 7 0Compliance 1/1 n/a

Neither Michael nor his peers displayed any inappropriate physical contact during the observed time; however, his behavior was very discrepant from his peers in the areas of vocal/noise and out of place. Michael was observed to be talking to peers, making loud comments to his teacher, singing loudly, or making other noises on 10 occasions. This translates to a rate of 60 instances per hour. (His talking out/noise behavior occurred throughout the observed time; however, it was noted that he became louder and more disruptive toward the end of the period.) His peers were observed to be talking or making noise on only 4 occasions, or at a rate of 24 instances per hour. Michael was observed to be out of his assigned place on 7 occasions, or at a rate of 42 times per hour, while his peers were not observed to be out of place. In the area of compliance, Michael was given a direction by his teacher (“Michael, go back to your seat”) on one occasion. He complied with the direction, but as he did so, he replied loudly, “I am!”

Present Level of Educational PerformanceThe following academic marks were reported for the first two quarters of 3rd grade:Subject 1st Quarter Mid- 2nd QuarterReading B C+Math B+ FSpelling A+ B-Social Studies S+ UScience S+Language S- UHandwriting U UMusic STechnology S-Phy Ed S+

At the time of this evaluation, the second quarter had not yet come to an end. The second quarter grades noted above were where Michael was standing at the time of assessment. Though they are not his final grades for second quarter, they are likely an accurate representation of what his final grades will be as there is only one week left of the quarter.

Michael's grades dropped dramatically from 1st to 2nd quarter. His teacher indicated that the lower grades were due to the amount of school Michael has missed, the amount of class he has missed when he is in school and his refusal to do his school work. She believes that Michael has the ability to do better; test results confirm that.

Michael's teacher noted that he does not accept help if he doesn't understand something; she notices this especially in Math. His teacher indicated that his strengths are in his academic ability and when he is having a good day, he can contribute to classroom discussion.

Attendance: During 1st quarter, Michael was absent 3 1/2 days. He had 2 doctor's appointments and was sick 1 day. During 2nd quarter, Michael was absent 15 1/2 days. He had 3 doctor's appointments, was sick (or without medication) 11 days and had 2 days of suspension.

Educational NeedsAcademic skills: Based on current assessment results, Michael does not demonstrate a need in any academic areas. Some of his present levels of performance are currently unsatisfactory, but this is largely due to the amount of school Michael has missed and the amount of class he has missed when he is in attendance due to behavior. It is believed that if Michael's behavior becomes more manageable, his academic performance will improve. His classroom teacher expresses concern in the area of math because he has missed a lot of instruction. The team is aware of this concern and will monitor Michael's progress in Math.

Behavioral skills: Michael needs to increase his social skills for following directions, listening to the teacher, accepting feedback, requesting help, requesting a break, getting along with others, expressing feelings and showing respect.

Compensatory strategies: If Michael's headaches continue, the school nurse may need to be consulted and a health plan may need to be written. Michael has an appointment with a neurologist scheduled. Information from that visit may be taken into consideration when making a plan for Michael at school. Also discussed at the meeting was the fact that Michael has been falling asleep every afternoon at school and at home. His parents believe this is due to the medication that he is on and were going to check in on this with their doctor. If Michael continues to fall asleep every afternoon, we may need to compensate for that. His parents will let us know what they find out.

Eligibility DeterminationIn order for a student to be eligible for special education and related services under the category of emotional/behavioral disorder the student’s pattern of emotional and behavioral responses must adversely affect educational or developmental performance. This includes interpersonal, academic, vocational, or social skills, and be significantly different from appropriate age cultural, or ethnic norms; and be more than temporary, expected responses to stressful events in the environment. The emotional or behavioral responses must be consistently exhibited in at least three different settings, two of which must be educational settings, and one other setting in either the home, childcare, or community.

A pupil is eligible and in need of special education and related service for an emotional or behavioral disorder when the pupil meets the criteria in items A to C.

A. A pupil must demonstrate an established pattern of emotional or behavioral responses that are described in at least one of the following sub items and which represents a significant difference from peers:

1. withdrawn or anxious behaviors, pervasive unhappiness, depression, or severe problems with mood or feelings of self-worth.

2. disordered thought processes manifested by unusual behavior patterns, atypical communication styles, or distorted interpersonal relationships.

3. aggressive, hyperactive, or impulsive behaviors that are developmentally inappropriate.

Michael has demonstrated severally aggressive and impulsive behavior as evidenced by high scores on teacher and parent BASC scores in the areas of hyperactivity aggression and conduct as well as the incidents of physical and verbal aggression, talking out and noncompliance documented in the discipline records and FBA. Discipline records show that Michael has had 9 office referrals and 2 bus referrals in 2nd grade. Those referrals were a result of the following various behaviors: physical aggression, talking out/making noise/swearing or name-calling, noncompliance and 2 incidents of sexually inappropriate behavior. In third grade, Michael has had 5 office referrals and 1 bus referral. Those referrals were a result of the following various behaviors: talking out/swearing or name-calling, physical aggression and noncompliance.

AND B. The pupil's pattern of emotional or behavioral responses adversely affects educational performance and results in:

1. an inability to demonstrate satisfactory social competence that is significantly different from appropriate age, cultural, or ethnic norms; or

2. a pattern of unsatisfactory educational progress that is not primarily a result of intellectual, sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum disorders under part 3525.1325; or inconsistent educational programming.

The evaluation team discussed exclusionary factors as listed above. Information derived from the evaluation results, health records, teacher and parent reports, and educational history are sufficient to rule out other exclusionary factors. While Michael has improved his social skills, he still demonstrates a pattern of inability to develop and maintain satisfactory social relationships with both peers and adults. Michael’s interactions with peers remain antagonistic and strained. While Michael is currently receiving some passing grades in his classes, his teachers report that his behavior often interferes with his academic progress.

ANDC. The combined results of prior documented interventions and the evaluation data for the pupil must establish significant impairments in one or more of the following areas: intra-personal, academic, vocational, or social skills. The data must document that the impairment:

1. severely interferes with the pupil's or other students' educational performance;

2. is consistently exhibited by occurrences in at least three different settings: two educational settings, one of which is the classroom, and one other setting in either the home, child care, or community; or for children not yet enrolled in kindergarten, the emotional or behavioral responses must be consistently exhibited in at least one setting in the home, child care, or community; and

3. has been occurring throughout a minimum of six months, or results from the well-documented, sudden onset of a serious mental health disorder diagnosed by a licensed mental health professional.


FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA) DEFINITIONMinnesota Rule 3525.0200, Subpart 3a. defines a functional behavioral assessment (FBA) as follows:“Functional behavior assessment means a process for gathering information to maximize the efficiency of behavior supports. An FBA includes a description of problem behaviors and the identification of events, times and situations that predict the occurrence and nonoccurrence of the behavior. An FBA also identifies the antecedents, consequences, and reinforcers that maintain the behavior, the possible functions of the behavior, and possible positive alternative behaviors. An FBA includes a variety of data collection methods and sources that facilitate the development of hypotheses and summary statements regarding behavioral patterns.”An FBA needs to include, at a minimum, the following components for each target behavior:

1. Definition of the target behavior;2. Baseline (frequency, severity, duration);3. Situations that predict the occurrence or nonoccurrence of the behavior;4. Hypothesis (function) of challenging behavior and consequences that reinforce or

maintain the behavior; and5. Alternative or replacement behavior to be taught and learned.

When an FBA is conducted prior to the development of a conditional behavior intervention plan (plans that include physical intervention or locked time out) the following components are also required in addition to those listed above:

1. Positive behavioral interventions and supports and other strategies used and changes in the environment that may reduce the behavior;

2. Effectiveness of positive behavioral supports;3. Other treatable causes for the behavior (mental or physical health condition); and4. Documentation that the team has considered whether any regulated

intervention may be contraindicated for psychological or health reasons.


EXAMPLE: FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)

Example: Functional Behavior Assessment

Student Name: Michael Watson ID: 12345678901 Date: 11/25/07School: Trailview Elementary Grade: 4 DOB: 4/25/91

Reason for functional assessment:A functional assessment was conducted to determine the function of Michael’s challenging behaviors prior to the development of a conditional behavior intervention plan. Michael demonstrates several behaviors. The behaviors demonstrated by Michael in the educational environments include being out of place, physical aggression and talking out and making noises.

Data collection:Data was collected by the special education staff working directly with Michael. Data has been collected on each significant incident of challenging behavior during the first trimester of the 2007 school year.

Additional evaluation data used or considered in the development of the behavior intervention plan:Michael’s educational evaluation from December 2, 2005 indicates the following:

Michael has no significant history of educationally relevant medical problems.

Michael’s General Intellectual Ability score would equal or exceed approximately 23 percent of same age peers within a national comparison group. This score falls within the low average range.

When compared to others at his age level, Michael's academic skills are within the average range. His ability to apply academic skills is also average. His performance is average in written language, written expression, reading and mathematics.

A pragmatic language assessment indicated that Michael demonstrates difficulty in initiating and maintaining conversational topics and understanding other people's perspective.

Michael had four incidents of escalated behavior during the evaluation process (November of 2005). Three of these incidents required the use of a physical intervention and removal from the classroom due to verbal or physical aggression, and running from staff while in an escalated state. All of these incidents began when Michael was directed to end a preferred task. The following were identified as situations in which Michael exhibited challenging behavior: 1) Michael did not want to come in from recess, 2) Michael wanted to go to media but was being picked up from school; 3) Michael wanted a book but it was group time, or 4) when he did not win a contest when he thought he should have won.

Michael has an educational disability label of Autism Spectrum Disorder.

Description of target behaviors:Target behavior 1. Out of place - which is defined as being out of the assigned area without teacher permission or running from school staff.

Baseline (frequency, severity, duration):Out of place behavior has occurred five times during the 2007 school year and lasts from a few minutes to 30 minutes.

Situations that predict the occurrence or nonoccurrence of the behavior:Data collected indicates that out of place behavior was most likely to occur when Michael was given a direction to begin working. Michael is most likely to stay in place when he is engaged in a preferred activity.

Hypothesis (function) of challenging behavior and consequences and reinforce or maintain the behavior:When given a direction to begin a task, Michael sometimes leaves the assigned area, which allows him to avoid or delay completing the task.

Alternative or replacement behavior to be taught and learned:Following instructions and staying in assigned area and requesting a break.

Target behavior 2. Physical aggression – which is defined as hitting, kicking, grabbing, biting, pinching, scratching, pulling hair, hitting head and any other behavior which can or does cause physical harm to self or others.

Baseline (frequency, severity, duration):Michael has three incidents of physical aggression during the 2007 school year. Each was very brief lasting less than 30 seconds.

Situations that predict the occurrence or nonoccurrence of the behavior:Physical aggression was most likely to occur when Michael was given corrective feedback or a consequence. Michael is least likely to engage in aggression when he is engaged in a preferred task or when he receives positive teacher attention and praise.

Hypothesis (function) of challenging behavior and consequences and reinforce or maintain the behavior:

When given corrective feedback (please remain quiet) or a consequence (go to time out), Michael sometimes engages in physical aggression, which allows him to avoid the feedback or consequence.

Alternative or replacement behavior to be taught and learned:Accepting corrective feedback and modifying his behavior as a result of the feedback.

Target behavior 3. Talking out/making noises – which is defined as making noises with objects, mouth or body or speaking without obtaining teacher permission.

Baseline (frequency, severity, duration):Michael has been observed to talk out on a daily basis. During a 30-minute observation on October 5 and 6 Michael talked out four times and seven times, respectively.

Situations that predict the occurrence or nonoccurrence of the behavior:Michael is most likely to talk out during seatwork and make noises when he is out of place.

Hypothesis (function) of challenging behavior and consequences and reinforce or maintain the behavior:When given a direction to complete seat work or when out of place Michael sometimes makes noises, which allows him to obtain attention from staff and peers.

Alternative or replacement behavior to be taught and learned:Requesting help, raising his hand before speaking during instructional time and obtaining attention in an adaptive manner.

Positive behavioral interventions and supports and other strategies used and changes in the environment that may reduce the behavior:A variety of antecedent and positive behavioral interventions and support strategies are used to reduce the probability of Michael using the challenging behavior. The following strategies and environmental modifications are used throughout the school day in an attempt to reduce Michael’s challenging behavior. These strategies are used to teach Michael adaptive alternative behaviors, reduce the probability of Michael needing to use a challenging behavior to communicate his needs and wants, reinforce the use of alternative behaviors and increase Michael’s compliant behavior.

Visual schedule:

Michael has a daily schedule that identifies each activity he is to engage in next as well as the preferred activity or reward he will receive following the task or tasks. Michael’s classroom also contains a large visual schedule of the day’s activities.

Differential reinforcement:School staff differentially reinforce Michael’s compliant behavior. That is, school staff provide praise on a frequent basis whenever Michael is demonstrating compliant behavior. When Michael is engaging in mild or minor challenging behaviors, these are ignored.

Non-emotional directions:School staff give directions in a non-emotional manner and maintain neutral body language when addressing noncompliance or other disruptive behavior.

When verbal directions are given, these are delivered in a neutral to positive voice tone. When Michael is given a direction he is allowed time to comply (e.g., 15-30 seconds) before being given a redirection or additional direction. School staff use a limited amount of verbal language with Michael when he is being redirected or beginning to become agitated.

Choices:When possible Michael is offered choices of activities or tasks. Choices may be as simple as allowing Michael to decide the order in which activities will be completed.

5 Point Scale:The Amazing 5 Point Scale is used to assist Michael in learning to regulate his emotions and behavior and as a structured method to direct him to take a break from the classroom or other situations in which he is becoming agitated.

Breaks:Michael is provided with the opportunity to take a brief break (3-5 minutes) in the classroom in which he can sit on a beanbag and read a book.

Positive reinforcement:Michael receives behavior specific praise frequently (many times per day) and other reinforcers on a daily basis.

Michael is provided with pre-specified reinforcers of his choosing. This is the strategy of following less preferred activities with more preferred activities. Staff using this strategy inform Michael of what he needs to do and what he will receive following that task or tasks.

Teaching alternative behaviors:Michael is taught adaptive alternative behaviors on a planned (before) and situational (following an error) basis. Michael practices an alternative behavior following each error that resulted in a removal from the classroom.

Social stories:Social stories are used to increase Michael’s social understanding and his ability to understand why he should or should not engage in certain behaviors.

Effectiveness of positive behavioral supports:Data indicates that the positive behavioral supports and environmental changes listed above have resulted in a reduction in Michael’s challenging behavior. While antecedent interventions have been an effective method to reduce challenging behavior, even with very consistent use,

these strategies have not prevented all instances of severely disruptive or dangerous acting out behavior. Occasionally antecedent interventions and positive behavioral supports alone are insufficient in addressing all instances of behavior. In those situations in which the behavior could not be prevented or de-escalated, a reactive behavior strategy needs to be employed which may include the use of physical intervention or locked time out.

Other treatable causes for the behavior (mental or physical health condition):The team did not identify any other treatable causes for Michael’s challenging behavior. Michael appears to be in good health and only occasionally misses school. Michael’s parents did not indicate that he has any other medical or psychological concerns. Michael has been identified as a student with Autism Spectrum Disorder.

Evaluation of the proposed regulated intervention and documentation that the team has considered whether any regulated intervention may be contraindicated for psychological or health reasons:The team discussed the proposed regulated intervention in relation to the severity of the challenging behavior that requires the use of regulated intervention and the effect of any current medications on his behavior. The team also reviewed available medical and psychological records and considered his chronological and developmental age, physical size, and personal history and determined that Michael has no known psychological or medical problems that would contraindicate the use of physical intervention or time out. Michael’s evaluation indicates that he has no significant history of medical issues. Michael has been identified as having Autism Spectrum Disorder. He has behavioral and social issues as a result of this disability that require additional support and instruction in the school setting.


ASSISTIVE TECHNOLOGYAssistive technology provides persons with disabilities devices and services to increase their independence. The Individuals with Disabilities Education Act (IDEA) as re-authorized in 1997 requires consideration of assistive technology for all students as part of the IEP process.

Assistive technology as defined in IDEA is both services and products. Specific language from the law states:

Assistive Technology Device—The term "assistive technology device" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.

Assistive Technology Service—The term "assistive technology service" means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. This term includes:

A. The evaluation of the needs of such child, including a functional evaluation of the child in the child's customary environment;

B. Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by such child;

C. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing of assistive technology devices;

D. Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;

E. Training or technical assistance for such child, or, where appropriate, the family of such child; and

F. Training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of such child.

There is a wide range of assistive technology devices, from very simple products such as pencil grips or templates through very sophisticated computer systems. The law makes it clear that the IEP team is responsible for insuring that students have access to appropriate devices and support services to insure access to a free, appropriate public education.


SAMPLE OF ASSISTIVE TECHNOLOGY (AT) DEVICES

Writing

Mechanics of WritingPencil/pen with adapted gripAdapted paper (e.g. raised lines, highlighted lines)SlantboardTypewriterPortable word processorComputerAlternate Computer AccessKeyboard with easy access or accessibility optionsWord prediction, word completion, macros, abbreviation expansion to reduce keystrokesKeyguardAlternate mouse (e.g. TouchWindow, trackball,

trackpad, mouse pen)Mouse alternative with on screen keyboardAlternate keyboard (e.g. Intellikeys, Discover Board,

Tash)Mouth stick, head pointer with keyboardSwitch with Morse codeSwitch with scanningVoice recognition

Composing Written MaterialWord cards, word book, word wallPocket dictionary, thesaurusElectronic dictionary/spell check (e.g. Franklin

Bookman ) Word processor with word prediction (e.g. Co:Writer or TextHelp) to facilitate spelling and sentence

constructionMultimedia software for production of ideas (e.g. PowerPoint, Overlay Maker with talking word processor)Voice recognition software

CommunicationCommunication book/boardEye gaze boardSimple voice output product (e.g. Big Mack, CheapTalk, talking picture frame, etc.)Voice output device with levels (e.g. Macaw,CheapTalk with Levels, Digivox)Voice output with icon sequencing (e.g. AlphaTalker, Vanguard, Liberator)

Voice output with dynamic display (e.g. Dynavox, laptop with Speaking Dynamically)

Device with speech output for typing (e.g. Link, Write:Out Loud with laptop)

Reading/Studying/MathReadingChanges in text size/space/color/background colorBook adapted for page turning (e.g. with page fluffers, 3 ring binder and folders)Use of pictures with text (e.g. Picture It, PixWriter)Talking electronic devices for single words (e.g. Reading pen, Franklin Bookman)Scanner with OCR and talking word processorElectronic Books (e.g. Start to Finish)

Learning/StudyingPrint or picture scheduleLow tech aids to find materials (e.g. color tabs, colored paper or folders)Highlight text (e.g. markers, highlight tape, ruler)Voice output reminders for tasks, assignments, steps to tasksSoftware for manipulation of objects/concept development (e.g. Blocks in Motion, Thinking

Things) – may use alternate input device such as Touch Window

Software for organization of ideas and studying (e.g. PowerPoint, Inspiration, ClarisWorks Outline)Recorded materials (e.g. books on tape, recorded lectures with number coded index)

MathAbacus, Math LineCalculator/calculator with print outTalking calculatorCalculator with large keys, large displayOn screen calculatorSoftware with cueing for math computationsTactile/voice output measuring devices (e.g. clock, ruler)

Aids for Daily LivingEatingAdapted utensil/platesArm supportAutomated feeding

DressingVelcro fastenersButton hookDressing aids

Recreation & LeisureAdapted toys and games (e.g. puzzles with handles)Battery interrupters and switchesAdapted sporting equipment (e.g. Velcro mitt, lighted orbeeper ball)Universal cuff to hold crayons, markers, paint brushModified utensils (e.g. rollers, stampers, scissors)Articulated forearm support (e.g. ErgoRest)Drawing/graphics computer programsMusic or games on the computer

Home LivingSwitchBattery interrupterControl unitInfrared sender/receiverX-10 unit and peripheral

TransitionWork/School to WorkAdaptations as identified to meet individual needsScheduling aids (calendars, reminders, task analysis)Switch/deviceAdapted keyboardCommunication aidKeyboard emulator

TransportationGet in and out of car as a passengerTransfer into vehicle and load mobility deviceGet into vehicle with ramp or liftIndependently arrange transportationIndependently utilize public transportationIndependently drive self with adaptationsIndependently drive self

TolerancePhysically tolerate school/work dayEmotionally tolerate full school/work dayMedically tolerate full work/school dayEnvironmentally tolerate full work/school dayTolerate with distance adaptations (internet, ITV)AdaptationsAdaptive seating/positioningElectronic communicationElectronic organizersAdapted computer inputEnvironmental control


STEPS FOR CONSIDERING ASSISTIVE TECHNOLOGY

Consideration ProcessStep 1: Prior to the meeting, to aid in practical consideration of assistive technology, ateam may choose to observe the student in his customary environment to gaininformation on current activities and supports, and determine how well they work. Thisobservation may assist the team in making an informed decision regarding whetherassistive technology is already in place, what is working well, and potentially give someguidance regarding areas where any additional options may be needed. A form whichmay be useful is the Assistive Technology Status Log. The Student, Environments, and TasksWorksheet, Family and Student’s Worksheets in Section 3 can also be used to gather inputfrom team members. Team members should make a point of reporting both successesand accomplishments in addition to areas of difficulty. The Worksheets are brought to theteam meeting.

Step 2: At the team meeting, members conduct a group planning process to reviewinformation obtained from the Worksheets. It is recommended that a flip chart oroverhead be used so everyone can see all the topics from the worksheet that need to bediscussed. A template that can be used for this activity is the Assistive Technology GroupPlanning Process provided in Section 3. Note that the topics on this template directlyrelate to the information on the Worksheets. The primary objective of this group processis to identify tasks the student needs to be able to do in relation to “student” factors (e.g.,skills, abilities, functional competencies) and environmental circumstances that impactperformance. It is recommended that teams quickly move through the information onthe Student, Family, and Environments, portions of the worksheet, spending only a fewminutes per topic if the team is in general agreement with the data that has beengathered. Generally, more attention is paid to the Tasks section (i.e., the naturallyoccurring activities that take place in the environment that are critical to the student),since the team cannot generate AT solutions until those tasks have been identified. Theteam should choose from 1 to 3 critical tasks for solution generation.

Step 3: Once all aspects of the Student, Family, Environments, and Tasks Worksheet have been addressed, the team needs to generate solutions through brainstorming. The details of the solutions will vary, based on the knowledge and experience of the team members. Some team members may be able to name a specific product that they think may assist the student. Others will only be able to list features; for example “sayseverything while it is typed” or “needs to be portable” or “has only 2 messages.” Teams can use the Assistive Technology Checklist in Section 3 to review a wide range of AT devices and strategies that can be used to address student needs in such areas as writing, reading, daily living skills and transition. Also, other resources in that can be used include the Closing the Gap Directory (as updated) Trace Resource Book (as updated), or teamscan seek the advice of an AT consultant or any one of the number of state and regionalresource persons listed in the Resources for Assistive Technology section of this manual.

Step 4: This step involves “solution selection.” The team discusses solutions listed, thinking about which ones might be the most effective for the student. Team membersmay want to identify solutions that can be implemented either immediately, in the nextfew months, or in the future. At this point, the Planning and Implementation Summary can be used to list specific devices, hardware and software. Consisting of two sections,“Planning” and “Implementation,” the Planning and Implementation Summary is used to help team members consider a wide range of factors (e.g., training, cost, storage) involved in selecting and using assistive technology. Once again, if team members are uncertain aboutthe name or purpose of the devices, you can use the resources included in this manual. It isimportant to note that in some cases, a strategy rather than a device or product may be identified.

Team members gather information prior to meeting. Use Assistive Technology Status Log and Student, Environments and Tasks, Family and Student Worksheets.

Team meets and conducts group planning process, using information gathered through worksheets.

Team generates possible solutions

through brain storming. Possible solutions can be specific or more

generic. May use AT Checklist to identify

solutions.

Specific tools or strategies are selected for

implementation. Use Planning and

Implementation Summary.

Step 5: Develop implementation plan, which could include extended consideration with any identified devices or products or evaluation. Use the Planning and Implementation Summary to assign names, dates and follow-up plan and meeting. Implement the plan, collect relevant data and conduct follow-up on the planned date.

Initiate the Implementation

Plan


SETT FRAMEWORK COLLABORATIVE CONSIDERATION OF ASSISTIVE TECHNOLOGY DEVICES AND SERVICES

Part 1.: Consideration of Student NeedStudent: ____________________________________________________ Date: ______________________________________Perspective: _________________________________________________PART 1: Examining Current Conditions to Consider Educational Need

Student Environments Tasks

Circle areas which may present barriers to student’s progress.

PART 2: Consideration of Tool System

System requirement

s

Required

Helpful Services or tools to

consider (no tech/low tech/high tech)

Tool availabili

ty

Services required for effective us

S P A Student Staff Family

Availability Key:S = Tools/devices systematically available to all students servedP = Tools/devices programmatically available through special education or other program for which student qualifiedA = Additional tools/devices which may be required to address identified need

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