Confidential Early Intervention Program - IFSP · PDF fileJanie likes to play with babies and her older sister's barbie dolls. ... Service: Speech-language therapy Setting: Home Service:

ConfidentialEarly Intervention ProgramStudent: Janie Smith Date Notice:School: Demo Elementary School District: Demo DistrictParents: Sally Smith

Initial IFSPChild's Name: Janie Smith Phone:Child's Birthdate: 2009-05-01 SSN: 222-77-7788Age: 2 Medicaid# 999888333-12Referral to Early Intervention: where does this come from? Address: 222 East Second Street Pall, NE 65789Family's Language Choice: Choose... Date of Consent for Evaluation: 10/26/2011Additional Language Choice: NoneFamily would like an interpreter: Date MDT: 11/04/2011

Parent(s) / Guardian1. Sally Smith Role: Parent

Home Phone: Work Phone:Address: 222 East Second Street Pall, NE 68789

Service Coordinator / Case Manager InformationIf you have any questions about this plan or any of the people working with your child, please call the person listed as the Services Coordinator / Case Manager.Name: Sue Bainter Phone: 402-471-1860Agency: Address:

IFSP Meeting DatesType Secondary Role Date Date SentInitial None 11/04/2011

IFSP Previous Meeting DatesType Date Date SentNo previous meeting dates found.

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EI-1 Rev 11/98 (57060)Student: Janie Smith | School: Demo Elementary | DOB: 2009-05-01 | SRS Student ID #1384739

NEBRASKA INDIVIDUAL FAMILY SERVICE PLAN (IFSP) | page 1

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Previous IFSPsNo previous IFSPs to display.

Date Family Concerns And Desired Priorities11/04/2011

Sally would like Janie to use more words and maybe even some phrases that are understandable to someoneoutside of their immediate family.

Sally wants to take some night classes. She is not sure yet what she wants to do for a job.

Sally wants to use a Services Coordinator.

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Previous IFSPsNo previous IFSPs to display.

Date Familychild And Family Strengths11/04/2011

Janie likes to be around other children and goes to the local daycare 3 mornings per week.

Janie likes to play with babies and her older sister's barbie dolls.

Sally says that about a fewmonths ago, she could not understand anything Janie would say but could figure out whatshe wanted by having Janie take her to what she wanted. She doesnt know why she can understand a few wordsnow, but no one else can.

Sally has made an appointment to talk to the local community college about possible coursework. Sally's Mom livesnearby and Janie and the family see her often.

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Initial IFSPChild's Present Levels of Development

Previous IFSPsNo previous IFSPs to display.Date Vision - Date / Current Abilities

11/04/2011 Janie can see things across the room on the floor or table. She gets around the house and daycare safely. She seesand recognizes pictures in books because she tries to say them.

Previous IFSPsNo previous IFSPs to display.Date Hearing - Date / Current Abilities

11/04/2011 Janie passed her newborn hearing screen and Mom has no current concerns. Janie has only had one ear infectionand can hear Mom calling her from across the house or when she is upstairs.

Previous IFSPsNo previous IFSPs to display.Date Health/Status - Date / Current Abilities11/04/2011 Janie has been very healthy. She recently got her H1N1 shot.

Previous IFSPsNo previous IFSPs to display.Date Cognitive/Thinking Skills - Date / Current Abilities

11/04/2011

Janie likes to "take care" of babies and puts them in blankets. She pretends to feed them with a bottle. She also likesto play with dishes and stacks them up as well as pretending to eat from them. Janie likes to do puzzles with her oldersister. She also likes to play barbies if her sister lets her. Janie loves books, especially ones about animals and bringsbooks to her family to read to her. She points to pictures and if Mom says the name, Janie will sometimes saysomething that is not understandable, other times she smiles or laughs. She tries to make animal sounds too. Janiefollows routine directions from Mom and also will go to her room, the bathroom, to the car, etc. if she hears Mom oranother family member talking about it.

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Previous IFSPsNo previous IFSPs to display.Date Communication Skills - Date / Current Abilities

11/04/2011

Janie says a few words that mostly only Mom can understand: "da" for her name when asked, "dee" when asked howold she is; also "owie", "mommy", "mama" (for gramma). She occasionally tries to put a couple words together "I ite"for "I write", "ho baba" for "hold baby". Sometimes Janie will take Mom or another family member by the hand to showwhat she wants but other times she gets frustrated and will cry or whine.

Previous IFSPsNo previous IFSPs to display.Date Social/Behavior Skills - Date / Current Abilities

11/04/2011

Janie loves music and likes to dance to it. She can even hum some of her favorite songs. She likes to be outside andchase the cat around. She plays well with the other children at daycare - usually this is alongside if in the house, butalso will do puzzles with other children her age or slightly older, or simple games. She also loves to go to Grandma'shouse.

Previous IFSPsNo previous IFSPs to display.Date Self-Help/Adaptive Skills - Date / Current Abilities

11/04/2011Janie is a really good eater and usually eats just about anything that Mom gives her. She drinks from a regular cupand uses silverware. She can undress herself and gets her pajamas on at night. She is very nearly potty trained andhas just started to tell Mom when she has to go "pe".

Previous IFSPsNo previous IFSPs to display.Date Fine Motor Skills - Date / Current Abilities

11/04/2011 Janie likes to scribble on paper. She picks up small pieces of food using her thumb and index finger. She uses theknobs on puzzles which are pretty small. She likes to color in her coloring book if her sister is doing this too.

Previous IFSPsNo previous IFSPs to display.Date Gross Motor Skills - Date / Current Abilities

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11/04/2011Janie can kick a ball and tries to peddle on her big wheel. Sometimes she can and other times she might just pushwith her feet. She runs, jumps, and climbs on furniture. She can go down the slide by herself at the park and likes toswing.

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Goal #1Goal / Outcome

Janie will spontaneously use words and phrases during mealtime, while reading books, and when playing babies/Barbies with hersister or other children at home and daycare. We will know she can do this when all family members and other children canunderstand her words and phrases and she does not have to show them what she wants/means. This should happen at least onceper day at home and daycare.

Child / Family strengths and resources related to this goal:

Janie loves playing with babies when at home and daycare. She also likes to play Barbies with her sister.

Jamie likes to have books read to her and sometimes tries to repeat something she hears Sallysay after Janie has pointed to apicture.

Janie has a few words and 2 word phases that are meaningful and Sallycan understand her.

Janie is a good eater and the family eats the evening meal together.

What will be done / by whom:

Sallyand daycare provider will:

* Be sure to talk about what they are doing in short words/phrases that match Janie's current level of communication.

* Offer Janie choices between things so that she can hear the words rather than trying to guess what she wants and askingquestions.

* Use Janie's interests to offer the opportunity for her to talk about what she likes.

* Repeat the words that Janie says, slowly and clearly so that Janie can hear what they sound like.

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Primary Coach (SLP) will:

* Come during high interest or high opportunity times of day to both the home and daycare, to discuss, model and brainstormabout how to promote Janie's words by using books, play with babies, etc. as opportunities for Sally to model sounds for Janiewithin the context of everyday language.

* Show Sallyand other caregivers how to use wait time when offering Janie a choice or the opportunity to say something, e.g. whenJanie points to a picture in a book, say "is that a puppy or a kitty?" and then reinforce anything she tries to say.

* Share progress observed and discuss next steps, invite Sally to include her observations in the GOLD assessment system.

* Help Sally and other caregiversapply successful strategies to other routines and learning opportunities.

* Be in contact with the early intervention team to participate in team meetings and receive coaching from the rest of the team.

Services Coordinator will:

* Participate in team meetings to provide updated information regarding the family.

* Be in contact with the family at least monthly to update the IFSP, record progress of outcomes, and assist in coordination ofresources to meet ongoing needs as identified by the family.

Progress will be reviewed every 3 months by family and PC through observation, family report

Plan Review for this Goal

Previous IFSPsDate: Previous IFSP TextHow much progress :Next Steps / Comments:

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Goal #2Goal / Outcome

Sally will meet with the community college counselor and find at least one course to enroll in by January of 2012.Child / Family strengths and resources related to this goal:

Sally has an appointment with the college already next month.

Sally's Mom is willing to help with taking care of the children depending on when the course(s) may be offered.

Sally will qualify for financial assistance.

What will be done / by whom:

Sally will:

* Think about what her interests are before the appointment at the college.

* Explorepossible courses and job/career possibilities.

* Fill out the paperwork for the financial assistance.

Services Coordinator will:

* Explain eligibility for use ofrespite funds to pay Grandma (Sally's Mom) if she watches the children.

*Assist Sally in completing necessary paperwork to access funding resources and explore other options such as childcare if Sally isnot eligible for respite subsidy.

* Assist Sally in completing financial aid paperwork and any additional needs related to college enrollment.

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Service: Speech-language therapySetting: Home

Service: Services coordinationSetting: Home

Progress will be reviewed every 3 months by family and ServicesCoordinator through Family report and

enrollment in coursework

Plan Review for this Goal

Previous IFSPsDate: Previous IFSP TextHow much progress :Next Steps / Comments:

Are there special conditions for safe transportation for this child?Car seat.

The Services that will be provided to support all goals and objectives are:

How Often? How Much? Group/Individual? Natural Environment?12 days/6 month period 60 min/day Group and Individual X Yes NoWhen service Starts and Ends? Who pays? Who's Responsible?11/04/2011 / 05/04/2012 School district Primary Service ProviderInclude a justification of the extent, if any, to which a service will not be provided in a natural environment.

How Often? How Much? Group/Individual? Natural Environment?1 days/month 30 min/day Individual X Yes NoWhen service Starts and Ends? Who pays? Who's Responsible?11/04/2011 / 05/04/2012 Early Development Network Services CoordinatorInclude a justification of the extent, if any, to which a service will not be provided in a natural environment.

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Initial IFSPIFSP TRANSITION PLAN

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Team Members Present at the Meeting

Print Name Role Other Address and PhoneSigonFile

Sue Bainter Service Coordinator NDE Lincoln, NE 68509Choose...

PARENTS /FAMILY

Yes No I (we) understand the content of the IFSP and give consent for all services in the IFSP to begin unless indicatedbelow.

Yes No I (we) understand that a copy of the IFSP will be distributed within 7 calendar days.

PARENT / GUARDIAN SIGNATURE

Parent Signature 1 Parent Signature Date 1Parent Signature 1

Yes No

Parent Signature 2 Parent Signature Date 2Parent Signature 2

Yes No(If 'No' selected above, please explain)Any Comments:

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Confidential Early Intervention Program - IFSP · PDF fileJanie likes to play with babies and her older sister's barbie dolls. ... Service: Speech-language therapy Setting: Home Service: