Behavior Chart Template for Adhd at School

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Behavior Chart Template for Adhd at School Powered By Docstoc
					                                                                     Revised 09-2010

           LPPS Sample IEP Statements
  Suggestion: Save these samples to your desktop for easy access.
  REMEMBER: These are only samples. They should be as a guide and
  should be changed to reflect the individual student!!

  NOTE: Anything highlighted in yellow is information added to this document for
  the 2010-2011 school year.

    Gen. Student             Gen. Student Information        Instructional Plan Page
  Information Page           Consideration of Special       Resource/Self Contained
                                      Factors                       Subjects
Instructional Plan Page       Instructional Plan Page        Instructional Plan Page
   Inclusion Subjects           Supplemental Aids                     LAA 1
  Dismissal of Related        Program Services Page           Assistive Technology
  Services Statements               Statements                     Statements



          GENERAL STUDENT INFORMATION
  The following is a suggested template to assist you with writing each section of
  the IEP. If these suggestions do not fit your student’s needs, you should
  delete the unnecessary information. Feel free to add additional information
  pertinent to the student.

  Note: After someone reads the GSI (pages 1 & 2) portion of a student’s IEP, they
  should know everything about that student that will follow in the IEP. The reader
  should know if the student is in an inclusion/resource/self contained setting, what
  related services the student receives, if he/she has be dismissed from related
  services, what, if any, AT the student utilizes, etc.

        PLEASE PROOFREAD STATEMENTS AND SPELLCHECK THE IEP.
        (IT IS UNACCEPTABLE TO WRITE AN IEP WITH INCOMPLETE OR
         GRAMMATICALLY INCORRECT SENTENCES.)


  General Information about the Student

  ___ is a ___ year old grade student who has been receiving special education
  services for the past ___ years. ___ is currently being served through
  ______________ (select one of the following service models: supplemental
  aides and services, inclusion, resource, a self-contained class or combination of
  services, name them). ___ has repeated ___ grade(s) or has never repeated a
  grade.

  Things to think about including:
      Make a case for alternate assessment
      What he/she can and can not do compared to regular students at his/her
       grade level
      Instructional/Behavioral strategies that were effective or ineffective
      Be specific
      Make statements that are factual or observable
      Do not make statements based on opinion

(Additional information about the family or particular situation/information may be
relevant and included in this section.)
 ____ lives with. (His/Her) family situation has (remained the same, changed
significantly {explain here}) ________. ___ enjoys ___________.

Strengths

Strengths are ___ (this information may be obtained from the most current
evaluation i.e., basic reading skills, reading comprehension, mathematics
calculations, mathematics problem solving, written expression, oral expression,
listening comprehension)

Parental Concerns

Parental concerns are _____.

Evaluation/Reevaluation Results

The last evaluation was conducted on **-**-****. ______ continues to have an
exceptionality of ______ and diagnosed condition (detail codes for SLD or
Multiple Disabilities students) included (see list above) _______. (His/Her)
triennial evaluation will be due on or before **-**-****.

(for a reevaluation, use below)

This is an IEP/Reevaluation. ___’s previous evaluation on **-**-**** indicated the
exceptionality of Developmental Delay, with related and academic services of
[Speech Therapy, Occupational Therapy, Adapted Physical Education, Physical
Therapy and list setting]. The current reevaluation results disseminated on **-**-
**** reveals that ___ now meets the criteria for a student with a (new
exceptionality) due to deficits in (see list above, or evaluation information).
Based on this current evaluation, ___ qualifies or no longer qualifies for related
services in (list). (His/Her) triennial evaluation will be due on or before **-**-****.

(for a triennial reevaluation waiver, use below)

A triennial reevaluation waiver was completed on ___ and (his/her) triennial
evaluation will be due on or before **-**-****. ____ continues to have an
exceptionality of ______. (His/her) diagnosed conditions (detail codes for SLD
students only) include (see above list) ______.
(LAA1 students)
Based on evaluation results_____ is functioning three or more standard
deviations below the mean in cognitive functioning and/or adaptive behavior and
is eligible for LAA1 assessment.

(LAA2 students)
____ is functioning three or more grade levels below the current grade level
placement in one or more core academic areas (i.e., math, science, social
studies, ELA) and is eligible for LAA2 assessment.


Academic, Developmental, and Functional Needs

______’s disability of _____ and impairments in _____ impede (his/her)
involvement and progress in the general curriculum. Results of the most recent
CBM indicate _____ is functioning on a _____ grade level in the area of
______________, ___ grade level in the area of _________, ___ grade level in
the area of __________ and ___grade level in the area of ___________.
Support needs are in the areas of_____. According to DIBELS Benchmark
testing conducted in the (fall/winter/spring) of (year), ___ was able to read __
words per minute given a __ grade probe. Access to the general curriculum can
be achieved through accommodations in these areas.

Statewide Assessment Results

_____ participated in the ______Statewide Assessment on ________ and results
are: Reading___, Language___, Mathematics ___, English ___, Science___,
and Social Studies___.

If iLEAP, report the national percentile rank NPR, for each area.
If LEAP, report the scaled score along with the descriptor.

(LAA1/LAA2)
____ participates in statewide assessment using the Louisiana Alternate
Assessment 1 (LAA1) [or, Louisiana Alternate Assessment 2 (LAA2)], due to
deficits in academic (or cognitive) skills. Results of the most recent LAA1 (or
LAA2), from the spring of ____, were: _____________________.

Progress or Lack of Expected Progress in the General Education
Curriculum

 ___ did/did not make satisfactory progress in the general curriculum. (His/Her)
grades for the __ nine weeks/interim were are as follows: Reading ___, Math
___, English ___, Science ___, Social Studies, and ______________. A review
of the IEP indicates that ___ achieved ___/___ goals from (his/her) last IEP.

CONSIDERATION OF SPECIAL FACTORS

Behavior
___’s behavior is _______ inappropriate and it _________ interferes with ___’s
educational performance. Behaviors of concern include ___. ___ has had a
Functional Behavior Assessment (FBA) and positive behavior strategies and
supports are being implemented through the attached Behavior Intervention Plan
(BIP). This behavior plan is being implemented and monitored by the
___________ (classroom teacher/Behavior Intervention Specialist-BIS/School
Social Worker/School Psychologist).

*** If the student’s behavior is no longer significant enough to warrant the
services of a BIS or a Pupil Appraisal SW/Psy, but will continue to be monitored
by the classroom teacher, the following statement should be included:

The IEP team has determined that ____’s behavior concerns no longer require
the related services provided by the school social worker (or school
psychologist). (His/Her) behavior intervention plan will be monitored by the
special education teacher.

NOTES: If you talk about behavior in this box, then it must be addressed either
with a BIP or with social goals. So discretion must be used.

If a student is OHI due to ADHD, and a BIP is attached, then you must have a
statement about ADHD type behaviors (use whatever behaviors the BIP is
focused on ex. Organization, paying attention etc.)

For other sample statements regarding behavior :
    Welcome Back IEP
    2nd and 3rd Suspension IEP
    Recommendation for Expulsion

Communication Needs

_____ receives ___ for ___ deficits.

____ was dismissed from speech therapy through the (IEP, reevaluation IEP) on
**-**-****. He/she has mastered all goals and objectives and demonstrates
appropriate articulation and language skills. (Consult with your Speech
Pathologist.)

Assistive Technology

The IEP team has considered assistive technology and it is not needed at this
time.

Based on current assessment results and analysis of required tasks within the
educational areas ____ has difficulty with ______________ task(s) and benefits
from the use of ___________ (calculator, hundred chart, alphabet chart, and
manipulatives, etc.) to access the general education curriculum.
Based on current assessment results, the IEP team determined that ____ no
longer is in need of the amplification device previously used on her hearing aide.

The IEP team has considered assistive technology and has decided to refer this
student for concerns in (specific area).*

*If you make the last statement on an IEP, then a copy of the IEP, current
evaluation and Request for Assistive Technology Form should be sent
immediately to the A. T. Department.

Please do not use the following statement in the AT box:

The IEP team may wish to consider the need for assessment of AT. (This is the
recommendation that comes from the evaluation team to the IEP team.)

To dismiss AT services use the following statement in the comments box
on the program service page of the IEP:

The IEP team has determined that ____’s AT services/devices no longer require
the related services provided by the Assistive Technology Team. His/Her
assistive technology devices/services plan will be monitored by the special
education teacher.

For more detailed information regarding AT services and devices, refer to
Assistive Technology.

Health Needs

Glasses/Hearing aids have/have not been prescribed. ___ has a medical
diagnosis of ___ and takes medication(s) (at home, at school). A health plan
was developed and will be incorporated into this IEP.

If a student that is OHI due to a medical diagnosis of ADD/ADHD and does not
take medication at all, we will no longer require you to request medical
information from the doctor. Please communicate with the parents, that school
personnel should be notified if this situation changes. The following statement
MUST be added to the Health needs box of the GSI for any student that is OHI
due to ADD/ADHD and does not take medication:

____ has a medical diagnosis of ADD/ADHD, which results in behaviors that
interfere with performance in the school environment (i.e., inattention, poor
organizational skills). ___ is not on medications, per parent report at this time.
However, behaviors are being addressed via _______ (i.e. BIP, social skills
goals). No IHP is required at this time. The parents have been asked to notify
the school if any changes are made in medications.

Other pertinent information relevant to the student’s health or medical
condition(s) may be included here. See IHP Cheat Sheet.
                   INSTRUCTIONAL PLAN

        RESOURCE/SELF-CONTAINED SAMPLE
         (Present Levels, Goals and Objectives)
Reading

Present Level of Academic Achievement and Functional Performance

Based on R-CBM administered in the fall of 2008, _____'s instructional levels are
at a ___ grade level in the areas of __________ and _______________. _____
’s present level of achievement adversely affects (his/her) performance in the
general education curriculum. Based on teacher observation, the student learns
best through (visual, auditory, tactile, kinesthetic, multi) strategies. Based on
(teacher interviews, observations, and evaluation results), ____
demonstrates the following: Strengths: [list] . Weaknesses: [list].

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level reading skills,
_____ will progress in the general curriculum by achieving 2 of the 3 targeted
objectives within the IEP year.

Objectives:

access _____’s current grade level comprehensive curriculum by achieving
scores of at least 67% accuracy throughout the IEP year in (his/her) reading
class as evidenced by weekly grades, teacher rubrics, observations and tests.

increase oral reading fluency from 32 words correct per minute (wcpm) to 79
wcpm in 1 minute from standard 2nd grade R-CBM reading passages in 36
weeks as evidenced by progress monitoring each 9 weeks.

increase correct responses on 2nd grade MAZE comprehension passages from 4
to 11 correct responses in 3 minutes in 36 weeks as evidenced by progress
monitoring each 9 weeks.

Math

Present Level of Academic Achievement and Functional Performance
Based on M-CBM administered in the fall of 2008, _____’s instructional level is
___ grade in the area of _________. _____’s present level of achievement
adversely affects (his/her) performance in the general education curriculum.
Based on teacher observation, the student learns best through (visual, auditory,
tactile, kinesthetic, multi) strategies. Based on (teacher interviews,
observations, and evaluation results), ____ demonstrates the following:
Strengths: [list]. Weaknesses: [list].

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____'s
academic achievement and functional performance on grade level math
calculations, _____ will progress in the general curriculum by achieving 1 of the 2
targeted objectives within IEP year.

Objectives:

access _________’s current grade level comprehensive curriculum by achieving
scores of at least 67% accuracy throughout the IEP year in _______’s math class
as evidenced by weekly grades, teacher rubrics, observations and tests.

increase digits correct from 15 to 26 in 2 minutes from standard 3rd grade
mathematics computation probes in 36 weeks as evidenced by progress
monitoring each 9 weeks.

*NOTE: 1st – 3rd grade (administration time - 2 minutes)
      4th – 8th grade (administration time - 4 minutes)

Written Expression

Present Level of Academic Achievement and Functional Performance

Based on WE-CBM administered in the fall of 2008, _____ 's instructional level is
___ grade in the area ________. _____ ’s present level of achievement
adversely affects (his/her) performance in the general education curriculum.
Based on teacher observation, the student learns best through (visual, auditory,
tactile, kinesthetic, multi) strategies. Based on (teacher interviews,
observations, and evaluation results), ____ demonstrates the following:
Strengths: [list]. Weaknesses: [list].

Measurable Academic/Functional Goal

Given appropriate modifications and accommodations designed to address
_____’s academic achievement and functional performance on grade level
written expression skills, _____ will progress in the general curriculum by
achieving 1 of the 2 targeted objectives within in the IEP year.

Objectives:
access ______’s current grade level comprehensive curriculum by achieving
scores of at least 67% accuracy throughout the IEP year in ______’s English
class as evidenced by weekly grades, teacher rubrics, observations and tests.

increase from 17 to 28 (total words written OR correct word sequences) in 3
minutes when given a story starter in 36 weeks as evidenced by progress
monitoring each 9 weeks.

Study Skills

Present Level of Academic Achievement and Functional Performance

Based on evaluation results, teacher observations, and review of academic
performance, _____ demonstrates difficulty with [organizational skills, completing
class and homework assignments, and staying on task]. _____’s present level
of functioning adversely affects (his/her) performance in the general education
curriculum. Based on teacher observation, the student learns best through
(visual, auditory, tactile, kinesthetic, multi) strategies. Based on (teacher
interviews, observations, and evaluation results), ____ demonstrates the
following: Strengths: asking for assistance when needed and writing assignments
in the daily planner.

Measurable Academic/Functional Goal

Given appropriate organizational techniques and study skill strategies designed
to improve _____’s academic performance, _____ will progress in the general
curriculum with scores of at least 67% in 6 out of 7 classes for 3 out of 4 nine
week grading periods.

Objectives

complete daily class and/or homework assignments when using the daily planner
with at least 67% completion of assignments as evidenced by teacher record
book each 9 weeks.

improve performance on tests given graphic organizers/study guides with at least
67% on tests as evidenced by teacher record book each 9 weeks.

keep a binder to organize notes, work sheets and materials as evidenced by at
least 67% as evidenced by teacher record book each 9 weeks.

Science

Present Level of Academic Achievement and Functional Performance

Based on teacher observations and review of academic performance, _____ is
functioning below current grade placement and _____’s academic and/or
behavioral deficits interfere with (his/her) performance in the general education
science curriculum. _____ has difficulty comprehending grade level science
materials. _____ is able to grasp concepts using modified materials and
instruction.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level science
materials, _____ will progress in the general curriculum by achieving scores of at
least 67% each nine weeks throughout the IEP year.

Objectives

complete class/ homework assignments with at least 67% completion as
evidenced by teacher record book each 9 weeks.

participate in classroom activities with 67% participation as evidenced by teacher
record book each 9 weeks.

participate in classroom experiments following teacher directives with 67%
participation as evidenced by teacher record book each 9 weeks.

complete projects as assigned by the teacher with 67% completion as evidenced
by teacher record book each 9 weeks.

Social Studies

Present Level of Academic Achievement and Functional Performance

Based on teacher observations and review of academic performance, _____ is
functioning below current grade placement and ______’s academic and/or
behavioral deficits interfere with (his/her) performance in the general education
social studies curriculum. Based on teacher observation, the student learns best
through (visual, auditory, tactile, kinesthetic, multi) strategies. _____ has
difficulty comprehending grade level social studies materials. _____ is able to
grasp concepts using modified materials and instruction.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____ ’s
academic achievement and functional performance on grade level social studies
materials, _____ will progress in the general curriculum by achieving scores of at
least 67% each nine weeks throughout the IEP year.

Objectives

complete class/ homework assignments with 67% completion as evidenced by
teacher record book each 9 weeks.
participate in classroom activities with 67% participation as evidenced by teacher
record book each 9 weeks.

complete projects as assigned by the teacher with 67% completion as evidenced
by teacher record book each 9 weeks.

Adaptive Social Skills (specific to each individual student’s behavior)

Present Level of Academic Achievement and Functional Performance

Based on teacher observations, a review of school disciplinary records, and
review of functional behavioral assessment(s), _____ exhibits inappropriate
social skills. _____ ’s present level of functioning adversely affects (his/her)
performance in the general education curriculum. Based on teacher observation,
the student learns best through (visual, auditory, tactile, kinesthetic, multi)
strategies. Based on (teacher interviews, observations, and evaluation
results), ____ demonstrates the following: Weaknesses: disrespectful to
authority figures at times and noncompliant with teacher directives. Strength:
interacts appropriately with peers.

Measurable Academic/Functional Goal

_____ will improve social skills development through the assistance of a behavior
plan specifically designed to address (his/her) difficulty with respect toward
authority figures and compliance issues by achieving 1 out of 2 objectives during
the IEP year.

Objectives

interact appropriately with authority figures as measured by daily/weekly
behavioral charting with __% compliance each 9 weeks.

comply with teacher directives as measured by daily/weekly behavioral charting
with ___% compliance each 9 weeks.

follow school rules as measured by daily/weekly behavioral charting with ___%
compliance each 9 weeks.


              INCLUSION SAMPLE (Goal Only)
Reading

Present Level of Academic Achievement and Functional Performance

Based on (teacher observations, report card grades, teacher, rubrics,
checklist, etc), _____________ is functioning at his/her current grade level
when provided appropriate modifications/accommodations. His/her deficits in the
area of _____ adversely affect his/her performances in the general education
curriculum therefore appropriate modifications/accommodations are needed to
enhance his educational functioning. Based on teacher observation, the student
learns best through (visual, auditory, tactile, kinesthetic, multi) strategies.
Based on (teacher interviews, observations, and evaluation results), ____
demonstrates the following: Strengths: reading basic sight words and words
containing CVC patterns. Weaknesses: decoding multi-syllabic words and words
with variant vowel sounds.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____ ’s
academic achievement and functional performance on grade level reading skills,
_____ will progress in the general curriculum by achieving scores of at least 67%
each nine weeks throughout the IEP year.

Math

Present Level of Academic Achievement and Functional Performance

Based on (teacher observations, report card grades, teacher, rubrics,
checklist, etc), _____________ is functioning at his/her current grade level
when provided appropriate modifications/accommodations. His/her deficits in the
area of _____ adversely affect his/her performances in the general education
curriculum therefore appropriate modifications/accommodations are needed to
enhance his educational functioning. Based on teacher observation, the student
learns best through (visual, auditory, tactile, kinesthetic, multi) strategies.
Based on (teacher interviews, observations, and evaluation results), ____
demonstrates the following: Strengths: adding and subtracting basic facts.
Weaknesses: adding and subtracting with regrouping.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level math skills,
_____ will progress in the general curriculum by achieving scores of at least 67%
each nine weeks throughout the IEP year.

Written Expression

Present Level of Academic Achievement and Functional Performance

Based on (teacher observations, report card grades, teacher, rubrics,
checklist, etc), _____________ is functioning at his/her current grade level
when provided appropriate modifications/accommodations. His/her deficits in the
area of _____ adversely affect his/her performances in the general education
curriculum therefore appropriate modifications/accommodations are needed to
enhance his educational functioning. Based on teacher observation, the student
learns best through (visual, auditory, tactile, kinesthetic, multi) strategies.
Based on (teacher interviews, observations, and evaluation results), ____
demonstrates the following: Strengths: writing simple sentences. Weaknesses:
writing complex sentences and paragraphs.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level written
expression skills, _____ will progress in the general curriculum by achieving
scores of at least 67% each nine weeks throughout the IEP year.

Science

Present Level of Academic Achievement and Functional Performance

Based on teacher observations and review of academic performance, _____ is
functioning below current grade placement and his academic and/or behavioral
deficits interfere with (his/her) performance in the general education science
curriculum. Based on teacher observation, the student learns best through
(visual, auditory, tactile, kinesthetic, multi) strategies. _____ has difficulty
comprehending grade level science materials. _____ is able to grasp concepts
using modified materials and instruction.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level science
materials, _____ will progress in the general curriculum by achieving scores of at
least 67% each nine weeks throughout the IEP year.

Social Studies

Present Level of Academic Achievement and Functional Performance

Based on teacher observations and review of academic performance, _____ is
functioning below current grade placement and ____’s academic and/or
behavioral deficits interfere with (his/her) performance in the general education
social studies curriculum. Based on teacher observation, the student learns best
through (visual, auditory, tactile, kinesthetic, multi) strategies. _____ has
difficulty comprehending grade level social studies materials. _____ is able to
grasp concepts using modified materials and instruction.

Measurable Academic/Functional Goal

Given appropriate modifications/accommodations designed to address _____’s
academic achievement and functional performance on grade level social studies
materials, _____ will progress in the general curriculum by achieving scores of at
least 67% each nine weeks throughout the IEP year.
Study Skills

Present Level of Academic Achievement and Functional Performance

Based on evaluation results, teacher observations, and review of academic
performance, _____ demonstrates difficulty with organizational skills, completing
class and homework assignments, and staying on task. _____ ’s present level
of functioning adversely affects (his/her) performance in the general education
curriculum. Based on teacher observation, the student learns best through
(visual, auditory, tactile, kinesthetic, multi) strategies. Strengths: asking for
assistance when needed and writing assignments in the daily planner.

Measurable Academic/Functional Goal

Given appropriate organizational techniques and study skills strategies designed
to improve _____ ’s academic performance, _____ will progress in the general
curriculum with scores of at least 67% in 6 out of 7 classes each nine weeks
throughout the IEP year.

Behavior

For other sample statements regarding behavior :
    Welcome Back IEP
    2nd and 3rd Suspension IEP
    Recommendation for Expulsion

Present Level of Academic Achievement and Functional Performance

Based on teacher observations, a review of school disciplinary records, and
review of functional behavioral assessment(s), _____ exhibits inappropriate
social skills. _____ ’s present level of functioning adversely affects (his/her)
performance in the general education curriculum. Weaknesses: disrespectful to
authority figures at times and noncompliant with teacher directives. Strength:
interacts appropriately with peers.

Measurable Academic/Functional Goal

_____ will improve social skills development through the assistance of a behavior
plan specifically designed to address (his/her) difficulty with respect toward
authority figures and compliance issues by receiving fewer than 4 office referrals
each 9 weeks.


    Supplemental Aids and Services (Goal Only)
Present Level of Academic Achievement and Functional Performance
Based on evaluation results, teacher observations, and review of academic
performance, _____ demonstrates difficulty with organizational skills, completing
class and homework assignments, and staying on task which adversely affects
(his/her) performance in the general education curriculum. Based on teacher
observation, the student learns best through (visual, auditory, tactile,
kinesthetic, multi) strategies. Based on (teacher interviews, observations,
and evaluation results), ____ demonstrates the following: Strengths: asking for
assistance when needed and writing assignments in the daily planner.
Weaknesses:

Measurable Academic/Functional Goal

When provided with teacher consultation, student monitoring, and teacher
collaboration, _____ will progress in the general curriculum with scores of at least
67% in 6 out of 7 classes for 3 out of 4 nine week grading periods.


  LAA1 STUDENTS USING BRIGANCE AS BASELINE
       (ACADEMIC/Reading or Literacy Skills)
Present Level of Academic Achievement and Functional Performance

_____ was assessed using the Brigance Diagnostic Inventory of Early
Development II. Strengths were noted in Response To/ Experience with Books,
with performance at the early 6 year developmental level. _____ could also read
a few color words (i.e., red, blue, green), a few number words (i.e., one, ten), and
a few common signs (i.e., go, stop, boys), with cues, at the early 6 year level;
most basic reading vocabulary were not known. Weaknesses were noted on
Matching Initial Consonants with Pictures (below 6 year level, with no correct
responses) and Word Recognition Grade Placement (no sight words correctly
identified at the kindergarten level or above).

Measurable Academic/Functional Goal

_____ will increase early reading skills at his/her grade level to progress in the
general education curriculum, with accommodations and modifications at his/her
instructional level, by achieving 3 of 4 targeted objectives during the IEP year.

Objectives

identify five of ten kindergarten sight words with maximum visual cues and
teacher modeling, given opportunity, at 80% accuracy. (NOTE: objective starts
at the Kindergarten level, page 25 of the Brigance record book.)

match initial consonants of “b, h, s, m, w, f” with pictures presented, with
assistance and verbal directions, at 80% accuracy. (NOTE: objective starts at
skills needed at 6 year developmental level; page 26 in booklet.)
identify common signs, color, and number words in the classroom environment,
with minimal assistance, given at least two opportunities during the school day,
with 80% accuracy.

(NOTE: objective addresses a skill that is emerging: words at the early 6 year
level are worked on with intent to increase the number of words and level of
independence in the 6 year range; page 25 in booklet).


LAA1 STUDENTS USING BRIGANCE AS BASELINE
         Non-Academic/Self-Help Skills
Present Level of Academic Achievement and Functional Performance

_____ was assessed using the Brigance Diagnostic Inventory of Early
Development II. Weaknesses were noted in Grooming (at beginning 5 year
developmental level), Toileting (at early 4 year level), and Dressing (at the mid-3
year level). Relative strengths were noted in Feeding/Eating (at 5 year level),
Bathing (nearing 6 year level), and Fastening (at the early 5 year level). _____
attempts tasks with prompting and assistance, but is not usually independently
successful. Visual cues, such as photos or icons, have been helpful in the
classroom instruction.

Measurable Academic/Functional Goal

_____ will increase self-help skills to the 5 year developmental level, with
accommodations and modifications at his/her instructional level, by achieving 3
of 4 stated objectives during the IEP year.

Objectives

brush teeth, given a toothbrush prepared with toothpaste, with visual cues and
teacher modeling, given daily opportunity, at 80% accuracy.

(NOTE: objective starts at the 5 year level, page 11 of the Brigance record book.)

pull pants/shorts down (or up) for toileting, given at least two daily opportunities,
with assistance and verbal directions as needed, at 80% accuracy. (NOTE:
objective starts at 4 year level to work toward the end of the Toileting section, at
the 5 year developmental level, but also taps into the Dressing section by
including a 3 year level task and working upward; pages 11 and 10, respectively,
in booklet.)

put on socks, with assistance only as needed, given at least two opportunities
during the school day, with 80% accuracy.

(NOTE: objective addresses a skill that is emerging in the 3 year range; page 10
        in booklet)

pull on a jacket or large garment, with maximum assistance as needed, given at
least two opportunities during the school day, with 80% accuracy.

(NOTE: objective addresses a skill that is nearing the 4 year range; page 10 in
booklet)




                      PROGRAM/SERVICES
Louisiana Education Assessment Program (LEAP)

If LAA 1 or LAA 2 is chosen, justification as to why the Alternate Assessment
is appropriate for the student must be provided.

Samples of justification statements:

LAA 1

1. “If alternate assessment is checked, explain why the student cannot participate
in the regular assessment, and”

(Sample 1) _______ has significant delays in the developmental skills areas of
(list impairments from current evaluation). _____requires extensive modified
instruction to acquire, maintain, and generalize skills; therefore, (his/her)
assessment needs should be aligned with the way (he/she) acquires knowledge.

(Sample 2) _____ continues to have significant delays in the developmental
skills areas of (list current qualifiers from physical, self-help, social,
communication, intellectual, and adaptive behavior.)

Academically, (he/she) does not have the reading, writing, and math skills
needed to be successfully assessed by the regular LEAP test even when given
numerous accommodations and modifications.

2. “why the particular alternate assessment selected is appropriate for the
student.”

(Sample 1) The regular statewide general education assessment will not be an
appropriate assessment because it does not provide an accurate appraisal of
_____educational progress.

(Sample 2) The IEP committee agrees that __________ continues to qualify for
Alternate Assessment because the statewide general education assessment will
not provide an accurate appraisal of his educational progress.
LAA 2

1. “If alternate assessment is checked, explain why the student cannot participate
in the regular assessment, and”

(Sample 1) The IEP committee has determined that _____cannot participate in
the regular statewide general education assessment because the statewide
general education assessment will not provide an accurate appraisal of (his/her)
educational progress. (He/She) does not have the reading, writing, and math
skills needed to be successful with the regular LEAP/GEE test even when given
numerous accommodations and modifications.

(Sample 2). The IEP committee has determined that _____cannot participate in
the regular statewide general education assessment because this assessment
even with accommodations and modification is not sufficient to measure (his/her)
persistent academic disabilities.

2. “why the particular alternate assessment selected is appropriate for the
student.”
The IEP committee has determined that the LAA 2 assessment is an appropriate
assessment for _____because it will afford (him/her) to demonstrate optimal
skills and knowledge gained in the general curriculum.


Regular Classes

Sample Statement
[This statement will only be used it the student does not attend regular classes.]

Currently, _____’s (cognitive, physical) needs are best met in a self-contained
classroom setting with accommodations and modifications.


Activities with Non-Disabled Peers

The rare instance a statement should be made in this box. You can always ask
for guidance.

Sample Statement:

[Only in those unusual situations where the student is unable to access the school
campus and non-classroom activities at ANY time during the school day with non-
disabled peers, provide a statement such as:]

_________ has severe behavioral and/or physical needs that make participating
with non-disabled peers difficult and/or unsafe for (him/her). (He/She) has access
to these activities through a one-to-one staff-student model at the discretion of
the IEP team.
Comments

This block (Comments) should be used to add any additional information that the
IEP team feels is needed to clarify a student's instructional program.

      Explanation of service delivery model for speech, OT and PT.
      State the need for doctor’s orders for OT and PT.
      May state that the IEP was held with a reevaluation with a change to
       exceptionality.
      Any specific comments directly related to the student.
      Use the following dismissal statements when a related service provider
       will no longer service a student.
           o AT - The IEP team has determined that ____’s AT services/devices
               no longer require the related services provided by the Assistive
               Technology Team. His/Her assistive technology devices/services
               plan will be monitored by the special education teacher.
           o BIS – The IEP team has determined that ____’s behavior concerns
               no longer require the related services provided by the school social
               worker (or school psychologist). His/Her behavior intervention plan
               will be monitored by the special education teacher.
           o OT (speech, APE, PT)– Based on current assessment, student
               progress, and development of skills, the IEP team has determined
               that ____ no longer qualifies for the related services provided by
               the ____________. The student will be monitored by the special
               education teacher.
           o Audiological - The IEP team has determined that the student no
               longer requires the related services provided by the school based
               audiologist. The student will be monitored by the special education
               teacher/Teacher of the Hearing Impaired.
      LAA2 - Every time a LAA2 decision is made on the annual IEP the
       following statement must discussed with the parent and added to the
       comment box.
           o Criteria for graduation with a high school diploma have been
               discussed with the parent. The parent is aware that earning a high
               school diploma requires: successful passage of Carnegie units for
               core curriculum that are taught by highly qualified regular education
               teachers, completion of the requirements for attendance and end of
               course testing.

Interpreter services (minutes) will no longer be listed on the Services section of
the IEP. The interpreter should be listed as an IEP participant under OTHER and
sign the IEP. The following statement will be made in the comment box:
Student receives interpreting services through an interpreter.


Supports Needed for School Personnel
The special education teacher will collaborate with _____’s regular education
teacher, and the related service providers.

Collaboration with regular and special educators, as well as (speech therapist,
occupational therapist, adapted physical education teacher, physical therapist,
Behavior intervention specialist) will address ______’s needs during the IEP
year.

				
DOCUMENT INFO
Description: Behavior Chart Template for Adhd at School document sample