Fillable Determining the Need for Special Circumstance Instructional Assistance

Fill Online, Printable, Fillable, Blank Determining the Need for Special Circumstance Instructional Assistance Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Determining the Need for Special Circumstance Instructional Assistance

On average this form takes 120 minutes to complete

The Determining the Need for Special Circumstance Instructional Assistance form is 33 pages long and contains:

  • 0 signatures
  • 168 check-boxes
  • 403 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 1
Determining the Need for Special Circumstance
Instructional Assistance (SCIA)
Section A Rationale
Section B Least Restrictive Environment (LRE)
Section C Factors for Special Circumstances
Section D Special Circumstance Assistance/Support
Section E Procedures for Requesting Special Circumstance Instructional Assistance
Section F Training
The purpose of this handbook is to provide Local Education Agency (LEA) personnel information and
guidance in determining a student with a disability’s need for special circumstance instructional
assistance (SCIA) support. A recommendation for a SCIA is a significant programmatic decision and one
that should only be made after a comprehensive discussion of other options considered and clear
documentation of as to why those options are not appropriate. While, some students may temporarily
need the support of a SCIA to receive a free appropriate public education (FAPE), for other students, the
assignment of a SCIA may be unnecessary and inappropriately restrictive.
A goal for all students with disabilities is to promote and maximize independence. LEAs are responsible
for developing and implementing individualized education programs (IEPs) that promote such
independence. When an IEP team determines that a student needs a SCIA, it should always be
considered a time-limited recommendation and specific conditions/goals must be established to fade
the use of a SCIA.
California Education Code states,
E.C. § 56363 (a) As used in this part, the term “designated instruction and services”
means “related services” as that term is defined in Section 1401(26) of Title 20 of the
United States Code and Section 300.34 of Title 34 of the Code of Federal Regulations.
The term “related services” means transportation, and such developmental, corrective,
and other supportive services (including speech-language pathology and audiology
services, interpreting services, psychological services, physical and occupational therapy,
recreation, including therapeutic recreation, social work services, school nurse services
designed to enable an individual with exceptional needs to receive a free appropriate
public education as described in the individualized education program of the child,
counseling services, including rehabilitation counseling, orientation and mobility
services, and medical services, except that such medical services shall be for diagnostic
and evaluation purpose only) as may be required to assist an individual with exceptional
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 2
needs to benefit from special education, and includes the early identifications and
assessment of disabling conditions in children.
A. Rationale
Every LEA within the Desert/Mountain Special Education Local Plan Area (SELPA) is required to
provide a full continuum of placement options for students with identified disabilities who are
receiving special education services. The Individuals with Disabilities Education Act (IDEA 2004) and
California laws and regulations describe a continuum of alternative placements such as instruction in
regular classes, special classes, special schools, home instruction, and instruction in hospitals and
institutions [Title 34 of the Code of Federal Regulations (CFR) 300.551(b)(1)]. Both federal and state
laws also contain provisions to ensure that children with disabilities are educated to the maximum
extent possible with children who are not disabled, and that children are removed from the general
education environment only when the nature and severity of the disability is such that education in
the regular classroom cannot be satisfactorily achieved with the use of related services.
B. Least Restrictive Environment (LRE)
By law, services to students with special needs must be delivered in the "least restrictive
environment." When an IEP team is considering special circumstance support for a student, all
aspects of the student's program must be considered with the intent of maximizing student
independence. The teacher(s) is responsible for the design and implementation of the student's
program.
C. Factors for Special Circumstances
Whenever special circumstance support is being considered by an IEP team for a student with
special needs, the following factors need to be considered:
Personal Independence
First and foremost, an important goal for all special education students is to encourage,
promote, and maximize independence. If not carefully monitored, special circumstance
assistance can easily and unintentionally foster dependence. A student's total educational
program must be carefully evaluated to determine where support is indicated. Natural support
and existing staff support should be used whenever possible to promote the least restrictive
environment.
The general categories to be considered for special circumstance instructional assistance
include:
1. Health/Personal Care Issues
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 3
2. Behavioral Support
3. Instruction
4. Inclusion/Mainstreaming
D. Special Circumstance Assistance/Support
1. IEP teams should identify the need for related services based on appropriate documentation
and assessment. If the IEP team recommends such services, the following statements must be
considered for inclusion in the IEP:
a) The related service is necessary to the child to benefit from his/her special education
program;
b) The program modifications or supports for school personnel are necessary to assist the
child; and
c) The related service will assist the child to:
1. Advance appropriately toward the annual goals;
2. Be involved in and progress in the general curriculum;
3. Participate in extracurricular and other nonacademic activities; and
4. Be educated and participate with other disabled and non-disabled children.
2. The IEP team shall address the means for reviewing and evaluating the necessity of continuing
special circumstance instructional assistance services to the student.
3. The IEP team shall also include a statement of the anticipated frequency and duration for the
services and modifications.
4. If it is determined that additional personnel support is required, the IEP team should periodically
review the effectiveness of this additional support. A systematic, written plan needs to address
how additional personnel support will be monitored.
5. For services requiring additional personnel support as a result of a student’s behavioral
difficulties, the student’s IEP needs to include appropriate goals. In addition, a behavioral
intervention plan (BIP) should be developed in accordance with Sections 3001 and 3052 in Title
5 of the California Code of Regulations (CCR). The BIP needs to include a provision describing
how and when support, including personnel, will be utilized to implement the plan, and when
the plan will be reviewed and modified.
6. When determining the need for additional personnel support due to an instructional need, the
IEP team must utilize appropriate assessment information to support this recommendation. The
written plan must be developed by a general and/or special education teacher specifying how
the additional personnel will be utilized to support the teacher in implementing the student’s
goals and objectives and what attempts will be made to transition other available classroom
resources and supports.
7. When a need for additional support is due to medical need, a specialized health care plan will
need to be developed. (Utilize D/M SELPA Form 93, 94, and 95, as appropriate)
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 4
8. When special circumstance assistance is being considered for a specific student, a LEA
representative shall be required to participate in the decision-making process of the IEP
meeting.
E. Procedures for Requesting SCIA
A SCIA may be provided for students with disabilities when additional support is necessary to the
student in order to meet his or her goals and to benefit educationally. Whenever possible,
additional assistance is assigned to a school environment, class, or case manager. Occasionally,
however, a student requires individual support for a designated period of time to address a unique
need. By law, services to students with special needs must be delivered in the "least restrictive
environment." When the IEP team is considering a SCIA, all aspects of the student's program must
be considered. A request for SCIA is made only after other site interventions have proven to be
ineffective. A student's educational program must be carefully evaluated to determine when and
where the additional support is required. Additionally, the IEP team must plan for periodic reviews
to assess the continued need for this type of individualized assistance.
It is expected that students enrolling in a non-public school (NPS) will not require SCIA support. For
students currently in NPS, if the need for SCIA becomes evident, the NPS should contact the
student's LEA of residence to initiate a referral for a SCIA evaluation. The LEA will evaluate the
student and present findings and recommendations to the IEP team. Whether in public school or
NPS, if the student already has a SCIA, it is recommended that the LEA conduct an evaluation to
determine the continued need for a SCIA prior to the next annual IEP meeting. When a student new
to the LEA enrolls with an existing IEP that indicates assistance is needed, a temporary substitute
should be assigned until the evaluation process is completed.
• Step 1: Referral for SCIA
If the principal and special education team at the site believe extra support may be
necessary to meet the student's goals, they must conduct an evaluation of the student's
needs prior to an IEP meeting, at which time this topic will be considered. The Referral for
Special Circumstance Instructional Assistance (D/M 157B) needs to be completed. Use the
Student Needs for Additional Support Rubric (D/M 157C) to assist in quantifying the
severity of student need. Supporting documentation should include Review of IEP Goals
(D/M 157E), Review of Behavioral Intervention Plan (BIP) (D/M 157F) and review of other
documents as appropriate, such as a nurse's assessment, health report, discipline records,
independent assessments, etc.
If the parent requests additional support, the school principal, designee, or special
education director shall confer with the parent to clarify his or her concerns, discuss
options, and assist the parent in completing the Reason for Referral and Other Unique
Needs sections of the Referral for Special Circumstance Instructional Assistance (D/M
157B). The parent should sign as the person requesting referral. The 15-day timeline for
developing the evaluation plan begins on the date of the parent signature.
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 5
If SCIA is requested during an IEP meeting without a previous referral, the procedure for
requesting SCIA must be initiated at that time. The IEP meeting should be completed and
the referral for SCIA should be indicated in the IEP notes. Another IEP meeting will need to
be scheduled to review the results of the evaluation.
Submit the Referral for Special Circumstance Instructional Assistance (D/M 157B), Student
Needs for Additional Support Rubric (D/M 157C and 157D), Review of IEP Goals (D/M
157E), and Review of Behavioral Intervention Plan (BIP) (D/M 157F) if appropriate, with
additional supplemental documentation, if necessary, to the director of special education.
• Step 2: Assessment Plan and Parent Permission
The director of special education will assign the referral to appropriate staff who will be
responsible for securing written parent permission/consent on an Assessment Plan (D/M
66), within 15 days of completion of the referral.
• Step 3: Parent/Teacher/Student Interviews
Best practices would be for the interviews to be completed at the beginning of the
evaluation process. The SCIA case manager/coordinator should complete the SCIA Parent
Interview (D/M 157G) and the SCIA Teacher Interview (D/M 157H) to identify specific areas
of concern. It is usually appropriate to also complete the SCIA Student Interview (D/M
157I).
• Step 4: Complete Evaluation including Observational Evaluation
It is the responsibility of the SCIA case manager/coordinator to ensure that the observation
is completed, using the Observational Evaluation for SCIA (D/M 157J). The SCIA case
manager/coordinator, in addition to the other appropriate assessors, will review strategies,
materials, modifications, and/or accommodations currently in place to assist the student
toward achieving goals and objectives.
• Step 5: Develop SCIA Evaluation Report
When an IEP team is considering SCIA for a student, all aspects of the student's program
must be considered with the intent of maximizing student independence. The SCIA
Evaluation Report (D/M 157K) should address the areas of concern identified in the
referral, assessments, interviews, and observations. The SCIA case manager/coordinator will
ensure the SCIA Evaluation Report (D/M 157K) is developed.
• Step 6: Review Evaluation at IEP Meeting
Within 60 days following the receipt of parent consent to evaluate for SCIA, an IEP team
shall review the results of the evaluation and recommendations at an IEP meeting. If the IEP
team determines a need for SCIA, it is written on the IEP with specific goals, monitoring
strategies, fading strategies, and review dates. Regardless of the circumstances that may
indicate the need for support, it is imperative for every IEP to address the skills that will be
taught in order for SCIA to be faded. The level of support required for the student to
advance appropriately toward annual goals needs to be defined. A systematic, written plan
should specify how additional support should be utilized and monitored. An IEP meeting
should be convened if necessary to modify SCIA. Discussion at this meeting should be
Appendix B Determining the Need for SCIA
Desert/Mountain SELPA Policy Chapter 5: Supports & Services
September 12, 2014
Page 6
concluded with a written plan outlining the team's criteria and possible timeline for phasing
out the necessity for SCIA.
• Step 7: Request/Assign SCIA
When an IEP team has determined that SCIA is required, the special education director or
designee will process the appropriate paperwork in accordance with LEA procedures.
• Step 8: Observational Review
The goal for any student with special needs is to encourage, promote, and maximize
independence. Periodic observations and review of data may be required to assess the
effectiveness of this additional support and to monitor the duration of services. The
Observational Review to Determine Continued Need for SCIA (D/M 157L) is used if direct
observation of the student is required. The IEP team should identify the next scheduled
observation date, often within six months and no later than the next annual IEP review, to
continually monitor the effectiveness of SCIA provided to the student.
F. Training
It is critical that all staff receive appropriate training on the student’s health issues, curriculum
modifications, the student’s instructional environment, behavioral interventions, using and fading
prompts, data collection and reporting, etc.
D/M 157A Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Checklist
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
DIRECTIONS: The following information to be completed by the school site staff. Initial and date as items are completed.
Initial Date
STEP 1:
Make Referral
Complete SCIA Rubric (D/M 157C & D)
Complete Review of IEP Goals (D/M 157E)
Complete Review of BIP (D/M 157F)
Review other records, as appropriate
Complete Referral for SCIA (D/M 157B)
Send Packet to district Director of Special Education
STEP 2:
Complete Assessment
Complete Assessment Plan (D/M 66)
Obtain written parent permission to assess and provide parents with a copy of the
Procedural Safeguards (D/M 77)
STEP 3:
Complete Interviews
Complete Parent Interview (D/M 157G)
Complete Teacher Interview (D/M 157H)
Complete Student Interview (D/M 157I)
STEP 4:
Complete Evaluation
Complete Observational Evaluation for SCIA (D/M 157J)
Complete Assessments
STEP 5:
Develop Evaluation Report
Develop SCIA Evaluation Report (D/M 157K)
STEP 6:
Review Evaluation at IEP Meeting
Hold IEP meeting (within 60 days of receipt of consent)
SCIA Not Recommended - process ends as per IEP
SCIA Recommended - develop IEP goals to be supported by SCIA
STEP 7:
Request / Assign SCIA
Request/Assign SCIA (LEA Personnel Forms)
STEP 8:
Observational Review
Observational Review to Determine Continued Need for SCIA (D/M 157L)
will be completed by
Name/Title
Date
...
D/M 157B Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
Referral for SCIA
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
DIRECTIONS: Please complete the following information. Submit the Referral for SCIA and the following forms: SCIA Rubric (D/M 157C and D)
,
Review of IEP Goals (D/M 157E), and Review of Behavioral Intervention Plan (BIP) (D/M 157F) to the special education office.
Reason for referral:
Areas of student need based on SCIA Rubric (D/M 157C and D):
Concerns identified on Review of IEP Goals (D/M 157E):
Concerns identified on Review of BIP (D/M 157F):
Previous interventions and results:
(including frequency, duration, and location)
Other unique needs:
This referral is made at the request of the:
Teacher
Case Manager
Parent/Guardian
Other:
Individual Requesting Referral:
Date:
Site Administrator/Designee:
Date:
...
D/M 157C Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Student Needs for Additional Support Rubric
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Review Date:
Disability:
Program/Placement:
Teacher:
Health/Personal Care Rating
Behavior Rating
Instruction Rating
Inclusion/Mainstreaming Rating
0
General good health. No specialized health care
procedure, medications taken, or time for health care.
Independently maintains all “age appropriate”
personal care.
Follows adult directions without frequent prompts or
close supervision. Handles change and redirection.
Usually gets along with peers and adults. Seeks out
friends.
Participates fully in whole class instruction. Stays
on task during typical instruction activity. Follows
direction with few to no additional prompts.
Participates in some core curriculum within general
education class and requires few modifications. Can
find classroom. Usually socializes well with peers.
1
Mild or occasional health concerns. Allergies or other
chronic health conditions. No specialized health care
procedures. Medication administration takes less than
10 minutes. Needs reminders to complete "age
appropriate" personal care activities.
Follows adult direction but occasionally requires
additional encouragement and prompts. Occasional
difficulty with peers or adults. Does not always seek
out friends but plays if invited.
Participates in groups at instructional level but may
require additional prompts, cues or reinforcement.
Requires reminders to stay on task, follow
directions, and to remain engaged in learning.
Participates with modifications and accommodations.
Needs occasional reminders of room and schedule.
Requires some additional support to finish work and
be responsible. Needs some social cueing to interact
with peers appropriately.
2
Chronic health issues, generic specialized health care
procedure. Takes medication. Health care
intervention for 10-15 minutes daily (diet, blood
sugar, medication). Requires reminders and
additional prompts or limited hands-on assistance for
washing hands, using bathroo
m, wiping mouth,
shoes, buttons, zippers, etc. Occasional toileting
accidents.
Has problems following directions and behaving
appropriately. Can be managed adequately with a
classroom behavioral management plan, but unable
to experience much success without behavioral
intervention plan implementation.
Cannot always participate in whole class
instruction. Requires smaller groups and frequent
verbal prompts, cues, or reinforcement. On task
about 50% of the time with support. Requires more
verbal prompts to follow directions.
Participates with visual supervision and occasional
verbal prompts. Requires visual shadowing to get to
class. Needs modifications and accommodations to
benefit from class activities. Regular socialization
may require adult facilitation.
3
Very specialized health care procedure and
medication. Limited mobility. Physical limitations
requiring assistance (stander, walker, gait trainer, or
wheelchair). Special food prep or feeding. Health
related interventions 15-45 minutes daily. Frequent
physical prompts and direction assistance for
personal care. Food prep required regularly. Requires
toilet schedule, training, direct help, and diapering.
Serious behavioral problems almost daily. Defiant
and /or prone to physical aggression. Requires a
Behavioral Intervention Plan (BIP) and behavioral
goals and objectives on the IEP. Requires close
visual supervision to implement BIP. Medication for
ADD/ADHD or other behaviors.
Difficult to participate in a large group. Requires
low student staff ratio, close adult proximity and
prompts including physical assistance to stay on
task. Primarily complies only with 1:1 directions
and monitoring. Cognitive abilities and skills likely
require modifications not typical for class as a
whole. Needs additional support(s) as determined
by the IEP team.
Participation may require additional staff for direct
instructional and behavioral support. Requires direct
supervision going to and from class. Always requires
modifications and accommodations for class work.
Requires
adult to facilitate social interaction with
peers.
4
Specialized health care procedure requiring care by
specially trained employee (G tube, tracheotomy,
cauterization). Takes medication, requires positioning
or bracing multiple times daily. Health related
interventions 45 minutes daily. Direct assistance with
most personal care. Requires two-person life. Direct
1:1 assistance 45 or more minutes daily.
Serious behavioral problems with potential for
injury to self and others, runs away, aggressive on a
daily basis. Functional Behavioral Analysis (FBA)
has been completed and the student has a well-
developed BIP, which must be implemented to
allow the student to safely attend school. Staff has
been trained in the management of assaultive
behaviors.
Cannot participate in a group without constant 1:1
support. Requires constant verbal and physical
prompting to stay on task and follow directions.
Regularly requires spe
cific 1:1 instructional
strategies to benefit from the IEP. Cognitive
abilities and skills require significant
accommodations and modifications not typical for
the class group.
Always requires 1:1 staff in close proximity for
direct instruction, safety, mobility, or behavior
monitoring. Requires 1:1 assistance to go to and
from class 80% of the time. Requires adult to
facilitate social interaction with peers and remain in
close proximity at all times.
*Attach a copy of documentation indicating frequency and duration over a period of time to determine further consideration of special circumstance instructional assistant.
If mostly ratings of 3’s and 4’s, in two or more areas, continue with needs assessment process.
...
D/M 157D Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
Summary of SCIA Rubric
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
Parent/Guardian:
Contact Phone:
DIRECTIONS: Please mark the boxes that best describes the health/personal care, behavior, instruction, and program supports for the student.
HEALTH / PERSONAL CARE
Specialized Health Plan G-Tube Medications Suctioning Food Preparation
Diaper Changing
Feeding Full Support
Seizures Weekly
Lifting / Transfers
Other:
BEHAVIOR
Behavior Plan in Place
Physically Aggressive Weekly
Non-compliant in Class
Non-compliant on Campus
Runs Away Weekly ADHD Medicated Mental Health Client
Other:
INSTRUCTION
Discrete Trial / ABA
Physical Prompts 80 % +
Verbal Prompts 80% +
Structured Teaching
Assistive Technology PECS Signing 80% +
Other:
INCLUSION / MAINSTREAM
Direct Adult Instruction Physical Support/Positioning Safety Supervision 80% + Close Visual Supervision 80% +
Other:
Describe each area of intensive need marked above and indicate if there is an IEP goal/objective written to address the area. Use additional paper if
needed to describe all of the needs.
Describe interventions used to support referred student in each of the areas marked above. Provide data that documents the prior success or failure of
interventions and attach. School day description and assistance needed.
...
D/M 157E Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Review of IEP Goals
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
* PROGRESS CODE
1 =
No Progress
2 =
1 - 50% Met
3 =
51 - 99% Met
4 =
Goal Met
** LEVELS OF ASSISTANCE
P =
Physical Prompt
M =
Modeling
V =
Verbal Cue
I =
Independent
AREA
Measurable Goal
Progress
Code *
Assistance
Levels **
Comments (Including frequency, duration, location of
assistance requested)
ACADEMIC
MOTOR
COMMUNICATION
SELF-HELP
SOCIAL /
EMOTIONAL AND
BEHAVIOR
PRE-VOCATIONAL
OTHER
...
D/M 157F Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Review of BIP
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
Behavioral Case Manager:
Contact Phone:
DIRECTIONS: The following information to be completed by the school site staff. Initial and date as items are completed.
What are the targeted behaviors in the Behavioral Intervention Plan (BIP)?
Yes No The request for SCIA is related to the identified targeted behaviors in the BIP.
Yes
No
All interventions are developmentally appropriate for the student.
Yes
No
BIP is written with enough clarity and detail for any new staff to understand and implement.
Yes
No
All implementers have a copy of the plan.
Yes
No
The BIP is being fully implemented.
Yes
No
All implementers understand and/or have training in the strategies contained in the plan.
Yes
No
Behavior support for the plan is adequate.
The student is making progress in the targeted behaviors. Indicate supporting evidence (e.g., grades, rate of homework completion,
duration of on-task behavior, frequency and quality of social interactions).
Actions:
BIP is appropriate, and no modifications are needed
Revise BIP
Develop BIP
Additional staff training needed. Describe:
Other:
Comments:
...
D/M 157G Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Parent Interview
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
Interviewee Name:
Interviewed By:
What does your child’s typical school day look like?
What’s working? When is he/she successful?
What are areas of difficulty or concern?
What staff supports are provided?
What natural supports from other students and/or other school programs does your child respond to?
What skills would you like your child to develop to be more independent?
Is there anything else you would like us to consider?
...
D/M 157H Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Teacher Interview
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
Interviewee Name:
Interviewed By:
What does the child’s typical school day look like?
What’s working? When is he/she successful?
What are areas of difficulty or concern?
What staff supports are provided?
What natural supports from other students and/or other school programs does the child respond to?
What skills would you like the child to develop to be more independent?
Is there anything else you would like us to consider?
...
D/M 157I Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Student Interview
STUDENT INFORMATION
Student/Interviewee Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
Interviewed By:
What does your typical school day look like?
What do you like about school? When are you successful?
When do you have problems during your school day?
How do school staff members help you during the day?
Who else helps you in school?
What programs do you participate in that help you?
What are some things you would like to learn to help you to be more independent?
Is there anything else you would like us to know about you?
...
D/M 157J Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
Observational Evaluation for SCIA
STUDENT INFORMATION
Student Name:
Date of Birth: Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
Observation Setting:
Observed By: (Name/Title)
A. Classroom: Please review the visual and the physical structure of the classroom, curriculum design, data collection, and planning.
1. Is the individual student/classroom schedule visually posted? Yes No
2. Is the transition between activities quick and smooth? Yes No (Explain)
3. Is the room organized with work areas defined and materials readily available for instruction? Yes No
(Describe)
4. Do students follow the established classroom procedures and routines? Yes No (Describe)
5. Indicate the level of prompt needed for the student to follow the schedule:
Independent
Physical Prompt
Indirect Verbal or Gesture Prompt
Direct Verbal Prompt
Other:
Describe:
6. Indicate the student’s use of the schedule:
Student Carries Schedule
Schedule Not Used At All
Teacher Carries and Shows the Schedule
Student Goes to Schedule Board
Student Goes to Schedule Board
Other:
Describe:
Comments:
...
Observational Evaluation for SCIA
Student Name:
Date of Birth:
D/M 157J Rev 9/14 Page 2
B. Curriculum and Instructional Planning: Check the curricular domains included in the student’s program.
1. Is the transition between activities quick and smooth: Yes No (Explain)
2. Is the room organized with work areas defined and materials readily available for instruction? Yes No (Describe)
3. Do students follow the established classroom procedures and routines? Yes No (Describe)
4. Indicate level of prompt needed for the student to follow the schedule:
Independent
Physical Prompt
Indirect Verbal or Gesture Prompt
Direct Verbal Prompt
Other:
Describe:
5. Student’s use of the schedule:
Student Carries Schedule
Schedule Not Used At All
Teacher Carries and Shows the Schedule
Student Goes to Schedule Board
Student Goes to Schedule Board
Other:
Describe:
Comments:
C. Current Data Systems and Collection of Data
1. Has data been collected on student performance? Yes No
2. How often is data collected?
Daily
Weekly
Bi-weekly
Monthly
3. How is data summarized?
Graphed
Written Narrative
Other:
4. What evidence is there that accommodations and/or modifications are being used? (Describe)
Observational Evaluation for SCIA
Student Name:
Date of Birth:
D/M 157J Rev 9/14 Page 3
Comments:
D. Behavior and Safety
1. Describe the behavior management system in the classroom, including positive re-enforces and consequences. Is it appropriate for the student or
does it need to be modified?
2. Are specific positive behavior supports utilized for the student? Yes No (Describe)
3. Is there appropriate safety equipment in place? Yes No
4. Are appropriate safety and medical procedures being used? Yes No
5.
Does it appear appropriate training has been provided? Yes No
Comments:
E. Student Behavior In Independent Activities
1. Describe the student’s interaction with peers.
2. Describe the student’s interaction with non-classroom staff in a less structured environment.
3. What activities does the student choose during break?
4. What problems are evident?
Observational Evaluation for SCIA
Student Name:
Date of Birth:
D/M 157J Rev 9/14 Page 4
Comments:
F. Describe the school day and assistance now provided. Include natural supports such as peers, school staff, volunteers, etc.
G. How is existing assistance utilized?
H. Can current conditions be modified to meet the student’s goals and objectives and/or personal care needs?
I. What other types of assistance is needed? Why?
J. Are there any other issues that need to be addressed?
Comments:
D/M 157K Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
SCIA Evaluation Report
STUDENT INFORMATION
Student Name:
Date of Birth: Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
SCIA Case Manager/Coordinator:
Contact Phone:
Psychologist:
Contact Phone:
Evaluation Report Prepared By: Date Completed:
1. Background Information and Educational Setting: (Summarize previous interventions and outcomes, include information regarding
educationally relevant health, developmental, and medical findings; and include the results of any independent educational evaluations.)
2. Assessment Procedures: (Include information regarding the administration of tests in the primary language of the student by qualified
personnel, the validity of the evaluation, and the validity of tests for the purposes in which they were used.)
3. Summary of Interviews and Observations: (Summarize results of the parent, teacher, and student interviews, include information regarding
relevant behavior noted during the observation of the student.)
4. Assessment Results: (Summary the results of standardized and/or curriculum-based testing.)
5. Recommendations: (Include information regarding the need for specialized services, materials, and equipment and indicate if the student’s
needs can be met in the regular education classroom with the current level of support.)
...
D/M 157L Rev. 9/14 Page 1
DESERT/MOUNTAIN SPECIAL EDUCATION LOCAL PLAN AREA
DESERT/MOUNTAIN CHARTER SPECIAL EDUCATION LOCAL PLAN AREA
17800 HIGHWAY 18 • APPLE VALLEY, CA 92307
(760) 552-6700 • (760) 242-5363 FAX
Observational Review to Determine Continued Need for SCIA
STUDENT INFORMATION
Student Name:
Date of Birth:
Age:
Disability:
Grade:
Gender:
Male
Female
School Site:
Program/Placement:
General Education Teacher:
Contact Phone:
Special Education Teacher:
Contact Phone:
Observation Setting:
Observer’s Name/Title:
Start Time:
End Time:
Previous Observation Date:
Name(s) and positions of SCIA provider(s):
Current status per teacher, support staff, and student:
Description of current SCIA provided: (time, setting, specific tasks)
Observation of student behavior:
Description of results of efforts to increase student independence and/or progress on goal(s):
Comments:
...
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Determining the Need for Special Circumstance Instructional Assistance

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 July 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document