Community-based Instruction - Anderson School District ...



Community-based Instruction

Anderson School District Five

Community Based Instruction (CBI) is a program designed for students that need instruction in functional and daily living skills. The goal of the program is to provide hands on learning activities at all age levels to help students acquire the skills to live in the world today. Domains to be covered include the following:

• Domestic – includes the area of personal health care, home health care, and interpersonal relationships. This area also includes emergency safety skills, nutrition, hygiene, dressing and eating. Home health care could be the payment of bills, insurance, cleaning, general house keeping.

• Recreation/Leisure – These should reflect the student’s age, interests, as well as family activities, culture and involvement with community facilities. Should span a wide range of activities to include the involvement of other people or individual activities. Examples could be bowling, putt-putt, visiting the local YMCA, going to the library, drawing class (arts/crafts)

• Community/Mobility – this domain should examine all possible means of community access. City buses, taxi service, planning activities that are in student’s area.

• Community/Consumer – purchasing or service related activities in the student’s immediate area. Examples include grocery shopping, clothes or gift shopping, miscellaneous shopping (e.g. browsing, buying records, plants), banking skills, using the post office, or visiting the social security office.

• Vocational – should consist of real work experience in real work settings. This would involve visiting work sites to observe people at work. Observing various jobs at your school could be one area to investigate.

Guidelines:

1. Permission forms must be obtained prior to participating in any activity.

2. Permission forms must be taken on all CBI trips.

3. Community-based instruction must be tied to IEP goals.

4. Students must have some form of identification with them.

5. Student Locator form submitted to school office prior to leaving grounds.

6. Submit reimbursement form as soon as possible.

7. CBI trips are NOT field trips. CBI is a way to reinforce what is being taught in the classroom.

8. Each domain should be addressed at least once per school year.

9. CBI trips should be individualized. It may not be appropriate for all students to participate in all activities.

10. All students must have appropriate supervision whether they’re staying at school or participating in CBI trip.

11. CBI may only take place within Anderson School District 5.

12. Trip is cancelled if having inclement weather.

13. Trip is cancelled if teacher cannot participate.

14. Contact coordinator IMMEDIATELY if CBI trip is to be cancelled.

15. May attend only one location during trip.

16. ALL transportation issues must go through coordinator such as scheduling, canceling, questions...) teachers/parapros should not contact transportation.

17. CBI times 10:30-12:30. Any request for variation on time(s) should be submitted with initial schedule submission.

18. Adhere strictly to times – just because you leave late does not mean you can stay late!

Community-based Instruction Checklist

o Appropriate IEP goals are on IEP

o Permission forms obtained

o Locations contacted to arrange CBI visit

o Schedule/Plan submitted to coordinator

o Reimbursement form submitted to coordinator

o Appropriate supervision planned for all students

o Student locator completed and submitted to front office at school prior to leaving school

o Copies of permission/medical emergency/photography prepared to take

Emergency Procedures

Lost student:

• Contact school principal immediately

• Two adults present: one searches for student, other stays with remaining students

• One adult present: entire group searches

• Contact security

• 10 minutes – student not found – contact school principal for further instructions

• Notify all appropriate persons when student is located

• Write a summary of the incident to submit to principal and coordinator

Medical Emergency:

Minor

• Assess the situation

• Use the first-aid supplies

• Call school site, if necessary

• Complete accident/incident report upon returning to school

Major

• Assess the situation and if life threatening:

Supervising adult should:

1. Request responsible person to call 911

2. Notify school principal ASAP

3. Remain with the student to administer first aid

4. Accompany the victim to the emergency facility with emergency info

5. Complete incident report

Designated staff member or other responsible person should:

1. Call 911 as directed

2. Be prepared to give the following information:

• victim’s condition

• location of the emergency

3. Arrange to have the students supervised in a different location

4. Meet the Emergency Medical Services (EMS) personnel and direct them to the specific location of the emergency

5. Write summary of incident

(July, 2015)

Community-based Instruction

Parental Permission

_______________________________________ _____________ ______________

Student Date of birth School

___________________________________________________________________

Address

Dear Parent/Guardian/Student of Majority Age:

Community-based Instruction (CBI) is a program designed for students that need instruction in functional and daily living skills. The goal of the program is to provide hands on learning activities within the community to help students acquire the skills to live and function with their community. Students participating in CBI will have the opportunity to travel to sites within the community during school hours to practice and acquire skills. Their teacher and other school personnel will accompany the students on these off-campus trips.

CBI provides instruction in basic life skills through four domains:

o Domestic (Examples: personal grooming, nutrition, laundry, cooking)

o Vocational: (Examples: job readiness such as being on time, following rules)

o Community: (Examples: transportation, library, shopping centers, post office)

o Recreation and Leisure: Examples: crafts, parks, bowling, movie theaters)

I give permission for my child to participate in Community-based Instruction and to visit places within the community during school hours.

AND

Permission is also granted for the provision of medical care in case of injury or accident involving my child. In case of emergency involving the above-student, the teacher should contact one of the persons listed below at the phone number(s) as indicated if unable to contact parent/guardian.

I appoint or designate a physician and/or medical center/hospital to carry out the necessary treatment in the event my child should, for any reason, require minor or major medical treatment. I understand that I will be contacted immediately in case of an emergency.

________________________________________________________

Parent/Guardian/Student of Majority Age Relationship to Student Phone Date

____________________________________________________________________________________

Medical conditions/Allergies

____________________________________________________________________________________

Doctor’s name Phone number Medicaid number

PHOTOGRAPHY/VIDEOTAPE

My child □ does □ does not have permission to be identified, interviewed, and/or photographed or videotaped for use by the media and/or school district regarding:

o Community-based Instructional activities and/or Supported Employment and Exploration activities (Work crew, Cooperative Placements, Job Shadowing, Internships)

________________________________________________________

Parent/Guardian/Student of Majority Age Relationship to Student Phone Date

(July, 2015)

Community-based Instruction

Student Locator Record

____________________________________________________________

Teacher Class Date

Person responsible for students remaining: _________________________

SpEd Assistant(s) out of building: _________________________________

Students on CBI trip:

1. __________________________ 7. __________________________

2. __________________________ 8. __________________________

3. __________________________ 9. __________________________

4. __________________________ 10. _________________________

5. __________________________ 11. _________________________

6. __________________________ 12. _________________________

Location of CBI trip: _____________________________________________________________

Transportation by (circle one): School bus Walking

Time Out: _______________ Estimated time of return: ________________

Form is to be completed and given to the school secretary

before leaving the campus.

Community Based Instruction

Schedule/Plan

__________________________________________________________________________

Teacher School Class Date Submitted

Nine week period: ___ 1st ___ 2nd ___ 3rd ___ 4th

(This may be submitted every nine weeks or semester)

Date: ______________________ Training Site: ________________________________ __________________

Domain: ____________________Activity: _______________________________________________________

Date: ______________________ Training Site: _______________________________________ ____________

Domain: ____________________ Activity: _______________________________________________________

Date: ______________________ Training Site: ___________________________________________________

Domain: ____________________ Activity: _______________________________________________________

Date: ______________________ Training Site: ____________________________________________________

Domain: ____________________ Activity: ________________________________________________________

Date: ______________________ Training Site:____________________________________________________

Domain: ____________________ Activity: _______________________________________________________

Must be approved by the school principal before transportation arrangements will be made.

_________________________________________________ _________________________________________________

Principal’s Signature Date Coordinator’s Signature Date

Participants: Adults ______ Students ______ Students/wheelchairs ______ Total _______

(July, 2015)

FUNDS REQUEST FOR COMMUNITY-BASED INSTRUCTION

TEACHER:____________________________ SCHOOL: _______________________

|PURPOSE | |AMOUNT |

|Community-based Instruction 15/16 school year | |$100.00 |

| Students based on October 1 caseload = ____ | _______ X 10.00 |+ |

| |Total to be disbursed to teacher: |$_______ |

| | | |

| Account: | | |

|Self-contained/Life Skills classes |(SpEd will insert upon receipt) | |

I understand these funds are to be used

For community-based activities and/or

Supplies to enhance the CBI experience. Approved by:

______________________________ ____________________________

Signature of Claimant Coordinator

______________________________ ____________________________

Date Director

____________________________

Date

(July, 2015)

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