Achieve Beyond – ABA Therapy & Related Services - Achieve ...



7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (



Dear Provider,

 

Attached please find the Age-Out Information Packet in which you will need for preparing your Age Out report(s).

 

If there is more than one provider on a case, please be sure that each of you submits an Age Out report with an IEP.

 

Π      Please read over the entire packet carefully.  Age Out reports are due into the office to your

CPSE Case Manager no later than December 15th of the year the prior to the child’s 5th birthday (unless otherwise indicated on your case cover letter OR a district schedules an annual review meeting prior to the end date, in which case you will be notified immediately).

✓ Age-Out Reports will be expected to be completed with an IEP when services are recommended to continue. This should not only be a reflection of professional observation but also clarified by formal testing scores to confirm the need and justification for service continuation.

← Please read the attached information very carefully for a full description of requirements. This will include observations of the child’s performance including strengths and weakness of their current present abilities.

 

ATTACHMENTS:

 

← Present Levels of Performance (PSLP) Overview & Examples

← SEIT Goal Bank Examples

← Annual Report Review Checklist

← Annual Report Review Explanation

← Annual Report Sample

 

Please be sure to prepare and give yourself enough time to test and write the report & goals and submit no later than the expected date.  Reports should be emailed to me at the following email address:

 

Debbie Ross: dross@

You will receive a reply confirmation email after submitting your report.  All reports will be reviewed and if revisions are needed, will be returned to you for corrections that need to be completed within 24 hours of the request.  Requested revisions on reports are expected to be completed & resubmitted immediately with your signature. No reports will be reviewed without your signature. Therapists who fail to submit their report(s) on time are submitted to having their direct deposit to be placed on hold and they will need to come into the office to pick up their check payment upon completion of reports due.

TESTING

Your are responsible for obtaining your own copy of the formal assessments. The agency does not carry extra copies of Educational Assessment tools nor by law are we allowed to copy and distribute these tests.

Here is some information on how to obtain these assessments for your use.

The DAYC-2 and PES -2:

You may be able to download the rating forms for testing off of some websites for free. Conversation charts can either be ordered online or you can come into the office and use the agency’s conversation chart between office hours (9:00 to 5:00) with an appointment to ensure the material is available for your use. You are NOT permitted to remove the chart from the office nor make copies of the chart to take out of the office.

All providers of CPSE SEIT/SEIT ABA cases are required to complete formal testing and informal test measure which must be included in the annual report in addition to the completion of an IEP.  If the child attends a program, and the program is completing the formal assessment, you are STILL required to complete an Annual report.  Please ensure you are using a Formal Assessment tool such as the DAYC – 2 or the PES -2.

The HELP-2, 3 to 6 year old Checklist is an INFORMAL Assessment tools that can be used within the Annual report for the observation and review area to provide an explanation of the child’s current level of performance and to also modify goals that are mastered.

GOALS & LEGEND KEY

Please remember to include school year goals, even if a CPSE child is transitioning to CSE.  The only time goals should not be included is if you are recommending a discontinuation of services.   Please be sure to include performance levels using the legend key for each student’s goal, both ANNUAL GOALS and SHORT TERM OBJECTIVES as the districts require up to date knowledge with service performance and the child’s improvements.

When services are recommended to continue please complete ON A SEPARATE PAGE an additional goal page for the continuation of services.

This will be marked as:

20--/20-- School Year Goals

We look forward to a successful year and thank you for your continued support and dedication to our children.

Thank you,

[pic]

SAS/SEIT Supervisor

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (



CPSE AGE OUT REVIEW CHECKLIST

(This form is for our personal use and should not be submitted with the reports)

o My report is due in the office by DEC 15 of the year prior to the child’s 5th birthday

o Reports are typed and used the new format (includes legend key)

o Formal assessment tools were used for the testing

o Indication of current level of performance is used after each and every goal including ANNUAL GOALS and SHORT TERM OBJECTIVES

o Discussion has occurred in detail, what strategies are used and how the family have been incorporated into the session in addition to child’s progress

o Refer to yourself in the third party, example: “The provider,” “The therapist,” Never use “I,” “My,” or “We”

o Recommendations for the school year have been provided. DO NOT recommend frequency, duration or location of services. If recommendations for continuation of services are provided, then on a SEPARATE page write goals for the School Year 20--/20-- using all necessary Annual goals and Short term objectives.

o Be aware of negatives used within the report; Ex: Child screams, Child cannot… As the provider you need to be specific in your explanations and include observations, what occurs for child to react in the manner that is unacceptable or the behavior that distracts the child from attending skills

o Ensure your report is SIGNED (you can send in a scanned copy of the signature page but always make sure you email a copy of the report in addition to your scanned or faxed copy the SAME DAY. If you decide to mail in your report make sure you give yourself enough time for delivery as it will be considered late if it is not submitted into the office on the due date).

o All results and recommendations have been discussed with the guardian/parents

o An IEP is added only when services are recommended to continue for the following school year in addition to the separate school goal page

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (

Educational AGe-OUT progress report

Child name: Be sure to use the ENTIRE CHILD’S NAME AS WRITTEN FROM IEP

Date of Birth: ALWAYS MAKE SURE THIS IS CORRECT FROM THE IEP

NYC ID#: TAKEN DIRECTLY FROM THE CHILD’S IEP

Chronological Age:

Date of Testing: (The date of the testing should not be MORE than a week from the report date)

Date of Report:

Examiner: only the provider writing the report – ONE provider per report

EVALUATION PROCEDURES:

Classroom Observation

Developmental Assessment of Young Children (DAYC-2) or

Preschool Evaluation Scale (PES-2)

Parent Interview

CURRENT EDUCATIONAL PROGRAM:

Include what current services the child is receiving. This includes: Location of all services, What services does the child qualify for, Frequency and Duration of all services

LANGUAGES USED:

Only languages used during testing which reflect child’s dominant language of use.

ACADEMIC ACHIEVEMENTS: This area needs to be filled in fully

Developmental Assessment of Young Children (DAYC-2)

Record of DAYC-2 Scores

|Domains |Raw Score |Age Equivalent |Percentile Rank |Standard Score |Description of the Standard Score|

|Cognitive | | | | | |

|Communication | | | | | |

|Social Emotional | | | | | |

|Physical Development | | | | | |

|Adaptive Behavior | | | | | |

Preschool Evaluation Scale, Second Edition (PES-2)

Record of PES-2 Scores

|Domain |Standard Score |Standard Deviation |Range |

|Large Muscle | | | |

|Small Muscle | | | |

|Cognitive Thinking | | | |

|Exp. Language Skills | | | |

|Social/Emotional Skills | | | |

|Self-Help Skills | | | |

You can also include Total Standard of Score for overall performance –check sample for example

*DO NOT SUBMIT WITHOUT INFORMATION – IF YOU NEED ASSISTANCE PLEASE CALL HOWEVER DO NOT SUBMIT WITH EMPTY AREAS*

COGNITIVE DEVELOPMENT:

Can include scores for each domain, standard scores, performance range and percentile scores.

Domains need to be a reflection of the child’s performance during the testing. What the child was successfully able to accomplish independently and what tasks need improvements. Each domain needs to be a small explanation of the questions asking from the test questions. Please check the sample for examples of test writing.

LANGUAGE DEVELOPMENT:

Expressive

Receptive

(EXPRESSIVE LANGUAGE DEVELOPMENT:)

SOCIAL/EMOTIONAL DEVELOPMENT:

PHYSICAL DEVELOPMENT:

Gross Motor

Fine Motor

(Large Muscle)

(Small Muscle)

ADAPTIVE DEVELOPMENT:

(SELP-HELP SKILLS:)

Progress toward IEP Goal(s) and Benchmark(s): (Must include list of IEP Goals and Benchmarks. Use the Goal and Objective/Benchmark Progress Legend below.)

Use the Goal Progress Legend Key to indicate the child’s current level of performance for EACH goal – LONG TERM GOALS AND SHORT TERM GOALS taken from the child’s IEP

➢ GOALS WILL ONLY BE INCLUDED IF YOU ARE RECOMMENDING CONTINUATION OF SERVICES FOR THE SCHOOL YEAR.

|Goal Progress Mark Legend |

|Progress toward IEP Goal(s) and Benchmark(s): (Must include list of IEP Goals and Benchmarks. Use the Goal and Objective/Benchmark Progress Legend below.) |

|E-Emerging O-Ongoing |

| |

|M – Mastered NYA – Not Yet Attained |

XXXX goals as listed on his I.E.P (Individual Educational Plan) are as follows:

All goals are to be reached at various accuracy levels. This will be judged by teacher observation

GOALS OF THERAPY:

Goal(s)/ Objective(s):

Annual Goals

The annual goal is a statement that identifies the knowledge, skills, and/or behavior that a child is expected to achieve between the IEP implementation and the scheduled annual school year. The goals are to be a reflection of the anticipated goal and realistic outcome throughout that specified school year. The Annual goal must be measurable, observable and describe a skill that the child will demonstrate well within the expected level of proficiency. Please include Criteria, Method and Schedule. The goals will be taken directly from the IEP or your previous Quarterly report to ensure update with criteria and mastery level. MUST BE WRITTEN IN NUMERICAL ORDER.

• Evaluation Criteria: This indicates what level of mastery must be demonstrated in order to consider the goal attained.

• Procedure to Evaluate the Goal: This is the method used to evaluate progress and mastery.

• Criteria Period: This refers to the period of time that the child must demonstrate mastery (according to the evaluation criteria) in order to consider the goal attained.

Short Term Goals and/or Benchmarks

There should be a minimum of THREE must be included with each annual goal. Short term objectives are indicators of progress and the steps in reaching the long term goals broken down to achievable, realistic and measurable goals. This is how progress is determined in reaching each of the Annual Goals in a sequential incremental step process. You do not have to include the Criteria, Method and Schedule.

MUST BE WRITTEN IN NUMERICAL ORDER AND COINCIDE WITH THE ANNUAL GOALS.

SUMMARY AND RECOMMENDATIONS:

Area needs to be specific in providing a picture of the child’s current performance; provide a detailed explanation of the child’s strength and weakness within the session and daily routine including parent’s participation within the session and transition of goals. NO PLACEMENT, DURATION OR FREQUENCY RECOMMENDATIONS ARE TO BE PUT HERE. As a clinician you are NOT permitted to recommend this as it is up to the district to finalize placement. You can explain as your professional opinion what services should continue and explain in detail WHY. Provide an explanation of a type of setting without actually stating the placement. Example: “Due to distractibility and impulsive behaviors the child would benefit from participation within a structured setting having the support of teachers and peers. The above are only recommendations.”

** Parents’ were informed of child’s progress to date and parental rights to obtain child records; parents understanding was assured**

“Final recommendations are to be made in conjunction with other reports and with the parents at the CPSE meeting.”

I certify that I personally evaluated the above-mentioned child, employing age-appropriate instruments and procedures as well as informed clinical opinion. I further certify that the findings contained in the report are an accurate representation of the child’s level of functioning at the time of my assessment.

______________________________ ____________________ _______________________

Signature of Provider Title Date

Office use only:

_________________________________ ______________________ __________________________

Signature of Supervisor Title Date

CSE School Year Goals

(If recommending continuation of services)

Child name: Ethan Stuart Little Provide child’s name and information as indicated

Date of Birth: 11/05/2008

NYC ID#: 2225452222

These goals will indicate the continuation of target goals for the school year. They should be measurable and appropriate for the child to attain within the school year. The modifications may include an increase in criteria pending upon the mastery level of the goals indicated within your report.

Remember – mastery level is at 100%.

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (

Educational AGe-OUT progress report

Child name: Ethan Stuart Little

Date of Birth: 11/05/2008

NYC ID#: 233931086

Chronological Age: 4 years 2 months (50 months)

Date of Testing: 1/30/13

Date of Report: 2/1/13

Examiner: Nicoleta Aspacia Unay

EVALUATION PROCEDURES:

Classroom Observation

Developmental Assessment of Young Children (DAYC-2)

Parent Interview

CURRENT EDUCATIONAL PROGRAM:

Ethan Stuart Little is a 4.2 month old male who has been receiving special education services at home since January 16th for ten hours a week. Ethan has qualified for a special education classroom and speech language therapy for a duration of three times a week, thirty minutes however placement has not yet been determined. He is receiving Occupational Therapy at Sunny Bright Center twice a week for thirty minutes. This report has been prepared in anticipation of the upcoming CPSE review.

LANGUAGES USED:

Testing was completed in English as this is the dominant language of the family.

ACADEMIC ACHIEVEMENTS:

Developmental Assessment of Young Children Second Edition (DAYC -2)

Record of DAYC – 2 Scores

The Developmental Assessment of Young Children Second Edition (DAYC-2) was administered to XXXX at Home/School. The following results are based on the formal assessment. The results are based on a battery of five subtests that measure different but interrelated developmental abilities. The battery is designed for use with children from birth through age 5 years and 11 months. It provides standard scores with a mean of 100 and a standard deviation of 15. There are 5 domains on the DAYC-2, Cognitive, Communication, Social/Emotional, Physical Development, Adaptive Development and self-help skills. XXXX received the following scores on the DAYC-2.

|Domains |Raw Score |Age Equivalent |Percentile Rank |Standard Score |Description of the Standard |

| | | | | |Score |

|Cognitive |25 |13 months |9 |80 |Below Average |

|Communication |22 |10 months |4 |74 |Poor |

|Social Emotional |25 |15 months |19 |87 |Below Average |

|Physical Development |40 |10 months |3 |71 |Poor |

|Adaptive Behavior |21 |15 months |12 |82 |Below Average |

According to the DAYC -2, Ethan’s total standard score resulted in a 75 reflecting at the 5th percentile and a composite within the overall poor range scale.

COGNITIVE DEVELOPMENT:

According to the DAYC-2, Ethan’s cognitive scores reflected within the below average range providing a standard score of 80 and a percentile of 9. He is able to independently match objects by their color, shape and size, tell if an object is ‘heavy’ or ‘light,’ understand concepts of ‘same’ and ‘different’ and match three pairs of objects that have the same function. Ethan is presently unable to demonstrate an understanding of ‘more’ or ‘less,’ sort objects by their physical characteristics, identify objects that do not belong in a group for three or more object sets, imitate drawing a face with a least three facial features or retell a story from a picture book with reasonable accuracy.

LANGUAGE DEVELOPMENT:

According to the DAYC-2, Ethan’s overall Communication Domain resulted in a raw score of 22 reflecting a standard score of 74 which results within the poor range and a percentile of 4.

Receptive Language:

Ethan’s Receptive language skills resulted in a raw score of 11 and a standard score of 71 resulting in an age equivalence of 10 months. Ethan is able to understand ‘in front of’ and ‘behind’ concepts, follow directions about placing an item ‘beside,’ or ‘under,’ demonstrates the understanding of big/little and points to five or more common objects described by their usage. He is presently unable to answer comprehension questions when told a short story, demonstrate an understanding of passive sentences, carry out a three step unrelated verbal command or identify words that rhyme or that have the same ending sound for at least three word pairs (e.g. “Does CAT and PAT have the same ending sound?”)

Ethan often demonstrates self-directed behaviors which impact on his ability to attend to the listener or attend to his environment. Once attention is attained, he is able to follow through with simple step commands and directions.

Expressive Language:

Ethan’s Expressive language skills resulted in a raw score of 11 and a standard score of 77 resulting in an age equivalence of 10 months. Ethan is able to give his full name upon request, changes his speech depending upon the listener (e.g. talks differently to babies than an adult), uses five or more regular plurals, successfully asks /what/ and /where/ questions and uses facial expressions and body language to demonstrate at least five various emotions, (e.g. ‘show me how you would look if you were…angry, proud, frightened, scared”). Ethan is unable to presently use five or more contractions, make a statement about a cause and effect, (e.g. “It won’t roll because the wheel is off”), define five simple words (e.g. “What is a car?”) or complete at least three simple verbal analogies (e.g. “Daddy is a man, Mommy is a ____?”).

SOCIAL/EMOTIONAL DEVELOPMENT:

According to the DAYC-2, Ethan demonstrates his Social Emotional skills to be within the below average range. He obtained a raw score of 25 and standard score of 87 which is within the 15 month age equivalence and a percentile of 19. Ethan likes competitive games, quiets down after active play, volunteers for tasks, plays group board or card games, attempts to return objects to their appropriate place and accepts mild and friendly teasing.

He is unable to explain the rules of a game to others, does not ask before using another person’s belongings, and is unable to provide or offer assistance to others when appropriate or help with group projects. Ethan’s social skills are very limited as he does not presently attend school or social related activities. He enjoys interacting with adults and often observes peers needing motivation to play or reciprocate a conversation with children his age.

PHYSICAL DEVELOPMENT:

According to the DAYC-2, Ethan demonstrates overall Motor and Fine skills that are within the poor range. He obtained a raw score of 40 and standard score of 71 which is within the 10 month age equivalent with a percentile of 3.

Gross Motor Skills:

As a result of the DAYC -2 scoring, Ethan’s raw score within his gross motor skill development resulted in a 35 and a standard score of 85.Ethan is able to walk up the stirs alternating his feet in an adult fashion while holding onto the railing or wall, run at least 10 feet without falling, climb low play equipment creep backwards down the steps and squat during play however he is unable to presently throw a ball overhand with relative accuracy or walk backward for at least 10 feet. Ethan is unable to catch a ball from a straight arm position, trapping the ball against his chest, walk forward heel to toe without losing balance for four or more steps or hop forward on one foot without losing balance for four or more hops.

Fine Motor Skills:

As a result of the DAYC -2 scoring, Ethan’s raw score for the Fine motor skill development resulted in a 5 and a standard score of 57. Ethan is able to transfer an object from one hand to the other, bang two objects together, and pick up a small object using his thumb and forefinger. Ethan can poke with his index finger and turn pages in book successfully, imitates circular, vertical and horizontal strokes when drawing and uses one hand consistently in most activities. He is unable to presently use a scissor without supervision, hold a pencil between his first two fingers and thumb, copy a cross, square or triangle or paste/glue neatly needing assistance.

ADAPTIVE DEVELOPMENT:

According to the DAYC-2, Ethan demonstrates his Adaptive skills to be within the below average range. He obtained a raw score of 21, a standard score of 82 and a percentile of 12 which is within the 15 month age equivalent. Ethan is able to presently dress himself completely except for tying his shoelaces, serve himself at the table, request for privacy in the bathroom, fasten his seat belt in the car, request for food to be passed at the table and put a dirty dish in the sink or dishwasher. He is unable to independently cross the street safely, select clothing appropriate for the temperature or occasion, make his own bed or set and clear the table without assistance.

|Goal Progress Mark Legend |

|Progress toward IEP Goal(s) and Benchmark(s): (Must include list of IEP Goals and Benchmarks. Use the Goal and Objective/Benchmark Progress Legend below.) |

| |

|E-Emerging O-Ongoing |

| |

|M – Mastered NYA – Not Yet Attained |

Ethan’s goals as listed on his I.E.P (Individual Educational Plan) are as follows:

All goals are to be reached at various accuracy levels. This will be judged by teacher observation

GOALS OF THERAPY:

Goal(s)/ Objective(s):

Annual Goals:

1. In one school year, Ethan will be able to place objects/pictures into categories with 90% accuracy as determined by the teacher through direct observation and anecdotal logs, 4 times per marking period. E

2. In one school year, Ethan will be able to ask and answer "wh" questions to his teacher and peers. E

3. In one school year, Ethan will follow 2 step directions with 85% accuracy as determined by daily data collection and observed by the classroom teacher.

E

Short Term Objectives:

1A. Ethan will be able to identify opposites using pictures and objects. O

1B. Ethan will learn the function of familiar objects. E

1C. Ethan will be able to group items into specific categories for shape,

size and function for 9 out of 10 trials. E

2A. Ethan will answer simple questions such as 'what is your name,'

"Where do you live?" and "How old are you?" O

2B. Ethan will remain on topic of reciprocal conversation for 8 out of 10 trials. O

2C. Ethan will ask peers or adults appropriate /wh/ questions. E

3A. Ethan will eliminate frustration when redirected by an adult. M

3B. Ethan will follow two unrelated verbal commands. O

3C. Ethan will follow two related verbal commands without gestured

prompts or visual cues. E

SUMMARY AND RECOMMENDATIONS

Ethan is a happy and active 4.2 year old male child that enjoys participating with his family and the therapist. He enjoys role playing with ‘Cars’ and trains, accepts reinforcers such as stickers and when given a choice of two desired items, Ethan is able to choose the item he prefers without becoming frustrated. He is learning to tolerate how to wait for items, request without whining and eliminate grabbing. Ethan is able to remain cooperative when engaged, accepts redirection to follow single step commands often paired with full physical redirection and is beginning to demonstrate an improvement in associative play. He participates in a variety of age expected items such as; number/picture puzzles, nesting cups, stacking blocks, grouping items with assistance, felt boards to encourage sensory integration, matching, peg boards, musical items, role playing, singing songs and encouraging cognitive problem solving. Ethan has improved in his ability to use toys appropriately as demonstrated, refrain from throwing, maintain eye contact with others, accept redirection and to follow simple step commands (‘put in,’ ‘sit down, then…,’ ‘do this first then,’) however he does require redirection to eliminate self-directed behaviors and eye gazing. He requires assistance with remaining seated, attending to the presented task, follow simple game rules, reciprocate in conversation, turn take and increase ability to communicate with others while maintaining eye contact.

Review of each session is completed through county logs in addition to an explanation and demonstration conducted with the parent and family during and after the session to ensure understanding of the goals and to encourage transition of tasks throughout the week. Ethan’s mother and family have been cooperative to work with and successful in communicating concerns, questions and attempts to transition skills. Mrs. Rollax is currently working on placement for Ethan to engage in a small ratio school setting full time.

It is recommended that services continue to address various developmental skills, target improvements within the concerned area, achieve cooperative performance and provide support for consistency. Ethan needs a well structured environment to attain skills for progress, motivate reciprocal conversations and improve self-directed behaviors. He often shows comprehension of skills when attained within the session however transition of skills attained from one activity to the next is not successful and needs to be continued consistently throughout the week. Concerned behaviors of toe walking, eye gazing and sensory sensitivity has been reviewed with the parent for observation and further review.

** Parents’ were informed of child’s progress to date and parental rights to obtain child records; parents understanding was assured**

“Final recommendations are to be made in conjunction with other reports and with the parents at the CPSE meeting.”

I certify that I personally evaluated the above-mentioned child, employing age-appropriate instruments and procedures as well as informed clinical opinion. I further certify that the findings contained in the report are an accurate representation of the child’s level of functioning at the time of my assessment.

_________________________ _______SEIT__________ ___10/20/13___

Signature of Provider Title Date

Office use only:

_________________________________ _______________________ ______________________

Signature of Supervisor Title Date

Attach separate IEP Goal Page (s) if recommending services to continue or services for next year.

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (



Child name: Ethan Stuart Little

Date of Birth: 11/05/2008

NYC ID#: 233931086

CSE School Year Goals

1. In one school year, Ethan will be able to place objects/pictures into categories with 90% accuracy as determined by the teacher through direct observation and anecdotal logs, 4 times per marking period.

Evaluation Criteria: 9 out of 10 trials with moderate assistance

Evaluation Criteria Period: by 4th marking period

Evaluation Schedule: by Mid-June

Evaluation Procedure: direct observation and logs

Evaluation Responsibility: Special Education Itinerant Teacher

A. Ethan will be able to identify opposites using pictures and objects with 90% accuracy through observation 4 times per marking period.

Evaluation Criteria: 90%

Evaluation Criteria Period: over 8 months

Evaluation Schedule: Mid-October

B. Ethan will learn the function of familiar objects with 85% accuracy as determined by the teacher through direct observation and anecdotal logs.

Evaluation Criteria: 88%

Evaluation Criteria Period: 4 months

Evaluation Schedule: end of June

C. Ethan will be able to group items into specific categories for shape, size and function for 9 out of 10 trials.

Evaluation Criteria: 90%

Evaluation Criteria Period: 6 months

Evaluation Schedule: end of August

2. In one school year, Ethan will be able to ask and answer "wh" questions to his teacher and peers.

Evaluation Criteria: 85% accuracy with moderate assistance

Evaluation Criteria Period: Quarterly

Evaluation Schedule: by Mid-June

Evaluation Procedure: recorded observation

Evaluation Responsibility: Special Education Itinerant Teacher

A. Ethan will answer simple questions such as 'what is your name,' "Where do you live?" and "How old are you?" with 85% accuracy as determined by the teacher through direct observation and anecdotal logs, 4 times per marking period.

Evaluation Criteria: 85%

Evaluation Criteria Period: over 8 months

Evaluation Schedule: Mid-October

B. Ethan will remain on topic of reciprocal conversation for 8 out of 10 trials.

Evaluation Criteria: 80%

Evaluation Criteria Period: 7 months

Evaluation Schedule: end of September

C. Ethan will ask peers or adults appropriate /wh/ questions with 85% accuracy.

Evaluation Criteria: 80%

Evaluation Criteria Period: 7 months

Evaluation Schedule: end of September

3. In one school year, Ethan will follow 2 step directions with 85% accuracy as determined by daily data collection and observed by the classroom teacher.

Evaluation Criteria: 85% accuracy with moderate assistance

Evaluation Criteria Period: Daily Data Collection

Evaluation Schedule: by November

Evaluation Procedure: recorded observation

Evaluation Responsibility: Special Education Itinerant Teacher

A. Ethan will eliminate frustration with 85% accuracy when redirected by an adult.

Evaluation Criteria: 90%

Evaluation Criteria Period: 7 months

Evaluation Schedule: end of September

B. Ethan will follow two unrelated verbal commands with 85% accuracy.

Evaluation Criteria: 85%

Evaluation Criteria Period: 8 months

Evaluation Schedule: end of October

C. Ethan will follow two related verbal commands without gestured prompts or visual cues for 85% accuracy..

Evaluation Criteria: 85%

Evaluation Criteria Period: 8 months

Evaluation Schedule: end of October

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (



Educational AGE-OUT progress report

Child name:

Date of Birth:

NYC ID#:

Chronological Age:

Date of Testing:

Date of Report:

Examiner:

EVALUATION PROCEDURES:

Classroom Observation

Preschool Evaluation Scale, Second Edition (PES-2)

Parent Interview

CURRENT EDUCATIONAL PROGRAM:

XXXXXX is a wonderful, 4 year 11 month old boy who has been receiving ABA/VB therapy since November 2005, five times a week as part of a classroom/home based educational and therapeutic program. XXXXXX’s VB sessions incorporate an array of strategies beginning with (DTT) discrete teaching trails, (ITT) intensive teaching trails for some targets, (NET) natural environment teaching, which includes focusing on spontaneous and reciprocal social interaction with family, teachers, and peers, separation anxiety, play skills including participating, sharing and wait time for turn taking. In addition to his home services he attends a Pre-K program accompanied by a SEIT at St. John the Baptist de la Salle Regional school in Farmingdale 3 afternoons a week for 3 hours.

XXXXXX’s strengths in his educational experience to date are highly associated with the amount of progress he is making within his school environment. XXXXXX still displays autistic behaviors such as self-simulation, (sensitivity to sound, singing, humming, whining and minimal self -inflicted physical abuse) in situations where he is having demands placed on him. During play he has begun to enjoy participating in self-directed activities or activities chosen by others and his wait-time along with turn-taking is increasing. Fine motor is an area of concern, however he is writing his name, cutting, pasting and recently coloring within a boundary. Providing XXXXXX with behaviors needed to learn from group situations was a goal regarding intervention.

XXXXXX’s areas of strength in his home program remain to be his ability to acquire, retain and generalize

most skills across persons, settings, and activities. At home his expressive language aids him in areas such as

his wants, needs and emotions. His gross motor imitation is strong. Fine motor, vocabulary skills, and yes/no preference are Ongoing to develop. He displays some autistic behavior such as self-stimulation, in situations

where he is frustrated, bored or not engaged and having demands placed upon him. Reciprocal social

interaction, spontaneous language requesting in sentences, responding to questions and attending skills are

areas that demand intense attention.

LANGUAGES USED:

English

ACADEMIC ACHIEVEMENTS:

Preschool Evaluation Scale, Second Edition (PES-2)

Record of PES-2 Scores

Assessments Administered (Formal/Informal):

XXXXXX’s progress is assessed through the Preschool Evaluation Scale (PES) School Version Rating Form 36 through 72 months and was completed over 2 sessions in a week’s span. XXXXXX’s behavior was rated as it occurred naturally in his Home/School environment. As per this standardized test, XXXXXX was assessed across six developmental domains.

|Domain |Standard Score |Standard Deviation |Range |

|Large Muscle |12 |.66 |Average |

|Small Muscle |10 |0 |Average |

|Cognitive Thinking |13 |1.0 |Average |

|Exp. Language Skills |4 |-2.0 |Below Average |

|Social/Emotional Skills |6 |-1.33 |Below Average |

|Self-Help Skills |9 |-.33 |Average |

Assessments Scores/Results:

XXXXXX’s Sum of Subscale SS was 54, which places him in the 31st percentile.

Subscales/SS Results:

(59 months)

PHYSICAL DEVELOPMENT:

In the domain area of Large Muscle Skills XXXXXX scores age appropriately.

The following are primary behaviors of concern in the domain of Small Muscle Skills:

• Unable to hold a pencil with a three to four finger grasp

• Presents difficulty drawing a fairly straight line between two designated points

• Unable to tie a simple knot

• Presents difficulty cutting a square with scissors

COGNITIVE DEVELOPMENT:

In the domain area of Cognitive Thinking XXXXXX scores age appropriately.

EXPRESSIVE LANGUAGE DEVELOPMENT:

The following are primary behaviors of concern in the domain of Expressive Language Skills:

• Unable to speak well enough so that an outsider can understand

• Unable to talk back and forth on a telephone

• Unable to use several pronouns correctly when speaking in conversations

• Unable to use past tense of verbs

• Unable to answer questions involving “why”

• Unable to distinguish the composition of common things

• Unable to rhyme words

SOCIAL/EMOTIONAL DEVELOPMENT:

The following are primary behaviors of concern in the domain of Social/Emotional:

• Presents difficulty separating from parents

• Presents difficulty taking turns appropriately

• Unable to ask permission before using others belongings

• Presents difficulty playing cooperatively with other children

• Presents difficulty behaving appropriately in social situations without an adults constant supervision

• Presents difficulty remaining in an assigned area for a specified amount of time

• Presents difficulty staying involved in an activity for a reasonable length of time

• Presents difficulty responding appropriately to redirection

• Unable to focus attention for necessary length of time

• Presents difficulty maintaining self-control in group situations

SELF-HELP SKILLS:

The following are primary behaviors of concern in the domain of Self-Help Skills:

• Unable to unbutton front buttons

• Unable to buckle a belt

• Presents difficulty putting belt through belt loops

|Goal Progress Mark Legend |

|Progress toward IEP Goal(s) and Benchmark(s): (Must include list of IEP Goals and Benchmarks. Use the Goal and Objective/Benchmark Progress Legend below.) |

|E-Emerging O-Ongoing |

| |

|M – Mastered NYA – Not Yet Attained |

GOALS OF THERAPY:

Summary and Progress toward Long Term Goal(s) and Short Term Objective(s):

XXXXXX’s goals and objectives were not attached to his IEP. The following goals and objectives are being currently addressed at home in the ABA/VB setting and they are being generalized at school.

Annual Goals:

To improve receptive language - Ongoing

To improve sensory processing skills without visual input - Emerging

To increase fine motor visual-motor skills/coordination - Ongoing

To increase expressive/spontaneous language – Ongoing

Short Term Objectives:

1a. XXXXXX will be able to sequence sets of pictures.

This objective is ongoing. XXXXXX is able to put 3 sets of 3 pictures in order of how they occur. Such as a boy climbing a slide; the boy climbs the ladder, sits at the top of the slide then the boy slides down the slide. XXXXXX is able to verbalize some of the actions he views in the pictures. There are other times he counts the order of the pictures (1, 2, 3). A four picture set was recently introduced to XXXXXX. He requires prompts to put those pictures in the correct sequence.

1b. XXXXXX will be able to sort pictures by the initial letter sound.

This objective is ongoing. In this program XXXXXX is given pictures and is required to sort them by the initial letter sound. For example a picture of an apple is sorted into the A pile, an elephant in the E pile and a hat in the H pile. XXXXXX is able to sort pictures into eight groups based on the initial letter sounds; A, B, C, D, E, F, G, and H.

2a. XXXXXX will increase attending skills.

This objective is ongoing. At home XXXXXX attends to a desired task for an unlimited amount of time. XXXXXX is able to play with toys he enjoys or complete puzzles he enjoys until it is completed. He also will sit at a table to draw symbols from cartoons he enjoys. However XXXXXX has difficulty attending to undesirable tasks such as some ABA/VB programs and certain games he does not enjoy.

At school XXXXXX has difficulty attending to certain group activities such as story time, academic lessons and some circle time activities. XXXXXX requires prompts to redirect his attention to the activity. These prompts are successful 70% of the time in both settings.

2b. XXXXXX will be able to accept a no or wait response to a desired item or activity.

This objective is ongoing. XXXXXX tends to get angry when he is asked to wait or told no when he wants to do something he wants. For example when he leaves school he wants to get right in the car however he must wait for his brother or for adults to talk. When he is asked to wait in this setting he kicks the car tire when he reaches the car and repeats any phrase the adults tell him, “we have to wait”, or “we can go in a minute”. At home when XXXXXX is asked to complete a task that he finds undesirable he tends to leave the room or repeats any phrases the adults say to him or he whines until he is redirected.

3a .XXXXXX will increase handwriting skills.

This objective is emerging. XXXXXX is able to clearly write upper case letters A, C, T. and r, e, w in lower case letters. He attempts to write his name appropriately; the way he writes the lower case n resembles an upside down v and the way he writes the lower case d is sometime unrecognizable. When XXXXXX writes his first name he writes an upper case A and the rest of the letters are lower case. XXXXXX writes all the letters large, he is unable to write his first name on one line across an 8 X 11 paper. He does write from top to bottom and left to right. He usually writes Andr on one line and then underneath he writes ew.

3b. XXXXXX will be able to copy and complete a pattern.

This objective is ongoing. XXXXXX is able to copy a pattern of shapes from a picture using the same shape tiles that are in the pictures. He also can duplicate a pattern using colored bears in different sizes from a picture and from an actual model. XXXXXX has difficulty adding onto a pattern at the end or completing a pattern with a missing piece.

3c. XXXXXX will be able to duplicate a block design from a model.

This objective is ongoing. XXXXXX is able to duplicate block designs such as a 6 block tower, 6 block line, 3 block bridge, and 4 block wall. He will learn a 3 block chair next.

4a. XXXXXX will be able to answer when, what, who, and where questions in complete sentences.

This objective is ongoing and is being addressed in different ways. XXXXXX is able to answer several social questions such as what is your favorite drink, toy, show, food, what are your teachers’ names, what are your friends’ names and what is the name of your school. He is also able to answer when questions such as when do you go to school (in the morning), when do you laugh (when something is funny) when do you cry (when I’m sad) and when do you eat (when I’m hungry). XXXXXX is able to answer questions about community helpers such as, "who is this?" (when shown a picture), "what do they do?” and where do they work? He is able to answer these questions about 7 community helpers such as a doctor, a librarian, a chef and a school bus driver.

4b. XXXXXX will able to read sight words.

This objective is ongoing. XXXXXX is able to read sight words such as I, two, up, we, my and the. He is able to read 25 sight words. He currently is learning to read what, have and like. XXXXXX is also able to read a simple book titled “A picnic” by Rozanne Lanczak Williams. He uses his knowledge of sight words, picture clues and his comprehension skills to read this book. The first page reads "We" have a banana. XXXXXX read it accurately. The last page reads "We have a picnic!" Yum! Yum! XXXXXX read “We have a picnic, delicious.” The words Yum and delicious do not look alike however they have very similar meaning. XXXXXX noticed the ants enjoying the food at the picnic in the picture on the last page; this picture may have caused him to read delicious.

4c. XXXXXX will be able to label adjectives using picture cards.

This objective is emerging. XXXXXX is able to expressively label descriptive pictures of prickly, sticky, glassy, rocky, and silky. XXXXXX is currently learning to label wet, sandy and hard.

SUMMARY AND RECOMMENDATIONS:

Overall XXXXXX is progressing within the ABA/VB setting at home. He has gained many valuable skills that he is utilizing in his school and at home outside of the ABA/VB sessions. XXXXXX is also progressing in his classroom setting. He enjoys attending school and looks forward to being in the classroom with his peers. The SEIT assists XXXXXX in participating in some of the structured classroom activities. However XXXXXX is independently able to transition between activities without difficultly.

The recommendation for the 20-20 school year is for XXXXXX to be a part of a full day class where he can engage with peers appropriately five days a week. The setting should support XXXXXX’s abilities as well as challenge him.

** Parents’ were informed of child’s progress to date and parental rights to obtain child records; parents understanding was assured**“Final recommendations are to be made in conjunction with other reports and with the parents at the CPSE meeting.”

I certify that I personally evaluated the above-mentioned child, employing age-appropriate instruments and procedures as well as informed clinical opinion. I further certify that the findings contained in the report are an accurate representation of the child’s level of functioning at the time of my assessment.

______________________________ ____________________ ______________

Signature of Provider Title Date

Office use only:

_________________________________ _____________________ ______________________

Signature of Supervisor Title Date

7000 Austin St, Suite 200 ( Forest Hills, NY 11375 ( Tel 718.762.7633 ( Fax 212.679.5894 (



CSE School Year Goals

XXXXXX XXXXXX Goals for school year 2014-2015

Goal: (6.49) XXXXXX will appropriately initiate own play activities and interaction with others.

Benchmarks:

• XXXXXX will appropriately initiate own play and interaction with others 80% with teacher redirection by December

• XXXXXX will appropriately initiate own play and interaction with others 50% without teacher redirection by March

• XXXXXX will appropriately initiate own play and interaction with others 80% without teacher redirection by June

Evaluation Procedure: Recorded observations

Evaluation Responsibility: Special Education Teacher

Goal: (6.99) XXXXXX will separate from his parent or primary caretaker to enter classroom.

Benchmarks:

• XXXXXX will separate from his parent or primary caretaker to enter classroom 80% with teacher redirection by November

• XXXXXX will separate from his parent or primary caretaker to enter classroom 50% without teacher redirection by January

• XXXXXX will separate from his parent or primary caretaker to enter classroom 90% without teacher redirection by May

Evaluation Procedure: Recorded observations

Evaluation Responsibility: Special Education Teacher

Goal: (6.101) XXXXXX will correctly follow the classroom morning routine (e.g., unpack own backpack, put away personal belongings and school materials, join in circle time, independently work on seat time activity).

Benchmarks:

• XXXXXX will correctly follow the classroom morning routine (e.g., unpack own backpack, put away personal belongings and school materials, join in circle time, independently work on seat time activity) 80% with teacher redirection by December

• XXXXXX will correctly follow the classroom morning routine (e.g., unpack own backpack, put away personal belongings and school materials, join in circle time, independently work on seat time activity) 50% without teacher redirection by March

• XXXXXX will correctly follow the classroom morning routine (e.g., unpack own backpack, put away personal belongings and school materials, join in circle time, independently work on seat time activity) 80% without teacher redirection by June

Evaluation Procedure: Recorded observations

Evaluation Responsibility: Special Education Teacher

Goal: (6.120) XXXXXX will actively participate in class activities (e.g., raise hand, respond to questions).

Benchmark:

• XXXXXX will actively participate in class activities (e.g., raise hand, respond to questions) 80% with teacher redirection by December

• XXXXXX will actively participate in class activities (e.g., raise hand, respond to questions) 50% without teacher redirection by March

• XXXXXX will actively participate in class activities (e.g., raise hand, respond to questions) 50% without teacher redirection by June

Evaluation Procedure: Recorded observations

Evaluation Responsibility: Special Education Teacher

Goal: (6.137) XXXXXX will display appropriate coping skills to deal with changes and disappointments (e.g., student will redirect or self- sooth)

Benchmark:

• XXXXXX will display appropriate coping skills to deal with changes and disappointments (e.g., student will redirect or self- sooth) 50% with teacher redirection by December

• XXXXXX will display appropriate coping skills to deal with changes and disappointments (e.g., student will redirect or self- sooth) 80% with teacher redirection by March

• XXXXXX will display appropriate coping skills to deal with changes and disappointments (e.g., student will redirect or self- sooth) 70% without teacher redirection by June

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