Eee Iepsamplenovember15th2012
Eee Iepsamplenovember15th2012
Eee Iepsamplenovember15th2012
Initiation and Duration of the IEP: Initiation and Duration of Extended Year Services:
Name:
Name:
*With parental consent, include individuals from CIS/Early Intervention if child is transitioning from EI services to EEE at age 3
MEDICAL History: (physical, hearing, vision, CDC report, etc.) Briefly describe how the child‟s disability or medical condition affects
his/her access to and participation in age appropriate activities.
Diagnosed with PDD-NOS (June 2012)
Amanda‟s hearing was tested in June of 2012 and results were within normal range
Amanda has mild to moderate pronation in both feet. She recently has been fitted with orthotics (dafos) to support her
mobility, coordination, stability and balance.
Amanda‟s most recent medical examination (July 2012) report stated that she was in good health for her age. No health
concerns at this time but physician will receive progress reports from physical therapist on a monthly basis
Child STRENGTHS: Consider child‟s strengths across the three early childhood outcome (ECO) areas:
A. Social emotional skills and relationship:
She has been observed imitating her peers actions along with some sounds (vocal imitation is increasing)
Child NEEDS: (consider and prioritize the necessary supports that adults need to incorporate in order for the child to access and participate in age
appropriate activities within a regular early childhood setting with his/her same-age peers and/or within their home environment.)
OTHER CONSIDERATIONS: (safety/health; school district partnerships with community-based early childhood programs (Act 62); functional
behavior assessment (FBA)*; private early childhood programs; home-visiting; community-based child and family resources (Children‟s Integrated Services;
transportation; disability awareness; advocacy needs, etc.)
Interagency support for Amanda‟s childcare participation? It is recommended that childcare staff apply for a
specialized accommodations grant through AHS.
Referral to CIS for family support
Early Childhood Outcomes Considering the child strengths, concerns and needs complete an ECO culminating statement for each of the
three Early Childhood Outcome areas. ECO reporting is required upon entry and exit of EEE services.
ECO A. Social-emotional skills and relationships: ECO B. Acquisition & use of knowledge and skills: ECO C. Take action to meet needs:
*Foundations for Early Learning (FEL) Functional Behavior Assessment Forms can be located on-line at www._______
Global Outcome Area: Building Positive Social Emotional Skills and Relationships
Please check one or more of the domain areas that you are addressing within this outcome area:
social/emotional adaptive communication fine/gross motor cognitive skills
Current developmental skill level: (information in this section is populated from child Concerns section located on present levels page)
o Amanda has a difficult time maintaining engagement with adults, peers and objects for more than 2 minutes.
o Amanda uses gestures paired with vocalizations in 25% or less of her communications with adults and peers
o Amanda demonstrates a limited range of emotions in play
Current functional ability: (Consider how the child uses discrete skills (as stated above) ‘in order to’ or ‘so that’ it is meaningful, intentional and functional within the context of everyday activities, routines and
transitions. Focus on the child‟s engagement, approaches to learning and independence in developmentally appropriate activities across a variety of settings.)
Amanda has learned to initiate interaction with an adult or peer, at home and at preschool, by pulling their hand or tugging their clothing in order to gain their attention. Amanda may
couple the gesture with sound approximations such mm for mommy, /n/ for no, /b/ for book, etc. Even though Amanda initiates contact with adults/peers, she has difficulty maintaining
engagement for more than 1-2 back n forth interactions.
Vermont Early Learning Standards: VELS II. 4. Interactions with Others: Children develop successful relationships with other members Progress Review
of their learning community. VELS: II 1. Children use play as a vehicle to build relationships and to develop an appreciation for their own abilities and accomplishments Progress is reported as often as the school district conducts parent/teacher conferences (on at
least two occasions) or as determined necessary by the IEP team.
Goal: 1 Amanda will take turns with another child or adult (e.g., sharing books, ball,
paintbrush or a basket of crackers) during preschool so that she is engaged during small group
activities, snack, choice time or outdoor play, or at home when playing with her sister. She will
take turns for four back-and-forth interactions at least 10 a day times for five consecutive days by
May 2013.
Short-term Objectives, Benchmarks, Evaluation Procedures and Personnel Responsible For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Goal 1
Objective a. By November, 2012, Amanda will take turns for two back-and-forth interactions Review 1 Review 2 Review 3 Review 4 Targeted behavior:
Date: Date: Date: Date: 2 back n forth exchanges
with her classmates at school and her sibling at home five times a day for five consecutive days.
Child’s skills in this area are not evidenced.
Child’s skills are emerging but inconsistently
demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Comments:
Global outcome cont’d: Building Positive Social Emotional Skills and Relationships
Short-term Objectives, Benchmarks, Evaluation Procedures and Personnel Responsible Progress Review cont’d
For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Goal 1
Review 1 Review 2 Review 3 Review 4 Targeted behavior:
Objective b. By January, 2013, Amanda will take turns for three back-and-forth interactions Date: Date: Date: Date: 3 back n forth exchanges
eight times a day for five consecutive days.
Child’s skills in this area are not evidenced.
Child’s skills are emerging but inconsistently
demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Comments:
Goal 1
Objective c. By May, 2013, Amanda will take turns for four back-and-forth interactions 10 times
a day for five consecutive days. For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Review 1 Review 2 Review 3 Review 4 Targeted behavior:
Date: Date: Date: Date: 4 back n forth exchanges
Comments:
Global outcome cont’d: Building Positive Social Emotional Skills and Relationships
Vermont Early Learning Standards: VELS II. 4. Interactions with Others: Children develop successful relationships with other members Progress Review
of their learning community. VELS: II 1. Children use play as a vehicle to build relationships and to develop an appreciation for their own abilities and accomplishments Progress is reported as often as the school district conducts parent/teacher conferences (on at
least two occasions) or as determined necessary by the IEP team.
Goal: 2 Given an array of 5 emotion picture cards/poster (happy, sad, angry, excited, tired),
Amanda will identify her own feelings and the feelings of others by pointing to corresponding
emotion cards so that she can communicate how she feels to others as well as recognize others‟
feelings. Amanda will identify at least 5 of her own feelings and 3 feelings of others by May 2013.
Short-term Objectives, Benchmarks, Evaluation Procedures and Personnel Responsible For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Goal 2
Objective a. Given set-up (teacher facilitated) pretend play situation with dolls, animals or peers Review 1 Review 2 Review 3 Review 4 Targeted emotions include:
Date: Date: Date: Date: Happy, sad, angry, excited, tired
and, when given a verbal prompt, (e.g., “Josie dropped her cookie and look how she‟s crying, she
must feel ____.”) Amanda will respond by pointing to the emotion picture card that best
Child’s skills in this area are not evidenced.
represents the targeted emotion. Amanda will identify 2 out of 3 emotions of others‟ within 6
separate set-up play sessions over of a 6 week period. Child’s skills are emerging but inconsistently
demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Comments:
Goal 2
Review 1 Review 2 Review 3 Review 4 Targeted emotions include:
Objective b. Given set-up (teacher facilitated) pretend play situation with adults and/or peers Date: Date: Date: Date: Happy, sad, angry, excited, tired
and or spontaneous learning opportunity, when given a verbal prompt, (e.g., “Amanda, you are
the helper of the day! You must feel ____.”) Amanda will indicate by pointing to the emotion Child’s skills in this area are not evidenced.
picture card that best represents her emotion. Amanda will identify 4 out of 5 of her own emotions Child’s skills are emerging but inconsistently
within 8 separate set-up play sessions over an 8 week period. demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Global Outcome Area: Acquisition and use of new skills and knowledge
Please check one or more of the domain areas that you are addressing within this outcome area:
social/emotional adaptive communication fine/gross motor cognitive skills
Current developmental skill level: (information in this section is populated from child Concerns section located on present levels page)
Amanda responds to and follows a one-step direction e.g., “put cup here” but has difficulty in responding to and following through given a two- step direction
When asked to identify specific objects, people, or symbols/pictures, Amanda may point to a few items correctly but not all. Her response is inconsistent across adults,
settings, materials.
Current functional ability: (Consider how the child uses discrete skills (as stated above) ‘in order to’ or ‘so that’ it is meaningful, intentional and functional within the context of everyday activities, routines and
transitions. Focus on the child‟s engagement, approaches to learning and independence in developmentally appropriate activities across a variety of settings.)
During preschool activities and at home, Amanda requires reminders from adults, a model or physical guidance to follow through with a 2 step direction. She tends to observe her peers
and uses their cues in order to know when to transition from activity to activity or steps within a task. Even though Amanda is highly motivated and interested in picture books she tends
to have a few favorite books. When asked to locate a certain picture/character on a page, if it is not one of her favorite pictures/characters she tends to turn the page quickly in order to
locate her favorites. In addition, if her favorite books are not readily available she becomes increasingly upset and is not able to make another choice.
Vermont Early Learning Standards: VELS III Children develop skills in listening and in understanding language. Progress Review
Progress is reported as often as the school district conducts parent/teacher conferences (on at
Goal 1 Amanda will respond to and carry out simple two step verbal directions so that she can least two occasions) or as determined necessary by the IEP team.
follow individual as well as group instructions in the classroom and at home over the course of
her daily routines 4 out of 5 opportunities per day over a 6 week period of time by May 2013.
Short-term Objectives, Benchmarks, Evaluation Procedures and Personnel Responsible For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Goal 1
Objective a. During routine activities, Amanda will respond and carry out a simple two step Review 1 Review 2 Review 3 Review 4
Date: Date: Date: Date:
direction given by an adult (e.g., “Amanda, pick out a book and sit on your carpet square”) with a
physical prompt (e.g., taking Amanda‟s hand or placing hand on Amanda‟s shoulder.) 3 out of 5
Child’s skills in this area are not evidenced.
times per day over a three week time period by Jan 2013. And without physical assist 4 out of 5
opportunities per day over a six week period by May 2013. Child’s skills are emerging but inconsistently
demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Comments:
Global outcome cont’d: Acquisition and use of new skills and knowledge
Short-term Objectives, Benchmarks, Evaluation Procedures and Personnel Responsible Progress Review cont’d
For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
Goal 1
Review 1 Review 2 Review 3 Review 4 Targeted include:
Objective b. Given small group learning activities, Amanda will respond to and carry out 4 out Date: Date: Date: Date:
of 5 simple two step direction involving a specified sequence with different objects (e.g., “first take
a cracker and then pass the basket to your friend” or “turn the page and point to the big cow” or Child’s skills in this area are not evidenced.
“carry the crate of blocks with ___ and take it to the circle rug” or “find the „A‟ for Amanda and Child’s skills are emerging but inconsistently
then stick it on the magnet board”) 3 times a week for a six week period of time by___. demonstrated.
Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
Please check one or more of the domain areas that you are addressing within this outcome area:
social/emotional adaptive communication fine/gross motor cognitive skills
Current developmental skill level: (information in this section is populated from child Concerns section located on present levels page)
Limited mobility and communication affects Amanda‟s participation and engagement with peers across daily routines and activities.
Amanda uses one-word/action signs (ASL) e.g., „more‟, „help‟, „stop‟, „please‟ however, her use of signs is inconsistent across daily routines
Current functional ability: (Consider how the child uses discrete skills (as stated above) ‘in order to’ or ‘so that’ it is meaningful, intentional and functional within the context of everyday activities, routines and
transitions. Focus on the child‟s engagement, approaches to learning and independence in developmentally appropriate activities across a variety of settings.)
Amanda has a mild gross motor delay which tends to make her shy away from participating with her peers during group music/movement activities, accessing play structures and
equipment, and moving from one activity to another in the classroom as well as outdoors. Amanda uses some sign such as „more‟ to ask for crackers during snack or “help” to ask for
assistance when hanging her coat on her cubby hook. Some of her peers will help Amanda locate and put on her boots, hat and mittens so she can be ready to go outside to play with
everyone.
Goal 1
Objective c. Amanda will combine two movements (marching, side-stepping, animal walk, walk For review of this outcome/goal and progress monitoring data,
we, the team, have evidence that demonstrates the:
backwards, tip-toes, jumping forward, balancing on one foot) during group time music, action
Review 1 Review 2 Review 3 Review 4 Target play structures include:
songs/games and movement activities on 8 out of 10 opportunities over a 6 week period of time by Date: Date: Date: Date: Target behavior include:
May 2013
Child’s skills in this area are not evidenced.
Child’s skills are emerging but inconsistently
Extra objective example--Amanda will avoid 3 obstacles/people in her path as she walks from demonstrated.
one area of the classroom to another or on the playground Child’s skills are progressing and being
maintained across some
settings/adults/peers/materials
Extra Goal example—Coupled with some vocalizations, Amanda will use sign language (more, The child has mastered this outcome/goal
across multiple settings/adults/peers/materials
help, stop, all done, go, etc.) to communicate her needs and wants more clearly when making
requests of adults and peers during meals, self-care routines, and when moving from one activity Comments:
to another at home and school 4 times a day on 5 separate days over a 6 week period of time by
May 2013.
LEA placement and responsibility: Amanda participates in an inclusive school district early childhood education
classroom 3 days per week for 4 hours each day. Her services are provided within this setting.
Amanda‟s family needs full day childcare 2 days per week. The family receives childcare subsidy to offset tuition
costs. At this time, Amanda does not require special education or related services in this setting.
An explanation of the extent, if any, to which the preschooler will not participate with same age peers in a
regular early childhood setting: N/A
The general characteristics of the child’s early childhood education environment/placement (ages 3-5):
Child is attending a regular early childhood program 10 or more hours per week.
and receives at least 50% of their special education services in the regular early childhood program
□ and receives at least 50% of their special education services in some other location
Child is attending a regular early childhood program less than 10 hours per week
□ and receives at least 50% of their special education services in the regular early childhood program
□ and receives at least 50% of their special education services in some other location
Child is not attending a regular early childhood program and receives special education services in:
□ a separate special class
□ a separate school
□ a residential facility
□ their home
□ the service provider’s location or another location
Identify environmental accommodations, curriculum modifications, supplementary aids, assistive technology etc.
that will support the child’s access to and participation in a regular early childhood setting and/or in age appropriate
activities.
Develop and implement a visual picture schedule, choice board and first/then board across prioritized
routines, tasks, settings
Incorporate ASL into targeted daily routines/tasks
Program Modifications/Supports for the Child, Preschool Personnel and
Parents as well as Other Options Considered by the IEP Team
Identify the program modifications, supports and training that will be provided for preschool personnel and family
to implement the IEP:
Team will meet on a monthly basis to discuss Amanda‟s progress and develop intervention plans with
classroom teacher for upcoming weeks.
Team members and family members will participate in 6 week ASL training beginning October 10th 2012.
For VT DOE reporting purposes, the IEP team has For VT DOE reporting purposes, the IEP team has
determined that the child’s annual progress will be assessed determined that the child’s annual progress will be assessed
using the GOLD (required statewide PreK assessment using an alternative assessment measure e.g., Battelle
measurement) Developmental Inventory (BDI); Trans-disciplinary Play-
based Assessment (TPBA); Assessment, Evaluation and
Programming System (AEPS), etc.
2.5
2 ECO A
ECO B
1.5
ECO C
1
0.5
0
ECO A ECO B ECO C