2 yr. 9 mo.Transition      Medical Services        Low Incidence Condition   

Other (Please describe):

1. (Indicator # 7A) Initial evaluation was completed and documented in Lotus Notes/ ASSIST within 45 days:    Yes    No

2.  Initial Referral Date (mm/dd/yy):                 

3.  (Indicator # 7B) Initial IFSP developed within 45 days:    Yes    No 

4.  IFSP Dates:  Start Date of IFSP (mm/dd/yy)    End date of IFSP (mm/dd/yy):  

5.  IFSP participants included: (check all that apply) 

  Parent

  Service Coordinator

  Person(s) providing direct service

 Person(s) directly involved in conducting evaluations/assessments

Other:

If  participant absent, how was information obtained? (Check all that apply.)

  Chart Review/written report

  Telephone Conference

Other:

6.  (Indicator #9A) List name of ALL individuals who completed an evaluation (even if they did not attend the IFSP meeting.)

Evaluator's Name and Title:       Check if individual attended IFSP meeting 

Evaluator's Name and Title:      Check if individual attended IFSP meeting 

Evaluator's Name and Title:      Check if individual attended IFSP meeting

Evaluator's Name and Title:      Check if individual attended IFSP meeting

  Unacceptable

Minimally Acceptable

Best Practice

The IFSP contains no information on family concerns, priorities, or resources,        AND      There is no documentation that the family declined to provide information on concerns, priorities, and resources          OR     The IFSP contains information about family routines and activities but no specific information on all of the following:

1. Important people 

2. Concerns

3. Resources

With family concurrence, information is described on all of the following; however, additional clarification is required (see comments):

1. Family concerns
2. Important people for the family
3. General resources
4. Specific resources related to families capacity to enhance child’s development    BUT

This information is not connected to what is working well and the challenges in the family’s everyday routines and activities.

OR    The family declined to provide information and documentation is present; however, additional clarification is required (see comments).

With family concurrence, information is described on all of the following:

1. Family concerns
2. Important people for the family
3. General resources
4. Specific resources related to families capacity to enhance child’s development

BUT

This information is not connected to what is working well and the challenges in the family’s everyday routines and activities.

1. Family concerns

2. Important people for the family AND

3. General specific resources included

 AND   The information is connected to what is working well and the challenges within typical routines and activities.

B. With family concurrence, there is clear information on family priorities and how they link to family concerns, strengths, and interests. (Indicator #9A)

  Unacceptable

  Minimally Acceptable

Best Practice

There is no information provided about family priorities.       AND     There is no documentation that the family declined to share this information.

With family concurrence, family priorities are described; however, additional clarification is required (see comments).        OR      The family declined to provide information and documentation was present; however, additional clarification is required (see comments).

With family concurrence, family priorities are described     OR      The family declined to provide information and documentation was present.

With family concurrence, information on family priorities is present along with how the priorities are linked to the family concerns, strengths, and interests.

(Indicator #9A)

1.   Includes interview:    Yes    No

2.   Priorities are ranked in numerical rank order by the family:    Yes    No

3.  Completed within 45 days for initial IFSP and prior to reviews and:     Yes    No

4.  Identifies supports and services when necessary:     Yes    No (This information is found in the service details on the Case Plan.)

Comments:  

  Unacceptable

Minimally Acceptable

Best Practice

Child and family outcomes seem to be based on provider priorities

(e.g., there is not a clear connection with the concerns and priorities expressed by the family.)        AND/OR      No family outcomes are included related to specific family needs and concerns 

Child and family (when identified by team) outcomes are based on family concerns and priorities; however, additional clarification is required (see comments).

 (e.g. There are unclear connections between information in the summary of family concerns, priorities, and resources to enhance the development of their child and the family and child outcomes.)

Child and family (when identified by team) outcomes are clearly based on family concerns and priorities

 (e.g. Connections between information in the summary of family concerns, priorities, and resources to enhance the development of their child and the family and child outcomes are outlined.)

Child and family (when identified by team) outcomes are clearly based on family concerns and priorities

 (e.g.  Family concerns, priorities are central to the family and child outcomes and  resources to enhance the development of their child are identified/secured based on the priorities of the family/child.

B.  Child outcomes are functional, measurable (including criteria, procedures, and timelines,) and related to participation in everyday routines.  (Indicator #9A)

  Unacceptable

Minimally Acceptable

Practice  Standard (Meets the intent of IDEA)

Best Practice

Child outcomes are written:

1. As services to be provided, and/or
2. In discipline-specific therapeutic language, and/or
3. In vague terms, rather than written as functional and measurable

Child outcomes are:

1. Functional, and
2. Measurable (outcome indicates end result and why; criteria indicates how we know outcome is met, however, additional clarification is required (see comments).

Child outcomes are:

1. Functional, and
2. Measurable (outcome indicates end result and why; criteria indicates how we know outcome is met)

Child outcomes are all of the following:

1. Functional
2. Measurable (including criteria, procedures, and timelines)

C.  Child outcomes are developmentally appropriate and can realistically be achieved in the given review period.       (Indicator #9A)

  Unacceptable

Minimally Acceptable

Best Practice

Child outcomes:

1. Have little or no relationship to the information on the child’s current functioning, and/or
2. Are not likely to be achieved given the review period

Child outcomes:

1. Are consistent and relevant with information on child’s current functioning, and
2. Can realistically be achieved in the agreed upon review period; however, additional clarification is required (see comments).

Child outcomes:

1. Are consistent and relevant with information on child’s current functioning, and
2. Can realistically be achieved in the agreed upon review period

Child outcomes:

1. Are consistent and relevant with information on child’s current functioning,
2. Can realistically be achieved in the agreed upon review period, and
3. Are reflective of the child's interests.

A.  Early intervention strategies and activities support the child’s and family’s everyday routines and activities and build family capacity (confidence and abilities).

  Unacceptable

Minimally Acceptable

Best Practice

Strategies and activities reflect only what the professional will do with the  child, and only include specialized places and equipment.

Strategies and activities reflect that the early intervention personnel are supporting the family/caregivers to implement intervention strategies, which take place in the home and community settings; however, additional clarification is required (see comments).

B. Early intervention strategies and activities are written in family-friendly language, are individualized to the family, address the child and family’s specific needs and concerns, and build on child and family strengths.

  Unacceptable

Minimally Acceptable

Best Practice

Strategies and activities:

1. Are written in professional jargon, and/or
2. Seem so general that they could appear on any IFSP

Strategies and activities are:

1. Written in commonly understood language, and
2. Individualized to address the child and family’s specific needs and concerns; however, additional clarification is required (see comments).

Strategies and activities are:

1. Written in commonly understood language, and
2. Individualized to address the child and family’s specific needs and concerns

1. Written in easy to understand language
2. Individualized to specific needs and concerns of the child and family
3. Build on child and family strengths

C. Early intervention strategies and activities are linked to the child’s functional skills and are connected to the identified outcomes.

  Unacceptable

Minimally Acceptable

Best Practice

Strategies and activities are disjointed and not connected to the outcomes (e.g., they could be implemented in isolation without achieving the outcome).

AND/OR  Strategies and activities do not link with the child’s functional skills.

Strategies and activities are connected to the outcome and reflect the child’s functional skills.

  Unacceptable

Minimally Acceptable

Best Practice

Specific child and family services are not listed.        OR         Frequency, intensity, and method are not included for each specific service.      OR      Frequency , intensity, and method for each specific service is documented, but information and/or number of service providers involved indicate that:

1. A clinical model of direct therapy will be implemented, and/or

2. Family capacity will most likely not be enhanced, and/or

3. Families are likely to feel overwhelmed or burdened

Frequency, intensity, and method of specific early intervention services appear to be related to child and family outcomes and the family’s/caregiver’s capacity and need for support and problem solving of challenges. However, additional clarification is required (see comments).

Specific child and family services are listed and seem reasonable given:

1. The developmental status of the child
2. The family’s concerns, priorities, and resources
3. The IFSP outcomes   

AND       Frequency, intensity, and method are specified for each service and seem reasonable and fit into the family’s daily routines and priorities given all of the following:

1. The  developmental status of the child

2. The family’s concerns, priorities, and resources

3. The IFSP outcomes

Specific child and family services are listed and seem reasonable given all of the following:

1. The developmental status of the child

2. The family’s concerns, priorities, and resources

3. The IFSP outcomes

AND   Frequency, intensity, and method are specified for each service and seem reasonable and fit into the family’s daily routines and priorities given all of the following:

1. The developmental status of the child

2. The family’s concerns, priorities, and resources

3. The IFSP outcomes

AND      There is evidence in the strategies of building family capacity through consulting across disciplines (or environments where concerns are being addressed by a single provider) and coaching with the family.

  Unacceptable

Minimally Acceptable

Practice  Standard (Meets the intent of IDEA)

Best Practice

Assistive technology is not clearly related to the identified outcome.

Assistive technology is clearly necessary to achieve IFSP outcomes based on all of the following information:

1. The child’s developmental status
2. IFSP outcomes
3. Strategies and activities

However, additional clarification is required (see comments).

Assistive technology is clearly necessary to achieve IFSP outcomes based on all of the following information:

1. The child’s developmental status
2. IFSP outcomes
3. Strategies and activities

1. Assistive technology:

2. Is clearly necessary to achieve IFSP outcomes, and
3. Enable the child to participate in everyday routines and activities based on all of the following information:

-The child’s developmental status

-IFSP outcomes

-Strategies and activities

B. Assistive technology devices are chosen with careful consideration of the child’s needs and the appropriate method(s) to achieve the outcome.          Check if Assistive Technology device Is not reqiored and skip these items.

Unacceptable

Minimally Acceptable

Best Practice

Strategies and activities are disjointed and not connected to the outcomes (e.g., they could be implemented in isolation without achieving the outcome).  AND/OR        Strategies and activities do not link with the child’s functional skills.

Specialized assistive technology equipment is authorized even when there is no documentation that it is necessary in the IFSP; and typically available equipment/materials could be used/adapted to meet the child’s needs.

1. When necessary to meet outcomes, and
2. When typically available equipment/materials cannot be used/adapted to meet the child's needs.

  Unacceptable

Minimally Acceptable

Practice Standard 

(Meets the intent of IDEA)

Best Practice

1. Administrative convenience, and/or
2. Fiscal reasons, and/or
3. Personnel limitations, and/or
4. Parent/therapist preferences

The child is receiving most services in natural environments.      AND    When a service is provided in a setting that is not a natural environment, a justification is included in the IFSP that is based on the needs of the child, justifying that the setting is necessary to achieve the outcome.

 However, additional clarification is required (see comments).

The child is receiving most services in natural environments.    AND    When a service is provided in a setting that is not a natural environment, a justification is included in the IFSP that is based on the needs of the child, justifying that the setting is necessary to achieve the outcome.

All services are provided in natural environments.       OR       The child is receiving most services in natural environments      AND     When a service is provided in a setting that is not a natural environment, a justification is included in the IFSP that is based on the needs of the child, justifying that the setting is necessary to achieve the outcome.           AND         For each service justified there is a plan to transition interventions into natural settings.

  Unacceptable

Minimally Acceptable

Best Practice

No information is noted in the IFSP, even about the required age three (3) transition items on the Transition Checklist.

The required transition discussion items in the Transition Checklist and transition issue(s) specific to the child and/or family needs and interests are identified (as appropriate) in the IFSP.       AND

The steps that support the transition to either Part B preschool services or other services that may be available as appropriate to the child are also described including all of the following:

1. Specific places
2. Programs
3. Dates
4. People who will need to be involved in the transition process.

 However, additional clarification is required (see comments).

The required transition discussion items in the Transition Checklist and transition issue(s) specific to the child and/or family needs and interests are identified (as appropriate) in the IFSP.      AND    The steps that support the transition to either Part B preschool services or other services that may be available as appropriate to the child are also described including all of the following:

1. Specific places
2. Programs
3. Dates
4. People who will need to be involved in the transition process.

The required transition discussion items in the Transition Checklist and transition issue(s) specific to the child and/or family needs and interests are identified (as appropriate) in the IFSP.     AND     The steps that support the transition to either Part B preschool services or other services that may be available as appropriate to the child are also described including all of the following:

1. Specific places
2. Programs
3. Dates
4. People who will need to be involved in the transition process are identified with contact information and implementation schedules. 

  Unacceptable

Minimally Acceptable

Best Practice

For all outcomes, information describes how well strategies are working toward achieving outcomes.     AND     For child outcomes, there is information on:

1. Progress toward meeting the outcomes, and
2. Current developmental status including child behavior and skills.   

AND     Information is adequate for reviewers to determine if modifications and revisions are appropriate.      However, additional clarification is required (see comments).

For all outcomes, information describes how well strategies are working toward achieving outcomes.          AND          For child outcomes, there is information on:

1. Progress toward meeting the outcomes, and
2. Current developmental status including child behavior and skills.

AND        Information is adequate for reviewers to determine if modifications and revisions are appropriate.

For all outcomes, information describes how well strategies are working toward achieving outcomes.         AND         For child outcomes, there is information on all of the following:

1. Progress toward meeting the outcomes, and
2. Current developmental status including child behavior and skills
3. Discussion of child behavior and skills in everyday routines and activities

AND       Information is adequate for reviewers to determine if modifications and revisions are appropriate.