School Consultation Project Application

Transcription

1 School Consultation Project Application The goal of the School Consultation Project is to help your school district increase its capacity to service students with autism spectrum disorders (ASD) by developing an in-house Autism Resource Team. Participants of this core team should reflect a variety of disciplines (e.g. Special Education, General Education, School Psychology, Social Work, Administration, OT, PT, Paraprofessionals, etc.) and be committed to serving your district as mentors/resources for colleagues after the training is completed. Knowledge of ASD and experience working with students who have ASD should be considered when determining who will serve on your district s Autism Resource Team however, qualities such as dedication, enthusiasm, openness to learning, and ability to serve as a mentor to others should also be given serious consideration. Autism Resource Core Team members must commit to attending all training sessions. Participating in this program also requires you to choose 2 students with ASD in your program/school/district to focus on as case examples throughout the process. Students can be either a typical example of many of the students with ASD in your program/school/district and/or be presenting unique challenges to the staff working with him/her. When deciding which students to serve as case examples it is helpful if 2-3 members of the Autism Resource Core Team are familiar with them. It is not necessary that all the Autism Resource Core Team members know the students selected. Student-specific team members will be invited to later sessions when discussion of the students begins. Parents of these students must be invited to participate in relevant training sessions although it is recognized that parents may be unable to participate in every session due to work or personal constraints. General Information School District County Person Making Request, Position Street Address City Zip Code Phone Fax The program is a: Public School (K-12) BOCES Private (non-residential) Private (residential) Other (please specify):

2 Demographic Information Total School District Enrollment % of students eligible for free or reduced lunch % of students in each ethnic category Number of students classified with a disability Number of students classified with an autism spectrum disorder American Indian or Alaska Native Black or African American Hispanic or Latino Asian or Native Hawaiian Islanders/ Other Pacific Islander White What is your district s preferred start month? (Choose 2) (Please note: Programs are scheduled with start dates in both the fall and winter) September 2018 January 2019 October 2018 February 2019 Please answer the following questions: 1. Which of the following classifications does your school/program fall under: (please circle all that apply) a. Public school- K-12 b. Public school- preschool c. BOCES program d. Private school-day e. Private school- residential f. Other (please specify): 2. What age group does your school/program primarily serve? (please circle all that apply): a. Early Intervention/Preschool (birth-4) b. Elementary (5-11) c. Middle (11-14) d. High (14-21) 3. Please identify how many of the following school personnel you will be including for participation in this program (please keep the total number between 7 to 10 people). A representative from each professional discipline listed in BOLD MUST be included in the project. Individuals chosen to participate must commit to attending all sessions and be prepared to take on roles such as leader, facilitator, record keeper, time keeper and be committed to collecting and reporting data on interventions the group chooses to implement. Special Education teacher(s) Regular Education teachers(s)

3 Paraprofessional(s) Speech Language Pathologist(s) Physical Therapist(s) Occupational Therapist(s) School Psychologist(s)/School Counselor(s) School Social Worker(s) Administrator(s) Parent(s) Specials teacher(s) Other(s) (please specify) 4. Please check reasons for applying for this program: Increase the knowledge/skills of staff that work with students with ASD Receive technical assistance on a few students that are particularly challenging Interest in developing a team to support the district Parent urging District currently involved in legal action Program is offered at no cost Participated in other CARD programs and had good experiences Other (please explain): 5. How do you plan on using an Autism Resource Team in your district if you are chosen for this project? 6. Which of the following types of training have members of your potential autism resource team participated in (check all that apply)? Characteristics of Autism Spectrum Disorders Floortime Applied Behavioral Analysis RDI Discrete Trial Training Facilitated Communication Verbal Behavior Positive Behavior Support TEACCH protocols Auditory Integration Therapy Sensory diet Pivotal Response Training Functional Communication PECS Other: 7. Does your program/school/district have a school-wide behavioral system Yes No If yes, please describe the program you have in place:

4 8. Is a Functional Behavior Assessment (FBA) used to direct intervention planning for persistent challenging behaviors? Yes No Please describe your process for handling challenging behaviors: 9. Are environmental accommodations and adaptations used to prevent or minimize occurrences of the problem behavior? Yes No If yes, please describe the environmental accommodations and adaptations your district uses to reduce challenging behavior: 10. How does your district routinely incorporate instruction in alternative, appropriate skills (e.g., communication, social, or self-regulatory skills) into behavior intervention plans? 11. Are Behavior Intervention Plans (BIP) based on positive supports and strategies? Yes No 12. Do behavior intervention plans focus on long-term outcomes (e.g., making new friends, participating in extracurricular activities)? Yes No 13. Do the identified students have a current FBA and BIP on file? Yes No If yes, is the BIP appropriately supporting the student s behavior? Yes No Please attach a blank copy of the FBA/BIP forms your district uses. If no, is completing an individualized plan to target challenging behavior and increase prosocial skills for the identified student(s) a goal of the team participating in the School Consultation Project? Yes No

5 14. What type of social programming is currently in place for students with ASD? Is assessing skill level and developing appropriate social programming for the identified students a goal of your program/school/building in the School Consultation Project? Yes No 15. Please describe the typical instructional modifications that are made for students with ASD in your district: 16. What are specific methodologies being used by the district for working with students who are diagnosed with ASD (e.g. ABA, Positive Behavior Supports)? 17. How does your district provide for speech/language/communication instruction for the following grade levels: Elementary level Middle school level High school level 18. Does your school currently contract with any other agency to provide consultation/training regarding autism spectrum disorders, or employ an in-house autism or behavior specialist? Yes No If yes, how would the role of CARD be different from the role that the specialist(s) play?

6 Please provide the names, addresses, and signatures of participating core team members after they have reviewed the application and have read the program description and commitment it entails. Also, please assign one contact person who is an administrator (principal, CSE chair) and one contact person who is a teacher or related service provider. Please denote these key people with an asterisk: Name Position Signature Please have the following people review and sign this application before returning it to the Center for Autism and Related Disabilities: CSE Chairperson/Director of Special Education Building Principal District Superintendent/Program Director PLEASE NOTE: Submission of completed application DOES NOT guarantee entrance into the School Consultation Project. The Center for Autism and Related Disabilities will be reviewing all applications and selecting schools/programs whose goals are consistent with those of this program. The contact person will be notified by phone and/or mail by mid-may 2018 regarding application status. Please complete and return this application to the address below no later than April 30, Applications received after this date may not be reviewed for the school year.