Confidentialearly Intervention Programnebraska Individualized Fami ✓ Solved

( CONFIDENTIAL ) EARLY INTERVENTION PROGRAM Nebraska Individualized Family Service Plan (IFSP) Child's Name: Phone: Address: Child's Social Security Medicaid Birthdate: Number: Number: Date of Referral to Date of Consent for Date of Early Intervention Evaluation MDT Family's language Family would like choice: an Interpreter D Yes D No Parent(s) / Guardian: Name: Home Phone: Address (if different) Role Work Phone: Name: Home Phone: Address (if different) Role Work Phone: Name: Home Phone: Address (if different) Role Work Phone: Name: Home Phone: Address (if different) Role Work Phone: If you have any questions about this plan or any of the people working with your child, please call the person listed as Services Coordinator.

Agency/ Name: Phone: Address: IFSP Meeting Dates: Interim / Initial / Annual / Transition / _ (Date sent) (Date sent) (Date sent) (Date sent) Periodic Review / Periodic Review / Periodic Review / Periodic Review / (Date sent) (Date sent) (Date sent) (Date sent) EI-1 Rev. 11/) This is a PDF form from the Nebraska HHS System Web Page. (Use previous version 5/94 first) Name of Child DATE: FAMILY'S CONCERNS AND DESIRED PRIORITIES: CONFIDENTIAL ( EI-1 Page )EI-1 Page ) ) Name of Child DATE CHILD AND FAMILY'S STRENGTHS: CONFIDENTIAL ( EI-1 Page ) ) ( --------- Denotes Periodic Update) Name of Child CONFIDENTIAL CHILD'S PRESENT LEVELS OF DEVELOPMENT Area/Date of Evaluation Current Abilities Vision / / / yrs mos / / / yrs mos Hearing / / / yrs mos / / / yrs mos Health / / / yrs Status mos / / yrs mos Area/Date of Evaluation Current Abilities ( ( Denotes Periodic Update) ) ( Name of Child ) ( CONFIDENTIAL ) ( CHILD'S PRESENT LEVELS OF DEVELOPMENT (CONT'D) ) ( EI-1 Page ) ) Cognitive/ Thinking Skills / / / yrs mos / / / yrs mos Communication Skills / / / yrs mos / / / yrs mos Social/Behavior Skills / / / yrs mos / / / yrs mos Area/Date of Evaluation Current Abilities Self-Help/Adaptive Skills / / / yrs mos / / / yrs mos Fine Motor Skills / / / yrs mos / / / yrs mos Gross Motor Skills / / / yrs mos / / / yrs mos Goal/Outcome Child/Family strengths and resources related to this goal: What will be done/by whom: Progress will be reviewed by through (How Often) (By Whom) (How Measured) Plan Review for this Goal Date: Next Steps:/Comments: How much progress ( CONFIDENTIAL ) ( Name of Child ) ( GOAL/OUTCOME: ) ( EI-1 Page 7a (57060) ) Plan Review for this Goal Date: Next Steps:/Comments: How much progress ( CONFIDENTIAL ) ( Name of Child ) ( GOAL/OUTCOME: ) ( EI-1 Page 7b (57060) ) D Interim D Initial D Annual D Transition D Periodic Review Date: Are there special conditions for safe transportation for this child? ( THE SERVICES THAT WILL BE PROVIDED TO SUPPORT ALL GOALS AND OBJECTIVES ARE: ) Service How often?

Where? How much? When will the service Who pays? Who's responsible? Group/Individual?

Start/End? Natural Environment? Include a justification of the extent, if any, to which a service will not be provided in a natural environment. ( CONFIDENTIAL ) ( School District # Name of Child ) ( EI-1 Page 8a (57060) ) D Interim D Initial D Annual D Transition D Periodic Review Date: Are there special conditions for safe transportation for this child? ( THE SERVICES THAT WILL BE PROVIDED TO SUPPORT ALL GOALS AND OBJECTIVES ARE: ) Service How often? Where? How much?

When will the service Who pays? Who's responsible? Group/Individual? Start/End? Natural environment?

Include a justification of the extent, if any, to which a service will not be provided in a natural environment. ( CONFIDENTIAL ) ( School District # Name of Child ) ( EI-1 Page 8b (57060) ) Transition Conference Date: Estimated Transition Date: What Needs Who is Time Date to be Done Responsible Line Completed ( CONFIDENTIAL ) ( School District # Name of Child ) ( IFSP TRANSITION PLAN ) ( EI-1 Page 9a (57060) ) Transition Conference Date: Estimated Transition Date: What Needs Who is Time Date to be Done Responsible Line Completed ( CONFIDENTIAL ) ( School District # Name of Child ) ( IFSP TRANSITION PLAN ) ( EI-1 Page 9b (57060) ) Name of Child CONFIDENTIAL CHILD/FAMILY TEAM Team Members Present at the Meeting: D Interim D Initial D Annual D Transition D Periodic Review Date: Print Name: Signature: Role: Address & Phone: Others Who are Part of the Child/Family Team: Name: Role: Address & Phone: Family Initial for Copy of Pages Sent ( EI-1 Page ) ) ( CONFIDENTIAL ) ( Parent's/Family )I (we) understand the content of the IFSP and give consent for all services in the IFSP to begin unless indicated below.

Yes No I(we) understand that a copy of the IFSP will be distributed within 7 calendar days. Yes No ( EI-1 Page ) ) Parent/Guardian Signature: Parent/Guardian Signature: Any Comments: Date: Date: Mock IFSP (10 points): Using the IFSP form provided, you will create an IFSP for a made-up child (you make up the child). Keep in mind IFSPs are for infants and toddlers aged birth-36 months and IEPs are for students 3-22 so make your outcomes meaningful. You must fill out the following sections: Isabel Peterson Age: 13 Grade: 8th Ethnicity: Caucasian Language: English Classification: Autism Family and Cultural Background: Isabel lives at home with her mother. Isabel has an older brother and a younger sister who are attending the state university and an older sister who is married and has two children.

Mr. Peterson passed away a few years ago; Isabel still cries herself to sleep at night, sobbing that she misses her daddy. Mrs. Peterson works full-time as a housekeeper at an upscale hotel. Mrs.

Peterson has been very appreciative of the education provided to Isabel, and has respected school personnel by accepting all of their educational recommendations. However, she had told her other children that she hopes for the day when Isabel can work for the local International Food Store, owned and operated by Mrs. Peterson’s brother, George Hansen. She feels confident that this would provide life-long employment for Isabel, whereas she is not as trusting of a commercial chain store to care as much about the special needs and circumstances of her daughter. Prior School Experience: Isabel was diagnosed as having ASD shortly after her third birthday.

She received early intervention services in the home and the Early Education Center, attended a preschool for students with developmental delays, and progressed through elementary and middle school in classes for students with disabilities and in classes alongside her nondisabled peers. Other Instructional and Behavioral Information: Functional Academics: Isabel can compute additional and subtraction problems with four digits using a calculator; but computes 2-digit multiplication and division problems with 50% accuracy. When asked, Isabel can give the names and values of coins, can count coins to values to , and can use the “dollar more†strategy to values of . She can read a digital clock to the minute but only an analog clock to the hour.

Isabel can read books on a 2.5 grade level, but her comprehension is on a 1st grade level. She enjoys books about young adults, but gets frustrated because of the reading skills necessary for reading such books. Isabel enjoys writing about events of the day in her electronic diary. Her Adapted from Guide to Writing Quality Individualized Education Programs , Gibb & Dyches, 2007 writing composition is on a 2nd-grade level; however, she uses a spell checker with 50% accuracy to check her work. Social/Emotional: Isabel is highly social, and loves to tease her friends in a playful way.

When required to complete difficult or “boring†tasks, Isabel often avoids these tasks by talking with her friends, and it often takes 5-10 verbal prompts to get Isabel to begin the task. Once she begins, she almost always completes the task. When she is tired she exhibits extreme emotions. She learns best when she can have fun or play games, is supported in her personal choices, and is given opportunities for social growth. Communication: Isabel is able to communicate many of her wants and needs, transferring information, using social etiquette, and engaging in conversation for social closeness.

She also engages in self-talk to regulate her emotions; however, she often gets “stuck†talking about negative feelings such as anger, frustration, sorrow, and jealousy, and is unable to resolve these issues by herself. Isabel’s intelligibility is not clear, especially for those not familiar with her, and she is unable to repair conversations when they break down.

Paper for above instructions

Confidential Early Intervention Program

Nebraska Individualized Family Service Plan (IFSP)

Child's Information

- Child's Name: Isabel Peterson
- Phone: [REDACTED]
- Address: [REDACTED]
- Social Security Number: [REDACTED]
- Medicaid Number: [REDACTED]
- Birthdate: [REDACTED]
- Date of Referral to Early Intervention Evaluation: [REDACTED]
- Date of Consent for Evaluation: [REDACTED]
- Family’s Language Choice: English
- Interpreter Required: No

Parent(s) / Guardian Information

- Mother's Name: Mrs. Peterson
- Home Phone: [REDACTED]
- Address: [REDACTED]
- Work Phone: [REDACTED]

Team Information

- Services Coordinator Name: [REDACTED]
- Phone: [REDACTED]
- Address: [REDACTED]

Family's Concerns and Desired Priorities

Mrs. Peterson's primary concerns for Isabel include her emotional well-being, social integration, and academic performance. The family desires to achieve the following outcomes:
1. Improve Isabel’s coping mechanisms for her grief and feelings of loss related to her father's passing.
2. Improve Isabel’s academic skills in reading, writing, and mathematics.
3. Enhance her communication skills to better express her emotions and regulate her speech in social settings.

Child and Family's Strengths

Isabel demonstrates several strengths, including:
- High social engagement when interacting with peers, which can be harnessed in educational settings.
- Ability to use technological tools such as spell checkers and a digital diary to support her writing.
- Familiarity with a variety of learning games and social activities that facilitate skill acquisition, notably in math and communication.

Present Levels of Development

Vision

- Current Abilities: Normal vision
- Date of Evaluation: [REDACTED]

Hearing

- Current Abilities: Normal hearing
- Date of Evaluation: [REDACTED]

Health

- Current Abilities: Stable Health
- Date of Evaluation: [REDACTED]

Cognitive/Thinking Skills

- Current Abilities: Can perform addition and subtraction with four-digit numbers using a calculator. Struggles with two-digit multiplication and division (50% accuracy).
- Date of Evaluation: [REDACTED]

Communication Skills

- Current Abilities: Can express needs but struggles with articulation and expressing complex thoughts.
- Date of Evaluation: [REDACTED]

Social/Behavior Skills

- Current Abilities: Highly social but often avoids tasks that are challenging. Requires verbal prompts to initiate engagement.
- Date of Evaluation: [REDACTED]

Self-Help/Adaptive Skills

- Current Abilities: Utilizes technology for daily writing and demonstrates an understanding of personal organization.
- Date of Evaluation: [REDACTED]

Fine Motor Skills

- Current Abilities: Adequate fine motor skills for daily tasks, may require assistance with activities demanding precision.
- Date of Evaluation: [REDACTED]

Gross Motor Skills

- Current Abilities: Exhibits normal gross motor skills for her age; enjoys sports and physical activities.
- Date of Evaluation: [REDACTED]

Goals/Outcomes

Goal 1: Emotional Regulation

Child/Family strengths and resources: Isabel's social skills can be supported by engaging in cooperative play with peers.
What will be done/by whom: Cognitive Behavioral Therapy (CBT) with a licensed therapist focusing on grief counseling.
Progress will be reviewed: Monthly by the therapist.
How Measured: Use of emotion regulation checklists.

Goal 2: Academic Achievement

Child/Family strengths and resources: Use of technology in her learning.
What will be done/by whom: After-school tutoring program focused on reading, writing, and math skills (by a special education teacher).
Progress will be reviewed: Bi-weekly in teacher meetings.
How Measured: Through assessments and observed homework completion.

Goal 3: Social Communication Skills

Child/Family strengths and resources: Isabel’s sociability can be leveraged to enhance her communication.
What will be done/by whom: Participation in social skills groups led by a speech-language pathologist.
Progress will be reviewed: Weekly.
How Measured: Social skills assessments and peer feedback.

Services to Support Goals and Objectives

Service 1: Cognitive Behavioral Therapy

- How Often: Weekly
- Where: Local healthcare facility
- How Much: 1-hour sessions
- Who Pays: Health insurance / Medicaid
- Who's Responsible: Therapist / Mrs. Peterson
- Natural Environment: Not applicable

Service 2: After-School Tutoring

- How Often: Bi-weekly
- Where: School
- How Much: 1 hour per session
- Who Pays: School district
- Who's Responsible: Special education teacher
- Natural Environment: Yes

Service 3: Social Skills Group

- How Often: Weekly
- Where: Community center
- How Much: 1 hour per session
- Who Pays: Insurance / Medicaid
- Who's Responsible: Speech-language pathologist
- Natural Environment: Yes

Transition Plan

Transition Conference Date: [REDACTED]
Estimated Transition Date: [REDACTED]
Needs and Responsibilities:
- Development of a transition plan for potential entry into high school settings, focusing on favorable outcomes for post-secondary life.

Team Members

Team Members Present at the Meeting:
- Mrs. Peterson
- Special Education Teacher
- Speech-Language Pathologist
- Therapist

Signatures

- Parent/Guardian Signature: ______________________
- Date: ______________________
Comments: This IFSP is tailored to address the unique needs and strengths of Isabel Peterson. The caregivers are encouraged to maintain open communication with all team members as they implement the proposed strategies and services.
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References

1. Gibb, L. & Dyches, T. (2007). Guide to Writing Quality Individualized Education Programs.
2. U.S. Department of Education. (2020). The Individuals with Disabilities Education Act (IDEA).
3. Early Childhood Technical Assistance Center (ECTA). (2021). Individualized Family Service Plan (IFSP).
4. Autism Society. (2022). Understanding Autism Spectrum Disorder (ASD).
5. American Speech-Language-Hearing Association. (2023). Communication Skills in Children with Autism.
6. Ramaswamy, V., & Muran, J. (2019). Creative Approaches to Autism and the Normative Development of Children's Writing.
7. Thomas, N., & Garris, J. (2021). Cognitive Behavioral Therapy and Children.
8. Nebraska Department of Health and Human Services. (2023). Early Intervention in Nebraska.
9. Individuals with Disabilities Education Improvement Act. (IDEA). (2004).
10. National Center for Learning Disabilities (NCLD). (2022). Educational Supports and Services for Students with ASD.
This IFSP will be reviewed and updated as Isabel's needs evolve, ensuring ongoing support and intervention that aligns with her development goals and family priorities.