IEP Form 5A – Services
Offer of FAPE
Special education and related services are
determined at the IEP meeting only after goals and if appropriate
objectives/benchmarks have been finalized. Placement decisions must be made in
conformity with the least restrictive environment (LRE) provisions. These
provisions direct that to the maximum extent appropriate, students with
disabilities be educated with typically developing peers, and that special
classes, separate schooling or other removal of students from the general
education environment occurs only if the nature or severity of the disability
is such that education in general education classes with the use of
supplementary aids and services cannot be achieved satisfactorily. The
placement must be made in the school that the student would attend if the
student did not have a disability unless unique circumstances prevent this
placement. Special education and related services and supplementary aids and
services, should be based on peer-reviewed research to the extent practicable.
1. Service Delivery Options Considered: Discuss
and document service delivery options considered. The team must first consider
placement in the general education classroom with supports prior to
recommending a more restrictive setting all or part of the day.
Note: In determining the LRE, consideration must be
given to any harmful effect on the child or quality of services that the child
needs.
Follow the continuum of services below as a guide to
determining LRE:
á General Education Class
á General Education Class – Supplemental aids or services
á General Education Class – Some direct
instruction by special education staff. Less than 21% of time out of the
classroom for special education services.
á General Education Class – 21% to 60% of
instructional day in a separate classroom.
á Some/or no instruction in General Education Class
– 60% or more of the instructional day in a separate classroom (intensive
services).
á Special day school – Separate facility (public
or nonpublic) with no general education students on campus.
á Residential School.
á Hospital Program.
á Home Instruction.
2. Supplementary
Aids, Services and Other Supports for School Personnel, or for the Student, or
On Behalf of the Student: Note supplementary aids and services and/or
supports for the student, school personnel (consultation to teachers,
preferential seating, enlarged text, etc.). Indicate if the supports are for
the student or for school personnel by checking the appropriate box in the
grid.
Team must also document modifications and/or
accommodations that will be needed in order for the student to progress toward
annual goals while participating in the general curriculum. Accommodations do
not fundamentally alter or lower
expectations or standards in instructional level, content, or performance
criteria (extended time on a timed task, enlarged text, etc.). Modifications
fundamentally alter or lower expectations or standards in instructional level,
content, or performance criteria (alternate math assignment, etc.). Indicate
who will be responsible for the supplementary aids and services, the start and
end date, duration, frequency, and location.
3. Special
Education and Related Services: The
team needs to determine the special education and related services that will provide
educational benefit and facilitate progress on the goals for the student (e.g.
specialized academic instruction, health and nursing, language and speech,
etc). Identify the type of
service. Indicate if the service will be individual or group. If the service is to support
secondary transition, check the secondary transition box. See CASEMIS codes below:
Specialized
InstructioN
330 |
Specialized
academic instruction |
Adapting,
as appropriate to the needs of the child with a disability the content,
methodology, or delivery of instruction to ensure access of the child to the
general curriculum, so that he or she can meet the educational standards
within the jurisdiction of the public agency that apply to all children.
(RSP- school based, RSP, SDC inclusion services, SDC-public integrated,
SDC-public segregated, SDC-non-public school.) |
340 |
Intensive
individual instruction |
IEP
Team determination that student requires additional support for all or part
of the day to meet his or her IEP goals. (1-1 instructional assistant) |
350 |
Individual
& small group instruction |
Instruction
delivered one-to-one or in a small group as specified in an IEP enabling the
individual(s) to participate effectively in the total school program. (For preschool only) |
Related Services
415 |
Language
and Speech |
Includes
receptive and expressive language, articulation, voice, and fluency. |
425 |
Adapted
physical education |
Direct
physical education services provided by an APE. |
435 |
Health
& nursing –specialized physical health care services |
Specialized
physical health care services means those health services prescribed by the
childŐs licensed physician and surgeon requiring medically related training
of the individual who performs the services and which are necessary during
the school day to enable the child to attend school. SPHCS include but are
not limited to suctioning, oxygen administration, catheterization, nebulizer
treatments, insulin administration, and glucose testing. |
436 |
Health
& nursing – other services |
This
includes services that are provided to students by qualified personnel
pursuant to an IEP when a student has health problems which require nursing
intervention beyond basic school health services. Services include managing the health problem, consulting
with staff, group & individual counseling, making appropriate referrals
and maintaining communication with agencies and health care providers. |
445 |
Assistive
technology services |
Any
specialized training or technical support for the incorporation of assistive
devices, adapted computer technology or specialized media with the
educational programs to improve access for students. |
450 |
Occupational
therapy |
OT
includes services to improve studentŐs educational performance, postural
stability, self-help abilities, sensory processing and organization,
environmental adaptation and use of assistive devices, motor planning and
coordination, visual perception and integration, social play abilities and
fine motor. |
460 |
Physical
therapy |
Services
provided by a register PT pursuant to an IEP when assessment shows
discrepancy between gross motor performance and other educational skills. |
Mental Health Services
510 |
Individual
counseling |
One-to-one
counseling, provided by a qualified individual pursuant to an IEP. |
515 |
Counseling
& guidance |
Counseling
in a group setting, provided by a qualified individual pursuant to an
IEP. |
520 |
Parent
counseling |
Individual
or group counseling provided by a qualified individual pursuant to an IEP to
assist the parent(s) of special education students in better understanding
and meeting their childŐs needs. |
525 |
Social
work services |
Includes
services provided pursuant to an IEP by a qualified individual. |
530 |
Psychological
services |
These
services provided by a credentialed or licensed psychologist pursuant to an
IEP. |
535 |
Behavior
intervention services |
A
systematic implementation of procedures designed to promote lasting, positive
changes in the studentŐs behavior resulting in greater access to a variety of
community settings, social contacts, public events, and placement in the LRE. |
540 |
Day
treatment services |
Structured
education, training and support services to address the studentŐs mental
health needs. |
545 |
Residential
treatment services |
A 24
hour out-of-home placement that provides intensive therapeutic services to
support the educational program. |
Low Incidence Services
610 |
Specialized
services for low incidence disabilities |
Low incidence services are defined as
those provided to the student population of orthopedic impairment (OI),
visual impairment (VI), deaf, hard of hearing (HH), or deaf-blind (DB).
Typically, services are provided in education settings by an itinerant
teacher or the itinerant teacher/specialist. Consultation is provided to the
teacher, staff and parents as needed. |
710 |
Specialized deaf and hard of hearing services |
These services include speech therapy, speech reading, auditory
training, and/or instruction in the student's mode of communication.
Rehabilitative and educational services; adapting curricula, methods, and the
learning environment; and special consultation to students, parents,
teachers, and other school personnel may also be included. |
715 |
Interpreter services |
Sign language interpretation of
spoken language to individuals, whose communication is normally sign
language, by a qualified sign language interpreter. |
720 |
Audiological services |
These services include
measurements of acuity, monitoring amplification, and Frequency Modulation
system use. |
725 |
Specialized vision services |
This is a broad
category of services provided to students with visual impairments. It
includes assessment of functional vision; curriculum modifications necessary
to meet the student's educational needs -- including Braille, large type,
aural media; instruction in areas of need; concept development and academic
skills; communication skills (including alternative modes of reading and
writing); social, emotional, career, vocational, and independent living skills.
It may include coordination of other personnel providing services to the
students (such as transcribers, readers, counselors, orientation &
mobility specialists, career/vocational staff, and others) and collaboration
with the student's classroom teacher. |
730 |
Orientation and mobility |
Students with
identified visual impairments are trained in body awareness and to understand
how to move. Students are trained to develop skills to enable them to travel
safely and independently around the school and in the community. It may
include consultation services to parents regarding their children requiring
such services according to an IEP. |
735 |
Braille transcription |
Any transcription
services to convert materials from print to Braille. It may include
textbooks, tests, worksheets, or anything necessary for instruction. The
transcriber should be qualified in English Braille as well as Nemeth Code
(mathematics) and be certified by appropriate agency. |
740 |
Specialized orthopedic services |
Specially designed
instruction related to the unique needs of students with orthopedic
disabilities, including specialized materials and equipment. |
745 |
Reading Services |
|
750 |
Note taking services |
Any specialized
assistance given to the student for the purpose of taking notes when the student
is unable to do so independently. This may include, but is not limited to,
copies of notes taken by another student, transcription of tape-recorded
information from a class, or aide designated to take notes. |
755 |
Transcription Services |
Any transcription
service to convert materials from print to a mode of communication suitable
for the student. This may also include dictation services as it may pertain
to textbooks, tests, worksheets, or anything necessary for instruction. |
760 |
Recreation Services |
Therapeutic recreation
and specialized instructional programs designed to assist pupils to become as
independent as possible in leisure activities, and when possible and
appropriate, facilitate the pupilŐs integration into general education
programs. |
Transition Services
820 |
College Awareness |
|
830 |
Vocational assessment, counseling, guidance, and career
assessment |
Organized educational
programs that are directly related to the preparation of individuals for paid
or unpaid employment and may include provision for work experience, job
coaching, development and/or placement, and situational assessment. This
includes career counseling to assist student in assessing his/her aptitudes,
abilities, and interests in order to make realistic career decisions. |
840 |
Career awareness |
Transition services
include a provision for in self-advocacy, career planning, and career
guidance. |
850 |
Work experience education |
Work experience
education means organized educational programs that are directly related to
the preparation of individuals for paid or unpaid employment, or for
additional preparation for a career requiring other than a baccalaureate or
advanced degree. |
855 |
Job Coaching |
Job coaching is a
service that provides assistance and guidance to an employee who may be
experiencing difficulty with one or more aspects of the daily job tasks and
functions. The service is
provided by a job coach who is highly successful, skilled and trained on the
job who can determine how the employee that is experiencing difficulty learns
best and formulate a training plan to improve job performance. |
860 |
Mentoring |
Mentoring is a
sustained coaching relationship between a student and teacher through
on-going involvement and offers support, guidance, encouragement and
assistance as the learner encounters challenges with respect to a particular
area such as acquisition of job skills.
Mentoring can be either formal as in planned, structured instruction
of informal that occurs naturally through friendship, counseling and
collegiality in a casual, unplanned way. |
865 |
Agency linkages (referral and placement) |
Service coordination
and case management that facilitates the linkage of individualized education
programs. |
870 |
Travel Training (includes mobility training) |
|
890 |
Other transition services |
These services may
include program coordination, case management and meetings, and crafting
linkages between schools and between schools and post-secondary agencies. |
900 |
Other Special Education/Related Services |
Any other specialized
service required for a student with a disability to receive educational
benefit. |
4. Start
and End Date: This will often be the same start/end dates for the primary
service on the IEP.
5. Provider: Note the title of the provider of the service (do
not put the personŐs name).
6. Frequency: Indicate the frequency of the service being
provided, such as daily, weekly, monthly, yearly, or any other frequency.
7. Duration: Indicate number of times per frequency (see
CASEMIS for examples).
8. Location: Select
the location of where the service is provided to the student from the
following:
210 Home
instruction based on IEP team determination (not medical)
220 Hospital
310 HeadStart
center
320 Child
development or childcare facility
330 Public
preschool
340 Private
preschool
350 Extended
day care
360 Residential
facility
510 Regular
classroom/public day school
Includes
students who are fully included in general education classrooms.. Also includes students who are seen
under a Ňpush inÓ model in the general education classroom and students who
receive DIS services in the general education classroom. Additionally, students
who receive services in a setting that includes other students with special
needs are included here if there are general education students who are
Ňreverse mainstreamÓ students in that class for that portion of the day.
520 Separate
class in public integrated facility
Includes
students receiving special education Ňpull-outÓ services, including RSP and
DIS, or in a Ňspecial day classÓ model,Ó etc.
530 State
Special School
540 Separate
school or special education center or facility
550 Public
residential school
560 Other
public school or facility
570 Charter
school operated by an LEA/district
580 Charter
school operated as an LEA/district
610 Continuation
school
620 Alternative
work education center/work study facility
630 Juvenile
court school
640 Community
school
650 Correctional
institution or facility
710 Community
college
720 Adult
education facility
810 Nonpublic
day school
820 Nonpublic
residential school-in California
830 Nonpublic
residential school-outside California
840 Private
day school (not certified by CDE Special Education Division)
850 Private
residential school (not certified by CDE Special Education Division)
860 Parochial
school
890 Service
provider location
This
would include CMH Outpatient Services provided at a clinic or other outside
medical/therapeutic setting.
900 Any
other location or setting
9. Extended School Year (ESY): Discuss if the student needs ESY to receive FAPE.
Check yes or no. If yes, specify in the grid the services the student will receive, the start and end date, provider, frequency, duration, and location.
Note:
ESY shall be provided to a student with a disability who the IEP deems
requires special education and related services in excess of the regular
academic year. Such students shall have disabilities which are likely to
continue indefinitely or for a prolonged period of time, and interruption of
the studentŐs educational programming may cause regression, when coupled with
limited recoupment capacity, rendering it impossible or unlikely that the
student will attain the level of self-sufficiency and independence that would
otherwise be expected in view of his or her disability. (5 CCR 3043)
[Source: State SELPA IEP Manual (draft), July 2008]