4/26/18 updates
June 15, 2017
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Access Log Tab
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Districtwide Case Management Notebook Access Log The Case Management Notebook contains confidential student information; therefore, access should be limited. All parties with an educational need to know, must sign the Districtwide Access Log. District personnel and parents may sign separate sign in logs. Remember parents have the right to inspect and review their own child’s educational records with respect to their child’s evaluation, identification, placement, and the provision of FAPE.
CONFIDENTIAL Districtwide Case Management Notebook Access Log Name
Date
Position
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Purpose
General Information Tab
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Case Management The goal of case management is to ensure that each student with a disability has a staff member who is very knowledgeable about the student and who can be an advocate for that student. Additionally, the case manager will ensure compliance with federal, state and local regulations in regard to the implementation of the Individualized Education Program (IEP) as decided by the student’s Admission, Review and Dismissal (ARD) Committee. All special education teachers and speech therapists are responsible for maintaining a Case Management Notebook for the students on a particular campus for whom they have been assigned as the Instructional Case Manager. This notebook system serves as an organizational tool, a documentation source and a monitoring instrument. The Case Management Notebook (CMN) contains confidential student information. Therefore, it should be maintained following Records Management procedures outlined in the Family Educational Rights and Privacy Act of 1974. Specific guidelines may be found in this notebook. The Case Manager (CM) is the special education teacher/provider of record who uses the Case Management Notebook System to coordinate a student’s educational program. The Evaluation Case Manager (ECM) is the evaluation staff member who is responsible for coordinating the specific evaluation/reevaluation in progress. These two professionals work closely together, especially in scheduling ARD/IEP meetings and in completing reevaluations. For instance, the CM should gather reevaluation information, the ECM should coordinate testing, and the CM and ECM should schedule the review ARD and draft the document together.
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Confidentiality and Responsibility for Records of Students in Special Education ● All school staff members must complete the district’s compliance training courses provided through Region X. Please note information related to confidentiality is embedded throughout these videos. After viewing the videos, print your certificate of completion and give a copy to your administrator. These certificates must be maintained in the campus Special Education Records Management File. ● All staff must read and sign the Student Records Confidentiality Form annually and return a copy to the principal for filing in the Special Education Records Management File. ● The official responsible for ensuring the confidentiality of any personally identifiable information in records of special education students shall be the principal or the District records management officer. (Board Policy FL- Local) ● The campus must maintain a Special Education Student Eligibility Folder(s) (Red Audit Folders) for each student receiving special education services, in addition to the student’s cumulative record. ● Only district-authorized personnel who have a legitimate educational interest in the designated student shall have access to the folders. A school officials have a legitimate educational interest in a student’s records when they are working with the student; considering disciplinary or academic actions, the student’s case, or an individualized education program (IEP) for a student with disabilities; compiling statistical data; or investigating or evaluating programs. (refer to Board Policy FL – Local) ● The notice “Confidentiality of Special Education Records Access Form” showing the authorized positions must be posted in the location of the student folders at each campus and at the District’s Records Management Office. (see attachment) ● Any folder (Special Education Student Eligibility Folder, Special Education Teacher Folder, General Education Teacher Information Folder, etc.) containing any part of a student’s ARD/IEP documentation must have a Folder Access Log. ● Folder Access Log attached to the front inside cover. This log must be completed by anyone accessing the folder. ● Check Out Logs must be used to mark the place of a Special Education Student Eligibility Folder (Red Audit folder) that has been removed from its secure location. The Eligibility Folder Check Out Log must be signed when the folder is removed and returned.
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Student Records Confidentiality Form Federal law protects confidentiality of records for all students. All policies regarding the release of information must be strictly followed. Access to the records of any students with disabilities is strictly limited, and all special education eligibility information is to be kept in a locked, secure place. The Family Educational Rights and Privacy Act of 1974 (FERPA) limits the release of any personally identifiable information about any student only to the student’s parents, educators with a direct legitimate educational interest in the child, and appropriate persons in the event of an emergency. Release of confidential information to any other agency or person requires the written consent of the parent. Personally, identifiable information is considered to be any data that includes: the name of the student, student’s parents, or other family members the address of the student or student’s family any personal identifier (social security number, student identification number or biometric record) a list of personal characteristics which would make it possible to identify the student, student’s birthdate, place of birth, and mother’s maiden name and any other information that would make the student’s identity easily traceable
Educational records, which are in the sole possession of the maker, are not accessible by any other person. Sole possession records that are exempt from parental access, challenge and control must meet the following test: Notes must be private, and created solely by the individual possessing them Notes must be a personal memory aid Notes must not be accessible or revealed to any other person (except possessor’s temporary substitute) It is important for all staff to understand the concept of sole possession, and that once a note is revealed to anyone, it becomes subject to parental access and challenge. Everyone should give careful consideration to any written descriptions of student behavior. Any written description of student behavior, once shared, becomes accessible information. Any verbal communication about students containing personally identifiable information in any situation except those listed above, may be a violation of that student’s right to confidentiality. I have read the information and understand the content________________________________ Signature _________________________________ _________________________________ Campus/Department Date Please note: This information must be presented and explained annually Place signed form in the Campus Special Education Records Management File
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Access by School Officials Board Policy FL- (Local) For the purposes of this policy, “school officials” shall mean any employees, Trustees, or agents of the District, of cooperatives of which the District is a member, or of facilities with which the District contracts for placement of students with disabilities. The term also includes attorneys, consultants, and independent contractors who are retained by the District, by cooperatives of which the District is a member, or by facilities with which the District contracts for placement of students with disabilities. School officials have a “legitimate educational interest” in a student’s records when they are working with the student; considering disciplinary or academic actions, the student’s case, or an individualized education program (IEP) for a student with disabilities; compiling statistical data; or investigating or evaluating programs.
Location of Records Special Education Student Eligibility Folders (Red Audit Folders) will be kept in a locked secure location on each campus. ● The location where the folders are kept will be locked when the room is left unattended and will be locked each afternoon by a campus designee. ● The Special Education Folder Access Log is placed in the front of each Special Education Student Eligibility Folder (Red Audit Folder), Special Education Classroom Student Folder, and General Education Student Folder that contains the student’s IEP or any part of the student’s IEP. Each person reviewing the folder who is not authorized must sign the Folder Access Log. When a Special Education Student Eligibility Folder (Red Audit Folder) is removed from its secure location, a check out card must be signed and used as a place marker for the folder until the folder’s return, at which time the checkout card is removed and completed.
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PLEASE POST
Notice of Confidentiality of Special Education Records Access All persons, agencies or organizations desiring access to the records of a student will be required to sign a written form, which will be kept permanently with the file of the student, to be inspected only by the parents or student, indicating specifically the legitimate educational or other interests that each person, agency, or organization has in seeking such information, excluding school personnel with a legitimate educational interest. The attached form will be available to parents and to the school official responsible for record maintenance as a means of auditing the operation of the system. See Board Policy FL (Regulation)
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CONFIDENTIAL Folder Access Log Name
Date
Position
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Purpose
Principal’s Role The principal will follow the directions outlined by the Special Education Department in order to monitor the case management process. The following guidelines will assist the principal with this process: 1. Review case management concept/process with campus staff ● Stress the importance of special education compliance ● Maintain documentation of teachers’ training on confidentiality, compliance training, and EasyIEP, as well as other recommended trainings ● Explain all teachers’ roles and responsibilities 2. Define assignment of caseload ● Select appropriately certified special education teachers to support students with disabilities within the continuum of services offered on each campus ● Assign each special education student to a case manager. Reassign caseload if case manager resigns or takes a leave of absence 3. Determine teacher case management assignments ● Recognize the number of students on a caseload will vary due to complexity of some students’ needs ● Obtain EasyIEP rosters from special education teachers and student counts rosters from the CRC, to compare and adjust rosters and verify accuracy to determine teacher caseload ● Select case managers who actively instruct/support the students assigned to their case management load 4. Act as a custodian for the Case Management Notebook ● Serve as the official custodian of students’ records ● Return secured Case Management Notebooks to the special education teachers on his/her campus at the beginning of the year ● Ensure that the Case Management Notebook system is functioning within the first two weeks of the school year ● Perform regular visits throughout the school year to ensure appropriate implementation, including any corrective action plans recommended following monitoring visits ● If campus special education teachers are reduced or increased, contact the Special Education Compliance staff to return or receive extra Case Management Notebooks ● Collect Case Management Notebooks at the end of each school year and secure in a locked location. ● Distribute Case Management Notebook at the beginning of the school year to the appropriate assigned Case Manager.
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Special Education Teacher’s Role as Case Manager Each special education teacher is responsible for case managing the students on the caseload assigned by the principal. The case manager is expected to be knowledgeable about each of his/her student’s Individualized Education Program as well as their student progress. This will ensure compliance with federal, state and local regulations. 1. Manage caseloads ● Be knowledgeable about students, be their interventionists, and their advocate ● Schedule and conduct ARD/IEP meetings for students on caseload ● Implement Case Management Notebook system within first two weeks of school ● Ensure that the ARD/IEP Committee decisions are implemented and all services are provided ● Ensure each student has a Special Education Student Eligibility Folder (Red Audit folder) which is kept in a designated confidential area on the campus ● Ensure goals/objectives, accommodations, assessment information, and Behavior Intervention Plans are distributed (Receipt of ARD/IEP Information Form) prior to the first instructional day of school to appropriate personnel o Disseminate new ARD information within five days o Signatures must be obtained from general education teachers o Bus drivers should receive a copy of a student’s BIP, if applicable ● Collaborate with all stakeholders (special campus service providers, special education teachers, general education teachers, IE staff, Vision, Auditory Impaired, OT/PT, Adapted Physical Education, Music Therapist, Nurse, etc) to create a campus ARD calendar. Rescheduled ARDs should also be coordinated with all appropriate staff. Submit a copy to the Campus Administrator and Campus Support Specialist no later than the second week of school and when new ARDs are scheduled o New students must be added to the ARD Calendar 2. Current and correct data ● Cross-reference EasyIEP reports, rosters, and Red Audit Folders for ongoing compliance and consistency monthly 12
● Ensure all ARDs are held on time 3. Progress Monitoring ● Input or verify progress monitoring documentation has been entered into Review 360 per program standards ● If you are the only special education teacher for that student, you are responsible for inputting progress monitoring data into Review 360 ● If multiple special education teachers serve a student, the campus will verify who will be input the progress data into Review 360. The assigned case manager will also send the student’s progress report home to the parent/guardian or adult student ● Speech therapist will input data using SMART Speech therapist will send home progress report each six weeks 4. Communicate with all stakeholders ● Serve as a point of contact for parents, campus staff, and district personnel (including ARD/IEP meetings) ● Distribute parent letter concerning case management within the first two weeks of school. Date sent should be documented on the Parent Communication Log (see attachment). A copy of the parent letter should be placed in the student information section of the CMN. ● Be able to articulate the specific gains, needs, strengths, and weaknesses of students as determined through ongoing and extensive communication with key stakeholders. Documentation must be provided ● Ensure Review 360 Summary Reports are sent home every six weeks as specified in the ARD/IEP 5. Serve as a resource for general education teachers ● Be knowledgeable about each student’s disability and the educational effects ● Communicate with general education teachers on a regular basis regarding IEP implementation and student success ● Be equipped to answer all questions concerning the student’s program needs ● Assist with planning and implementing appropriate strategies for accommodations/modifications
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Beginning of the Year Procedures Procedures for the beginning of the year: ● Principal or designee, returns secured Case Management Notebooks to the special education teachers on his/her campus ● Retrieve last year’s Case Management Notebook information that was stored from the previous school year in the Special Education Student Eligibility Folders (Red Audit Folders) and return to the individual student sections of the Case Management Notebook -
goals and objectives - accommodations current schedules of service - general education progress assessment information reports medication sheets, if applicable. These sheets should be reviewed with the nurse for any necessary updates
● Please discard or follow district guidelines to shred obsolete documents, as appropriate ● Case managers receive new caseloads using the most current (Easy IEP) ARD/FIE rosters by attending school. Other rosters include: PEIMS 163- Monthly, Due Date by Months, Statewide Testing Roster and Assessment Curriculum Course Alignment ● Send letters home to parents introducing yourself as the case manager within two weeks of the opening of school or within two weeks of the student’s enrollment ● Contact your Campus Support Specialist with transportation concerns ● Use current EasyIEP reports, including the Statewide Testing Roster, to ensure accuracy of the Student Test Audit Report in My Data Portal. Share with campus test coordinator to ensure accurate ordering of appropriate assessments no later than the first week in October ● Verify Preschool Programs for Children with Disabilities (PPCD) students are enrolled in correct grade, if appropriate, by the second week of school. Please make sure the Location Code and Least Restrictive Environment (LRE) Code is correct and matches. ● Identify all service providers for your campus by the second week of school ● Complete a yearly ARD Calendar and submit to your Campus Support Specialist by the second week of school ● Case managers must review the Special Education Student Eligibility Folders for each of the students that they case manage to ensure accuracy of information in this notebook
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â—? All sections of the Case Management Notebook should be functional by the end of the first two weeks of school and located in a secure, locked location to ensure confidentiality
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End of the Year Procedures Procedures for the end of the year: ● Ensure all ARDs/Events are finalized in EasyIEP ● End all student plans in Review 360 ● Each student’s entire tabbed section should be removed from the Case Management Notebook and placed on top of the ARD divider in each student’s Special Education Student Eligibility Folder(s) ● Place district wide access logs, rosters, and schedules in an envelope, marked by year, and kept in a locked and secure file cabinet or room. Please follow Record Management procedures for archiving records ● Maintain tabs, general information pieces, and the Records Management section in the secured Case Management Notebook for the next school year ● Turn all Case Management Notebooks in to the principal or designee, for secure summer storage ● Submit the location of the audit file cabinet key to your Campus Support Specialist prior to the end of the school year ● Follow the Records Management procedures for details on bundling and transferring student folders to receiving schools during the last week of school ● For those students eligible for Special Education Transportation, ensure that students changing schools have two completed transportation forms electronically (one for the current year with the current date and one for the next school year within the next year’s starting date and school) ● All case managers must complete transportation forms based on current student address for ESY and next year school location by the first week in May ● Ensure students who are transitioning to middle and high school have their next year campus (NYC) reset by the data controller ● Submit a list of potential graduates to the Area Campus Support Specialist staff by the end of January. ● Ensure that seniors not graduating have their Next Year Campus (NYC) reset to the current home school by the Data Controller ● Drop graduating students from transportation electronically, if applicable ● Verify student addresses before identifying next year’s school (check with the Special Education Campus Support staff, especially for students in centralized units) 16
● Ensure the Campus Records Clerk (CRC)/Data Controller has class rosters for the centralized units prior to the end of the school year ● All case managers must complete and submit a Roll-up Projection Form for centralized units to the Special Education Compliance Specialist by the end of January ● Ensure students’ Special Education Eligibility Folders (Red Folders) are delivered to the appropriate receiving campus(es) ● Verify with your CRC/Data Controller that PPCD students are enrolled in the correct grade for the upcoming school year ● Complete the End of Year Checklist by the last week of May. Submit a copy to the Campus Support Specialist.
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Dismissal Procedures When students are dismissed: ● Conduct an ARD/IEP Committee meeting with an evaluation staff member present. The student status should indicate “Dismissed” ● The student’s entire tabbed section of the Case Management Notebook should be removed and placed in the Special Education Student Eligibility Folder during the Dismissal ARD ● Store inactive file should be placed in the inactive folder file drawer
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In District Case Management Transfer Procedures When a student transfers from within the district, the student’s information contained in the Case Management Notebook and the Special Education Student Eligibility Folder (Red Audit Folder) should be sent to the receiving school via a green special education transmittal envelope. � See the Records Management section for more detailed information about the entire within district transfer process. � When students transfer to Disciplinary Alternative Education Placement (DAEP), collaborate with the receiving school to make sure specific transfer procedures are followed. The home campus case manager will continue to monitor services and needs, including administration of state and district assessments o The home school remains the managing school and is responsible for coordinating ARDs and compliance.
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Out-of-District Case Management Transfer Procedures When a student transfers out of district: ● The individual student’s entire student information tab section of the Case Management Notebook should be removed and placed on top of the ARD divider in the Special Education Student Eligibility Folders (Red Audit Folder) along with a copy of the student’s withdrawal form. The Special Education Student Eligibility Folders (Red Audit Folders) should be placed in the inactive folder drawer. ● The original Special Education Eligibility Folders (Red Audit Folder) and the Case Management information are never sent out of district. Only the most recent ARD/IEP information, FIE and disability statement should be forwarded to the requesting school district. ● See the Records Management section of this notebook for more detailed information regarding the maintenance of inactive records.
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Michael Hinojosa, Ed.D. Superintendent of Schools
Date: _____________________
Dear Parent/Guardian: Each student receiving special education services is assigned a special education service provider as his/her case manager by the principal. This person is an advocate and interventionist for the student and is to ensure implementation of the IEP/ARD in accordance with federal and state guidelines. I have been assigned as the case manager for your child, ________________________. You may find my information below. Name: Telephone: E-mail: Best time to call:
@dallasisd.org A.M.
P.M.
I look forward to a rewarding, successful year. Please feel free to contact me with any questions or concerns regarding your child’s educational plan or progress. Sincerely,
9400 N. Central Expressway Dallas, TX 75231 (972) 925-3700 www.dallasisd.org
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Michael Hinojosa, Ed.D. Superintendent of Schools
Fecha: _____________________
Estimado padre/tutor legal: Cada estudiante que recibe servicios de educación especial, el director de la escuela le asignará un proveedor de servicios que se encargará de administrar su caso. La persona representará al estudiante y asegurará y intervencionista la implementación del programa académico individual (IEP) y del ARD de acuerdo a las normas estatales y federales. He sido asignado como la persona encargada del caso de sue hijo/hija, __________________________________. Si tiene alguna pregunta, este es mi información personal. Nombre: Número de teléfono: Correo electrónico:
@dallasisd.org
Mejor hora para llamar:
A.M.
P.M.
Esperando tener un año exitoso y lleno de triunfos. Por favor comunίquese conmigo si tiene preguntas o preocupaciones sobre el plan o progreso académico de su hijo/hija. Atentamente,
9400 N. Central Expressway Dallas, TX 75231 (972) 925-3700 www.dallasisd.org
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Rosters Tab
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Rosters This section contains rosters that may be available through the EasyIEP Database. Current copies of the ARD/FIE Roster by attending school should be printed monthly and kept in this section. If a case manager has a student placed at an alternative campus, run a managing ARD/FIE roster for the sending school to identify students being managed by the case manager, but attending an alternative location. Other data resources include: ● ● ● ●
Due Dates by Months PEIMS 163 – Monthly Statewide Testing Roster Assessment Curriculum Course Alignment
NON-EasyIEP Form The “In-School Suspension/Disciplinary Alternative Education Placement (ISS/DAEP) Tracking Form by Case Manager,” is a tool for documenting the time that a student is in ISS/DAEP. Note: students that have transferred to a Disciplinary Alternative Education Placement are the responsibility of the home school case manager.
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CONFIDENTIAL ISS/DAEP Tracking Form by Case Manager ______________________________ Campus/Org # Date
Student Name/ID#
_____________________________ Case Manager ISS Date(s)
DAEP Duration
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DAEP Start Date
DAEP End Date
State/District Assessment Info.
Schedule Tab
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Schedules This section contains copies of: ● ● ● ●
Staff rosters Teacher/teacher assistant schedules Campus-wide master schedule One campus-wide staggered annual ARD calendar
Annual ARD Calendar ● Case managers are to schedule ARD meetings using a campus-wide ARD calendar and should submit the calendar to the respective Area Campus Support Specialist by the second week of school and as changes/additions are made.
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Student Information
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Student Information Each individual student tab in this section contains:
● A Case Management Access Log is for anyone outside the Case Manager viewing particular student information ● A copy of each Student’s Enrollment/Registration Form and Home Language Survey is placed in this section in order for case managers to have easy access to basic student information. o If a change in student address, phone numbers, etc., occurs, notify your CRC/Data Controller ● Student Information Checklist ● A Personal Communication Record ● My Data Portal Profile ● LPAC Report, if applicable Reminder: A LPAC member must attend ARDs for LEP students
● Schedules for Instructional Support/Related Services (if applicable): this form is used to document all support services received by a particular student. Each service provider is responsible for completing the short form for each student served and providing a copy to the case manager and/or general education teacher, as applicable. ● Copies of medical information, such as: - Obtain from nurse current physician’s orders on H72 form titled “Physician/Parent Request for Administration of Medicine or Special Procedure by School Personnel” (if applicable). There is a generic form and specialized forms. The nurse will determine which H72 is needed per individual student. - Dietary Order Form which provides physician’s documentation of need for specific food/feeding modifications (if applicable). Nurses provide the orders from the physician to Food and Child Nutrition Services to initiate the Dietary Order Form. Individualized Health Plan (previously known as Health Management Plan) outlines special health needs of the students and care given by staff on campus and may include an emergency care plan. Reminder: The nurse must attend any ARD involving students with Other Health Impairment (OHI), special health needs, medications, and/or special procedures.
● A copy of the Occupational/Physical Therapy Services Staff Training form (if applicable)
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Student Information (continued) ● Accommodations, Assessment Information, Behavior Intervention Plans, Goals/objectives and other pertinent information in the IEP necessary for implementation, will be given to all appropriate personnel. o Initial distribution of these documents and completed Receipt of ARD/IEP Information form with signatures should occur within the first two weeks of school or within two weeks of enrollment. o Autism Schedule, if applicable ● Receipt of ARD/IEP Information form is a signed receipt that indicates which ARD/IEP documents have been given to general education teachers working with a particular student. Distribution must occur during the first two weeks of school or within 2 weeks of enrollment. o The signed receipts will be filed in the this section ● Teacher documents should be updated as ARD’s occur or as schedules change. Distribution of documents should occur using one folder for each general education teacher, marked “Confidential” on the front, with an access log inside the front cover, and containing all appropriate ARD documents for students of that teacher. This distribution, perhaps at grade level meetings, provides an opportunity for discussion of what they are receiving, what it means, and what their role is for student success. ● The Counselor Input Form, Academic Achievement Record (AAR) and graduation plan, both obtained from the school counselor, and a graduation option form as indicated in student’s most current ARD. ● A copy of the secondary class schedule (if applicable). ● General Education Progress Report will be completed and submitted to the student’s case manager each 3rd/6th week. If the student’s grade is below a 70, note challenges and document intervention strategies. ● The special education teacher/case manager is expected: - Use Review 360 to document student progress weekly or as indicated by program standards. Progress monitoring demonstrates the student’s progress toward mastery of the individualized education program goals and objectives. - The schedule for reporting a student’s IEP progress is determined by the child’s Admission, Review, and Dismissal Committee.
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Student Information (continued) Note: The IEP progress reporting process is in addition to the student’s report card, which is distributed by each school in the same manner and same time frame as for all other non-disabled students at the campus. Generally, report cards are provided to parents each six week. Teachers are to send progress reports to parents every three weeks if a student’s performance in any subject is below passing grade. ● A copy of the Behavior Intervention Plan (if applicable) ● General Education Progress Report (if applicable) The General Education Progress Report will be distributed to the appropriate general education teacher during the third week of the six weeks grading period. Returned form should be placed in the Student Information tabbed section. ● Refer to EIA (Local) and FNG (Legal) regarding questions about grade changes
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Confidential Case Management Access Log
(To be placed behind each student’s individual information tab)
Student Name
Date & Year
Name
Position
Page ___ of ___
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Purpose
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CONFIDENTIAL STUDENT INFORMATION CHECKLIST ____________________________________________________ (Student Name)
Check all statements that are applicable for this particular student ❑
This student is classified as LEP
❑
This student is enrolled in modified course(s)
❑
This student is receiving additional special education services other than those provided by the case manager, so the Schedule(s) for Instructional Support/Related Services are needed
❑
This student does have an Administration of Medicine or Special Procedure form (PROVIDED BY NURSE)
❑
This student does have a Dietary Order Form (PROVIDED BY NURSE)
❑
This student does have an Individualized Health Plan (IHP)
❑
This student does have an Occupational/Physical Therapy Services Staff Training form (PROVIDED BY OT/PT)
❑
This is a secondary student
❑
This student does have a Behavior Intervention Plan
❑
This is a student receiving all services in the General Education setting
❑
This is a student receiving AI services
❑
This is a student receiving VI services
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CONFIDENTIAL
Personal Communication Record ____________________________________ (Student Name) Date
Name/Position of Person Contacted
Type of Contact
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Subject/Purpose of Contact
CONFIDENTIAL Schedule for Instructional Support/Related Services This form should be completed for each student on a service provider’s caseload. Student Name: ____________________________
School Year: _________________
Receives the following service: ___Adapted Physical Education ___Itinerant Deaf Education ___Itinerant Vision Services ___Occupational Therapy ___Orientation and Mobility ___Physical Therapy ___Speech-Language Therapy ___Assistive Technology ___Other
Service Provider Name: _______________________________________ Phone #: ___________________________ E-mail:_____________________________
Scheduled on: _____ Mondays _____ Tuesdays _____ Wednesdays _____ Thursdays _____ Fridays _____ Other: ________________________
Time: (If appropriate):
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Medication This section contains sample forms used by the nurse to document physicians’ orders and staff training. The form referred to as an H72 may be generic and titled “Physician/Parent Request for Administration of Medicine and Special Procedure by School Personnel.” A specialized H72 instead of the generic H72 may be used by the nurse for specific procedures such as trach care and G-tube feedings. The second form is a staff training form titled “Skills Checklist”. The nurse determines the “Skills Checklist” to be used. These forms should be copied from the school nurse and placed in this notebook during the first two weeks of school, within 2 weeks of enrollment for new/transfer students, and/or when the health status of a student changes. It is recommended that case managers consult with the school nurse concerning all students on the caseload in order to learn of any medications taken at home or any other medical conditions impacting care and needs of students. Be aware that as the health status of a student changes the care, plans and forms may need to change. Check box if no administration of medication or special procedures forms exist for the caseload.
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CONFIDENTIAL INFORMATION Special Education Occupational/Physical Therapy Services Training was provided by Occupational and/ or Physical therapy staff for special procedures for: ______________________________________, on _____________________. Student Date(s) The trainee demonstrated good understanding and competence in the implementation of the following activities/procedures: 1.)
______________________________________________________________ ______________________________________________________________
2.)
______________________________________________________________ _______________________________________________________________
3.)
_______________________________________________________________ _______________________________________________________________
4.)
_______________________________________________________________ _______________________________________________________________
Comments: _______________________________________________________ _________________________________________ Therapist __________________________________________ Trainee/Position __________________________________________ Trainee/Position __________________________________________ Trainee/Position __________________________________________ Trainee/Position
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____________________ School ____________________ Date ____________________ Date ____________________ Date ____________________ Date
Receipt of ARD/IEP Information This form will be updated after changes are made and agreed upon by the ARD/IEP Committee.
Student Name _______________________________________ Check documentation given to the appropriate staff ❑
Accommodations
❑
Behavior Intervention Plan
❑
Goals/Objectives
❑
Assessment Information
❑
Other _______________________________
My signature indicates that the information received will be implemented according to the ARD/IEP Committee requirements. I understand that I need to document implementation of these strategies and that all information is to remain confidential. Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
Teacher’s Signature
Subject/Class
Date
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General Education Progress Report Student Name _________________________ Teacher Name________________________Subject _______________ Please complete the following for the special education student in your class. Please return this form to ________________________________ Special Education Teacher Name 6week term
Return By date
Grade for the 3rd/6th weeks
Challenges
Interventions/ Strategies
Comments
1 2 3 4 5 6 If the student’s grade is below a 70, note challenges and document intervention strategies. Challenges 1. Attention to class work needed 2. Attendance 3. Class work Incomplete 4. Homework Incomplete 5. Accommodations not meeting student needs 6. Behavior Inappropriate 7. Difficulty retaining information 8. Little to no class participation 9. Other __________________
Intervention Strategies A. Contact case manager B. Recommend before or after school tutoring C. Student Conference D. Parent Conference E. Small group F. Peer tutoring G. Assistance with note taking H. Student classroom observation requested I. Study skill assistance needed J. Assistance with organizational/prioritizing skills K. Revisit Behavior Plan L. Revisit Accommodations
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Records Management
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Management of Special Education Records Transfer of Records between Dallas ISD Schools ● When a student transfers from one Dallas ISD school to another, the receiving school requests the hard copy of the Special Education Student Eligibility Folder(s) records from the sending school and must document this request on the Special Education Records Tracking Log. ● The sending school must mail records in a timely manner in order for the receiving school to have necessary information within 10 school days. ● Eligibility folders must be hand delivered or mailed through school mail, using a “green” Special Education Student Records transmittal envelope marked “Confidential," and must be accompanied by a copy of the In-District Special Education Audit Folder Transmittal Log. DO NOT SEND A COPY TO RECORDS MANAGEMENT DEPARTMENT. ● The sending school may document mailing the envelope on the Special Education Records Tracking Log. Ensure the folder transfer request has been sent and receipt documented. ● The receiving school must document receipt of the envelope on the enclosed Transmittal Log, retain a copy in the campus Special Education Records Management File, and return a copy to the sending school by mail or fax. Both schools should update their Tracking Logs as needed. ● At the end of a particular grade, when numerous students are moving from one grade level of school to another (5th to 6th, 6th to 7th, 8th to 9th, etc.), Special Education Student Eligibility Folders (Red Audit Folders) should be bundled, accompanied by a Transmittal Log, and hand-delivered to the receiving school before the end of the school year. The receiving school’s Records Custodian should verify receipt of all folders listed on the Transmittal Log and sign that log. Both schools should retain a copy of the log and update their Tracking Logs as needed. ● If a student is a “No Show” after the first 6 weeks of school, that student’s Special Education Student Eligibility Folder (Red Audit Folder) should be returned to the last school attended, using appropriate procedures for transmittal. The last school attended will either re-route the folder or place it with other Inactive Files.
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Management of Special Education Records (continued) Requests for Records by another School District ● In accordance with §TEC 25.002, and 34 CFR §300.323(g), the school district in which the student was previously enrolled shall furnish the new school district with a copy of the student’s records, including the child’s special education records, no later than the 30th calendar day after the student was enrolled in the new school district. Any records sent should be photocopies only and original documents are never to be sent. Within the State of Texas ● Public school districts within the state of Texas must follow the TREx process. Be sure the signature pages and all disability statements are included in the transmission. ● A signed parental release for education records is not required if the requesting school district is operating within the State of Texas. Outside the State of Texas ● A signed parental release for education records is required if the requesting school district is operating outside the State of Texas. ● Copies should be mailed in a brown envelope marked “Confidential.” Postage is the responsibility of the Dallas ISD School. Note: Copies mailed or sent by TREx must be documented on the Special Education Records Tracking Log.
Requests for Records by Outside Agency ● Upon receipt of a written request for student specific special education records from an agency, the receiving school or district department is required to provide the requested information to the agency within 10 business days. The agency’s request must be accompanied by a signed parental release. The Consent for Release of Confidential Information Form is to be filed in the “Other Documents Section” of the student’s Special Education Student Eligibility Folder (Red Audit Folder). ● Copies should be mailed in a brown envelope marked “Confidential”. ● Copies mailed out must be documented on the Special Education Records Tracking Log.
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Requests for Records by Parent/Legal Guardian/18-year-old Student ● Upon the verbal or written request for a special education record from that student’s parent, legal guardian, or the student him/herself (if 18 years old), the Dallas ISD school must provide copies of the items requested without unnecessary delay. ● ● A charge may be levied for copies, provided that the fee does not effectively prevent the parents from exercising their right to inspect and review their child’s records. If the parent is unable to pay for the copies, they must be provided free of charge. ● Copies should be placed in a brown envelope and marked “Confidential.” ● The distribution of copies must be documented on the Special Education Records Tracking Log.
Locating Special Education Student Records Please take the following steps to locate records of special education students: ● Research the EasyIEP system to see if student is still active or withdrawn and for any available student information. ● Contact the student’s special education case manager at the student’s last school of record. The special education staff at the student’s last school of record should be contacted for any available information. ● When no other information can be found, the Archive Records Manager may be contacted using the Campus Request for Special Education Records Fax Transmittal.
Electronic Documentation of Transfer of Records within Dallas ISD ● All entries are to be made in the NOTES section of EasyIEP. No other information is to be included in the documentation. Sending Folder: (Date) Campus A enters a note that the folder was sent to Campus B. Ex.: 05/12/2013 Bryan Adams sent folder to Woodrow Wilson. Ex.: 06/10/2013 Robert T. Hill sent folder to Archives. Receiving Folder: (Date) Campus B enters a note the folder was received. Ex.: 05/15/2013 Woodrow Wilson received folder from Bryan Adams. Ex.: 06/13/2013 Archives received folder from Robert T. Hill. Requesting Folder: (Date) Campus C request folder from another campus or Archives. 46
Ex.: 04/05/2013 Emmett Conrad requested folder from Skyline. Ex.: 08/15/2013 South Oak Cliff requested folder from Archives.
Records Management Materials Special Education Student Eligibility Folders and green transmittal envelopes are also available through the District wide Records Management Center (DMC). District wide Records Management Department – Special Education Records Dallas ISD Records Center 3111 W. Commerce Street School Box # 448 Dallas, Texas 75212 Phone: (972) 925-7840 main (972) 925-7518 office Fax: (972) 925-7850 Records Management Staff Contact Information Michael Greer (Supervisor) (972) 925-7849 Olivia Taylor (Olitaylor@dallasisd.org) (972) 925-7852 Margaret Jackson (Marjacks@dallasisd.org (972) 925-7845 Instructions regarding the ordering of record storage boxes, Special Education Eligibility Archive Forms, EXCEL-Page Break Directions and the Special Education Transfer Instructions can be found at:
http://inet.dallasisd.org/forms/index.html Click: District wide Records Management Or Go to Dallas ISD.org Website Click on: Staff Tab Click on: My Dallas ISD icon Click on: Forms Click on: District wide Records Management
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In-District Special Education Audit Folder Transmittal Log Date Delivered: _____________ Sending School: ________________________________ Box #: ____________________ Fax #: ________________________________________ Sending School Contact Name: ______________________________________________ Sending School Contact Title: _______________________________________________ Date Received: ___________________Receiving School: ___ _____________________ Receiving School Contact Name: ____________________________________________ Receiving School Contact Signature:__________________________________________ Receiving School Contact Title:______________________________________________ Note: If a folder has been received by mail, please sign and date this form, and return a copy to the sending school by mail or fax.
Student Name (Last, First – print only)
ID# (7 digit)
Date of Birth
Page ___ of ___
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Last Action Date (complete date)
CONFIDENTIAL SPECIAL EDUCATION RECORDS TRACKING LOG Student Name
ID #
DOB
Requested By
Date Received
Date Sent
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Sent to Dallas ISD School
Copies to Outside Agency/Other District
Record Not Found
Resources
Admission, Review and Dismissal Process Guides are available at: http://framework,esc18.net/ Legal Framework for Child-Centered Special Education Process: http://framework,esc18.net/ Notice of Procedural Safeguards: Dallas ISD Special Education Website Dallas ISD Board Policy
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