The madison social relationship inventory



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Extra Support

Extra support refers to the PERSONNEL, INFORMATION-TRAINING, INDIVIDUALIZED ADAPTATIONS, MONEY, and OTHER phenomena a student and those who interact with her/him need in order to participate meaningfully in appropriate experiences after school and during weekends THAT WOULD NOT BE NEEDED IF HE/SHE WAS NOT DISABLED. In reality, it is often difficult or impossible to delineate mutually exclusive categories of support. However, attempts seem necessary here for organization and communication purposes.

Record the PERSONS who provide support during Time Segment #1 who would not do so if the student was not disabled.
Adult activity leader
Educational assistant
Special education teacher
Schoolmates without disabilities
Personal attendant
Volunteer
Respite worker
Parent/Guardian

Are the PERSONS who provide support during Time Segment #1 acceptable?


Yes
No

If "No," report why the PERSONS who provide support during Time Segment #1 are unacceptable.



Report the PERSONS who should provide support during Time Segment #1, but do not, and the support they should provide.



In some instances those who interact with the student may be in need of INFORMATION and/or specific kinds of TRAINING that would not be needed if he/she was not disabled.

Record the extra INFORMATION-TRAINING that has been provided those who interact with the student during Time Segment #1?



Is the INFORMATION-TRAINING that has been provided those who interact with the student during Time Segment #1 is acceptable?
Yes
No

If "No," report why the INFORMATION-TRAINING that has been provided those who interact with the student during Time Segment #1 is unacceptable.



Is there additional INFORMATION-TRAINING that should be provided those who interact with the student during Time Segment #1?
Yes
No

If "Yes," report the additional INFORMATION-TRAINING that should be provided and who should receive it.


INDIVIDUALIZED ADAPTATIONS are the materials, assistive devices, sequences, regulations and other factors that have to be utilized, modified or created so that the student can function acceptably, that would not be needed if he/she were not disabled.


Record the INDIVIDUALIZED ADAPTATIONS used during Time Segment #1.

Are the INDIVIDUALIZED ADAPTATIONS utilized during Time Segment #1 acceptable?
Yes
No

If "No," report why the INDIVIDUALIZED ADAPTATIONS utilized during Time Segment #1 are unacceptable.


Are there INDIVIDUALIZED ADAPTATIONS that might enhance the functioning of the student during Time Segment #1?


Yes
No

If "Yes," describe them and report how each might be used.



Record OTHER extra support provided during Time Segment #1.

Is the OTHER extra support provided during Time Segment #1 acceptable.
Yes
No

If "No," report why the OTHER extra support provided during Time Segment #1 is unacceptable.


If there is extra support that should be provided during Time Segment #1 that has not been described above, report it below.



Record the amounts of MONEY being spent per typical day and week during Time Segment #1, that would not be spent if the student was not disabled.
M $
T $
W $
TH $
F $
S $
S $
Total Per Week $

Is the amount of extra MONEY spent per typical week during Time Segment #1 acceptable?


Yes
No

If "No," report why the amount of extra MONEY spent per week during Time Segment #1 is unacceptable.


Parents cannot afford the extra costs.
The cost of paying professionals to assist the student could be reduced if proper adaptations were utilized.


Extra Hardships

Record extraordinary hardships being experienced during Time Segment #1.


Are there reasonable courses of action that can be taken to alleviate at least some of the extra hardships experienced during Time Segment #1?


Yes
No

If "Yes," report the actions that may reduce at least some of the extra hardships and those who should take them.




Future Experiences

Have plans for future, or changes in existing, after school-weekend experiences during Time Segment #1 been developed?


Yes
No

If "Yes," report where the plans are located.


In the current IEP
In the most recent Multidisciplinary Team Report
In the most recent Individualized Transition Plan (ITP)
In the Individualized Family Support Plan (IFSP)
In the most recent Individualized Habilitation Plan (IHP)

If "No," report why such plans have not been developed.


Changes in existing experiences in the near future are not anticipated.
A plan is currently being developed.


Additional Information

Record additional information that should be considered in the process of determining whether the life of the student during Time Segment #1 is in reasonable accordance with the values presented.






Summary Judgment

After considering the information gathered, is it your summary judgment that the after school-weekend life of the student during Time Segment #1 is in reasonable accordance with the values or is otherwise acceptable?


Yes
No



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