The madison social relationship inventory


Subenvironment From   To Eating Related Activities With



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Subenvironment From   To Eating Related Activities With







 




 



 




 


Other Information

Record relevant information about the current eating experiences of the student that was not addressed in the charts above.







The School

The school day is from AM to PM


Does the student attend his/her home school, i.e., the school he/she would attend if not disabled?
Yes
No

If "Yes," proceed.

If "No," does the fact that the student does not attend his/her home school have any effect on the nature of eating relationships with nondisabled schoolmates?
Yes
No

If "Yes," report how eating relationships with nondisabled schoolmates are effected by attending a nonhome school.


It is too hard for eating relationships developed at school to be expressed during nonschool days and times.



Eating Environments
Record the environments in which the student eats during school times or refer to the Current Eating Experiences Chart.
School cafeteria
Special education classroom
Regular education classroom
Sit down restaurant
Fast food restaurant
Lunch room at work
Break area at work
Nurse's office



Is the array of environments in which the student eats during school times acceptable?
Yes
No

If "Yes," report why the array of environments in which the student eats during school times is acceptable.


The student eats in the same array of environments in which he/she would eat if not disabled.
The array of environments is larger than it would be if she/he were not disabled. This is acceptable because



The array of environments is smaller than it would be if he/she were not disabled. This is acceptable because


If "No," report why the array of environments in which the student eats during school times is unacceptable.


The student could eat in the same environments in which he/she would eat if not disabled, but does not.


Record the environments in which the student should eat during school times, but does not.


School cafeteria
Regular Education Classroom
Fast food restaurant
Sit down restaurant
Lunch room at work
Break room at work



Record the environments in which the student eats after school and during weekends and the nonschool days or examine the Current Eating Experiences Chart.


Home
Home of neighbor
Home of nondisabled schoolmate
Home of nondisabled coworker
Fast food restaurant
Sit down restaurant



Is the array of environments in which the student eats after school and during weekends and other nonschool days acceptable?


Yes
No

If "Yes," report why the array of environments in which the student eats after school and during weekends and other nonschool days is acceptable.


The student eats in the same array of environments in which she/he would eat if not disabled.
The array of environments is larger than it would be if she/he were not disabled. This is acceptable because



The array of environments is smaller than it would be if he/she were not disabled. This is acceptable because



If "No," report why the array of environments in which the student eats after school and during weekends and other nonschool days is unacceptable.


The student eats at home too much.





Report the environments in which the student should eat after school and during weekends and other nonschool days, but does not.
Fast food restaurant

Sit down restaurant

Friend's house

Street vendor's stand



Eating Periods
Is the number of eating periods the student typically experiences per day during school times acceptable?
Yes
No

If "Yes," report why the number of eating periods the student typically experiences per day during school times is acceptable.


The student experiences about the same number of eating periods during school times he/she would experience if not disabled.
The student experiences more eating periods during school times than he/she would if not disabled. This is acceptable because


The student experiences fewer eating periods during school times than he/she would if not disabled. This is acceptable because

If "No," report why the number of eating periods the student experiences during school times is unacceptable.





Record the numbers of eating periods the student typically experiences after school and during weekends and other nonschool days.
Eating Periods Per Eating Periods During Weekends

Day After School and Other Nonschool Days
1 1
2 2
3 3
_

Are the numbers of eating periods the student experiences after school and during weekends and other nonschool days acceptable?


Yes
No

If "Yes," report why the numbers of eating periods the student experiences after school and during weekends other nonschool days are acceptable.


The student experiences about the same numbers of eating periods after school and during weekends and other nonschool days he/she would experience if not disabled.
The student experiences fewer eating periods after school and during weekends and other nonschool days. This is acceptable because



The student experiences more eating periods after school and during weekends and other nonschool days. This is acceptable because




If "No," report why the numbers of eating periods the student experiences after school and during weekends and other nonschool days are unacceptable.






Time
Record the time ranges within which the student typically eats during school hours or refer to the Current Eating Experiences Chart.

Eats AM Snack From To


Eats Lunch From To
Eats PM Snack From To
Eats From To
Eats From To

Are the time ranges within which the student typically eats during school hours acceptable?


Yes
No

If "Yes," report why the time ranges within which the student eats during school hours are acceptable.


The student eats during the same time ranges she/he would eat if not disabled.

If "No," report why the time ranges within which the student eats during school hours are unacceptable.
Different eating time ranges are unnecessary and segregate him/her from nondisabled schoolmates.




Are there time ranges within which the student should eat during school hours, but does not?


Yes
No

If "Yes," report the time ranges within which the student should eat during school hours, but does not.

Should Eat AM Snack From To
Should Eat Lunch From To
Should Eat PM Snack From To
Should Eat From To
Should Eat From To

Record the time ranges within which the student typically eats after school and during weekends and other nonschool days or refer to the Current Eating Experiences Chart.

Eats Breakfast From To
Eats AM Snack From To
Eats Lunch From To
Eats PM Snack From To
Eats Dinner From To
Eats Evening Snack From To
Eats From To
Eats From To

Are the time ranges within which the student typically eats after school and during weekends and other nonschool days acceptable?


Yes
No

If "Yes," report why the time ranges within which the student typically eats after school and during weekends and other nonschool days are acceptable.


The student eats during the same time ranges she/he would eat if not disabled.



If "No," report why the time ranges within which the student typically eats after school and during weekends and other nonschool days are unacceptable.
The student does not eat during the same time ranges she/he would if not disabled. There is no good reason for this.
Different eating times are unnecessary and segregate him/her from nondisabled peers and family members.



Are there time ranges within which the student should eat after school and during weekends and other nonschool days, but does not?
Yes
No

If "Yes," report the time ranges within which the student should eat after school and during weekends and other nonschool days, but does not.

Should Eat Breakfast From To
Should Eat AM Snack From To
Should Eat Lunch From To
Should Eat PM Snack From To
Should Eat Dinner From To
Should Eat Evening Snack From To
Should Eat From To
Should Eat From To

Record the amount of time per eating period the student typically spends consuming food and drink during school hours or refer to the Current Eating Experiences Chart.


AM Snack min.
Lunch min.
PM Snack min.
min.

Are the amounts of time per eating period the student typically spends consuming food and drink during school hours acceptable?


Yes
No

If "Yes," report why the amounts of time the student spends consuming food and drink during school hours are acceptable.


She/he spends about the same amounts of time consuming food and drink he/she would spend if not disabled.
_____ More time is spent because___________________________



Less time is spent because





If "No," report why the amounts of time per eating period the student spends consuming food and drink during school times are unacceptable.



Record the amounts of time per eating period the student typically spends consuming food and drink after school and during weekends and other nonschool days or refer to the Current Eating Experiences Chart.

Breakfast min.
AM Snack min.
Lunch min.
PM Snack min.
Dinner min.
Evening Snack min.
min.
min.

Are the amounts of time per eating period the student typically spends consuming food and drink after school and during weekends and other nonschool days acceptable?


Yes
No

If "Yes," report why the amounts of time per eating period the student spends consuming food and drink after school and during weekends and other nonschool days are acceptable.


She/he spends about the same amount of time consuming food and drink he/she would if not disabled.
The student spends more time consuming food and drink than she/he would if not disabled. This is are acceptable because


The student spends less time consuming food and drink than he/she would if not disabled. This is are acceptable because


If "No, report why the amounts of time per eating period the student spends consuming food and drink after school and during weekends and other nonschool days are unacceptable.





Eating Related Activities
Record the eating related activities in which the student engages during school times or examine the Current Eating Experiences Chart.
Listening to music with
Walking with
Looking at magazines/picture books
Talking to
Playing on the school playground with




Are the eating related activities in which the student engages during school times acceptable?


Yes
No

If "Yes," report why the eating related activities in which the student engages during school times are acceptable.


The student engages in the same eating related activities he/she would engage in if not disabled.

If "No," report why the eating related activities in which the student engages during school times are unacceptable.

If "No," report why the eating related activities in which the student engages during school times are unacceptable.

Record or consider the eating related activities in which the student engages after school and during weekends and other nonschool days.


Playing cards
Watching television with
Talking to
Looking at magazines/picture books
Listening to music with

Are the eating related activities in which the student engages after school and during weekends and other nonschool days acceptable?
Yes
No

If "Yes," report why the eating related activities in which the student engages after school and during weekends and other nonschool days are acceptable.


The student engages in the same eating related activities he/she would engage in if not disabled.

If "No," report why the eating related activities the student is involved in after school and during weekends and other nonschool days are unacceptable.
She/he is rarely involved in activities with nondisabled peers.

Report the eating related activities in which the student should be involved after school and during weekends and other nonschool days, but is not.
Playing cards with
Watching television with
Talking to
Looking at magazine/picture books
Listening to music with

Eating Companions
Record the persons with whom the student typically interacts while eating during school times or refer to the Current Eating Experiences Chart.
Schoolmates with disabilities
Schoolmates without disabilities
Regular education teachers
Special education teachers
Instructional assistant
Peer tutor
Job coach
Coworkers without disabilities
Coworkers with disabilities
Supportive eating companion





Is the array of persons with whom the student typically interacts while eating during school times acceptable?
Yes
No

If "Yes," record why the array of persons with whom the student typically interacts while eating during school times is acceptable.


The student interacts with the same array of persons he/she would interact with if not disabled.
The array of persons the student interacts with while eating during school times is larger than it would be if he/she were not disabled. This is acceptable because


The array of persons the student interacts with while eating during school times is smaller than it would be if he/she were not disabled. This is acceptable because





If "No," record why the array of persons with whom the student interacts while eating during school times is unacceptable.
She/he only interacts with professionals.

Report those persons the student should interact with while eating during school times, but does not.
Schoolmates without disabilities
Brother
Sister
Nondisabled coworkers

Record or consider those persons with whom the student interacts while eating after school and during weekends and other nonschool days.
Mom
Dad
Brother
Sister
Respite worker
Babysitter
Neighbor
Schoolmates with disabilities
Schoolmates without disabilities
Coworkers without disabilities
Job Coach


Is the array of persons with whom the student interacts while eating after school and during weekends and other nonschool days acceptable?


Yes
No

If "Yes," report why the array of persons with whom the student interacts while eating after school and during weekends and other nonschool days is acceptable.


The student interacts with the same array of persons she/he would interact with if not disabled.
The array of persons the student interacts with while eating after school and during weekends is larger than it would be if he/she was not disabled. This is acceptable because


The array of persons the student interacts with while eating after school and during weekends is smaller than it would be if he/she was not disabled. This is acceptable because


If "No," report why the array of persons with whom the student interacts while eating after school and during weekends and other nonschool days is unacceptable.


He/she does not interact with nondisabled schoolmates.
She/he does not interact with neighbors.
He/she interacts too much with a personal attendant.
She/he interacts with family members too much.
He/she interacts with peers who have disabilities too much.
She/he is alone too much.


Report those persons with whom the student should interact when eating after school and during weekends and other nonschool days, but does not.


Neighbors
Nondisabled coworkers
Friends with disabilities
Nondisabled schoolmates
Teammates



Extra Support
Extra support refers to the PERSONNEL, TRAINING-INFORMATION, INDIVIDUALIZED ADAPTATIONS, MONEY and OTHER phenomena a student and those who interact with her/him need in order to eat together acceptably THAT WOULD NOT BE NEEDED IF SHE/HE WAS NOT DISABLED. In reality, it is often difficult or impossible to delineate mutually exclusive categories of support. However, for organization and communication purposes, it seems necessary here.

Record the PERSONS who provide support while the student eats during school times, who would not provide it if he/she were not disabled.


Special Education Teacher
Regular Education Teacher
Instructional assistant
Occupational therapist
Speech and language therapist
School nurse
Lunchroom monitor
Job coach
Peer tutor
Supportive companion




Are the PERSONS who provide support while the student eats during school times acceptable?


Yes
No

If "No," report why the PERSONS who provide support while the student eats during school times are unacceptable.


She/he receives too much supervision from Special Education PERSONS.
School PERSONS who interact with the student have not been properly trained.
He/she receives much more supervision than is needed.
Natural supervision is impossible.




Record the PERSONS who should provide support to the student while he/she eats during school times, but do not.


Classmates without disabilities
Coworkers without disabilities
Lunchroom supervisors
Cafeteria workers
Peer tutors
Nutritionist
Adaptation specialist
Mobility specialist
Behavior specialist
_____ Supportive companion


Record the PERSONS who provide support while the student eats after school and during weekends and other nonschool days.


Personal care attendant
Occupational therapist
Nurse
_____ Mom
_____ Dad
_____ Brother
_____ Sister


Are the PERSONS who provide support while the student eats after school and during weekends and other nonschool days acceptable?
Yes
No

If "No," report why the PERSONS who provide support while the student eats after school and during weekends and other nonschool days are unacceptable.



Record the PERSONS who should provide support while the student eats after school and during weekends and other nonschool days, but do not.
Schoolmates without disabilities
Neighbors
An adaptation specialist
A peer tutor

In some instances those who interact with the student may be in need of INFORMATION or specific kinds of TRAINING. A cafeteria worker may need specific INFORMATION about behavior management strategies; a supportive companion may need TRAINING to use an emergency medical procedure, etc.

Record the extra INFORMATION TRAINING that has been provided those who are involved with the student while he/she eats during school times.

Is the INFORMATION TRAINING provided those who are involved with the student while he/she eats during school times acceptable?


Yes
No

If "No," report why the INFORMATION TRAINING provided those involved with the student while he/she eats during school times is unacceptable.



Is there additional INFORMATION TRAINING that should be provided those involved with the student while he/she eats during school times?
Yes
No

If "Yes," report the additional INFORMATION TRAINING that should be provided.



Record the extra INFORMATION TRAINING that has been provided those who are involved with the student while he/she eats after school and during weekends and other nonschool days.

Is the extra INFORMATION TRAINING provided those who are involved with the student while he/she eats after school and during weekends and other nonschool days acceptable?
Yes
No

If "No," report why the extra INFORMATION TRAINING provided those involved with the student while he/she eats after school and during weekends and other nonschool days is unacceptable.



Is there additional INFORMATION TRAINING that should be provided those who are involved with the student while he/she eats after school and during weekends and other nonschool days?


Yes
No
If "Yes," report the additional INFORMATION TRAINING that should be provided.

INDIVIDUALIZED ADAPTATIONS are materials, assistive devices, sequences, regulations and other factors that have to be utilized, modified or created so that the student can function acceptably while of eating that would not be needed if he/she was not disabled.
Record the INDIVIDUALIZED ADAPTATIONS used in the eating process during school times.
Adapted utensils
Pureed food
Gastrostomy tube
Modified spoon
Modified plate

Are the INDIVIDUALIZED ADAPTATIONS used in the eating process during school times acceptable?
Yes
No

If "No," report why the INDIVIDUALIZED ADAPTATIONS used in the eating process during school times are unacceptable.


The adaptations used do not work properly.
The adaptations used prevent the student from engaging in social interactions with nondisabled peers.
The adaptations used do not increase her/his ability to eat better.
The adaptations used attract negative attention.
The adaptations used are demeaning.

Are there INDIVIDUALIZED ADAPTATIONS that can be utilized or created that might help the student participate better in the eating process during school times?


Yes
No

If "Yes," report the ADAPTATIONS and how they might be used.



Record the INDIVIDUALIZED ADAPTATIONS used in the eating process after school and during weekends and other nonschool days.

Are the INDIVIDUALIZED ADAPTATIONS used in the eating process after school and during weekends and other nonschool days acceptable?
Yes
No

If "No," report why the ADAPTATIONS used in the eating process after school and during weekends and other nonschool days are unacceptable.


The ADAPTATIONS used do not work properly.
The ADAPTATIONS used prevent the student from engaging in social interactions with nondisabled peers.
The ADAPTATIONS used do not increase the students ability to eat more proficiently.
The ADAPTATIONS used attract negative attention.
The ADAPTATIONS used are demeaning.





Are there INDIVIDUALIZED ADAPTATIONS that can be utilized or created that might help the student participate better in the eating process after school and during weekends and other nonschool days?
Yes
No

If "Yes," report the INDIVIDUALIZED ADAPTATIONS and how they might be used.



Record OTHER extra support provided as the student participates in eating and related activities during school times.

Is the OTHER extra support provided in eating and related activities during school times acceptable?
Yes
No

If "No," report why the OTHER extra support provided in eating and related activities during school times is unacceptable.



Is the OTHER extra support that should be provided as the student participates in eating and related activities during school times that has not been described, report it below.

Record OTHER extra support provided as the student participates in eating and related activities after school and during weekends and nonschool days.

Is the OTHER extra support provided as the student participates in eating and related activities after school and during weekends and other nonschool days acceptable.


Yes
No

If "No," report why the OTHER extra support provided in eating and related activities after school and during weekends and other nonschool days is unacceptable.



If there are OTHER extra supports that should be provided as the student participates in eating and related activities after school and during weekends and other nonschool days that have not been describe, report them below.

Record the total amount of MONEY spent per school year on eating and related activities during school times that would not be spent if the student was not disabled.
$

Is extra MONEY spent in relation to eating and related activities during school times acceptable?


Yes
No

If "No," report why the amount of extra MONEY spent on eating and related activities during school times is unacceptable.


The cost of paying professionals to assist the student to eat could be reduced if proper adaptations were utilized.
Less MONEY could be spent if cafeteria workers and nondisabled schoolmates assisted the student.
Less MONEY would be spent if the student participated in integrated eating related activities.



Record the total amount of MONEY spent per year on eating and related activities after school and during weekends and other nonschool days that would not be spent if the student was not disabled.
$

Is extra MONEY spent on eating and related activities after school and during weekends and other nonschool days acceptable?


Yes
No

If "No," report why the amount of extra MONEY spent on eating and related activities after school and during weekends and other nonschool days is unacceptable.


The cost of paying professionals to assist the student to eat could be reduced if proper adaptations were utilized.

Extra Hardships
Record extraordinary hardships associated with the eating experiences of the student.

Are there reasonable courses of action that can be taken to alleviate at least some of the extraordinary eating related hardships?
Yes
No

If "Yes," report the actions that may reduce at least some of the extraordinary eating related hardships and those who might take them.


Parents/guardians could hire personal attendants to assist the family.
Teachers and parents/guardians can arrange for nondisabled schoolmates to eat with the student after school and during weekends.
Teachers and parents/guardians can teach the student to eat more proficiently.




Future Eating Experiences
Have plans to develop eating experiences that will be needed in the future been designed?
Yes
No

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


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


If "No," report why such plans are not available.
Changes in eating experiences in the near future are not anticipated.
Eating experiences are not high priorities at this time.
Plans are currently being developed.
No one has taken the responsibility.


Additional Information
Record additional information that should be considered in the process of determining whether current eating experiences are in reasonable accordance with the values presented.



Summary Judgment
After considering all the information gathered, is it your judgment that current eating experiences are in reasonable accordance with the values or are otherwise acceptable?

Record your judgment on the Social Relationship Summary Chart in the Summary and Preferences Section.




Travel Relationships
Assume that the student will live 70 years. How many trips will she make in her lifetime within and between home, school, work and community environments? One million? Must a family member be with him on every trip? Must we use tax dollars to pay nondisabled persons to be with her on each trip? If not on all trips, then on how many?
Some students with severe disabilities require highly specialized travel services. Most do not. In fact, the overwhelming majority have been erroneously deprived of opportunities to travel with nondisabled persons safely and efficiently, simply because they are disabled. If supportive travel relationships with nondisabled persons are developed, costs to the student, his/her family and taxpayers will decrease. If dollars, time and energy are not wasted on travel, they can be used more effectively elsewhere.
Values

Traveling to and from school should require the same amounts of time and money that would be required if the student were not disabled. Exceptions must be scrutinized carefully and rejected if not absolutely necessary.


Whenever safe and reasonable, the supervision provided during travel should be the same as that provided nondisabled schoolmates and other relevant persons when they use the same modes of transportation.
The student should make approximately the same number of trips per day, week, month and year she/he would make if not disabled.
The student should visit approximately the same range of environments per day, week, month and year she would likely visit if not disabled.
The student should travel with the same array of persons she/he would travel with if not disabled.
School officials should develop travel relationships and then arrange and/or verify that they are manifested in nonschool environments during nonschool days and times in the absence of school personnel.
If a student actually needs specialized transportation services, they should be provided. However, atypical travel services that separate a student from nondisabled persons should be used only when absolutely necessary.
The extra demands or hardships too often associated with travel should be minimized.
If existing travel experiences are not acceptable, plans to improve them should be initiated. However, even if they are acceptable, components can be expected to change in importance across time. Thus, plans to meet future travel needs must always be operative.

Realities

Much of the information needed to evaluate travel realities can be recorded on The Current Travel Chart. For each trip made per day record: the departure and arrival environments and times, the total amount of time actually spent in transit, the modes used to travel to and from each environment and the persons the student typically interacts with while traveling.

THE CURRENT TRAVEL CHART
M T W Tr F S Su

Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

Home   7:30   School   8:00 30 min. Regular school bus Nondisabled schoolmates 

Supportive travel

companion




 



-



-


THE CURRENT TRAVEL CHART
M T W Tr F S Su

Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART


M T W Tr F S Su

Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART



M T W Tr F S Su


Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART



M T W Tr F S Su


Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART



M T W Tr F S Su


Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART



M T W Tr F S Su

Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-

THE CURRENT TRAVEL CHART



M T W Tr F S Su


Environment Time in The Student

From   Time   To   Time Transit Mode Interacts With

 



-



-



Other Information

Record other information needed to obtain a reasonable overview of the current travel experiences of the student.







The School
Does the student attend his/her home school, i.e., the school he/she would probably attend if not disabled?
Yes
No

If "Yes," proceed.

If "No," does the fact that the student does not attend his/her home school have any effect on the development of travel relationships with nondisabled schoolmates?
Yes
No

If "Yes," report how the development of travel relationships with nondisabled schoolmates is effected because the student does not attend his/her home school.



Environments
Report the environments the student typically travels to and from off school grounds during school times or examine the Current Travel Charts.
Home
School
Home of relative
Home of child care provider
Home of friend
Home of neighbor
Church
Grocery store
Department store
Work place
Health club
Shopping center
Athletic field
Movie theater
Physicians office
Hospital
Office of therapist



Is the array of environments the student typically travels to and from off school grounds during school times acceptable?


Yes
No

If "Yes," report why the array of environments the student travels to and from off school grounds during school times is acceptable.


He/she receives instruction in several community environments. This justifies traveling to a larger array of nonschool environments during school times.

If "No," report why the array of environments the student travels to and from off school grounds during school times is unacceptable.


The student does not receive direct instruction in any nonschool environments.
The student does not receive instruction in any recreation/leisure environments.
The student does not receive instruction in any nonschool general community environments.
The student does not receive instruction in any nonschool domestic environments.
The student does not receive instruction in any nonschool vocational environments.




Record the environments the student should travel to and from off school grounds during school times, but does not.




Report the environments the student travels to and from after school and during weekends or examine the Current Travel Charts.


Home
School
Home of relative
Home of child care provider
Home of friend
Home of neighbor
Synagogue
Mosque
Church
Grocery store
Department store
Work place
Health club
Shopping center
Athletic field
Movie theater
Physicians office
Hospital
Private therapist



Is the array of environments the student travels to and from after school and during weekends acceptable?


Yes
No

If "Yes," report why the array of environments the student travels to and from after school and during weekends is acceptable.


The student travels to and from the same array of environments he/she would travel to and from if not disabled.

If "No," report why the array of environments the student travels to and from after school and during weekends is unacceptable.





Report the environments the student should travel to and from after school and during weekends, but does not.

Modes
Report the modes the student uses to travel from home to school and from school to home or examine the Current Travel Charts.
Public bus
Regular school bus
Special education school bus
Taxi
Specialized van   family
Specialized van   commercial
Legs   walks
Family car
Wheelchair electric
Wheelchair manual
Car of teacher
Carpool
Car of paid driver



Are the modes the student uses to travel from home to school and from school to home acceptable?


Yes
No

If "Yes," report why the modes the student uses to travel from home to school and from school to home are acceptable.






If "No," report why the modes the student uses to travel from home to school and from school to home are unacceptable.


The "special van" used is unnecessary and segregates the student from schoolmates.




Are there more integrated and typical modes the student should use to travel from home to school and from school to home?


Yes
No

If "Yes," record the more integrated and typical modes the student should use.



Report the modes the student uses to travel to and from nonschool environments during school times or examine the Current Travel Charts.
Public bus
Regular school bus
Special education school bus
Taxi
Specialized van   family
Specialized van   commercial
Legs   walks
Family car
Wheelchair electric
Wheelchair manual
Car of teacher
Carpool
Car of paid driver


Are the modes the student uses to travel to and from nonschool environments during school times acceptable?


Yes
No

If "Yes," report why the modes the student uses to travel to and from nonschool environments during school times are acceptable.


The student uses the same modes of transportation he/she would use if not disabled.
School personnel drive the student in their cars. This minimizes travel time.
Specialized vans are used because public buses and available cars are not accessible.
The teacher drives the student in his/her car because public transportation is not available.

If "No," report why the modes the student uses to travel to and from nonschool environments during school times are unacceptable.
Specialized modes of transportation are unnecessary and segregate the student from nondisabled persons and others.
Specialized modes are prevent learning to travel on public buses.

Are there more integrated and typical modes the student should use to travel to and from nonschool environments during school times?


Yes
No

If "Yes," record the more integrated and typical modes that should be used.



Report the travel modes the student uses after school and during weekends or examine the Current Travel Charts.


Public bus
Regular school bus
Special education school bus
Taxi
Specialized van   family
Specialized van   commercial
Legs   walks
Family car
Wheelchair electric
Wheelchair manual
Car of teacher
Carpool
Car of paid driver



Are the modes the student uses to travel after school and during weekends acceptable?


Yes
No

If "Yes," report why the travel modes the student uses after school and during weekends are acceptable.


The student uses the same travel modes he/she would use if not disabled.





If "No," report why the modes the student uses to travel after school and during weekends are unacceptable.

Are there more integrated and typical travel modes the student should use after school and during weekends?
Yes
No

If "Yes," record the more integrated and typical modes that should be used.



Are there more integrated and typical modes of travel the student could and should learn to use to better prepare for postschool life?
Yes
No

If "Yes," record the more integrated and typical modes she/he could and should use to better prepare for postschool life.



Companions
Report the persons who typically interact with the student as she/he travels from home to school and from school to home or examine the Current Travel Charts.
Nondisabled schoolmates
Peers with disabilities
Mother
Father
Sister
Brother
Guardian
Job coach
Mobility instructor
Travel tutor
Volunteers
Supportive companion

Are the persons with whom the student travels from home to school and from school to home acceptable.


Yes
No

If "Yes," report why the persons with whom the student travels from home to school and from school to home are acceptable.


They are the same as they would be if she/he were not

disabled


If "No," report why the persons with whom the student travels from home to school and from school to home are unacceptable.


He/she travels only with others who are disabled.
She/he travels only with others who are paid to

travel with him/her.



Report those persons with whom the student should travel from home to school and from school to home.


Nondisabled schoolmates
Brother
Sister
Supportive companion


Report the persons who typically travel with the student to and from nonschool environments during school times or examine the Current Travel Charts.


Nondisabled schoolmates
Peers with disabilities
School staff
Job coach
Nondisabled coworkers
Coworkers with disabilities
Mobility instructor
Travel tutor
Volunteers
Paid personnel
Supportive companion



Are the persons with whom the student travels to and from nonschool environments during school times acceptable?
Yes
No

If "Yes," report why the persons with whom the student travels to and from nonschool environments during school times are acceptable.





If "No," report why the persons with whom the student travels to and from nonschool environments during school times are unacceptable.



Report those persons the student should travel with to and from nonschool environments during school times.


Classmates
Nondisabled schoolmates
The general public




Report the persons who typically travel with the student after school and during weekends or examine the Current Travel Charts.
Nondisabled peers
Peers with disabilities
Mother
Father
Sister
Brother
Guardian
School staff
Job coach
Nondisabled coworkers
Coworkers with disabilities
Mobility instructor
Travel tutor
Volunteers
Paid personnel
Supportive companion


Are the persons the student travels with after school and during weekends acceptable?


Yes
No

If "Yes," report why the persons the student travels with after school and during weekends are acceptable.


The student travels with the same persons he/she would travel with if not disabled.

If "No," report why the persons the student travels with after school or work and during weekends are unacceptable.
_____ She/he only travels with family members.


Report those persons the student should travel with after school and during weekends.
Nondisabled schoolmates
Teammates
Neighbors
Friends
Nondisabled coworkers
Peers with disabilities
Supportive companion


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