The madison social relationship inventory


Persons With Whom The Student Interacts



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Persons With Whom The Student Interacts

Report the persons the student interacts with while participating in Current Tutor Relationship #1.


Schoolmate with disabilities
Schoolmate without disabilities
Instructional assistant
Special education teacher
Health assistant
Adult activity leader
Mobility instructor
Tutor
Bus Driver
Store Clerk
Librarian


Are the persons with whom the student interacts while participating in Current Tutor Relationship #1 acceptable?


Yes
No

If "No," record why the persons with whom the student interacts while participating in Current Tutor Relationship #1 are unacceptable.



Report the persons the student should interact with while participating in Current Tutor Relationship #1, but does not.
Schoolmates without disabilities
Bus driver
Regular education teacher
Neighbor
Store clerk



Teaching Techniques

Is the tutor utilizing professionally acceptable teaching techniques?


Yes
No

If no, report the teaching techniques the tutor is using that are unacceptable.



Report the teaching techniques the tutor should be using.




Materials

Describe the materials used in Current Tutor Relationship #1.



Are the materials used in Current Tutor Relationship #1 acceptable?
Yes
No

If "No," report why the materials used in Current Tutor Relationship #1 are unacceptable.




Are there materials that should be used in Current Tutor Relationship #1?


Yes
No

If "Yes," report the materials that should be used in Current Tutor Relationship #1.




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 function acceptably in a tutor relationship 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 extra support. However, it seems necessary here.

Record the PERSONS who provide support to Current Tutor Relationship #1, who would not do so if the student was not disabled.
Special Education teacher
Regular Education teacher
Instructional assistant
Occupational therapist
School nurse



Are the extra PERSONS who provide support to Current Tutor Relationship #1 acceptable?


Yes
No
If "No," report why the PERSONS who provide support to Current Tutor Relationship #1 are unacceptable.
The student and the tutor receive more supervision than is actually needed.

Record the PERSONS who should provide support to Current Tutor Relationship #1, but do not, and what they should do.

In some instances those who interact with the student may be in need of INFORMATION and/or specific kinds of TRAINING. An after school shopping tutor may need specific INFORMATION about behavior management strategies; a travel tutor may need TRAINING about the procedures to follow if a wheelchair breaks, etc.


Record the extra INFORMATION-TRAINING that has been provided those involved in Current Tutor Relationship #1.

Is the INFORMATION-TRAINING that has been provided those involved in Current Tutor Relationship #1 acceptable?
Yes
No
If "No," report why the INFORMATION-TRAINING that has been provided those involved in Current Tutor Relationship #1 is unacceptable.

Is there INFORMATION-TRAINING that should be provided those involved in Current Tutor Relationship #1?


Yes
No

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


INDIVIDUALIZED ADAPTIONS refer to the materials, equipment, assistive devices, sequences, regulations and other phenomena that might have to be utilized, modified or created so the student can function acceptably in a tutor relationship that would not be necessary if she/he was not disabled.


Record the INDIVIDUALIZED ADAPTIONS used in Current Tutor Relationship #1.

Are the INDIVIDUALIZED ADAPTIONS used in Current Tutor Relationship #1 acceptable?
Yes
No

If "No," report why the INDIVIDUALIZED ADAPTIONS used in Current Tutor Relationship #1 are unacceptable.


The adaptations used do not work properly.

Are there INDIVIDUALIZED ADAPTIONS that might enhance Current Tutor Relationship #1?
Yes
No

If "Yes," describe the INDIVIDUALIZED ADAPTIONS that might enhance Current Tutor Relationship #1 and how each might be used.



Record any OTHER support provided to Current Tutor Relationship #1 that has not been presented thus far.



Is the OTHER support provided to Current Tutor Relationship #1 acceptable?
Yes
No
If "No," report why the OTHER support provided to Current Tutor Relationship #1 is unacceptable.

Record the total amount of money spent on Current Tutor Relationship #1.



Is the total amount of MONEY spent on Current Tutor Relationship #1 acceptable?
Yes
No

If "No," report why the total amount of MONEY spent on Current Tutor Relationship #1 is unacceptable.






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