SSPS:Matrix of Services Domain C

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DOMAIN C: Independent Functioning

Includes services that are necessary for independent functioning of students with exceptionalities which may be noted in other domains. These services include instruction in organizational strategies, assistance for activities of daily living and self-care (DLS), physical therapy (PT), occupational therapy (OT), orientation and mobility training (O&M) and supervision of students to ensure physical safety.

Contents

Level 1

Requires no services or assistance beyond that which is normally available to all students

Level 2

Requires periodic personal assistance, monitoring or minor interventions

OPTION 1: Monthly personal assistance with materials or equipment

This area addresses personal assistance with materials or equipment such as prosthetic devices, eating, toileting, or personal hygiene.

REQUIRED DOCUMENTATION: DOE requires evidence of assistance on a monthly basis.

IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning OR appropriate transition services
  • PLS: Addresses then need for monthly assistance with materials or equipment.
Example: As a result of the student’s disability, he requires periodic assistance when toileting.
  • Accommodations: Toileting Schedule
  • Related Services: Health Monitoring & Management, Skilled Medical Services

SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Accommodation documentation form
  • Staff schedule assigns personnel to student monthly
  • Teacher developed checklist/data collection monthly


OPTION 2: Consultation on a monthly basis with teachers, family, therapists, service coordinators, or other providers

This area addresses consultation held at least monthly. Consultation can be between teachers regarding independent functioning of a student or the review of skills and progress by a PT, OT, or service coordinator.

REQUIRED DOCUMENTATION: DOE requires documentation of face-to-face, virtual, or conference calls occurring monthly.

NOTE: Skype (using face-to-face dialogue) has been approved for this use. Written exchange with families is allowable for consultation.

IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning OR appropriate transition services
  • PLS: Supports need for monthly consultation
Example: As a result of the student’s disability, consultation between the classroom teacher, ESE teacher, occupational therapist, and parent must occur on a monthly basis.
  • ESE Services: Consultation with monthly frequency

SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Consult log documenting monthly scheduled consultation
  • Home notes
  • Parent conference forms
  • Parent contact log
  • Team planning notes

OPTION 3: Organizational strategies or supports for independent functioning

This area applies to students in general education classes only – it includes assistance with monitoring the use of an assignment notebook/planner, time management skills, study skills, or supports or adaptive equipment for daily living activities. NOTE: Students who receive all their instruction in an ESE class have organizational strategies addressed under Domain A.

REQUIRED DOCUMENTATION: DOE requires evidence strategies and supports and their use in the general education classroom by the student.

IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning OR appropriate transition services
  • PLS: Addresses then need for organizational strategies or supports that are used in the general education classroom.
Example: As a result of the student’s disability, he requires assistance with keeping track of his assignments using a planner.
  • OPTIONAL -- Goals: Include a goal for the student to improve strategies for organizational or study skills
  • ESE Services: Specialized Instruction for General Curriculum – Organization, Study Skills & Strategies

SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • General education teacher lesson plans and/or grade book
  • Checklist of strategies used in general education
  • Logs used in general education

OPTION 4: Special equipment, furniture, strategies, or supports for motor control in the classroom

This area addresses supports used to assist with writing, eating, toileting, and/or personal hygiene. It also refers to allowing extra time between classes, special furniture, or use of switches, alarms, or bells.

REQUIRED DOCUMENTATION: DOE requires evidence of special equipment or supports used for the student

IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning OR appropriate TSAA
  • PLS: Addresses then need for special equipment, furniture, strategies, or supports for motor control
Example: As a result of his cerebral palsy, the student requires extra time when passing between classes and assistance with toileting.
  • Accommodations: Toileting Schedule, Adapted Equipment, Adaptive Furniture, Positioning Tools, Additional Adult Assistance

SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Accommodation documentation form
  • Teacher developed checklist/data collection monthly
  • Logs
  • Schedules

Level 3

Requires weekly personal assistance, monitoring or intervention

OPTION 1: Specially designed organizational strategies or supports for independent functioning

This area applies to students in general education classes only – includes instruction and monitoring, use of daily checklist and/or organizational strategies provided in the classroom. NOTE: Students who receive all their instruction in an ESE class have organizational strategies addressed under Domain A.


REQUIRED DOCUMENTATION: DOE requires evidence of an individualized strategy or adaptation (specially designed for a particular student) and its use in the general education classroom.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses student area(s) of organizational need
Example: As a result of his ADHD, the student independently completes his assignments 50% of the time.
  • ESE Services: Specialized Instruction for General Curriculum – Organization, Study Skills, & Strategies
  • Accommodations: Specific to student organizational needs
Examples: Color transparencies/ overlays, Increased practice opportunities, Page tabs, and Written notes provided


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Accommodation documentation form
  • Lesson plans indicating accommodations in use

OPTION 2: Supervision to ensure physical safety during some activities

This area addresses student escort or supervision/ assistance covering less than 50% of the school day during transitions or selected activities to ensure safety or physical mobility.


REQUIRED DOCUMENTATION: DOE requires evidence of a plan for supervision and its daily use.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • OPTIONAL: Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Disability statement addresses student need for assistance/monitoring
Example: As a result of his cerebral palsy and frequent falls, student requires additional adult supervision during passing times in crowded hallways.
  • Accommodations: Related to student need for assistance
Example: Additional adult supervision for physical safety


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Classroom staff schedule assigns personnel to student daily
  • Lesson plans reflect staff assigned for transition/activities daily

OPTION 3: Weekly instruction in self-monitoring of independent living skills

This area includes staff assigned for instruction of self-care and DLS including toileting, eating and personal hygiene. It also applies to weekly instruction in responsible decision-making and cause and effect relationships, including generalization of these skills.


REQUIRED DOCUMENTATION: DOE requires documentation of specific goals and planned activities AND evidence of training (date/time/topic).


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Baseline levels and priority educational need addressed for each goal
Example: Student is able to feed himself finger foods and scoop food across a plate with a lip with frequent spillage and some physical prompting. His priority educational need is to scoop food with an adapted spoon.
  • Goals: Relevant to student needs in the area of daily living skills
Example: The student will use a modified spoon to scoop food laterally, bring spoon to his mouth, chew and swallow with only verbal prompts and minimal spillage for 10 consecutive days.
  • ESE Services: Instruction in Daily Living Skills with Weekly frequency
  • Accommodations: Related to daily living assistance needed
Example: Additional adult assistance; Toileting schedule


SUPPORTING DOCUMENTATION EXAMPLES: MUST have evidence of training (date/time/topic) and one or more of the following is needed.

  • Lesson plans reflect staff assigned for instruction in self-care/DLS
  • Teacher developed checklist / data collection weekly
  • Staff/LPN training of menstrual care – Student/LPN log

OPTION 4: Weekly monitoring of or assistance with independent living skills, materials, or equipment

This area refers to weekly assistance with or monitoring of (provided by teachers or therapists) independent living skills or daily living skills including toileting, eating and hygiene.

REQUIRED DOCUMENTATION: DOE requires documentation of monitoring OR staff scheduled to provide assistance.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses area(s) of need for instruction or assistance with daily living skills
Example: Due to lack of fine muscle control, student is not able to consistently open packages and cartons during meals.
  • OPTIONAL: Domain: Mark Independent Functioning or appropriate transition services
  • OPTIONAL -- ESE Services: Instruction in Daily Living Skills with Weekly frequency
  • Accommodations: Related to daily living assistance needed
Example: Additional adult assistance


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Classroom staff schedule for assistance
  • Lesson plans reflect weekly monitoring or assistance with DLS
  • OT/PT log showing weekly DLS assistance (if receiving these services)
  • Teacher developed checklist/data collection

OPTION 5: Weekly collaboration with teachers, family, agencies, or other providers

This area refers to regularly scheduled, face-to-face meetings AND integration of strategies and instructional materials through collaboration of teachers, therapists, private providers, and/or parents.


REQUIRED DOCUMENTATION: DOE requires face-to-face meetings AND documentation of regularly scheduled collaboration. NOTE: Skype (using face-to-face dialogue) has been approved for this use.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • OPTIONAL: Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Disability statement addresses need for collaboration
Example: Due to student’s difficulty transitioning to new environments and people, weekly collaboration between teachers is required to anticipate stressors and to prepare student for upcoming activities.
  • ESE Services: Consultation with Weekly frequency
  • OPTIONAL -- Related Services: OT and/or PT collaboration with Weekly frequency (if applicable)


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed

  • Agency Contact Log
  • Contact log between teachers, family, services
  • Lesson plans reflect set meeting time – WEEKLY
  • OT/PT collaboration log (if receiving these services)

Level 4

Requires daily personal assistance, monitoring or intervention

OPTION 1: Supervision to ensure physical safety during the majority of activities

This area refers to adult escort or supervision/ assistance during transitional or selected activities covering more than 50% of the school day to ensure safety from self-injury, explosive behavior, or physical mobility concerns.

NOTE: Supervision must be beyond that provided to same age peers.


REQUIRED DOCUMENTATION: DOE requires evidence of a plan for supervision for more than 50% of the school day and its use.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses reason for additional supervision
Example: Due to the severity of student’s cerebral palsy and loss of balance, he requires adult supervision to avoid falling while transitioning on the campus and throughout the day.
  • Accommodations: Related to supervision and safety

Example: Additional adult supervision for physical safety with Daily frequency

  • OPTIONAL -- Related Services: Specialized Behavior Supports


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Classroom staff schedule assigns personnel to student daily
  • Lesson plans reflect staff assigned for transition/activities daily



OPTION 2: Individual assistance or supervision in activities of daily living, self-care and self-management for part of the day

This area addresses daily assistance with eating, toileting, self-care or movement around campus; daily instruction in self care; and/or escort between classes, to lunch, to the bathroom, and to the bus.


REQUIRED DOCUMENTATION: DOE requires evidence of staff assigned for personal assistance or supervision.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses need for personal assistance
Example: As a result of her limited fine motor skills, the student is able to dress herself with hand-over-hand assistance provided to initiate dressing and for clothing fasteners.
  • OPTIONAL -- ESE Services: Instruction in Daily Living Skills with Daily frequency
  • Accommodations: Additional adult supervision with Daily frequency


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Classroom staff schedule assigns personnel to student daily
  • Lesson plans reflect staff assigned for transition/activities daily
  • Toileting charts, feeding charts, transition charts



OPTION 3: Special equipment or assistive technology for personal care with frequent assistance

This area includes frequent assistance with motorized wheelchairs or positioning equipment provided by the school.


REQUIRED DOCUMENTATION: DOE requires written assistive technology evaluation and report AND evidence of assistive technology device and assistance with its use.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • Special Considerations: Does the student need assistive technology materials, equipment, services, and/or support?
  • PLS: Addresses student need for special equipment
Example: Due to her medical condition, the student fatigues easily and requires adaptive equipment with frequent adjustments to maintain her upright position and increase her endurance during daily instructional activities.
  • Accommodations: Related to special equipment or assistive technology for personal care and frequent assistance using it
Example: Additional adult assistance, Materials positioning tools, Adaptive furniture
  • Related Services: Positioning assistance

SUPPORTING DOCUMENTATION EXAMPLES: In addition to required assistive technology evaluation and assessment report, at least one of the following is needed.

  • Accommodation/equipment checklist noting frequent assistance
  • Lesson plans reflect use of assistive technology with frequent assistance
  • Positioning charts
  • Staff schedule showing frequent assistance with assistive technology device(s)


OPTION 4: Regularly scheduled OT, PT, or O&M training

This area refers to any one of the above therapies that is scheduled at least once a week. It can also include use of MOVE Curriculum on a daily basis.


REQUIRED DOCUMENTATION: DOE requires documentation of therapy occurring at least once a week.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses student area(s) of need. If the student is using MOVE, there should be baseline levels, a priority educational need, and corresponding goal(s).
Example: As a result of his fine motor limitations, the student is able to hold child scissors with the correct grasp; however, he needs hand-over-hand assistance to cut paper.

Example: According to MOVE performance summary, the student is able to stand and bear weight up to 5 minutes while being supported in a gait trainer with a hip prompt. His priority educational need is to maintain weight bearing while initiating stepping skills.

  • Goals: (For MOVE curriculum only)
Example: The student will maintain weight-bearing skills while taking up to 3 steps in 5 minutes utilizing a gait trainer with no more than a waist prompt.
  • OPTIONAL -- Accommodations: Related to therapies or MOVE Curriculum
Example: Positioning chair
  • Related Services: OT, PT, O&M AND/OR Positioning assistance


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • MOVE data charts noting DAILY use of equipment
  • Lesson plans show DAILY use of MOVE Curriculum
  • Therapist contact log

Level 5

Requires continuous personal assistance, monitoring or intervention

OPTION 1: Continuous supervision to ensure physical safety

This area requires continuous adult supervision of no more than 3 students to eliminate explosive or self-injurious behavior to ensure safety of the student or others. It also applies to constant supervision of students with unstable mobility or sensory impairments who require assistance for most activities.


REQUIRED DOCUMENTATION: DOE requires documentation of student behavior that indicates a pattern of regular outbursts or self-injurious behavior AND evidence of a supervision plan with allocated staff for more than 50% of the school day.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • OPTIONAL -- Special Considerations: Does the student’s behavior impede his learning or the learning of others?
  • PLS: Addresses student area(s) of needs
Example: As a result of his frequent physical outbursts with lack of attention toward others and regular attempts to run off campus, the student requires ongoing supervision throughout the school day in order to prevent injury to himself and others.
Example: As a result of his severe cerebral palsy and seizure disorder, the student requires ongoing supervision when ambulating on the campus and in the classroom to ensure his physical safety.
  • Accommodations: Specific to physical safety
Example: Additional adult supervision for physical safety with Daily frequency in School environment and Community (if applicable)


SUPPORTING DOCUMENTATION EXAMPLES: In addition to the required documentation of student behavior that indicates a pattern of regular outburst or self-injurious behavior, one or more of the following is needed.

  • Classroom staff schedule assigns personnel to student daily (3:1 ratio or less) more than 50% of the day
  • Lesson plans reflect staff assigned for transition/activities (3:1 ratio or less) for more than 50% of day



OPTION 2: Individual assistance or supervision in activities of daily living, self-care, and self-management for the majority of the day

This area addresses a personal aide assigned more than 50% of the school day to a student to assist with daily living skills and/or mobility.


REQUIRED DOCUMENTATION: DOE requires evidence of a plan for supervision for more than 50% of the school day and allocated staff to provide service.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses student need for additional adult assistance
Example: Due to his quadriplegia, the student requires assistance with all toileting, feeding and transitioning activities throughout the school day.
  • Accommodations: Related to need for assistance throughout the day
Example: Additional adult assistance, Toileting schedule (if applicable)


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • Classroom staff schedule assigns personnel to student for independent functioning for more than 50% of the school day
  • Lesson plans reflect staff assigned for transition/independent functioning for more than 50% of the school day




OPTION 3: OT, PT, or O&M training more than once a week

This area addresses any of the above therapies scheduled more than one time each week.


REQUIRED DOCUMENTATION: DOE requires documentation of any one of the above therapies that occur more than one time per school week.


IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Domain: Mark Independent Functioning or appropriate transition services
  • Additional Exceptionality: Visually Impaired OR Related Services: OT AND/OR PT
  • PLS: Addresses current skill level related to therapy needs and the impact of therapy area with priority educational need noted
Example: Student is able to hold a writing tool using a tripod grip with reminders from an adult when writing personal information and short sentences. As a result of his fine motor limitation, student has difficulty holding writing utensils for long periods of time. Priority educational need is to independently hold a variety of writing utensils while completing class work.
  • Goals: Therapy supports integrated into an educational goal
Example: The student will independently trace the letters of his name while maintaining a tripod grip in 4 out of 5 writing situations during the quarter.
  • Related Services: O&M, OT, or PT with (time in minutes) weekly


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • TERMS schedule noting therapy multiple times each week
  • Therapist/teacher contact log noting therapy more than once a week

OPTION 4: Multiple therapies and services (OT, PT and/or O&M)

This area addresses multiple therapies, each occurring at least once a week.


REQUIRED DOCUMENTATION: DOE requires documentation of two or more therapies, with each therapy occurring at least once per week.


T/IEP CONTENT TO SUPPORT THIS OPTION: All of the following are required unless noted optional.

  • Additional Exceptionality: Visually Impaired (if applicable) AND/OR
  • Related Services: OT and/or PT (must have at least 2 of the above)
  • Domain: Mark Independent Functioning or appropriate transition services
  • PLS: Addresses current skill level related to therapy needs and the impact of therapy area with priority educational need noted
Example: Student is able to hold a writing tool using a tripod grip with reminders from an adult when writing personal information and short sentences. He is able to walk up to 30 feet on level terrain when focused and provided clear visual cues for motor planning. As a result of his fine motor limitations, student has difficulty holding writing utensils for long periods of time. Due his unsafe mobility, he requires ongoing supervision while moving about the campus. His educational needs include independently holding a variety of writing utensils and safely accessing the school campus.
  • Goals: Therapy supports integrated into an educational goal
Example: The student will independently trace the letters of his name while maintaining a tripod grip in 4 out of 5 writing situations during the quarter.
  • Related Services: O&M, OT, and/or PT with (time in minutes) weekly


SUPPORTING DOCUMENTATION EXAMPLES: One or more of the following is needed.

  • TERMS schedule noting multiple therapies each week
  • Therapist/teacher contact log noting multiple therapies each week