Doe, Jane

Date of Report: 12.02.2015

DOB: xx.xx.2001

Paradise Unified School District

Special Services
6696 Clark Road
Paradise, CA 95969
P: 530.872.6400; Fax: 530.872.6409

***Confidential Psychoeducational
Report***
The following psychological assessment report is confidential and is intended as a communication
between professionals. It should only be viewed by parties with specific interest in the students
educational outcomes. This report includes sensitive information that is likely to be misinterpreted
by those without the necessary training. Authorization for use of this report is limited to the
examinee and their designated consultants. Any further use requires the authorization of the
examinee or their legal guardian. Use or disclosure outside these parameters constitutes a
violation of Section 5328 of the Welfare and Institutions Code.

Name: Jane Doe

Doe

Parent(s)/Guardian: Mr. and Mrs.

Date of Birth: XX.XX.2001

Age: 14 years, 6 months

Sex: Female

Grade: 9th

Primary Language at Home: English

Telephone: (530) xxx-xxxx

Primary Language of Instruction: English

ST
Magalia, CA, 95954
Care Home: xxxx Faux Lane
xxx-xxxx
Paradise, CA 95969
School: Paradise High School

Address: xxx Made Up

Telephone: (530)

Teacher (s): Michelle Jones

Test Dates: 12.01.2015, 12.02.15

Ramirez,
Michelle Jones

Examiner(s): Lizbeth

REASON FOR REFERRAL

Jane is a 9th grader at Paradise High School and this assessment was
conducted for her triennial evaluation. The following will serve as Janes
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triennial/transition or three-year review. It will also assist in planning her

educational program and help in determining the most appropriate
educational placement or Least Restrictive Environment for Jane.
BACKGROUND INFORMATION
According to a cumulative file review, Jane currently lives at a care home
under the care of ___________. As indicated in her confidential file, Janes legal
guardians are Mr. and Mrs. Doe and their primary language is English.
According to her confidential file Jane was initially placed in special education
in 2004 under the category of Multiple Disability. As reported in her file, Jane
has significant global deficits. Mrs. Doe completed a health developmental
form and she reported that Jane has been under her care since Jane was born
and at age ten Jane was placed in the group home where she continues to
live.
HEALTH, MEDICAL, AND DEVELOPMENTAL HISTORY
(See the Nurses report for complete health information)
The following information was gathered from a report completed by Mrs. Doe
and ___________: Jane was born prematurely at twenty-two weeks. There had
been no prenatal care and her mother was seventeen years old when she
gave birth. During the pregnancy, Janes mother smoked and used drugs and
alcohol. Jane was placed on life support upon birth and remained on life
support for fourteen months. Jane weighed one pound and seven ounces at
birth and was born in critical condition. An incubator and oxygen were used
to resuscitate her. During the first thirty days of her life Jane had a blood
transfusion and an infection. She also required cardiac surgery at eleven
days old. Mrs. described Jane as a happy baby although very delayed, fragile
and nervous. Jane was allergic to cow milk, she had speech problems,
asthma, eye problems, bowel problems and bed wetting problems which
continues to be an issue today. Jane suffers from total blindness in her left
eye and poor vision in her right eye, hypothyroidism and has a G-tube and
tracheostomy. Jane has had her G-tube for fourteen years and is limited to a
pureed diet.
Jane was late in reaching her developmental milestones. She first rolled over
at age sixteen months, sat alone at eighteen months, crawled at age twentyone months, pulled to stand at age two years and walked at age two and a
half. She did not develop bladder control until about age eight or nine. Janes
language development was also slow as she did not say a single word until
age four and is currently unable to produce a multiword sentence. She began
receiving speech therapy at age four and continues receiving it. Janes
hearing appears normal. Janes immunizations are current and her last
physical examination was on November twenty-fifth of this year. Her dental
and present health are reported to be good and her pediatrician is Dr. Suk
Lee. Jane also sees a psychiatrist, Dr. Pappas; a pediatrician, Dr. Daniyan; a
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pediatric endocrinologist, Dr. Nadgir; a pulmonologist, Dr. Chipps and a

pediatric gastroenterologist, Dr. Peterson.
According to a memo reported by Patty Sagers, on October 26th 2015: Jane,
does not take routine medications at school but has as needed medication
orders for Ibuprofen via GT Tube for pain and Calmoseptine and Polysporin
which are ointments for skin irritation. She is taking medication for a
hypothyroid condition but when initially started on this medication in
elementary school, Jane had an adverse reaction. She took Cytomel which
she tolerated but her medication was changed a few months ago. In October,
the medication was changed again to Armour Thyroid. After this change was
made, a decrease in undesirable behaviors was noticed. Janes psychiatrist is
Dr. Pappas and she receives injections of Invega Sustanna once a month for
her undesirable behaviors which she exhibits both at school and at home.
SCHOOL HISTORY AND EDUCATIONAL PROGRESS
According to the information found in her cumulative file and reported by
Janes legal guardian, Mrs. Doe, Jane attended pre-school through Cedarwood
home hospital when she was age three through four. She entered
kindergarten at age five and is currently in ninth grade. The following
information was taken from her cumulative file and from the health and
developmental history form completed by Mrs. Doe:
Kindergarten through 5th Grade- Jane attended Ponderosa Elementary School
in the Paradise Unified School District. During this time, her curriculum was
modified. In fifth grade, Janes teacher reported that Jane loves music and at
the time was working on positive peer interactions.
6th through 8th Grade - Jane attended Paradise Intermediate School.
9th Grade- Jane is currently attending school at Paradise High School and is in
the Functional Living Skills Class with Mrs. Ertsad.
PREVIOUS ASSESSMENT
Janes most previous triennial evaluation dated February 28th 2013 indicated
that intellectual or academic achievement testing was not needed at the
time. However, based on that report, under the academic achievement
section there was a summary of present levels of performance. To
summarize, at the time of her previous triennial evaluation Jane was able to:

use some sign language

follow verbal directions
point to body parts
identify and match colors, shapes, and patterns with a model
follow the class schedule
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transition from one center to the next

work for a chosen activity (most frequently music)
attempt to trace shapes and lines
attempt to match numbers or letters
successfully complete inset puzzles

ASSESSMENT/EVALUATION PROCEDURES
As part of this assessment, information provided by the parents and teacher
was included and observations were made. Janes confidential and
cumulative files were reviewed for this assessment. Janes primary language,
racial, and ethnic background were considered prior to selection and during
interpretation of test results. Tests were chosen so as not to be biased in any
manner. The following test battery was selected:
Assessment Tool/Procedure

Date

OBSERVATIONS

11.17.2015,
12.01.2015
CUMULATIVE FILE REVIEW
12.02.2015
PARENT INTERVIEW
11.30.2015
BEERY-BUKTENICA DEVELOPMENTAL TEST OF VISUAL MOTOR
Attempted on
INTEGRATION-6TH EDITION (VMI-VI)
12.02.2015
WECHSLER INTELLIGENCE SCALE FOR CHILDREN-FOURTH EDITION
Attempted on
(WISC-IV)
11.08.2015 and
12.01.2015
BEHAVIOR ASSESSMENT SYSTEM FOR CHILDREN, THIRD EDITION (BASC- 10.27.2015,
3) PARENT AND TEACHER RATING SCALES
11.18.2015
ADAPTIVE BEHAVIOR ASSESSMENT SYSTEM, THIRD EDITION (ABAS-3)
10.27.2015,
PARENT AND TEACHER FORM
12.02.2015

OBSERVATIONS AND INTERVIEWS

CLASSROOM OBSERVATION
Jane was observed in her class on two separate occasions. One of the times
she was observed it was during the afternoon and she was listening to music
with an aide. She requested the song The Wheels on the Bus. After
listening to music, Jane walked over to another aide and interacted with her
through modified sign language. Jane appeared to understand what the aide
was communicating to her as she responded to the aide. For example, when
asked to sign that she wanted salad, Jane was able to follow directions. At
the time of this observation, Jane interacted minimally with her peers. The
second time Jane was observed, it was during the morning and she was
working on a photo album. The teacher was working on putting the album
together and asked for Janes input on what color of yarn she wanted to use
as binding. During this observation, Jane asked for juice but she had to be
spoon-fed. Jane appears to benefit from the current classroom structure. She
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was observed to follow directions with prompting and support from

instructional aides and the teacher. Janes current placement and level of
service appears to meet her individual needs.
TEST SETTING OBSERVATIONS
Various attempts were made to test Jane. It was suggested by the teacher
that testing be conducted in the classroom so that Jane would be more
willing to participate. A private room in Janes classroom was used and there
were no interruptions. During the first attempt to test Jane, she refused and
pulled at the examiners scarf. She also scratched the examiners arm. A
second attempt to test Jane was made on a different day and she was unable
to respond to the items that were administered. She appeared to have
difficulty understanding what was being asked of her. During an attempt to
administer the VMI Jane was observed to be able to hold a pencil but unable
to follow test instructions.
STATEMENT OF VALIDITY
The instruments and procedures used as part of this assessment are
considered valid. The findings from this assessment are considered an
accurate representation of Janes skills at the time of this report.
INTERPRETATION OF SCORES
STANDARD SCORES
Standard scores allow us to compare scores from different tests. This helps
us determine whether a student is achieving at or above his/his ability. A
standard score of 100 is considered average with a standard deviation of 15
(Standard Scores between 85-115 are in the average range).
Standard Scores
Classification
131 & above
116 to 130
85 to 115
80 to 84
70-79
69 & below

Significantly Above Average

Above Average
Average
Below Average
Borderline
Significantly Below Average

PERCENTILE RANK
A percentile rank compares a students performance with others in the same
grade or at the students age level. Percentile ranks range from 1 (low) to
99 (high). A percentile rank between 16 and 84 is within the average
range. A percentile rank of 65, for example, means that a student performed
better than 65% of the students who have taken that particular test.
RESULTS
COGNITIVE ABILITY
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To test Janes ability to learn the Wechsler Intelligence Scale for

Children Fourth Edition (WISC-IV) was attempted. This is an individually
administered instrument for assessing the learning potential of children aged
6 years through 16 years, 11 months. This test was intended to assess Janes
ability to learn. This test is considered a good measure of verbal and
nonverbal intelligence, memory, and cognitive processing speed. Because
Jane is nonverbal, the measures of nonverbal intelligence were attempted.
When the Block Design subtest was attempted, Jane was unable to replicate
the design. Items 1 through three were attempted and she was unable to
respond. She moved the blocks but did not arrange them in any particular
pattern. Picture Concepts was also attempted but when given the directions
to point to two items that were alike, Jane pointed at all of the items in
random order. Finally, the Matrix Reasoning subtest was also attempted and
Jane again pointed at all of the pictures in the stimulus book in a random
order. In between subtest attempts, Jane requested to listen to The Wheels
on the Bus and by while attempting Matrix Reasoning, Jane appeared to
become impatient and she requested to listen to music.
VISUAL-MOTOR INTEGRATION ASSESSMENT
The Developmental Test of Visual-Motor Integration-Sixth Edition
(VMI-VI) is an individually administered instrument that assesses the ability
to integrate visual-motor stimulithe degree to which visual perception and
finger-hand movements are well-coordinated. This examiner attempted to
administer the VMI but Jane was unable to get a firm grasp on the pencil and
was able to scribble but unable to replicate the drawings that were presented
to her. Her inability to perform the tasks on this test may be partially
attributed to her being blind in her left eye and poor vision on her right eye.
To provide a more comprehensive idea of Janes motor development, he
following information was provided by her teacher, Michelle Jones:
Gross Motor: Jane can move and support her head, and is able to roll over
from back to front and front to back. She is able to ambulate and has object
permanence (can locate dropped items). She is able to sit without support
and moves around by walking. Additionally, Jane can walk, run, and hop, and
can start/stop her body movement in response to a signal. She maintains
balance while in motion, but can at times become unsteady on her feet,
especially when she is tired. Jane enjoys exploring movement with
equipment, and likes to roll on the stability ball. She will engage in activity,
and likes to throw a ball or go on a walk. She engages ad cooperates in
sports and games for a few minutes at a time before needing a break. Jane
will maintain movement for upwards of ten minutes at a time before
requesting to sit and have a break.
Fine Motor: Jane can use a pincer grasp to pick up and manipulate items,
like placing pegs in a pegboard, or picking up beads. She can push a toy car
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and will squeeze a wet sponge with some prompting and assistance. She can
squeeze liquids out of a bottle, and manipulates flexible objects. She can
push an object or switch and can squeeze the trigger of a spray bottle. Jane
can cut with adapted scissors when provided physical and verbal
prompting/assistance. Jane can place puzzle pieces in a form board with
assistance, and benefits from being reminded to use her other hand to help
hold the puzzle, or to be provided physical assistance in doing so.
ACADEMIC ACHIEVEMENT
Due to Janes lack of verbal abilities, she was not administered an
achievement test. To provide a better understanding of Janes academic
skills, the teacher provided the following information:
Jane, while having a visual impairment, has functional vision that allows her
to look at and identify people and things in pictures and in her environment.
She displays reaction to familiar people nearby and looks at the face of the
person speaking to her (although she may require verbal prompting to do
so). She can visually focus on objects, pictures, and people, and looks and
touches books and pictures. Jane can point to objects and points to pictures
on requires. Jane can also look at the television or computer and appears to
have average hearing. Jane can match colors and objects same to same,
although she may require verbal and gestural prompting to attend to the
task. Jane can also match shapes and letters same to same, but may require
verbal and gestural prompting to attend. Jane can also indicate "sad" by
using sign language but cannot consistently identify emotion from a picture.
She can also identify color and will indicate using sign language. Jane can
consistently identify the first letter of classmates' names when they are
spoken and will refer to them by signing the letter, but does not consistently
recognize student names in print. Jane can follow oral directions and can
identify a picture of one object. Additionally, Jane knows body parts and can
indicate by pointing
Additionally, Jane has voluntary grasp and release and has the ability to pick
up and hold objects. She can transfer objects from hand to hand and holds a
writing implement with a pincer grasp. Jane can independently mark or
scribble on a paper. Jane can use a touchscreen to interact with a computer
or iPad (she prefers watching videos), and will tap the screen to exit a video
or make her next video selection. Jane understands the concept of more, but
may need verbal and/or gestural prompting to give the number more
requested. She can also flip a switch on and off and make choices between
big and little. Jane demonstrates the concept of same by matching same
shapes and objects, but may need prompting to attend to the task.
Additionally, Jane can sort by object, color, shape, and size when provided
prompting. Jane can identify a watch and a countdown timer, and may even
independently retrieve a countdown timer and request help setting it to help
her know when an upcoming transition will be occurring (e.g. getting her
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lunch). She also makes weekly trips into the community to practice shopping
skills, and with aide support, is able to use money to make a purchase.

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SOCIAL/BEHAVIORAL
The Behavior Assessment System for Children, Third Edition (BASC3) is an integrated system designed to facilitate the differential diagnosis
and classification of a variety of emotional and behavioral disorders of
children and to aide in the design of treatment plans. Janes teacher and
guardian were each asked to complete the BASC Rating Scales to understand
Janes current behavioral profile at school and at home. Any score in the
Clinically Significant range suggests a high level of maladjustment, and
may need formal treatment. Scores in the At-Risk range identify either a
significant problem that may need formal treatment or that has the potential
of developing into a problem that needs careful monitoring.
Indices/Constructs

Parents Teachers
Rating Rating
66*
64*

Externalizing
Problems
Hyperactivity
71**
63*
Aggression
71**
64*
Conduct Problems
54
61*
Internalizing Problems
51
60*
Anxiety
43
50
Depression
52
59
Somatization
58
67*
School Problems
-68*
Attention Problems
71**
63*
Learning Problems
-71**
Behavioral Symptoms
66*
64*
Index
Atypicality
61*
59
Withdrawal
53
59
Adaptive Skills
28**
32*
Adaptability
31*
38*
Social Skills
29**
31 *
Leadership
30**
36*
Activities of Daily Living
32*
31*
Functional
12**
34*
Communication
All T-scores have a mean of 50, standard deviation of 10.
Clinically significant **
At-risk*
According to Janes teacher, Mrs. Jones, there were many areas of concern in
regards to Janes behavior at school. Mrs. Jones scored Jane in the at-risk
range on all of her composite scores. Janes teacher reported that she often
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engages in a number of behaviors that may adversely affect other children in

the classroom. She also reported that at times, Jane is considered to be
restless and impulsive and has difficulty maintaining her self-control. Her
behaviors are not severe but may warrant further follow up. Mrs. Jones also
reported that Jane sometimes engages in aggressive behaviors such as being
argumentative defiant and/or threatening others. Regarding the School
Problems composite, Janes teacher reported that she has significant
difficulty comprehending and completing schoolwork in a variety of academic
areas. Regarding the Adaptive Skills composite, Mrs. Jones reported that
Jane has difficulty adapting to changing situations and takes longer to
recover than from difficult situations than most others her age. Jane also has
difficulty making decisions, seeking out and finding information on her own.
Jane demonstrates poor expressive and receptive communication skills.
Given that Jane is nonverbal and exhibits significant global deficits, Mrs.
Joness ratings are congruent with classroom and test setting observations.
According to Mrs. Doe, Janes legal guardian, Jane displays a similar behavior
profile at home. Most of Mrs. Does ratings were in the at-risk to
clinically significant range. According to Mrs. Doe, Jane engages in
many disruptive, impulsive and uncontrolled behaviors. She also displays a
high number of aggressive behaviors and may be reported as being
argumentative, defiant, and or threatening to others. According to Mrs. Does
ratings, Jane sometimes engages in behaviors that are considered strange or
odd and she at times seems disconnected from her surroundings. Jane is also
reported to have difficulty maintaining necessary levels of attention. Mrs.
Doe reported that Jane has difficulty adapting to changing situations and
takes longer to recover than from difficult situations than most others her
age. She also reported that Jane has difficulty making decisions and
performing simple daily tasks in a safe and efficient manner. Finally, Mrs. Doe
reported that Jane demonstrates poor expressive and receptive
communication skills and has significant difficulty seeking out and finding
information on her own.
Mrs. Jones and Mrs. Doe had similar ratings in terms of Janes behavior.
Although they both rated Janes behavior in the at-risk to clinically
significant range, it is important to consider that many of Janes behaviors
may be related to her significant global deficits and her lack of verbal
abilities. Mrs. Doe explained that due to the fact that Jane has the mental
capacity of a 2-3-year-old and is non-verbal, autistic and legally blind, most
of the questions do not apply. N/A would have been the answer if given that
option. Although many of the item ratings from both Mrs. Jones and Mrs.
Doe suggest that follow-up is warranted, it is important to consider that Jane
already has a behavior support plan in place. The results from the rating
scales completed by Janes teacher and guardian correlate with each other
and with the behaviors of concern listed in Janes current behavior support
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plan. The behaviors of concern are being addressed through the behavior
support plan. The following is a summary of that plan:
Jane will grab, pinch, hit, kick and/or spit on class mates and staff. These
behaviors typically happen together during a behavioral event and can range
in duration from 5 minute events to over two hours, and the intensity has
increased from moderate to severe; Jane is harming herself, and/or acting
aggressively toward other students and staff. The behaviors occur when she
is unable to access a requested person or item (i.e. requested staff member
is at lunch or with another student; the CD player is being used by another
student). Her behavior disrupts learning because she is not available for
instruction, she disrupts the classroom, she takes other students away from
their learning by injuring them, and her behavior requires staff members'
time, which takes time away from other students. Because Jane currently
receives intensive one-on-one support for the duration of her school day, and
is constantly visually supervised, she has not yet pulled out her g-tube
during the 2015-2016 school year; however, she may make several attempts
per day when highly agitated. To help reduce undesirable behaviors, the
following supports are being implemented: continued one-on-one
instructional aide time for Jane throughout her school day, thereby providing
her the support needed to learn and demonstrate appropriate interactions
with peers and staff, when Jane asks for something that cannot be
immediately provided (i.e. seeing mom, eating lunch), visual supports such
as a countdown timer, signing "later" or "wait" and activities that can help
redirect her (such as going on a walk, listening to music, watching videos on
her iPad, doing desk work, or using the computer) will be used, Jane will be
provided choices of activities (e.g. "Would you like to take a walk or listen to
music?"), rather than enforcing an arbitrary choice for her, staff will use a
calm, positive voice, and provide her activities she can access rather than
telling her what she cannot have, Jane will be allowed to access to the
"Relaxing Room" where she can have a preferred activity to help her deescalate. Instead of engaging in the problem behavior, Jane can self-initiate
use of or request access to calming spaces (outside, the "Relaxing Room")
and calming activities (listening to music, watching videos on her iPad, going
for a walk) when escalated. Jane can be allowed to access to the requested
available activity/staff person as a means of reinforcing her positive choicemaking. If Jane demonstrates aggressive behavior during the activity, access
to that activity/staff person will be removed until she is able to demonstrate
calmer behavior (i.e. "nice hands). When she has "nice hands" Jane will be
allowed access to the activity/staff person. Repeat this cycle as necessary to
reinforce the correlation between nice hands and access to preferred
activities/staff members.
ADAPTIVE BEHAVIOR
The Adaptive Behavior Assessment System-Third Edition (ABAS-3) is
designed to evaluate whether an individual displays various functional skills
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necessary for daily living without assistance from others. The measure
focuses on individual behaviors required to function and meet environmental
demands, including aspects of independent daily living skills, interacting with
others, as well as functional academics. The main skills involved on the
Parent and Teacher forms include communication, community use, functional
academics, school/home living, self-direction, leisure, self-care, health and
safety, and social areas. Michelle Jones, Janes special education teacher, and
Janes legal guardian, Mrs. Doe were each asked to fill out the adaptive
measure. Information regarding Janes adaptive behavior at school can
provide us with a more comprehensive view of her functional skills.
Adaptive Behavior Assessment System- 3rd Edition
Special Education Teacher: Mrs. Guardian: Mrs. Doe
Jones
Standard Percentile Descriptor
Standard Percentile Descriptor
Score
Rank
Score
Rank
Global
49
<0.1
significantly 48
<0.1
significantly
Ability
below
below
Composite
average
average
Conceptual 49
<0.1
significantly 51
0.1
significantly
Composite
below
below
average
average
Social
61
0.5
significantly 57
0.2
significantly
Composite
below
below
average
average
Practical
50
<0.1
significantly 48
<0.1
significantly
Composite
below
below
average
average
**A standard score from 85 - 115 is within the average range
Michelle Jones, Janes special education teacher, rated Jane within the
significantly below average range in all areas of adaptive behavior.
According to Michelles ratings, Janes General Adaptive Composite (GAC =
49; <0.1 percentile), Conceptual Composite (SS=49; <0.1 percentile), Social
Composite (SS=61; 0.5 percentile) and Practical Composite (SS= 50; <0.1
percentile) are all in the significantly below average range. Her ratings
indicate that Jane has poorly developed functional skill. She cannot
communicate verbally but Michelle reported that Jane can use modified sign
language to make requests and communicate information. According to
Michelle, Jane can feed herself with a spoon and can sign complete
sentences when prompted to make requests. For example, Jane can sign I
want lotion please and she knows modified signs for things such as
backpack, hairbrush, eating, pizza, music, hamburger etc. Jane is unable to
rely on herself to get around the community, she is unable to read and follow
the class schedule without needing to be reminded, is not productive or
cooperative in groups. However, Jane does follow safety rules.
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Mrs. Doe, Janes legal guardian, rated Jane within the significantly below
average range in all areas of adaptive behavior. According to Mrs.s ratings,
Janes General Adaptive Composite (GAC = 48; <0.1 percentile), Conceptual
Composite (SS=51; 0.1 percentile) and Social Composite (SS=57; 0.2
percentile) are all in the significantly below average range. Her ratings on
the Practical Composite (SS= 48; <0.1 percentile) also fell within the
significantly below average range. These ratings are congruent with the
results from Michelles ratings.
Overall, this assessment tool indicates that Janes adaptive skills at both
school and home are poorly developed. The results of this assessment
indicate that Janes current placement and level of service are the most
appropriate given her individual needs.
TRANSITION ASSSESSMENT
Jane was assessed using the Student Annual Needs Determination Inventory
(SANDI).
Areas of interest for Jane include: watching videos on the computer or her
iPad (to include babies, and home videos of events like Special Olympics, or
those featuring family and friends), taking walks and sitting in the sun,
listening to music and dancing, interacting with staff and peers, preparing
her meals at school by putting the food in a blender and activating the
blender with a switch, and going on community-based training outings. Jane
works best when she is provided supervision from an adult that she knows
and trusts. Jane also responds best to verbal and physical prompts, one-step
directions, using a calm voice and demeanor, and when provided choices of
activities and reinforcements. Jane also benefits from frequent breaks, and
instruction and modeling on how to use or request access to calming
activities when escalated. Positive behavior is also supported by the use of
affirmative phrasing and visual supports (i.e. later or soon rather than
no and use of a countdown timer). Jane also participates in clerical types of
vocational activities to include shredding, sharpening pencils, and delivering
documents.

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SUMMARY AND CONCLUSIONS

Jane is a 9th grader at Paradise High School and this assessment was
conducted for her triennial evaluation. The purpose of this assessment is to
assist in planning Janes educational program and help in determining the
most appropriate educational placement or Least Restrictive Environment for
her. The results of this evaluation indicate that Jane has significant global
deficits that prevent her from accessing the general education curriculum.
Therefore, based on the following Educational Code definition of Multiple
Disability, Jane continues to qualify as a student with the primary disability
category of Multiple Disability. The California Ed Code defines a Multiple
Disability as the following:
5 CCR 3030
3030. (7) Multiple disabilities means concomitant impairments, such as
intellectual disability-blindness or intellectual disability-orthopedic
impairment, the combination of which causes such severe educational needs that
they cannot be accommodated in special education programs solely for one of
the impairments. Multiple disabilities does not include deaf-blindness.

Jane continues to be eligible for special education services as a student with

Multiple Disabilities at this time. It is likely that her educational needs can
best be met primarily within the Functional Living Skills class. The IEP team
should consider all of the above information in determining the most
appropriate placement for Jane in the Least Restrictive Environment.
RECOMMENDATIONS
Based on assessment findings, it appears that Jane may benefit from the
following:
1. An IEP meeting to discuss the results of this evaluation and to
determine the most appropriate placement for Jane in the Least
Restrictive Environment.
2. Jane may benefit from being given more choices instead of being told
what are not possible choices for her.
3. Implementation of her behavioral support plan in order to reduce
undesirable behaviors in the classroom.

Lizbeth Ramirez, School Psychologist Intern

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Doe, Jane

Date of Report: 12.02.2015

DOB: xx.xx.2001

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