DOCUMENT RESUME ED 097 788 TITLE Handbook ...DOCUMENT RESUME ED 097 788 EC 070 238 TITLE Handbook:...

DOCUMENT RESUME

ED 097 788 EC 070 238

TITLE Handbook: Exceptional Child Education.INSTITUTION Hillsborough County Board of Public Instruction,

Tampa, Fla.PUB DATE 24 Jan 74NOTE 75p.

EDES PRICE MP-$0.75 HC-$4.20 PLUS POSTAGEDESCRIPTORS Evaluation Criteria; Exceptional Child Education;

*Handicapped Children; identification; ProgramDescriptions; *Records (Forms); Referral; *SchoolDistricts; Special Classes; *Special Education;*Student Placement

IDENTIFIERS Hillsborough County (Florida)

ABSTRACTThe handbook contains forms, placement criteria, and

procedural provisions for 17 program departments in the exceptionalchild program of the Hillsborough County public school system inTampa, Florida. Included in the description of the Exceptional ChildEducation Department and the Exceptional Child Education Office areaspects of staffing and samples of general forms such as parentalagreement to special class placement. Individually described areprograms serving the following exceptionalities: educable mentallyhandicapped, trainable mentally handicapped, speech and languagehandicapped, specific learning disabilities, emotionally disturbed,socially maladjusted, gifted, hearing impaired/deaf, blind andpartially sighted, physically handicapped, homebound andhospitalized, multiple handicapped--deaf/blind, hearingimpaired/multi-method, and hard of hearing. Usually provided for eachprogram are criteria for participation, procedural provisions such asscreening and referral, placement, dismissal, and samples of specificprogram forms. Also explained is the role of the coordinator ofadmissions and special services. It is noted that the handbook is aworking document intended to be revised for each school year. (DB)

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HILLSBOROUGH COUNTY PUBLIC SCHOOLSEXCEPTIONAL CHILD EDUCATION

RAYMOND 0. SHELTONSuperintendent

JACK R. LAMBDirector

REVISED

11

.414colt

0'4464

TO: Recipient of the ECE Handbook

FROM: Dr. Jack R. Lamb, Director, Exceptional Child Education

SUBJECT: BCE Handbook

The ECRU Handbook is a working document and pages will be revisedfor each school year to reflect changes in State Statutes, stateand local school board regulations, federal laws and the manychanges in ECE Programs.

Please send your requests for additionsam deletions, technicalchanges and/or format suggestions to Dr. Jack R. Lamb, ExceptionalChild Education Office, 411 East Henderson Avenue, Tampa, Florida,33602.

Rev. Jan. 1974

THE SCHOOL BOARD O1'HILLSBOROUGH COUNTY

Ben H. Hill, Chairman

Bob Bondi, Vice Chairman

Mts. Cecile Essrig

Mrs. Pat Frank

Ddn C. Kilgore

Roland H. Lewis

Hugo Schmidt

Raymond 0. SheltonSuperintendent of Schools

Frank M. FarmerAssistant Superintendent for Instruction

Jack R. LambDirector of Exceptional Child Education

PHILOSOPHY OF THE COUNTY EXCEPTIONAL CHILD EDUCATION PROGRAM

The goal of the exceptional child program is to provide within

the public school equal opportunities for the identification,

evaluation, adjustment, and learning of children needing this

service, and thus promote their academic achievement, social

competency, pre-occupational adequacy and other personal develop-

ment within the total school community.

The philosophy of the School Board of Hillsborough County

states that it will make every effort to provide for exceptional

children who differ from the average to such a degree in physical

or psychological characteristics that school programs designed

for the majority of children do not afford them opportunity

for all-round adjustment and optimum progress, and who therefore

need either special instruction or in some cases special ancillary

services, or both, to achieve at a level commensurate with their

respective abilities.

CONTENTS

Prozram No P rain tae art nriEairwrliw

3000 Exceptional Child Education Department

3001 Exceptional Child Education Office

3002 .Educable Mentally aandicapped

3003 Trainable Mentally Handicapped

3004 Speech and Language

3005 Specific Learning Disabilities

3006 Emotionally Disturbed

3007 Socially Maladjusted

3008 Gifted

3009 Hearing Impaired/Deaf

3010 Blind and Partially Sighted

3011 Physically Handicapped

3012 Homebound and Hospitalized

3013 Multiple Handicapped - Deaf/Blind

3014 Hearing Impaired/Multi-Method

3015 Admissions/Special Services

3016 Hard of Hearing

Each department describes its criteria of participationand procedural provisions.

OarOlt4114114624°

STAFF= couarms AND PROCEDMES

garret Statement

"It is necessary to reiterate a statement regarding thu enrollment

of exceptional children that move into (a) school's attendance

area. These children are to be enrolled and records sent for --

make referral to the School Social Work Department and notify the

Exceptional Child Department of the Child's enrollment. Child's

records will be evaluated to see if child meets (the) established

criteria for placement, and if so, placement (if available) will

be offered."

"In extreme cases, if there's some doubt about enrolling a particular

child, contact the Director of Exceptional Child Education.

(Administrative Bulletin, No. 1, August 7, 1973)."

PROCEDURES rat CASE COM:RANCE COMMITTEE MEETINGS

197 4

Is EarE022.21902Prs

Mrs. Dicksie Mitchell, Director of Pupil Personnel Services,ChairmenDr. Jack Lamb, Director of Exceptional Child EducationMrs. Rosina Seigel, Supervisor of Psychologicll ServicesMiss Carol Thackhem, Supervisor of School Social Work

Others who have been involved with the pupil or who may serve as aresource may be invited with the prior approval of either director.

II. Eapose

Case Conference Committee considers those situations in which severe orcnmpiex physical, mental and emotional problems may necessitate specialplanning or placement within the school system or exemption from schoolattendance. It also serves those pupils for whose difficulties otherstaffing conferences have been unable to determine adequate and satis-factory educational plans. The Cr.se Conference Committee assiststhrough recommending services mailable within the school system,including cooperative planning and coordination of services by theschool, parent and community agencies and suggesting referral to otherresources.

III. Meetirfrs

The Case Conference Committee is scheduled to meet on the first andthird Monday afternoon of each month at 1:30 o'clock in ConferenceRoom 303 of the Henderson Building.

IV. Arynda

1. Schools, special service personnel and community agencies mayrequest a moo be placed on the agenda.

2. A written request form for a case to be placed on the Cp.seConference Agenda must be in the office of the Director of NpilPersonnel Services by 4:00 p.m. on the second or fourth Monday, aweek prior to the Case Conference Meeting. Case material should beattached to the request and should include the intake study, reportsof psychological evaluations and medical examination as wall asother pertinent data.

3. Cases to be presente'l by the staff of Exceptional Child Educationand Pupil Personnel Services must be apprcved in advance byappropriate Director.

4. The agenda, with case material attached, will be Cstribucd tothe Case Conference Committee members on Tuesday prior to the CateConference on the following Monday,

S. The agenda will include a maximum of three cases.

Pipil Personnel ServicesJanuary 1974

C..

14,e5rim% &MN, omi 8154,1

?Roca= ocin, EXCVTIVIO, CHILD EDUCATIONSTAFFING MEETINGS

I. Committee Members

John Friend, Supervisor, Exceptional Child Education, ChairmenMrs. Rosins Seigel, Supervisor of Psychological ServicesMies Carol Thaokham, Supervisor School Social Work Services

The person placing the case on the agenda may invite those persons thatmay have information to present on the case. When inviting personnelfrom Exceptional Child Education it should be noted that only depart,went heads or their specifically designated repLosentAtives may Utast&

11. Purpose

The Exceptional Child Education Staffing Committee serves any childthat is being considered for placement, educational planning, and/orinformational purposes in the following Exceptional Child EducationPrograms:

1. Trainable Mentally Handicapped2. Physically Handicapped3. Visually Handicapped4, Hearing Impaired5. Emotionally Disturbed6. Socially Maladjusted - Natures'7. Specific Learning Disabilities8. Children that may have multiple9. Educable Mentally Handicapped

III. Meeting

Classroom

handicapsonly after being considered bythe Exceptional Child EducationPlacement Committee.

1 The Exceptional Child Education Staffing Committee is scheduled to meeton each Wednesday at 8:45 A.M. in Conference Room 303, Henderson Build-ing.

IV. Agenda

1. School Social Workers, School Psychologists and Exceptional ChildEducation department heads may request a case to be placed on theagenda.

2. Names to be placed on the agenda must be turned into the designatedclerical person in the Exceptional Child Education office prior.to5:00 P.M. on the Friday proceeding the Wednesday the case is to bediscussed.

3. Odlyyfive cases will be taken each Wednesday with a time space ofapproximately 30 minutes each - no one person may place more than

7

three cases on the agepda eath week. Larger blocks of identicalc4180V may be placed on the agenda only with the prior permissionof the Director of Exceptional Child Education or the Chairman ofthe Staffing Committee.

4. The Chairman will be responsible for bringing any existing Exception-al Child Educ. 'ion case material to the meeting.

8/

lalata1..0111laa

The purpose of an 19:0394 staffing it to develop plans, Adjust schedules,request re-evaluations, etc. for students entering, enrolled in, or with-drawing from a special program or regular tides in that particular school.Representatives from the Pupil Personnel Services Department and Exception-al Child Education Department are usually in attendance.

If a case warrants further study or there is an indication that a changein school placement may be necessary, the case is referred to the Place-ment Committee, Exceptional Child Education Staffing Committee, and/or CaseCommittee.

HILLSBOROUGH COUNTi PUDLIC SCHOOLS

EXCEPTIONAL CHILD EDUCATION

PICTURE PERMIT

Dear Parents;

Some phases of our program in Exceptional Child Education will bephotographed, video taped and/or filmed for newspaper artietea, brochures,television, etc.

We shall grant the use of some of these pictures only when thepublicity is Lai Keeping with the policies in our county.

You may be assured we would not permit the taking of a picturethat would in any way embarrass the patents or the child.

If you will give your permission to have your child's picture madeand used as mentioned above, please sig below and return this slip toyour child's teacher.

Sincerely,

Parent s ignatu:e

Student's Name

MIIMMOsitim1011111111141110111

Sc ool

Grade Date

Revised: 1/1/74

HILLSBOROUGH COUNTY PUbLIC SCHOOLS

EXCEPTIONAL CHILD EDUCATION411 Cast Henderson Avenue

Tampa, Plorida 33602

TO: Principal

for

Nommeammotia ImMillaablaammlemsala....1011110.1.10111111B111111015.11011110118.0e

School

Placement in an exceptional child class ts available

allsoftWooftlinewmajb Imoomiimilwommomod 64.. . - +4, IMMO

?Lease have the Parents or guardian complete the enclosed forme.

It is necessary that you make personal contact with the

parents on this student's problem prior to their being asked

to complete the unclosed forms.

One completed form must be returned Lo the Otfics

Exceptional Child Education within tilt.* days. Parente must

indicate their agreement or disa emeet. Please file remaining

form in student's cumulative f

If it is not poegible completed, please

return both forms to the Office id Education.

DATE8111,111.00111ummoimoulmsmmulmOIWOONNoil

HILLSBOROUGH COMITY PUBLIC SCHOOLS

EXCEPTIONAL CHILD EDUCATION411 East Henderson AvenueTampa, Florida 33602

We, the undersigned parents or guardians of

agree (a box must be checked)

do not agree

to placement of our c d in the Exceptional Child Education class at

If you have any qu acement, please

contact the Exceptional Child number 223-5331.

These forms must be returned within ten days or offer of immediate place-

ment will be withdrawn and child's name will be placed on a pending list.

Principal a Signature

School

cc: ECE FileSchool File

I 2.

Parents or Guardian's Signature

HILLSBOROUGH COUNTY PUBLIC SCHOOLS

INTEROFFICE COMMUNICATION DATE f44440

TO:

FROM: Cr. Jack R. Lamb, Director, Exceptional Child Education

SUBJECT:

111110111.11PININIMININ=r11111M10111

111/1111.

Returning copies of case summary to you.

Has been placed on pending list for later assignment. Principalto notify present classroom teacher.

Placemen 110!et ale

et .

1. VParent should contactmake bus transportation arrangements.

1110~11111111/IMINNION

e of Class:

in order to

Principal should contact the parents concerning thisplacement.

Please contact this office if parents cannot accept this placement.

5/3/72

?rosrArA 3042.

EDUCABLE MENTALLY HANDICAPPED

I. Criteria for Participation

A. Children suspected of primiry intellectual deficits must meet thefollowing criteria to be considered for placement in the EMHprogram:

1. A score of two or more standard deviations below mean ona standardized test of intellectual ability Om 100; s.d.15) administered by a qualified psychologist;

2. Academic performance congruent with obtained estimate ofintellectual ability;

3. A determination that retarded academic performance is relatedprimaries with intellectual deficit and not with physical,behavioral or social problemsa. auditory and visual screening must be providedb. information related to behavior and adjustment rust be

obtained (Yeshiva Adaptive Behavior Scale being revisedto meet our needs)

4. C.A. 7 to 21 years.

Individual needs and differences are taken into consideration.Group tests and teacher evaluations must be on the referral.In most instances, a child will have the opportunity to attendthe primary program before placement with an E.M.H. class.The only exception is if a child has been in an establishedKindergarten program. The program is permissive and parentsmust sign acceptance letter. Each child is staffed in theSpring to determine the placement for the next year.

B. Observation and Evaluation Center - Program for Mentally Handicapped.

A child must be between 7 and 11 years of age. Psychologicaltest results must fall in the E.M.H /T.M.H. range. After review bythe placement committee if some doubts remain as to the correcteducational placement, an intensive observation and evaluation ofthe child will be offered for 6-8 weeks. A prescription and per-formance-based individual objectives will be written for each child.Prior to re-assignment, the receiving teacher wq.11 observe thechild in the Center.

II. Procedural Provisions

A. Screening--Referred by teacher and/or guidance counselor. Preferchildren to have the opportunity to participate in a primary programor to have attended a structured kindergarten before being considered.Do not presently place children under seven in an EMH class.Children participate in a county-wide testing program--those

it4

fteStCopp

441404

receiving stanimes of 1 or 2 are referred by teacher on a compre-hensive referral form to Psychological Services. County-wide tparineis done in the early fall each year.

B. Referral--Enrolled children-- classroom teacher and/or guidancecounselor prepares referral for individual psychological evaluationwhich is signed by school principal--referral forwarded toPsychological Services. School social workers are involved inreferral procedure on complex cases.

C. Identification--Social worker gathers medical records and a psycho-gist evaluates the child or validates reports.

D. Placement--All cases are staffed by members of the PlacementCommittee-Mentally Handicapped Program. Cases that School SocialWorkere are involved in may go to Exceptional Child StaffingCommittee and/or Case Conference.

E. Dismissal -- Teachers or parente.. may request re-evaluation afterconsultation with Resource teacher. In-school staffings are heldto discuss dismissal of child. Parents may withdraw children attheir discretion. Supervisor follows recommendations of the group.

A diploma is issued to E.M.H. students at the completion of theprogram. This will be issued at the school's graduation ceremonywith the other students.

III. E.M.H. Temporary Placement Procedures (30 School Day Limit)

A. If a student from an out-of-county location enrolls in a school andpresents some evidence (documents) of having been in an EducableMentally Handicapped program a principal should:

1. Enroll the student.2. Forward a copy of what ever documentation that is available

on the previous out-of-county placement to the Exceptional.Child Education office,Addluding,41:,copy of thecdatedlirequestfor records from the previous school.

3. Immediately send a request to the student's last out-of-countyschool for detailed records.

B. The documentation mentioned in 2 above will be presented to theSupervisor of Psychological Services to determine if these aresufficient to offer a Temporary EMH Placement. If a TemporaryPlacement is approved by the Exceptional Child Education PlacementCommittee and if space is available, the Exceptional Child Educationoffice will:

IS

Apr

1. Forward a parent permission form. (see attached form)2. Accomplish all the necessary placement forms and forward them

to the school when the permission form has been approved.These forms will be stamped Temporary.

3. Prepare an Exceptional Child Education file with the conferencesheet marked Temporary Placement.

4. Prepare an file card for the Placement Clerk. Thiscard will be blue and will be replaced by a white card whenthe placement becomes regular.

C. When the official records are received from the students lastplace of enrollment they should be forwarded to the Supervisor ofPsychological Services for evaluation. The Exceptional ChildEducation office upon receiving these evaluated records fromPsychological Services will either offer regular placement orterminate the temporary placement with explanations.

D. If Temporary Placement is approved but space is not available thestudent will be put on the E.M.H. pending list.

E. If within 20 schoOl days the school does not receive these officialrecords, a referral form for psychological services will be forwardedto the Supervisor of Psychological Services along with a dated copyof the request for the out-of-county records. Here again theExceptional Child Education office upon receipt of the psychologi-cal tests results will offer regular placement or terminate thetemporary explanation.

HILLSBOROUGH COUNTY PUBLIC SCHOOLSExceptional Child Education

Programs for Mentally Handicapped

Observation and Evaluat Center

In School Staffing

Name Date

Birthdate:

t.ssigned Date

Re-,Assignment Date Active SSW

Problem Areas.1011.111.11111101101.1.01.24.1011.111.1111MIMMMOINNIONIMIIMEANNIII

10.

Recommendations:

.11110104.0.-

ONEM11=m.....milIMIn.

wera~rwsr

IIMM=MWEIN.M11...111= //

-a

.111111

17

ADE

D7.RTHDATE:

HILLSBOROUGH COUNTY runic OCHOOLSracceptional rhild Educat:An

Programs for Mentally Hand 'capped

:.17-CCHOOL STATP?ING SUIIWRY SHEET

re-!'so %nel Presen'::

Fsason for Referral.:

:'rob'em areas noted:

Recommendattons7

4.41,C,44,4

ECE A

PPS

DATE 0? ST!TING

SCHOOL:

CRADE:_.

SnCIAL WORKER:

la'

--Pre51-04% 30o 3

TRAINABLE MENTALLY HANDICAPPED


Children suspected of primary intellectual deficit must meet thefollowing criteria to be considered for placement in the ThAR program:

A. A score of three or more standard deviations below mean on astandardized test of intellectual ability (m = 100; s.d. = 15)administered by a qualified psychologist;

B. An academic performance congruent with obtained estimate ofintellectual ability;

C. A determination that retarded academic performance is relatedprimarilz with intellectual deficit and not with physical, behavioralor social problems1. auditory and visual screening must be provided2. information related to behavior and adjustment must be obtained

(Yeshiva Adaptive Behavior Scale being revised to meet ourneeds)

3. complete intake study completed by the School Social Worker4. the ability to be toilet trained

D. Approximately one fourth to one half of normal I.Q. Score (30-55).C.A. 7-18 years.

A child's individual needs and differences are taken into considera-tion and recommendations are discussed at the Exceptional ChildStaffing and/or Case Conference. Individual examination by aschool psychologist and an intake study by a School Social Workeris executed. Children are re-evaluated approximately every threeyears or upon requests by staff or parents, and approval of saidrequest by resource staff.


A. Screening--Anyone referred who will be 7 by September or will havea year with the program before the 18th birthday. Pre-schoolchildren are screened during the spring and summer. Screening isscheduled by Supervisor, Programs for Mentally Handicapped: Abattery of tests are administered by a psychologist.

B. Referral--Agencies, parents, and school per.;onnel.

C. IdentificationAn evaluation of child by a school psychologistand Intake Study developed by School Social Worker.

D. Placement--Placement is made by the Director of Exceptional ChildEducation on the recommendation of the Staffing Committee, or theCase Conference Committee.

19

E. Dismissal--Children are dismissed at the present time upon completionof the school year in which they are 18 --referred to the Departmentof Vocational Rehabilitation and MacDonald Sheltered Workshop- -

Any of the TMH Centers, parents, or agencies may request a re-eval-uation of children for consideration of another placement ordismissal. Children receive a certificate of completion at theend of the program.

III. TI.M.H. Placement Procedures

A. Psychologist refers any cases falling within the Trainable MentallyHandicapped range to the Supervisor of School Social Work.

B. Social Worker develops an Intake Study.

C. Social Worker brings the child to an ECE Staffing.

D. Recommendations of the Staffing are forwarded to the Supervisor ofPrograms for the Mentally Handicapped.

E. Exceptional Child Education folder is made, Exceptional ChildEducation file card is made for the pending file.

F. Exceptional Child Education pending file card filed by date.

G. When an opening is available Placement Clerk will forward theassignment papers:

1 copy to place of assignment1 copy to School Social Worker1 copy to Director of Pupil Personnel Services,

attention: Supervisor of School Social Work1 copy to child's folder

H. The Placement Clerk will also forward to the School Social Workerthe parent permission form.

I. The School Social Worker will return the signed parent permissionform to the Exceptional Child Education office along with two copiesof the short case summary, one for the Exceptional Child Educationfolder and one for the school or placement of assignment.

J. If the parents refuse a voluntary placement, the School SocialWorker will return the assignment sheet and parent permission formto the Placement Clerk and bring the child to a Case Conference.

?ro51'Aret 300q

SPEECH AND LANGUAGE PROGRAM


A student's speech is considered impaired when it is unintelligible,conspicious, unpleasant, or has caused the student's educationalachievement to be adversely affected. Appropriate programs areavailable for those students, Kindergarten through twelve, regular andspecial education, who have been diagnosed as having a speech impair-ment by a speech therapist and has parental permission to be enrolledin the program.

An early intervention program of speech and language improvement isavailable through inservice training for early childhood, Headstart,first level teachers, and parents by speech and language resourcetherapists. Workshops are scheduled throughout the year in generalareas.


A. Screening--A Primary III/Gth Grade speech screening is conductedthe first month of each school year in all Hillsborough CountyPublic Elementary Schools. A short form of the Photo ArticulationTest (PAT) is used for screening of articulation and providesobservation for voice rhythm, pitch, and language. 100% accuracyis expected at this age level on phoneme production.

B. Referrals--Referrals are made directly to the speeci therapist onthe elementary level. Referrals are accepted throughout the yearfrom classroom teachers, principals, parents, physicians, communityagencies, etc.

Referrals are made to the counselors in the junior and senior highschools by teachers, principals, related school personnel, communityagencies, and parents.

C. Identification--Further identification of speech and languageproblems are defined by means of several of the appropriate tests,which may include but not restricted to:

1. McDonald Deep Test of Articulation2. Van Riper Predictive Test of Articulation3. Goldman Fristoe Test of Articulation and Auditory Discrimination4. Peabody Picture Vocabulary Test5. Illinois Test of Psycholinguistic Abilities6. Templin-Darley Test of Articulation7. Pure Tone Audiometric Test8. Oral and Visual Examination

2/

D. Placement--Speech therapists schedule students for group orindividual therapy with regard to severity of problem, chronologicalage, maturation or readiness, and prognosis.

E. Dismissal--Dismissal from the program is based on corremaximum improvement, or students inability to benefit from program.

Jack R. LambDirector

Child's Name

Speech Therapist


HEARING THERAPY REMRRAL

Sch

1a and O. Sheltonerintendent

Nature of Hearing Loss

Does Child Wear An Aid?

Teacher nue2s Crhow to deal with

Therapist wants sue.

tnnetin chilkl's problem and

onfl to meetin[., child's innRuaN needs.

Child can function !..n a ru3ular clasroon 1,ut

in order to keen up with his chum.

Child does not seen to be Z)le to 7unct:.onroom due to his hcarir 1010.

ET-1

rice.s trtoring

in rc,,,,ular class-



SPEECH AND HEARING REFERRAL

CHILD'S NAME AGE BIRTHDATE

ADDRESS

PARENT'S NAME

TELEPHONE

SCHOOL

TEACHER

NATURE OF SPEECH PROBLEM

itsercop

Raymond O. SheltonSuperintendent

amsmirmesiduelbres~assagmgraimossINANI

arapwrommorber

.../N/Note 4408OWNSMONISI.

nkWoeDESCRIBE ANY OTHER PERTINENT FACTORS

HILLSBOROUGH COMM PUBLIC SCHOOLS

Enceptional Child Education

REQUEST FOR LANGUAGE AND SPEECH IMPROVEMENT SERV

TEACHER GRADE DATE

SCHOOL SPEECH THERM=

REQUEST FOR: Handbook

Materials *V.(

Consultive Services:

COMMENTS:

improvement

nguage patterns

IPfIRMIXInbaffax.m.

PLEASE RETURN TO SCHOOL'S SPEECH THERAPIST

HILLSBOROUGH COUNTY PUBLIC SCHOOLSExceptional Child EducationSpeech and Hearing Department411 East Hc.derson AvenueTampa, Florida 33602

Jack R. Lambnirector

Dear Parents:

Raymond 0. SheltonSuperintendent

As a part of the regular school program, Hillsborough County Schools providethe services of a speech and hearing therapist. There is no charge for thisservice.

The purpose of this service is to offer adequate speech instruction to allchildren.

It is felt that your child will profit from this help. In order that we maybe advised of your wishes in this matter, it is necessary that you fill i,the blank below and return it this week to your child's teacher. This mustbe returned to the speech therapist before your child is enrolled in therapy.

Corr ly yours,

pal

Thera

Detach here and return this portion of the sheet to t

I do wish to have

I do not wish to have

enrolled in Speech Class.

School

Child s Name

Child's Namemomipmeft...

Parent's Signature%lb

Note to Classroom Teacher: When child returns this form, would you please seethat the speech therapist receives it.

SPT9a


Speech and Hearing Department411. East Henderson Avenue

Tampa, Florida 33602


DateDear Parents:


The speech therapist has recommended thatbe included in a Speech Therapy class which meets onat School.

QUESTIONS

4111.11111111.11.

1. What is speech therapy?Speech therapy is a service provided by trained speech and hearingtherapists for the Hillsborough County Public School System designedto help students with speech difficulties.

2. How are students selected for speech class?At the beginning of the school year all third graders, previous speechcases, and all students new to the county are tested by the speechtherapist to determine if the child has a speech difficulty. Studentsreferred by their teachers are also tested.

3. Will my child outgrow his speech problem?A child may improve his speech to a degreework in a speech therapy class will help i

rapidly in overcoming his difficulty.to overcome their difficulty without pro

special help. However,rogress farther and moreildren may never be ableal help.A;

4. What can the parent do at home to help the c with his)Veech?Encourage the student to practice any assigrAfske there t

suggests Try to give the child opportunities t ir gooin situations that are calm and without undue stre

ch

A5. Will my child be self-conscious when he leaves the ro eech rapy?Most children enjoy coming to speech therapy. They spexercises and activities that are part of therapy. Speec s aee

1:7114part of the total educational program.

6. How will I be informed as to the progress of my child's speech?You are welcome to visit the speech therapy class. Conferences maybe arranged whenever necessary or advisable. The speech therapist willlet you know by conference or written report as to the progress yourchild is making in speech.

Sincerely,

Principal

Speech Therapist

"Procrt r% 30061"

SPECIFIC LEARNING DISABILITIES


Potential for average or above intellectual functioning is determinedby individual examination. K-7 grade is served with major emphasisin the elementary program. Included are children who are achievingmore than one year below grade placement in the ability to listen,think, read, write, spell, or do mathematical calculations due to suchdisorders as perceptual handicaps, brain injury, minimal brain dysfunetior.,dyslexia or developmental aphasia. This term does not include childrenwho have learning problems which are orimarilt the result of visual,hearing, or motor handicaps, of mental retardation, emotional disturbance,or environmental disadvantage.


A. Screening

1. In the fall, elementary classroom teachers observe and ratepupils on a 0-5 scale for SLD behaviors using the IdentificationGuidelines for Specific Learning Disabilities. Other personnelsuch as the school social worker, psychologist, speech therapist,nurse or special area teacher working with a child with asuspected learning disability may request screening but shoulddo so in conjunction with the regular classroom teacher.

2. The SLD teacher determines potential for average intellectualfunctioning and then utilLLJs an informal group inventorydesigned for Hillsborough County to assess tae child for grossdisabilities. This is followed by the group screening instru-ment - the Slingerland Screening Tests for Identifying Childrenwith Specific Language Disability.

3. Behavioral and group diagnostic data are evaluated by the SLDteacher and the SLD county-wide resource teachers. The SLDSupervisor is available for in-school eligibility staffing uponrequest.

B. Referral

The classroom teacher may initiate a referral through the princir41to the SLD teacher for any child who has been screened and foundto have a suspected disability in conjunction with normal intellectualpotential.

C. Identification

1. The SLD teacher defines each child's strengths and weaknessesfor learning and prepares a psychoeducational profile.

8414COPP

447/148144

2. A comprehensive yet cost effective diagnosis is provided byutilizing a variety of available instruments depending on eachchild's integrities for learning as determined during screening.Commonly used instruments include, Bender, Wepman, Frostig,ITPA, Detroit, Silvarole, Key Math, and informal assessments.

D. Placement

1. Psychoeducation, behavioral, and social data are gathered andevaluated at an in-school staffing to determine educationalplanning and treatment.

2. An integrated program is devised along the parameters of pre-requisite learning skills, tool subjects, social behaviors andadjustment.

3. A parent conference is held to explain the child's program andto include the family in the remediation strategy.

4. Children retain placement in the regular classroom and arescheduled for individual and/or small-group instruction with theSLD teacher after obtaining parental permission. The lengthof time spent in the program and the degree of interventionis therefore contingent up "n the severity and multiplicity ofthe disability.

5. Children with specific learning disabilities requiring moreextensive intervention than is available within their schoolsetting will be referred to BCE Staffing. If recommended,children will receive an additional two half-days per week inthe SLD Center located at Tampa Bay Boulevard Elementary School.A maximum caseload of twenty children may be served at the SLDCenters.

E. Dismissal

1. When the child has been provided with the necessary remediationalor circumventive skills required to learn in the regular class-room, he is then staffed out of the SLD program.

2. The SLD teacher provides consultive service during the transitionperiod.

HILLSBOROUGH COMITY PIN= SCHOOLExceptional Child Education

Program for Specific Learning Disabilities411 East Henderson Avenue


Jack R. Lamb Raymond O. SheltonDirector Superintendent

Date

Dear Parent:

will continue to receive service in a small grouptraining program to improve learning. These groups will meet twice a week andare part of the school program.

This service will be extended to your chi long as it is beneficial. If- you desire a parent conference, a mutual c venient time can be arranged.

Sincerely,

rning Disabilityr

Principal's Signature

MiLLSTIORITGH CM! TY PUT= MOMSExceptional Child Education

Program for Specific Learning Disabilities411 East Henderson Avenue


We, the undersigned parents or guardians of

COP?

0 agree(Please check one box only)

0 do not agree

to service for our child by the Specific Learning Disabilities program. Smallgroups for improving learning meet twice a week and are part of the schoolprogram.

If you desire a parent conference, a mutually convenient time can be arranged.

Please check the appropriate box and return these signed forms within ten daysor offer of service will be withdrawn.


S.L.D. Teacher's Signature

School

Parent's or Guardian's Signature

mit

cc: ECE FileSchool File

Confidential HILLSBOROUGH COUNTY PUBLIC SCHOOLSNOT TO BE Exceptional Child EducationDUPLICATES Program for Learning Disabilities

Request for Services 4/a.'Wale

Name 0./..6 Student Number Grade Grades Retained

School

Address

Parents

kmIN1.11161111

.....0Reason for request

TeacherYWO M.P./MVO 00.

Phone Birthdate,

Brothers (ages) Sisters (ages)

mom ...we

10.11 d .....Attendance: Total days absent to date 0 Last year

Date of most recent evaluation for: Speech Vision__ HearingComment:

MI/010 *Mg.

.11100

Significant Medical History

NII.

as.......... aPresent Medication:_

Has the pupil's problem been discussed with the.parents?

Has this pupil been receiving help from the following: (indicate date)Psychologist_ Social Worker Counselor Speech Therapist__

Comment:owe..

Record recent group test results for ability and achievement.

..,,,..gomam --.........-------

Date ,Grade Test Lang. Non-Lang Dateotal Date Grade TestReadt_fArfth. Lan .

, 1

1 . ,

Note individual test results: (WISC, Binet, S

Date Test Results111,

Othei)

__--------------_!ales 411 est Rests

Estimated reading grade level Describe:

=Ulm. -. van. . ...new avow

Estimated arithmetic grade level Describe.

Describe writing ability__

Describe oral language ability

Describe attitude toward school, work, peers, authority figures

11

=Describe areas of strength this child exhibits.

Signature of Principal

ow.

Signature of Teacher Date

Confidential HILLSBOROUGH COUNTY PUBLIC SCHOOLSNOT TO BE Exceptional Child EducationDUPLICATED Program for Learning Disabilities

OD 2

4estcoPe

4446'4

NAME GRADE DATE OF BIRTHneel112111040 .0 121

The following identification guidelines are for analyzing symptom rompleneoand facilitating appropriate management and educational procedures for the learn-ing disabled child. Rate each characteristic with a 0-5 scale in terms ofincreasingly observed behavior with 1 indicating behavior exhibited to a slightdegree through 5 indicating behavior exhibited to a very large degree. Remember

that appropriate behavior varies with chronological age. If only part of thestatement is applicable, underline the specific characteristic that applies tothe child.

Significant discrepancy between ability and achievement.Difficulty with activities involving rhythm.Difficulty judging size, shape, or distance.General awkwardness. Poor balance.Difficulty with tasks requiring fine coordination.ConfusesReversesReversesConfuses.0.

..f.a.f..aw4left and right body parts.letters or words when reading.letters, words or numbers when writing.letters, words or numbers that look alike.

Confuses letters, words or numbers that sound alike.ing or writing.

a words in unfamiliar corga ation and detail.

or rules.

Omits letters or words whenDifficulty recognizing fam'Drawings are immature.Difficulty rememberingDifficulty learning facts s as his ddress or phone number.

ontext.

Difficulty learning a ser s

Forgets almost immediatelyConfused by oral directions.Dif'ficulty with concepts involviktimeAchieves high in some areas and rip iM

'eh 101:1, %alphabet.

'has alit or heard.ki.culty lowing directions.

Poor printing or writing. Difficu copyArithmetic more than one grade level beloReading more than one grade level belDifficulty learning sight words. LacksDoes not comprehend the significance ofSpelling more than one grade level below gThinks slowly. Delayed response to question

rom the board.ade acement.

nt.

skills.e eads.placement.

or commands.

Poor abstract reasoning ability.Performs inconsistently from day to day or hour to hour.Short attention span. Difficulty concentrating.Impulsive. Responds without considering consequences.Distracted by minor sights or sounds. Notices everything.

Difficulty focusing on center of attention.Repeats a task or movement when it is no longer appropriate.Hyperactive. Excessive motor activity.Low tolerance for frustration. Gives up easily.Poor judgment in social and interpersonal relations.Poor adjustment to change of routine.Sudden unexplainable shifts from one emotion to another.One eye occasionally turns in or out.Speech irregularities. Distorts or omits sounds.

Easily fatigued by mental exertion.

Signature of Teacher31 Date

H/LLSOROM COUP)?? PUBLIC SCHOOLSExceptional Child E2.,.cation

Program for Specific Learning Disabilities COp

411 East Henderson Avenue P446Tampa, Florida 33602 W4604,

Jack R. Lamb Raymond O. SheltonDirector Superintendent

Date

Dear Parent:

Due to current progress, will no longer requireservice from the Specific Learning Disabilities Program.

Thank-you for your cooperation. Should a final parent conference bedesired, a mutually convenient time an be arranged.

..1*et

.r:.

41t.

°No:...:

Sincerely,

Learning Disabilitycher

Sch


1)tli.tnN 30040

EMOTIONALLY DISTURBED

I. Itinerant Resource Teachers

A. Criteria for Participation

The student must be in grades K-12; a legally enrolled student inthe school served; have an average or above average I.Q., or thepotential for such; be diagnosed by a psychological and/or psychiatricevaluation as emotionally disturbed requiring more than full-timeregular class programming and less than full-time special classassistance.

B. Procedural provisions

1. Referral--Referral occurs by the principal submitting a regularPupil Personnel Services Referral Form (0345) requesting studentevaluation. If psychological evaluation indicates emotionaldisturbance, a referral to the Program for the EmotionallyDisturbed is completed by the teacher, signed by the principaland returned to the Itinerant Resource Teacher assigned to thatschool.

2. Placement--The Itinerant Resource Teacher works with identifiedemotionally disturbed students on a scheduled basis and inconjunction with the classroom teacher(s) on academic/social/emotional behaviors.

3. Dismissal--Observable progress in modifying or eliminating theentering behaviors is the major indicator of readiness to returnto full time regular class programming. Students are consideredas having reached maximum benefit of the program when they canbe maintained in a regular class program with less than 10%incidence of the entering behavior as noted by classroom andIRT.

II. Resource Rooms (Elementary)


The student must be between 5-13 years of age; a legally enrolledstudent of the particular school served (may not transfer intothat school to receive this service); have an average or above I.Q.,or the potential for such; be diagnosed by a psychological and/orpsychiatric evaluation as emotionally disturbed requiring more thanfull-time regular class programming and less than full-time specialclass assistance.

B. Procedural Provisions

Pp400.1. Referral-Each school's Screening, Committee will review all

referrals. If recommendation for Resource Room Evaluation ismade by the committee, it will be indicated on the top of thereferral and returned to the Department of Pupil PersonnelServices. The Principal's signature must appear on thecompleted referral form.

2. Identification--The social worker gathers case study datafrom the home, school and community. The resource room teacherreads child's school records, observes in the classroom, conferswith teachers, and works with the child individually, i.e.,Slosson Test, Frostig, Winter Haven, and any other generalpaper-pencil and verbal testing appropriate to assess the child'sneeds. The school psychologist is also scheduled to evaluate thechild. Psychological evaluations performed by other thanschool personnel are accepted when approved by Supervisor ofPsychological Services.

3. Placement--After evaluation, the Resource Team, i.e. SocialWorker, Resource Room Teacher, Principal, Psychologist, andinvited personnel (Classroom teacher, nurse, etc.) meet inweekly staffing meetings to finalize the candidacy of eachchild referred and to establish the plan of action. Periodicstaffings are scheduled to note progress, recommend continua-tion of program, etc.

Distisshl--TheAtesource Team determine in staffing meetings onthe basis of the child's progress whether he is able to returnto regular class full time without Resource Room Services.

III. Mendez Day Care Center


The student must be between 6-12 years of age; a resident ofHillsborough County (or county of residence agrees to pay out-of-county tuition to local board); have an average intellectualpotential; the potential to profit from therapy and academicinstruction within 9 to 18 months; the ability to develop meaning-ful relationships; the willingess of the parents to also becomeinvolved in therapy and/or counseling; be able to pay fee to the

, Hillsborough Community Mental Health Center for therapy based ontheir ability-to-pay scale; have reliable transportation providedto and from the center or bus pick-up points; be evaluated bypsychological and/or psychiatric evaluation as emotionallydisturbed requiring not less than full-time special classprogramming and therapeutic involvement.


1. Referral

34/

COPp

a. Persons who may refer:

1. Staff of the Hillsborough Community1AMAA

HealthCenter, Inc.

2. Staff of the Departments of Exceptional Child Educationand Pupil Personnel Services of the HillOorougE CountyPuhM S:hobli. .

3. Private Psychiatrists, Psychologists, Administratorsof Non-Public Schools and Community social agencies.

b. Method of Referral

1. Letters of referral are sent to the Director, CharlesE. Mendez Day Care Center, 5707 N. 22nd Street, Tampa,Florida 33610.

2. The letter of referral should include a brief written2. 'Summary of pertinent information relating to the

child with all available evaluation data attached.a. Persons submitting referrals from the school

system should send a smx, directly to E.C.E.

2. Placement--The Admissions Committee offers placement on a9-18 months basis to those students meeting the above criteria:.

3. Dismissal--The Mendez Center Staff (includes teachers) meeton a regular basis to determine students readiness to return toregular schools.

IV. Bay Child Center (Residential)


The student must be between 7-13 years of age; a resident ofHillsborough County (or county of residence agrees to pay out-of-county tuition to local board); have an average intellectualpotential; the potential to profit from therapy and academicinstruction; the ability to develop meaningful relationships; thewillingness of parents to become involved in therapy/counseling;be able to profit and make progress within 6 months; have a homeor other placement to return to upon dismissal; the ability ofparents to pay fee for evaluation and therapy as established bythe Division of Children's Services; be diagnosed by psychologicaland/or psychiatric evaluation as emotionally disturbed requiringnot less than full-time special class programming and residentialcare.


3

1. Referral

DES?COPf

AVIULAOLE

a. Persons who may refer:

1. Staff of the Hillsborough Community Mental HealthCenter, Inc.

2. Staff of the Department of Exceptional Child EdurationIMO Pupil Personnel Services of the Hillsborough CountyPublic Schools.

3. Private Psychiatrists, Psychologists, Administrators ofNon-Public schools and all Community Social Agencies.

b. Method of Referral

1. Letters of referral are sent to the Bay Child CenterResident Administrator, 2905 E. Henry Avenue, Tampa,Florida 33610.

2. The letter of referral should include a brief writtensummary of pertinent information relating to the childand the disabling condition, Psychiatric or PsychologicalEvaluation and Social Case Worker summaries. TheMedical Director will determine if an evaluation byhim is necessary.a. Persons submitting referrals from the school

system should send a 22pa directly toEA.E.

2. Placement--The Admissions Committee offers placement on a 6months basis to those students meeting the above criteria.

3. Dismissal--The Bay Child staff (includes teacher) meet on aregular basis to determine readiness to return to regularschools.

V. Hospital Centers - Psychiatric Wards

A. Criteria fkir Participation

The student must be enrolled in a K-12 program at the time ofadmission; be admitted by attending physician to the psychiatricward for a serious emotional disorder; have a physician's authoriza-tion form to participate in an instructional program; have theauthorization of the ECE Director to participate; have release ofinformation and permission of the parent to participate. A student'sexpected length of stay must be 4 weeks (20 school days) or longerto qualify for admission to a hospital school program.

B. Procedural provisions

1. Referral- -Must be recommended by the examining physician andauthorized by the Director of Exceptional. Child Education.

3'

starcope

4014184

2. Dismissalis based upon psychiatric readiness to return homeor to another agency or institution as determined by thephysician and the hospital team which includes the educationalstaff.

A

AM

37

I

HILLSBOROUGH COUNTY PUBLIC SCHOOLSP. 0. BOX 3408 TAMPA, FLORIDA 33601

DEPARTMENTOF

EXCEPTIONAL CHILD EDUCATION411 EAST HENDERSON AVENUE.

TAMPA, FLORIDA 33602

TO: Parent or Guardian

8E$AVA11481,E

SCHOOL BOARDMRS. CECILE RSIN110. CHAIRMANRCN H. W.A., VICOCHAIRMANBOO BeniMRS. PAT FRANKDON C. KILCIOR1ROLAND H. LCWISHUGO SCHMIDT

SUPERINTENDENT OP SCHOOLSRAYMOND C. !WILTON

JACK R. LAMSDIRECTOR

A Hospital Program of Scholastic Rehabilitation is being consideredfor your child while he/she is unable to attend a local school. Thisprogram will enable the child to either keep up.with assigned studies orto have remedial work depending on the need. This service is provided bythe Exceptional Child :education Department of the Hillsborough CountyBoard of Public Instruction.

In order forfor the parent or

1. sign the2. rill out

your child to be enrolled in the program it is necessaryguardian t

relearn oand sign th!

Both places requiring

this page.is sheet.

cur con-venience. Both farms should be returner to the Bxcept ona Id Mucation,411 'T.ast lenderaon Avenue, Attention: Joanne 7. Rocco, as early ea possiblein order to begin service or the chili.

16231T or. GUARD/All AUTHCIIIZATIO1! TO :111,:?,..AS3 IITT/0111.1ATIOF

hereby authorize the release of information concerning

tion 3eiJartment and PupilSchools, Tampa, Florida.kept confidential.

7orm 0/:ospital

to/from the :exceptional Child Ziuca-Personnel Services, Hillsborough County PublicY. understand net this information will be

31

XParent or Guardian

Oate

HILLSBOROUGH COUNTY PUBLIC SCHOOLSP. O. BOX 3408 TAMPA. FLORIDA 33601

DEPARTMENTOF

EXCEPTIONAL. CHILD EDUCATION411 EAST HENDERSON AVENUE

TAMPA. FLORIDA 33602

PP.OGRAII FOR TM EHOTIOVALLY DISTURBED

Dear

R3:

10.611.111

(date)

SCHOOL MORROCRCILR RICRICI. CHAIRMAN

S RN H. HILL. VICECHAMMANS OO MONDIMRO. PAT PRANKDON C. KILGOREROLAND H. LimaHuoo SCHMIDT

SUPERINTENDENT Or SCHOOLSRAYMOND 0. SHELTON

JACK R. LAMBDIRECTOR

.1.....M.O.I.

Your child's needs have d' Eby

highly trained in the educati

u111needs are expected to be hon u

disoriers. All specia/ school u

Any change in these special assignments will be determined bythe professional staff of the Exceptional Child Department. Theirfunction is to be of service to your child's needs.

Please be assured that your child's best interest is our goalat all times. Your child's school placement for school year 19 - 19is

(student's name

rsonnellearningional

Very sincerely,

Jack R. Lamb, Ed.D.

Jr.L/crw

cc: John Neuer, Director of Pupil Admin. ServicesE.C.3. File

revised 9/10/73 31

HILLSBOROUGH COUNTY PUBLIC SCHOOLSP. 0. BOX 3408 TAMPA. FLORIDA 33601

DEPARTMENTOF

EXCEPTIONAL CHILD EDUCATION411 EAST HENDERSON AVENUETAMPA. FLORIDA 33602

TO: Physician, Hospital, or Clinic

!JEST coil AvAimea

SCHOOL MORROMRS. C[CILI EIMIRIO. CHAIRMANBCH H. HILL. VICILCHAIRMANBOB BONDIMRS. PAT PRANKDON C. KILOORIROLAND H. LIWIHuoo SCHMIDT

SUPERINTENDENT Or SCHOOLSRAYMOND 0. !MILTON

JACK R. LAMBOIRECTOR

Authorization

Cements:

A Hospital Program of Scholastic Rehabilitation is available for

the child whose name appears below. Your advice and.recommendation

is necessary in order to determine whether or

to attend this school program.

lo you recommend a Scholastic Program at this

Child's Name:

Parent's/Guardian's Name:

Address:

Admitting Diagnosis:agree:

Approx.Admitting Date to Hospital: Length of Stay:

Any physical activity limitations?

not the child is able

time NO

Any specific. recommendations?

Last school attended:

11~......11.01

.1.........moINIONNOINSENanlwilIMIWOMmalls

Grade Level:

(Examining Physician)

(Ai -tress )

(Phone)

Form #1 Lk)(Date)

I

=OPTIONAL cnro EXCATION

PROGRAM FOR THE :NOTIONALLY DISTURBD

=cut= ROOM STAFFIUG curttax SHEET

3.C.EP.P.C. it

Psychologicaldate

INITIAL STAFFING DATE:

SCHOOL: zup-or-min STAFF/VG DATE:

WADE TERLIITAT/ITG STAFFING DATE:

pzncorua =ENT:Principal:Psychologist:Social Uorker:

111".^ClIC For, r,;:x....nRAL:

Resource Room Teacher:Classroom Teacher:Other:

eligible to enroll

(date withdrawn)

I services no longer require.

transferring to(school)

eligible to continue - 19 at Resource Room

not eligible to enroll (state explicit reasons)

cc: 3xceptional Child Ed. 'Files PrincipalPupil Personnel Files Resource Room Teacher

ti

Itinerant nesourc9 meacher

HILLSBOROUGH coma? PUBLIC scamsResource noom E.1:02.M0EAL CHILD MUCATIOU

411 East Henderson AvenueTampa, Florida 33602

PROGRAN VOR TH3 MOTIOUALLY DISTURBED


Dear Parents:

(date)


has been referred for educational(student's name)

evaluation and planning by the at(Program)

Check One

110111101

(Cchool)S

A110.1111=p1m1011.ftwo

We do accept this service of educational for our child.

We do not accept this service ofchild.

Parents' signature

Street address~1.0,0111.wmak.smiaNas

Telephone

Zate signed

cc: E.C.E. FileSchool File

9/17/73

uat d planning for our

iPP

Resource Teacher

*Phis form must beitreturned within 10days.

42-

"ay Child Center

Yendez Center

Hospital

HILLSDOROUGR COUNTY PUBLIC SCHOOLS"'CI PTIONAL CH/LD EDUCATION411 cast Henderson AvenueTampa, Florida 33602 .

PROGRAM FOR THE EMOTIONALLY DISTURBED

Jack R. Lamb Raymond O. SheltonDirector

Superintendent

(date)

has been recommended for(student s

went in the Exceptional Child Education program at

We, the undersigned parents or guard

accept placement.

do not accept placement..1.011.111PINIMINOM

cc: E.C.E. FileSchool/Center File

9/17/73

Parents' or guardians' signature

Date signed

*This form must be returned within10 days.

4-3

HILLCBOROUGH COUNTY PUBLIC SCHOOLSExceptional Child Education411 East Henderson AvenueTampa, Florida 33602


RESOURCE TEACHER SUhkIARY

Name Btrthdate

AddressParent's Name

School Grade Teacher

Source of referral:

Reason .for referral:

E.C.E. #S.S.W. 0Tested

IniorMIIIIrroM11111M111111111111111Mme


Phone

12/71

(iv

Reoource Teacher

Data

2122102Aig HILLMOROUGH COUNTY PUBLIC SCHOOLSTOT"rOTBEF EICEPTTOMAL CHILD EDUCATION'UPLICATED PROGRAMS FOR THE EMOTIONALLY DISTURBED

REFERRAL FOR SERVICES FOR THE EMYITONALLY DISTURBED

1 SONAL HISTORY

Name

Address

Birthdate

Phone

OFFICE USE OliaE.C.E.

S.S.W. I

Tested

mmoommamo

Parents/Guardians

(Indicate separated, divorced, deceased, foster, etc.)

Total Number Living in Home ... Sisters: older younzer other:

Brothers: older younger

Significant Information about Home Tivironm .

,.. ........--.........--2. Health: Difficulty with Speeoh

Hearing

On Medication

Vision0-ordination

Significant Medical Mato:4Specify

3. Is this child and/or family known to any orlfr wing agencies:Dept. of Public Welfare Family BdiVieal Guidance Center

Juvenile Court

JOHOOL HISTORy

1. School

Attendance: good fairOMOMOMMOMMMIM

2. Previous School (a), if any

3. Date entered county schools

4. Number of Years in School Including Present Years retained

5. Date and Scores of Latest Tests:

Grade!!! Teacher

OMOMMOMM.MOMIIIMIPO. ONNIOINMEOMMMNMOMMIIIIMA.

C T.M.M.

M.A.T.

Other

.11MOMMI.MOMMMNIM MEM.. alliMMoMm

MIMOMMOINMIMM MMIP.1010 LVrr M.MIMM.MMOMMIMONMI.MOMINOMMIMMOOMMIIMMOIMM. ...1.111. MOIMOMMOIM

6. Has this child ever been seen by the following: (indicate date!)

School Psychologist

School Social Worker

WATT: MS= FOR .RF1421RAT. (be expliCit)t

Speeoh Therapist

Ouidanaa Cemtaelor Other


Date

?ftrh% 3061

PROGRAMS FOR THE SOCIALLY MALADJUSTED

Criteria for Eligibility for Special Education Programs and Provisionsfor Screening, Referral, Identification, Placement, and Dismissal ofExceptional Children and Youth.

I. Socially maladjusted youth between the ages of 7 - 17 are placed inthe juvenile shelter by Juvenile Court. Facilities are providedby the Board of County Commissioners/Division of Children's Servicesand are governed by the Board of Visitors. The Division of Children'shas a Director to supervise the operation of the juvenile shelter.The School Board of Hillsborough County provides educational programs.The office of Exceptional Child Education, in conjunction withVocational and Adult Education, provide instructional personnel.The school is classified as an Exceptional Child School and is theresponsibility of the Director of Exceptional Child Education andThe supervisor of Programs for the Socially Maladjusted. An Evalua-tion Center has been established at Lake Magdalene Juvenile Home andis staffed through funds obtained under the Omnibus Crime Bill. Thegoal of this program is to prevent recidivism in delinquent youththrough evaluation, planning with schools and community agencies, andsubsequent placement in appropriate school programs conducive to thechild's needs. Procedures have been established for in-school staffingof youth dismissed from Juvenile Shelter to secure proper placement.

No provision is made for screening, referral, or identificationprior to entry into the Juvenile Shelter. Youth are dismissed fromthe Juvenile Shelter by Juvenile Court.

II. An additional Evaluation Center has been established at Pierce JuniorHigh School to serve this school and its immediate feeder elementaryschools. The total program is based on Prevention of JuvenileDelinquency.

A. Screening, Referral, Identification, Placement, and DismissalProcedures:

The Pierce Evaluation Center serves children varying in agefrom five years to about fifteen years of age. Every youngsteridentified for treatment receives a psychological evaluation.The psychological test battery includes any of the followinginstruments at the discretion of the psychomet.rist or psychologistin accordance with the individual needs of the child:

Wechsler Intelligence Scale for ChildrenStanford Binet Intelligence ScaleMcCarthy's Scales of Children's AbilitiesKelly PatternsRender Visual Motor Gestalt Test

1A4

House-Tree-PersonDraw-A-ManKinetic Family DrawingsGraham-Kendall Memory for Designs

B. Identification of Children Assigned to Treatment and Control:

The following instruments are used in the identification ofelementary school children to be assigned to the treatment anAcontrol groups:

1. klmksjasialhajagLacial: This scale is completed by theclassroom teacher who is asked to assess the students in termsof aggression and withdrawal. Under each category is listed anumber of descriptions of behavior which reflect aggressionand withdrawal. The teacher circles the types of behaviorwhich apply to each student. Besides providing identificationof potential problems to designate treatment children, theresults assist the Pupil Personnel Worker in assessing eachchild's problems and treatment needs. Every elementaryschool child referred is rated using this instrument.

2. School Readiness Survey: This test is individually administeredto children between the ages of 4 and 6. All first graders intreatment and control are evaluated. Results are reported interms of three categories - ready for school, borderlinereadiness, and need; to develop. The Educational Diagnosticianand Pupil Personnel Worker administer the test.

Junior High students are selected on the basis of offensereports and randomly assigned to treatment and control.

C. Pre-Post Test Measures:

For purposes of obtaining pre- and post test measures for evaluationof objectives, the instruments utilized are the Devereau ElementarySchool Behavior Rating Scale, (all elementary children) the SchoolReadiness Survey, (first graders), the Piers-Harris Self ConceptScale, (4th graders, 5th graders, and Jr. High students), theTennessee Self Concept Scale, (Jr. High students) and the WideRange Achievement Test, (2nd graders and up). The test regulLsprovide valuable information for formulating behavioral objectives,according to the individual needs of each child.

D. Dismissal Procedures

Youth are dismissed from this program only after a thorough re-eval-uation of the youth's situation warrants dismissal. The behavior ofthe youth is then monitored as a precaution against the recurrenceof maladaptive behavior. Technically the youth is never dismisseduntil he or she enters senior high school.

LP?

gestcot

44/104

E. Childrenle Home

This component of the programs serving socially maladjustedchildren also provides consultation and evaluation services to theChildren's Home which is located in the western part of HillsboroughCounty. One teacher position is established at the Children'sHome through E.S.E.A. funds to provide a continuing program ofeducation to youth not attending the community schools. This teacheralso serves as liaison between the Children's Home and the communityschools for purposes e' appropriate school placement, parent-teacherconferences, and remedial teaching.

III. A residential program has been established at Nature's Classroom,Hillsborough County's outdoor education facility, for delinquentand delinquent prone youth.

The program at Nature's Classroom is designed to provide youthan educational setting to initiate a new self attitude value systemin order to prevent recidivism in delinquent youth. Residentialfacilities are provided for youth during the school week, and theschool calendar determines the days youth will not be in residence.Youth will be transported to Nature's Classroom on the first schoolday of the week, and returned home on the last school day of theweek. There is no maximum time that youth will be in residencein this program. Residence time will be determined by the progressbeing made by the individual child. Food, personal groomingsupplies, instructional materials, etc. will be provided for theyouth. Supervision is provided by the school system during theday and the Division of Children's services at night.

A. Screening, Referral, Identification, Placement and DismissalProcedures:

Screening Procedures: Client of the Division of Youth Services.One Supervisor of Intake has been designated to coordinate theprogram for the Division of Youth Services in order to insureopen communication at all times.

B. Identification Procedures:

1. This student has serious difficulty in reading.

2. This student has serious difficulty in mathematics.

3. Lacks interest in school work or appears to dislike school.

4. Has difficulty relating to his peer group.

5. There is history of absenteeism or truancy.

4411447P4P440400tir

6. Evidence can be presented that all appropriate schoolprograms have been explored to provide the child an opportunityto adjust, but his needs have not been met.

7. Youth has apparent educational abilities not being utilizedin the regular school curriculum.

8. Youth with a disruptive home environment who would profitfrom a stable environment.

9. Youth who has no apparent outside interests or shows abilityto spend leisure time effectively.

A psychological evaluation of intelligence and personalityappraisal, and an academic evaluation of the youth will beaccomplished by Pupil Personnel Service, Pierce or DorothyThomas Evaluation Centers, or by a recognized community agency.

C. Referral Procedure:

Code: SSW-School Social WorkerDYS-Division of Youth Services CounselorMCC-Nature'. Classroom Case Counselor

Responsibility

SSW, DYS, Dean, Counselor

SSWSSWSSW

SSW, DYS, Principal, Dean, Counselor

SSW, PrincipalSSWSSW,DYS

SSW, DYS

SSW, Psychologist, DYS Principal,Counselor, DeanSSW,NCCC, DYS

SSW/NCCC

'11

Procedure

1.. Initial contact to JanetBabich, NCCC, Tel: 223-5332,ext: 415 or 353

2. Screening:a. Discuss with DYSb. Review Pupil Personnel

recordsc. /n-school joint screen-

ing

d. Complete formal referral3. Intake Study

a. Arrange Psychologicalevaluation

b. Family Involvementc. Authorization for

release of informationd. In-school staffing

4. Home Visit:a. Medical historyb. Request for medical exam

5. Case Staffing preparation

SSW, NCCC6. Case Staffing7. Placement Planning:

a. School entrance dateand transportation

b. Parents1) Clothing list2) Medical Permit3) Placement Permit4) Photo Permit

Forms to be completed prior_ to placement

1. Referral form for Pupil Personnel Services2. Psychological Evaluation3. Medical history4. Release form for Confidential Information5. Parental Consent6. Medical Permit for emergency treatment7. Medical examination - form to be provided by physician or

clinicS. Photo permit9. Transportation pass

D. Placement Procedures:

Placement will be determined by a Placement Committee involvingthe Office of Exceptional Child Education, Pupil Personnel Services,Division of Youth Services and other related community agencies.

The placement will be requested by the Division of Youth ServicesCounselor, School Social Worker, and School Dean through the Supervisorof Programs for The Socially Maladjusted paprr to a formal recommenda-tion being made to the presiding Juvenile Court Judge.

Youth are not to be committed to lbs; program. Participation isvoluntary on the part of the child and oarente, and written parentalor guardian approval must be obtained by the Division of YouthServices Counselor or School Social Worker prior to the youth enteringthe program.

Severly retarded, severely emotionally disturbed or multiplephysically handicapped youth can not be considered for the programdue to the nature of the program itself. Mental ability will beconsidered with other factors in determining eligibility for programparticipation.

The chronological age limits will range between nine (9) tofourteen (14) years of age. The fifteenth (15th) year will not bereached prior to six (6) months upon entry into the program.

A racial balance of maximum 50:50 will be maintained as presentlyprescribed by county policy for Exceptional Child Education classeswith movement toward a population more truly reflective of the totalschool population. This procedure will insure the participants anopportunity to resolve problems within a racially balanced environment.

9>

A release for medical and dental services will be obtained oneach youths in case of emergency, by the Division of Youth ServicesCounselor or School Social Worker.

The youth will remain on the parent school's roll for attendancepurposes. The Project Case Counselor will be responsible forcontacting Schools on a weekly basis for purposes of accounting forattendance.

In case of illness or accident, while participating in theProgram, the youth will be transported to the nearest hospital andevery attempt will be made to locate the parent or guardianimmediately.

The School Social Wnrker will retain thu yoisth as a cliant inan open case status for the duration of time the youth is in theprogram, or leaves the program and transfers to another school areain the county.

In those instances where youth are expelled from the program,or leaves the program before adequate planning for return to schoolcan be accomplished, they will return to the parent school whichinitiated the referral.

E. r4amissal Procedures:

Youth-will be released to parent school and neighborhood onlyafter the Division of Youth Services Counselor, in conjunction withschool personnel, agree on the time of release. A recommendationwill be made to the Judge that the youth has achieved the goals ofthe Program, or cannot adjust to the Program, and the release willbe accomplished.

In those instances where youth run away from the Program, aredeemed detrimental to the best interests of the Program because ofdisruptive behavior, who consistently display an attitude of non-conformity to those rules applicable to the best interest of him-self and the group, and/or who do not demonstrate a desire to helpthe Program themselves, will be removed from the Program and relocatedat the discretion of the presiding Juvenile Court Judge and Divisionof Youth Services' Counselor. The youth who runs away from Nature'sClassroom will be returned to Nature's Classroom depending on thosecircumstances prevailing prior to the action of running.

Once a determination has been made that a youth is ready to returnto his parent school and neighborhood, the following items will beaccomplished prior to release: A written evaluation of the youth'sprogress and recommendations for a continuation thereof will beaccomplished by the Case Counselor in conjunction with the classroomTeachers and Division of Youth Services Counselor. (one copy willbe transferred to the parent school, one copy will be sent to DorothyThomas Evaluation Center and one copy will be sent to the CentralFile it' Pupil Personnel Services.) The Case Counselor, inconjunction with the Division of Youth Services Counselor, willconduct a joint staffing with the Principal of the parent schooland the School Social Worker mks to the return of the youth.The staffing will be inUiated by the Case Counselor.

5/

IV. A program for the treatment of Drug and Alcohol Abuse of school ageyouth has been estlithrough an agreement between the SchoolBoard of Hillsborough County and Family Service Association.Effective July 2, 1973, staff tom the Project for Pre-Delinquentand Delinquent Identification and Planning, in conjunction with FamilyService Association, serve as a referral agent to community baseddrug abuse treatment programs. This program is an addition to theexisting drug education program.

A. Screening, Referral, Identification, Placement and DismissalProcedures:

Screening of youth in need of services will be accomplished inthe schools, Lake Magdalene Juvenile Home, community agencies, andthrough the criminal justice system. Referrals will be received byProject Personnel and services for treatment of drug and alcoholabusing offenders of school age will be provided for the youth andhis/her family members. The program involves individual, group,and/or conjoint family sessions with a family oriented focus.Medical and/or psychiatric consultation is provided by FamilyServices Association.

Referrals should be made to:

Mr. Harold Ed Davis, Drug Counselor,Hillsborough County Public SchoolsFamily Service Association of Greater Tampa, Inc.Riverside Professional Building Suite 23205 W. Brorein StreetTampa, Florida 33606Telephone: 253-0531, 253-0895

Project personnel will provide appropriate folloviup withthe client to insure the effectiveness of the treatment process.

'Pr osnon 3oorGIFTED


The following factors determine a student's eligibility to participatein the Gifted Program.

A. Preponderance of 9's on OLMAT, CTMM, or individual test score(Stanford Binet, WISC etc.) in the 98 percentile.

B. Preponderance of 8's on group ability test (OLMAT, CDNO and 8'sand 9's on MAT or three of the following:

1. Superior scores representing the gifted range for the schoolstudent attends, although not 8's or 9's.

2. Guided teacher selection using check lists or a gifted teachercounseling.

3. Recommendation by principal, social worker, psychologist.4. Verification of ability by U.S.F. gifted program.5. Talent:highly exceptional ability in one area (art, science,

math, etc.)

It's to be noted that the last 5 items are not sufficient forrecommendation unless child meets three of them.


A. Screening--Group testing stanines of .8 or 9, teacher observation,ability test scores when available.

B. :ieferralSchools or parents to the Exceptional Child EducationOffice (Gifted Program Supervisor or Resource Teachers).

C. Identification -- Referral may be made to Psychological Services forindividual evaluation--WRAT, WISC, Binet, etc., administered bypsychologist or psychometrist.

D. Placement -- Children remain in regular program--referrals are accepterfor attendance at Learning Center or for Resource Teacher to workwith. Gifted Program personnel work with local school personnel todetermine children to be served.

E. Dismissal -- Parents may withdraw at their discretion. GiftedProgram personnel may dismiss child after staffing with localschool personnel.

III. Using the Nomination Form

As far as possible list all students in your school above grade 3 whomeet the criteria for eligibility. Information may be obtained direct-ly from test print-outs or from students' records.

Teachers should be encouraged to submit nominations of students who.fit the characteristics of the gifted child but may not be good testperformers. It should be understood that not all nominations areselected for the final lists.

Students with good test scores or with several nominations who are notselected to attend the Learning Center may be nominated for in-schoolgifted classes with itinerant teachers from the Gifted program if theschool desires.

(School)

(Prepared by)

HILLSBOROUGH COUNTY PUBLICSCHOOLS

DEPARTMENT OF EXCEPTIONALCHILD EDUCATION

1972-73

Nominations for theLearning Center Program

(Subject to Approval)

L. C. ResourceTeacher

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HEARING IHPA/RED/DEAF

hetir004044.4


A student is considered for special placement in a class for rho hAarimimpaired when he has a loss of hearing in the better ear of 40 db ormore (ISO) and functions as a hearing impaired student in need of specie:educational planning. According to their functioning level, studentswill either receive all academic work within the classroom or fuse outfor selected academic classes in the regular classroom according totheir ability. A complete medical diagnosis including etiology,audiometric, and speech receptive threshold testing, visual acuity,psychological evaluation, speech, speech reading, and language assess-ment is made on each child before placement in the program is con-sidered. Parental permission must be granted in all cases. Hearingimpaired students capable of benefitting from an oral academic programwill be recommended for placement in an oral day class at one of theappropriate levels at Seminole, Sligh, Van Buren, or Chamberlain.

Hearing impaired children five and below will be referred to the TampaOral Pre-School for the Deaf. Children referred to this office who arebelow the compulsory attendance age and have not had pre-school train-ing will be referred t-o the pre-school program at Tampa Oral.

II . Procedural Provisions

A. Screening--Hearing Screening is provided by the Hillsborough CountyPublic Health Nurses in the elementary schools each year. A 20 dbsweep test at 500, 1000, and 2000 cps, is given individually toeach new child in the school, all children suspected of having ahearing loss, and all children known to have a hearing loss.

B. Referrals--Speech therapists accept referrals throughout the yearfrom teachers, parents, principals, community agencies, and otherschool related personnel on children whose behavior indicate thepossibility of a hearing loss. A Pure Tone Threshold Test is givenby the therapist in the school.

C. Identification--Students failing the screening test as administeredby the health nurse are reported to the parent by the nurse. Theparents are urged to take the student to a physician and to contactthe University of South Florida for further Audiometric Testingor other speech and hearing clinics in the community.

Students referred to the school speech therapist not performingwithin normal limits on the Pure Tone Threshold Test are alsoreferred to the University of South Florida, with the consent ofthe parent, for further tasting.

D. Placement--Children whose hearing loss is either found to besevere or profound and whose language require intensive habilita-tion are referred to the school social worker for an intake study.The social worker initiates the intake study which includes thefollowing information to be presented at a staffing: Psychological,Audiometric Evaluation, Speech and Language Assessment, andAcademic Progress.

Placement is wade by the Director of Exceptional Child Educationupon the recommendation of the ECE Staffing Committee and/or CaseConference Committee.

Children who have been identified as having moderate, moderatelysevere, or severe hearing losses and require special languageinstruction are placed in a special education class for the hearingimpaired. If a child can profit from instruction with hearingchildren, he may be fused out at the discretion of the teacher,principal and receiving teacher in selected academic areas.Referral of such children is made to the school social worker whocollects information for staffing and placement.

E. Dismissal--Students are evaluated annually. Dismissal from theprogram would be contingent upon the following:

1. Admission to the state school or private school2. Admission to the basic program full time3. Has reached his potential in the program and is eligible for

Vocational Rehabilitative Services4. Graduation5. Withdrawal by parental decision6. Poor progress due to other factors unrelated to the hearing

loss.

?rotrarn 3010

VISUALLY HANDICAPPED


Blind - -Any child who is totally blind or legally blind to the extentthat he must work with braille receives the services of an itinerantteacher for the blind. Initial placement in the program at Exceptional.Child Education Wings of Foster, Sligh or Chamberlain requires intakestudy, individual psychological examination by school psychologist andrecommendation by Exceptional Child Staffing and/or Case ConferenceCommittee. The program services children from 5-21 years of age.

Partially Sighted-- Doctor's statement as to visual acuity. Individualneeds considered 20/70 in better eye with correction. Parent's per-mission to work with child.


Blind

A. ScreeningPre -schoolers are identified by The Bureau of BlindServices and The National Society for The Prevention of Blindness.

B. Referral--Bureau of Blind Services, County Health Nurse, GuidanceCounselor, and parents, to Coordinator of Admissions.

C. Identification--Coordinator of Admissions gathers medical anddevelopmental reports. School Psychologist evaluates or validatesreports received.

D. Placement- -Made by Director of Exceptional Child Education afterStaffing and/or Case Conference Committee meeting. Placement ismade at preschool or elementary level in Foster Wing and if aprotective setting is needed at Secondary level, ECE Wings atSligh Junior High or Chamberlain Senior High School. Wheneverpossible children are returned to community school as soon aspossible. Service by itinerant personnel is provided in all place-ments.

Partially Sighted

A. Screening--Pre-Schoolers screened by a trained group--The NationalSociety for the Prevention of Blindness. They are checked and re-checked during their pre-school years.

Preliminary screening of elementary students by school nurse ora trained PTA Committee. Screening is usually done each fall.Snellen Test is most commonly used; also used, Telebinocular,Titmius Vision Tent ada.theVisual Effkeioncy.Sctie developedby Dr. Natalie C. Barrage.

Sp

84S1CO

44/4194

B. Referral--Doctor, school nurse, social worker, guidance counselor,parent, teacher, community agency, etc. to Exceptional ChildEducation Office. Case assigned to one of itinerant teachers.

C. Identification--Reports ftam an opthalmalogist or optometrist arerequired before educational planning is undertaken. Each uses hisown equipment, techniques, and battery of tests.

D. Placement--Children, unless other involvement enters into function-ing, are left in community schools and are furnished special equip-ment and material depending upon their needs. An itinerant teacherfurnishes large print materials, textbooks, magnifiers, taperecorders, talking books, etc.

E. Dismissal--If a child's eyesight has improved and he no longerfalls within the category of partially sighted or he can functionwithout the special aids, he may be dismissed by the itinerantteacher. This information is obtained from the doctor and nurse.Parents may withdraw upon their discretion.

HILLSBOROUGH COUNTY PUBLIC SCHOOLS

EXCEPTIONAL CHILD EDUCATION411 East Henderson Avenue


tp--------zDa-Tt-e7--o-----0411111P

We, the parents or guardians of

(desire, do not desire) the services sually Handicapped

Program for our child.

(Date)

Child's Signature

Date

Classroom Teacher

Resource Teacher

Sincerely,

g/.-)/JJack

46-'

ack R. Lamb, Ed. D.

IMININMERMOMOINIIN*

Howard Hutchins, CoordinatorVisually Handicapped Program

dmn Cot

VISION CONSULTANT'S REPORT

CONSULTANT DATE OF REPORT

NAME OF PUPIL 8IRTHDATE

PARENT'S NAME TELEPHONE

AD4RFSS(Street) (City) (State) (Zip)

SCHOOL LAST ATTENDED GRADE

ADDRESS OF SCHOOL

VISUI.L ACUITY PHYSICIAN

1.

2.

4.

5.

6.

7.

8..

9.

10.

APPEARANCE

ZOBILITY

INTERESTS

SOCIAL STATUSef 1

ACADEMIC STATUS

SPECIFIC NEEDS

GENERAL HEALTH

CONFERENCES (PARENTS, TEACHERS, OTHERS),

11,10011111WPIENIMONI~

EQUIPMENT USED OR RECOMMENDED

RECOMMENDATIONS

WINDSIONNIIIMM.

IIMMNBIBOMMINVOMOMNENNanNsMNIMMNOMPPININIMORIMMellaiPta

12/20/1362.

?rosram SagPHYSICALLY HANDICAPPED


One-half normal I.Q. and up. Ages served - 5 - 12 years, FosterElementary; 12 - 16 Sligh Junior High; 16 - 21 Chamberlain High.Children with less than one-half normal I.Q. are served in TMHprogram if feasible. Individual psychological examination byschool psychologist and Intake Study is done by school socialworker--medical records are gathered and need for therapy deter-mined. Individual differences and needs are evaluated atExceptional Child Education Staffing and/or Case Conference Meeting.Children are re-evaluated every three years when possible.Exceptional Child Education attendants are provided for childrenon the elementary and on secondary level.


A. Screening--Outside agency or school - 4-21 years of.age.

B. Referral--Outside agency, parents or school makes referral--enrolled children handled by school social worker, non-enrolledby Coordinator of Admissions Social Worker.

Co Identification--Social worker or Coordinator of Admissionsgathers medical and developmental reports, psychologist evaluateschild and/or 'alidates reports.

D. Placement--Made by Director of Exceptional Child Education afterExceptional Child Education Staffing and/or Case ConferenceCommittee Meeting.

E. Dismissal--Children are periodically re-evaluated and wheneverpossible children are returned to community school. Dismissalis handled by Director of Exceptional Child Education. Parentsmay withdraw at their discretion.

?mar*" sofa

HOMEBOUND AND HOSPITALIZED


Referral by home, school, or community agency. Any child fourththrough twelfth grades that will be out of school at least 20 schooldays. Require doctor's signature on form. Exceptions may be madewhere circumstances warrants it.

I/. Procedural Provisions

A. Screening "Proper medical form must be signed and returned bydoctor. Children are served on elementary and secondary levels.

B. ReferralSchool, parent, doctor, or hospital to ExceptionalChild Education Office.

C. IdentificationDoctor's completion of Exceptional ChildEducation form and his signature.

D. Placement--Upon completion of referral and medical form,Director of Exceptional Child Educatior gives forms to Chairmanof Homebound Program who then assigns one of the homeboundteachers.

E. Dismissal - -(l) Child returns to school. (2) Doctor refuses torenew medical when it has expired. (3) Director of ExceptionalChild Education recommends termination after discussion withhomebound teacher, former school personnel, and/or medicalpersonnel.

HOMEBOUND REFERRAL

DATE

SCHOOL GRADE

REFERRED BY BIRTHRATE

CHILD'S NAME

PARENT'S NAME

HOME ADDRESS

TIME EXPECTED TO BE OUT OF SCHOO

PHONE

DISABILITY

DOCTOR'S NAMEawn UOIMMIIIIIM14~.011~

lireeeleb POIMINIP6101.11111Mila.

DOCTOR' ADDRESS PHO

SUBJECTS BEING TAKEN

1

2

3

MININIIPONINIMMINIPIMmy

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WIIIMWINMINIMIPIMMOMMIIIMMIONINN/WRANNASIO~Is/0/~~ONINNI~NOMMINISONNOWDZOMMINIMINMONfe*e~/.6011111.11

11MY1M04110111.60....MIIMNINIIINIIMMII

11111MOIMPNVIIIMINIIINVIMMI.40111

Does child have books at hone?

Comments:

TEACHER ASSIGNED

DATE OF WITHDRAWAL

4

5

5

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GS

DATE OF ENTRY

THE BOARD OF PUBLIC INSTRUCTIONHILLSBOROUGH COUNTY


TO: Physician, Hospital or Clinic

Home instruction is being considered for the child whose name appears below.Medical advice is necessary in determining whether or not the child is physicallyable to attend school without undue hazard. Your advice and recommendation in thisregard will be appreciated.

CHILD'S NAME

PARENT'S NAME DRESS

NATURE OF DISABLEMENT

EXTENT OF DISABLEMENT

CAUS2.

WILL DISABILITY GET WORSE? REMAIN AS IT IS?

IMPROVE. IS PROPER TREATMENT BEING PR

RACE SEX.....AGE GRADE

Does your examination of this child satisfy you that he/she nable toattend regular school?

DO YOU RECOMMEND HOMEBOUND INSTRUCTION FOR THIS CHILD?

WHAT LIMITATIONS SHOULD BE OBSERVED AS TO PHYSICAL ACTIVITY?

PLEASE INDICATE PROBABLE LENGTH OF TIME CHILD WILL BE HOMEBOUND:

Weeks Months 1 Year

aullimmomft_

M.D.(Examining P. iician)

(Address)

(Date)

This report should be returned to the Homebound Department:Exceptional Child Education, 411 East Henderson Avenue, Tampa, Florida 33602

"p

MEIVRAND1IM

TO: Parents of Students Obtaining Homebound Services

FROM: Jack R. Lamb, Director, Exceptional Child Education

Your child has been entered on the Homebound Program. The followingare desirable conditions to be met by the parent and student duringhis or 'her stay on the program:

mrh

1. A suitable physical location conducive to study and learningis to be provided in the home.

2. The parent is to supervise a regularly scheduled period ofdaily study time for the preparation of assignments betweenthe periodic visits of the homebound instructor. Any childfailing to meet this requirement and, therefore, makingunsatisfactory progress will stand-liable for dismissal fromthe program.

3. The parent is requested to see that no unwarranted intrusionor presence of a third person shall occur to disrupt thepupil-teacher activity.

4. Readiness and promptness will be.observed on the part of thechild so that instruction may begin and proceed according toa regularly scheduled period.

5. The presence of another adult in the home is required duringHomebound instruction.

6. Parents must assume responsibility for care and return of booksissued by the Homebound Department.

7. Students on Homebound are expected to eliminate outside activi-ties.

S. A doctor's statement must be 1n the Homebound Office from yourphysician stating that your child is eligible for HomeboundService before instruction can begin. A statement must alsobe obtained from your physician stating that your child isable to return to school.

'7

MEMORANDUM

TO: PRINCIPALS, COUNSELORS AND DEANS

FROM: Jack R. Lamb, Director, Exceptional Child Education

SITIVIRCT: Homebound Instruction

I. Homebound Instruction Policies

1. ebildeen wt.-0 01,04rit ramAirine AtrOnta an absence from schoolfor at least four weeks may be eligibles fine- hinnebund inetrucrien.

2.. Except in rare instances this program is not'offered below fourthgrade level.

3. The student must be doing satisfactory school work.

4. A medical report is required from the attending physician beforea student can be accepted on the program. A doctor's recommenda-tion is only one criterion for acceptance. (Medical forms areavailable from the Exceptional Child Education Office.)

II. The Principal is responsible for:

1. Informing parents of the Homebound Program.

2. Assuring the cooperation of the classroom teacher in issuingassignments when requested by the homebound teacher.

3. Directing the classroom teacher to furnish partial grades forthe child who enrolls in the Homebound Program.

4. Keeping the child on roll until transferred to the HomeboundProgram.

JRL:mh

?mean 3*(3

MULTIPLE HANDICAPPED - DEAF/BLIND


A student who has been screened and identified by a professionalteam as Multiple Handicapped - Deaf/Blind is provided a programto meet his unique needs. Self-help and personal management skillsare emphasized in the program.


A. Screening -- Pre-schoolers are identified by a professional team.

B. Referral--State Coordinator of Deaf/Blind Program, Bureau ofBlind Services, County Health Nurse, parents to Coordinator ofAdmissions, and other community agencies.

C. IdentificationCoordinator of Admissions gathers medical anddevelopmental reports.

D. PlacementPlacement is made by the Director of ExceptionalChild Education after review of the intake study by the Co-ordinator of Admissions, results of the professional team andrecommendations of the ECE Staffing Committee and/or CaseConference.

E. Dismissal - -Each case for dismissal will be studied on an individua.basis following established procedures or upon the request ofthe parent (s).

III. Supportive Services

The Multiple Handicapped-Deaf/Blind program receives supportiveservices from the State Coordinator of the federal Deaf/Blind Pro-gram, the Bureau of Blind Services, the Childrens Medical Services,the Trainable Mentally Handicapped and Visually Handicapped Programsof Exceptional Child Education, and Pupil Personnel Services, andthe Florida Instructional Materials Center-for the VIsuaoly Handicappe

Welptft 3D V4

HEARING IMPAIRED/MULTI-METHOD


Hearing impaired children between the ages of 6 - 12, who have beenevaluated as needing a more visual means of comminication will berecommended for the Multi- Method Program at Tampa Bay Blvd.


A. Screening--Hearing Screening is provided by the HillsboroughCounty Public Health Nurses in the elementary schools each year.A 20 db sweep test at 500, 1000, and 2000 cps, is given individu-ally to each new child in the school, all children suspectedof having a hearing loss, and all children known to have a hearins loss.

B. Referrals--Speech therapists accept referrals throughout theyear from teachers, parents, principals, community agencies,and other school related personnel on children whose behaviorindicate the possibility of a hearing loss. A Pure ToneThreshold Test is given by the therapist in the school.

C. Identification--Students failing the screening test as administer-ed by the health nurse or speech therapist are reported to theparent by the nurse. The parents are urged to take the studentto a physician and to contact the University of South Floridafor further Audiometric Testing or other speech and hearingclinics in the community.

Placement--Children whose hearing loss is either found to besevere or profound and whose languagA require intensive habilita-tion are referred to the school social worker for an intakestudy. The social worker initiates the intake study whichincludes tite following information to be presented at a staffing:Psychological Audiometric Evaluation, Speech and LanguageAssessment, and Academic Progress.

Placement is made by the Director of Exceptional Child Educationupon the recommendation of the ECE Staffing Committee and/orCase Conference Committee.

Children between the ages of 6 - 12 with severe to profoundhearing losses are placed in the multi-method program if theyhave not been able to function successfully in an oral program,not accepted by the state school for the deaf, or come from aprogram that was basically manual.

70

E. Dismissal Students are evaluated annually. Dismissal fromthe program would be contingent upon the following:

1. Admission to the state school or private school.2. Admission to the basic program full time.3. Withdrawal by parental decision.4. Poor progress due to other factors unrelated to the

hearing loss.

ROLE OF COORDINATOR OF ADMISSIONS/SPECIAL SERVICES

on-Enrolled - Child enE....,.......E...w121ave never been in a school ro ram

The Coordinator of Admissions does intake and makes referrals as neededto Psychological Services. Appointments for psychological evaluationand/or consultation are assigned through the Admissions Office.

Referrals from Tampa Oral Pre-School for the Deaf

The Director of the Tampa Oral School will complete the referral onchildren who are candidates for the Programs for the Hearing Impaired.These referrals are returned to the Supervisor of Communication Dis-orders for screening and approval. They are then submitted to theCoordinator of Admissions for an intake study. The Coordinator willoriginate requests for psychological testing as needed and will forwardthem to the Supervisor of Psychological Services. The report fromPsychological Services is to be sent to the Exceptional Child EducationDepartment.

Referrals from Pre-School Programs for the Mentally Handicapped

The Directors of the Pre-School Centers will refer those childrenthey feel are ready to move into the school program and all children ofcompulsory age. Referrals are forwarded to the Coordinator of Admis-sions for an intake study, which is then screened by the Supervisor ofPrograms for the Mentally Handicapped. The Coordinator willoriginate requests for psychological testing as needed and will forwardthem to the Supervisor of Psychological Services. The report fromPsychological Services is to be sent to the Exceptional ChildEducation Department.

mg.tecsirera...aclusasjeaidzBILClit4ornistarSchool

Appropriate personnel from each of these sources make referrals directto the Coordinator of Admissions of those children they feel are readyfor a public school program.

Exemptions

If a child's mental or physical condition prevents his attendance ina public school program, a Certificate of Exemption (represented by aletter of exemption addressed to the parents) is issued to him.Letters of Exemption are recommended by the Case Conference Committeeand co-signed by the County Health Officer.

Pro5rarti 3014

HARD OF HEARING


Students with hearing losses of 30 db or greater in the better earwho can profit from instruction with hearing children in allacademic areas, but who need supportive service, are seen 1 or 2hours per week by a hearing therapist for weekly individual instru-ction.

Hearing impaired children functioning at the trainable level willbe recommended to the trainable program and will receive theservices of a hearing therapist.


A. Screening--Hearing Screening is provided by the HillsboroughCounty Public Health Nurses in the elementary schoOls eachyear. A 20 db sweep test at 500, 1000, and 2000 cps is givenindividually to each new child in the school, all childrensuspected of having a hearing loss, and all children known tohave a hearing loss.

A hearing conservation program is being initiated for the1973-74 year. A mobile screening-van, operated by a hearingtherapist with the services of the school audiologist, willvisit approximately 10 schools. All children in grades R,1, 3; those who are new to the school and those who have knownhearing losses will be screened at 25 db ISO for the freq. of500 lk-2k-4k HZ. Children who fail the first screening willreceive a second screening. Criteria for both screenings arefailure to respond to two freq. in the same ear or one freq.in both ears. Those children who fail the second screeningwill be referred to the school and/or the public health nursefor follow-up and educational planning.

B. Referrals-Speech therapists accept referrals throughout theyear from teachers, parents, principals, community agencies,and other school related personnel on children whose behaviorindicate the possibility of a hearing loss.

C. Identification-Students failing the screening test as administ-ered'by the health nurse are reported to the parent by thenurse. The parents are urged to take the student to a physiciatand to contact the University of South Florida for furtherAudiometric Testing or other speech and hearing clinics inthe community.

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Students referred to the school speech therapist not perform-ing within normal limits on the Pure Tone Threshold Test arealso referred to the University of South Florida, with theconsent of the parent, for further testing.

D. Placement Children who arc identified as having, moderate tomoderately severe hearing losses and good communicative skillsare assigned to their neighborhood school. Weekly individualsupportive instruction is provided by a hearing therapist.(lipreading, auditory training, tutoring, and hearing aidorientation)

Children whose hearing loss is either found to be severe orprofound and whose language requires intensive habilitationfollow the procedure as found in Program 3009.

E. Dismissal--Students are evaluated annually. Dismissal from theprogram would be contingent upon the following:

1. Admission to the state school or private school2. Admission to the basic program full time3. Has reached his potential in the program and is eligible

for Vocational Rehabilitation Services.4.- Graduation5. Withdrawal by parental decision6. Poor progress due to other factors unrelated to the

hearing loss7. Is performing satisfactorily in all areas and does not

need supportive help

IF

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