REF- 2624.

7 Ju 2, 2012

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Special Education

ATTACHMENT A

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ISIC School: _____________________________ Civitas SOL 8500 Local District: ______ Location Code: _________
The due date for submission of the completed checklist is September 15, 2012. Access to Adobe Reader 9 is required to complete and submit this checklist electronically. Free downloads are available from adobe.com. Go to the Division of Special Education website at: http://sped.lausd.net/. Follow the link to the School Self Review Checklist. Download and save the file. Exit the web browser and then use the saved file to com plete the checklist. DO NOT complete the checklist while you are in the web browser. To complete the checklist, indicate the status of each item by marking In Place, Not in Place, or Partially in Place. After completing the checklist: 1. Click the Submit button located in the purple bar at the top of the form to send the checklist through email to the Division of Special Education Compliance Support and Monitoring Department. 2. Save and print the completed checklist. 3. Send the completed checklist for review and signature to the appropriate administrator listed below. Subsequent to review and signature, the signed checklist will be returned to the site administrator. Correct items marked Not in Place or Partially in Place. As items are corrected, document the date in the Date Completed column. It is not necessary to resubmit the checklist when all corrections have been made and completion dates have been entered. Principal:
Signature

Date:

District operated schools send signed checklist to Local Educational Service Center (LESC) Superintendent Innovation and Charter operated schools send signed checklist to Innovation and Charter Schools Division Executive Director Reviewed by: _________________________________________ Date: ___________________
Signature of LESC Superintendent or Executive Director All schools shall maintain a copy of the checklist u ntil next years checklist is co mpleted and signed by the appropriate LESC Superintendent or Executive Director. The Superintendent or designee for the Intensive

Support and Innovation Center and Education Service Centers, and the Director or designee for the Charter School Division shall periodically conduct site level visits during the school year to determine the status of concerns identified by the Self Review Checklist.
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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

SECTION 1: SCHOOL TEAM AND DESIGNEES

The school has a Modified Consent Decree Review Team which includes a minimum of the following members: Principal Assistant Principal with special education responsibilities Two general education teachers with knowledge of collaborative practices/strategies for diverse learners One or two special education teachers with knowledge of elementary/secondary instruction/curriculum/collaborative practices Member of school staff with expertise in data analysis and use of school data systems, including Welligent. (May be one of the team members listed above) The school has a trained Behavior Intervention Case Manager (BICM) and notifies staff of the BICM's responsibilities. (Elementary schools, a minimum of one person; middle/senior high schools, a minimum of two people; multi-track schools, sufficient staff to ensure that coverage is available throughout the school year) The school has identified a designee to attend IEP meetings at nonpublic schools and coordinate public school services for all dually enrolled students in accordance with their IEPs. The school has notified staff of the designee assigned to assist individuals who seek to file a complaint through the District's "Uniform Complaint Procedures" process or, for fiscally independent charter schools, through a similar complaint process. The school has identified a Section 504 designee and notified staff and parents of the designee's responsibilities. The school's Modified Consent Decree Review Team: Reviews the Modified Consent Decree reports Establishes school-wide practices to achieve and maintain the outcomes of the MCD Communicates the school's status toward meeting the outcomes of the MCD to school staff Maintains documentation as evidence of completion of the MCD requirements. The school implements District procedures for safeguarding the confidentiality of IEPs and IEP related documents. The school documents expenditures of Program 2817 funds allocated to support special education compliance. (Not applicable for fiscally independent charter schools)
Memorandum: Special Allocation for Support of Special Education Compliance

   

4 5

SECTION 2: ESTABLISHED SCHOOL PROCEDURES

 

REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-201

ATTACHMENT A

Item #

Review Item The school maintains a roster of staff eligible to interpret at IEP meetings and submits a current copy to the Division of Special Education by 12/2 of each school year. (Not applicable for fiscally independent charters)
REF-1596. Oral Interpretation at an Individualized Education Program (IEP)

In Place

Not in Place

Partially Not Date in Place Applicable Completed

10 11 12

The school maintains a list of resident students attending nonpublic schools. For parentally placed private school students, the public school follows procedures for developing a "Services Plan" for eligible students. The school follows the procedures for requests for initial assessment for students on an inter-district permit.
REF-5195.0 Special Education Assessment for Students Attending LAUSD on General Education Inter-district Permits

 


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The school has established a Learning Center that adheres to the requirements listed on the "Learning Center/Alternatives to Suspension Observation Checklist." (May not be applicable for fiscally independent charter schools)

        

http://sped.lausd.net, click eLibrary Forms

14 15 16 17 18 19

The school provides school level staff development which includes special education issues and maintains corresponding agendas, sign-ins and evaluation forms. The school facilitates parent involvement to improve services and results for students with disabilities. The school provides parents special education related forms in the parents' primary language when requested. The school uses a Student Success Team, or similar review process, to implement and evaluate prereferral interventions to reduce the number of students inappropriately referred for special education assessment. The school schedules IEP meetings far enough in advance to coordinate and facilitate IEP team member preparation and participation. The school uses the "Notification to Parent/Guardian to Participate in Individualized Education Program Meeting" to document attempts to get parents to attend IEP meetings. The school submits the "Request for a Surrogate Parent" form to the Special Education Support Unit as soon as the need for a surrogate is known. The school uses strategies, such as individual or conference telephone calls, when parents cannot attend the IEP meeting.

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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item All staff responsible for implementing the student's program, including substitute teachers, have access to, or a copy of, the IEP and a clear understanding of the supports and services required for the student. The school provides all instructional and behavioral accommodations, modifications, supports, and services (including frequency and duration) that are documented in the student's IEP. The school uses the Welligent "30 Day Service Report" (SER311L) report to monitor provision of special education Services. . The school has procedures for updating in Welligent the "IEP Report of Progress and Achievement from Current IEP" and distributing it to parents at the same time progress reports or report cards are issued. For staff who have left the school, changed positions, and/or acquired different roles as Welligent users, the school updates Welligent account information. The school has posted a copy of the "Culture of Discipline: Guiding Principles for the School Community" and "Culture of Discipline: Student Expectations" for public view.
BUL-3638.0 "Discipline Foundation Policy: School-Wide Positive Behavior Support"

In Place

Not in Place

Partially Not Date in Place Applicable Completed

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The school has established practices consistent with the "Discipline Foundation Policy: School-Wide Positive Behavior Support" to reduce the number of suspensions for students with disabilities. For a student who has been suspended the first time, the school convenes a Disciplinary Review Team meeting and documents the interventions to be used to address the student's behavior, or convenes an IEP meeting to review, modify, or develop a Behavior Support Plan. For a student who has been suspended a second time, the school convenes an IEP meeting to: (1) review the student's instructional program, (2) review, modify, or develop a Behavior Support Plan or Behavior Intervention Plan, and (3) if appropriate, recommend a behavioral assessment. When a behavior emergency intervention is used for a student with a disability, the school: (1) completes "Behavior Emergency Report for Individuals with Disabilities", notifies parents within 24 hours of incident, files report in student's cumulative record and, submits copies to Support Unit Administrator and Division of Special Education Behavior Support Office, (2) develops an IEP that addresses behavioral emergency and documents review, revision or development of Behavior Support Plan (BSP), Behavior Intervention Plan (BIP), and, if appropriate, recommendation for Functional Analysis Assessment (FAA).

BUL-5376.0 Behavior Intervention Regulations for Students with Disabilities with Serious Behavior Problems

REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item The school implements the following District recommended practices in classrooms where special education students receive instruction in the core curriculum: 1. Implementation of classroom management procedures 2. Availability of core curriculum materials 3. Instruction guided by content standards 4. Evidence of instructional planning 5. Academic rigor 6. Provision of IEP supports 7. Ongoing assessment of student progress. The school implements the following District recommended practices in classrooms where special education students receive instruction in the alternate curriculum: 1. Daily schedule/routines posted 2. Implementation of classroom management procedures 3. Availability of "Curriculum Guide for Students with Moderate to Severe Disabilities" 4. Availability of age-appropriate instructional materials 5. Provision of IEP supports 6. Active student participation 7. Ongoing assessment of student progress. The school implements the following District recommended practices in classrooms where special education students receive instruction in the preschool curriculum: 1. Daily schedule posted in words and pictures 2. Children work in large group, small group, and individual activities with various materials 3. Children work in teacher directed activities and teacher supported child chosen activities 4. Provision of instructional adaptations 5. Teacher-student communication that extends learning and builds logical thinking skills 6. Teacher guiding student behavior in positive ways 7. Portfolios of student work to evaluate progress. The school provides training and supervision of the staff's use of differentiated instructional strategies for students with disabilities. The Section 504 team follows District procedures to conduct evaluations and develop Section 504 Plans for students who meet Section 504 criteria. (Similar procedures applicable to fiscally independent charter schools) All staff responsible for implementing the student's Section 504 Plan, including substitute teachers, have access to or a copy of the plan and a clear understanding of the accommodations required for the student. The school provides all accommodations that are documented in the student's Section 504 Plan.

In Place

Not in Place

Partially Not Date in Place Applicable Completed

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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

SECTION 3: BEGINNING OF SCHOOL YEAR

39 40 The school annually disseminates policies that address the elimination of hostile environments to staff, students, and parents. The school displays the "Complaint Response Unit/Parent Resource Network" (CRU/PRN) poster.
CRU/PRN: 1-800-933-8133

  

41

The school displays the monthly "Special Education Parent Training Calendar."
http://sped.lausd.net, click Parent Training Calendar

The school distributes to all parents and students:

42 Parent-student handbook containing the District's nondiscrimination statement and sexual harassment policy. (Similar statement and policy applicable to fiscally independent charter schools)
Memorandum: Nondiscrimination Required Notices

43

Written notice regarding Uniform Complaint Procedures or similar complaint process. Notice may be in any form that will reach the school community, e.g. newsletter, parent-student handbook, memorandum or brochure.
Memorandum: Uniform Complaint Procedures (UCP)

  

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"Section 504 and Students with Disabilities" brochure. (Similar notification applicable to fiscally independent charter schools).
http://storescatalog.lausd.net

"Are you Puzzled by Your Child's Special Needs?" brochure.

http://storescatalog.lausd.net

The school distributes to parents of students with disabilities:

46 Complaint Response Unit/Parent Resource Network (CRU/PRN) "Notification Letter".
Reference Guide: Complaint Response Unit/Parent Resource Network for Parents of Students with Disabilities

  

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"Complaint Response Unit/Parent Resource Network" (CRU/PRN) brochure.

CRU/PRN: 1-800-933-8133

" Special Education Parent Training Calendar."

Distribute monthly updates which are available on http://sped.lausd.net, click Parent Training Calendar

REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

SECTION 4: DISTRIBUTION OF IEP RELATED DOCUMENTS

49 Upon enrollment, or with initial referral for special education assessment, the school provides the parent a "Request for Reasonable Accommodations" form and maintains a copy in the student's green folder. (Recommend attaching form on inside front of green folder)
Welligent Downloads

       

50

With the assessment plan, the school provides the parent "A Parent's Guide to Special Education Services," revised 2009.
http://storescatalog.lausd.net

At least 10 days prior to the IEP meeting, the school provides the parent:
51 52 "A Parent's Guide to Special Education Services," revised 2009.
http://storescatalog.lausd.net

"Notification to Parent/Guardian to Participate in Individualized Education Program Meeting." "The IEP and You" booklet, revised 2008.

Welligent Downloads

53

BUL-4296.0 Distribution and Use of "The IEP and You" Booklet http://storescatalog.lausd.net

54

For Secondary Schools: "The ITP and You" booklet, revised 2008
REF-1368.1 Distribution and Use of "The ITP and You" Booklet http://storescatalog.lausd.net

At the IEP meeting, the school provides and explains to the parent:
55 56 57 "A Parent's Guide to Special Education Services," revised 2009.
http://storescatalog.lausd.net

"Least Restrictive Environment" brochure.

REF-1388.1 Distribution and Use of Least Restrictive Environment (LRE) Brochure http://storescatalog.lausd.net

"Parent Input Survey."

Welligent IEP




At the IEP meeting when Extended School Year is being considered:

58 The school provides and explains the "Extended School Year (ESY) Services for Students with Disabilities" brochure to the parent.
REF-5276.1 "Guidelines for the IEP Team when Students with Disabilities Are Being Considered for Extended School Year Programs and Services"

REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

At the IEP meeting when there is an IEP dispute:

59 The school provides and explains the "Informal Dispute Resolution for IEP Disagreements" (IDR) brochure to the parent.
REF-1410.3 Special Education Dispute Resolution

    

At the IEP meeting, the school provides to staff members: 60 "Staff Input Survey."
Welligent Downloads

SECTION 5: FOR HIGH SCHOOL STUDENTS

61 62 63 The school supports and monitors the student's progress toward meeting the requirements for a diploma or certificate of completion. During the student's final semester in high school, the school develops a "Summary of Performance" (SOP) and provides it to the student.
www.lausd.net, click Offices, click District Office of Transition Services

During the student's final semester in high school, the school assists the student in completing the "Senior Transition Inventory."
www.lausd.net, click Offices, click District Office of Transition Services

SECTION 6: TIMELINES
64 School office staff and administrators follow the procedures for student enrollment forms so that students with IEPs or Section 504 Plans are identified upon enrollment and parent referrals for special education assessment are processed within mandated timelines. The school provides the parent with a "Special Education Assessment Plan" in the language requested by the parent, unless clearly not feasible to do so, within 15 calendar days of the written request for assessment. If requested by the parent, the school provides copies of assessment reports to the parent 4 working days before the date of the IEP meeting. (Reports should be translated into the parent's primary language, upon written request from the parent, unless clearly not feasible to do so) The school completes an initial assessment and develops an IEP within 60 calendar days of receipt of written parental consent to the assessment plan unless the parent agrees in writing to an extension. The school follows the appropriate timelines for conducting annual and three-year review IEPs. The school convenes an IEP meeting within 30 calendar days of parent written request. When a student transfers into the District with an out-of-District IEP, the school develops an IEP within 30 calendar days of enrollment. For an initial assessment and a three-year reassessment, the school conducts vision and hearing screenings within the previous 12 months of the IEP meeting date and documents the screening dates in the IEP. If requested by parents, the school provides copies of their child's educational records within 5 business days of the date the request was made.
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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

SECTION 7: ASSESSMENT
73 The school documents the request for special education assessment on a "Request for Special Education Assessment" form and maintains a copy in the student's green folder.
Welligent Downloads

  

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For English language learners, the assessment plan documents the student's home language and COM/ELD/ESL level. When standardized tests are considered invalid for the student, the assessment plan documents alternative assessments. Initial assessment reports document all of the following required elements: 1. Use of multiple assessment measures 2. Results of tests (including primary language tests) administered 3. Tests given were valid for student's evaluation 4. Test results were a valid reflection of student's skills and aptitudes 5. If interpreter was used, a statement regarding validity of assessment 6. Whether student may need special education/related services 7. Basis for making the above determination 8. Relevant behavior noted during observation of student in an appropriate setting and relationship of that behavior to academic and social functioning 9. Educationally relevant health, development, medical findings 10. Determination concerning effects of environmental, cultural, or economic disadvantage 11. (For psychologist's report only) For students with learning disabilities, whether there is a significant discrepancy between achievement and ability that cannot be corrected without special education and/or related services 12. (For students with low incidence disabilities only) Need for specialized services, materials, and equipment. For a student transitioning from preschool to kindergarten, the school conducts a reassessment using the CTAR and develops an IEP. For a student with Emotional Disturbance disability, the school conducts a comprehensive reassessment for a three-year review IEP. The IEP team completes the "Behavior Instruction and Intervention Certification" form when considering Behavior Intervention Consultation, Behavior Intervention Therapy, Behavior Intervention Development and/or Behavior Intervention Implementation services.
REF- 5052.1 Guidelines for Determining Appropriate Behavior Instruction and Intervention

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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item #

Review Item

In Place

Not in Place

Partially Not Date in Place Applicable Completed

SECTION 8: IEP CONTENT

80 For a student with limited English proficiency, the IEP documents that the student's English language development has been assessed. The IEP documents the student's present levels of performance which includes the following elements: Strengths Needs How the disability affects involvement and progress in the general education curriculum. The IEP documents grade level, standards-based and measurable goals. (For students instructed in an alternate curriculum, goals are aligned to the student's skill level rather than grade level) As appropriate, the IEP documents: Program accommodations and modifications, supplementary aids and services, and related services provided to the student Supports for school personnel that will assist the student to advance toward attaining annual goals, progress in the general or alternate curriculum, and participate in extra-curricular activities. The IEP documents a direct relationship between the present levels of performance, goals, supports, and services to be provided to the student. The IEP documents participation in State and District assessments and indicates the accommodations, if applicable. The IEP documents the percentage of time outside of general education. The percentage of time services are provided outside of general education matches the percentage of time outside of general education documented in the IEP. The IEP documents that the IEP team considered the need for assistive technology. For students with low incidence disabilities (blind, deaf, or severe orthopedic impairment), the IEP documents that the team considered the need for specialized services and materials. The IEP documents attendance of all required team members: Administrator/designee General education teacher of the student Special education teacher of the student Assessor(s), as appropriate Parent(s)/Guardian(s). For students with the eligibility of Emotional Disturbance, the initial and three-year IEP includes an "Emotional Disturbance Disability Certification" form. For students with Speech Language Impairment eligibility or Language and Speech services, the initial and three-year IEP includes a "Speech Language Impairment Eligibility Certification" or "Language and Speech Services Certification" form.
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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT A

Item # 93

Review Item For limited English proficient students, the IEP includes a "Master Plan For English Language Learners" and ELD goal. For students beginning at age 14, the IEP includes an Individual Transition Plan (ITP) that documents the following elements: Career Pathway Agency Involvement Achievement of Transition Activities from Current ITP Education/Training Employment Independent Living Course of Study The IEP documents the offer of FAPE that includes: FAPE Part 1 - Eligibility, Placements and Supports FAPE Part 2 - Summary of Services

In Place

Not in Place

Partially Not Date in Place Applicable Completed

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REF- 2624.7 July 2, 2012

SCHOOL SELF REVIEW CHECKLIST, STUDENTS WITH DISABILITIES: 2012-2013

ATTACHMENT B

Charter School Addendum

Item # Charter School Review Item The charter school annually submits its student application, lottery participation and enrollment forms to the Innovation and Charter Schools Division for review including notices of updates to forms. Specific information notifying parents that the school is open to enroll and provide services to all students is included in the charter school's general outreach materials, website, community meetings, open forums, and specific regional center meetings. The charter school disseminates outreach materials to its charter community containing the District's standard contact number (213-241-5104) to access additional information regarding enrollment procedures. The charter school does not require a copy of a student's IEP prior to participating in the lottery or as any condition for enrollment. The charter school provides parents of students with disabilities for the parent interview component of the comprehensive oversight visit conducted by the Innovation and Charter Schools Division. The charter school has identified a grievance designee on its annual oversight documents for the staff of the Innovation and Charter Schools Division. Charter school staff regularly access the Learning Zone to view and/or participate in training on special education topics. The charter school submits evidence to the Innovation and Charter Schools Division specifically documenting the provision of professional development regarding service to students with disabilities, including students with moderate to severe disabilities. The charter school uses and can provide evidence of consistent use of the Welligent system to document the IEP process and development of the IEP. All Resource Specialist Teachers and Related Services providers at charter schools use the Welligent Service Tracking System to weekly document provision of special education and/or related services and the school has identified an individual who regularly monitors this use.
In Place Not in Place Partially Not Date in Place Applicable Completed

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