NYC EARLY INTERVENTION PROGRAM Note Page 1 (Circle (3),6, 9, 12)

Provider Progress

Complete this progress report and review with the parent. Submit the completed report to the service coordinator no later than 2 weeks prior to the 6 month (submit 3 and 6 month notes) or annual review (submit 9 & 12 month notes). All questions must be answered or the report will be returned. Use additional pages if needed. Typed reports are preferred. Illegible hand written reports will be returned. Oscar Peralta 8/19/09 Childs Name: EI #: 77915 DOB: IFSP Period: To Provider Agency 4/23/12 8/18/12 THERACARE From: : Name: Provider Agency ID Print Name of 21100 Sandra Botero #: Interventionist: Service Interventionists Phone ST SPEECH 3475204310 Discipline: Type: Number: Date reviewed with Parents parent: Signature:

Authorized Date you started working with this 2 X 60 Frequency? child: Where have services been In the childs home delivered? Has the parent(s) been present for the sessions, if not, how have you communicated with the family?

The parent was present and an active participant for all sessions.
If there have been any gaps in service delivery of more than three consecutive scheduled visits, describe the length and the reason(s). No Gaps In The Interventions. List the childs medical diagnosis(es) (if any): Is the child using assistive technologies? Yes Is a new AT Device being requested? Yes No No If yes, identify the Functional Outcome (from the IFSP) and specify how the device is helping (or will help) to achieve the Outcome. 1. IFSP Functional Outcome 1:

Oscar will learn to repeat words being

Rate Progress in This Time Period

No Progres s Little Progress Moderat e Progres s Great Deal of
f

Taught in order to retain them so he may verbally express himself Without tantruming frustration.

Outco me Achiev ed

Progres s

1a. List the short-term objectives that are currently being worked on to achieve the IFSP Functional Outcome: Check Y/N to indicate if the objective(s) was achieved in this time period. Check (E) to indicate if the skills related to the objective are emerging. 1. Objective: Repeat sounds being taught. Yes x No Emerging 2. Objective: Repeat words being taught. Yes x No Emerging

1b. State the changes/modifications made to objectives in order to facilitate developmental progress. Be specific.

The objectives were not changed; more time is needed to achieve these objectives .

1c. What routine activities are you and the family/caregivers using to achieve each objective stated above (ex: mealtime, bath time, etc.)? Describe how interventionists are being incorporated into the routine activities. Which family member(s) have you been working with?

OBJECTIVE 1:

OBJECTIVE 2:

1d. What changes were made if the routine activities or the strategies/methods approaches were ineffective (progress limited), or difficult for the family to incorporate into daily routines?

There were no methods that proved to be ineffective at this time related to this goal, more time is necessary to achieve these objectives.

Provider Progress Note 5/10

NYC EARLY INTERVENTION PROGRAM (Circle (3),6, 9, 12 ) (Additional outcomes)

Childs Name:

Provider Progress Note Page 2

Oscar Peralta

IFSP Period: From

4/23/12

To:

8/18/12

2. IFSP Functional Outcome 2:

Oscar will learn to adhere to Limits and follow directions given , in order to assure His safely both at home and when in public.

Rate Progress in This Time Period

No Progress Little Progress Moderate Progress Great Deal
of Progress

Outcome Achieved

2a. List the short-term objectives that are currently being worked on to achieve the IFSP Functional Outcome: Check Y/N to indicate if the objective(s) was achieved in this time period. Check (E) to indicate if the skills related to the objective are emerging. 1. Objective: Oscar will be given directives and be provided Yes No Emerging with the prompts level that he needs to begin and complete the directive. 2. Objective: Praise and applauds will be given once the directive has been completed. Yes No Emerging

2b. State the changes/modifications made to objectives in order to facilitate developmental progress. Be specific.

The objectives were not changed; more time is needed to achieve these objectives .
2c. What routine activities are you and the family/caregivers using to achieve each objective stated above (ex: mealtime, bath time, etc.)? Describe how interventionists are being incorporated into the routine activities. Which family member(s) have you been working with?
Objective 1: The interventionist uses hand over hand, verbal and visual prompts. For example the interventions use hand over hand, verbal prompts and visual prompts during clean up (e.g. put in, take out) and other activities. Parents have been taught to use physical and verbal prompts throughout daily routines. Mom practices strategies such as hand over hand to help child follow directives throughout daily routines. For example, during shopping, mom will provide hand over hand assistance while having child follow directives ( e.g. give me cereal, stop, etc) with the prompts level that he needs to begin and complete the directive.

Objective 2: The interventionist uses hand over hand, verbal and visual prompts, Praise and applaud will be given once the directive has been completed. For example the interventions use hand over hand, verbal prompts and visual prompts during

clean up (e.g. put in, take out) and other activities. Parents have been taught to use physical and verbal prompts throughout daily routines. Mom practices strategies such as hand over hand to help child follow directives throughout daily routines. For example, during shopping, mom will provide hand over hand assistance while having child follow directives ( e.g. give me cereal, stop, etc) with the prompts level that he needs to begin and complete the directive.

2d. What changes were made if the routine activities or the strategies/methods approaches were ineffective (progress limited), or difficult for the family to incorporate into daily routines?

There were no methods that proved to be ineffective at this time related to this goal, more time is necessary to achieve these objectives.

NYC EARLY INTERVENTION PROGRAM (Circle (3),6, 9, 12 ) outcomes)

Childs Name:

Provider Progress Note Page 3 (Additional

4/23/12 8/18/12
Great Deal
of

Oscar Peralta

3. IFSP Functional Outcome Posture and drooling.

IFSP Period: From Oscar will learn to decrease his open mouth

To: Rate Progress in This Time Period

Little Progres s Moderat e Progres s Outcome Achieved

No Progres s

Progress

3a. List the short-term objectives that are currently being worked on to achieve the IFSP Functional Outcome: Check Y/N to indicate if the objective(s) was achieved in this time period. Check (E) to indicate if the skills related to the objective are emerging. 1. Objective: Oscar will be given stimulations, cues and and praise to Yes No Emerging decrease his open mouth posture and drooling. 3b. State the changes/modifications made to objectives in order to facilitate developmental progress. Be specific.

The objectives were not changed; more time is needed to achieve these objectives .
3c. what routine activities are you and the family/caregivers using to achieve each objective stated above (ex: mealtime, bath time, etc.)? Describe how interventions are being incorporated into the routine activities. Which family member(s) have you been working with?

Objective 1: The interventionist uses verbal and visual prompts. For example the interventionist will use verbal and visual prompts doing several exercises oral linguistic to help him to achieve this objective. Parents have been taught to use visual and verbal prompts throughout daily routines. For example during daily routines mom will remember him, how it should be the correct posture of his mouth. During the play time she will tell to Oscar close the mouth this will help him to decrease his open mouth posture.

NYC EARLY INTERVENTION PROGRAM 3 (Circle( 3), 6, 9, 12 ) outcomes)

Childs Oscar Peralta Name: 4. IFSP Functional Outcome 4:
IFSP Period: From Oscar will learn to that he can not have

Provider Progress Note Page (Additional

4/23/12 8/18/12

To:

Rate Progress in This Time Period

No Progres s Little Progres s Moderat e Progres s Great Deal
of

Not have his way both at home or when in public or when displaying Aggressive or dangerous behaviors.

Progress

Outco me Achiev ed

4a. List the short-term objectives that are currently being worked on to achieve the IFSP Functional Outcome: Check Y/N to indicate if the objective(s) was achieved in this time period. Check (E) to indicate if the skills related to the objective are emerging. 1. Objective: Parents will be taught methods to Yes No Emerging change/address/decrease and stops the following behaviors:

- Hitting parents in face.

- Running away from parents when in the street. - kicking and hitting others/parents when told no. - Throwing himself onto the floor/street when in public while screaming or crying for attention. 4b. State the changes/modifications made to objectives in order to facilitate developmental progress. Be specific.

The objectives were not changed; more time is needed to achieve these objectives .
4c. What routine activities are you and the family/caregivers using to achieve each objective stated above (ex: mealtime, bath time, etc.)? Describe how interventionists are being incorporated into the routine activities. Which family member(s) have you been working with?

Objective 1: During playtime the interventionist uses imitations, hand over hand and verbal prompts, reforzamiento positivo for
example the interventionist uses diferentes actividades como salir al supermercado para ensenar a la madre estrategias que le ayudaran change/address/decrease and stops the following behaviors Hitting parents in face, Running away

from parents when in the street and kicking and hitting others/parents when told no . The parents have been
educated to use reforzamiento positive y negativo. For example, during playtime si Oscar se no realiza las acividades adecuadamente se le dara un reforzamiento negative y en caso se le dara un reforzamiento positivo.

4d. What changes were made if the routine activities or the strategies/methods approaches were ineffective (progress limited), or difficult for the family to incorporate into daily routines?

There were no methods that proved to be ineffective at this time related to this goal, more time is necessary to achieve these objectives.

NYC EARLY INTERVENTION PROGRAM (Circle3, ( 6), 9, 12 )

Provider Progress Note Page 4

Note: Questions 4, 5, and 6 do NOT need to be answered separately for each outcome

Childs IFSP Period: 4/23/12 8/18/12 Oscar Peralta Name: From To: 7. In addition, to working with the family, describe all collaborative efforts made to address the IFSP outcomes for this child. (Examples: Interactions with outside medical providers (with written parental permission), other EI therapists, day care staff, other caregivers, community resources ).

Interventionist uses communication notebook to track progress, discuss successful strategies and methods, and ask questions of other interventionist providing therapy to child.

5. Based on your ongoing assessment of the childs progress, what is the childs current level(s) of functioning? For 6 month and 12 month notes, address current functioning and state the developmental status according to Public Health Law and NYS Memorandum 2005-02 as it relates to criteria for establishing ongoing eligibility.
Oscar 35 is a months old male who currently receives speech and language service twin a week for 60 minutes. He is functioning at 20 months in all language. In the area of the receptive language, he can respond to give me command, understand new words, and identifies eight body parts or clothing items, identifies objects by category and understands 50 words . In expressive language ,names one object frequently, imitates five animal sounds .In social language (pragmatic) uses vocalizations more frequently during interactions ,imitates other children. In the area of pragmatics he points to, show or request objects, uses words to protest, plays with a toys in different way, plays ball with adults, places one object inside another and inconsistently makes eye contact. Oscar presents as friendly and engaged during session.

In addition, for the 6 and 12 month progress note, please estimate the percentage of delay. Percent Delay: Provide an explanation of how the percentage delay was determined (e.g. standardized instrument and/or informed clinical opinion). If an instrument was administered, please report the results according to the instruments manual Rossetti Infant-Toddler Language Scale is a criterion referenced measure that outlines skills according to age of acquisition. The Rossetti was used in combination with clinical opinion based on time spent in treatment. 6. What can the child do now, that he/she was previously unable to do (childs strengths). Address each functional outcome.

In the area of the receptive language, he can respond to give me command, understand new words, and identifies eight body parts or clothing items, identifies objects by category and understands 50 words . In expressive language ,names one object frequently, imitates five animal sounds

Note: If the Interventionist has additional comments or observations, please attach additional documentation. I certify that I have received & reviewed a copy of the childs IFSP and evaluation/progress notes prior to starting services, have provided services in accordance with the IFSP services specified frequency and duration, and have worked towards addressing the relevant IFSP outcomes. I further certify that my responses in this report are an accurate representation of the childs current level of functioning. Signature of therapist completing report: *License Print Sandra Botero, CF number: Name: Date Report Was 6/01/12 Completed:
*If certified, write certified and do not indicate number

Provider Progress Note 5/1