HomeMy WebLinkAbout04-0157IN RE: TANYA FENSTERMACHER
FE t4/'8 .004
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
ORDER
AND NOW, this ~0~day oj~~n ~. 2004, IT IS HEREBY ORDERED AND
-- -Fenstermachr' . i0 . _
DECREED that William e is appoimea guaraian ad litem for his daughter, Yanya
Fenstermacher for the purpose of investigating her medical treatment with any medical provider
who has provided her with medical care and pursuing any legal action arising from such treatment.
BY~C~T:
tZ:¢d OZB3J ~-
IN RE: TANYA FENSTERMACHER
AND NOW,
Angino & Rovner, P.C., and respectfully represents the following:
1. Petitioner, Tanya Fenstermacher is a
Cumberland County Pennsylvania, is the daughter of William Fenstermacher.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
PETITION FOR THE APPOINTMENT OF A
comes the Petitioner, Tanya Fenstermacher, by and through her attorneys,
resident of New Cumberland,
2. Tanya Fenstermacher is currently 21 years old. However, she has severe
mental retardation and developmental delay, a seizure disorder which includes, grand mal seizures
and diabetes. Tanya is in a Multiple Disability Support Program at Allen Middle School. Her
education level is below kindergarten, having a receptive language vocabulary of under 200 words,
and being able to count from 1 to 12 but is inconsistent if asked to use the numbers out of sequence.
She can speak only in 2 to 3 word broken sentences, and is difficult to understand.
(See IEP of 11/12/02 attached hereto as Exhibit A)
3. William Fenstermacher has retained the firm of Angino & Rovner, P.C., to
investigate, and if appropriate, pursue a potential medical malpractice claim arising from medical
treatment Tanya received at Hershey Medical Center.
4. Because of her severe mental physical condition, Tanya Fenstermacher is not
capable managing and determining matters related to any claims, litigation or legal actions arising
from such potential medical malpractice.
271785.1 \TSH\TSH
5. William Fenstermacher is Tanya's only surviving parent. Tanya has lived
with William for all of her life, and Mr. Fenstermacher has provided care for her since birth.
Although no formal guardianship has been filed, Mr. Fenstermacher, (and his deceased wife
Darlene) have made all decisions for Tanya throughout her minority and has continued to do so
since she has attained majority.
6. Under the law, William Fenstermacher will have no direct financial interest
in the outcome of his daughter's claim and has no interest adverse to Tanya Fenstermacher with
respect to any medical malpractice claim arising from Tanya's treatment.
7. No other petition has been filed for the appointment of guardian ad litem for
Tanya Fenstermacher nor has any court appointed a guardian ad litem for Tanya
8. As her only parent, and the person who has, by far the knowledge and
concern for Tanya's welfare at heart, appointment of her father, William Fenstermacher, as Tanya's
guardian ad litem is in her best interests.
9. William Fenstermacher hereby affirms that he understands that if the Petition
is granted, he will have authority to make all decisions related to the possible litigation including,
but not limited to, the decision to terminate the litigation for any reason, to settle the case or any
sum, or to decline any sum which may be offered in settlement. He further swears and affirms he
will use that authority solely to further Tanya's best interests. He further understands the Court may
intervene as permitted or required by law to review, limit or override his decisions.
10. William Fenstermacher does swear and affirm that she has fully read, and
does understand this petition. He understands his duties and promises to act only in best interests of
his daughter in carrying them out.
271785.1\TSI~TSH
11. If William Fenstermacher would not be appointed to act as guardian ad litem
for Tanya in all claims relating to her treatment at Hershey Medical Center, Tanya's claim could not
be investigated, and if it has merit, be pursued.
WHEREFORE, Petitioner Tanya Fenstermacher respectfully requests Your Honorable
Court to appoint her Father William Fenstermacher as guardian ad litem for the purpose of
investigating, and, if meritorious, pursuing a medical malpractice claim on Tanya's behalf.
Date:
Respectfully submitted,
ANGINO & ROVNER, P.C.
Te S"H , squire
l.e .~No.
4503 N. grerfft Street
Harrisburg, PA 17110
(717) 238-6791
Counsel for Plaintiff
271785. I~TSI-BTSH
IN RE: TANYA FENSTERMACHER
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT
:
: NO.
CONSENT OF GUARDIAN
I, William Fenstermacher, PhD. hereby consent to be guardian ad litem in any medical
malpractice investigation, claim and/or action pertaining to Tanya Fenstermacher.
VERIFICATION
I, Tanya Fenstermacher, being of sound mind, and without coercion, unfair influence or
duress, have retained the law firm of Angino & Rovner, P.C., to represent the interests in the
investigation and possible prosecution of a medical malpractice claim relating to my medical
treatment while a patient at Lewistown Hospital. I firmly believe that my father, William is the best
person to make judgments and make decisions in my best interest conceming these possible medical
malpractice claims. Therefore, wish him to be appointed guardian ad litem for such claims,
understanding he will have the final authority on all decisions relating to the case, including
settlement.
I have read the foregoing Petition for Appointment of Guardian Ad Litem and do swear or
affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge,
information, and belief. I understand that this Verification is made subject to the penalties of 18
Pa.C.S.A. {}4904, relating to unswom falsification to authorities.
Date:
6
EXHIBIT A
Tanya Fenstermacher
INDIVIDUALIZED EDUCATION
November 12, 2002
PROGRAM (IEP)
page
IEP Team Meeting Date:
IEP Implementation Date:
Anticipated Duration of Services and Programs:
November 12, 2002
November 13, 2002
November 13, 2003
Student Name: Tanya Fenstermacher
Grade: 12 +
School District: West Shore School District
DOB: 10-16- 82 Age: 20
Anticipated Year of Graduation: 2004
Parent Name: Bill & Dee Fenstermacher
Address: 209 1/2 Bridge Street, New Cumberland, PA 17070 Phone: 774 3279 (H)_774 0546 (W)
County of Residence: Cumberland Other Information:
IEP TEAM/SIGNATURES*
The Individualized Education Program (IEP) Team makes the decisions about the student's program and placement. The
student's parent(s), the student's regular teacher and a representative from the local education agency are required
members of this team. A regular education teacher must also be included if the student participates, or may be
participating in regular education. Signature on this IEP documents attendance, not agreement.
NAME (typed or printed) POSITION .-... SIGNATURE
Dee&Bill Fenstermacher Parent ~_ __~____~ ~-~
Tanya Fenstermacher Student* -~---"'~---~ /~--~_~__~_~_~
Stephen Hughes Special Education Teacher ~~_~_.~
Pam Wilson L~/~/ Local Ed. Agency Rep. (Chair)
Dave Roseman Transition Teacher ~~2.~
Jen Schlegel Occupational Therapist
M aryAnn D elegrotto Speech ~,,~_~.~c~_~/~... ~
* The IEP team must invite the student if transition services are being plaP~ned or if the parents choose to have the
student participate.
** As determined by the LEA as needed for transition services.
PROCEDURAL SAFEGUARDS NOTICE
I have received a copy of the Procedural Safeguards Notice. The District has informed me whom I may contact if I need
more informa~r~_ (/~ ,,~/~__.~
Signature: ~"~ ~' v Date Received:
copies: ACE Parent MH / MR Trans. S&L eT Vision PT Allen
IEP Tanya Fenstermacher November 12, 2002
Page .~/i (~
Special Considerations the IEP Team Must Address Before Developing
The IEP. Any factors checked must be addressed in the IEP
Is
the Student Blind or Visually Impaired? X No
__ Yes - Team must provide for instruction in Braille and the use of Braille unless the IEP team determines
after an evaluation of the child's reading and writing skills, needs and appropriate reading and writing
media ( including an evaluation of the child's future needs for instruction in Braille or the use of Braille ) ,
that instruction in Braille or the use of Braille is not appropriate.
Is the Student Deaf or Hearing Impaired?
X No
Yes - Team must address the student's language ~and communication needs, opportunities for direct
communication with peers and professionals in student's language and communication mode, academic
level, and full range of needs including opportunities for direct instruction in the child's language and
communication mode in the development of the IEP.
No COMMUNICATION NEEDS
yes ASSISTIVE TECHNOLOGY, device and / or services
no LIMITED ENGLISH PROFICIENCY
yes BEHAVIORS THAT IMPEDE HER LEARNING and that of OTHERS
yes TRANSITION SERVICES
no OTHER ( specify )
IEP Tanya Fenstermacher November 12, 2002 page
I1.PRESENT LEVELS OF EDUCATIONAL PERFORMANCE
STUDENT'S PRESENT LEVELS OF EDUCATIONAL PERFORMANCE:
Tanya is a student enrolled in the West Shore School District and attends a
Multiple Disabilities Support class at Allen Middle School, in the West Shore School
District. She receives S & L consultation services once a week, OT consultation
services once every four cycles. She has Adapted Physical Education two times
a cycle. Tanya is transported from home to school door to door. She does not
attend any regular education classes but eats in the lunch room and often sits at a
table with other regular education students. Tanya continues to show
improvement in her behavior, and has increased her level of independence. Her
physical stamina and flexibility has declined over the last 5 months as she has had
a considerable weight gain. weight. She has gained over 30 lbs since September
2001. This may be affecting her return to sleeping in class, toilet accidents, and
an increase in falling over accidents.
Strengths:
Academic:
Tanya's academics have remained the same. She can count 1 to 12, but is
inconsistent when asked to name a number in isolation. She can occupy herself
with games and activities. She likes to look at books and magazines. She has a
good eye for spotting small details in pictures. She will match picture items and
sort items. She holds a pencil and will trace letters and numbers. She can color but
often goes outside the lines. She will sit and interact with a computer, and can play
some simple computer games with assistance. She knows that items have to be
paid for and will give money for exchange of goods. She is inconsistent with the
four coins, but knows a dollar bill. She has a small sight word vocabulary of about
five words, 'exit' , 'stop' 'hot' , ' cold' and 'on' . This has not increased from last
year. She can read the name of the school when we pass it each day. She can
recognize some community places and fast food places by their logo.
Communication:
She has a receptive language vocabulary of over 200 word. Tanya talks a lot but
she is difficult to understand due to articulation difficulties. It is difficult for a
stranger to comprehend Tanya's speech. She talks in two or three word
fragmented sentences. She uses a 'Talk Box' that can be programmed up to 32
words per card. She has been quick to pick up on the symbols when first
introduced. However she rarely uses the Talk Box' except for certain requests.
She will go get her talk box if you say, "1 am sorry can you tell me with your Talk
Box", but she is then likely to change the topic.
IEP Tanya Fenstermacher November 12, 2002 page /-~-//~
Daily Living Skills:
Tanya can undress and dress, needing help only with shoe lace tying, and most
times her bra. She takes herself to the toilet but needs to be monitored. She
attempts to clean herself after a bowel movement (BM), but can have difficulties
due to her size and lack of flexibility. She will wash her hands and face. She will
use a regular toothbrush, or a power operated toothbrush. Tanya has been using a
shower at school to clean up after a toilet accident, or to prepare for a PE with
regular education students. She can turn on the shower and wash herself with soap
and washcloth. She does have some difficulty controlling the shower head which is
on a removable flexible hose, and keeping the water inside the shower stall. Tanya
is not yet aware of water spilling out of the shower on to the floor. This can
present a slippery problem.
She is independent in feeding, but has limited use of a knife for cutting. She will go
through the lunch line and clear her tray, however she needs to be monitored.
Leisure Skills:
Tanya can occupy herself quite easily. She will read picture books, look through
magazines, play games, watch TV, play on the computer by herself, do puzzles,
color picture. She never seems to tire of games or activities. She loves to play
balloon volley ball.
Motor Skills:
Tanya can walk, and will on occasion run. Her balance has deteriorated and she is
taking more tumbles. She will do 50 sits ups. She loves to throw the frisbee and
play balloon volley ball. Her stamina has deteriorated, however the PE teacher
reports her flexibility has not yet deteriorated since the weight gain. She will do 10
push ups and assumes butterfly sit position for stretching. Tanya can pick up
small items such as thumb tacks and 1" nails. Her fingers lack muscle tone for
some tasks. Her lack of muscle tone and dexterity with her hands impacts on her
fully using a knife and scissors effectively.
Social Skills:
Tanya remains a very outgoing young lady, she will talk to any one. She likes to hug
people and invade their personal space. The number of temper tantrums has
declined and she is not abusing herself by hitting or head butting, compared to
previous years. Dramatic progress has been made in Tanya going to a Time Out
when told and without the teacher having to physically take her there. This is an
important step. A new and recent development has been Tanya taking herself to
Time Out. It seems as she then uses this voluntary Time Out to sleep.
She has some social graces and will usually put her hand in front of her mouth when
she coughs, and looks for a tissue when sneezes.
IEP
Tanya Fenstermacher
November 12, 2002
page ..~-//~
Vocational Skills:
Tanya can do simple pre-vocational tasks, sorting, matching , inserting items,
sticking labels on envelopes, stapling, and packaging two items. She can sit for up
to 60 minutes, and is spending more time on task. She has shown improvement in
accuracy using a one hole punch. Usually work is done correctly on the first
attempt.
Needs:
To improve health by losing weight.
To improve physical stamina, flexibility and endurance.
To reduce temper tantrums and manipulations.
To attempt more difficult pre-vocational task.
To become more independent in daily living skills.
To travel around school more independently.
Opportunity to make some choices and decisions.
Improve social skills.
Improve clarity in communication by using Talk Box more frequently.
HOW THE STUDENT'S DISABILITY AFFECTS INVOLVEMENT AND PROGRESS IN GENERAL
EDUCATION CURRICULUM (Include the child's strengths and needs which will effect the student's
involvement and progress in the general curriculum.):
Tanya's intellectual functioning is considerably lower than her peers. Her
intellectual abilities, require specifically designed instruction and activities
different from a general education curriculum.
Tanya's behavior has improved and she has responded well when sitting in on
different school assemblies. She has also done well having lunch with regular
education students.
Tanya Fenstermacher November 12, 2002 page ~/"~/~
III. GOALS AND OBJECTIVES:
MEASURABLE ANNUAL GOAL:
Tanya will improve academic skills as measured by teacher observation of
performance tasks and check lists.
SHORT TERM OBJECTIVE/BENCHMARK &EXPECTED LEVEL OF ACHIEVEMENT
Tanya will identify numbers 1- 10 , 100% of attempts
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will identify 10 functional or community words. 100% accuracy
once a cycle
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE~ENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will identify nickel, dime, penny, quarter coins and dollar bill. 100%
accuracy once a cycle.
METHOD OF EVALUATION Teacher observation and charting
MEASURABLE ANNUAL GOAL:
Tanya will improve communication skills, increasing receptive language and
expressive language as measured by teacher observation of performance
tasks and check lists.
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will recognize 32 symbols on her Tech Talk Box with 100% accuracy
with two tests of 16 words a cycle.
METHOD OF EVALUATION Teacher observation and charting.
Tanya Fenstermacher
November 12, 2002
page
MEASURABLE ANNUAL GOAL:
Tanya will improve skills necessary for appropriate behavior and
in the community as measured by teacher observation
integration
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
In a community store or restaurant, Tanya will use her Talk box to say" I want to
buy ...... ", give money in exchange for the item, hold hand out for change and or
receipt.
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
When in the community, Tanya will walk with the group; not draw attention to
self by tantrums, not grab people or getting too close; follow directions.
Four trips in one year, with 100 % compliance on each trip in the community
METHOD OF EVALUATION Teacher observation and charting
MEASURABLE ANNUAL GOAL:
Tanya will improve social skills as measured
performance, and checklist of behavior
by observation of student
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will have appropriate behavior, with no tantrums, accepting of
directions and change avoid having to go to Time Out with no more than a
maximum of 5 Time Outs in any day
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya when inappropriate and sent to Time Out; will go to Time OUT without physical
assistance, will remain in Time Out area, will not self abuse, will say "ready" to come out in
less than 5 minutes.
METHOD OF EVALUATION Teacher observation and charting
Tanya Fenstermacher November 12, 2002 page ~'/'//~
MEASURABLE ANNUAL GOAL:
Tanya will improve job skills necessary for success in work place or
sheltered workshop as measured by teacher observation of task completion
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will match number of items to a template 100% accuracy
METHODOF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will use a stapler to staple two pieces of paper together in a
designated area.100% accuracy for ten stapled pages, once a cycle
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will use a one hole punch in a designated 'area. 100% accuracy for ten
pages, once a cycle
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will fold 10 pages so that each page will fit into a standard envelope
with 100% accuracy, once a cycle
METHOD OF EVALUATION Teacher observation and charting
SHORT TERM OBJECTIVE/BENCHMARK & EXPECTED LEVEL OF ACHIEVEMENT
Tanya will place a stamp on a standard envelope in a designated area
with 100% accuracy, once a cycle
METHOD OF EVALUATION Teacher observation and charting
REPORT OF PROGRESS ON ANNUAL GOALS
How goals will be measured:
How progress will be reported:
by charting
quarterly report cards
1ST
2ND
3RD
4TH
IEP Tanya Fenstermacher November 12, 2002 page
IV. SPECIAL EDUCATION/RELATED SERVICES:
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION:
Social skills instruction
Encourage independent work skills
Individual and small group instruction
Home / school book.
Bathroom and shower in classroom to improve independent hygiene skills
Communication assistive devices
Opportunity to eat Iow fat lunch items
Opportunity to walk at school without close supervision
Daily exercise activities to include sit ups, walking, lifting weights, push ups, ball & balloon games
Community Based Instruction
Behavior plan - Wherever possible, inappropriate behavior, examples: tantrums, non compliance,
whining, Tanya will be sent to Time Out and ignored until she says "ready"
If in transition, or there is a refusal to go to Time Out then Tanya is to sit down and then told" let me
know when you are ready". She is ignored until Tanya says "ready" she will then go to Time Out.
Opportunity to. make simple foods, such as sandwiches, cereal, heating food in microwave.
Opportunity to participate in a mainstream PE class once a cycle, and dependent on her behavior, and
being ready for the class on time.
Will participate in garden project.
B. RELATED SERVICES: List the services that the student needs in order to benefit from or access her
special education program:
TRANSPORTATION Door to door service due to class location and safety
Service Location beginning date frequency anticipated
duration
Adapted Phys. Ed. AMS November 13, 2002 2 x per cycle one year
Co
SUPPORTS FOR SCHOOL PERSONNEL RELATED TO STUDENT'S NEEDS:
Occupational Therapy consult with classroom teacher and Phys Ed teachers.
Speech & Language consult with classroom teacher.
EXTENDED SCHOOL YEAR:
The IEP Team has considered and discussed ESY services, and determined that
Tanya can benefit from ESY to maintain social and motor skills
IEP Tanya Fenstermacher
PARTICIPATION IN STATE AND
November 12, 2002
DISTRICT-WIDE ASSESSMENTS
page
STUDENT PARTICIPATION - STATE ASSESSMENTS
This section applies to student's age/grade eligible for the PSSA/PASA
(Reading, Math-grades 5, 8, 11; Writing-grades 6, 9, 11)
__ Student will participate in the PSSA without accommodations. OR
__ Student will participate in the PSSA with the following accommodations:
PSSA Reading (grades 5, 8, 11)
PSSA Math (grades 5, 8, 11)
PSSA Writing (grades 6,9, 11)
OR
__ Student will participate in the Pennsylvania Alternate System of Assessment (PASA).
If the IEP Team has determined it is not appropriate for the student to participate in the PSSA,
the team must explain why the PSSA is not appropriate:
Tanya's intellectual functioning is considerably lower than her peers. Her
intellectual abilities, require specifically designed instruction and activities
different from a general education curriculum. Tanya is too old for PASA testing.
Choose how the student's performance on the PASA will be documented:
__Videotape (which will be kept confidential as all other school records)
__Written Narrative (which will be kept confidential as all other school records)
STUDENT PARTICIPATION - DISTRICT ASSESSMENTS
Student will participate in the District assessments without accommodations.
OR
Student will participate in the District assessments with the following accommodations:
OR
X
If the IEP Team has determined that it is not appropriate for the student to participate in the
district-wide assessment they must explain why the assessment is not appropriate for the
student and how the student will be assessed.
Tanya's intellectual functioning is considerably lower than her peers. Her
intellectual abilities, require specifically designed instruction and activities
different from a general education curriculum. Student will be assessed by an
Ecological Assessment and on-going evaluation of her progress in IEP goals and
objectives.
IEP Tanya Fenstermacher November 12, 2002 Page
VI. LEAST RESTRICTIVE ENVIRONMENT (LRE)
EDUCATIONAL PLACEMENT Full Time Multi-Disabilities Support
Explanation of the extent, if any, the student will not participate with non-disabled children in the
regular class and in the general education curriculum:
Tanya's intellectual functioning is considerably lower than her peers. Her
intellectual abilities, require specifically designed instruction and activities
different from a general education curriculum. Tanya will attend certain
school assemblies with non- disabled children and has the oportunity to eat
in the cafeteria at a table with non- handicapped children.
Percentage of time the student receives special education outside of the regular education
classroom:
__ Less than 21% outside of the regular education classroom
21-60% outside of the regular education classroom
X 61% or more outside of the regular education classroom
Location: Multi-Disabilities Support classroom at Allen Middle School
Tanya Fenstermacher IEP
November 12, 2002
page
VII. TRANSITION PLANNING
1. Will the student be 14 years of age or older during the term of this IEP?
No - (Not necessary to complete this Section)
X Yes - Team must address the student's courses of study and how the
course of study applies to components of the IEP.
Student's courses of study:
Tanya's course of study is her IEP goals & objectives based on the Ecological Assessment,
the Functional Living curriculum ( CAIU ), and the Life Skills curriculum
(CAIU).
2. Will the student be 16 years of age or older during the term of this IEP or is the student younger and in
need of transition services as determined by the IEP Team?
No - (Not necessary to complete this Section)
X Yes - Team must address and complete this Section
DESIRED POST-SCHOOL OUTCOMES: Define and project the desired post-school outcomes as identified by
the student, parent and IEP team in the following areas. State how the services will be provided and person(s)
responsible for coordinating these services.
SERVICE HOW SERVICE IS PROVIDED PERSON RESPONSIBLE
Post Secondary Education
/Training
through sheltered workshops ( CIT )
and Adult Activity Center ( UCP Alternatives )
placement funded by MH / MR
Shelly Gettle
MH / MR
caseworker
Employment
Tanya will require post high school training
before being skilled or suitable for
employment
caseworker
Community Living
a) Residential
parents &
Tanya currently resides with her parents,
parents
at a future date she will require a supervised caseworker
group home living arrangement. & parent
Mrs Fenstermacher agreed to use respite care in a CPARC
group home in New Cumberland, to help Tanya adjust to
being away from home, and opportunity to socialize with other
handicapped adults.
Tanya Fenstermacher
SERVICE
IEP
November 12, 2002
HOW SERVICE IS PROVIDED
page ( _~//~
PERSON RESPONSIBLE
community living cont .......
b)Participation
Tanya goes to various places in the community
shopping, restaurants, parks with her parents
parents
c)Recreational & leisure
Tanya is taken to the park by her parents.
Last summer Tanya went to camp funded by MH / MR
Attempts to find an activity aid to work with Tanya in
evenings / weekend was not successful
parent &
caseworker
STATEMENT OF COORDINATED TRANSITIONAL SERVICES AND ACTIVITIES NEEDED TO
SUPPORT DESIRED POST-SCHOOL OUTCOMES:
The instructional areas should support the desired post-school outcomes. The following instructional areas
should appear in the IEP as annual goals, short-term instructional objectives or benchmarks, and/or specially
designed instruction. For example (if appropriate):
Instruction and Related Services
Instruction and activities are based on four priorities:
Physical Exercise to promote and maintain health, increase stamina, strength and flexibility,
to allow release of energy to help improve behavior and have fun.
Behavior Management so Tanya can be under control and be exposed to more social
interactions. For Tanya to learn that her actions can have positive and negative effect and
that she is held responsible for inappropriate behavior.
Communication to allow Tanya to get more of her needs met and reduce her social isolation.
Skills Training that allow Tanya to be more independent in caring for self, and working with
peers under adult supervision.
Community Experiences
Tanya has visited various places and activities in the community.
Acquisition of Daily Living Skills
Tanya works on daily living skills in the areas of dressing, hygiene, and eating.
Functional Vocational Evaluation
At school Tanya works on pre-vocational skills and simple jobs
Tanya Fenstermacher
IEP November 12, 2002 page
STATEMENT OF COORDINATED TRANSITIONAL SERVICES AND ACTIVITIES cont .........
Adult Living
Tanya works on simple tasks at school that are similar to tasks at home or in a group home. Social skills are
reinforced for appropriate behavior. Certain tasks are aimed towards adult living, such as receiving payment
for jobs, having a choice on how her money is spent, and exchanging money to buy items at the snack table.
Tanya will help to prepare simple foods.
Tanya will help fold laundry.
Tanya will have daily chores and responsibilities.
Ms Gettle MH MR caseworker and Mr Roseman WSSD Transition coordinator will arrange a trip to CIT and UCP
program in Spring 2003.
IEP Tanya Fenstermacher November 12, 2002 page
LINKAGES
List the agencies, which may provide services/support (before the student leaves the school setting):
Agency Name
Shelly Gettle
Cumberland Perry MH / MR
Mental Retardation Services
16 W High Street, Carlisle, Pa 17013
responsibilities / linkages
Case Management Services with a Life Management Plan
Family Support Support Program through UCP
Phone Number
697 0371 ext. 6325
respite care so parents can go on holiday or have a weekend of rest
homemaker service help with household chores when unusual family crisis
family education and parent support groups
Post Graduation
MH / MR to find and fund agency to provide Tanya with work or training after graduation.
IEP Tanya Fenstermacher November 12, 2002 page
Medical Management Plan
Seizure Procedure
In the event of a petit mai seizure with the following presenting symptoms:
1 Tenseness of extremities.
2 Generalized tremors
3 Eyes rolling back in head
4 No indication of respiratory distress
The following protocol should be followed:
1 Observe student and call her name
2 Maintain student safety and stay with student until end of seizure
3 Complete seizure record chart
4 Notify parent by via Home Book, or call , or other means.
In the event of a grand mai seizure with the following
1
2
3
4
5
presenting symptoms:
Frothing of mouth
Severe body tenseness
Severe jerking movements of entire body
severe respiratory distress ( cessation of breathing )
any seizure lasting longer than 5 minutes
The following protocol should be followed: 1 Signal office to call 911
2 Remain with student at all times until emergency personnel arrive
3 Make all attempts to establish an open air way.
In the event of respiratory distress any currently certified CPR personnel
should begin CPR
4 Once emergency personnel arrive, notify parents.
Parents will make contact with transportation and drivers to let them know the plan if
seizure happens on t~us coming to or going from school.
parent signature ~_~b~_ f;~_ date/_/~___ __/__~/__O~.
nurse
date
teacher
date
teacher will make copy for driver __