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HomeMy WebLinkAbout11-23-11IN RE: : IN THE COURT OF COMMON PLEAS Mr. Justin Fisher :CUMBERLAND COUNTY, PA an Alleged Incapacitated Person ORPHANS' COURT DIVISION ,. , GUARDIANSHIP ~~ ~-__ -n - _ , - . °; -''~ PETITION FOR APPOINTMENT OF ~ ;,_~_~ - , AN EMERGENCY GUARDIAN PURSUANT ~' < - -, _. ,., TO 20 PA. C.S.A. § 5513 '-~~~ ? - , -- - .J - J 'C_ 1) Petitioner: -L - ~ ~ ~~ ~ - ' ' ' . _ ~,~ ~~ T~ Petitioner: Robert L. O'Brien, Esquire Address: 19 West South Street, Carlisle, PA 17013 717-249-6873 2) The Alleged Incapacitated Person: Name: Justin Fisher Age: 20 DOB 9/21/91 Address: 650 North College Street, Rear Carlisle, PA 17013 3) The Alleged Incapacitated Person's Heirs: Spouse: none Children: none Parents: Joseph Fisher, same address Address: Other: 4) Residential Services Provider: Justin lives with his father and two brothers with assistance services provided in the home. 5) Other Providers of Services: Cumberland/ferry MHMR, Big Spring School District 6) Proposed Guardian: The petitioner, Robert L. O'Brien, Esquire, of MHMR, requests the appointment of Susan Carbaugh, as Emergency Guardian of the person of Justin Fisher. 7) Averment of Disinterest: The proposed Guardian has no interest adverse to that of Mr. Fisher 8) Reasons Why Guardianship is Requested: To assist in medical decisions, and insure availability of all possible resources for Mr. Fisher's care and treatment. School District has concerns about the apparent neglect of Justin and has documented those concerns. A report from the district is attached. 9) Functional Limitations and Physical and Mental Condition: see attached report, severe mental retardation and gastric problems 10) Value of Estate: Gross value: 0 Income: SSI. Financial Obligations: Cost of care. WHEREFORE, Petitioner respectfully requests that Susan Carbaugh be appointed guardian of the estate and person. Respectfully submitted, O'BRIEN, BARK & SCHERER By ~~ Robert L. O'Brien, Esquire Attorney for Petitioner I.D. # 28351 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 IN THE MATTER OF : IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA Tustin Fisher AN ALLEGED INCOMPETENT :ORPHANS' COURT DIVISION IN RE NO. PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN OF THE PERSON PURSUANT TO 20 Pa. C.S.A. 5513 The Petition of respectfully represents: 1. Your Petitioner is: Susan Carbaug_h/Cumberland-Perr~Intellectual and Developmental Disabilities Director. 2. Tustin Fisher is currently receiving care at 650 N College Street Rear Carlisle, PA 17013. 3. Tustin Fisher domiciled at 650 N College Street Rear Carlisle. PA 17013 . 4. 5 6. Tustin Fisher is 20 years of age having been born on September 2, 1991 Justin Fisher's marital status is single Those persons, if any, who are Justin Fisher's next-of-kin and their relationship to same, of whom your Petitioner has knowledge are as follows: Joseph Fisher, father 7. No other Court within the Commonwealth of which Petitioner has knowledge has appointed a guardian for Tustin Fisher 8. ~ustin Fisher is intellectually disabled. 9. Because of mental deficiency, ~ustin Fisher lacks sufficient capacity to make or communicate responsible decisions concerning his/her person as set forth in the attached Affidavit prepared by: Susan Carbaugh/Cumberland-Perry Intellectual and Developmental Disabilities Program Director marked as Exhibit A and made a part hereof. 10. Tustin Fisher is in need of residential mental retardation services. 11. Tustin Fisher has been accepted for placement at upon the condition that a guardian of the person be appointed to consent to said placement on his/her behalf. 12. Susan Carbaugh/Cumberland-Perry Intellectual and Developmental Disabilities Pro rg am Director, having no interest adverse to justin Fisher has agreed to act as Temporary Guardian of the Person of ~ustin Fisher if this Honorable Court shall so appoint. WHEREFORE, Petition prays this Court place under the temporary guardianship of Tustin Fisher ;pursuant to 20 Pa. C.S.A. 5513 and empower said temporary guardian to provide substitute consent for such community-based or institutional services as may be necessary to provider for his/her needs. BY: 7177764428 BIG SPRING ADMIN OFFIC BIG SPRING DISTRICT OFFICE 08;42;17 a.m. 11-10-2011 2 /5 ~~Wg S°hao~ BIG SPRING SCHOOL DISTRICT ,~ K Jessica Winesickle, LSW as ~--~;, ~. Home and School 'Visitor ~' ~~` x 45 Mount Rock Road -~ ~~~ ~~ ~"' ~ ~ ~'~ Newville, PA 17241 `P (717) 776-2446 1h rh~F4st a ~nda`"~ November 10, 2011 Ms. Connie Herman Cumberland County MH/ IDD ] 6 W. High St. Carlisle, PA 17013 Dear Ms. Herman, The following documentation lists health and safety concerns Big Spring School District has seen regarding Justin Fisher. The first two pages list concerns, as well as any action taken by Jessica Winesickle, Big Spring Home and School Visitor. On page three, you will find observations from Justin's teacher, Mrs. Jessica Dagle. 3/20/08- Mrs. Dagle observed right lower arm- three small bruises. 4/29/08- Mrs. Dagle observed right lower arm bruise noted-'/4 inch X 1 '/Z inch wide. Left arm above and below elbow four circular bruises % inch in diameter. 4/23/08- Justin arrived to school with vomit in his hair. Mrs. Dagle was not able to reach parents as all numbers were disconnected. Mrs. Dagle and aides washed Justin's hair. 5/5/08- Mrs. Dagle observed bruise on left shoulder-'/a inch. 517/08- Mrs. Winesickle spoke with Lori at CYS regarding injuries observed over past few months. 8/4/0$- Mrs. Winesickle called CYS and spoke to Beth Browning regarding concern of Justin's weight loss: 7/3- 75.5 lbs, 7/15-74 lbs, 7/25- 7l ibs, 7/30- 68 Ibs ~ Per Rita Warren of Carlisle Area School District, Mr. Fisher reported they are giving Justin Pediasure again 9/9/08- Big Spring received letter from Dr. Thaler at Sadler. Letter dated 8/28/08. Stated Justin has a chromosome disorder and his stature and weight are appropriate for his condition. November/ December 2008 Report from bus driver that Justin was put on the bus with a soiled diaper on 10/21!48, 11/4/08, and 11/7/08. 7177764428 BIG SPRING ADMIN OFFIC BIG SPRING DISTRICT OFFICE 08:42:36 a.m. 11-10-2011 3 /5 Report from Mrs. Dagle that Justin sent to school several days in November (] 1112, 1 l/l 3, 11/14, 11/17, 11/18, 11/19, 11/20) in short sleeves. High temperature outside ranged from 36 degrees to 54 degrees. Mrs. Dagle wrote several notes home asking for Justin to be dressed in long sleeves. 12/3/08- Per Mrs. Dagle, Justin has feces up his sides and on his stomach; has had diarrhea; she e-mailed Carlisle SD 12/4/08- Mrs. Winesickle placed a call to Childline regarding above concerns along with some concerns about Justin's younger brother Jarret -Case at this time with Perry County CYS involving mom's boyfriend 3/25/09- Meeting with representatives from Carlisle Area School District, Big Spring School District, Megan Johnston from CASSP, and Mr. Fisher. Met to provide information about various services county may be able to offer such as MH/MR. Also discussed concern about lack of transportation when Justin is sick and needs to go home. A case was not opened with MH/ MR as a result of this meeting. 5/2/09- CASD made call to Childline 2/17/1 U Per Mrs. Dagle, Justin came to school with a substance on hands that looked and smelled like feces, Continues to have a rash. Mrs. Weingarten obtained permission from dad to do a finger prick test and also spoke with dad about getting linked with MH/MR. 3/2/10- Mrs. Winesickle spoke with Mr. Fisher about getting linked with MH/MR for assistance. 3/22/1 ] -Mrs. Dagle observed a few dime sized black and blue marks on Justin's inner Left thigh. Mrs. Dagle wrote a note to Mr. Fisher about the injury but received no response or explanation. Mrs. Dagle called police- Detective Griest investigated. 8/30// 1-Justin presented to the nurse as "very pale, lethargic and unable to ambulate independently" per Mrs. Madden (nurse). She provided coke syrup, food, and water. Justin weighs 70 (bs, down from 75 lbs in June. Nurse spoke with father who said doctor had recommended Pediasure. Father trying to get him an appointment so doctor could write a prescription and insurance would cover the cost. -Mrs. Dagle and Mrs. Madden observed bruise above Justin's right knee- resembles a bite mark; Also, a "V" shaped bruise on his lower back/ hip area. Mrs. Winesickle spoke with Detective Griest. 10/4/11- Mrs. Dagle observed bruise on outside of left thigh; Mrs. Winesickle spoke with Connie Herman and e-mailed Detective Griest 10/17/11- Mrs. Dagle observed small bruises on inner right thigh. Mrs. Winesickle e-mailed Detective Griest and Connie Herman. 7177764428 BIG SPRINGADMINOFFIC BIG SPRING DISTRICT OFFICE 08:43:OOa.m. 11-10-2011 4/5 Tuesday 8/30: Justin arrived looking disheveled. He was pate and needed a haircut. 1 called Mr. Fisher about getting Jt-stin a haircut. He said that he would get him one once he got paid. I told him that Justin was scratching his right ear-not sure if hair was tickling him or if he had an earache. i also talked to him about the importance of sending the communication book back to school every day so that we can communicate our concerns and other information. I also sent home a school picture form. We sent Justin to nurse after recreation class because he was very pale, lethargic and almost unable to walk independently, The nurse gave him food and coke syrup. His temperature was also 98.3. See documentation from Carol Madden, our nurse. When changing his diaper, bruises were noticed. He had a large v-shaped bruise on the back side of his right hip. He also had what appeared to be a bite mark above his right knee. This bruise is in a position where Justin would not be able to inflect on himself, Photo documentation was taken and Carol Madden, Jess Winesickle, and Rita Warren were notified. Jess Winesickle phoned Det. Griest. Wednesday 8/31: Mr. Fisher couldn't get through to the classroom so he called the front office twice and explained to the secretary that Justin had projectile vomited twice on the night before('I'uesday 8/30), f-Ie took Justin to the hospital. The hospital gave him medicine to stop tl~e vomiting. Mr. Fisher was also told to give Justin Miralax because he wasn't having BMs. Thursday 9/1: Justin has what appears to be a hemorrhoid. The nurse called dad and asked him to monitor it. Tuesday 9/6: Justin arrived pale, gaunt, and with dark circles under his eyes. Once he walked into the classroom, he immediately went to his breakfast area. Wednesday 9/14: We washed Justin's coat because of the strong smell. Wednesday 9128; Sent Justin home with his backpack and paperwork. Thursday 9/29: Justin's driver told us that Mr. Fisher wouldn't take the backpack, saying that it wasn't Justin's. Mr. Fisher said that he had never seen the backpack before and wouldn't take it. I wrote a note explaining that he indeed sent the backpack iri one of the first days of school. When another backpack was inadvertently sent it, we kept the other backpack in the classroom as a back-up. Friday 9/30: We washed Justin's coat because it had a bad odor. Justin also appeared to have been wearing the same socks all week. They progressively appeared darker and smelled stronger. Tuesday 10/4: Justin began scratching his right ear again so he was taken to the nurse. She noted that it was very red and phoned Mr. Fisher to get Justin a dr. appointment. Mr. Fisher told her that he would call Sadler as soon as she hung up the phone. He also said that if he couldn't get an appointment, he would take him to the emergency room that evening. 1 called him later that day to remind him to fill out forms. I asked him if he made Justin an appointment. He said that he got an appointment for the following Wednesday J O/12. 1 explained that he should see a dr. sooner than that. Tuesday 10/I1: I called to remind Mr. Fisher to take the Physical Therapy form to Justin's dr. appointment the next day. He told me that he canceled that appointment because he took Justin 7177764428 BIG SPRING ADMIN OFFIC BIG SPRING DISTRICT OFFICE 08:43:29 a.m. 11-10-2011 5 /5 to the emergency room over the weekend (10/8,9). He said that Justin has an ear infection and he is taking medication. Monday 10/17: Justin arrived with dried blood caked to his right ear canal. The nurse looked in his ear and could see nothing but dried blood. The nurse called Mr. Fisher and suggested that Justin see a doctor. Mr. Fisher walked to the Real Deal House in Carlisle to get Justin at 9:30. Once he arrived, he told Rhonda Stokes, a classroom aide, that he didn't want to walk Justin to the hospital because Justin has asthma. He has never communicated that condition on any health information form. He also said that he had no money for a cab and that he had no one to pick him up and take him to the hospital. He then called for an ambulance to take Justin to the hospital. After Justin was seen at the hospital, Mr. Fisher called for a ride and dropped Justin back at the Real Deal House at around 1:00. Mr. Fisher also told Rhonda that he had given Justin 2 doses ot'the antibiotic (this was more than a week since the medicine was prescribed), After changing him, we found bruising on his upper right thigh that appear to be from pinching. Photo documentation was taken and Carol Madden, Jess Winesickle, and Rita Warren were notified. Justin was also walking abnormally. The OT removed his shoes to see if he had discomfort or any signs of injury. She found a sock balled up in the toe area of one of his shoes. Those toes and heel were red. Monday 10/24: Justin arrived appearing weak, pale, and with dark surilcen eyes. Once in the room, he immediately walked to the area where we feed him breakfast. Wednesday 10/27: Justin arrived very pale. When we changed his diaper, we noticed a lot of residual BM that had not been cleaned properly. Monday 10/31: Justin walked directly to his eating area. He also had what appeared and smelled like feces under his fingernails. He seemed restless throughout the school day. Tuesday 11/1: Justin walked directly to his eating area. He also had what appeared and smelled like feces under his fingernails. Sincerely, Jessica Winesickle, LSW Home and School Visitor BIG SP~~HOOL DISTRICTSpecial Education45 Mount Rock RoadNewville, ,Q(~`" ; ~ °~ ~;_ PA 17241REEYALUATION REPORT (RR ) ~ ~ ~• ~~ School Age ~~ `~ ~ DEMOGRAPHICS F, DATE OF i~ Eno w~~s DATE REPORT WAS PROVIDED TO THE PARENT: 412912010 °Y~rs~.~ ,~ STUDENT NAME':SltsstJ~'~is~her GENDER:MaIe STUDENT BIRTH DATE: 9/21/91 AGE: 18 SOCIAL SECURITY NUMBER: 204724691 ETHNIC BACKGROUND: White, not Hispanic Origin DISTRICT OF RESIDENCE: Carlisle COUNTY OF RESIDENCE: Cumberland Student Address Home Phone Number E-Mail address 1349 Grandview Ct. Carlisle, PA 17013 226-5696 Additional Contacts & Addresses Relationshi to Child Phone Agency Type Name Address Type Number E-Mail Address ParentJGuardian with whom the child lives Father 3oseph Fisher NA Cell 226-5696 Parent/Guardian with whom the child lives NA SCHOOL STUDENT IS ATTENDING: Middle School GRADE: 10 TEACHER: Jessi Antol SCHOOL COUNSELOR: Anne Fulker Date IEP Team Reviewed Existing Evaluation Data:4/29/2010 The IEP team must decide if it has enough data to determine: the student's educational needs; the present levels of academic achievement and related developmental needs of the student; whether any additions or modifications to the special education and related services are needed to enable the student to meet the measurable annual goals in the IEP and to participate as appropriate in the general education curriculum; and whether the student continues to need special education and related services. Distribute To ^ File a Report (Rev July 2008) special Ed. secrecaryParent0[her TeacherPDEBSE Reevaluation 4126! 10 RR for Justin Fisher I. SUMMARIZE INFORMATION REVIEWED Complete items 1-7 for all students. 1. Physical condition, social, or cultural background, and adaptive behavior relevant to the student's disability and need for special education: Justin is an 18 year old student who has attended the MDS classroom at Big Spring Middle School since the 2007-2008 school year. Prior to this placement, he attended the MDS classroom at the Cedar Run School. He lives in Carlisle with his father and two brothers. Justin is a student identified with multiple disabilities, including mental retardation. According to information obtained in a previous review of his records, Justin has translocation chromosome 17, asthma, gastroesophageal reflux, oral sensitivity, and in need of "breathing prompts". Justin is ambulatory but requires close supervision because he can be unsteady and can walk in unsafe areas. While at Big Spring, he has never required "breathing prompts". His father has told us that Justin suffers from acid reflux and is given Prilosec at home to limit the effects. He also said that Justin should not have tomato products or shelled vegetables (corn, peas, beans). We have noticed rumination after Justin has dairy products, so we try to limit these as well. Justin is completely dependent on others for all daily living tasks. He must have adult assistance to eat, change his diaper, safely navigate his environment, perform hygiene routines, and keep him on task. When Justin arrived in the 07-08 school year, he displayed some oral stimulation behaviors. He consistently placed most of his hand in his mouth. He also pushed his fist into his throat. It was speculated that he may have done these things due to an acid reflux problem, a possible swallowing problem, or simply for sensory stimulation. We had begun pureeing his food that school year and saw a significant decrease in these behaviors. If he does this behavior, we direct him with "hands down". He follows this directive well. At the beginning of each school year, the cafeteria requires that his father obtain a prescription for pureed food. He also rubs his hands and fingers, probably another replacement for sensory stimulation. We have some toy rings or shower curtain rings that we give him as fidgets. These decrease the hand rubbing. While he is eating, he will slide his hand up and down on the spoon when it is in his mouth. He will also push the spoon all the way to the back of his throat. We adapted a baby spoon with a guard and a large foam handle cover so he is unable to harm himself. The IEP team has expressed multiple concerns over Justin's health. During mild exercise, Justin's heartrate has been timed at 170 beats per minute. His face appears flushed and his nail beds appear bluish. A letter was sent home by the teacher after she consulted 2 nurses. The nurses both agreed that Justin could have a circulation, heart, or pulmonary problem. The school has received no follow- up information. In the summer of 2008, Justin lost 12 pounds in 2 months. A letter from Sadler Medical stated that for his disability, his weight is normal. His weight has been maintained throughout the 08-09 and 09-10 school yeazs. The school is also concerned that Justin doesn't swallow or chew his food. He regurgitates food all day long. We are concerned with Justin choking on regurgitated food. It was recommended that Justin have a dysphagia exam performed. In 2009, a speech therapist performed the exam and thought that Justin should be evaluated for his eating/swallowing skills at Hershey Medical Center. The exam was never performed. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 2 4126/ 10 RR for 3ustin Fisher 2. Evaluations and information provided by the parent (or documentation of LEA's attempts to obtain parental input): None provided 3. Aptitude and achievement tests: In November 1997, Justin received a psychological assessment as a school aged student. The summary of the assessment included the following information: "Justin Fisher, age 76 months with a mental age equivalent of about 19 1/x months and an IQ equivalent of 26 appears to be functioning within the severe range of mental retardation with moderate to severe deficits in all areas of adaptive functioning including communication, daily living skills, socialization, and motor skills. Justin appears eligible for and in need of continued special education services as a student with Multiple Disabilities with multiple diagnoses of severe mental retardation, gastroesophageal reflux, severe motoric involvement, and hypotonicity." It is also recommended that Justin receive a psychological evaluation before he graduates in 2013. 4. Current classroom based assessments and local and/or state assessments: Due to Justin's current level of academic functioning, he does not participate in local or state assessments, with the exception of the PASA. Justin is eligible to participate in the PASA based on the 6 criteria outlined by the PA Department of Education. PASA reports indicate that Justin requires considerable support to complete the reading and math activities. His latest PASA results can be found attached to his IEP for 2009-2010. Due to Justin's low academic functioning, he is not assessed in any academic subjects and cannot write or express his thoughts. He follows a curriculum based on daily living skills. This curriculum is mainly focused on developing communication, sensory awareness, and self-help skills. The IEP team believes that post graduation, Justin will benefit the most from an adult day care program. Based on the Quality of Life Survey and the progress of his goals, it's proven that he is completely dependant on others for safety, sustenance, hygiene, work ethic, and leisure activities. The Quality of Life survey is attached to the back of this IEP. Below is Justin's goal data from the beginning of the school year until 4/261 10. 1. "put-in" activity-currently averaging 8.7 items. His goal is 20 items. 2. visually attend-currently averaging 3.1 seconds. His goal is 10 seconds or more. 3. "do this"-NR. His goal is to perform the task within 3 seconds. 4. one step direction- currently averaging 16.7 seconds. His goal is 10 seconds or less. 5. Observations by teacher(s) and related services provider(s), when appropriate: Occupational Therauy- Justin was seen for 2 visits per month over the last IEP year for self help skills and upper body strengthening within his educational setting. Justin typically demonstrates aright-handed preference during functional activities like picking up objects within his environment and self feeding. Justin can demonstrate a functional pincher grasp and demonstrates the ability to cross midline when reaching for objects. Self help skills- Justin continues on a puree diet and is able to feed himself after set-up of his tray is competed by staff. Justin currently uses a pediatric sized spoon with a built up handle to prevent an excess of food being placed in his mouth. Justin's spoon now has a guard around the shaft of the spoon to also prevent Justin from pushing the PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 3 4/26/10 RR for Justin Fisher spoon too far back in his mouth. Justin is independent in using his sippy cup for his liquids. Justin is seated on a wedge cushion with a soft cushion positioned behind his back during the lunch time meal to promote the best possible position for digestion. Sensory regulation skills- Justin appears to enjoy a multitude of sensory experiences both in and out of the classroom. Justin appears to enjoy tactile and visual experiences the most. He will smile, and squeal when an activity is pleasing to him. Physical Therapy School Mobility and Positioning When in the classroom, Justin sits in either a Rifton chair during classroom activities or a regular chair while eating breakfast. He has no difficulties sitting or transferring into and out of either of the chairs independently, but he usually requires verbal cues to sit or stand from the chair. Justin transitions from standing to sitting on the floor independently without the use of support, but he prefers to use furniture for support when transitioning into standing. When completing this transition he is able to use ahalf--kneel technique leading with his left leg and if Justin is given very light assistance to initiate the stand he is then able to follow through successfully. Justin is able to lead with his right leg when moderate assistance or support (i.e. wall, furniture)is provided, but he prefers to lead with his left leg. Justin walks independently throughout his school environment with a narrow base of support, both feet occasionally scissor (cross over) and decreased arm swing. He is independent in his ability to walk around the classroom and in the hallways, but requires supervision for safety. Recently, Justin has required contact guard and hand held assistance when walking in the halls during therapy sessions due to his increased unsteadiness. School Posture and Gross Motor Foundations Justin continues to ascend and descend a short flight of stairs using the handrail and verbal prompts to "step". Justin is unable to lead with his right foot when descending the stairs even when he is verbally and manually prompted. When ascending the stairs Justin is able to alternate his feet, but he still requires close supervision on the stairs for safety. He presents with decreased strength throughout his arms and hands. He does well with activities that encourage strengthening if it is paired with an activity that provides sensory input. Justin has balance difficulties and when challenged by uneven surfaces, he may lose his balance. Justin has to use increased postural adjustments to maintain his balance during static balance (standing on one leg) activities and he is unable to perform dynamic balance (jumping) activities during our sessions when verbaUmanual cues are provided along with demonstration. He is able to stand on either leg momentarily when ascending/descending acurb or step and he is unable to walk on a line. Most recently he worked in the mat room using a tall kneel position, walking while kicking a ball (10 feet four times), and practiced transitioning to/from the floor into standing. When leading with the left leg he required hand held assistance from the therapist. He walked in the mat room IS feet, six times while placing bean bags in a bin and practiced kicking a 5" ball with his left foot. He was unable to consistently kick the ball and more often required a weight shift to be provided by the therapist in order to lift either leg to kick the ball. 6. Teacher recommendations: It is recommended that Justin's IEP and current educational placement are appropriate for him at this time. It is also recommended that Justin receive a psychological evaluation before he graduates in 2013. This will provide necessary information for Justin's post-graduation experiences. 7. DETERMINING FACTORS - A student must not be found to be eligible for special education and related services if the determining factor for the student's disability is any of those listed below. Respond Yes or No to, and provide evidence for, each determining factor below. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 4 4/26/10 RR for Justin Fisher Yes ® No Lack of appropriate instruction in reading, including the essential components of reading instruction. Provide evidence: Adaptations have been made to include reading in the curriculm to address Justin's specific needs. (] Yes ® No Lack of appropriate instruction in math. Provide evidence: Adaptations have been made to include reading in the curriculm to address Justin's specific needs. Yes ® No Limited English proficiency. Provide evidence: English is Justin s primary language. II. DETERMINATION OF NEED FOR ADDITIONAL DATA, SUMMARY AND CONCLUSIONS Based on all evaluation data reviewed, complete item 1 or item 2. 1. ® The IEP team determined that additional data are not needed. Reason(s) additional data aze not needed: The IEP team has determined that Justin's need for Specially Designed Instruction and Related Services can be determined from the information that the team already has available. Conclusion: Complete section A or B or C. A. ® The student has a disability AND continues to need specially designed instruction. i. Disability Category Primazy disability category: Multiple Disabilities Secondary disability category(s), if any: Mental Retardation ii. Summary of Findings Student's educational strengths and needs: Stren¢ths • Self feeds after initial set-up is complete. • Can maintain sitting posture. • Tolerates a vaziety of sensory experiences. • Pleasant, cooperative • Eagerly activates a switch in order to participate in classroom activities • Eager to gain praise with participation in routines • Makes choices for leisure activities from real object photo icons • Sits in a regular student chair for short periods of time • Sits with good posture when using cushions • Walks independently on level surfaces • Walks up and down stairs with a railing • Assists with toileting/dressing tasks • Accepts sensory input such as deep pressure, textured items, vibration • Alert and responsive to classroom activities • Responds to and recognizes familiar adults and peers PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 5 4/26/10 RR for Justin Fisher • When prompted, grasps objects with right hand for short time • Walks independently throughout school environment • Sits independently in school chairs and while in the cafeteria • Functional grasp in both hands Needs • Supervision for safe movements throughout the school setting • Needs a pureed diet to help with reflux disorder • Improved balance skills • Improve independence with fine motor skills. • Improve "put in" work type tasks • Increase visual attention to activities • Improve imitation skills • Improve following direction skills • To increase daily communication through picture exchange • Needs close supervision for most tasks to ensure safety • Increase safety awareness in different settings • When walking, needs to improve visual attention to look where he is stepping to ensure safety • Opportunities to perform daily living skills independently (rinsing and putting away dishes, placing communication book on teacher's desk, putting away blanket, passing out items to other students, carrying items to lunch) • Decrease hand over hand assistance to complete most tasks • Improve consistency in performing daily tasks • Needs assistance for self help tasks: feeding, hygiene, grooming, diapering, and dressing • Needs assistance to participate in turn-taking activities such as passing objects to a classmate • Needs additional response time to respond to a direction and to visually attend to presented materials • Needs adult to make purposeful eye contact with him when giving him directions • Needs to improve ability to express wants and needs by choosing a preferred object from a field on an augmentative device • Improve ability to transition from sitting on floor to standing position • Use amulti-sensory approach to learning • Increase use of upper extremities during functional activities Present levels of academic achievement and related developmental needs, including transition needs as appropriate: Ongoing assessments have been requested to better gauge possible post-secondary outcomes for Justin. The IEP team believes that post graduation, Justin will benefit the most from an adult day care program. Based on the Quality of Life Survey and the progress of his goals, it's proven that he is completely dependent on others for safety, sustenance, hygiene, work ethic, and leisure activities. The Quality of Life survey was administered in May 2009 and can be found attached to the back of his May 2009 IEP. Justin requires multiple verbal, visual, and physical prompts to complete pre-vocational job tasks. His main interest has shown to be food. He enjoys interaction with certain adults but food is his main motivator. He vocalizes utterances for some things. He says "EEEEE" when he wants something to eat. He says "INK" when he wants something to drink. He also says "A SIGH" when he wants to go outside, but this is said less frequently than the other two utterances. According to ongoing Curriculum Based Assessments and Progress Monitoring Data, Justin has decreased progression in 3 out of 4 of his goals since the end of the 08-09 school year. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 6 4/26!10 RR for Justin Fisher Below is Justin's goal data from the beginning of the school year until 4/26/10. 1. "put-in" activity-currently averaging 8.7 items. His goal is 20 items. 2. visually attend-currently averaging 3.1 seconds. His goal is 10 seconds or more. 3. "do this"-NR. His goal is to perform the task within 3 seconds. 4, one step direction- currently averaging 16.7 seconds. His goal is 10 seconds or less. Recommendations for consideration by the IEP team regarding any additions or modifications to the special education and related services needed to enable the student to meet the measurable annual goals in the IEP and to participate as appropriate in the general education curriculum (including special considerations the IEP team must consider before developing the IEP, measurable annual goals, specially designed instruction, and supplementary aids and services): A Due to Justin's functional ability in daily living skills, rate of acquisition, skill retention, present academic levels, and communication, he would need significant modifications and adaptations to be successful in the general educational curriculum. Therefore, Justin participates in the Multiple Disabilities Support curriculum for the majority of the day, which focuses on those communication, daily living, and personal caze skills needed for everyday life. He will continue to receive Physical Therapy, Occupational Therapy and Adaptive Physical Education as direct service and receive Support for School Personnel for Speech and Language Therapy. OR B. ^ The student does not have a disability and no longer is eligible for special education. (The pazent may request an assessment to determine whether the student continues to be a student with a disability.) OR C. ^ The student has a disability but no longer needs specially designed instruction, and no longer is eligible for special education. (The pazenUguazdian/surrogate may request an assessment to determine whether the student continues to be a student with a disability.) 2. ^ The IEP team determined that there is a need for additional data. The LEA must issue the Permission to Reevaluate -Consent For-n and administer tests and other evaluation materials as may be needed to produce the data below. NOTE: IF REEVALUATING THE STUDENT TO DETERMINE SPECIFIC LEARNING DISABILITY, COMPLETE THE DETERMINATION OF SPECIFIC LEARNING DISABILITY COMPONENT AT THE END OF THIS DOCUMENT BEFORE COMPLETING THE SECTION BELOW. Interpretation of additional data: Conclusion: Complete section A or B or C. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 7 4/26/10 RR for Justin Fisher A. ^ The student has a disability AND continues to need specially designed instruction. i. Disability Category Primary disability category: Secondary disability category(s), if any: None ii. Summary of Findings Student's educational strengths and needs: Present levels of academic achievement and related developmental needs, including transition needs as appropriate: Recommendations for consideration by the IEP team regarding any additions or modifications to the special education and related services needed to enable the student to meet the measurable annual goals in the IEP and to participate as appropriate in the general education curriculum (including special considerations the IEP team must consider before developing the IEP, measurable annual goals, specially designed instruction, and supplementary aids and services): OR B. ^ The student does not have a disability and no longer is eligible for special education. (The parent may request an assessment to determine whether the student continues to be a student with a disability.) OR C. ^ The student has a disability but no longer needs specially designed instruction, and no longer is eligible for special education. (The parent/guardian/surrogate may request an assessment to determine whether the student continues to be a student with a disability.) Upon completion of the reevaluation, the Local Education Agency will complete and issue the report to the members of the evaluation team. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 8 4/26/10 RR for Justin Fisher REEVALUATION REPORT SIGNATURES DIRECTIONS TO TEAM MEMBERS: Check AGREE if you agree with this report; check DISAGREE if you do not agree. If you do not agree, Please sign Form B instead and write the reason for your disagreement in the space provided. A ree Disa ree Evaluation Team Participants Name Or Signature** Title (Required when evaluating children with specific learnin disabilities.) Rita Warren, Carlisle Administrator Angela Heishman School Psychologist* Jessi Antol MDS teacher Laura Kosak Physical Therapist Heidi Sowers COTA/L ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ * A certified school psychologist is required for evaluation of the following disability categories: Autism, Emotional Disturbance, Mental Retazdation, Multiple Disabilities, Other Health Impairments, Specific Learning Disability or Traumatic Brain Injury. A certified school psychologist is not required for Deaf-blindness, Deaf and Hazd of Hearing, Speech/Language Impairment, Visual Impairment, and Orthopedic Impairment. ** For specific learning disability only, if a team member disagrees with the team's conclusion related to the identification of the student as having a specific learning disability, the member must submit a sepazate statement presenting the member's dissent to the LEA. This information must be attached to the Evaluation Report. Please submit this statement to: William Gillet 717-776-2422 gillet@bigspring.kl2.pa.us LEA Representative Name Phone Number Email Address A copy of the Procedural Safeguards Notice is available upon request from your child's school or is available on the District's web page (www.bigspringklZ.pa.us). This document explains your rights, and includes state and local advocacy organizations that are available to help you understand your rights and how the special education process works. For help in understanding this form, an annotated Reevaluation Report is available on the PaTTAN website at www.oattan.net Type "Annotated Forms" in the Seazch feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800- 441-3215. Waiver of Waiting Period (If Applicable) I would like the IEP Planning meeting to immediately follow the Multidisciplinary Team meeting. I understand that I will not have a finalized copy of the "Reevaluation Report" prior to the IEP planning meeting, and I am waiving my right to the minimum 10 day wait period to review the report. Parent Signature Date PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 9 4/26/10 RR for Justin Fisher REEVALUATION REPORT SIGNATURES FORM B (To be used when a team member disagrees with the report of a child with a Learning Disability or when a team member does not have access to the original ER signature page) DIRECTIONS TO TEAM MEMBERS: Check AGREE if you agree with this report; check DISAGREE if you do not agree. A ree Disa ree Evaluation Team Participants Name or Signature Title (Required when evaluating children with specific leatnin disabilities.) ^ ^ ^ ^ If you disagree with the report please write the reason for your disagreement here, or attach a separate statement. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 10 4/26/10 RR for Justin Fisher DETERMINATION OF SPECIFIC LEARNING DISABILITY NOTE: This component must be completed when reevaluating students for Speck Learning Disability. The information must be attached to and/or incorporated into Section II Item 2 of the completed Reevaluation Report. Provide documentation for items 1-10. 1. The student does not achieve adequately for the student's age or does not meet State-approved grade-level standards in one or more of the following areas when provided with learning experiences and scientifically based instruction appropriate for the student's age or State-approved grade level standards and level of English language proficiency: oral expression, listening comprehension, written expression, basic reading skill, reading fluency skills, reading comprehension, mathematics calculation, and mathematics problem-solving. Click Here 2. Check below to identify the process(es) used to determine eligibility. ^ Response to Scientific Research-Based Intervention (RtI). Document the criteria below. The student does not make sufficient progress to meet age or State-approved grade-level standards in one or more of these areas: oral expression, listening comprehension, written expression, basic reading skill, reading fluency skills, reading comprehension, mathematics calculation, and mathematics problem-solving: Click Here ^ Severe Discrepancy between Intellectual Ability and Achievement. Document the criteria below. The student exhibits a pattern of strengths and weaknesses in performance, achievement or both relative to age, standards or intellectual development: Click Here 3. The instructional strategies used and the student-centered data collected: Click Here 4. The educationally relevant medical findings, if any: Click Here 5. The effects of the student's environment, culture, or economic background: Click Here 6. Data demonstrating that prior to referral or as part of the referral process for a specific learning disability, the student's regular education instruction was delivered by qualified personnel, including the English as a Second Language (ESL) program, if applicable: Click Here 7. Data based documentation of repeated assessments of achievement at reasonable intervals, reflecting progress during instruction, which was provided to the parents: Click Here PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: I 4/26/10 RR for Justin Fisher 8. An observation in the student's learning environment (including the regular classroom setting) to document the student's academic performance and behavior in the areas of difficulty. Note the relationship of that behavior to the student's academic functioning: Click Here 9. Other data, if needed, as determined by the evaluation team: Click Here 10. Include a statement for each item below to support the conclusions of the evaluation team that the findings are not primarily a result of Visual. hearing` motor disability: Click Here Mental retardation: Click Here Emotional disturbance: Click Here Cultural factors: Click Here Environmental or economic disadvantaee: Click Here Limited En lg ish proficiency NA Upon completion of the SLD Component, attach and/or incorporate this information into Section II Item 2 of the completed Reevaluation Report. PDE/BSE EVALUATION REPORT (Rev. 8/2008) Page: 2