Bend - La Pine Schools

Special Programs
520 NW Wall St Individualized Education Program
Bend, OR 97703
Phone: 541-355-1060
Fax: 541-355-1069

Student Name: Fletcher, Laila R. Home Phone: Date: 04/20/2022

Date Of Birth: 01/31/2015 Home Address: 1880 NE Maker Way
Student No.: 323758 Bend, OR 97701
State Student ID: 21271429
Age Gender Grade Home School Attending School
7 Female 01 Juniper Elementary School Westside Village Magnet School
Ethnicity Phone Phone
White 541-355-1800 541-355-2000
Primary Language - Date Determined Address Address
1300 NE Norton 1101 NW 12th St
Home Language - Date Determined
English Bend, OR 97701 Bend, OR 97703

Parent/Guardian
Name Cell Name Home Phone
Aria Fletcher 541-337-9665
Address Home Address Work Phone

1880 NE Maker Way 541-337-9665

Emergency Phone Emergency Phone
Bend, OR 97701

IEP Review Due Date : 04/19/2023 Re-evaluation Due Date: 08/06/2023

Eligibility(ies): Developmental Delay

Interpreter Needed: Yes No

Documentation of efforts to schedule the IEP Meeting:

Date Description

04/19/2022 Addy re-scheduled Laila's meeting due to Aria's work schedule.

B. IEP Team Members

Names Position Present/Absent

Fletcher, Aria D. Mother Present
Fairman, Lisa A. District Representative Present
Moscatello, Gianna L. Educational Assistant Present
Beck, Kelsi E. General Ed Teacher Present
Cena, Lisa Occupational Therapist Present
Fairman, Lisa A. Person Interpreting Evaluation Results Present
Ramina, Addy A. Special Ed Teacher Present
Notebaart, Jessica C. Student Success Coordinator Present
Ashley Ludwig WRAP coordinator Present
Kelly Harrild Family Partner Present
Lovely Elrod Aftercare coordinator Present
* If required team member is excused, attach signed written agreement between parent and district before proceeding.

Bend - La Pine Schools - Individualized Education Program Page 1 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

C. SUMMARY OF PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Strengths of Student (Academic, Functional, Behavior, Learning characteristics, etc.)
Laila is a very bright student with a great sense of humor at Westside Village. She loves cats and all animals and her favorite Middle Schooler.
Laila craves and seeks social relationships. She loves to play with her mom at home, especially baby dolls. She has a great imagination and
enjoys imaginative play. She likes the color black. She loves to do all kids of art, especially painting and is very creative.

Her favorite part of the school day is seeing her favorite middle school student. She loves making cards for her. Laila enjoys going to the
school garden and collecting and taking care of bugs. She also said that she likes writing. She has strong developing academic skills. She is
also developing strong leadership skills and is fun. She has a great memory.
Concerns of the parent(s) for enhancing the education of the student
Aria shared that she has been improving with bathroom accidents. She is speaking up more for herself, but still wants mom to talk for her when
she is around.

Mom noticed that she can be unkind and aggressive with peers and wants to help her with that.

She is currently trailing 1 mg of guanfacine daily. Teachers and parent have not yet noticed any effects.
Present level of academic performance, including the student's most recent performance on state or district-wide assessments

Results of state and district group assessment measures:

Test Test Level Test Date

DIBELS (DI) 01 02/09/2021

Subject Score Performance

Words Read 15 At or Above

(Low Risk)
Accuracy (%) 75 Below
Benchmark
(Some Risk)
Retell Fluency 0
Retell Quality 1
Nonsense Words - CLS 54 At or Above
(Low Risk)
Nonsense Words - WWR 16 At or Above
(Low Risk)
First Sound Fluency -
FSF
Letter Naming Fluency -
LNF
Phoneme Segmentation
- PSF

Daze-Adjusted
Composite 135 At or Above
(Low Risk)

Additional Present Levels

ACADEMICS:
At Westside Village we measure student progress using the Oregon state benchmarks. Students often meet the emergent benchmark at the
end of first grade. Typically students meet the first benchmark in all academic areas at the end of third grade. Students should meet the
second benchmark between the end of fifth grade and the middle of sixth grade. Students show their mastery of the benchmarks through
samples of their academic work. These work samples are scored using rubrics aligned with the Common Core state standards. Currently
Laila is working to meet the emergent benchmark in math and the emergent benchmark in reading and writing.

READING:
Laila struggles to engage in formal ELA activities that are not of her choice. She loves to be read to, and is also able to demonstrate grade
level reading fluency skills. She earned 2 at the emergent benchmark on her ELA work sample, demonstrating that her skills are around grade
level expectations.

WRITING:
Laila is able to sound out many words and spell phonetically. She particularly enjoys writing cards to her favorite middle school students. She
earned 2 at the emergent benchmark on her writing sample, demonstrating that her skills are around grade level expectations.

MATH: Bend - La Pine Schools - Individualized Education Program Page 2 of 14

Laila earned a 1.5 at the emergent benchmark on her math science investigation. This work sample requires many steps to follow a process to
explore a math/science question.

BEHAVIOR/ SOCIAL/ EMOTIONAL:

Laila struggles to regulate in the school environment. This impacts her social relationships and access to academic instruction. When she is
Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022
earned 2 at the emergent benchmark on her writing sample, demonstrating that her skills are around grade level expectations.

MATH:
Laila earned a 1.5 at the emergent benchmark on her math science investigation. This work sample requires many steps to follow a process to
explore a math/science question.

BEHAVIOR/ SOCIAL/ EMOTIONAL:

Laila struggles to regulate in the school environment. This impacts her social relationships and access to academic instruction. When she is
not ready for learning (ready is calm safe body and kind words) she has a menu to choose from. She is currently receiving constant adult
support to help her to be safe and to support pro-social relationships with peers. She also takes scheduled regulation breaks. Gum is a great
regulation tool for her. She also loves to draw and to be a helper.

OCCUPATIONAL THERAPY
See OT Evaluation below. Recommend adding 180 min/year of consult service.

Recovery Services: On 4-21-22, the IEP team, including parents, considered the student's need for recovery services. It was determined that
Laila does not require recovery services. The student has made progress in all goal areas as compared to pre-COVID levels. She does
qualify for ESY due to regression over breaks and transitions.
Present level of developmental and functional performance (including results of initial or most recent evaluations)
OT EVALUATION, LISA CENA 4-20-22
Reason for Referral/Background:
Laila is a creative, hardworking 1st grade student at Westside Village Elementary School. She currently has an Individual Education Program
(IEP) with eligibility under developmental delay. Occupational therapy evaluation was completed to provide information to the educational
team, including the family, for determining Laila's need for occupational therapy services in the school environment. The purpose of this report
is to share the OT assessment with the educational team and family.

Assessment / Observations:
The following sources of information contributed to the occupational therapy evaluation:
Informal assessment of gross motor and fine motor skills
Classroom observations (3/9/22, 4/11/22, 4/18/22)
Sensory Processing Measure (3/7/22, completed by Jill Moore)

Strengths: Staff report Laila has many academic strengths. She loves learning, and shows a strong interest in reading and writing. She enjoys
coloring, especially if she is coloring with a peer. Laila reports to really enjoy drawing and participating in craft activities.

Reasons Staff Are Seeking Support: Staff would like to see Laila engage in classroom work on a consistent basis, and increase independence
in completing and turning in assignments. Staff would also like to see Laila work on self-regulation skills to be ready to learn, and to engage in
positive peer interactions.

Observations:
Laila was observed on several occasions both in the general education classroom and also working one on one with a staff member in the
project room. Several attempts were made to observe Laila playing outside with peers during recess, but she often chose to remain in the
building rather than play outside.

On 3/9/22, Laila was observed in her classroom. She was repeatedly running in and out of the classroom and would not stay in her classroom
despite staff support/prompts to return to the classroom. This continued for more than 15 minutes.

On 4/11/22, Laila was observed working one on one with a staff member in the project room. The plan was to construct a musical instrument
out of recycled materials. Laila brought a book of instrument samples and instructions to the project room. Once she arrived in the project
room, she stated she would rather make a pillow for a friend. She independently used the scissors and glue gun to create a pillow with stuffing.
She was able to cut the material with heavy scissors independently and use the glue gun to approximate the edges together. She alternated
between right and left handed use with cutting, but used her left hand primarily for handwriting tasks. She wrote a large heart on the pillow and
reported she would share this with another student. She was cooperative with following the guidelines for use of the items in the project room,
asked for help to retrieve items she couldn't reach, and was agreeable to help clean up and put the items away. She required multiple
reminders to finish the project within the agreed upon time frame to prepare to transition back to class.

On 4/18/22, Laila was observed in her general education classroom with her peers. She sat behind the rest of her classmates at a table by
herself while the rest of the class was sitting on or near the risers to watch a short video. The class was focusing on the topic of self-esteem.
The teacher asked the class several questions and encouraged the students to participate in partner discussions. Laila remained at the table
by herself. She did not raise her hand or answer any of the question prompts. She was working on a drawing. The picture was of a snow
globe with a snowman inside, with the words "Laila RIP" written underneath the snowman.
When the video was over, Laila moved closer to the other students. She stood behind them and started making loud animal noises.
The teacher asked Laila to stop, and encouraged her to take a break. Laila continued to make the noises, even when the other students asked
her to stop and reported that they did not like the noises. The teacher briefly had to step out of the room, and Laila then went to the front of the
class and made the same loud animal noises. The teacher then escorted her to a different classroom to work on a different activity.

Fine Motor Function: fine motor skills refer to skills using the hands for grasping objects, writing, cutting, development of hand dominance, and
many activities that require precise manipulation using small muscle groups. These skills were observed both in the general education
classroom and also during her time in the project room.
Laila uses her left hand for handwriting.Bend
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3 of 14
She is able to write letters primarily from a top down approach and maintain correct letter orientation. She alternates between upper and lower
case when writing the alphabet.

Activities of Daily Living: Her teacher did not report concerns with self-dressing, toileting, opening packages with snack/meal time or with
feeding.
Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022
many activities that require precise manipulation using small muscle groups. These skills were observed both in the general education
classroom and also during her time in the project room.
Laila uses her left hand for handwriting. She is able to maintain a tripod positioning with markers for coloring and for writing letters.
She is able to write letters primarily from a top down approach and maintain correct letter orientation. She alternates between upper and lower
case when writing the alphabet.

Activities of Daily Living: Her teacher did not report concerns with self-dressing, toileting, opening packages with snack/meal time or with
feeding.

Gross Motor/Movement Skills: Laila is able to run, skip, hop and gallop without difficulty. She demonstrates overall age appropriate
coordination for PE and play activities.

Sensory Processing:
The second edition of the Sensory Processing Measure, School Form (ages 5-12 years) was completed by Laila's teacher, Jill Moore. The
SPM-2, edited by L. Diane Parham, PhD, OTR/L, FAOTA, Cheryl L. Ecker, MA, OTR/L, Heather Kuhaneck, PhD, OTR/L, FAOTA, Diana A.
Henry, MS, OT/L, FAOTA, Tara J. Glennon, EdD, OTR/L, FAOTA, is a standardized questionnaire that assesses a student's sensory strengths
and differences. It addresses six areas of sensory processing including: Vision, Hearing, Touch, Taste and Smell, Body Awareness, Balance
and Social participation. Items are rated in terms of the frequency of a specific behavior (never, occasionally, frequently, always). Typical range
scores are indicated by a T-score between 40-59, moderate difficulties in the range of 60-69, and severe difficulties in the range of 70-80.
Results of the Sensory Processing Measure suggest that Laila is experiencing sensory differences from her peers in the areas of hearing,
planning, and social participation. Results for hearing and planning were in the moderate difficulty range with social participation in the severe
difficulties range.

Social (SOC) participation:

A child's ability to engage with others can be influenced by sensory processing issues. Often, difficulties in social-relational skills are related to
problems with sensory modulation or sensory seeking. In the area of social participation: Laila's T-score was 72.

Vision (VIS) Scale:

The Vision (VIS) items represent a range of visual processing vulnerabilities, including over and under responsiveness to visual stimulation,
seeking of visual input and problems with perception and ocular-motor function. A child who scores with a definite dysfunction may appear
distracted in environments that are visually rich and may try to avoid environments that are visually overwhelming. Often, such a child will
perform poorly in important functional activities that depend on vision, such as reading or copying material from a blackboard. In the area of
vision: Laila's T-score was 49.

Hearing (HEA) Scale:

This scale reflects the auditory processing vulnerabilities of over and under responsiveness, seeking behavior and perceptual difficulties. A
hearing score in the Definite Dysfunction range usually indicates multiple difficulties with auditory processing in a variety of settings. This child
may avoid auditory stimuli, make noise to drown out other sounds, or may cover the ears or retreat from noisy environments. Such a child may
appear unable to follow directions or hear well from a distance. In the area of hearing: Laila's T-score was 65.

Touch (TOU) Scale:

The touch scale includes many items representing tactile defensiveness, or over-responsiveness to tactile stimulation. A child who scores in
the Definite Dysfunction range is likely to demonstrate consistent problems with the processing of tactile information. This score may also
represent a child who seeks out experiences that provide deep and heavy touch or who has difficulty perceiving the location, intensity or
duration of tactile stimulation. In the area of touch: Laila's T-score was 43.

Taste and Smell (T&S):

The T&S scale items measure a range of taste and smell processing challenges, such as over- and under-reactivity to smells or tastes, active
seeking of taste or smell stimuli, and perception of taste or smell sensations. In the area of taste and smell: Laila's T-score was 44.

Body Awareness (BOD) Scale:

This is a lay term that refers to the proprioceptive sensory system. This describes a child's ability to sense the position in space of limbs,
fingers and other body parts. With a score of Definite Dysfunction a child may likely appear clumsy and uncoordinated and will often be too
rough with objects and people. Seeking behaviors are often related to under-responsiveness. In the area of body awareness: Laila's T-score
was 43.

Balance and Motion (BAL) Scale:

This is a lay term that refers to the vestibular sensory system. The vestibular system comprises a child's ability to maintain balance and upright
posture by sensing his or her own orientation with respect to gravity. A child who scores in the Definite Dysfunction range usually demonstrates
multiple difficulties with movement and balance, as well as postural control. This child may frequently move with poor control, may seem
fatigued or weak, or may appear clumsy and uncoordinated. In the area of balance and motion: Laila's T-score was 50.

Sensory Total (ST):

The Sensory Total (ST) score is a composite score that includes all of the items from the six sensory system scales (VIS, HEA, TOU, T&S,
BOD, BAL). In the area of Sensory Total: Laila's T-score was 51.

Planning and Ideas (PLA) Scale:

This is a lay term for praxis (motor planning), the ability to conceptualize, plan, and organize movements in order to complete unfamiliar motor
tasks. A child who scores in the Definite Dysfunction range may show consistently poor performance in many activities that require motor skill
and flexible problem solving. They may resist unfamiliar tasks, preferring repetitive play to novel activities. In the area of planning and ideas:
Laila's T-score was 68. Bend - La Pine Schools - Individualized Education Program Page 4 of 14

Social (SOC) participation:

A child's ability to engage with others can be influenced by sensory processing issues. Often, difficulties in social-relational skills are related to
problems with sensory modulation or sensory seeking. In the area of social participation: Laila's T-score was 72.
Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022
tasks. A child who scores in the Definite Dysfunction range may show consistently poor performance in many activities that require motor skill
and flexible problem solving. They may resist unfamiliar tasks, preferring repetitive play to novel activities. In the area of planning and ideas:
Laila's T-score was 68.

Social (SOC) participation:

A child's ability to engage with others can be influenced by sensory processing issues. Often, difficulties in social-relational skills are related to
problems with sensory modulation or sensory seeking. In the area of social participation: Laila's T-score was 72.

Summary and Recommendations:

Laila is a kind, creative student. Some strategies to consider to support her self-regulation and participation in the classroom include:

In the category of hearing:

Support Laila's arousal level by engaging her in the current activity and providing maintained-touch pressure (e.g., lap pad, weighted vest).
Encourage and practice taking turns with peers
Laila's teacher reported Laila often hums, sings or makes unusual noises during class time. She may benefit from incorporation of sensory
tools such as vibration, gum to keep the mouth busy, bubbles etc. She may also benefit from movement input (eg rocker board, T-stool, wiggle
cushion) to help with regulation. It may also be helpful to consider that this response may be Laila's attempt to manage the anxiety she feels
at the prospect of unexpected sounds interrupting the "quiet." Teach her how to substitute deep breathing for noise.
Provide time for Laila to hum, sing or make noises, Use a timer to limit the duration
In the category of Planning and Ideas:
Allow more time to accomplish activities.
Provide a checklist or reminder sheet that describes basic tasks and their steps (visually or in written form).
Encourage Laila to begin tasks on time by using a timer and the prompt "please get started before the timer runs out." Additionally, a timer may
be used to remind Laila how much time remains to complete the activity.
Remind Laila to check the schedule daily before she starts her morning
In the category of Planning and ideas:
Brainstorm together
To help Laila perform the correct sequence of actions in everyday routines such as putting away materials, ask Laila to repeat the sequence
verbally before doing the movement
Reduce the number of steps and ask the Laila to repeat the steps and ask, "what's next?"
Provide frequent opportunities to go through obstacle courses indoors (eg sensory walk) and with outdoor/playground equipment
In the category of Social Participation:
Ask Laila to help mediate when other children are having problems
Facilitate social learning using a social communication curriculum (Social Thinking Curriculum)

INITIAL EVALUATION
Laila was evaluated for ECSE services in August 2020 following ongoing aggressive behaviors in her preschool setting. Laila's mother, Aria
Fletcher, completed a BRIEF-2 form and her teacher completed a BASC-3 form. On the BASC-3, her teacher indicated Clinically Significant
concern on the Externalizing Problems, Internalizing Problems, and Behavioral Symptoms Indexes. The Adaptive Skills composite fell in the
At-Risk range. ON the BRIEF-2, Ms. Fletcher indicated Clinically Significant concern in Inhibit, Inhibitory Self Control Index, and the Global
Executive Composite. Ms. Fletcher also provided input for the Developmental Profile-3 (DP-3). Laila's score for Social-Emotional was a SS 70,
which falls in the "low" range (delay of 1.5. standard deviations or more). Her score in Cognitive fell at SS 107 (average).
The team evaluating Laila for ECSE services used the composite score from the BRIEF-2, which fell in the Clinically Significant range, to
indicate a cognitive delay (in executive functioning). Scores from the BASC-3 were used to determine a delay in social-emotional. Laila was
found eligible as a student with Developmental Delay in the areas of cognitive and social-emotional on 08/06/20.
Describe how student's disability affects involvement and progress in the general education curriculum
Laila's disability impacts her self-regulation which can lead to disruption in the general education environment and may result in behaviors that
limit her access to the general education curriculum. Laila's disability also impacts her ability to focus in the general education classroom, and
some of her instruction may be delivered in a smaller environment to mitigate this affect. Laila benefits from adult prompting to use the
restroom. During free time (recess, lunch) Laila benefits from adult check-ins and support positive interactions with peers.

E. TRANSFER OF RIGHTS

Will the student be age of majority, married, or legally emancipated The student and parent have been informed of rights under Part B of
while the current IEP is in effect? IDEA that will transfer to the student at the age of majority?

Yes No
Yes Date informed:
Not-applicable
The district must also provide written notice of the transfer of rights to
the student and the parent when the student reaches the age of
majority.
Date anticipated: 01/31/2033

The district has provided written notice of the transfer of rights to the
student and the parent?
Bend - La Pine Schools - Individualized Education Program Page 5 of 14
Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022
The district has provided written notice of the transfer of rights to the
student and the parent?

Yes Date provided:

Student has not reached age of majority

Bend - La Pine Schools - Individualized Education Program Page 6 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

H. SPECIAL FACTORS FOR IEP DEVELOPMENT

Check all factors that apply Explanation
Does the student exhibit behavior that impedes his/her learning or Laila will receive social skills instruction and accommodations to
the learning of others? increase access to general education curriculum.

Yes
No
If yes, the IEP team must consider the use of strategies, positive
behavioral interventions and supports to address the behavior(s)

Does the student have limited English proficiency?

Yes
No

Is the student blind or visually impaired?

Yes
No
If yes, Braille needs must the addressed in the IEP, or evaluation of
reading/writing needs has been completed and determined that
Braille is not appropriate

Does the student have communication needs?

Yes
No
If yes, needs must be addressed in the IEP

Is the student deaf or hard of hearing?

Yes
No
If yes, the IEP addresses the student’s language and
communication needs, opportunities for direct communication with
peers and professional personnel in the child’s language and
communication mode, academic level, and full range of needs,
including opportunities for direct instruction in the student’s
language and communication mode.

Does the student need assistive technology devices or services? Fidgets, sensory materials, active seating options, visuals for
movement breaks
Yes
No
If yes, services or devices must be addressed in the IEP

Bend - La Pine Schools - Individualized Education Program Page 7 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

I. REQUIRED TESTING AND ASSESSMENTS

Statewide Assessments
Will the student participate in any Statewide Assessment?
Yes – assessment will be conducted while the current IEP is in effect.
No – at the time of testing, assessment is not conducted at the student's grade level.

Districtwide Assessments

Will the student participate in any Districtwide Assessment?

Yes – assessment will be conducted while the current IEP is in effect.
No – at the time of testing, assessment is not conducted at the student's grade level.
Assessment Participation
Testing Assessment Area Administration Method Explanation* Accommodation
Grade Why the student cannot participate in
regular assessment and why alternate
assessment was chosen.
01 District Math (K-10) Standard with Test when emotionally
Accommodations regulated; one-on-one testing
in a separate environment with
a familiar adult with minimal
distractions, chunk test into
smaller session (10-15
minutes)
01 District Reading (K-5) Standard with Test when emotionally
Accommodations regulated; one-on-one testing
in a separate environment with
a familiar adult with minimal
distractions
02 District Reading (K-5) Standard with Test when emotionally
Accommodations regulated; one-on-one testing
in a separate environment with
a familiar adult with minimal
distractions
02 District Math (K-10) Standard with Test when emotionally
Accommodations regulated; one-on-one testing
in a separate environment with
a familiar adult with minimal
distractions, chunk test into
smaller session (10-15
minutes)

Bend - La Pine Schools - Individualized Education Program Page 8 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

J. MEASURABLE ANNUAL GOALS

When will progress be reported to the parent? How will progress be reported?
Semesterly With schools progress reports

Anticipated Dates
Progress Period 1 06/17/2022
Progress Period 2 02/03/2023

Category: Behavioral Skills

Is the goal area related to alternate assessments aligned to alternative Yes (If Yes, short-term objectives are required)
achievement standards?
No

Goal:
In 36 instructional weeks, Laila will demonstrate a safe body by keeping hands, feet, and objects to herself with a minimal level of support (2 on
rubric) as measured by teacher observation.

RUBRIC
3-Independent: Consistently safe at school (fewer than 1 incident/ week) with occasional adult check-ins/ support
2- Minimal: Consistently safe at school (fewer than 1 incident/ week) with frequent adult check-ins/ support
1- Significant: 3 or more incidents per week with significant adult check-ins/ support
0- Constant: 1 or more incidents of unsafe body daily. Requires consistent adult support.
Present Level:
Currently at a 0. Daily incidents of unsafe body. Requires constant adult support

Category: Social Skills

Is the goal area related to alternate assessments aligned to alternative Yes (If Yes, short-term objectives are required)
achievement standards?
No

Goal:
In 36 instructional weeks after experiencing a social interaction with a peer that concerned her or the peer, Laila will participate in problem
solving by sharing her concerns, hearing the other person's concerns, then agreeing to a solution that solves both concerns with a minimal level
of support (score of 2) as measured by teacher observation using the following rubric.

RUBRIC
0--Constant Support--Does not ask for help from an adult, or engage in a problem solving conversation within the same school day.
1--Significant Support--Attempts problem solving conversation, but struggles to listen to other perspectives, or participate in collaborative
problem solving even with significant adult support.
2--Minimal Support--Engages in problem solving with minimal guidance from adults. May require a few prompts to listen to other perspectives
on the situation.
3--Independent--Actively engages in problem solving independently with peers and staff.
Present Level:
0-Constant Support
Laila is not yet ready to engage in problem solving conversations after a challenging situation that involved her. She often wants to make
amends with an action, but it is hard for her to talk about. She is skilled at problem solving with peers around problems they experienced if she
was not involved.

Bend - La Pine Schools - Individualized Education Program Page 9 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

Category: Emotional Skills

Is the goal area related to alternate assessments aligned to alternative Yes (If Yes, short-term objectives are required)
achievement standards?
No

Goal:
In 36 instructional weeks, given a visual schedule and adult support, Laila will stay in an expected location that matches her regulation within the
school (including classroom, break spaces, and regulation spaces) with a minimal level of support (2 on rubric) as measured by teacher
observation.

RUBRIC:
3- Independent- Independently follows her schedule with occasional adult check-ins.
2- Minimal Support- Follows her schedule with frequent adult check-ins.
1- Significant Support- Follows schedule when provided with constant adult support.
0-Constant Support- Does not follow schedule when provided with constant adult support.
Present Level:
Currently at a 0.5.

Bend - La Pine Schools - Individualized Education Program Page 10 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

K. SERVICE SUMMARY

Specially Designed Instruction

Service Area Provider Role Anticipated Location Time Frequency Start Date End Date
Behavior Skill LEA (Local Special Ed General Education 200 every month 04/20/2022 04/19/2023
Education Teacher Class Min
Agency)
Emotional Skills LEA (Local Special Ed General Education 200 every month 04/20/2022 04/19/2023
Education Teacher Class Min
Agency)
Social Skills LEA (Local Special Ed General Education 200 every month 04/20/2022 04/19/2023
Education Teacher Class Min
Agency)

Related Services

The team considered the need for related services and determined that the student is not in need of related services.
Extended School Year Services (ESY)

The team has determined the student DOES NOT require ESY services
The team has determined that ESY services WILL be provided to this student
The team will meet to determine whether ESY services are required

Service Area Provider Role Anticipated Location Time Frequency Start Date End Date
Behavior Skill LEA (Local Special Ed Community 30 per week 04/20/2022 04/19/2023
Education Teacher Min
Agency)

Emotional Skills LEA (Local Special Ed Community 30 per week 04/20/2022 04/19/2023
Education Teacher Min
Agency)

Social Skills LEA (Local Special Ed Community 30 per week 04/20/2022 04/19/2023
Education Teacher Min
Agency)

Supplementary Aids and Services

Need for Aids/Services; Accommodations

The team considered the need for supplemental aids, services, and accommodations and determined that they are needed.

Supplementary Aids/Services: Accommodations

Description Provider Role Anticipated Location Time Frequency Start Date End Date
Access to alternative learning LEA (Local General Ed schoolwide 200 every month 04/20/2022 04/19/2023
tasks. Make connections to Education Teacher Min
interests. Agency)
Adult support during unstructured LEA (Local Educational schoolwide 200 every month 04/20/2022 04/19/2023
times (lunch/ recess/ fitness) to Education Assistant Min
support regulation and safe Agency)
choices.
Adult support leaving the area LEA (Local General Ed schoolwide 100 every month 04/20/2022 04/19/2023
when dysregulated/ unsafe to Education Teacher Min
regulate, then support re-entering Agency)
the learning environment
Frequent adult positive praise for LEA (Local General Ed schoolwide 15 every month 04/20/2022 04/19/2023
pro-social behaviors. Education Teacher Min
Agency)

Bend - La Pine Schools - Individualized Education Program Page 11 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022
Adult support during transitions to LEA (Local Educational schoolwide 200 every month 04/20/2022 04/19/2023
support regulation and safe Education Assistant Min
choices. Agency)
Adult support during academic LEA (Local Educational schoolwide 200 every month 04/20/2022 04/19/2023
periods to support regulation and Education Assistant Min
safe choices. Agency)
Transition warnings, use visual LEA (Local General Ed schoolwide 15 every month 04/20/2022 04/19/2023
timer when possible. Education Teacher Min
Agency)
Notification & review of changes to LEA (Local General Ed schoolwide 30 every month 04/20/2022 04/19/2023
schedule, beforehand whenever Education Teacher Min
possible Agency)
Visual schedule with built in breaks. LEA (Local General Ed schoolwide 15 every month 04/20/2022 04/19/2023
Adult support following schedule. Education Teacher Min
Agency)
Access to calming tools, sensory LEA (Local Special Ed schoolwide 30 every month 04/20/2022 04/19/2023
items (including a stuffy), Education Teacher Min
self-regulation tools/charts (ex. Agency)
Zones of regulation, size of the
problem, feelings chart,
strategy/tool menu, etc.)

Support identifying strategies for

each regulation zone.

Individualized "not ready"

regulation menu. Scheduled
regulation breaks.
Opportunities to be a helper in the LEA (Local General Ed schoolwide 60 every month 04/20/2022 04/19/2023
community Education Teacher Min
Agency)
Allow snacks, water and gum LEA (Local General Ed schoolwide 10 every month 04/20/2022 04/19/2023
Education Teacher Min
Agency)
Allow music with headphones LEA (Local General Ed schoolwide 30 every month 04/20/2022 04/19/2023
Education Teacher Min
Agency)
Adult support introducing and LEA (Local General Ed schoolwide 60 every month 04/20/2022 04/19/2023
practicing collaborative problem Education Teacher Min
solving. Agency)

Need for Aids/Services; Modifications

The team considered the need for supplemental aids, services, and modifications and determined that they are not needed.

Supports for School Personnel

The following supports are necessary for school personnel in order for this student to benefit from instruction in the general education
classroom:
Description of Supports Provider Role Time Frequency Start Date End Date
Consultation between general and LEA (Local Special Ed 30 every 04/20/2022 04/19/2023
special education Education Teacher Min semester
Agency)
Occupational Therapy Consult LEA (Local Occupational 180 every year 04/20/2022 04/19/2023
Education Therapist Min
Agency)

Bend - La Pine Schools - Individualized Education Program Page 12 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

L. STATEMENT OF NONPARTICIPATION JUSTIFICATION

The team has determined that no removal is necessary in order for the student to receive specially designed instruction, related services,
or supplementary aids or services.

Bend - La Pine Schools - Individualized Education Program Page 13 of 14

Name Date of Birth Student Number Document Date
Fletcher, Laila R. 01/31/2015 323758 04/20/2022

M. PARENT STATEMENTS

Parents Rights

I have had the opportunity to participate in the development of this Individualized Education Program (IEP). I have received a copy of "Parent
Rights for Special Education (K-18)".

Bend - La Pine Schools - Individualized Education Program Page 14 of 14