Using the Anatomy of an IFSP Download Anatomy of an IFSPhandout, students, please complete the IFSP table (50 points). Part 2: Using the Sample Individualized Family Program Download Sa

Individualized Family Service Plan Child information Child’s Name: Billy Hay Date of Birth: 01/21/2013

Date of Birth: 01/21/2018 Home Address: 11454 Pruder Street Fargo, SDChronological Age: 18 mos.

Primary Family Contact: Debbie Hay

Relationship to Child: Mother

Daytime Phone: 555-2358

Email Address: [email protected]

Secondary Family Contact: John Hay

Relationship to Child: Father

IFSP Meeting Type: Annual Meeting Date: 07/11/19

IFSP Start Date: 07/12/19 IFSP End Date: 07/13/20

© 2015 Understood for All, Inc.

Anatomy of an IFSP

An Individualized Family Service Plan (IFSP) guides and supports a family’s efforts to boost a young child’s development. Available for kids up to age 3, the early intervention services in an IFSP are tailored to meet the child’s unique needs. Most plans have common elements. Below are the most important things you’ll find in most IFSPs.

Child and family information This first section lists the child’s name, date of birth, and other basic details. It also includes contact information for the child’s family. The date of the IFSP meeting may be noted, too.

© 2015 Understood for All, Inc.

© 2015 Understood for All, Inc.

Service coordinator information Name: Annie Lee Agency:

South County Early InterventionWork Phone: 555-3535

Email Address: [email protected]

IFSP team Name / Position Phone #

Annie Lee / Service Coordinator 555-3535

Agency: South County Early Intervention

Sally Foo, OTR / Occupational Therapist 555-5397

Agency: Foo Rehab

Debbie & John Hay / Parents 555-2358

Agency: N/A

Connie Kemp, SLP/CCC / Speech Therapist 555-3434

Agency: Kemp Language, Inc

Service coordinator information The service coordinator is the person responsible for making sure the IFSP is carried out. Other members of the IFSP team may be listed here or at the end of the plan.

Anatomy of an IFSP Page 2 of 7

© 2015 Understood for All, Inc.

Physical skills

Billy has low muscle tone, which keeps him from reaching milestones like crawling and sitting independently as quickly as his same-age peers. He moves by pulling himself with his arms while positioned on his belly. He is not yet crawling or walking, but can bear some weight on his legs for short periods of time and will pull himself up to a standing position if he is near enough to an object. Building his physical strength and balance as well as further investigating his fine motor skills like his grasp and lip/mouth/tongue coordination will help to get him moving more independently and help provide him access to interacting with toys, people, and his environment.

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Communication skills

Billy is not able to consistently follow simple one-step directions, such as “give me.” He also does not demonstrate an understanding of age-appropriate language. Expressively he…

Self-help or adaptive skills

Billy has general overall low muscle tone, which is impacting his ability to support himself in a seated position and maintain head control. He needs support to learn to transition from…

Social or emotional skills

Based on the H.E.L.P. assessment, Billy is demonstrating a greater than 25% delay in the social/emotional area. He does initiate interaction by vocalizing when he sees someone…

Present levels of development This describes the child’s current abilities and skills. These can include:

• Physical skills (reaching, crawling, walking, drawing, building)

• Cognitive skills (thinking, learning, solving problems)

• Communication skills (talking, listening, understanding others)

• Self-help or adaptive skills (eating, dressing)

• Social/emotional skills (playing, interacting with others)

Anatomy of an IFSP Page 3 of 7

© 2015 Understood for All, Inc.

Statement of family resources, concerns, and priorities Strengths and resources

• Billy’s parents both have college degrees and have worked in computer programming positions, but his mother recently lost her job. She is working part time now, but she was the main breadwinner for the family. As a result, the family is experiencing some financial stress.

• Billy typically spends the day at home, and his grandmother watches him while his parents work, either in the office or from home.

• Because the family lives in a major city, there are many resources available nearby for early intervention services.

• The family has a small home with little space for movement activities.

Family concerns

• Billy’s low muscle tone doesn’t seem to be improving as he gets older.

• Several times a day, Billy cries and fusses because his family doesn’t understand what he wants or needs.

Family priorities

• Would like Billy to get stronger and be able to sit up.

• Would like Billy’s mobility and independence to improve so that his grandmother and parents won’t need to pick him up and put him down as often.

• Would like to help Billy’s grandmother feel more confident and able to lift and carry Billy safely.

Family resources, concerns, and priorities The child’s family will help create this statement of their strengths and challenges.

Any concerns the family has, as well as what the family believes is important, will be noted here.

Anatomy of an IFSP Page 4 of 7

© 2015 Understood for All, Inc.

Anatomy of an IFSP Page 5 of 7

Outcome #1

Billy will improve head and trunk control, allowing him to crawl on all fours.

Strategies and activities

• The family will work with Billy to improve his lower body strength. The occupational therapist (OT) will consult with Billy’s family to help address this.

• Billy’s mother or father will take him to a park or open- space playdate three times a week to encourage movement.

• Billy’s grandmother will get training on strengthening activities so she is better able to pick up Billy and move him from place to place.

Evaluation

• Billy’s parents will observe and take notes on Billy’s movement.

• The OT will formally track progress at every therapy session.

Outcome #2

Billy will learn to understand and use simple words and one- step directions.

Strategies and activities

• Billy’s family will model one-step directions for Billy by pointing and using words or commands.

• Billy’s mother will name every piece of clothing each day while she dresses him.

Measurable results or outcomes This important section lays out the goals (“outcomes”) for the child, how they’ll be met, and how the child’s progress will be measured. These goals can also help the IFSP team decide if services should be added or changed.

© 2015 Understood for All, Inc.

Anatomy of an IFSP Page 6 of 7

Early intervention services

Outcome #1 Service: Occupational Therapy

Start Date: 7/12/2019 End Date: 7/11/2020

Provider: Sally Foo Location: Home 1x, Office 1x

Frequency: 2x monthly Intensity: 60 minutes

Outcome #2 Service: Speech Pathology

Start Date: 7/12/2019 End Date: 7/11/2020

Provider: Connie Kemp Location: Home

Frequency: 1x monthly Intensity: 30 minutes

Natural environments/settings

Outcome #1 Service: Occupational Therapy

Once a month, this service will be provided at the OT office. This is appropriate because the office has a larger area for play and movement. This is intended to help motivate and support Billy in his goal of crawling on all fours.

Other services Service: Playgroup Service Type: Family & Child

Responsible Individual: Local Playdate Group

Funding: Parent

Service: Neurologist Service Type: Child

Responsible Individual: Dr. Sullivan

Funding: Health insurance

Early intervention services This describes the early intervention services the child and family will get. The plan should specify where the services will be provided, how often they’ll be provided, and how long each session will last.

Natural environments/ settings Services in an IFSP should be provided in “natural environments” for the child. This could be at home or in a daycare. If a service is provided in a place where kids of a similar age would not typically be, this section will explain why.

Other services Some services that the child and family need may not be paid for by early intervention. But they’re listed here to give you a complete picture. Potential sources of funding are also noted.

© 2015 Understood for All, Inc.

Anatomy of an IFSP Page 7 of 7

Consent A parent or guardian’s consent is required before early intervention services can be provided. Some IFSPs have a signature line.

Parent/guardian consent

I (we) the parent(s)/guardian(s) of Billy Hay hereby certify that I (we) have had the opportunity to participate in the development of my (our) child’s IFSP. This document accurately reflects my (our) concerns and priorities for my (our) child and family.

I (we) therefore give my (our) permission for this plan to be implemented. .

x I/we give permission.

I/we do not give permission.

Parent/Guardian Signature

© 2015 Understood for All, Inc.

Service coordinator information Name: Annie Lee Agency:

South County Early InterventionWork Phone: 555-3535

Email Address: [email protected]

IFSP team Name / Position Phone #

Annie Lee / Service Coordinator 555-3535

Agency: South County Early Intervention

Sally Foo, OTR / Occupational Therapist 555-5397

Agency: Foo Rehab

Debbie & John Hay / Parents 555-2358

Agency: N/A

Connie Kemp, SLP/CCC / Speech Therapist 555-3434

Agency: Kemp Language, Inc

Statement of family resources, concerns, and priorities Strengths and resources

• Billy’s parents both have college degrees and have worked in computer programming positions, but his mother recently lost her job. She is working part time now, but she was the main breadwinner for the family. As a result, the family is experiencing some financial stress.

• Billy typically spends the day at home, and his grandmother watches him while his parents work, either in the office or from home.

• Because the family lives in a major city, there are many resources available nearby for early intervention services.

• The family has a small home with little space for movement activities.

Family concerns

• Billy’s low muscle tone doesn’t seem to be improving as he gets older.

• Several times a day, Billy cries and fusses because his family doesn’t understand what he wants or needs.

Family priorities

• Would like Billy to get stronger and be able to sit up.

• Would like Billy’s mobility and independence to improve so that his grandmother and parents won’t need to pick him up and put him down as often.

• Would like to help Billy’s grandmother feel more confident and able to lift and carry Billy safely.

Outcome #1

Billy will improve head and trunk control, allowing him to crawl on all fours.

Strategies and activities

• The family will work with Billy to improve his lower body strength. The occupational therapist (OT) will consult with Billy’s family to help address this.

• Billy’s mother or father will take him to a park or open- space playdate three times a week to encourage movement.

• Billy’s grandmother will get training on strengthening activities so she is better able to pick up Billy and move him from place to place.

Evaluation

• Billy’s parents will observe and take notes on Billy’s movement.

• The OT will formally track progress at every therapy session.

Outcome #2

Billy will learn to understand and use simple words and one- step directions.

Strategies and activities

• Billy’s family will model one-step directions for Billy by pointing and using words or commands.

• Billy’s mother will name every piece of clothing each day while she dresses him.

Individualized Family Service Plan Child information Child’s Name: Billy Hay Date of Birth: 01/21/2013

Date of Birth: 01/21/2018 Home Address: 11454 Pruder Street Fargo, SDChronological Age: 18 mos.

Primary Family Contact: Debbie Hay

Relationship to Child: Mother

Daytime Phone: 555-2358

Email Address: [email protected]

Secondary Family Contact: John Hay

Relationship to Child: Father

IFSP Meeting Type: Annual Meeting Date: 07/11/19

IFSP Start Date: 07/12/19 IFSP End Date: 07/13/20

Physical skills

Billy has low muscle tone, which keeps him from reaching milestones like crawling and sitting independently as quickly as his same-age peers. He moves by pulling himself with his arms while positioned on his belly. He is not yet crawling or walking, but can bear some weight on his legs for short periods of time and will pull himself up to a standing position if he is near enough to an object. Building his physical strength and balance as well as further investigating his fine motor skills like his grasp and lip/mouth/tongue coordination will help to get him moving more independently and help provide him access to interacting with toys, people, and his environment.

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Cognitive skills

Billy’s low muscle tone is impacting his cognitive abilities. He is unable to obtain, hold, and activate age-appropriate toys. He is not demonstrating…

Communication skills

Billy is not able to consistently follow simple one-step directions, such as “give me.” He also does not demonstrate an understanding of age-appropriate language. Expressively he…

Self-help or adaptive skills

Billy has general overall low muscle tone, which is impacting his ability to support himself in a seated position and maintain head control. He needs support to learn to transition from…

Social or emotional skills

Based on the H.E.L.P. assessment, Billy is demonstrating a greater than 25% delay in the social/emotional area. He does initiate interaction by vocalizing when he sees someone…

Early intervention services

Outcome #1 Service: Occupational Therapy

Start Date: 7/12/2019 End Date: 7/11/2020

Provider: Sally Foo Location: Home 1x, Office 1x

Frequency: 2x monthly Intensity: 60 minutes

Outcome #2 Service: Speech Pathology

Start Date: 7/12/2019 End Date: 7/11/2020

Provider: Connie Kemp Location: Home

Frequency: 1x monthly Intensity: 30 minutes

Natural environments/settings

Outcome #1 Service: Occupational Therapy

Once a month, this service will be provided at the OT office. This is appropriate because the office has a larger area for play and movement. This is intended to help motivate and support Billy in his goal of crawling on all fours.

Other services Service: Playgroup Service Type: Family & Child

Responsible Individual: Local Playdate Group

Funding: Parent

Service: Neurologist Service Type: Child

Responsible Individual: Dr. Sullivan

Funding: Health insurance

Parent/guardian consent

I (we) the parent(s)/guardian(s) of Billy Hay hereby certify that I (we) have had the opportunity to participate in the development of my (our) child’s IFSP. This document accurately reflects my (our) concerns and priorities for my (our) child and family.

I (we) therefore give my (our) permission for this plan to be implemented. .

x I/we give permission.

I/we do not give permission.

Parent/Guardian Signature

An Individualized Family Service Plan (IFSP) guides and supports a family’s efforts to boost a young child’s development. Available for kids up to age 3, the early intervention services in an IFSP are tailored to meet the child’s unique needs. Most plans have common elements. Below are the most important things you’ll find in most IFSPs.

Anatomy of an IFSP

Child and family information This first section lists the child’s name, date of birth, and other basic details. It also includes contact information for the child’s family. The date of the IFSP meeting may be noted, too.

Service coordinator information The service coordinator is the person responsible for making sure the IFSP is carried out. Other members of the IFSP team may be listed here or at the end of the plan.

Present levels of development This describes the child’s current abilities and skills. These can include:

• Physical skills (reaching, crawling, walking, drawing, building)

• Cognitive skills (thinking, learning, solving problems

• Communication skills (talking, listening, understanding others)

• Self-help or adaptive skills (eating, dressing)

• Social/emotional skills (playing, interacting with others)

Family resources, concerns, and priorities The child’s family will help create this statement of their strengths and challenges.

Any concerns the family has, as well as what the family believes is important, will be noted here.

Measurable results or outcomes This important section lays out the goals (“outcomes”) for the child, how they’ll be met, and how the child’s progress will be measured. These goals can also help the IFSP team decide if services should be added or changed.

Early intervention services This describes the early intervention services the child and family will get. The plan should specify where the services will be provided, how often they’ll be provided, and how long each session will last.

Natural environments/ settings Services in an IFSP should be provided in “natural environments” for the child. This could be at home or in a daycare. If a service is provided in a place where kids of a similar age would not typically be, this section will explain why.

Other services Some services that the child and family need may not be paid for by early intervention. But they’re listed here to give you a complete picture. Potential sources of funding are also noted.

Consent A parent or guardian’s consent is required before early intervention services can be provided. Some IFSPs have a signature line.

Sample Individualized Family Service Plan

I. Child and Family Information Child’s Name Maria Ramirez Date of Birth 12-9-14 Age in Months 30 Gender F

Parent(s)/Guardian(s) Bruce & Catherine Ramirez Address 2120 Valley Park Place Middletown, IN 46610

Street City Zip Code

Home Telephone No. (513) 555-0330 Work Telephone No. (513) 555-1819

Preferred Language English Translator Appropriate Yes X No

II. Service Coordination Coordinator’s Name Susan Green Agency Indiana Early Intervention Program

Address 105 Data Drive Burlington, IN 46980 Telephone No. (513) 555-0214

Street City Zip Code

Appointment Date 6-16-17

III. IFSP Team Members Name Agency Telephone No. Title/Function

Susan Green Indiana Early Prevention (El) Program 513-555-0214 Service Coordinator

Mr. and Mrs. B. Ramirez N/A 513-555-0330 Parents

Barbara Smith Indiana El Program 513-555-0215 Speech/Language Pathologist

Martha Kind Indiana El Program 513-555-0213 Occupational Therapist

Libby Young Middletown Preschool Program 513-555-3533 Preschool Teacher

IV. Review Dates Date of IFSP 6-16-17 Six-Month Review 12-15-17 Annual Evaluation Not applicable

V. Statements of Family Strengths and Resources Maria’s parents are well-educated professional individuals with realistic goals for her educational development. The entire family unit, including her grandparents, are committed and motivated to assist her in any way. Because of the family’s geographic location, limited resources are available for service delivery at this time.

VI. Statements of Family Concerns and Priorities Concerns Due to Maria’s medical diagnosis of Down syndrome, her parents are concerned about appropriate early intervention services to assist in ameliorating her developmental delays. Additionally, the parents have stated a reluctance about a change in Maria’s service delivery from her natural environment (i.e., her home) to an inclusive community-based preschool.

Priorities The priorities that Maria’s parents have for her include improving her communication skills, her ability to use utensils, and her toileting skills. They desire services to be delivered at home with the eventual goal of a placement with typical children who attend the local kinder- garten. Her parents and grandparents want to learn ways in which they can help to facilitate Maria’s development in her natural environment.

VII. Child’s Present Level of Development and Abilities Cognitive Skills (Thinking, reasoning, and learning) Maria’s cognitive abilities are commensurate with a 20-month-old child. She’s extremely inquisitive and understands simple object concept skills. Imitative play is consistently observed; however, discrimination of objects, persons, and concepts continues to be an area of need.

Communication Skills (Understanding, communicating with others, and expressing self with others) Communication/language competency skills appear to be similar to that of an 16-month-old toddler. Her receptive language is further developed than her expressive abilities. Primitive gestures are her primary mode of communication. She consistently exhibits a desire/ interest to interact with others. Verbal responses primarily consist of vocalizations and approximations of single word utterances (e.g., ma-ma, da-da, ba-ba),

Self Care/Adaptive Skills (Bathing, feeding, dressing, and toileting) Feeding, in general, such as drinking from a cup and finger feeding, is appropriate at this time. A great deal of assistance from caregivers is still required for daily dressing tasks and toileting.

Gross and Fine Motor Skills (Moving) Maria appears to be quite mobile. She is adept at rambling and walking, but needs to improve muscle strength and endurance. She enjoys movement to music. She can scribble, grasp large objects, turn pages of books, and prefers using her right hand while performing tasks. She needs to work on her ability to use utensils and writing tools.

Social-Emotional Development (Feelings, coping, and getting along with others) Maria is a very happy, affectionate, and sociable child. She enjoys being the center of attention and engaging in interactive games; how- ever, she appears content to play alone. Temper tantrums are triggered by frustration from her inability to communicate. Sharing and turn taking continue to be difficult for Maria,

Health/Physical Development (Hearing, vision, and health) Maria’s general health is good, but she has a history of chronic otitis media and upper respiratory infections. Vision and hearing are monitored frequently.

VIII. Outcome Statements 1. Participate in stimulation of all language modalities (visual, auditory, tactile) in order to increase communication competency.

Strategies/Activities Responsible Person/Agency

Begin Date

End Date

Frequency of Service Location

Evaluation Criteria

1.1 Maria will use word approximations combined with consistent gestures for 5 different needs across 3 different people and 2 different settings.

SLP 6-19-17 12-15-17 Once weekly

Home Preschool Language Scale

1.2 Maria will use words combined with signs for 5 different needs across 3 different people and 2 settings.

Mom and Dad 6-19-17 12-15-17 Observation samples

2. Maria’s daily self-care skills will improve in the areas of dressing and toileting abilities.

Strategies/Activities Responsible Person/Agency

Begin Date

End Date

Frequency of Service Location

Evaluation Criteria

2.1 Maria will push down/pull up under- garments with minimal assistance.

Mom and Dad Service Coord.

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