Protocol for Evaluating 26.5 Processes

Special Education Self Review Worksheet __ Educational Benefit REVIEWER: Review: Worksheet 2a Students Previously Receiving MH Services under CCR Title 2 DATE: Regulations and California Government Code Chapter 26.5 STUDENT NAME:

Use this form for reviewing services provided by the Community BIRTH DATE: Mental Health program for Special Education eligible students

COMPLIANCE TEST LEGAL FINDINGS CITATIO NS ASSESSMENT Was the student assessed in all areas related to the suspected GC 7572(a) Comment: disability by qualified personnel before any action was taken with Compliant respect to the provision of related services or designated instruction and services to a student, including, psychotherapy, and other mental health Non-Compliant assessments? Not Applicable

Does the assessment plan include, at a minimum, a review of the 2 CCR Comment: student's school records and assessment reports and observation of 60010(b) Compliant the student in the educational setting when appropriate? Non-Compliant

Not Applicable

Did the community mental health service provide the IEP team a written 2 CCR assessment report including but not limited to all the following: 60045(g) Compliant (a) Whether the student may need mental health services. (b) The basis for making the determination. Non-Compliant (c) The relevant behavior noted during the observation of the student in an appropriate setting. Not Applicable (d) The relationship of that behavior to the student's functioning. (e) The educationally relevant findings, if any. (f) The need for specialized services, materials, and equipment for students with low incidence disabilities?

1 California Department of Education Special Education Division Special Education Self Review Worksheet __ Educational Benefit REVIEWER: Review: Students Previously Receiving MH Services under CCR Title 2 DATE: Regulations and California Government Code Chapter 26.5 STUDENT NAME:

COMPLIANCE TEST LEGAL FINDINGS CITATIO NS IEP When it was determined that mental health service was necessary for a 2 CCR 60050 Compliant student to benefit from special education, was the following documentation included in the mental health portion of the IEP: Non-Compliant (1) A description of the present levels of social and emotional performance; Not Applicable (2) The goals and objectives of the mental health services with objective criteria and evaluation procedures to determine whether they are achieved: (3) A description of the types of the mental health services to be provided; and (4) The initiation, duration and frequency of the mental health services, (5) Parental approval for the provision of mental health services? OUT OF HOME PLACEMENT Does the individualized education program for a student placed out of GC 7572.5(c) Comment: home include: Compliant 1) Designation of the county mental health department as lead case manager, Non-Compliant 2) Provisions for a review of the case progress, 3) Statements about the continuing need for out-of-home Not Applicable placement, 4) The extent of compliance with the individualized education program, 5) Statements about the progress toward alleviating the need for out-of-home care, by the full individualized education program team at least every six months, and 6) Identification of an appropriate residential facility for placement?

COMPLIANCE TEST LEGAL FINDINGS CITATIO NS When an IEP team member recommended a residential placement for a 2 CCR student with multiple disabilities did the IEP team: 1) Document the 60100(b)-(e) Compliant alternatives to residential placement that were considered and the reasons why they were rejected, 2) document the student's educational Non-Compliant and mental health treatment needs that support the recommendation for residential placement, 3) Identify a satisfactory placement that is Not Applicable acceptable to the parent and addresses the student's educational and mental health needs including the requirement that the placement be in the least restrictive environment and is cost effective? Does the residential services plan for a student who is placed out of 2 CCR Comment: home include: provisions, as determined in the student's IEP, for the 60110(b)(1) Compliant care, supervision, mental health treatment, psychotropic medication monitoring, if required, and education of a student with a disability who Non-Compliant has seriously emotionally disturbance? Not Applicable

Did the mental health services case manager develop a plan and assist 2 CCR Comment: the family with the student's social and emotional transition from home 60110(c)(5) Compliant to the residential placement and the subsequent return to the home? Non-Compliant

Not Applicable

Does the record contain evidence that quarterly face-to-face contacts at 2 CCR Comment: the residential facility were carried out with a student with a disability to 60110(c)(8) Compliant monitor the level of care and supervision and the provision of the mental health services as required by the IEP. In addition, for students Non-Compliant placed in a community treatment facility, was an evaluation made within 90 days of the residential placement to determine if the student meets Not Applicable the continuing stay criteria?

COMPLIANCE TEST LEGAL FINDINGS CITATIO NS For a student with a disability who is seriously emotionally disturbed, 2 CCR Comment: was residential placements made outside of California only when 60100(h) Compliant documentation is in the record confirming that no in-state facility could meet the student's needs? Non-Compliant

Not Applicable

4 California Department of Education Special Education Division