Community-Based Instruction s1

Community-based Instruction Anderson School District Five

Community Based Instruction (CBI) is a program designed for students that need instruction in functional and daily living skills. The goal of the program is to provide hands on learning activities at all age levels to help students acquire the skills to live in the world today. Domains to be covered include the following:

 Domestic – includes the area of personal health care, home health care, and interpersonal relationships. This area also includes emergency safety skills, nutrition, hygiene, dressing and eating. Home health care could be the payment of bills, insurance, cleaning, general house keeping.  Recreation/Leisure – These should reflect the student’s age, interests, as well as family activities, culture and involvement with community facilities. Should span a wide range of activities to include the involvement of other people or individual activities. Examples could be bowling, putt-putt, visiting the local YMCA, going to the library, drawing class (arts/crafts)  Community/Mobility – this domain should examine all possible means of community access. City buses, taxi service, planning activities that are in student’s area.  Community/Consumer – purchasing or service related activities in the student’s immediate area. Examples include grocery shopping, clothes or gift shopping, miscellaneous shopping (e.g. browsing, buying records, plants), banking skills, using the post office, or visiting the social security office.  Vocational – should consist of real work experience in real work settings. This would involve visiting work sites to observe people at work. Observing various jobs at your school could be one area to investigate.

Guidelines: 1. Permission forms must be obtained prior to participating in any activity. 2. Permission forms must be taken on all CBI trips. 3. Community-based instruction must be tied to IEP goals. 4. Students must have some form of identification with them. 5. Student Locator form submitted to school office prior to leaving grounds. 6. Submit reimbursement form as soon as possible. 7. CBI trips are NOT field trips. CBI is a way to reinforce what is being taught in the classroom. 8. Each domain should be addressed at least once per school year. 9. CBI trips should be individualized. It may not be appropriate for all students to participate in all activities. 10. All students must have appropriate supervision whether they’re staying at school or participating in CBI trip. 11. CBI may only take place within Anderson School District 5. 12. Trip is cancelled if having inclement weather. 13. Trip is cancelled if teacher cannot participate. 14. Contact coordinator IMMEDIATELY if CBI trip is to be cancelled. 15. May attend only one location during trip. 16. ALL transportation issues must go through coordinator such as scheduling, canceling, questions...) teachers/parapros should not contact transportation. 17. CBI times 10:30-12:30. Any request for variation on time(s) should be submitted with initial schedule submission. 18. Adhere strictly to times – just because you leave late does not mean you can stay late! 2

Community-based Instruction Checklist o Appropriate IEP goals are on IEP o Permission forms obtained o Locations contacted to arrange CBI visit o Schedule/Plan submitted to coordinator o Reimbursement form submitted to coordinator o Appropriate supervision planned for all students o Student locator completed and submitted to front office at school prior to leaving school o Copies of permission/medical emergency/photography prepared to take

Emergency Procedures Lost student:  Contact school principal immediately  Two adults present: one searches for student, other stays with remaining students  One adult present: entire group searches  Contact security  10 minutes – student not found – contact school principal for further instructions  Notify all appropriate persons when student is located  Write a summary of the incident to submit to principal and coordinator Medical Emergency: Minor  Assess the situation  Use the first-aid supplies  Call school site, if necessary  Complete accident/incident report upon returning to school Major  Assess the situation and if life threatening: Supervising adult should: 1. Request responsible person to call 911 2. Notify school principal ASAP 3. Remain with the student to administer first aid 4. Accompany the victim to the emergency facility with emergency info 5. Complete incident report Designated staff member or other responsible person should: 1. Call 911 as directed 2. Be prepared to give the following information:  victim’s condition  location of the emergency 3. Arrange to have the students supervised in a different location 4. Meet the Emergency Medical Services (EMS) personnel and direct them to the specific location of the emergency 5. Write summary of incident

(July, 2015) 3

Community-based Instruction Parental Permission

______Student Date of birth School ______Address

Dear Parent/Guardian/Student of Majority Age:

Community-based Instruction (CBI) is a program designed for students that need instruction in functional and daily living skills. The goal of the program is to provide hands on learning activities within the community to help students acquire the skills to live and function with their community. Students participating in CBI will have the opportunity to travel to sites within the community during school hours to practice and acquire skills. Their teacher and other school personnel will accompany the students on these off-campus trips.

CBI provides instruction in basic life skills through four domains: o Domestic (Examples: personal grooming, nutrition, laundry, cooking) o Vocational: (Examples: job readiness such as being on time, following rules) o Community: (Examples: transportation, library, shopping centers, post office) o Recreation and Leisure: Examples: crafts, parks, bowling, movie theaters)

I give permission for my child to participate in Community-based Instruction and to visit places within the community during school hours. AND Permission is also granted for the provision of medical care in case of injury or accident involving my child. In case of emergency involving the above-student, the teacher should contact one of the persons listed below at the phone number(s) as indicated if unable to contact parent/guardian.

I appoint or designate a physician and/or medical center/hospital to carry out the necessary treatment in the event my child should, for any reason, require minor or major medical treatment. I understand that I will be contacted immediately in case of an emergency. ______Parent/Guardian/Student of Majority Age Relationship to Student Phone Date ______Medical conditions/Allergies ______Doctor’s name Phone number Medicaid number

PHOTOGRAPHY/VIDEOTAPE My child □ does □ does not have permission to be identified, interviewed, and/or photographed or videotaped for use by the media and/or school district regarding: o Community-based Instructional activities and/or Supported Employment and Exploration activities (Work crew, Cooperative Placements, Job Shadowing, Internships) ______Parent/Guardian/Student of Majority Age Relationship to Student Phone Date (July, 2015) 4

Community-based Instruction Student Locator Record

______Teacher Class Date

Person responsible for students remaining: ______SpEd Assistant(s) out of building: ______

Students on CBI trip: 1. ______7. ______2. ______8. ______3. ______9. ______4. ______10. ______5. ______11. ______6. ______12. ______

Location of CBI trip: ______

Transportation by (circle one): School bus Walking

Time Out: ______Estimated time of return: ______

Form is to be completed and given to the school secretary before leaving the campus. 5 Community Based Instruction Schedule/Plan

______Teacher School Class Date Submitted

Nine week period: ___ 1st ___ 2nd ___ 3rd ___ 4th (This may be submitted every nine weeks or semester)

Date: ______Training Site: ______Domain: ______Activity: ______

Date: ______Training Site:______Domain: ______Activity: ______

Must be approved by the school principal before transportation arrangements will be made.

______Principal’s Signature Date Coordinator’s Signature Date

Participants: Adults ______Students ______Students/wheelchairs ______Total ______

(July, 2015) 7

FUNDS REQUEST FOR COMMUNITY-BASED INSTRUCTION

TEACHER:______SCHOOL: ______

PURPOSE AMOUNT Community-based Instruction 15/16 school year $100.00 I Students based on October 1 caseload = ______X 10.00 + Total to be disbursed to teacher: $______

Account: Self-contained/Life Skills classes (SpEd will insert upon receipt) understand these funds are to be used For community-based activities and/or Supplies to enhance the CBI experience. Approved by:

______Signature of Claimant Coordinator

______Date Director

______Date

(July, 2015)