Community Based Work Assessment Tool

Transition Educational Exiting Profile Page 1

I. Name Bill Smith D.O.B 1-9-88

Student Address SS#

Parent/Guardian Phone #

Diagnosed Primary Disability Aspergers Secondary Disability

Medication(s)

County Lehigh EDUCATIONAL INFORMATION

II. High School Graduate Yes No Date of Graduation 6-2009

Name of School Project SEARCH-School to Work Transition Program Teacher Suzanne Campfield

Type of Program Life Skills Support Home District Allentown SD

Reading Level 3.0 Math Level 3.0 ELIGIBILITY INFORMATION III. Does the individual receive SSI Benefits? Yes No Does the individual receive SSDI benefits? Yes No Has the family/individual received information on Social Security Work Incentives and/or MAWD? Yes No (i.e. PASS, Ticket-to-Work, Impairment Related Work Expense) Has the individual met with a Work Incentive Planning Assistance Program (WIPA)? Yes No Does the individual have a Social Security identification card? Yes No Does the individual have a Pennsylvania Photo Identification Card? Yes No Is the individual registered to vote? Yes No Is the individual registered for the Selective Service? Yes No Does the individual have a Driver’s License? Yes No Is it a realistic goal for the individual to get a Driver’s License? Yes No Does the individual have an ACCESS card? Yes No #

Is the individual eligible for services through the MR system? Yes No Page 2 If yes, Name of Supports Coordinator for MR system: Dyanne VanHorn Is the individual eligible for services through the MH system? Yes No If yes, Name of Case Manager for MH system: Did the individual apply to OVR for services? Yes No If yes, date application was completed. 11-2008 (2 years prior to graduation) If no, comment. Does the individual currently receive OVR services? Yes No Name of OVR Counselor: Brooke Cho

If the individual receives other services, please list agencies, providers, and contact person(s):

IV. Participants who contributed to completing this Profile

Name Suzanne Campfield Role Life Skills Support Phone Number xxx-xxx-xxxx Areas completed all Educator

Name Betty Benjamin Role Project SEARCH Phone Number xxx-xxx-xxxx Areas completed all Facilitator

Name Katherine Smith Role Parent Phone Number xxx-xxx-xxxx Areas completed I, II, IV, V

Name Bill Smith Role Student Phone Number xxx-xxx-xxxx Areas completed IV, V

Name Role Phone Number Areas completed

Summer Contact Number, Extension and Name for additional documents and further information:

A. Individual Desires to be Competitively Employed in the Community: YES NO If yes, (Check) Full-time employment Part-time employment Less than 20 hours per week If no, comment.

Scheduling Concerns: (church activities, recreation/leisure activities, lack of experience with full-time employment): The student relies on his family or Metro Plus services for transportation to his place of employment.

Negotiable/Non-negotiable: (activities that could conflict with structured competitive employment schedule): (List) none

B. Communication: 1. Mode of Communication: (Check what applies) a. Verbal If yes, describe type of communication (e.g. one word, utterances, complete sentences). The student can communicate in the classroom and work setting. The student is verbally prompted to ask for help or to ask for more work when he has completed a task. Bill uses cue cards to prompt communication with co-workers. b. Non-verbal If yes, describe type of communication (i.e. communication board, picture book, eye gaze, is an interpreter needed).

2. Primary Language: English C. Family Supports Available to Assist Individual in Meeting this Post-School Outcome: Parent Guardian Sibling Friend Other (Identify)

Parent John & Pat Smith. Sibling Mary & John Other Guardian Friend

2. Type of Support Needed: (Check what applies) a. Independent b. Needs Training (i.e. Training in Pedestrian Safety, Training in reading & interpreting a bus schedule-Travel Instruction) c. Needs Assistance (to access transportation services) d. Travel Instruction Assessment Completed Travel training was conducted since 9-2008 with an emphasis on safety awareness. Since April 2009, Bill has travel trained independently using Metro Plus services. e. Evaluator’s Name Betty Smith, Travel Trainer Instructor

E. Individual’s Job Preferences/Expressed Areas of Interest: (List) Recommendations by IEP Team: The student would like to work competitively with computers, linens or in The student can be competitively employeed with supports for social skills central supply. practice. Bill's strengths are his ability to memorize, mathematics, computers and oranization of a department. (Once Bill is taught the organization and flow of a department, he runs it like methodically.)

F. Employment Possibilities Near Residence or through Personal Contacts: (List business name and address if known) None

G. Work-Based Learning: (Check)

Career Days Internship Work Release (paid) Career Expos Job Shadowing Work Study Cooperative Education Registered Apprenticeship Volunteering Community-Based Vocational Training Service Learning Other Diversified Occupation Program Work Experience (part-time/full-time)

(List) Bill worked at Sacred Heart(cleaned tables and folded napkins) and Scottish Rite(vaccuumed and cleaned windows). G. Work-Based Learning: (continued) No work related experiences: (Explain) Bill participated in the Project SEARCH transition to work program. Bill participated in the following internship sites: Central Supply, Mailroom and the Linen Department. In Central Supply, Bill retrieved carts from the residents' floors. He counted

H. Specific Job Tasks: (Check) Able to Perform: One step task Two/three step tasks Multi-step tasks Page 5 (Describe tasks and level of independence) A job needs to be broken down into sub-steps and modeled. With repeated practice, Bill can perform most tasks. Does the individual meet employer expectations? (Comments) Yes, once trained Bill can complete all aspects of the job that are concrete. Kevin needs cue cards and modeling for components of the job that are abstract.

I. Description of Strengths and Abilities in Jobs Assessed: (Describe) Bill is methodical, organized and focused on all job tasks. Bill can perform multi-step tasks. In Central Supply, Bill retrieved carts from the residents' floors. He counted carts, determined amount of supplies needed for each cart and then entered the supply data to reorder materials. Bill also worked in the mailroom using a postage machine to apply postage to outgoing mail and he also sorted inner department mail. Lastly, Bill worked in the linen department. Bill retrieved linen carts from the residents' floors. Bill counted the individual linens on the carts and restocked the carts according to the predetermed amounts. Bill needs to continue to work on using his cue cards to ask for help.

J. Motor/Mobility Skills: (Check) – Independent Wheelchair Crutches Cane Walker Assistance Needed (Describe)

K. Endurance: (Check) 1. Endurance is less than: 1 hour 1-2 hours 2-3 hours or more 3 hours or more 2. Can the individual work while seated for at least 2 hours at a time? Yes No Don’t Know 3. Can the individual work while standing for at least 2 hours at a time? Yes No Don’t Know 4. Must the individual alternate between standing and sitting? Yes No 5. Individual can: Lift 50 pounds, Carry 50 pounds, Push 50 pounds 6. List any restrictions: sit stand kneel stoop bend crawl none

Comments:

L. Individual’s Behavior in Work Environment and Supports Needed to Maintain Appropriate Behavior: (List) Bill needs cue cards to prompt him to greet hie co-workers. Bill also uses cue cards to prompt him of tasks to perform where there is down time. If Bill is corrected when performing a task, he may slam an object. Staff verbally prompts him to take a deep breathe and use his words.

N. Habits, Routines, Idiosyncrasies: (List) None in school.

Page 6 O. Safety Considerations: (i.e. Overly friendly, unaware of danger/environment, knowing what to do in an emergency, carries ID, has emergency contact list) (List)

P. OTHER COMMMENTS

This document is the result of a collaborative effort of CLIU 21, CIU 20, DCIU 25, Private Industry Council, VIA of the Lehigh Valley, OVR, OMR of Lehigh County and Delaware County – OPTIONS Job Developer No parts of this document are to be used or reproduced without permission from Lehigh Valley & Northampton Employment Project Page 7 VI. Mark by indicating: 3-Independent/strong ability, 2-Support Needed, 1-Not evident A. COMMUNICATION Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 12-2008- Bill uses a cue card 6-2009-Bill uses a cue card to Expresses basic needs and wants to prompt him to prompt him to communicate communicate his needs. his needs. 12-2008-Billuses a cue card 6-2009-Bill uses a cue card to Asks for assistance and verbal prompting to ask prompt him to communicate for help. his needs. 12-2008 - Bill uses a cue card Speaks effectively and verbal prompting to ask 6-2009- for help. 6-2009-Bill interprets all instructions in a literal manner. Understands verbal instructions 12-2008 Staff re-directs Kevin for approximations. 6-2009-Bill interprets all instructions in a literal manner. Follows verbal instructions 12-2008 Staff re-directs Kevin for approximations. 12-2008-Bill responds to more tasks when they are Understands written instructions 6-2009- written down. He will follow each sub skill or task. 12-2008-Billresponds to more tasks when they are written Follows written instructions 6-2009- down. He will follow each sub skill or task. Interprets non-verbal cues and gestures 12-2008-with a cue card 6-2009- Requests accommodations 12-2008--with a cue card 6-2009- Reports work related problems to supervisor/coworker 12-2008--with a cue card 6-2009- Able to answer telephone appropriately 12-2008 6-2009- 12-2008-with a cue card and Takes an accurate telephone message 6-2009- a script Leaves an appropriate telephone message 12-2008-with a script 6-2009- 12-2008-with a script and Asks for time off appropriately 6-2009- role modeling Completes paper application 12-2008 6-2009-

This document is the result of a collaborative effort of CLIU 21, CIU 20, DCIU 25, Private Industry Council, VIA of the Lehigh Valley, OVR, OMR of Lehigh County and Delaware County – OPTIONS Job Developer No parts of this document are to be used or reproduced without permission from Lehigh Valley & Northampton Employment Project Mark by indicating: 3-Independent/strong ability, 2-Support Needed, 1-Not evident Page 8 B. PLANNING AND PROBLEM SOLVING Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 12-2008- Bill follows a chart, 6-2009-Bill follows a chart, if if a task deviates he will a task deviates he will continue Exhibits decision making skills continue to follow the chart to follow the chart and not and not adapt. adapt. 12-2008-Bill follows a chart, 6-2009-Bill follows a chart, if if a task deviates he will a task deviates he will continue Adapts to change continue to follow the chart to follow the chart and not and not adapt. adapt. Takes initiative 12-2008-Needs a flow chart. 6-2009-Needs a flow chart. Understands employer expectations 12-2008 6-2009- Follows emergency procedures 12-2008-Needs a flow chart. 6-2009-Needs a flow chart. Exhibits perseverance 12-2008 6-2009- Respects opinions/customs/differences of others 12-2008 6-2009- 12-2008-Gets upset and slams 6-2009-Gets upset and slams objects. He is verbally objects. He is verbally Accepts constructive feedback (criticism) prompted to take deep prompted to take deep breathes breathes and use his words. and use his words. Accepts compliments 12-2008 6-2009- Handles physical problems that arise (i.e. illness, pain or 12-2008 6-2009- bodily function) Takes necessary medications according to instructions 12-2008 6-2009- Recognizes/reports unsafe condition(s) 12-2008 6-2009- C. SOCIAL INTERACTION Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 12-2008-with verbal 6-2009-with verbal prompting prompting and cue card Establishes rapport with others and cue card otherwise does otherwise does not interact not interact with others with others Brings only work-related items to work 12-2008 6-2009 12-2008-with verbal 6-2009-with verbal prompting Keeps personal issues separate from work prompting and cue card and cue card Interacts appropriately with coworkers/supervisor during 12-2008-with verbal 6-2009-with verbal prompting

This document is the result of a collaborative effort of CLIU 21, CIU 20, DCIU 25, Private Industry Council, VIA of the Lehigh Valley, OVR, OMR of Lehigh County and Delaware County – OPTIONS Job Developer No parts of this document are to be used or reproduced without permission from Lehigh Valley & Northampton Employment Project Page 9 Mark by indicating: 3-Independent/strong ability, 2-Support Needed. 1-Not evident C. SOCIAL INTERACTION (continued) Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 12-2008-with verbal Listens while others are speaking 6-2009-with verbal prompting prompting 12-2008-with verbal Engages in conversation 6-2009-with verbal prompting prompting 12-2008-with verbal Dresses/grooms appropriately 6-2009-with verbal prompting prompting Offers help 12-2008 6-2009 D. WORK SKILLS Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 Understands work responsibilities 12-2008 6-2009- Remains focused 12-2008 6-2009- Locates tools/equipment 12-2008 6-2009- Returns tools/equipment to proper place 12-2008 6-2009- 12-2008-Bill needs a task Works under pressure/meets deadlines/makes rate 6-2009-Bill needs a task card. card. Recognizes obligation to attend trainings or other work 12-2008 6-2009- related meetings Completes assigned task(s) 12-2008 6-2009- E. PUNCTUALITY Response Code 3 2 1 DATE/YEAR 12-2008 3 2 1 DATE/YEAR 6-2009 Arrives to work on time 12-2008 6-2009- Leaves and returns from break on time 12-2008 6-2009- Leaves and returns from lunch on time 12-2008 6-2009- Attends work as scheduled 12-2008 6-2009- Clocks in/out of work accurately 12-2008 6-2009- Tells time standard/digital 12-2008 6-2009- Uses a clock or watch to manage time 12-2008 6-2009- Keeps and manages own schedule 12-2008 6-2009- Date of Transition Educational Exiting Profile Finalized 6-2009 Student Signature ______

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The Carbon Lehigh Intermediate Unit is an equal opportunity employer and does not discriminate on the basis of race, color, religion, national origin, age, marital status, sex or non-relevant handicap in activities, programs, or employment practices. For information regarding civil rights or grievance procedures contact Mr. John B. Houser, Section 504 Coordinator or Mrs. Kim Talipan, Title IX and ADA Coordinator at the Carbon Lehigh Intermediate Unit, 4210 Independence Drive, Schnecksville, PA 18078-2580, 800-223-4821.