Materials: What Type of Plate, Cup, and Utensils Work Best
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TRANSITION EDUCATIONAL EXITING PROFILE/MDS FUNCTIONAL
Name: D.O.B. Home Graduating School: District:
Graduating Teacher: Contact Number: Anticipated Year of Graduation: Type of Program:
Address: Phone #:
SS#:
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name: List residence: Phone: Emergency Contact: Phone: Second Contact: Phone:
Attach a Vision and Hearing statement and/or report for the individual if one is available.
1. DAILY LIVING SKILLS
A. Feeding
Likes Dislikes
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 2
Procedure: Indicate how the individual is positioned? Tell to what degree he/she participates in the activity. Include suggestions to facilitate the process.
Materials: What type of plate, cup, and utensils work best.
How does the individual communicate this need?
B. Toileting Does the individual indicate? How?
Is he/she successful on the toilet? Is there a recommended schedule? How is he/she positioned?
Is there any special equipment used?
C. Dressing
How does the individual participate in the activity?
D. Additional Areas
Add relative information concerning tooth brushing, hand washing, etc.
2. MOBILITY
Is the individual ambulatory? Explain.
Does he/she require any assistance in the process?
Is there a distance limitation?
What devices are used to facilitate ambulation? (walker, cane, gait trainer, etc.)
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 3
What procedure is used for transfers?
Is a Hoyer Lift recommended?
List any other considerations.
3. SEATING AND POSITIONING
What seating and positioning supports are used?
List special considerations or concerns.
What is the suggested time limitation on any position?
What safety assists are needed: tray, lap belt, harness, etc.
4. BEHAVIORAL CONSIDERATIONS
List all behaviors the individual exhibits along with the meaning that is attributed to them. Include strategies implemented to address the demonstration, e.g. hitting self seems to be an expression of anger. Best dealt with by refocusing.
Are any behaviors determined to be of danger to self or others? Explain.
5. COMMUNICATION
What are the present skills of the individual?
What are the access methods?
What Vocal Output Communication Devices have been used successfully?
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 4
List any communication boards, books, or schedules that are used.
Since behavior is also a communication mode, please list any behaviors as well as what the inferred message might be, e.g. individual will drop to the floor as a way of telling us he does not want to comply.
Other behaviors under communication:
6. ASSISTIVE TECHNOLOGY/ACCESS
List any devices that enable access.
Tell how they are used.
7. COMPUTER
Is this a preferred activity?
Is there recommended software? List.
What is the best method of access?
8. SENSORY STRATEGIES
What techniques or equipment assists the individual to attend to the task and decrease negative behaviors?
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 5
Are there any items that elicit negative responses?
9. VOCATIONAL SKILLS
Attach a job skills inventory if one has been done. Obtain information from special education personnel, job coaches, etc.
List any skills that allow partial or full participation.
10. LEISURE/RECREATION/COMMUNITY BASED ACTIVITIES
Provide a list of preferred activities.
11. AGENCIES
Indicate agencies involved in providing services, e.g. MH/MR and caseworker name with contact number; OVR; equipment companies; nursing agencies, etc.
Name of Agency Contact Name Contact Number
12. TRANSPORTATION
What are the requirements needed to transport the individual. Indicate any safety precautions.
What transportation considerations have been made to access the community?
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 6
13. MEDICAL STATUS
Medical Condition/Disability Diagnosis:
Concerns:
List current medications with dosage and time.
Indicate seizures and protocol to be followed.
Doctor’s Name: Phone: Hospital/Clinic Name: Phone:
14. ADDITIONAL INFORMATION
Team members who participated in the completion of this profile:
Name Role Contact Information
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21. Name: Page 7
15. PROVIDE A CURRENT PHOTO FOR THE EXITING PROFILE.
16. PARENTAL INPUT
(Please list any information that may have been overlooked which you think is pertinent to the care and programming for the individual.)
This document is the result of a collaborative effort of Maia Geiger, Social Worker, and Phoebe Sechrist, Speech and Language Pathologist, MA, CCC/SLP, of the Carbon Lehigh Intermediate Unit #21. Created 2006, Updated 2008. No parts of this document are to be used or reproduced without permission from Carbon Lehigh Intermediate Unit #21.