Holly Day, Special Education Director

3 Aggregate Road
Poland, ME 04274
207.998.2727
hday@rsu16.org

Date Mailed to Family: 10/27/2017

Student Name: Autumn Hincks School: Poland Community

Dear, Mr. Hincks and Mrs. Dennison,

Please find a copy of the evaluation report(s) enclosed. The areas checked off below will be
reviewed at your child’s upcoming Individualized Education (IEP) Program Team meeting
scheduled for:

11 /7/2017 3:30 pm

Day/Date of IEP Meeting Time of Meeting

• X Academic/Developmental
• ___ Intellectual
• ___ Learning Development
• ___ Psychological
• _X_ Observation
• ___ Physical Therapy
• _X_ Speech Language
• _X_ Occupational Therapy
• ___ Interest/Aptitude
• ___ Additional
• ___ Other
If you have any questions, please feel free to contact me at 998-4915 x156.
Sincerely,
Ann Butler OTR/L, Tracy Gagne CCC/SLP, Christina Bichrest, Sp. Ed., Examiners

___Original=Special Ed Brick File ___ Copies=Case Manager and Special Ed Office

Updated 9.18.14REGIONAL SCHOOL UNIT NO. 16
Special Education Department
 Confidential Evaluation Report

Student: Autumn Hincks Dates of Evaluation: 10/18/2017 Date of Report: 10/20/2017

Date of Birth: 10/25/10 Age at the time of testing: 6 years, 11 months Grade: First

Tests Administered: School Function Assessment

Evaluators: Ann Butler/ Occupational Therapist, Tracy Gagne, CCC/SLP, Christina Bichrest, Sp. Ed.

Background/Rationale:
This evaluation was completed as part of Autumn's 3-year re-evaluation to assess her present level of
functional performance in the school environment. These tasks relate to her participation in academics
and social interactions at Poland Community School. Because it is a criterion referenced test, it can be
used to compare student performance over time to determine growth of independence within the least
restrictive environment.

Sub-tests and converted criterion scores

Autumn’s Earned Comparative Expected
Scores Score
Travel 62 100
Maintaining and Changing 75 100
Positions
Recreational Movement 49 83
Manipulation with Movement 68 93
Using Materials 42 83
Setup and Cleanup 53 87
Eating and Drinking 58 100
Hygiene 48 92
Clothing Management 54 93
Up/Down Stairs 64 100
Written Work 0 73
Computer and Equipment Use 42 65
Functional Communication 14 91
Memory and Understanding 39 79
Following Social Conventions 22 73
Compliance with Adult 44 76
Directives and School rules
Task Behavior/Completion 26 72

Positive Interaction 31 81

Behavior Regulation 26 74

Personal Care Awareness 35 92

Safety 0 91
Physical Domain:
Gross motor skills for Autumn are considered in the normal range for accessibility within the
school environment. She has no challenges with being able to navigate any aspects of the school or
playground outside for recreational activities. Swinging is a favorite choice for her. Adaptive swim is
another preferred activity. She is in the pool with a belt, paddling independently and appears content.
She allows for others to move her and play with her without issue. Showers have been a challenge this
year and they appear to be traumatic for her. The following are relative strengths: Travel 62, Maintaining
and Changing Directions 75, Manipulation with Movement 68, Setup and Cleanup 53, Eating and Drinking
58, Clothing Management 54, Up/Down Stairs 64, Computer and Equipment Use 42. Fine motor skills are
a challenge for Autumn when related to written work.
She really does not understand the purpose of writing or coloring yet.

Cognitive and Behavioral Domain:

Autumn has many challenges that relate to daily function in the classroom. She is showing some
gains in her ability to understand one-step directions, her understand routines and in her understanding
of spatial concepts. She continues to struggle with more complex two-step directions, time and sequence
concepts and overall expressive communication through sign or PECs. These are common with her lack
of engagement with staff and students and work. Some of these challenges relate to her lack of
perception and understanding of social norms. Other challenges that will require further continued
development and specialized instruction are as follows: Functional Communication 15, Memory and
Understanding 39, Following Social Conventions 22, Compliance with Adult Directives and School 44,
Task Behavior Completion 26, Positive Interaction 31, Behavior Regulation 26, Personal Care Awareness
35, and Safety 0.
Last year routine was never consistent due to absences. This year Autumn has begun to learn
the routine at a new school and has begun to take more initiative. She has taken an interest in musical
instruments and simple six piece puzzles, which she does independently.

Observation:
Autumn is a first grade student in the Functional Life Skills Program at Poland Community School.
She works in a small group for story time and calendar time for morning meeting with her regular
education class. She works in one-on-one situations for all academic work. Autumn struggles in all
situations to maintain focus. Limited spurts of 15 minutes or less are common. She can sit in group
settings for around 30 minutes at a maximum. Redirection does help sometimes, but it often appears to
be an evasion of non-preferred activities. When given the choice, Autumn will work or play alone. She
does not engage peers, but will seek out her staff member to request help.

8:35 a.m. - The education technician came in carrying Autumn’s bag and she placed it down by the
cubbies as Autumn walked to her table. Autumn came into the classroom carrying her breakfast tray with
two hands. Autumn grabbed her straw and stood up her grape juice. She put both her hands together
and opened them. Her education technician demonstrated hand over hand to open her hands in the
American sign language motion for “open.” Autumn sat and drank her juice for a few minutes. She
decided she wanted her cereal open.

8:39 a.m. - Autumn made another motion with her hands putting them both together and then opening
them. Her education technician helped her hand over hand. A peer jumped up from his seat and came
over to help Autumn open the cereal. When the cereal was open, Autumn dumped the cereal on her tray.
She picked at it but hadn’t yet tried a bite.

8:42 a.m. - Autumn tried a bite of cinnamon toast cereal. She made a face of dislike. After 3-4 minutes
the education technician asked her if she was all done. Autumn shook her head. She continued to sit, but
did not show signs of wanting any more food or drink.

8:45 a.m. - Autumn sneezed twice. Her teacher said bless you and Autumn smiled at the teacher.
Mrs. Lawlor, her education technician said breakfast is all done, time to clean up. Autumn gathered all
the trash from her area and began to walk to the trash can. She took a piece of trash from her friend’s
space and threw that in the trash too.
8:47 a.m. - Autumn came back to her desk. Autumn worked to earn 3 panthers. Her first task was to
touch the color her teacher requested of her. The education technician held up two color cards. She
showed Autumn red and yellow and said, “Point to yellow.” Autumn pointed to yellow. The education
technician held up blue and green and said, “Point to blue.” Autumn pointed to blue. The education
technician held up orange and yellow and said point to yellow. Autumn did. Mrs. Lawlor asked Autumn to
identify numbers the same way she did colors, with two choices asking Autumn to point to the requested
number. The education technician asked her by using numbers 1-4.

8:52 a.m. - Autumn earned all three Panthers. As she put them on the paper, she put them upside down.
Mrs. Lawlor passed Autumn her PECS book. She asked, “What do you want?” Autumn opened the book
and flipped through the pages. She requested her blanket. Autumn picked up her sentence strip and
pointed to the picture of Autumn, and then she pointed to blanket. “Autumn wants blanket.” Mrs. Lawlor
read this out loud, and then she stood up to go get the blanket. Autumn stood up, she pushed in her
chair and went over to lay on the letter carpet.

Summary of Test Results/Diagnostic Impressions:

Autumn is showing significant delays in cognitive, fine motor and communication domains.
Recently because attendance has been more consistent Autumn has begun to demonstrate gains in
routines and behaviors. She appears more comfortable in the classroom setting and is demonstrating
more positive facial expressions when engaged in work.

Recommendations:

1. The continuation of social skill training, with practical application for peer interactions, is
indicated.

2. Autumn needs to build her signing and use of PECs.

3. Small group or one-on-one instruction best suits Autumn’s social and academic needs. Practical
application is key, in order for her to gain meaning in her day.

4. Visual application when possible to help Autumn relate and comprehend her academic work.

5. The IEP Team will continue to compare all evaluation data to determine if Autumn continues
meets the criteria for identification as a student with an educational disability at this time.

6. If there are any questions regarding this evaluation, please contact Christina Bichrest at 998-
4915, extension 156.

Christina Bichrest
Special Education Teacher/ Grades K-3
Poland Community School