Santa Barbara County
Special Education Local Plan Area ……….A Joint Powers Agency
Request for Consideration of SBCSELPA Funded Mental Health Nonpublic School (NPS) Placement
To be completed by the referring Local Education Agency (LEA) Special Education Administrator/designee and forwarded to the SBCSELPA Director for consideration of an NPS placement in order for the SBCSELPA Director to determine if the NPS placement (residential or nonresidential) meets the criteria for being funded out of SBCSELPA shared funding.
Directions : The referring Local Education Agency (LEA) Special Education Administrator/Designee completes all of the following steps:
Note: It is recommended that the Special Education Administrator/designee contact the SBCSELPA's Director as soon as possible to notify him/her of the potential for a student NPS placement and possible forthcoming request for access to
SBCELPA funding
.
Step 1: Please indicate below the reason why the request for consideration of an NPS placement is being made:
 Parent / Guardian request for an NPS placement
Within 15 days of the receipt of the request, the LEA Special Education Administrator/designee must either:
1) send the parents a Prior Written Notice (PWN) denying the request for an NPS placement. or
2) send the parent/guardian a PWN and proposed Assessment Plan to assess the need for an NPS placement.
 IEP team recommended an assessment to determine if an NPS placement is potentially needed
Within 15 days of the request, the LEA Special Education Administrator/designee must send the parent/guardian a PWN and proposed Assessment Plan to assess the need for an NPS placement.
 Other (describe)___________________________________________________________________
If a NPS and residential placement is being requested, the SBCSELPA Mental Health Specialist is listed on the assessment plan as taking part in the Need for Out of Home Placement assessment process under “Social/Emotional” and the title “SBCSELPA Mental Health Specialist” is added along with the district School Psychologist.
yes no Step 2: Student is eligible for special education services:
Is student Medi-Cal eligible: yes no unknown
Student’s primary disability: secondary disability: (if applicable)
Student has a mental health diagnosis (if applicable): yes
If yes indicate diagnosis: .
no
(Note: this is required to access the state mental health funding if student is not eligible as ED)
Student has been referred and received Intensive Mental Health services prior to the consideration of placement: yes no
Step 3: IEP team has ruled out the continuum of least restrictive environments: yes no
Please List:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Step 4: The SBCSELPA Mental Health Specialist and SBCSELPA Director are notified within 5 calendar days of the pending assessment via email, fax or phone call and a copy of the assessment plan is sent to the SBCSELPA.
Date Notified
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Santa Barbara County
Special Education Local Plan Area ……….A Joint Powers Agency
Step 5: Within 10 days of the LEA receiving the signed Assessment Plan, the LEA Special Education Administrator/
Designee shall forward the following information to the SBCSELPA Director for review: o Cover letter with referral request and brief history of the case to include developmental, health, and o o o o o o o o educational history, including history of previous educational and behavioral interventions and the results of these interventions. Information/input from the current classroom teacher should also be included in the letter
Current IEP, including any behavior intervention plans
Current psycho-educational evaluation (intellectual functioning, language, adaptive behavior, academic skills, social/emotional functioning, and psycho-motor development)
Current academic assessment reports (public/private) not included in psychologists report
Related service assessment reports (if applicable)
If student is a Tri-Counties Regional Center (TCRC) client, an assurance that TCRC has been notified of the potential placement and whether or not TCRC has determined if they will potentially co-fund an outof-home NPS placement (the parent/guardian must make this request to TCRC if they feel they cannot safely maintain the child at home)
Copy of any suspensions or expulsion records and behavior emergency reports
Current observation data
Any other relevant documents
Date Sent
Within 5 days of receiving the signed Assessment Plan, the SBCSELPA Mental Health Specialist contacts the referring LEA Special Education Administrator/designee and School Psychologist to discuss the case and start assessment process.
Within 50 days of the signed Assessment Plan, the School Psychologist in consultation with the SBCSELPA Mental
Health Specialist completes the need for out-of-home placement (related to FAPE) and social emotional assessment report and forwards it to the referring LEA Special Education Administrator/designee and SBCELPA Director.
Note: Final recommendations for NPS placement are made by the IEP team , not SBCSELPA.
The SBCSELPA MH Specialist and Director shall review the referral and assessment results prior to an IEP taking place to determine if the referral meets the criteria for SBCSELPA funding of a potential NPS (with or without residential treatment) placement. The LEA Special Education administrator shall be notified of this decision prior to
IEP.
Within 60 days of the signed Assessment Plan, the LEA schedules an IEP meeting to review the assessment data and to discuss placement options, to include potential placement in a nonpublic school / residential treatment center. The
SBCSELPA Mental Health Specialist and Director must participate in this IEP meeting if it has been determined that a potential placement would meet the criteria for SBCSELPA funding.
If the IEP team recommends a NPS placement (residential or non residential) and the parent consents to the
SBCSELPA seeking a mutually-agreeable placement, SBCSELPA will begin the referral process and seek an appropriate placement for the student. Once a suitable placement is found, the parent and district will be notified to hold an IEP to offer a final NPS placement. The staff from the tentative NPS placement will be invited to participate in the IEP meeting. SBCSELPA will arrange and fund (in part as appropriate) a transport of the student to the new
NPS placement (this may be the parent or a transport company).
The SBCSELPA will schedule a follow-up thirty (30) day IEP if deemed needed to review and update behavior plan, services and goals.
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