British Columbia Public Schools
Process for Accessing SET-BC Services
School Based Referral Action Steps
1. Teacher refers the student to the School /
District Team.
2. School selects a school based contact
person.
3. If SET-BC services are considered, consult
the occupational therapist, physiotherapist,
teacher of the visually impaired, speechlanguage pathologist and/or district
resource teacher.
4. The District Screening Checklist is
reviewed by the School / District Team and
district contact person(s).
5. When the school based decision is made
to send the student’s name forward to
District Screening, submit the completed
District Screening Checklist.
School Based Responsibilities
1. Student must be funded by Ministry of
Education in categories A,B,D,E, or G
and be described by one or more of the
following disability groups:
a. physical handicap
b. visual impairment
c. dependent or multiple handicap
d. autism
Student’s access to the curriculum is
restricted by their disability.
Category C is a pilot project in the
2007/2008 school year.
2. School / District Team completes the
Screening Checklist or the pilot Assistive
Technology District Screening Checklist.
3. School based contact person submits
the District Screening Checklist to the
SET-BC District Partner before the
District Screening Meeting. For students
put forward for SET-BC service, the
school based contact person will be
asked to complete a Request for Service
form.
SET-BC Mandate
SET-BC is a Provincial Resource Program designed to assist BC School Districts in meeting the
technology needs of students with physical disabilities, visual impairments and autism.
SET-BC’s mandate is:
1. to loan assistive technologies (reading, writing, and communication tools) where those
are required to ensure students’ access to educational programs, and
2. to assist School Boards in providing the necessary training for students and educators in
the use of these technologies
District Screening
Checklist
Student Name:
Submitted By:
School District
Richmond
Please Return
form to:
Kathyrn D’Angleo
Date Submitted:
Due Date:
for SET-BC Service
YY / MM / DD
SD # 38
Tel:
at:
Fax:
Email:
1. Student Information:
Student is currently using SET-BC
Assistive Technology
Yes
No
Student is currently using District
Assistive Technology
Yes
No
Surname
Given name(s)
Birth Date (yy/mm/dd)
Home Address (Complete Mailing Address)
City:
SET-BC / District Partner
use only Service Points
1.2 Student Status Information:
Student is reported as: (B)
Deaf/Blind (DB)
(D)
physically handicapped /chronic health (PH)
(A)
dependent handicapped (DH)
Student Pen # (9digits)
_ _ _ _ _ _ _ _ _
Postal Code
(G)
(C)
(E)
autistic (AUT)
moderate to profound (MP)
visually impaired (VI)
Disability Diagnosis:
Grade:
Gender
M
F
Type of Impairment (Check those that apply)
motor
vision
communication
cognitive
Ministry Funding Category:
(Form 1701)
A
B
C
D
E
(Category C is a pilot project in 2007/2008)
G
1.3 School Information:
Key School Contact Person:
Position:
Email:
Telephone:
Facsimile:
Complete Mailing Address:
City
Name of School:
School Telephone:
School Mailing Address (if different than above)
City:
Classroom Teacher:
School Principal:
Primary Teaching Assistant:
Postal Code:
School Facsimile:
Postal Code:
Email:
1.4 Parent Guardian Information:
Parent / Guardian Name:
Postal Code:
Telephone (Home)
Complete Mailing Address (if different than above):
Email:
Telephone (Work)
Foster Parent/Associate Family Name (if applicable):
Email:
Telephone (Home)
Complete Mailing Address:
Postal Code:
Telephone (Work)
1.5. Referrals and Services Received:
Special Education Services Received: (please check all that apply)
Speech / Language Services
Services for the Visually Impaired
Physical / Occupational Therapy
Services for the Hearing Impaired
Has this student been referred to and/or received services from other programs? Please name program and specify year.
2. Student Profile
complete relevant sections only
2. 1. Cognitive / Academic Level:
Cognitive Level: (based on psycho-educational assessment)
above average
Achievement Level:
average
mild delay
not yet meeting
reading
reading comprehension
written language
math / numeracy
Pre-academic skills:
(describe if applicable)
Recognizes
objects
moderate delay
minimally meets
photos
severe / profound delay
fully meets
exceeds
line drawings
choice making ability:
visual matching skills:
2.2. Motor Skills
No Concerns
walks independently
manual wheelchair
self propels
non propellor
Mobility:
Hand Use
(dominance & function):
walker
power wheelchair
crutches/cane
other (eg. crawls.)
right hand
age appropriate
Typing Speed
left hand
impaired/delayed
scribing
extended time
Comment::
both
not functional
Please rate student use with the following scale: B = beginner SP = some proficiency
B SP P NA
B SP P NA
regular pencil
regular keyboard
adapted pencil grip
regular mouse
alternate keyboard
joystick
trackball
(specify type)
Physical needs:
P = proficient
Reading
Medium:
Student
Ability:
NA = not applicable
B SP P NA
head pointer
hand switch
head switch
switches alternate site
writing samples attached
reduced workload
2.3. Vision
Visual
Impairment:
WPM
No Concerns
low vision
totally blind
visual field restrictions
Braille
large print (lp)
lp with speech support
auditory only
cortical visual impairment
colour vision deficit
progressive
right eye
left eye
both eyes
large print (preferred font size)
Braille:
uncontracted
typing speed
low vision clinic
Acuity
contracted
Optical Aids Used
(include report)
2.4. Communication
Speech/Language:
speaking
non-speaking: communicates by (explain briefly below)
preferred magnification
No Concerns
articulation difficulties
sign language
gesturing/pointing
communication boards/books
Picture Exchange Communication System
simple speech output device (Big Mac)
dedicated voice output communication device
other (specify)
What is the student’s primary mode of communication?
language difficulties
2.5. Social / Behavioural
Please Describe:
No Concerns
peer interaction
time on task / attention span
work productivity
impulsivity
safety issues
no concerns
2.6. Access to Curriculum (student snapshot)
What barriers prevent this student from meeting reasonable educational goals?
What non-technical and / or technical strategies have been investigated or put in place to overcome the barrier(s)?
Please indicate and comment on the student’s willingness to use technology and on his / her technology preference.
3. Educational Program:
The student’s educational program is
modified
List 1 primary goal.
adapted
Two additional goals may be recorded.
other (explain)
Technology will be used:
in class,
in resource room,
in multiple locations.
Estimate frequency of technology use a in the student’s program
occasionally (1-2 times per week)
frequently (3-5 times per week)
on a daily basis (up to one hour per day)
almost continually (3-5 hours per day)
Please list the primary educational goal that will be supported through the use of technology. Include current level of functioning
(baseline statement) and how progress will be measured specific to the affect of A.T.: (attach copy of IEP)
Goal 1:
current level of
functioning:
evaluation
criteria:
Goal 2:
current level of
functioning:
evaluation
criteria:
Goal 3:
current level of
functioning:
evaluation
criteria:
4. School / District Team
Please indicate your School / District Team’s readiness to implement technology:
Technical Skills/Support
o School / District Team’s technical skills
beginning
intermediate
o Access to tech support within the school
limited
adequate
School / District Support
Availability for meetings
limited
adequate
easily met
Release time for training
limited
adequate
easily met
Purchase of peripherals (printer, scanner)
limited
adequate
easily met
Purchase of consumables (printer ink, etc.)
limited
adequate
easily met
Purchase of educational\productivity software
limited
adequate
easily met
School based transition plans
limited
adequate
thorough
Will the student be transitioned to a new team or new school next year?
Please comment
yes
advanced
occasionally
(not supplied by
SET-BC)
no
4.1 School Personnel:
Please List school personnel involved with this student
Job Role
Name
Aware of this referral
Classroom Teacher
yes
no
Resource Teacher
yes
no
Speech/Language Pathologist
yes
no
Augmentative Communication Consultant
yes
no
Vision Teacher
yes
no
Occupational Therapist
yes
no
Physiotherapist
yes
no
Teaching Assistant
yes
no
Counselor
yes
no
Parent
yes
no
Other
yes
no
5. Technology Considerations
What computer platform is currently in the school?
Macintosh
Windows
Are there other SET-BC computers in the school?
Yes
No
How is the student currently accessing computers in the school? (include location and frequency of access)
What type of technology is currently in place for the student? (include hardware and software)
What type of technology has been recommended / are you considering requesting from SET-BC ?
Screen magnification
Portable word processor
Screen magnification with speech
Computer
CCTV
Talking word processing software
Print to Braille software and Braille printer
Word prediction
Screen reader
Picture processor
Refreshable Braille device
Integrated scan/read/write software
Augmentative and alternative communication software
Alternate access
Augmentative and alternative communication device
Other
Attached Documents:
Please list attached documents:
NOTES:
ACCESSING SET-BC SERVICES
SET-BC is a Provincial Resource Program designed to assist BC School Districts in meeting the technology
needs of students with physical disabilities, visual impairments and autism.
Successful selection and implementation of Assistive Technology may include:
o
o
o
o
o
o
o
o
effective consultation including student input, to ensure a good match of technology features to student
need
clear educational goals and a clear idea of how technology will support those goals
adequate time for School / District Team planning, training and follow-up training
the School / District Team sharing responsibility for solving problems, creating overlays/templates,
monitoring use, etc.)
integration throughout the daily schedule
adequate practice time for the student
adequate funding for purchase of necessary peripherals (printers, scanners) or consumable items
(printer ink, batteries, etc.)
coordinated maintenance and support
SET-BC provides:
consultation services to match technology to student need
loan of assistive technology to School Districts for the use of eligible students (software and/or
hardware)
school team training, follow-up training and re-training
implementation resources
technical support to maintain and repair SET-BC equipment
School / District Team undertakes to provide:
release time for consultation, planning meetings, follow-up training and retraining
peripheral devices (printers, scanners) and consumables as needed
access to additional educational software required, eg. MS Word
safekeeping of the SET-BC loaned technology
School / District Team Commitment:
I have read the suggested guidelines for successful implementation of assistive technology and I
understand the School / District Team’s responsibilities. Should my student be put forward by the
school district for SET-BC service, I am committed to providing time and resources to successfully
implement the assistive technology.
School Principal Signature
Date
School-based Contact Signature
Date