Effective Implementation and Support of
Illinois Educational Program for Autism 2.1
(Adapted from EBS Self-Assessment Survey version 2.0 Sugai, Horner, Todd, Educational and Community Support, University of
Oregon)
Date____________ School ____________________________
District_____________________________________
City____________ Staff
Completing_______________________Title_____________________________________
Has school participated in IEP Experiential Training ___yes ___no
If yes, Date attended____________
Has school participated in On-Line Autism Training ___yes ___no
Has Team participated in Focus Family Support Model ___yes ___no
If yes, Date attended____________
Is school a PBIS school ___yes ___no
If school observation, Observer ___________________________
Description of Tool:
The EISIEPA Survey is used by school staff for initial and annual assessment of effective support systems in
their school. The survey examines the status and need for improvement of five systems: (a) district-wide
systems b) school-wide systems, (b) non-classroom management systems (e.g., cafeteria, hallway, playground),
(c) classroom systems, and (d) systems for individual students. Each question in the survey relates to one of the
five systems.
Survey results are summarized and used for a variety of purposes including:
1. annual action planning,
2. internal decision making,
3. assessment of change over time,
4. awareness building of staff, and
5. team validation.
The survey summary is used to develop an action plan for implementing and sustaining effective support
systems throughout the school
Conducting the EISIEPA Survey:
Who completes the survey?
Initially, the staff in a school or district who have attended the Experiential Practicum completes the EISIEPA
Survey. In subsequent years and as an on-going assessment and planning tool, the EISIEPA Survey can be
completed in several ways:



All staff at a staff meeting.
Individuals from a representative group.
Team member-led focus group.
When and how often should the survey be completed?
Since survey results are used for decision making and designing an annual action plan in the area for effective
support, most schools have staff complete the survey at the end of summer following the Experiential Practicum
or the beginning of the school year.
How is the survey completed?
1. Complete the survey independently.
2. Schedule 20-30 minutes to complete the survey.
3. Base your rating on your individual experiences in the school. If you do not work in classrooms or
have a child with autism in your classroom, answer questions that are applicable to you.
4. Mark (i.e., “” or “X”) on the left side of the page for current status and the right side of the page for
the priority level for improvement for each feature that is rated as partially in place or not in place
and rate the degree to which improvements are needed (i.e., high, medium, low) (right hand side of
survey).
5. To assess support, first evaluate the status of each system feature (i.e. in place, partially in place, not
in place) (left hand side of survey). Next, examine each feature:
a. “What is the current status of this feature (i.e. in place, partially in place, not in place)?”
b. For each feature rated partially in place or not in place, “What is the priority for improvement for
this feature (i.e., high, medium, low)?”
Definitions:
Current status = perceived status of the feature as of the day the rating takes place:
*In Place= perceived to be 100% in place
*Partially In-Place=perceived to be 50-99% in place
*Not in Place=Perceived to be 0-49% in place
Priority for Improvement = perceived status of the importance or impact of implementing the feature as it
relates to the student and/or team’s process:
*High=Perceived priority of extreme to total importance to implementation feature
*Medium=perceived priority of moderate importance to implement feature
*Low=perceived priority of minimal to no importance to implement feature
DISTRICT SYSTEMS
Current Status: Level of
Implementation
In
Partial Not in
Place
in
Place
Place
Need for Improvement
Feature
DISTRICT SYSTEMS are defined as involving policy and support from the
district to the school to develop and provide support students with ASD.
1) District has identified and makes use of community and state level resources to ensure
access to best practices (e.g., professional development, personnel with unique technical
skills).
2) Adequate resources are allocated to build the skills of identified district staff assigned
as coaches in the area of ASD (e.g. professional development, dedicated FTE, and release
time).
3) Adequate FTE for coaches to build capacity of school-based teams regarding ASD is
available (e.g., sub coverage).
4) The district demonstrates commitment to effectively educate students with ASD with
their same-age non-disabled peers (e.g., including students in district-wide programs).
5) District policies ensure access for all students including those with ASD to all school
facilities and activities (e.g., consistent procedures for behavioral expectations).
6) District incorporates collaborative practices that ensure families needs/priorities are
incorporated into district decision making (e.g., requires/requests teams to share and
explain data).
7) District collects and analyzes academic, social, behavior and placement data on
students with ASD to determine staff and support needs (e.g., curriculum based measures,
discipline referrals, least restrictive environmental data).
High
Med
Low
SCHOOL-WIDE SYSTEMS
Current Status: Level of
Implementation
In
Partial Not in
Place
in
Place
Place
Need for Improvement
Feature
School-wide is defined as involving all students, all staff and all settings.
8) Schools implement policies regarding appropriate school-wide supports and strategies
for students with ASD (e.g., consistent expectations of behavior, classroom policies
are taught).
9) School-based problem-solving teams are in place to develop/implement effective
interventions for students with ASD (e.g., functional behavior assessment behavior
intervention plans).
10) School-based teams use data-based decision-making to ensure progress of students
with ASD (e.g., direct observation, rating scales, interventions).
11) School-based problem-solving teams includes an individual skilled at conducting
functional behavior assessment for students with ASD (e.g., determine function of
behavior).
12) School-based indentified coaches have developed appropriate Professional
Development goals to increase their skill base regarding ASD (e.g., in data collection,
support plans, direct instruction).
13) Buildings allocate adequate planning time for identified coaches to ensure effective
interventions for students with ASD including: Student assessment, intervention
development, material development and intervention trials (e.g., common planning time).
14) General education staff has access to technology needed to provide accommodations
for students with ASD (e.g., examples of adaptations, assistive technology, communication
devices).
15) Schools routinely provide opportunities for typical students to understand and explore
individual differences common to students enrolled in their classrooms, including students
with ASD (e.g., creating circles of friends).
16) General education teachers are routinely provided with information about
characteristics, needs and best practices for students with ASD (e.g., concerns regarding
over or under stimulation).
17) Interventions found to be effective for individual students are implemented in all areas
of the school as needed (e.g., teaching routines, story boards, social stories).
18) Grade-level transition plans are written and implemented across grade level faculty
and include Student/program data, Professional Development and resource allocation (e.g.,
name of related personnel, skills to be taught, timeline for implementation).
High
Med
Low
.
NON-CLASSROOM SETTING SYSTEMS
Current Status: Level of
Implementation
In
Partial Not in
Place
in
Place
Place
Need for Improvement
Feature
Non-classroom settings are defined as particular times or places where
supervision is emphasized (e.g. hallways, cafeteria, playground, bus).
19) Selected strategies and supports for students with ASD are utilized in multiple settings
across the school.
20) Supports are utilized to assist students with ASD in transitioning from place to place.
21) All staff in non-classroom settings is trained in provision of appropriate strategies and
supports.
22) Trained staff actively supervises students with ASD in all non-classroom settings.
23) Comprehensive support plans are in place and generalized to non-classroom settings.
(e.g., practicing appropriate interactions in classroom and on playground or hallway to
increase success at school).
24) Typical students in non-classroom settings receive support in maintaining interaction
with students with ASD. (e.g., learning to acknowledge appropriate behavior, learning to
set appropriate physical boundaries with the support of the teacher to increase personal
safety).
25) Environmental modifications are implemented to facilitate/maximize student
independence and personal safety.
26) Staff receives regular opportunities for developing and improving active supervision
skills.
27) All staff is directly or indirectly involved in management of non-classroom settings.
High
Med
Low
CLASSROOM SYSTEMS
Current Status: Level of
Implementation
In
Partial Not in
Place
in
Place
Place
Need for Improvement
Feature
Classroom settings are defined as instructional settings in which teacher(s)
supervise and teach groups of students.
28) Specific classroom areas are clearly defined.
29) Classroom expectations and routines are clearly defined.
30) Classroom expectations and routines are taught directly.
31) Classroom teachers use positive behavior strategies and proactive classroom
management.
32) Expected student behaviors are clearly defined.
33) Expected student behaviors are taught directly.
34) Procedures for problem behaviors are clearly defined and followed.
35) Students with ASD receive specific instruction in math, reading, and written language.
36) Students with ASD receive specific instruction on social skills and communication.
37) All teachers share responsibility for providing universally designed and differentiated
instruction for presenting, engaging and expressing content to support learning of students
with ASD.
38) Related service personnel support students with ASD in the classroom to minimize
pull out time.
39) Structured reinforcement is built into classroom schedule.
40) Instruction for students with ASD uses grade level curriculum and is based on analysis
of student performance data.
41) Learned skills are being practiced to maintain skill and promote generalization.
42) Instruction for students with ASD is designed to allow for maximum interaction with
typical students.
43) Individual aides are trained to provide variable support and adjust proximity to
students as to allow maximum independence for the student.
44) Classroom is designed with access to a quiet space for down time as needed.
45) Data are collected, summarized and used to systematically make decisions regarding
classroom adjustments to improve outcomes for students with ASD.
High
Med
Low
INDIVIDUAL STUDENT SYSTEMS
Current Status: Level of
Implementation
In
Partial Not in
Place
in
Place
Place
Need for Improvement
Feature
Individual student systems are defined as specific supports designed for the
individual student with ASD.
High
Med
Low
46) Student has individual workspace designed according his/her needs.
47) Student has efficient access to an individual daily schedule throughout day.
48) Changes in student’s schedule are planned for and on schedule prior to the change.
49) Student’s workspace and supports are designed to be age-appropriate.
50) Student’s instruction includes grade level instruction with modifications and supports
individually designed.
51) Student can access sensory supports and breaks as needed.
52) Student has a reinforcement system that is used and understood by student, other
students and all staff.
53) Student’s communication system(s) is (are) available at all times.
54) Student’s communication system(s) is (are) understood and used by all staff and other
students.
55) Task organizers are used to maximize understanding throughout day.
56) Behavior Support Plans (BIP) are monitored and revised regularly.
57) A simple process exists for teachers to request assistance.
58) Identified ASD coaches respond quickly (within 2 days) to students who present
escalated problem behaviors.
59) Scheduling of student movement is designed to increase consistency and reduce high
noise, confusion, crowding and other occurrences that could be problematic for students
with ASD.
60) Family members and/or community supports are involved in planning, evaluation and
support for individual students.
61) Opportunities exist for families to participate in training re: behavioral support, homebased strategies and communication.
62) Data are collected, summarized and used to make systematic decisions regarding
changes in individual student systems to improve outcomes for students.
Rev 7.08