CONSIDERATION FOR IEP/EDUCATIONALLY RELATED RESIDENTIAL TREATMENT SERVICES
Ventura County Special Education Local Plan Area (SELPA)
Student Name D.O.B. Meeting Date
IEP/Educationally related Residential Treatment Services are provided to assist a student in accessing his/her Special Education program. The decision to provide Residential Treatment Services should be based upon a thorough assessment.
1. Residential Treatment Services were requested by : Reason :
2. Based upon all information gathered, student demonstrates behaviors that:
 Are  Are not primarily due to social/emotional issues or symptoms and result in significant ongoing difficulties in educational performance (Briefly summarize) and/or
 Are  Are not presenting frequent, ongoing safety risks at school to self and/or others (Briefly summarize) and
 Are  Are not sufficiently responsive to extensive supports and services which have been provided at school and/or home to address educational needs (Briefly describe response to services provided) and
 Require  Do not require a comprehensive full-time therapeutic setting in order to access educational services (Give rationale)
3. The IEP Team agrees that the:
 Student should receive additional Intensive Social/Emotional Services to address his/her educational needs before considering
IEP/Educationally related Residential Treatment Services. (Describe)
 The student requires IEP/Educationally related Residential Treatment Services in order to benefit from his/her special education program.
Residential Placement Consultant will work with district and parent to locate an appropriate placement.
If residential placement is selec ted, note “ Residential Treatment Services ” as well as Specialized Academic Instruction and all social/emotional services student is to receive on Student Information and Services page. Indicate projected date of return. Also complete the “ Worksheet for
Specialized Out-of-District Placement ” to specify skills and competencies required for return to a less restrictive setting.
Copy to:
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District Office
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Cumulative File
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Case Manager
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Parent/Adult Student
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Related Services
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Mental Health
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Other
4.20.12