School District 200-Hastings
Rubric to Determine Level of Adult Support
Student:
Adult
Support
IEP Manager:
Health/Personal Care/Physical Support
Behavior/Social/Emotional
Location:
Date:
Instruction/Presentation
Communication/Response
None
General good health. No specialized health care,
procedure, or medication. Independently
manages all “age appropriate” personal care.
Follows adult directions without frequent prompts
or supervision. Handles change and redirection.
Usually gets along with peers and adults. Seeks
out friends. Able to process situations after the
fact.
Participates in whole class instruction. Stays on
task and follows directions with additional
prompts &/or accommodations typical in a
classroom.
Participates in and responds to core curriculum
within the general education class with response
accommodations typical to a classroom.
Intermittent
(Classroom
Adaptation)
Mild or occasional health concerns. No specialized
health care procedure. Medication administration
takes less than 10 minutes daily. Needs reminders
to complete “age appropriate” personal cares.
Student can ask for help and can wait.
Follows adult direction. Requires additional
encouragement and prompts. Occasional difficulty
with peers or adults. Does not seek out friends but
interacts when others initiate. Behavior has a
limited impact on others.
Participates in groups at instructional level. May
require additional prompts, cues, or
reinforcement to stay on task, follow directions,
and remain engaged in learning. Responds to
support from peers.
Participates in and responds to core curriculum
within the general education class with
accommodations to pace and output mode.
Responds to support from peers.
Limited
(Occasional
PSA
Support)
Requires reminders and prompts or limited hands
on assistance for washing hands, using bathroom,
wiping mouth, dressing, etc. Occasional toileting
accidents. Student can wait for assistance. May
need adult escort between classroom
environments for safety.
Does not consistently follow adult direction or
expected rules of conduct. Can be managed
adequately with a positive behavior support plan
(PBSP). Behavior can impact others in the learning
environment.
Some limits in ability to participate in whole class
instruction. Requires frequent verbal &/or visual
prompts, cues, or reinforcement to follow
directions and stay on task.
Some limits in ability to participate in whole class
discussion. Requires accommodations to complete
class activities.
Physical limitations/mobility may include stander,
walker, gait trainer or wheelchair. Special food
prep or feeding. Health or sensory interventions
or toileting support. Requires frequent physical
prompts and direct care. Necessary
accommodations are not typical for classroom
and require additional adult support.
Demonstrates serious behavior problems almost
daily. Defiant and/or prone to verbal aggression.
Requires close visual supervision. Possibility of
elopement. Behavior significantly disrupts others.
Necessary accommodations are not typical for
classroom and require additional adult support.
Difficulty participating in a large group. Requires
close adult proximity, frequent prompts, and
physical assistance. Necessary accommodations
are not typical for classroom and require
additional adult support.
Difficulty independently generating a
response/output or class/curriculum activities.
Necessary accommodations are not typical for
classroom and require additional adult support.
Specialized health procedures requiring specially
trained staff. Requires direct and frequent
assistance with positioning, health/medication,
sensory related interventions, &/or personal care.
Frequent and serious physically aggressive
behavior with risk of injury to self or others.
Likelihood of elopement. Staff must be trained in
CPI. Accommodations require extensive and
proximal adult support.
Participates in group activities only with direct
adult support. Requires constant verbal, visual,
and physical prompting to stay on task and follow
directions. Cognitive abilities and skills require
significant curriculum accommodation and
modification.
Accommodations for response mode are
significant and require extensive and proximal
adult support (e.g. PECS, augmentative
communication, etc.).
Extensive
(Shared
PSA)
Pervasive
(PSA)
Adapted from Jill Kuzma 2007 and ISD 917 2012
Rev. 12/13