Rating Sheet for IFSP Quality Review Scale

Rating Sheet for IFSP Quality Review Scale

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Rating Sheet for IFSP Quality Review Scale

Date:Reviewer:

Child’s Name:FSC:

Section A:Your Family- This is MUST PASS Section – All items must be rated either Acceptable or Exemplary

Check here if the family declined to share information for Section A: ☐

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater Reliability
Item A1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item A2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item A3 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section B: Summary of Relevant Health Information- This is MUST PASS Section – All items must be rated either Acceptable or Exemplary

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater Reliability
Item B1.1
(vision) / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Vision rescreening needed?
☐ Yes (If yes, proceed to Item B1.2)
☐ No (If no, proceed to Item B2.1)
Item B1.2
(vision rescreen) / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item B2.1
(hearing) / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Hearing rescreening needed?
☐ Yes (If yes, proceed to Item B2.2)
☐ No (If no, proceed to Section C)
Item B2.2
(hearing rescreen) / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section C: Present Abilities, Strengths, and Needs

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater Reliability
Item C1 / ☐ / (none) / ☐ / ☐ Yes ☐ No
Item C2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section D: Child/Family Outcomes- This is aMUST PASS Section – All items must be rated either Acceptable or Exemplary.

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater
Reliability
Item D1.1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item D1.2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item D2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section E: Child/Family Outcomes – Strategies- This is MUST PASS Section – All items must be rated either Acceptable or Exemplary.

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater
Reliability
Item E1.1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item E1.2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item E2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item E3.1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item E3.2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item E3.3 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section F: Supports and Services Needed to Achieve Outcomes

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater
Reliability
Item F1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item F2.1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item F2.2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section G: Natural Environments Justification

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater
Reliability
Item G1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

Section H: Periodic Review

Check here if this is NOT a periodic review of the IFSP: ☐

Review Area / Needs Improvement / Acceptable / Exemplary / Inter-rater
Reliability
Item H1.1 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item H1.2 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Item H1.3 / ☐ / ☐ / ☐ / ☐ Yes ☐ No
Comments:

To use this Rating Sheet:

• Review the IFSP using the IFSP Quality Rating Scale and the Rating Scale Manual
• Record the rating for each item by clicking on the appropriate box
• Use comments section to support improvement

Understanding Ratings:

• Sections A, B, D and E are Must Pass section. If any items in Sections A, B, D, or E are rated as “Needs Improvement”, the entire section does NOT pass. Refer to the IFSP Quality Rating Scale Manual as needed to better understand each item on the Rating Scale.

The following Must Pass sections had needs improvement ratings: