AREAS OF IMPACT CONTINUUM STUDENT NAME: ______

Key Indicators SCHOOL: ______

DATE OF APPLICATION: ______

Areas of Impact / KeyIndicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
ACADEMIC / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
AcademicINDICATORS
Academic skills / Typicalstudentlearningoutcomes.
☐Consistency inlearningacross subjects
☐Utilizes criticalthinkingskills
☐Able to read withaccuracy,fluency andcomprehension
☐Can communicate ideas through writtenexpression
☐Able to communicate clearly withorallanguage
☐Has good number sense,math fluencyandproblemsolvingskills / Performance belowexpectations asindicatedbyclassroombased orschool-wideassessments.
In addition to Level1 characteristics,maydemonstrate:
☐Inconsistency in learningacross subjects
☐Difficultyreadingwith accuracy,fluencyand/or comprehension
☐Readingis 2 years or more belowgrade levelin secondary(decodingand comprehension)
☐Difficulty with aspects of production(writing/speaking)
☐Limited academic vocabulary
☐Number sense,math fluency and problemsolvingskills have some deficiencies / Performance well belowexpectationsin 1 ormore core learningarea as indicatedbyschool assessments AND/ORlevel Bassessments (WIAT,WJIII, Key Math,informalreadingdiagnostic).
In addition to Level2 characteristics,maydemonstrate:
☐Significant difficultyreadingwith accuracy,fluency and/orcomprehension
☐Significant difficultyinitiating,completingand organizing
☐Significant difficulty maintainingattentionon school-related tasks
☐Difficulty with allor mostaspect of writing
☐Number sense,math fluency and problemsolvingskills have significantdeficiencies / Performance well below inatleast 2or morecore learningareas.Belowaverageperformance and extreme variabilityin schoolperformance as indicated by level Band/orCassessments.
In addition to level 3 characteristics,maydemonstrate:
☐Functional readingabilities arelimited,non-reader (limited sound-symbol association)
☐Functional writingabilities are limited,non-writer (limited abilityto write simplesentences)
☐Functional math skills limited (limitedabilitytelltime or count money)
☐Limited executive functioningskills
ADDITIONAL COMMENTS:
Areas of Impact / KeyIndicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
Social Emotional Behavioural / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
SocialEmotionalBehaviouralINDICATORS
Behaviour is theprimary supportneed
Behaviour notexplained bylowcognitive ability,learningdifficulties,classroommanagementorphysicalchallenges / GENERAL
☐Follows routines independently
☐Reasonably compliant
☐Respects self,others and property
SOCIAL
☐Takes initiative
☐Accepts responsibility
☐Engaged in learningat a reasonable level
EMOTIONAL
☐Responds tocorrectionand naturalconsequences
☐Able to formsocialrelationships
☐Is self-regulatingand emotionally stable
☐Self-Advocating / Mild severity andintensity
(occasional–weekly or less frequent).
GENERAL
☐History ofinvolvementwith other agencies
☐Behaviourthat has impact onsome settings
☐Difficulty with functioningin regular
classroom
☐May have attendance issues
SOCIAL
☐Withdrawal,socialisolation
☐Dependency
☐Lack of socialskills acquisition(socialcues)
☐Lack of socialreciprocity
☐Lack of socialunderstanding / Moderate severity and intensity(frequently -dailyor on regular schedule)
GENERAL
☐History ofinvolvementwith other agencies
☐Behaviourthat has impact onmostsettings
☐Difficulty with functioningin regular
classroom
☐May have attendance issues
SOCIAL
☐Withdrawal,socialisolation
☐Dependency
☐Lack of socialskills acquisition(socialcues)
☐Lack of socialreciprocity
☐Lack of socialunderstanding
EMOTIONAL
☐Harmfulto self
☐Sadness and/orunhappiness
☐Worry and/orfear
☐Worthlessness
☐Hopelessness / Severe intensity.
(continuously –regular/on a consistentbasis)
GENERAL
☐History ofinvolvementwith other agencies
☐Behaviourthat has impact onall settings
☐Difficulty with functioningin regularclassroom
☐May have attendance issues
SOCIAL
☐Withdrawal,socialisolation
☐Dependency
☐Lack of socialskills acquisition(socialcues)
☐Lack of socialreciprocity
☐Lack of socialunderstanding

LRSD AREAS OF IMPACT CONTINUUM – KEY INDICATORS (COMPLEX NEEDS APPLICATION) REVISED June 2017 Page 1 of 8

Thank you to Wolf Creek School Division for sharing their Indicators of Impact scales from which this application was adapted.

AREAS OF IMPACT CONTINUUM STUDENT NAME: ______

Key Indicators SCHOOL: ______

DATE OF APPLICATION: ______

Areas of Impact / KeyIndicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
Social Emotional Behavioural / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
Caution:
Variances forstudents diagnosedwith ADHD,ASDand FASD. / BEHAVIORAL
☐May experience short-term emotional behaviourdifficulties (grief,divorce,peerissues)
☐Ability toempathize and demonstrateremorse / EMOTIONAL
☐Harmfulto self
☐Sadness and/orunhappiness
☐Worry and/orfear
☐Worthlessness
☐Hopelessness
BEHAVIOURAL
☐Aggression to self orothers
☐Lies
☐Steals
☐Property disruption
☐Argumentative
☐Defiant,non-compliant
☐Easily annoyed
☐Angry
☐Easily distracted
☐Task avoidance
☐Disorganized
☐Attention
☐Restless
☐Impulsive / BEHAVIOURAL
☐Aggression to self orothers
☐Lies
☐Steals
☐Property disruption
☐Argumentative
☐Defiant,non-compliant
☐Easily annoyed
☐Angry
☐Easily distracted
☐Task avoidance
☐Disorganized
☐Attention
☐Restless
☐Impulsive / EMOTIONAL
☐Harmfulto self
☐Sadness and/orunhappiness
☐Worry and/orfear
☐Worthlessness
☐HopelessnessBEHAVIOURAL
☐Aggression to self orothers
☐Lies
☐Steals
☐Property disruption
☐Argumentative
☐Defiant,non-compliant
☐Easily annoyed
☐Angry
☐Easily distracted
☐Task avoidance
☐Disorganized
☐Attention
☐Restless
☐Impulsive
ADDITIONAL COMMENTS:
Areas of Impact / Key Indicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
COGNITIVE / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
CognitiveINDICATORS
Ability
Primary supportand/orinstructional needis related tocognitive ability
Difficulties withlearning,Behaviour,physicalorsensory challengesbestexplained bycognitivechallenges
Caution:
Attend to full scaleIQ scoring. / Full scale IQ typically 85+
☐Able to achieve or master studentlearningoutcomes with differentiated instruction andassessment / Full scale IQ70-85May demonstrate:
☐Functions bestin familiar activities andstructured routines
☐Difficulties become more evidentwhenpresented with abstract learningmaterials
☐Presentswith difficulties in language
☐Presentswith difficulties in articulation
☐Presentswith difficulties in motordevelopment
GIFTED
☐Full scale IQ130
Gifted studentsrequire programmingsupports. / Full scale IQ50-70
May demonstrate:
☐Delays in all or mostareas of development
☐Workingon early orfunctional academictasks
☐Extremely limited generalization oflearning
☐Delayed communication skillsandfinemotor functioning
☐May be independent within familiarstructured activities orfor short periods
☐Asan adult,group or assistedlivingarrangements
☐Could beinvolved in some vocationalandrecreational activities
☐Asan adult,capable offunctional literacy
☐May qualifyfor governmentassistance / Full scale IQ below 50 or may be considereduntestable
May demonstrate:
☐Severe delaysin allor mostareas ofdevelopment
☐Extremely limited generalization oflearning
☐Littleif anyfunctional communication exceptfor basicvocalization,gestures
☐Delays infineand gross motorfunctioning
☐Asan adult,will require assistiveliving,mayqualifyfor AISH, PDD,guardianship
ADDITIONAL
COMMENTS:
Areas of Impact / Key Indicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
PHYSICAL INDICATORS / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
PhysicalINDICATORS
Primary need isrelatedto amedicalconditionor syndrome
Learningorbehavioural
difficultyisprimarily relatedto theeffects ofthemedicalcondition / ☐Physically healthyorhas a physical conditioncontrolled withlittle or no educational,social,emotionalor behaviouralimplications
☐Examples may include butare notlimited tocontrolled asthma,diabetes,epilepsy,allergies,depression,anxiety,ASD,ADHD,FASD / Hasa medicalor physicalcondition resultinginmild difficulties duringphysicalactivities orself-help skills.
May demonstrate:
☐Finemotor delays
☐Grossmotor delays
☐Attention difficulties
☐Increased absencefromschool
☐Restrictionsto activities and/or diet
☐Hesitancy to participatein some activities
☐Mobility difficulties
☐Sensory sensitivities / Hasa medicalor physicalcondition resultinginmoderate difficulties duringphysicalactivitiesor self-help skills.
In addition to level 2 characteristics,maydemonstrate:
☐Difficulties with specific physicalactivities
☐Restrictionson participation in activities
☐Limited mobility,difficulty modulatingawareness
☐Limited functioningin a school settingwithoutextensive supports and services
☐Physicaldisability may affectcommunication
☐Unusualresponsesto sensory stimulation / Hasa medicalor physicalcondition resultinginsevere difficulties duringphysicalactivitiesorself-help skills.
In addition to level 3 characteristics,maydemonstrate:
☐Significant difficulties with specific physical
activities
☐Significant restrictionson participation inactivities
☐Has medical conditionresultingin severedifficulties
☐May be considered “medically fragile”
☐Total dependence upon adults
☐Need for 1:1 assistant for all activitiesof dailylivingsuch astoiletingand eating
☐Need for medicalinterventions suchas tube-feeding,monitoringof seizures
ADDITIONAL
COMMENTS:
Areas of Impact / Key Indicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
VISUALLY IMPAIRED / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
VisuallyImpairedINDICATORS
Support needsrelated primarilyto low,limited orno vision / Normalvision (with correction ifnecessary) / Studenthas reduced acuity of 20/30 –20/70
May demonstrate:
☐Difficultyfollowingdirection that requiresuse of vision
☐Clumsiness
☐Proneto accidents
☐Fatigue
☐Difficulty with academic andplay/recreational skills involvingvisual/motor coordination
☐Difficulty with normalsized text
☐Poor printing / Studenthas acuity of 20/70 –20/200or worse,may be considered legally blind (code56 or 46)
May demonstrate:
☐A deterioratingcondition
☐Head tiltingor body posturingtocompensate for restrictedfield of vision
☐Difficultyfollowing a visualdemonstrationwithoutadditionalcues
☐Clumsyor excessively cautious in unfamiliarenvironments
☐Difficulty negotiatingthephysicalenvironment / Studenthas acuity of 20/200 or worse,evenafter correctionin thebettereye
May be considered legally blind
(coded 46):
☐Studenthas no usable vision or afield ofvision reduced toan angle of 20 degrees
☐Follows theprograms of study withappropriate adaptations
☐Child is unableto function with extensivesupports
ADDITIONAL
COMMENTS:
Areas of Impact / Key Indicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
DEAF AND HARD OF HEARING / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
Deaf andHard ofHearing
Support needsrelated primarilyto hearingimpairments / No apparenthearingproblems or mayexperiencetransienthearingdifficulties / Residualhearingwith possible delay inlanguage development.
May demonstrate difficulty:
☐Followingwhole class instruction (may seeminattentive or “non-compliant”)
☐Delay in response time to verbal instruction
☐May be reliant on visual cues
☐Difficulty with theproduction of specificconsonantspeech sounds / Some residualhearingwith language delayresultingfromlack ofexposureto language.
May demonstrate difficulty:
☐Difficultyfollowinginstructionsin theabsence of contextual cues
☐Demonstrates some difficultiesin socialrelationships
☐Will have difficulty knowingwhatis saidwithoutvisual support
☐Language developmentmay be delayed
☐Sign language or picture basedcommunication / Minimalor no residualhearingand deprivationfromvisuallanguage (code45).
May demonstrate difficulty:
☐Language developmentmay be delayed
☐May have difficulty developingsocialconnections on own
☐Aural-oralcommunication ineffective
☐Unless others sign will have difficultydevelopingsocial relationships,communicatingwith others
☐Requires consistentsupport for allforms ofcommunication
ADDITIONAL
COMMENTS:
Areas of Impact / Key Indicators
HIGHLIGHT THE INDICATORS THAT APPLY FOR YOUR STUDENT
EXECUTIVE FUNCTIONING / Level 1
Student meets generalstudentoutcomes atorabovegrade level through high qualityinstruction,includingdifferentiation. / Level 2
Student requiresadaptation and additional support. / Level 3
Student requiresextensiveadaptation and/or modification andmay have difficulty meetinggradeleveloutcomes. May or may not meet criteria forAlberta Education specialeducation coding. / Level 4
Student who requireshighly specialized andintensive programmingand supports. Meets the criteria for Alberta Education special education coding.
ExecutiveFunctioningINDICATORS / ☐Planning
☐Organization
☐Workingmemory
☐Time management
☐Goaldirected persistence
☐Flexibility
☐Ability to takeinitiative,self-starter
☐Self-monitoring
☐Metacognition,self-reflection / ☐Planning
☐Organization
☐Workingmemory
☐Time management
☐Goaldirected persistence
☐Flexibility
☐Ability to takeinitiative,self-starter
☐Self-monitoring
☐Metacognition,self-reflection / ☐Planning
☐Organization
☐Workingmemory
☐Time management
☐Goaldirected persistence
☐Flexibility
☐Ability to takeinitiative,self-starter
☐Self-monitoring
☐Metacognition,self-reflection / ☐Planning
☐Organization
☐Workingmemory
☐Time management
☐Goaldirected persistence
☐Flexibility
☐Ability to takeinitiative,self-starter
☐Self-monitoring
☐Metacognition,self-reflection
ADDITIONAL
COMMENTS:

LRSD AREAS OF IMPACT CONTINUUM – KEY INDICATORS (COMPLEX NEEDS APPLICATION) REVISED June 2017 Page 1 of 8

Thank you to Wolf Creek School Division for sharing their Indicators of Impact scales from which this application was adapted.