INDIVIDUALIZED FAMILY SUPPORT PLAN

Child’s Name: / Child’s Last and First Name / DOB: / Child’s Date of Birth

INDIVIDUALIZED

FAMILY SUPPORT PLAN

CHILD’S NAME:
CARE COORDINATOR:
PROGRAM:
Select Type of IFSP
Please check one: Initial IFSP Annual IFSP / Date: / Date Meeting Held / If Annual IFSP, date of Initial IFSP: / If annual, enter date of Initial IFSP
6-month IFSP Review / Date: / Date Meeting Held / Other IFSP Review Date(s): / List all dates of IFSP Review(s) between Initial and the next Annual IFSP, excluding the 6-month Review.
I.  INFORMATION ABOUT OUR CHILD AND FAMILY
Purpose: This section provides an opportunity for the family members to think about and share their hopes, dreams, and concerns for their child and realize that they have strengths and resources that can be used to address their concerns and priorities.
The information in this section will be primarily guided by the family and should be addressed during the course of service delivery. This section is not designed to be a question and answer format, but to be done in more of a “talk story” fashion. If family feels comfortable, offer choice of having them fill out this section. Check with the family about the content and wording of information before writing it down. It is important to use the family’s words as much as possible. Families can choose what information they want written on the IFSP. NOTE: It is not optional for the care coordinator to have a discussion regarding concerns, priorities and resources. However, it is important that families know they can choose not to include information in any section (if so, check the appropriate box).

A.  OUR CHILD’S STRENGTHS/QUALITIES:

This area should contain a summary of the child’s strengths and qualities as identified by the family. List whatever information the family agrees to have written down using their own words as much as possible. The following types of questions may be used to encourage the family to talk about their child. What are your child’s likes and dislikes? How would you describe your child’s personality? What does your child enjoy doing? What is your child good at doing? Try to be specific, by encouraging the family to explain or give examples of what they mean. Additional strengths/qualities noted by other members of the IFSP team may be written down if the family agrees.

B.  OUR FAMILY’S STRENGTHS AND RESOURCES: (Family declined to complete this section YES )

This area should contain a summary of the family’s strengths, qualities, and resources as they relate to their child’s development. It may include the people, skills, capacities, relationships, and concrete assets (e.g., insurance) that the family has, or has access to, which support and sustain the family. List whatever information the family chooses to share and agrees to have written down, using their own words as much as possible. Additional strengths that have been noted by the IFSP team in the course of getting to know the family may also be included if the family agrees.
The following types of questions may be used to encourage the family to share about their strengths and resources. Describe your family (e.g., single parent, married, supportive spouse). Who would you list as part of your family? If something happens to a family member, who would you call for help/support? What kinds of things do you do together as a family? How often? Describe a typical day for your family. What kinds of cultural values and traditions have been helpful to you and your family)?
NOTE: Try to get specific information, but be sensitive to what family is comfortable sharing.

C.  CONCERNS FOR OUR CHILD AND FAMILY: (Family declined to complete this section YES )

This area should contain a summary of circumstances related directly or indirectly to the child’s development, which worry, distress, or create difficulties for the family. List concerns the family has identified and agreed to include in this section. Also, explore with the family the concerns brought up by the pediatrician, specialists, or other team members regarding their child’s development. Explore possible behavioral and/or emotional concerns (e.g. temper tantrums, etc.). What could their child benefit from to enhance his/her development? Any major stressors? (e.g. financial, difficult work schedule, or any family members ill that family provides care for, no child care, divorce). If team members are concerned about something, but the family feels strongly that they are not important issues at the present time, the family’s wishes need to be respected. Discussion should be noted here or on the IFSP Meeting Notes Page. Example: “Family not concerned about child’s speech development at this time.” Use the family’s words and avoid professional jargon.

D.  PRIORITIES FOR OUR CHILD AND FAMILY: (Family declined to complete this section YES )

This area should contain a summary or list of the family’s priorities for their child and family as they relate to their child’s development. Family priorities are goals or accomplishments that are important to the family. What would the family like to see for their child in the future? What are the family’s hopes and dreams for their child? The family can rank their concerns in order of importance. It is not necessary to address all the concerns that have been identified in Section C. Asking the family which of the items on the list are the most important right now (e.g. ”Which should we start with?”) sometimes helps the family rank them. Remember that you will be referring back to this section when developing the outcomes to ensure that all their priorities are addressed. All priority areas identified must be addressed in outcomes unless otherwise specified by the family.
REMINDER: If the family’s priorities are different from the service provider’s, it is important to remember that under Part C, the family’s priorities take precedence. Perhaps at a later date the issues that are important to the service provider will also become important to the family.

E.  CHILD’S PRESENT LEVELS OF DEVELOPMENT

Purpose: This section serves as a summary of information that has been gathered regarding the child’s present abilities, strengths, and needs. The information must be based on current (within 3 months) evaluation/assessment results, observations, parent, medical, and other reports. This section must also include statements of the child’s present levels of development. This section must be completely up-dated at Initial IFSP, 6-month Review IFSP, and Annual IFSP.

Area / Date / Information From (Source) / Present Levels of Development /
Insert date of when evaluation/ assessment/screening was completed and/or information gathered. / List sources where present levels of development were obtained. / Include short narrative of skills, emerging skills and age expected skills not observed. May also add specific source with narrative (i.e., Per Pediatrician…; Per Mom…). If the test could not be completed, make a notation that the domain(s) was not administered and include any observations about the child’s developmental skills.
Health / To be based on professionally acceptable objective criteria (i.e., evaluation tool – Battelle Developmental Inventory-2; Pediatrician report; Parent Report; etc.). / Provide information that describes any medical conditions or other health issues (e.g. “asthma episodes”) that may impact the service provision. If there are no health issues to report, simply note fact (e.g., “Child has been healthy during the past six months and all immunizations are up to date”). May include other significant medical information such as Apgar scores, weight/height, immunization, and prenatal/postnatal history (e.g., gestational diabetes, emergency cesarean, etc).
Vision / Note any vision screening or evaluation that has been completed and any recommendations for re-screening. Provide information on the child’s visual skills/abilities.
Hearing / Note any hearing screening(s) or evaluation that has been completed and any recommendations for re-screening. Newborn Hearing screening may be obtained from Newborn Hearing Screening Program. Include history of ear infections, ear tubes, hearing loss, etc. Provide information on the child’s hearing skills/abilities.
Adaptive
(Self-Care/Personal Responsibility) / Describe skills related to daily living such as how the child takes care of self (e.g. eating, dressing, toileting), demonstrates independence, helps with simple household chores, etc.
Social Emotional/Personal-Social
(Adult Interaction, Peer Interaction, Self-Concept and Social Role) / Describe how the child shows feelings, relates to other people, and develops self-concept. For example how an infant/child interacts with children and adults, plays with others, and show his/her independence.
Communication
(Receptive Language/Expressive Language) / Describe how the child expresses and understands ideas. Include what the child is saying/expressing and understanding, and how the child communicates (gesturing, signing, using pictures, pointing, etc.).
Motor
(Gross Motor-Body Movements/Fine Motor-Hand Skills/Perceptual Motor-Eye Hand Coordination) / Describe the child’s gross motor skills such as head control, sitting, crawling, walking, climbing, etc. Include large muscle involvement and body tone (rigid or “floppy”). For fine motor skills, describe the child’s use of arms, hand, and fingers. Examples may include small muscle development, using one or both hands, picking up small objects, eye hand coordination, and manipulation of objects. For perceptual motor skills, include such items as placing objects into containers, stacking pre-writing skills, etc.
Cognitive
(Attention and Memory/Reasoning and Academic Skills/Perception and Concepts) / Describe the child’s ability to utilize vision/auditory information; attends and retrieves information; ability to use critical thinking/problem solving. This may include how the child plays with toys, explores the environment, and sorting/matching objects.

II. OUTCOMES (Use a separate page for each outcome.)

Date: / Date Outcome Added
Outcome #: / Number each outcome consecu-tively. / What do we want for our child/family?: Indicate, using the family’s words, the desired outcome for the child and/or family relating directly or indirectly (e.g. housing, financial, childcare assistance, other family concerns, etc.) to the child’s development.
What is happening now with our child/family? / Indicate how the child is currently functioning in the particular outcome area or current family status.

OBJECTIVES: Steps to reach outcomes (each objective must be measurable, have a time frame, and include how progress will be evaluated)

STRATEGIES: Activities for working on the objective during our child and family’s daily activities/routines.

REVIEW: At IFSP review meeting, record any progress and changes toward reaching our child/family outcomes/objectives. Also, indicate if objectives have been MET, PROGRESSING, DISCONTINUED or MODIFIED.

OBJECTIVE / Number the Objectives to coincide with the Outcome. If a new Objective is added at an IFSP Review Meeting, include the date in parenthesis next to the Objective Number.
Through a collaborative discussion with the family and other team members, smaller, measurable steps (objectives) are developed and indicated here. Each objective must be 1) measurable, 2) have a time frame, and 3) have a statement on how progress will be obtained/reported. Indicate the approximate time frame for reaching each objective. An exact date is not necessary. Time frames can be reported in the number of months or an expected date. Time frames should reflect an appropriate sequence of implementation for the objective.
STRATEGIES / Number the Strategies to coincide with the Objective.
Indicate the ways in which the child can learn the skills needed to make progress towards meeting the outcome/objective. Strategies must be associated with the child and family’s daily routines. Also indicate who will be actively involved in the strategies, e.g. parents, peers, siblings, grandparents, childcare providers, other caregivers, and other professionals. If applicable, may refer to Strategy/Activity Sheet that has been individualized for the child and family.
NOTE: The Strategy/Activity sheet does not need to be attached to the IFSP; however, must be kept in the child’s chart and must be distributed to the Care Coordinator, Family, and all other providers implementing the IFSP.
REVIEW / This area should indicate the progress towards reaching the child/family outcomes. Record and date any progress and changes at the time of the IFSP Review; also determine if the objectives have been MET, PROGRESSING, MODIFIED, or DISCONTINUED.
MET: is when objective is achieved. If child exceeds the objective, you may elaborate.
PROGRESSING: is when objective is only partially met or skill is emerging. Record any progress and changes toward reaching the outcome/objective.
MODIFIED: is when an objective has been changed.
DISCONTINUED: is when family and/or team decide that objective is no longer appropriate or a concern.
NOTE: As part of the Annual IFSP meeting, the current IFSP objectives must be reviewed. The Review Status section must be completed with a date and parent initial. If the objective is not met and the team determines that it will be continued, transfer (re-write) the objective on the Annual IFSP. Renumber if needed.
III. TRANSITION PLAN

Purpose: This section addresses steps taken upon the initiation of early intervention services to support the transition of the toddler, upon reaching the age of three or developmental milestones, to preschool Special Education Services (SPED) or to other community services as may be appropriate and based on family preferences.

NOTE: A transfer from one early intervention program to another early intervention program or from one placement to another (from foster family to biological family; from one early intervention program) could be developed as an outcome.

Transition Activities

·  Activities A, B, C, D, and E are the required components of the IFSP Transition Plan. Section F only as needed. Middle column of Sections B. C, D, and E must include date of IFSP and a statement and statement in right column of Section A to be considered a “complete transition plan.” NOTE: Right hand column must have the IFSP date and a review statement for 6-Month Review and Annual IFSPs.

·  Review all the components at every IFSP meeting and allow the family the opportunity to decide how and when they will participate in the transition planning process. Possible points of discussion are listed for each activity.

Strategies, Steps, & Decisions to support Transition Activities

·  This section is used to document any decisions, steps and/or strategies that were discussed with the family to support each transition activity.

·  Include who will be responsible for each step and any anticipated start dates and/or due dates for each step/strategy.

·  Review, discuss and update this section of the Transition Plan at every IFSP meeting to add on any new steps, strategies, and/or decisions.