This is an application assignment based on what you did in the previous assignment. Review ?Tamiya’s transition profile found below this assignment link.? You are ?going to compl

Handout 2.3

Page 1

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Home Visit Planning Form

Child’s Name

Parent or Guardian Phone #

Address

Date of visit

Teacher/Provider

Materials for Home Visit

1. Transition Profile 2. Transition Plan from the Early Intervention program 3. Snapshots and/or video of classroom 4. Follow-up Home Visit Sheet (Classroom schedule, calendar, menu, pictures of other staff members) 5. Camera

Conversation Guide

Area Planning Notes Meeting Notes

1. Building rapport with the child and family

2. Family transition concerns and goals

3. Describe your program

4. Plan for next steps

1. Childs Name:
2. Parent or Guardian:
3. Phone:
4. TeacherProvider:
5. Planning Notes1 Building rapport with the child and family:
6. Meeting Notes1 Building rapport with the child and family:
7. Planning Notes2 Family transition concerns and goals:
8. Meeting Notes2 Family transition concerns and goals:
9. Planning Notes3 Describe your program:
10. Meeting Notes3 Describe your program:
11. Planning Notes4 Plan for next steps:
12. Meeting Notes4 Plan for next steps:
13. Address:
14. Date of visit:

Handout 2.2

Page 1

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Child Transition Profile Sample This profile is to be completed by the sending provider and family member and given to the receiving teacher to support the child’s transition. This information does not replace a formal child assessment. However, it provides practical information that will help facilitate the child’s ability to engage and adapt to the new setting.

Child’s Name

Date of Birth Age

Parent / Guardian

Parent contact

phone number

Person(s) Name

completing profile Relationship to Child Phone

Name Relationship to Child Phone Name Relationship to Child Phone

Date completed

What are the child’s favorite activities, people, and places?

Has the child had opportunities to play with peers in community or other settings?

Tamiya

Tim and Rosemary

10/1/xx

Favorite people- Mom and Dad, aunts, uncles and grandparents

Favorite activities- singing, dancing

Places-home

Yes. At church and play dates with other children her age.

xxx-xxx-xxxx (home)

11/13/xx 3

Melanie B.

Rosemary

mother

EI Service Coordinator

xxx-xxx-xxxx (cell)

xxx-xxx-xxxx (office)

Handout 2.2

Page 2

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Communication

What is the child’s primary language?

How does the child communicate with others (both adults and peers)? Check all that apply and explain.

some words  sign language  communication boards and/or devices

Does the child ask for assistance/express needs and wants?  yes  no  sometimes (please explain)

Does the child follow verbal directions?  yes, 1-step directions  yes, 2-step directions  no  sometimes

What strategies are effective if child exhibits frustration during communication?

List strengths and areas of focus for communication.

Include any additional comments on the back of this form.

English

Have her take your hand and take you to what she wants.

The team’s focus has primarily been on motor skills and feeding.

She mostly will repeat words but doesn’t often ask for anything directly.

Handout 2.2

Page 3

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Classroom Skills

Do you feel this child will use or require any supports to participate in classroom activities?

 augmentative communication devices  adaptive equipment  other (e.g., pair with a friend or adult assistance)

Does the child show curiosity and enthusiasm for new activities?  yes  no  sometimes (explain)

What helps the child adjust to new situations?

Social/Emotional

What comforts the child? (e.g., special toy, blanket, singing)

What frightens the child?

What types of play does the child engage in?

 individual – only plays alone

 parallel – plays next to a peer but does not interact

 cooperative – plays with another child, sharing toys or conversation

Include any additional comments on the back of this form.

She will probably need lots of one on one attention from adults in the classroom. She doesn’t

interact well with other children and feels more comfortable with adults.

Most of the time she is very fearful of new activities. Once she is used to doing them then she

begins to enjoy them.

She is sometimes comforted by singing or a pacifier but often times she won’t be comforted at all.

New activities, new people, new places

Lots of close attention and comfort from an adult she trusts.

Handout 2.2

Page 4

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Motor/Health

Does the child participate in self-care?  hand washing  toileting  eating  dressing

What support(s) does the child need to be successful in self-care?

Will the child need help moving around the building, playground or the classroom?  yes (explain)  no

Additional Concerns

What is the family or guardian most concerned about regarding the transition to preschool?

Include any additional comments on the back of this form.

Please include any artifacts that you think will help introduce your child to the receiving teacher and program staff at the preschool. This can include video clips, pictures, social stories, etc.

Tamiya does not do any self-care. She is spoon-fed some solids and very minimal liquid. She

must be tube-fed supplement drinks for her nutritional needs to be met.

She will need help on stairs.

Rosemary’s biggest priority is for Tamiya to be happy in a new situation. She knows Tamiya

will be okay and this placement will be good for her. But she is concerned and doesn’t want her

daughter to be terrified or scared.