VII. Current/Past Interventions Please check all current and/or past interventions attempted with student, and list result: Environment Teaching Techniques Intervention Outcome Intervention Outcome Clarify rules Vary voice volume Change seating Use hand on shoulder contact Reduce distractions Reduce stimulation Change class activities Teacher circulates around room Change groups Repeat instruction same way Increased physical space Designate activities Special quiet/time-out area Use behavior modification Modify schedule Use visual aids Add structure Activities Miscellaneous Intervention Outcome Intervention Outcome Simplify Review cum folder Shorten Keep work samples Individual contracts Assessment results Buddy system Parent contact Notebooks for assignments Referral to counselor Alt assignment structure Referral to office Use of tape recorder Referral to (specify): Instruction Program Materials Intervention Outcome Intervention Outcome Cooperative learning Use varied materials Individualized instruction Tapes Health awareness Soft music Guidance lesson Play activities Small group Computer Other (specify): Books/stories Completed by: __________________________________________________ ____________ Teacher / Staff Signature Date
VII. Current/Past Interventions Please check all current and/or past interventions attempted with student, and list result: Environment Teaching Techniques Intervention Outcome Intervention Outcome Clarify rules Change seating Reduce distractions Change class activities Change groups Increased physical space Special quiet/time-out area Modify schedule Add structure Vary voice volume Use hand on shoulder contact Reduce stimulation Teacher circulates around room Repeat instruction same way Designate activities Use behavior modification Use visual aids Activities Miscellaneous Intervention Outcome Intervention Outcome Simplify Shorten Individual contracts Buddy system Notebooks for assignments Alt assignment structure Use of tape recorder Review cum folder Keep work samples Assessment results Parent contact Referral to counselor Referral to office Referral to (specify): Instruction Program Materials Intervention Outcome Intervention Outcome Cooperative learning Individualized instruction Health awareness Guidance lesson Small group Other (specify): Use varied materials Tapes Soft music Play activities Computer Books/stories Completed by: __________________________________________________ ____________ Teacher / Staff Signature Date
form_1_sst_request_electronic_0.docx