II-3. Recreational Play (PAST 30 DAYS) No evidence that the child has Child is doing adequately Child is having moderate Child has no interest in play problems with recreational with recreational or play problems with recreational or recreational activities. play. Any concerns are age activities although some activities, may resist play, May spend most of time appropriate or this problems may exist. Child show little enjoyment or non-interactive or cannot information is unknown to me. may be uninterested or interest in activities. demonstrate enjoyment or poorly able to sustain play. use play to further development. If the needs / functioning fall within a shaded box, explain why: child’s II-4. Preschool / Child Care (PAST 30 DAYS) No evidence of problem with Mild problems with Moderate to severe Profound problems with functioning in current functioning in current problems with functioning in functioning in current preschool or child care preschool or child care current preschool or child preschool / child care. Child environment. Any concerns environment. care. Child has difficulties is at immediate risk of being are age appropriate or this maintaining his / her removed from program due information is unknown to me. behavior creating significant to his / her behaviors or problems for others. needs. If the needs / functioning fall within a shaded box, explain why: child’s B. BEHAVIORAL CHARACTERISTICS (Ages Birth to 5) (Continued) II-5. School Attendance (PAST 30 DAYS) – Child attends preschool / child Child has some problems Child is having problems Child is absent most of the care regularly. Any concerns attending preschool / child with preschool attendance time and this causes a are need / age appropriate or care, but generally is and is missing at least 2 significant challenge in this information is unknown to present. days / week on average. achievement, socialization me. and following routine. If the needs / functioning fall within a shaded box, explain why: child’s II-6. School Compatibility (PAST 30 DAYS) – Infant / preschool / child preschool / child care preschool / child care The preschool / child child’s Child’s Child’s child’s care meets the needs of the is marginal in its ability to does not meet the unusual care is contributing to infant / child or this information meet the unusual needs of needs of the child in most problems for the child in one is unknown to me. the child and / or the areas and the environment or more areas. environment may be weak in may not support the child’s areas. growth or promote further
II-3. Recreational Play (PAST 30 DAYS) No evidence that the child has problems with recreational play. Any concerns are age appropriate or this information is unknown to me. Child is doing adequately with recreational or play activities although some problems may exist. Child may be uninterested or poorly able to sustain play. Child is having moderate problems with recreational activities, may resist play, show little enjoyment or interest in activities. Child has no interest in play or recreational activities. May spend most of time non-interactive or cannot demonstrate enjoyment or use play to further development. If the child’s needs / functioning fall within a shaded box, explain why: II-4. Preschool / Child Care (PAST 30 DAYS) No evidence of problem with functioning in current preschool or child care environment. Any concerns are age appropriate or this information is unknown to me. Mild problems with functioning in current preschool or child care environment. Moderate to severe problems with functioning in current preschool or child care. Child has difficulties maintaining his / her behavior creating significant problems for others. Profound problems with functioning in current preschool / child care. Child is at immediate risk of being removed from program due to his / her behaviors or needs. If the child’s needs / functioning fall within a shaded box, explain why: B. BEHAVIORAL CHARACTERISTICS (Ages Birth to 5) (Continued) II-5. School – Attendance (PAST 30 DAYS) Child attends preschool / child care regularly. Any concerns are need / age appropriate or this information is unknown to me. Child has some problems attending preschool / child care, but generally is present. Child is having problems with preschool attendance and is missing at least 2 days / week on average. Child is absent most of the time and this causes a significant challenge in achievement, socialization and following routine. If the child’s needs / functioning fall within a shaded box, explain why: II-6. School – Compatibility (PAST 30 DAYS) Infant / child’s preschool / child care meets the needs of the infant / child or this information is unknown to me. Child’s preschool / child care is marginal in its ability to meet the unusual needs of the child and / or the environment may be weak in areas. Child’s preschool / child care does not meet the unusual needs of the child in most areas and the environment may not support the child’s growth or promote further The child’s preschool / child care is contributing to problems for the child in one or more areas.
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