Special Education Intervention Plan

Lesson Plan Title Special Education Intervention Plan (Rosa)
Objectives/ Learning Targets
Lesson Summary (what is the lesson about): The usage of
adapted spoon in eating soft food
I can statement here: ‘’I can eat independently’’.
Primary learning target: For the first trimester, Rosa will eat 4
bites independently during lunchtime within 10 minutes by
using adapted spoon.
Secondary learning target: The lesson also aims to teach the
corresponding tools for every step in dining/eating. The lesson
aims to teach the importance of using spoon in dining and how
to go about this process. Moreover, English will teach Rosa
some communication skills. For instance, learning names of
utensils such as, spoon and dish.
At the end of the lesson, Rosa must be able to:
1. Hold the adapted spoon.
2. Rise her palm to her mouth with adapted spoon
3. Return her palm to the dish
4. Pronounce spoon and dish by using English language.
Standards and/or
Competencies
List all standards and/or competencies used for this lesson here.
Use Extended Learning Standards if appropriate or Early
Learning Standards if apporpriate Links to Bloom’s Taxonomy
and Adapted Bloom’s Taxonomy if appropriate
Topic: Social Communication Attempt to respond to basic forms
of social communication with the appropriate facial expression,
vocalization and/or gesture. Participate in and often initiate

basic communications with family members or familiar others.
Participate in and often initiate communication according to
commonly accepted expectations with family members and in
social groups. With modeling and support follow typical
patterns when communicating with others (e.g., listens to
others, takes turns talking and speaks about the topic or text
being discussed). With modeling and support, continue a
conversation through multiple exchanges.
Academic Language & Vocabulary
Basic words like the following:
1. Adapted Spoon
2. Fork
3. Plates
4. Breakfast
5. Lunch
6. Dinner
Materials Needed
1. Adapted Spoon for Rosa
2. Spoons for other students
3. Plates
4. Soft food such as mashed potato.
5. Cups
6. Fork
Procedure
Outline your lesson here.

Introduction, Middle and Conclusion
Include times.
Include evidence based practices and cite research
You and Mentor do:
Introduction:
1. Introduce topic. Tell anecdotes about eating.
Middle:
1. Name the different utensils one by one.
2. Tell how they are being used and demonstrate these to the
students.
3. Ask the students to repeat the names and uses of the utensils.
Conclusion:
1. Supervise the students and correct them if necessary.
Students do:
Introduction:
1. Pay attention the teacher. Ask questions if there are.
Middle
1. Listen to the teacher.
2. Repeat the names of the utensils and identify their uses.

Conclusion:
1. Show how utensils are used.
Differentiation Strategies
Address needs of groups and individuals as needed
Maintenance and
Generalization Strategies
Since Rosa has low cognitive capacities and is hard to express
herself, the coach must pay close attention to her and attend to
her strenuously during the process. Also, it must be borne in
mind that Rosa is near-sighted and so the coach must also be
ready to support Rosa as she does the activities. The sample
food must also be appropriate to what Rosa can take at the
moment such as mashed potato by using the adapted spoon.
Introduction:
2. Introduce topic. Tell anecdotes about eating.
Middle:
4. Name the different utensils one by one. For Rosa, she can
answer by her own language and teach her utensils’ names by
English.
5. Tell how they are being used and demonstrate these to the
students.
6. Ask the students to repeat the names and uses of the utensils.
For Rosa, the educator should give her more time and extra help
such as hand over hand.

Conclusion:
Supervise the students and correct them if necessary. As needed
for Rosa, ask her for more repetitions till master the skill or
offer some help.
Assessment
How will you assess student learning for this specific lesson?
(Pre- Assessment Formative assessing and Post Assessment)
Data collection and documentation of data collection.
Pre-Assessment:
For the pre-assessment, the question and answer portion could
suffice. The coach will see if Rosa already has a prior
knowledge of the utensils, i.e. if she knows how they are called
and what their uses are.
Meanwhile, for the post-assessment, the coach will base this on
Rosa’s performance during the activity parts. The collection and
documentation of data will rely mainly on class hours activities
and exchanges and can be supplemented by relayed information
from Rosa’s parents and relatives.
Rationale Including Knowledge of Students and
Before & After the Lesson
Why are you teaching this? Explain the importance of the
lesson, what the students will learn and why you want them to
learn this. Explain the relationship to the IEP goals.
What came before this lesson? How does this lesson connect to
previous lessons?

What will come next? How will this lesson lead into the next
one?
Given Rosa’s background, there is the need to improve her
motor skills, particularly her ability to control and manipulate
utensils so as to help herself while eating. This is significant
simply because eating is one of the more fundamental activities
essential to human life, i.e. in sustaining human functions.
Before this lesson, preliminary social skills might have been
done in order to acquaint Rosa to the Coach if not create a
rapport between the two of them. This can facilitate the conduct
of the lessons and Rosa’s learning. Since there is a long-term
goal appended to this initial lesson, the activities of
demonstrating ability to use utensils will be done repeatedly
until Rosa is able to show mastery in doing such and until the
goals are met.
Engagement Strategies
How does this lesson engage students and help them achieve the
goal of the lesson? How will you measure their engagement and
time on task? How are you incorporating assistive technology
into the lesson? How are you using para professional support in
the activity if appropriate?
Rosa is hoped to be engaged once the rapport between her and
her coach has been established. In addition to this, the practical
tests included as components in the lesson are also hoped to
make Rosa more participative in her own learning process.
Assistive technologies can come in the form of audio materials
– say, songs with instructions on how to sue utensils or songs
about eating in general or dining etiquettes in particular – in
order to supplement Rosa’s learning. This can work well since
Rosa has no reported condition that impairs her hearing.
Post – Observation Reflection: (Response/Reflection)
CSU Intern: _____________________________________
Supervisor: _____________________________________

Grade level/subject area: _________________________
Date: ________________ Observation #: ________
Directions: Following the observation and post-conference,
interns are to complete the post-observation reflective responses
provided below and submit them electronically to their
supervisor within 48 hours of the observation. Interns and
supervisors should then use the data from the observation, post-
conference, and post-observation reflection to formulate next
steps for both the intern and supervisor.
Post-observation Reflective Responses:
1. What was the greatest surprise in the lesson today?
2. What evidence supports that students understood the purpose
of the lesson and the connection between the purpose and their
learning?
3. What were some of the most effective connections between
the lesson purpose and the activities?
4. How did the assessment tasks provide students the
opportunity to demonstrate and explain their thinking?
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Maladaptive Behavior and Psychopathology

© 2013 Argosy University
Psychological Evaluation
Confidential: For Professional Use Only
Name: Jessica E. Smith
Date of Birth: 7-18-68
Date of Evaluation: 4-12-09
Clinician: S. Freud, PhD
Reason for Referral
Smith was referred for a psychological evaluation by Bart
Jackson of the Division of Vocational
Rehabilitation to assess her current level of cognitive,
behavioral, and emotional functioning and to provide
recommendations for vocational service planning.
Background History
The following background information was obtained from an
interview with Smith and a review of the
demographic information sheet that she completed before the
evaluation.
Smith is a forty-one-year-old Caucasian female who was
referred for a psychological evaluation by the
Division of Vocational Rehabilitation to assist with determining
eligibility and to assess whether her

emotional problems are interfering with her ability to work. She
initially requested assistance from the
Division of Vocational Rehabilitation in October 2008 to assist
her with maintaining employment. At this
time, she is interested in learning new skills to enable her to
find full-time work in an office setting.
Smith was born in Jersey City, New Jersey, and raised in a
small nearby town, Williamsport, Pennsylvania.
She is the oldest of three children born to her mother and father
following an uncomplicated pregnancy and
delivery. Her younger sisters relied upon her for their after-
school child care once their mother returned to
work when she was twelve years old. She spoke of her mother
as having been physically and emotionally
abusive in the past, often yelling, hitting her, and pushing her
around. While her mother took her frustration
out on Smith, her father would drink alcohol in excess. To cope
with the difficult situation at home, she
began to drink alcohol and cut herself with a straight-edged
razor. Smith was active in school-related
activities. She did not receive special educational services or
have significant behavioral problems in
school, describing the classroom as a safe place where she could
be a ―kid.‖ Smith graduated from high
school and began attending a business college in Allentown,
Pennsylvania.
After attending classes for several months, Smith dropped out to
spend more time with her friends and to
begin working at various part-time jobs. She has worked as a
waitress, in a grocery store, and as a
babysitter. After leaving school, Smith returned home, where
she began spending time with old friends who
drank alcohol and used recreational drugs. By the age of
eighteen, she had begun to starve herself and

burn herself with a lighter. Her second to youngest sister was
killed in a car wreck around this time. To
assist her with coping, Smith began to drink on a regular basis
and rely upon crank (crystal meth) to
regulate her mood. She attempted suicide by taking someone
else’s prescription medications and slitting
her wrists. She was subsequently hospitalized on a psychiatric
unit for one week. After discharge, Smith did
not follow through with recommendations to follow up with
outpatient counseling. Instead, she resumed her
alcohol and drug use as a means of coping with the emptiness
that she was feeling inside. As her
substance use became more problematic, Smith began to
participate in inpatient and outpatient substance
abuse programming. She met with a counselor at the local
community mental health center and was
admitted to a residential rehab program. She has remained drug
free since leaving the program in 2004;
however, she has had difficulty in remaining sober. Smith has
been arrested three times for drinking under
the influence (DUI) and at times, has temporarily lost her
driver’s license. In November 2005, she sought
Page 2 of 3
2
mental health services again to assist her with remaining sober
and to address her underlying history of

depression. She continued to attend outpatient counseling on a
sporadic basis until August 2006 when she
recognized that her depressed mood rendered her incapacitated.
Thus, she began attending two individual
psychotherapy sessions per week, biweekly psychiatric
consultations, and participating in weekly home-
based case management services.
Smith identifies her eight-year-old daughter and her boyfriend
as her supports and sources of motivation to
remain sober. She describes having had a series of physically
and emotionally abusive relationships with
men in the past, which have affected her mood and ability to
cope with difficult situations. Smith has often
become depressed and had thoughts of suicide after a
relationship has ended. She acknowledges turning
to alcohol or isolating herself when she feels overwhelmed. She
initially moved to Jersey City two years ago
to get away from the people whom she described as ―bad
influences.‖ She has worked part-time at a local
grocery store and participated in the vocational rehab program
to assist her with returning to work. Despite
their interventions, Smith has failed to maintain employment for
longer than six months. She has also
described herself as having difficulty maintaining friendships
and trusting others. Smith currently lives in
New Jersey with her daughter. She is unemployed and receives
food stamps and Medicaid.
Behavioral Observations
Smith is a Caucasian female of average build who appeared to
be her stated age. She was dressed
casually and her grooming and hygiene were adequate. She wore
small, round-framed glasses with her
short-brown hair pushed back behind her ears. She maintained

good eye contact with the examiner, often
pushing her glasses up on her nose or placing her hair behind
her ears as she spoke of something that
made her feel uncomfortable. Smith was cooperative during the
evaluation, appearing motivated to answer
all questions posed to her in an honest and forthright manner.
She seemed alert and well rested, relating
appropriately to the examiner. Smith often apologized for not
knowing an answer to a test item or stated
that she could not do something that she perceived as difficult.
Tests Administered
—Third Edition
(WAIS®–III)
—Third Edition (WRAT-3)
ic Personality Inventory: Second Edition
(MMPI-2)
-Motor Gestalt Test
Mental Status Examination Results
Smith reports an extensive history of mental health treatment,
having received inpatient and outpatient
treatment for depression and substance abuse. She has been
prescribed Prozac, Paxil, Remeron,
Klonopin, Xanax, Valium, and Librium to assist with managing
her depressive symptomology and difficulties
with controlling her anxiety and physical withdrawal from
alcohol and methadone. Smith’s attitude toward

this evaluation seemed quite positive as evidenced by her
interest in participating in the evaluation and self-
report. She appeared to answer all questions honestly and did
not appear to be irritated with the evaluation
process. Her responses were spontaneous and she needed
minimal redirection to respond to the questions
that were asked of her. Smith was oriented to person, place, and
time and denied having experienced
auditory or visual hallucinations. She denied current thoughts of
suicide; however, she acknowledged
having attempted suicide as a teen. Smith reportedly used a
razor blade to slash her arms, hit herself with a
hammer in the face, took someone else’s prescription
medication, and burned her arms with a lighter after
fighting with her mother, breaking up with a boyfriend, feeling
rejected, and losing her younger sister. She
reported having had a couple of mutually fulfilling relationships
in the past, although she indicated that she
had difficulty getting along with people. Her remote and recent
memory showed no signs of impairment;
however, her ability to make realistic life decisions was marred.
Medical history is significant for a back
injury that occurred following a car wreck (1984) and removal
of her gall bladder (1996). Since the car
wreck, Smith has experienced lower back pain when lifting
heavy weights or moving in an awkward fashion.
Assessment Results and Interpretations
Page 3 of 3

3
Intellectual Functioning
The WAIS®–III was administered to obtain an estimate of
Smith's current level of cognitive functioning. The
results from this evaluation suggest that Smith is functioning
within the Low Average range of cognitive
functioning with no significant difference evident between her
verbal and nonverbal reasoning abilities.
Overall, Smith demonstrated abilities ranging from the Low
Average to Average range with relative
strengths in her word knowledge, categorical thinking, and
ability to distinguish essential from nonessential
details with a relative weakness in her abstract reasoning skills.
Smith's WRAT-3 performance showed high school–level
reading, eighth grade–level spelling, and fifth
grade–level arithmetic skills. She achieved a Low Average
range standard score on the reading and
spelling subtests with a Borderline range standard score on the
arithmetic subtest. She reported having had
difficulty with arithmetic in school and often becoming too
anxious to complete her assignments or finish
test items. Thus, this score is likely an underestimate of her
current level of functioning. Results suggest
that her fundamental academic functioning is below average;
however, due to the lack of discrepancy
between her achievement and intelligence test scores, the
presence of a learning disorder was not
evidenced.
Visual Processing and Visual–Motor Integration

Smith's ability to reproduce or copy designs was assessed on an
instrument involving visual–motor
integration and fine-motor coordination. She appeared to
accurately see the stimulus figures and
understand what she saw; however, she had difficulty
translating her perceptions into coordinated motor
action. She completed the Bender-Gestalt test in two minutes,
forty-two seconds and incurred four errors of
distortion and rotation. A short completion time such as this is
often associated with impulsiveness and
limited concentration.
Personality Assessment Results
The MMPI-2 was administered to assess Smith’s personal
attitudes, beliefs, and experiences. Smith’s
MMPI-2 profile suggests that she acknowledges that she is
experiencing a number of psychological
symptoms. She is likely to be experiencing a great deal of stress
and seeking attention for her problems. At
times, Smith comes across as a confused woman who is
distractible, has memory problems, and may be
exhibiting personality deterioration. Thus, she is in need of
intensive outpatient therapy and psychotropic
medication to continue to address her long-term personality
problems. Smith might be described as an
angry woman who is immature, engages in extremely pleasure-
oriented behaviors, and feels alienated. She
is likely to feel insecure in relationships, act impulsively, and
have difficulty developing loving relationships
with others. She often manipulates others (men) and may
hedonistically use other people for her own
satisfaction without concern for them. She has difficulty
meeting and interacting with other people, is
uneasy and overcontrolled in social situations, and tends to be

rather introverted.
Smith has a negative self-image and often engages in
unproductive ruminations. She frequently reports
having numerous somatic complaints when she is anxious and
feels as though other people are talking
about her. Under stress, her physical complaints will likely
exacerbate. Her insight into her problems is
limited and she often attempts to find solutions that are simple
and concrete. She may prefer to be alone or
with a small group due to feeling alienated from the
environment. She often exhibits poor judgement,
emotional liability, and impulsivity. Smith may become upset
easily and overreact to situations. Her profile
reflects a chronic pattern of maladjustment, which may affect
her ability to solve problems and fulfill her
obligations. It is likely that Smith has a history of
underachievement in school and in the work force due to
her inability to cope with difficult situations.
Hibah Alharbi
In Rosa's case, she needs to communicate with her parents or
other people to ask for things that she wants. From that point,
the picture
exchange communication system (PECS) is one of the solutions
that might help her to communicate. PECS is designed to teach
functional
communication skills with an initial focus on spontaneous
communication. Also, PECS can be implemented in a variety of

settings such as home,
school, and the community so that the users and the people who
try to communicate with them have the materials to
communicate and understand the
users' wants and needs. It's an accessible system that requires
pictures only. Also, it can be developed into six phases that can
help to make the user
use a couple of words in advanced phases. According to that,
research has shown that many preschoolers using PECS also
begin developing speech.
In this case, Rosa is the right age to start using this system,
which can increase her communication skills.
The lack of communication creates different challenges for
affected persons within the community and education systems
across the country,
which could lead to other behavioral issues that we are trying to
avoid such as aggressive behavior or the child becoming more
shy and silent. The
appropriateness of PECS is not officially documented, but, on
common grounds, it is considered vital for those who lack
functional communication
skills to express their needs, lack ways to make people
understand their connection, and require a communication
system that allows them to express
themselves across different settings. For that reason, I picked
the goal of using a picture to communicate because it can help
Rosa with other skills

that will need later in an educational setting and also in the
home or community.
In addition, Rosa comes from a family where English isn’t the
native language, which makes communication in signs difficult
because of the
difference in the meanings of signs between countries. Pictures
are easier than signs and can combine words and pictures
together. An early
intervention specialist and the team involved in her case can
collaborate to make sure that Rosa uses the pictures in a
different setting. Also, her
family should be involved in the picture exchange
communication system to make sure that Rosa is mastering the
skills that she needs to
communicate effectively. All the team should know the
strategies that are being used with Rosa and the picture
exchange system, and what to do in
case an error occurs.
I started with pictures related to food and lunchtime because to
begin, Rosa can pick something that she wants. In this case, it
will be easy to
follow up and generalize this task in different settings such as
the home and restaurants. The OT also can help Rosa to
vocalize the words in the

system when she asks for something specific. All this
collaboration will help Rosa to communicate in different places
by using different
pictures, and the long-term aim is to adapt this system to other
development targets such as life skills or educational sessions.
Rosa will pick up the picture for the item she wants, reach to
the communcation partner who’s holding the item, and release
the picture into
the comuncator hand.
The Annual goal:
Rosa will independently complete request sequence on 8 of 10
opportunities when comuncation partner ask for the picture for
different 3
reinforcers across and 3 activites, with 80%.
Through this routine Rosa will:
- pick the right picture.
- Hand the picture to the trainer
- get the food or utensils from the trainer
- matching the food name or the tools by using the English
language.
-
Three short objective goal:
- Rosa will match picture that has the right part to ask and to
communicate 2/5 times per lunchtime
- Rosa will Hand the picture to the trainer within 6/8 times per
item or lunchtime
- Rosa will be able to match the right picture with the wanted

item 8/10 per week.
Special Education Intervention Lesson Plan
LESSON INFORMATION
This lesson is about: Communicate using signs, pictures or
words. ( in lunchtime)
The lesson will be taught (individual, small group, or whole
class): in both ways, an individual and small
group to generalize the lesson and for peer modeling.
Prerequisite skills:
None- the trainer should know what is the favorite food for
Rosa to make the Communicate using pictures
more efficient.
LEARNER OUTCOME
The lesson is about the usage of picture to ask for her favorite
food

(Communicate using signs, pictures or words)
Primary Learning Target(Objective): For the first trimester,
Rosa will use pictures 4 to 5 times to get her
food from the trainer.
Secondary learning target:
- The lesson also intends to teach Rosa how to ask for what she
want through a picture. And generalize the
picture tools outside the class and in everyday life.
- The lesson tries to teach the value of using the picture to
communicate through pictures and how to move
through this process in every sitting.
Moreover, the language will develop some vocabulary such as
knowing the names of her food and the
utensils.
At the end of the lesson, Rosa must be able to:
1. pick the right picture.
2. Hand the picture to the trainer
3. get the food or utensils from the trainer
4. matching the food name or the tools by using the English
language.
- Rosa will pick the picture in English 8/10 times per lunch.
- Rosa will use different pictures to pick what she want during
lunchtime 4/5 time per lunchtime.
- Between every two trails, Rosa can use her hands to get
other food from her plate.
*EXPRESSIVE/RECEPTIVE
COMMUNICATION SKILL
(INCLUDES ACADEMIC
LANGUAGE IF IT IS RELATED
TO AN ACADEMIC AREA

VOCABULARY DEVELOPMENT
Academic Language: Rosa will use picture for these Basic
words such as:
1. Spoon
2. Fork
3. Plates
4. Her favorite food ( more than one item)
Expressive Communication Skill: . Rosa will ask for her spoon,
food through picture in English
Receptive Communication Skill: . the trainer will say the object
name everytime Rosa pick the picture ( or
Iwant …)
OMIT FOR ESE413/513
STATE STANDARDS ADDRESSED
(EXTENDED STANDARDS,
EARLY LEARNING STANDARDS)
BLOOM’S TAXONOMY OR
ADAPTED BLOOM’S
TAXONOMY
Using picture to communicate with other: the social
communication attempt to respond to basic form of
social communication with approptiate facial expression or
gesture.
Participate usually initiate basic communication with her family
or other people who knows her and right
know the participate using picture to communicate with other.
With modeling and support follow typical patterns when
communicating with others (using pictures and signs). With
modeling
and support, continue a conversation through multiple picture

exchanges.
MATERIALS NEEDED
- pictures of the objects that Rosa going to need during lunch
- Rosa favorite spoon, plate, and food
- Two trainers ( physical prompt and communication partner)
INSTRUCTIONAL STRATEGIES
(BEGINNING, MIDDLE AND
LESSON CONCLUSION,
EVIDENCE BASED STRATEGY,
ASSISTIVE TECHNOLOGY
SUPPORTS )
What will the teacher do:
1- The communication partner will show the most
preferred item to Rosa
2- Reinforce Rosa to exchange the item with
picture within ½ second
3- After Rosa correctly hand the picture, the
communication partner will say( I want …. And
named the object) in English.
The physical promoter:
- will wait for Rosa to initiate to prompt her to
exchange the picture physically
- when Rosa get the picture and hand it to the
communication partner, the physical prompt will
systematically fade.
CONCLUSION:
Teacher( communication partner and the physical
prompt can help when Rosa makes a mistake and if
she hands the picture to the communication partner.

What will the students do:
4- when Rosa tries to reach the item ( initiate)
5- with the physical promoter, Rosa will reach the
picture and hand it to the communication partner.
Error correction:
When Rosa has to choose between two pictures, and
match them with the wrong item.
The communication partner corrected the error with
pointing to the right object.
If she does it again, the communication partner can
fade the other picture and object from her sight.
*SUPPORTS FOR THE
TARGETED
RECEPTIVE/EXPRESSIVE
COMMUNICATION SKILL OR
ACADEMIC LANGUAGE
.
OMIT FOR ESE 413/513
DIFFERENTIATION STRATEGIES
FOR INDVIDUAL, FOCUS
LEARNER OR GROUPS OF
Since Rosa has low cognitive capacities and is hard to expose
herself, the teacher must pay close attention
to her and attend to her strenuously during the process. Also, it
must be shown in mind that Rosa is near-

CHILDREN sighted and so the coach must also be ready to
assist Rosa as she does the activities( the physical promoter).
The sample food must also be suitable to what Rosa want or
like, by using the picture exchange system.
ASSESSMENT STRATEGIES (you
should have assessment strategies for
each lesson you teach AS WELL AS
baseline data and summative
assessment at the end of the
unit(baseline and summative is edtpa
requirement)
Pre assessment- the coach will see if Rosa knows some of the
current vocablary or not, and based on her
knowledge the coach will start to use new words.
Formative assessment-
Post assessment- for the post-assessment, the coach will base
this on Rosa’s performance during the activity
parts.
For data collection: the physical promoter can take the data,
using the data sheet. ( how many times Rosa
initiate to the object and how many times she needs the physical
promoter help to reach the picture, also,
what she knows and what she likes with free access to the
object and what is her reactio{ to reaction- reject-
show pleasure .., etc,,)
REFERENCES, RESEARCH AND
CITATIONS Cite evidence based practice as well as any work

that is not you own.
ENGAGEMENT STRATEGIES
Using materials that Rosa like and want to have; could help
with her engagement in training. Make some
gaps between each routine. Add other items that she likes to
different learning sitting. Assistive
technologies can come in the form of audio materials such as
say, songs with instructions about food in
general. To supplement Rosa’s learning, this can work well
since Rosa has no reported condition that
damages her hearing
MAINTENANCE AND
GENERALIZATION OF THE
SKILL
Maintenance of skill
Redo the task with Rosa, in different times and different sitting.
If she do it correctly we can move to
another task. Or we can start to Generalize the task into outside
the usual sitting.`
Generalization of skill
Generalize the task into home sitting, different places (
restaurant, grandparents house)

Also the whole team from OT.PT going to help this
communicational system with Rosa to make sure that
she can use and generalize this system in different setting.
CSU Intern: _____________________________________
Supervisor: _____________________________________
Grade level/subject area: _________________________ Date:
________________ Observation #: ________
provided below and submit them
electronically to their supervisor within 48 hours of the
observation. Interns and supervisors should then use the data
from the observation, post-conference, and
post-observation reflection to formulate next steps for both the
intern and supervisor.

learning?
Preschool Case Study
Name: Rosa
Age: 4years 9 mos.
Reason for ECSE services: Down syndrome, intellectual
disability requiring constant support, complex communication
needs
Medical Information: Down syndrome, thyroid deficiency
(takes synthyroid), strabismus, atlanto-axial subluxation,
ventricular septal defect repair, feeding difficulties (aspirates

on thin liquids, has difficulty chewing solid foods).
Family History: Rosa lives with her parents and grandmother.
The family is from Puerto Rico. They moved here when Rosa
was two years old. Rosa has no siblings. The family is deeply
religious. The family travels back to Puerto Rico several times
a year. The family is bi lingual. Rosa has had most of her
medical interventions here in the United States. She did not
participate in EI services. Family was reluctant to send her to
preschool but finally agreed to do so when Rosa was 3 and half.
Medical History: Rosa was born full term. She was diagnosed
with Down syndrome shortly after birth. Rosa was being
monitored in Puerto Rico for her heart condition (ventricular
septal defect) as well as for her overall developmental delays.
Her parents report that she had frequent bouts of pneumonia as
an infant. It was determined through medical tests that Rosa
was aspirating on thin liquids like formula. She was NG fed for
a few weeks, and then she did fairly well with formula that was
thickened to nectar consistency. Her family moved here right
before her second birthday. Rosa had heart surgery to repair the
VSD at age 29 months. She continues to have difficulty with
thin liquids, however, when liquids are thickened to nectar
consistency she does not aspirate. She also has difficult
chewing solid foods so right now her food is ground up. She
still needs assistance with feeding herself. She has very low
muscle tone. She walked at 30 months of age. She has been
diagnosed with atlanto axial subluxation so she cannot
participate in any rough and tumble play activities. She is also
near sighted and will need surgery in the near future to correct
strabismus. She does not like to wear her glasses. She has
frequent ear infections that respond to antibiotics.
Educational History: Rosa attends her LEA inclusive preschool
classroom. She enjoys coming to school. She receives the
services of a preschool intervention specialist, an OT, a PT and
an SLP. She attends 4 half days per week. There is also a nurse
in the building for the program. Rosa walks although she tends
to fall a lot. She is learning how to go up and down steps. Her

fine motor skills are also delayed. She is able to pick up
objects like small blocks but has difficulty picking up smaller
objects. She finger feeds but does not yet use utensils
consistently. She drinks from a cut out cup and a staff member
must assist her with this because of the aspiration issues. She
communicates using facial expressions, pointing, and
vocalizations. Her parents speak Spanish to her at home and
she hears English in school. Rosa has said 1 or 2 words in
Spanish at home according to her parents. In school, she says
hi to her peers during circle time. She can make choices of
what she wants to play with by pointing to the objects. She
uses gestures to communicate, for example she turns her head
when she does not want any more food. She pushes an object
away when she is done with.
Her IEP team including the parents has identified the following
areas of need for Rosa:
1. Develop self help skills of using utensils
2. Improving motor skills so that she can walk up and down
steps
3. Communicate using signs, pictures or words
Special Education Intervention Lesson Plan
LESSON INFORMATION
This lesson is about:
The lesson will be taught (individual, small group, or whole
class):
Prerequisite skills:
LEARNER OUTCOME
Primary Learning Target(objective)- must be written in
observable and measurable terms

*EXPRESSIVE/RECEPTIVE COMMUNICATION SKILL
(INCLUDES ACADEMIC LANGUAGE IF IT IS RELATED TO
AN ACADEMIC AREA
VOCABULARY DEVELOPMENT
Academic Language:
Expressive Communication Skill: .
Receptive Communication Skill: .
OMIT FOR ESE413/513
STATE STANDARDS ADDRESSED (EXTENDED
STANDARDS, EARLY LEARNING STANDARDS)
BLOOM’S TAXONOMY OR ADAPTED BLOOM’S
TAXONOMY
USE EXTENDED STANDARDS FROM ODE WEBSITE
MATERIALS NEEDED
INSTRUCTIONAL STRATEGIES
(BEGINNING, MIDDLE AND LESSON CONCLUSION,
EVIDENCE BASED STRATEGY, ASSISTIVE TECHNOLOGY
SUPPORTS )
What will the teacher do:
(be very specific, include how you will use systematic
instruction and/or direction instruction, how will you build in
error correction and reinforcement)
What will the students do:
*SUPPORTS FOR THE TARGETED
RECEPTIVE/EXPRESSIVE COMMUNICATION SKILL OR
ACADEMIC LANGUAGE

.
OMIT FOR ESE 413/513
DIFFERENTIATION STRATEGIES FOR INDVIDUAL, FOCUS
LEARNER OR GROUPS OF CHILDREN
ASSESSMENT STRATEGIES (you should have assessment
strategies for each lesson you teach AS WELL AS baseline data
and summative assessment at the end of the unit(baseline and
summative is edtpa requirement)
Pre assessment-
Formative assessment-
Post assessment-
REFERENCES, RESEARCH AND
CITATIONS
Cite evidence based practice as well as any work that is not you
own.
ENGAGEMENT STRATEGIES
MAINTENANCE AND GENERALIZATION OF THE SKILL

Maintenance of skill
Generalization of skill
CSU Intern: _____________________________________
Supervisor: _____________________________________
Grade level/subject area: _________________________
Date: ________________ Observation #: ________
provided below and submit them electronically to their
supervisor within 48 hours of the observation. Interns and

supervisors should then use the data from the observation, post-
conference, and post-observation reflection to formulate next
steps for both the intern and supervisor.
learning?

Special Education Intervention Plan

Special Education Intervention Plan

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Special Education Intervention Plan