Community Based Instruction
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The following information can be found in this section:

• Guidelines And Procedures For Implementing Community-Based Instruction For Students With Severe Impairments - page Al, A2, A3, A4, A5, A6, A7
• Special Education Department Sign Out Sheet - page BI
• Permission for Community-Based Instruction -page C1
• With Severe Impairments - page D1
• Parent/Guardian Authorization For Independent Travel -page El
• Student Information Card For Community-Based Instruction - page F1
• Schedule Analysis -page GI

Guidelines And Procedures For Implementing Communuity - Based Instruction For Students With Severe Impairments

What Is Community-Based Instruction?
Community-based instruction occurs routinely, on a regularly scheduled basis (i.e., weekly, twice weekly, daily, etc.) and must be specifically related to and reflected in EEP objectives. The basic guidelines for determining which of a student's educational goals are to be implemented in the community-based context are: a) an interview with the student's parent/guardian to determine the individualized critical/functional skills; b) the chronologically age-appropriateness of the tasks and of the environments; and c) an emphasis in allowing greater participation and independence in the most natural environments.

All students who receive community-based instruction must have goals and objectives in their most recent IEP that are specifically related to the community instruction they are receiving. Students need specific consumer (restaurant, shopping), recreational, and vocational objectives in their IEPs in order to receive community instruction.

The following is a delineation of requirements as to IEP related community-based instruction. Your Program Consultant is available for assistance with scheduling, obtaining Regional Transit Discount Cards and MUNI fast passes, providing training to you and/or your paraprofessionals, developing training sites, setting up data collection, and any other related question.

IEP Related

• Each student needs an IEP goal(s) that indicates the specific objective(s) to be carried out in community environments; specific IEP objectives should relate to community activities.
• In addition to a signed IEP, each student needs a signed "Permission for Community-Based Instruction" form that indicates the site(s)/Iocation(s) of the community-based instruction and mode of transportation.
• Community-based instruction occurs routinely, on a regularly scheduled basis (i.e., daily, weekly, twice weekly, etc.) and must be specifically related to and reflected in IEP objectives. See Field Trips below.
• Written documentation (anecdotal and/or data sheets) must be recorded regularly (i.e., at least once a week - on each community objective for every student receiving community based instruction.

Teacher Preparation
Review emergency procedures with staff who will be providing community-based instruction prior to implementation of such. Have staff sign-off that they have read and understand the procedures for implementing community-based instruction.

A daily sign-out log and/or classroom schedule, which identifies the location of each student in the con3munity and on campus, must be posted in an accessible and visible place in the classroom. A copy should be given to the school site office and the Department Head.

Transportation routes (MUNI and walking) to and from community sites should be posted with the schedule along with addresses and phone numbers of regularly used training sites.

Each campus should have a file containing each students picture and emergency information. This file should be kept with a site administrator or the Department Head.

Each Supervising Staff Should Carry A Binder Or Folder Containing The Following

• Identification and emergency information on each student who is receiving instruction in the community. Information should include:
  1. The student s name addresses and phone number
  2. The parent's name and phone number
  3. The name of the school and the phone number.
  4. The name of the site administrator.
  5. Medical information.
  6. The student's mode of communication.
  7. A picture of the student, if one is available.
• First-aid supplies, at minimum should include rubber gloves, compresses (or sanitary napkins), Band-Aids, and at least $.35 for emergency calls.
• "Guidelines for Emergency Situations" (pages CBI 5 & 6), including school site phone numbers and names of relevant site personnel.
• On-going written records (anecdotal and/or data sheet) related to the implementation of community EEP objectives. Student progress must be recorded regularly on each student.

Each Student Should Carry The Following

• Personal identification, any necessary emergency information (i.e., medical considerations) and relevant phone numbers. Students unable to independently carry identification and emergency information should have an ID tag attached to their shoe or around their neck.
• Each student should carry at least $.35 for an emergency phone call.

Paraprofessionals

• Paraprofessionals can supervise and instruct a group of students going to and from or at another at community training site while the teacher remains at school with another group of students. However, the teacher is ultimately responsible for the supervision and instruction of all of the students in his/her class.
• Paraprofessionals can remain at the school with a group of students with disabilities and provide supervision and instruction without being in close proximity to the classroom teacher.
• Read and adhere to these "Guidelines and Procedures for Implementing Community-Based Instruction for Students with Severe Impairments".

Substitutes, Student Teachers And Volunteers

• Substitute teachers and substitute paraprofessionals may not go off campus without a regular classroom staff person who is familiar with each student's instructional program and behavioral issues.
• Student teachers and volunteers can supervise or provide instruction to students with disabilities while in close proximity to or in the presence of the certificated teacher.

Administration

• Keep a copy of these "Guidelines and Procedures for Implementing Community-Based Instruction for Students with Severe Impairments" and the Department of Labors Fair Labor Standards Act (FLSA).
• Have access to daily sign-out log and/or daily classroom schedule.

Have access and/or maintain file containing students pictures and emergency information.

Transportation Related

• MUNI Fast Passes are distributed to classes providing community-based instruction. The allotment is as follows:

  Middle School	1 Adult (A) and 3 Youth (Y)
  High School	2 Adult (A) and 5 Youth (Y) or Disabled (D)
  Transition	3 Adult (A) and 8 Disabled (D) or 1 for each of the students
  	Who do not receive a fast pass to travel independently to and from school and home.

• All Transition students need a Regional Transit Discount Card to use with the "D" MUNI Fast Pass. We encourage all teachers to assist their students in obtaining a Regional Transit Discount Card.
• Staff- should not transport students in personal cars. Rather, travel instruction including using public transportation, should be provided for students to learn how to get to locations they utilize during community-based instruction, and to get to and from home.
• Travel instruction needs to be indicated in the student's IIEP when appropriate for the student and specified on the "Permission for Community-Based Instruction" form.
• Students in Special Day Classes who travel independently on MUNI need this indicated in their IEP, and should have a signed "Parent/Guardian Authorization for Independent Travel." They may be eligible to receive a MUNI Fast Pass from Special Education.

Vocational Education And Domestic Sites

• Guidelines for utilizing non-paid and paid vocational sites as delineated in the Fair Labor Standards Act are located in the (Transition) section of the Special Education Teacher Resource Guide.
• Domestic skills instruction should occur on the school campus or in a public place, (i.e., at a boys & girls club). Instruction should never occur in personal/staff members homes; the District does not permit this.

Field Trips

• When students participate in community outings that do not occur on a regular and planned basis, they are considered to be on a field trip. Separate permission forms (obtained from school site secretary) are needed for each field trip, since these outings are not covered with the community-based permission form.

Reimbursement

• Complete the expense sheet at the end of each month for which reimbursement for community-based expenses is requested. Monthly reimbursement for elementary and middle school classes is $25.00; high school and transition classes are $30.00. In June, the reimbursement is 1/2 the regular monthly amount. Reimbursement for Extended School Year/Summer School is the amount listed above for the entire period. Please read "Reimbursement for Implementation of Programs for Students with Severe Impairments for guidelines. Reimbursement is not available for parties or field trips.

Responsibility And Liability

• In order to minimize the causes for liability, these "Guidelines and Procedures for Implementing Community-Based Instruction for Students with Severe Impairments" and the guidelines provided by the Department of Labor's Fair Labor Standards Act (FLSA) must be adhered to completely.
• The SFUSD ultimately bears liability whenever a student is injured while participating in community-based instruction, both on his/her way to, from or at each community training site, if the plaintiff can establish that the district and/or its staff was negligent in providing supervision for the safety of the student.
• The teacher is ultimately responsible for the supervision and instruction of the students placed in his/her class.

Guidelines For Emergency Situations
When an emergency of any type occurs, the major concerns are to secure the supervision and safety of the students and to notify the proper authorities.

All staff members should carry at least $.35 for emergency phone calls, a copy of each students emergency information and first -aid supplies.

Emergencies Other Than Medical
Lost Student

1. The supervising adult, or a responsible adult who is available at the scene, should contact the school principal and give the location and pertinent details of the situation.
2. If two District adults are present, one should search for the lost student and one should remain with the other students.
3. If one District adult is present, he/she should search the premises with the entire group of students, if possible. In addition, they should request assistance from a available security systems.
4. If the student is not found within IO minutes, the school principal is to be contacted for additional instructions. The principal will make further contact as necessary to the parent and to law enforcement agencies.
5. If lost on public transportation, give full information to the transit system, including student information, what route the student was last on, and the destination of the trip.
6. Write a summary of the incident and give a copy to the principal.
7. Notify all appropriate persons when the student is located.

1. Assess the medical situation/emergency
2. Use the first-aid supplies
3. Call school site, if necessary
4. Complete accident/incident report upon returning to school

Staff Responsibilities

Staff member

1. Assess the situation to determine if it is life threatening.
2. If it is a life threatening situation:
   1. Request a responsible person to call 911.
   2. Notify the site administration as soon as possible.
   3. Remain with the victim to administer first aid or CPR, if trained.
   4. Accompany the victim to the emergency facility with emergency information.
3. Complete Incident/Accident Report

Designated Staff Member or other Responsible Person (i.e., the secretary, other classroom, or school staff)

1. Call 911 as directed. Be prepared to provide the following information:
   • The victim's condition
   • The location of the emergency
   REMEMBER - - Hang up last!
2. Arrange to have the other students supervised in a different location.
3. Have a copy of the victim's emergency information available.
4. Meet the Emergency Medical Services (EMS) personnel and direct them to the specific location of the emergency.
5. Important Names, Phone Numbers and Extensions:

School ____________________________________________ Principal ____________________________________________ Dept. Head ____________________________________________ Teacher ____________________________________________ STAFF MEMBER'S STATEMENT OF UNDERSTANDING I, ________________________________________________________________ (Print name of staff person) have read, understand, and agree to follow the above "Guidelines and Required Procedures for Implementing, Community-Based Instruction for Students with Severe Impairments". Signature of staff member ______________________________________________ Date __________________________ Teacher should keep all signed "Staff Member's Statement of Understanding" forms for her/his records. Sign Out Sheet School ________________________ Room ________Teacher______________ Date Student(s) Staff Destination Time In Time Out Special Education Placement Office 555 Franklin St. Rm. 103 San Francisco, CA 94102 Permission for Community-Based Instruction I give permission for my son/daughter, _________________________________, at _______________________________ School to participate in community-based instruction as indicated in his/her IEP, for the school year _______ to ________ {or for Summer/ESY____. I understand that: my son/daughter will be going off school site into the community on a regularly scheduled basis (i.e., daily, twice weekly, weekly, etc.) to learn skills that are indicated in his/her IEP. my son's/daughter's program will be developed by his/her teacher and will be implemented by his/her teacher, a paraprofessional, and/or a student teacher under the direct supervision of the teacher. if any of the information indicated below changes, I will be informed and will be given a new form to sign. if I have any concerns I can contact (Teacher)___________________ at # __________________________________. I understand that my son/daughter will be participating and in the following community-based instructional activities: IEP Objectives/Activities _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Instructional Sites ___________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Transportation Modes: (circle) MUNI METRO BART Para-transit Walk Other_______________________ Check one: ( I give my permission for the above activities ( I do not give permission ________________________________ ___________________________________________ Parent/Guardian Signature Date Comments:_________________________________________________________ REIMBURSEMENT FOR IMPLEMENTATION OF PRORAMS FOR STUDENT WITH SEVERE IMPAIRMENTS 1. Expenses must be directly related to your students' IEP objectives; no party or field trip expenses. 2. Fill out all information below. To be reimbursed, this form must be used. 3. TAPE all receipts to an 8 1/2" x I I" piece of paper. The receipts should be dated and itemized in relation to the expenses listed on this form. Submit receipts with this form. 4. Monthly allotment is $25.00 per pre-K, elementary, and middle school SI program and $30.00 per high school and transition SI program. The reimbursement for June is half the amount. 5. Sign this form and have the site Principal or Department Head sign this form. Keep a copy for your records! 6. Submit original form with originals of all receipts by the 10th of the following month to: SI Program Reimbursement, Department of Special Education 300 Seneca, San Francisco, CA 94112 7. The Special Education Office will fill out the necessary requisition for reimbursement and submit it for payment. Payment will be sent to the teacher's mailing address as provided below. -----------------------------------------------------------------------------------------------------------------------------------------Expenses indicated below are for the month of:_______________________________ IEP Objective/Activity Student(s) Involved Actual Expenses ___________________________________________________________________________________ ___________________________________________________________________________________ _________________________________________________________________________________ ___________________________________________________________________________________ __________________________________________________________________________________ EXPENSES WITH NO RECEIPTS (i.e., coin-operated machines): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ PRINT CLEARLY EXPENSE TOTAL:_________________________ Teacher's: Name _________________________________ School Site:_________________________________ Mailing Address:_____________________________________________________________________ Teacher's Signature:_________________________________________________________________ Principal's or Dept. Head's Signature____________________________________________________ Date:__________________________________________________________ Department of Special Education 2555 25th Ave. Rm. 14 San Francisco, CA 94116 Instruction for traveling independently was implemented per your son/daughter's current IEP. (Student)_______________________________________________________ has completed the travel instruction established to teach him/her how to independently get from_______________________________to___________________________and from__________________________________to______________________________. Your son/daughter has learned the following travel route(s): From (address)____________________________to_________________________ departure time__________bus lines _____________ transfer point(s)____________ Transportation mode(s): (BART (METRO (Walk (Taxi From (address)___________________________to___________________________ Departure time__________ bus lines___________________transfer point(s)_______ Transportation mode(s): (BART (METRO (Walk (Taxi Your son/daughter knows the following safety procedures if s/he gets lost while traveling: _______________________________________________________________________________________________________________________________________________________________________________________________________________ Your son/daughter may begin traveling independently as of (date) ________________ If you have any questions, please contact ________________at_________________ Teacher/Job Coach Telephone No. ---------------------------------------------------------------------------------------------------------------------- Please check one and sign: ( I give permission/consent for to travel independently using the above,- mentioned transportation mode(s) and route(s). I do not give permission/consent for my son/daughter to travel independently. Parent/Guardian's Signature___________________________________ Date____________________________

Student Information Card for Special Education Department Community-Based Instruction

One copy of this card is to be carried by the adult who is providing community-based instruction. One copy of this card is to be carried by the student receiving this instruction.

Use a 3" x 5" index card and include the following information.

Front of the card:

Student Name ______________________________________________________ Home Address _____________________________________________________ Home Phone _______________________________________________________ Parent/Guardian ____________________________________________________ Parent Phone - Home _______________________________________________ Work _____________________________________________ Doctor's Name _____________________________________________________ Doctor's Phone ____________________________________________________ Medication Info, to include: Type ____________ Dosage Level _________________________ Reason for Med. ________________________________________ Times to be given _______________________________________ Student's mode of communication ____________________________________ __________________________________________________________________ ________________________________________________________

Back of the card:

School Name ___________________________________________________ School Address_______________________________________________ School Phone_________________________________________________ Principal Name________________________________________________ Teacher Name_________________________________________________ Mode of Independent Transportation, to include: Route Number(s) ______________________________________________ Location of Bus Stop(s) for Pick-up and Drop-off and Transfers _________________________________________________________ Behavior Information: ___________________________________________ ______________________________________________________________ Reinforces ____________________________________________________ ______________________________________________________________ Interventions _______________________________________________________ ____________________________________________________________________