About these Forms

The forms included in this document are designed to capture typical data collected by a team along with specialized information that is critical for a student who is deafblind or has visual and multiple impairments. We encourage all teams to consider all the questions that are included as they take into consideration the specialized needs of the child who is deafblind or has visual and multiple impairments. (Note: you may want to have various members take the lead on responding to a particular step. For example, the school nurse may have much of the information that is needed in the section on medical issues. An intervener may be able to answer some of questions better than the teacher of students who are visually impaired. If there is a teacher of students who are deafblind, they may want to take the lead on gathering this information.)

Teams should be proactive in supporting the social and emotional development of these children who are deafblind or has visual and multiple impairments.  They do this by providing quality intervention and instruction developed for the specific unique strengths, preferences, and challenges of the child. We consider these to be Tier 2 level interventions and supports.

However, sometimes, additional responsive intervention is needed after implementing Tier 2 level interventions and supports. This occurs when the child continues to show signs or escalates to extreme distress and exhibits behaviors that are self-injurious, highly disruptive or can hurt others. At this point, the educational team typically develops a formal Behavior Intervention Plan (BIP). Most school districts have standard processes and forms they use for this purpose.

For the Tier 3 Student – A note to the assessor

During creation of a Behavior Intervention Plan, a Functional Behavior Assessment (FBA) will be completed.  Traditionally, the functions of behaviors identified fall into a few common motivations, such as gaining attention or tangible items, or rejecting activities and situations.  Some formats lead assessors to select motivations such as control, escape, revenge, attention seeking, or sensory stimulation.

However, these frequently identified functions do not include recurrent explanations of distress leading to behaviors that are not as purposeful in the same way.  Many students who blind or deafblind with additional disabilities may respond to distress related to sensory, emotional or physical complications, past experiences of perceived adversity; difficulty being understood when expressing concerns, or other factors unrelated to the motivations found on FBA checklists.

The underlying factors leading to behavioral episodes for students who are deafblind or visually impaired with additional disabilities often might include: