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Department of Education



Guidelines for Completing Documentation Only*

for Teacher Support under

Section 10.1 (G) of the

Teacher Staffing Policy,

Severe Health/Neurological Disorders


Division of Student Support Services

January 2000


* Re-documentation requires copies of the following:
                Evaluated ISSP (Progress Report)
                Revised ISSP
                Student Schedule
                Principal’s Letter
                Outline of Alternate Courses
                District Office Confirmation


NB. Documentation Package is 12 pages including cover and criteria statements.





A child/youth qualifies for services via Teacher Staffing Policy 10.1 (G) if s/he meets the following six criteria:

1. The child/youth demonstrates four (4) or more of the following six characteristics :

(i) severe or pervasive impairment in several areas of development, in reciprocal social interaction skills and/or communication skills,
(ii) stereotyped behaviour and/or interests,
(iii) manifested in the first years of life,
(iv) prenatal and /or postnatal growth restriction,
(v) central nervous system involvement, such as neurological abnormalities,developmental delays, behavioural dysfunction, learning disabilities or other intellectual impairments,
(vi) skull and brain malformations and characteristics,

OR s/he has sustained a traumatic brain injury and is experiencing severe problems in two or more of the following areas: metacognition, social/emotional, sensorimotor, communication/language areas.

2. A comprehensive assessment demonstrates the presence of a Pervasive Development Disorder as defined by the DSM IV1 or Fetal Alcohol Syndrome or Traumatic Brain Injury


has ruled out other primary causes for the disability such as a visual impairment, hearing impairment, learning disability, emotional / behavioural disorder, physical disability, cognitive disability, environmental deprivation, cultural or economic disadvantage or speech disorder.

3. Documentation of services offered in Pathways 1, 2 and/or 3 demonstrate that interventions have been unsuccessful in meeting the  child’s/youth’s needs and  Pathway 4 interventions must be added.







4.The student is enrolled in four or more alternate courses in the high school/ alternate programs in K- 9. Each course should require at least 60 minutes teaching per week. These alternate courses could be in any of the following areas: academics, social skills, communication, problem solving/reasoning, metacognition, social rules, abstract concepts, self help skills, functional life skills, organization strategies. Alternate course descriptions are included with the ISSP. If the course is registered for credit it must be at least 55 hours in length for one credit and 110 hours for two credits.

5.The student is receiving direct instruction to transfer skills learned in alternate courses to other environments.

6.The educational component of the ISSP, as signed by the team, indicates:

  • goals and objectives/outcomes for modified courses;
  • required alternate courses;
  • specific strategies which the child/youth must learn to accommodate his/her disorder;
  • supports required by the child/youth to enable learning;
    • alternate instructional and /or evaluation strategies
    • needed structures and routines
    • needed structures and routines
    • transitional supports
    • cues and memory strategies
    • concrete demonstration of abstract concepts
  • how and where (include the child’s/youth’s schedule) these intense interventions will be provided.












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Department of Education


Severe Health/Neurological Disorders
Criteria G

Student’s Name:___________________________MCP#_______________DOB:_________

Grade Level: _____ School Name and #: _______________________ District #: _____

1(A). I/We certify that

the student demonstrates 4 or more of the following characteristics


The attached medical certification confirms the presence of:
a) Pervasive Developmental Disorder Spectrum* Yes__ No__
b)Fetal Alcohol Syndrome Yes__ No__

If there are four Yes responses to 1(A) plus confirmation of diagnosis, please proceed to Section 1(B). If not, the student is not eligible for this service.

*NB. Use of the Childhood Autism Rating Scale (CARS) or the Autism Behaviour Scale may assist in the determination of the range of severity of PDD


1(B). The student has sustained a documented traumatic brain injury and is experiencing severe problems in two or more of the following areas:

  • meta-cognition        Yes__ No__
  • social/emotional        Yes__ No__
  • sensorimotor                 Yes__ No__
  • communication/languageYes_No__

If there are two Yes responses to 1(B), please proceed to Sections 2-13. If not, the student is not eligible for this service.

2.        I/We certify comprehensive assessment has ruled out other primary causes of the  disability:

3.     I/We certify that comprehensive assessment verifies this student is able to access and achieve the outcomes of the Prescribed Provincial Curriculum and to meet graduation requirements.                                                                                                                               Yes____ No____

4.     I/We certify this student has received direct instruction in areas relevant to his/her excepionality for a minimum of one year from the  non-categorical special education teacher .                                                                                                                                           Yes ___ No____


Note: Persons signing this section must be certified to administer relevant assessment instruments.
Signature:______________________________ Position:_____________________________

Signature:______________________________ Position:_____________________________

Signature:______________________________ Position:_____________________________

If Sections 1 - 4 are completed, and the responses to all subsections are Yes, then please proceed to Sections 5-13. If any of the responses are No, then the student is not eligible for this service.













5. This student has received direct instruction, for a minimum of one year from the special education teacher, in the following areas relevant to his/her learning disability. Please complete this page only if the information is not apparent in the ISSP.

































Last year’s student schedule is attached indicating the above information. Yes___No___

The Programming Pathways chart is completed in detail and is enclosed. Yes___No___

The student is receiving direct instruction to transfer skills learned in alternate courses or programs to other environments. Yes___No___

This student is using the following low-tech/high-tech technology to access/demonstrate knowledge. See Using Technology to Enhance Students’ Differing Abilities for the decision making framework.


Subject Areas/Environments Used


10.   The student’s ISSP, including the educational component, as signed by the team, is attached indicating:

Principal’s letter is signed and attached. Yes___ No___
ISSP team confirmation is signed and attached. Yes___ No__
District Office Confirmation of Procedures
is signed and attached. Yes___ No___

Form completed by:_______________________________ ___________________________________

                                            _______________________________ ____________________________________

Telephone Number:______________________ Fax Number:_________________________




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We, the undersigned have been involved in the assessment and individual support services

planning process for ___________________________________ and verify the accuracy of the
                                                               (Child’s Name)

information provided in this documentation for support under Teacher Staffing Policy 10.1 (F)

Severe Learning Disability.

_____ We understand this service is provided to supplement the services of the non-categorical special education teacher.

_____ We understand this service will not remain in effect throughout the student’s school career, and planning for transition from this support to support from the non-categorical special education teacher will form part of the student’s program.

_____ We confirm this student is able to access the prescribed curriculum.

_____ We understand this is only an application.


___________________________ ______________________________
Date                                         Teacher


___________________________ ______________________________
Parent                                         Principal


___________________________ ______________________________
Student                                         Guidance Counsellor/ Psychologist


___________________________ ______________________________
Other                                              Other


___________________________ ______________________________
Other                                              Other






As principal of this school I acknowledge, as I sign my initials before each statement, that the following conditions exist in this school and the utilization of Student Support Services personnel will be monitored by the Division of Student Support Services:

---------- 1. Special education teachers are providing services on a prioritized basis in Pathways 5, 4, 3 and 2 respectively, and also on the severity of the students’ exceptionality.

---------- 2. Special education teachers are not teaching prescribed courses (high school) or programs (K-9) except under the following circumstances:

                   ______ the course/curriculum is being offered only to students with identified exceptionalities,                                           as articulated in Appendix A of the Transitional Student Support Services Policy

                    ______ the group size is kept to a maximum of ten (10) students.

---------- 3. Special education teachers are not used as remedial teachers, other than for students with diagnosed exceptionalities.

--------- 4. There is not sufficient time in the schedules of the Special Education teachers (non categorical) to meet the needs of children/youth with the above mentioned exceptionalities.

--------- 5. Any categorical units allocated for students with severe mental handicaps and severe physical disabilities are utilized solely for the students designated.

----------- 6. It is fully understood that any teacher allocated is provided as a support to the non categorical special education teacher and is not seen as a separate and unrelated allocation.

----------- 7. The student will be in school on a full time basis.








Signature of Principal:____________________________________







The documentation, including the required forms and the ISSP, has been reviewed. Services that have been provided through existing resources have been deemed insufficient to meet this student’s needs and therefore we concur with the request of the ISSP team for this categorical teacher allocation.







Program Specialist for Student Support Services



Director or Assistant Director (Programs)