1 Start 2 Complete Welcome to ECHO Idaho's K12 Education: Supporting Students with Autism Case Submission Form.Case Study Discussion Guidelines As part of our training, we will be engaging in discussions about student case studies. This is a wonderful opportunity to learn from each other, share experiences, and explore solutions collaboratively. Please provide your contact information. We will not share this information. Presenter first and last name * School role/title and/or credentials * Email * Phone number * Name of school and/or district * City * ECHO Idaho offers $100 compensation for student case presentations. Would you like to accept compensation for presenting this case? * Yes (ECHO staff will reach out to you with compensation paperwork that must be completed three weeks prior to your presentation date.) No, I would like to donate my time. Please do not include any identifiable student information, Personally Identifiable Information (PII), or Protected Health Information (PHI) or information protected by The Family Educational Rights and Privacy Act (FERPA). If you have any questions regarding this form, please contact echoidaho@uidaho.edu. * Click here to acknowledge Student grade level Kindergarten to 2nd grade 3rd to 5th grade 6th to 8th grade 9th to 12th grade Please list any known past or current diagnoses for this student. What percent of time does this student spend with their general education peers? All day with their general education peers More than 50% of the day with their general education peers Less than 50% of the day with their general education peers All day in a self-contained classroom What adult supports does the student have throughout the day? Full support of a 1:1 paraprofessional for the entire day Partial support only during targeted activities No paraprofessional support during the day Other, please specify: What adult supports does the student have throughout the day? Other, please specify: Tell us about the strengths of this student (academic, motor, special talents, personality, etc.). What are the passions of this student (specific interests, hobbies, pursuits, etc.)? Briefly describe the specific challenge or concern you have for this student. Is this student on an IEP? Yes No Identify any relevant accommodations and/or modifications that are stipulated on the student's IEP. Presentation (how information is presented to the student) Visuals for academic concepts (ie for homophones, science concepts, or other things presented orally, also have an accompanying visual). Individual copy of the book during group instruction Larger text Text to speech software Closed captioning when available Headphones Fidgets Use of symbols in page or book format (PECS, PCS, PODD) Other, please specify: Presentation (how information is presented to the student) Other, please specify: Response (how the student responds to the prompts from the teacher) Speech to text software More time for testing Remove time constraints on all tests Scribe (for written responses) AAC system Special writing devices (e.g., weighted pencils, specific grips or sizes) Please specify AAC system or other: Response (how the student responds to the prompts from the teacher) Please specify AAC system or other: Setting Accommodation Testing in a separate place Testing with familiar adult Instruction in a small group Individual instruction Preferential seating (to maintain attention or for vision, hearing or other issue) Other seating needs (e.g., wiggle disc, alternative seating, band on chair legs for movement) Transitions to occur prior to the general population, switch classes early Use of speaker for hearing related issues Other, please specify: Setting Accommodation Other, please specify: Scheduling Accommodation Frequent breaks (for sensory input, during tests, etc.) Scheduled bathroom breaks Shortened day Other, please specify: Scheduling Accommodation Other, please specify: Organizational Skills Accommodation Back and forth communication log with caregivers Use of highlighter Alarms/reminders/timers (visual, auditory or both) Graphic organizers Daily visual schedules Other visuals for specific tasks Other, please specify: Organizational Skills Accommodation Other, please specify: Modifications Reduced difficulty for tests, assignments Reading (text at a lower Lexile level) Writing (shortened assignment) Different grading rubric Math (shortened assignment, fewer problems) Alternative state testing (e.g., Idaho Alternate Assessment) Other, please specify: Modifications Other, please specify: Is this student on a 504 plan? Yes No Identify any relevant accommodations that are stipulated on the student's 504 plan. What other interventions/strategies have already been tried with this student? Please provide information about any internal or external evaluations relative to your concern. Does this student have a Behavior Intervention Plan (BIP) in place? Yes No Is there a crisis plan in place? Yes No Does the student participate in any services outside of the school setting? Yes No Describe the services provided outside of the school setting. Please list any relevant, non-identifiable background information about the student (e.g., medical/psychological diagnoses, family/social history, etc.). If known, what current medications is the student taking? What does the student/family hope to achieve next? What do you hope to achieve next with regards to this student? What specific questions do you have for ECHO about this student or situation? FERPA & HIPAAOur discussions must also strictly comply with the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA).FERPA is a federal law that protects the privacy of student education records. This means that any academic information, such as grades or educational services received, should not be shared without explicit consent from the student or the student's parents if the student is a minor.Meanwhile, HIPAA safeguards patient health information. Under HIPAA rules, it is prohibited to disclose health information that could identify a patient. This includes medical histories, treatment records, or any other health-related information.Discussion EtiquetteIn keeping with these rules:Please use broad terms when discussing a student’s academic performance or health information.Consider using fictitious names or simply refer to the student as "the student."Share information only as relevant to the professional development of the group, always keeping the student's privacy at the forefront.Our goal here is to learn and grow as professionals, not to investigate personal details of our students' lives. Their trust in our services hinges on our commitment to confidentiality and respect for their private information. Thank you for your commitment to upholding these crucial standards.Thank you for completing ECHO Idaho's K12 Education: Supporting Students with Autism Submission Form. You will receive a copy of your responses in the email you provided and be contacted by ECHO staff about presenting your case in a session or follow-up consultation with a panelist within two business days. Leave this field blank
