5340 Skylane Blvd. Santa Rosa, CA 95403

Sonoma County SELPA

5340 Skylane Blvd. Santa Rosa, CA 95403

CHILD AND ADOLESCENT NEEDS AND STRENGTHS REPORT

Student Name: School:

Date of Birth: Grade:

Date of Report: Primary Language:

Age of time of Assessment:

Evaluator:

Reason for Referral:

Results:

The following information was obtained from interviews with Parent, or School Staff or LCI staff person conducted on ______(date).

STUDENT STRENGTHS:

______has been described as (list positive characteristics). The following student strengths have been identified from the conducted assessment:

1.

2.

3.

STUDENT NEEDS:

Based upon the obtained results, there is evidence that ______has the following areas of need (Individual areas under the specific domains):

1.

2.

3.

4.

Educational Needs / Student’s Needs
Life Domain Needs / Student’s Strengths

Please view attached chart of indicated needs (imbed graph of scores from Excel worksheet here).

Recommendations:

As a result of the above stated needs (items which scores 2 or 3), the following behavioral or social emotional goals are suggested:

1.

2.

3.

4.

This assessment report is part of a thorough psycho-educational evaluation. The results may be used to determine appropriate supports and services for this student.

RESOURCE SHEET

Goal Bank for CANS Domains: Examples of social emotional goals copied from SOCIAL EMOTIONAL GOAL BANK/SonomaSELPA.org/DOCS/ERMHS.

Consider identified student strengths when creating goals. Numbers in italics refer to CANS items.

Educational Needs:

1.  Student will display productive school behavior (participate in small group activities; or complete assigned work on a daily basis) on a daily basis with ______frequency as measured by ______. (01 and 02)

2.  Student will arrive at school/class on time, on a daily basis with ______frequency as measured by ______. (03 and 04)

3.  Student will work consistently without verbal or physical disruption of other students, on a daily basis with ______frequency as measured by ______. (05 and 06)

4.  Student will demonstrate ability to generalize classroom/school rules in various situations (lunch, recess, passing through hallways) on a daily basis with ______frequency as measured by ______. (07 and 08)

Student Needs:

1.  Student will express or demonstrate concern/sympathy towards others by (describe the desired behavior; under what conditions; how often; with or without adult assistance; (10)

2.  Student will practice self-controlled behaviors in real or simulated situations with ______frequency as measured by ______. (09; 13)

3.  Student will identify and manage feelings (i.e. anger, anxiety, stress, frustration) on a daily basis with ______frequency as measured by ______. (09,10,13,14,15)

4.  Student will use age-appropriate social-sexual behavior______frequency as measured by ______. (23, 25).

Life Domain Needs:

See Social Emotional Goal Bank for further examples of goals under “Interpersonal Skills”, and “Problem-Solving Skills” as well as the other areas of need. Focus on the manifested behaviors caused by the Life Domain Needs when creating goals for needed items in this strand.

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