Livingstone Range School Division

Complex Needs Application (Grades 1-12)

An estimated 10-15% of Alberta’s children and youth have special needs and of the 10-15% approximately 1-3% have complex needs some of which require care and services at a high fiscal cost to meet the student’s needs in an educational setting. The LRSD Complex Need Fund supports a small number of students (15-20) that require services and supports that are significantly beyond what can be reasonably expected to be covered through the increased special needs funding provided directly to schools.

Who qualifies as complex?

Students with complex needs require extraordinary services and usually include concerns regarding safety to self or safety for others including:

• multiple impairments in more than one domain or across multiple domains (medical, physical, behavioral, etc.)

• extraordinary specialized services that are at a very high cost AND/OR

• human resources that strain the capacity of the school.

Referral Process Timelines

Application Deadlines:
·  April 30 – Applications are due for existing students for funding for the upcoming school year
·  October 31 & February 15 – Applications are due for newly identified students, students new to our jurisdiction or re-submissions
·  Students moving away from a school:
o  After February 28 receive full year assigned funding
o  Before February 28 receive half of the assigned funding
o  Students moving into a school receive:
§  Pro-rated assigned funding or
§  Pro- rated basic student funding if they do not qualify for complex needs funding but require significant supports

Complex Needs Committee

The application review committee consists of a balance of high school and elementary representation as well as administrators, learning support teachers and family school liaisons from the north and west end of Livingstone Range. When possible, committee members will serve on the committee for no more than 3 years with 2 people transitioning each year.

Positions / 2013-2014 / 2014-2015 / 2015-2016 / 2016-2017 / 2017-2018
Central Office / Lorna Adrian / Lorna Hewson / Ken Sampson / Ken Sampson / Ken Sampson
Admin K-6 / Bill Powlyk / Dana Burrows / Dana Burrows / Dana Burrows / Curtis Uyesugi
Admin 7-12 / Sandy McDuffe / Sandy McDuffe / Jason Porteous / Jason Porteous / Jason Porteous
Learning Support K-6 / Savi Houldin / Savi Houldin / Marnie Davidson / Marnie Davidson / Marnie Davidson
Learning Support 7-12 / Alysa Fisher / Denise Getz / Denise Getz / Denise Getz / Carol Lach
Learning Support / Lori Austin / Lori Austin / Lori Austin / Dakoda Kuftinoff / Deanna Fidelak
FSLC K-6 / Karen Sparkes / Karen Sparkes / Karen Sparkes / Karen Manzer
FSLC 7-12 / Holly Stewart / Holly Stewart / Holly Stewart / Marli Duncan
Psychologist / Shaun Metz / Shaun Metz / Dr. Kendra Massie
Behaviour Teacher / Kevin Verberk

COMPLEX NEEDS APPLICATION
New Renewal / PLEASE CHECK CODE
41 Severe Cognitive
42 Severe Emotional/Behavioural
43 Severe Multiple
44 Severe Physical or Medical
45 Deafness
46 Blindness

School:

Student Name:

Current Support Plan: IPP ISP BSP MSP SIS Other ______

Birth date (yyyy/mm/dd): ______Grade:

1.  Supporting Documentation from the appropriate professionals (please attach copies):

Diagnosis / Year / Professional Conducting Assessment / Attachment
(Y) or (N)
Assessment(s) / Year / Professional Conducting Assessment / Attachment
(Y) or (N)
Areas of Impact Continuum
/ Date Completed / Professional(s) Completing the Impact Continuum / Attachment
(Y) or (N)
Key Indicators Document
Supports Document
Highlight all areas of concern(s) on the templates and submit documents with application

2.  The student requires which of the following in the learning environment because of his/her disabilities?

adapted/alternate materials / increased supervision/assistance
modified instructional focus / medical/personal care
adjusted instructional level / mobility/motor development
alternate communication / ongoing or emergency medical plan (attach copy)
specialized facility/furniture / behaviour plan (attach copy)
Other

3. Complete a summary of school functioning below. What does the students programming look like? Describe a day in the life of this student (please be descriptive as this will provide the best indicator of programming). Include extraordinary supports, services and safety to self and others.

4. Identify supports from (a) to (e) that are being provided to the student:

a.  Frequent specialized one-on one intervention:

Intervention / hours per day / staff:student ratio
specialized setting with teacher
small group work with teacher
teacher assistant
interpreter
other

b.  Specialized equipment and/or assistive devices:

communication devices / specialized furniture
assistive technology/devices / specialized software
personal FM system / specialized equipment
other (specify)

c.  Assistance with personal care/health-related interventions:

assistance with personal hygiene / lifts and transfers
catheterization / respiratory therapy
g-tube feeding / management of equipment
other feeding program / oxygen administration
administration of medication / mobility training (walker, wheelchair)
other (specify)

d.  Frequent documentation of behavioural and/or medical status through anecdotal records, checklists and/or medical logs:

Hourly / Daily / Weekly / Monthly
Behaviour is monitored
Medical condition is monitored

Describe the student’s current behavior status (if applicable):

e.  Direct support services for the student:

How often? / How often?
assistive technology consultant / physical therapist
audiologist / registered psychologist
behaviour specialist / school liaison worker
hearing consultant / school/guidance counsellor
itinerant teacher / social worker
nursing services / special education consultant/lead teacher
occupational therapist / speech language pathologist
orientation and mobility specialist / vision consultant
other (specify)

5. BUDGET

Complex needs funding is determined by the committee based on the application review and the following standard:

High Needs - $20,000.00 max

Medium Needs - $15,000.00 max

Low Needs - $10,000.00 max

LIST EXPENSES / Projected cost for the School Year
Staffing (role/hours)
Supplies and Materials (be specific)
Staff in-service (extraordinary and related to student need, e.g. sign language interpreter training)
Contracted services (include provider name/rate/estimated hours). Only include services that are contracted at an additional expense to the school (e.g. AHS services are not charged to the school, behavior consultant would be additional)
Extraordinary PROGRAMMING related transportation costs (do not include costs related to getting to and from school).
Other (be specific)
TOTAL

LRSD Complex Needs Application (Revised June 2017) Page 2 of 4