Working with Severely Impaired Students

Discussion in 'Special Education Archives' started by JessCentral28, Aug 9, 2006.

  1. JessCentral28

    JessCentral28 Rookie

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    Aug 9, 2006

    Hi everyone!
    I have done a LOT of research over the internet, and there just isn't very much information out there on classroom ideas for working with SCI/SXI kids, or websites for setting up a program. I am setting up a brand new program- I am not replacing a teacher. Of course many many ideas from the internet can be adapted, but I would love to hear from those of you who have worked with Severely/Profoundly impaired children. How was your schedule layed out? Any classroom activity ideas that worked really well? I have been organizing forms on my computer getting ready for the school year, specifically the Daily Communication form which goes home every day. Let's get a chat starting if there are SCI/SXI experienced out there!
    Thanks!
     
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  3. bcblue

    bcblue Comrade

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    Aug 9, 2006

    SCI/SXI? Everyone's abbreviations seem different--what's this one? If it is what it sounds like, I'd love to hear what people have to say! My class falls into the severe/profound range, and sometimes it does feel lonely to be teaching something so different from my co-workers. . .
     
  4. JessCentral28

    JessCentral28 Rookie

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    Awe sorry- Michigan Terms- Severely Cognitively Impaired and Severely Multiply Impaired.

    I'm sorry about that- it sounds like you have an SCI/SXI program....SXI generally has SCI kids but also in wheelchairs/medical issues. (maybe feeding tubes, etc.) I know I'm generalizing so I hope I don't start a debate that not all SXI children are in wheelchairs :)

    Anyone out there, including you bcblue, working with the severe to profound population:

    What does your schedule look like?
    What types of activities are an important part of your classroom/enjoyable for students?
    Etc. Etc... There is NOTHING on the internet about SCI/SXI programs!
     
  5. MissFrizzle

    MissFrizzle Virtuoso

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    Is this a day treatment setting?
     
  6. JessCentral28

    JessCentral28 Rookie

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    My classroom will have a sensory area and include a lot of sensory activities in the daily schedule. My schedule includes Morning Meeting with switches/devices. Morning groups are Pre-Voc/Fine Motor, Sensory, and Music. We have a great deal of "specials" here including a Sensory Room, Art Room, Voc-Ed program (work tasks), Adaptive P.E., Music Therapy, and an interactive Computer Lab with a SmartBoard!! I'm coming from a Rural RESA, so these services are new to me. In the afternoon we will have a large group Cognitive Development Time with Music & Lights, Arts & Crafts, Cooking and Leisure depending on the day. We also have CBI trips into the community.

    I would like to see how other people have their programs set up and get some great ideas for some activities to do consistently with the program.

    For example, we do hand massages daily.

    Things that we may have forgotten about or never thought of!
     
  7. JessCentral28

    JessCentral28 Rookie

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    Aug 9, 2006

    MissFrizzle-
    Many SCI/SXI programs here in Michigan are in Center Based Program. At my Center (which is huge) there are 19 programs, all SCI/SXI aged 14-26. There are districts that may place their SCI/SXI program(s) in the local buildings, but not too many that I am familiar with. It is basically a public school for all severly impaired children- they may have other services at home as well.
     
  8. MissFrizzle

    MissFrizzle Virtuoso

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    I am a case manager for this population. I visit my individuals at there day program settings. Obviously, with the move towards inclusion, more and more of our guys are moving from center based settings to what we call hubsites in the community. Rented storefronts where the guys have a kitchen/living area. It is geared towards Activities of Daily living... just as you mentioned. (cooking, self,care, etc).

    They also have excercise time, arts and crafts, and inclusion where they volunteer in the community. (as best they can)

    In the center based programs our schedules were almost exactly as mentioned in the previous posts.
     
  9. bcblue

    bcblue Comrade

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    Aug 10, 2006

    I have my class (we're labelled "multi-handicapped", although I prefer "life skills" as more descriptive of what we DO) in a regular public school. The benefit is the integration, the down side is lack of resources and peers for me and for the kids.

    Our schedule:
    Morning circle (greetings, communication from home, weather, calendar, schedule)
    Worktimes (sometimes group, sometimes 1:1)
    Exploratories--here's where we integrate into general ed for art, music, or gym
    Free choice time
    Lunch
    ADLs--cleaning the table, washing the dishes from lunch, toothbrushing, hand washing, face washing
    Group work
    Gross motor--outside walks if possible
    Wrap-up

    That's a sketchy outline. And generally subject to change without notice!

    One of my favorites is cooking, for it is life-applicable, age-appropriate for any group, and can be adapted to all different skill levels and needs. Also, when we cook we turn it into social learning activity and make a lot and go share it--then we have the motor part (getting to the other classrooms) the communication (presenting what we made) appropriate social (asking students would you like a ___ and the please/thank you thing) and of course gives the kids the feeling of having done something that is appreciated by others.

    We also like taking surveys, maybe once a month or so. Anything--what did you do over vacation last week, or when we were doing Stone Fox (the boy lives on a potato farm) we did how do you like your potatoes: mashed or fried? Anyway, we go class to class, we use our Big Mac switches b/c my kids are mostly non-verbal, but we approach, greet, ask if we can ask questions, the kids use the switches to ask, we have a clipboard and paper and use a bingo marker to make a mark in the column they answer (so the survey has to have pre-set choices). When you get back, depending on how much your kids can do there are all kinds of fun things to do with results. Graphs, charts, make results to post somewhere in the school, as most of your survey-ees will be curious.

    That's what comes immediately to mind, I must run now to work, for we have 2 more days of summer school!
     
  10. ellen_a

    ellen_a Groupie

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    I love this idea! We graphed a lot of these types of things in our classroom--favorite flavors, activities, etc.--but it would have been neat to extend it beyond the room. I am going to remember this!!
     
  11. JessCentral28

    JessCentral28 Rookie

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    I love this idea too!! Thanks! A "Question of the Day" during morning groups would be a great addition...Thanks for the idea!
     
  12. gwat1aw

    gwat1aw Rookie

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    I love all of your ideas!!! But I have the feeling that your students are higher functionally than mine are. I also have the multiple-handicapped, medically fragile students (mine not only have feeding tubes, but some also have tracheas and are on oxygen--and I've lost several over the years due to medical complications, luckily all were at home at the time). But I too have a schedule similar to bcblue. Although there isn't alot of time between getting them off the bus, the first diaper changes of the day (all of my students require TOTAL care and we don't have 1:1 aides, just one aide for my classroom) and breakfast before it is time for lunch for the students (they eat EARLY at 10:30 in the morning). We often integrate positioning into the circle time as well--with some in standers or corner chairs or other positioning equipment given to us by the PT and OT. Instead of doing hand massage, we do almost a full body massage on our students. We use lotion and massage the hands, arms, back, legs, feet, sometimes belly area as well. We do this after lunch in our class with lights out, the students on bean bags and soft music playing in the background. It's sometimes tempting for us to fall asleep, but it helps those with contracted muscles to relax and we get a better stretch and ROM exercises with them. As we begin loading buses at 2:00, our day is quickly over. I hope this helps someone out there. Looking forward to seeing other ideas from those of you that teach these severely cognitively impaired, multiple handicapped, visually impaired, TBI, medically fragile kids. I've taught this population for 8 years (total of 20 years teaching in sped areas) now and I'm really looking for new ideas! I do try to integrate one of the best suggestions I've ever received: Work on things and units that YOU like to do. You may not get any response from your students about some of the activities, but if you enjoy doing it, they have a better chance enjoying it as well. If you have fun, they will pick up on the enthusiasm you have. If you hate the unit, they will pick up on that as well and will dread working that day for you.
     
  13. PKPLAY

    PKPLAY Rookie

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    Aug 12, 2006

    Have you heard of Dr. Lilli Nielsen and the active learning approach for working with severely impaired students? Our district has opened up Active Learning Classrooms(ALC) and Experiential Learning Classrooms (ELC) . Dr. Nielsen's theories are based on her experiences working with the visually impaired population and can be used with students with significant motor and cognitive impairmments. Very good stuff!!!
     
  14. gwat1aw

    gwat1aw Rookie

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    PKPLAY,
    I had not heard of Dr. Nielsen and the active learning approach; but be sure I'll be doing my "homework" to check it out! Thanks!
    gwat1aw
     
  15. bcblue

    bcblue Comrade

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    Aug 14, 2006

    gwat1aw,
    Have you ever done story boxes? This I picked up from a vision therapist I worked with during my student teaching. She would have a book on tape, and a box full of various items that were in the story, with as many sensory components as possible. First she would play the story and show the pictures, then she would go back through, reading a page at a time, and using the object props--something to smell, to feel, an action to do, something to taste--having each student touch it, smell it, perform the action, etc. I saw her do this with classes like yours, and it went over well. I've also used it in modified versions in my class, which is probably a little less involved than yours.
     
  16. gwat1aw

    gwat1aw Rookie

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    BC:
    Thanks so much for the idea. I'm not real sure if I'm imaginative to do all that, but I will definitely have to see if I can figure it out to try
     
  17. bcblue

    bcblue Comrade

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    Aug 15, 2006

    "If You Give a Mouse a Cookie" is a good one to start with, or any of that series.
     
  18. WhyBeNormal?

    WhyBeNormal? Rookie

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    Finally!

    SO glad to have found this group! I don't remember what I Googled to get here, but thank goodness I did!

    Every forum or website out there seems to say it's about "severe" disabilities, but usually turns out to be about students who are far higher functioning than mine.

    I, too teach medically fragile students with severe and profound disabilities, some with g-tubes and trachs, most w/ seizure disorders. Most are unable to bear weight, a few can ambulate with assistance or gait trainers.

    I think we can learn a lot from each other!

    I love the sensory ideas, the massage leading to better ROM.

    Other than the usual diapering/toileting and ROM/hygiene/medical activities,my students are positioned in a variety of equipment throughout the day: Tumbleform seat, Rifton chair, mobile prone stander, standing table, wedge, sidelyer, Advancement chair.

    While in those positions they engage in a variety of activities: switch use with computer or electronic "toys" (always w/ choicemaking integrated into this), group social times (bring Step-By-Steps from home w/ messages to relay), home ec. cooking activities w/ switches. For P.E. time they are in the gym in various positioning equip. w/ peer tutors or swimming at the h.s. with staff. Community trips occur 2x/weekly with an emphasis on choice-making for items bought and using Big Mac or Step by Step switches to interact with store personnel.

    What I would like to know is
    1)what kind of medical support/staff do your students with medical issues receive?

    2) Toileting issues: have you attempted habit training and if so, how is it going?

    Again, SO glad to be here!!!! I feel like I hit the jackpot!
     
  19. PKPLAY

    PKPLAY Rookie

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    One thing that I am going to be making in my classroom this year is an area against a wall with a handrail attached to the wall at student height. Behind the hand rail I am going to attach a mirror and mount some peg board so I can attach various textured/visually stimulating, &/or noisy items for the student to explore while they are in a standing position. I have one student in mind in particular for this, ( who has a Trach. and g-tube, but is able to support herself with some assistance), but I think many others that I have
    had could have benefitted from this area to help motivate them to gain strength and independence in standing. With the peg board mounted on 2x4's (?) I think I'll be able to change out the hanging items ( hanging with elastic)...it's a work in progress, so we'll see.

    AS far as support staff for medically fragile students, in our district we do offer school heath services ( a nurse) for students that potentially life threatening issues, especially if they are riding on the bus toand from school ( the nurse rides with them and stays in class with them).
    Some have private duty nurses at home that the family may opt to send instead.We also have a school nurse for all of the students who can assist with tube feedings, treatments, etc.
    Then we have the other related service staff, PT, OT, assistive technology ( provides assessment, switches, cause and effect toys and software, and communication devices such as springboards or techtalks). We also have music therapy, but the age group that I work with usually does not seem to qualify for this service. Our staff in the vision and auditory impairments have been a wealth of information for me as well.
     
  20. WhyBeNormal?

    WhyBeNormal? Rookie

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    "One thing that I am going to be making in my classroom this year is an area against a wall with a handrail attached to the wall at student height."

    I like that- I have 3 students out of 7 that would benefit from an activity bar- great idea.

    How about toileting....has anyone attempted habit training?

    School starts this week!! :eek: I never feel prepared enough!
     
  21. PKPLAY

    PKPLAY Rookie

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    What I usually do for toileting is very individual. If they have the trunk support to sit up with little assistance I do start them on the toilet and have them do as much of the toileting routine as they can do, at the least to acclimate them to the whole idea and get them comfortable in that area. I have had the most success when families are actively working together with us on this skill and when we share what works ,what doesn't work...
    I do try to go with the student's natural schedule for toileting to help increase the likeliness for success in the toilet.
    Not sure if this is at all like habit training...can you go into what that is?
     
  22. twin

    twin New Member

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    Yes I have with two of my students last year and will be working with two this year. It has worked. I am also working with PECS and I started working with the MOVE curricullum this year :) I am excited to see if I get any results.
     
  23. PKPLAY

    PKPLAY Rookie

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    What is the MOVE curriculum? We use pecs too and we use alot of photos &/or objects for students that need more concrete exchange items.
     
  24. PKPLAY

    PKPLAY Rookie

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    I just looked up the MOVE Curriculum...how doyou like it? What do you like and what is difficult with this population?
     
  25. twin

    twin New Member

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    I like the program. It is very time consuming and without enough help I can only work with one student. I am looking for a high school that may have a class that has the general education students come in and help us while they get credit. Any suggestions, models out there?
     
  26. WhyBeNormal?

    WhyBeNormal? Rookie

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    That's exactly what it is- putting the student on at the time of day that your data shows you is the most likely voiding time. Doing that increases the "sit on toilet/void connection" (the ol' stimulus-response).

    Any suggestions for feeding a student (pureed food) who has a very active arm movement PLUS a head weave that makes his mouth a very tough target? I don't know him very well yet- he's new to my class- and this very well could be behavioral, b/c he is much calmer with Mom!
    I could wait him out with the spoon and require "hands down" while presenting the spoon at midline only but have other students to feed and he needs all the calories he can get.

    Any advice out there?
     
  27. bcblue

    bcblue Comrade

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    Talk to your OT, but I've found that with the head weave a gentle pressure with your pointer finger along the jawline and your thumb under the chin can help both of you to get the food to the target--but this was shown to me by an OT, it's hard to visualize it in type. Hopefully some of his resistance will settle as he gets to know you!
     
  28. clarnet73

    clarnet73 Moderator

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    I had a little guy last year w/ feeding issues, and we found that giving him something to do while we were feeding him REALLY kept his hands down and he ate SO much more... he loved my mini keyboard or some favorite books. Because he was distracted, he didn't fight.
     
  29. bailey18

    bailey18 New Member

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    new teacher!

    Hello everyone... I was recently hired as a perm. sub. in a CI room. There are plenty of supplies in the room, however, I am terrified for the year to begin! Obviously, there will be the paraprofessional to help me, but I am wondering how to go about planning the day. Next week, I will be able to see the student's IEP's and get a better understanding of what they need. Can anybody offer suggestions on where or how to begin? I am very nervous!
     
  30. clarnet73

    clarnet73 Moderator

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    bailey, what age students will you be working with?
     
  31. bailey18

    bailey18 New Member

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    I am not sure yet....I will see their IEP's Monday. I would venture to say that they are about 7 or 8 years old. I have thought about some ideas such as: sending home folders daily to keep in touch with parents. Are there any other ideas that you have found to be beneficial? I am looking for any help I can get!
     
  32. tigerlily

    tigerlily Rookie

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    Bailey18,
    Your students are likely young enough that you will not have to worry as much about "age appropriatness" although don't take this to mean you can do "babyish things". Find out what the other 2nd and 3rd grade teachers are working on. Then you can set up your daily schedule in a similar way with adaptations for your student's needs.

    I like to use themes and units. For example: I might make a month long unit about the animal kingdom and then each week we focus on another area, mammals, reptiles, amphibians, fish, insects... So each week I plan a art activity, cooking activity, science activity, and social studies activity based on my theme.

    Do you have a specific curriculum? Are you using Edmark reading, touch math, etc. Once you find out about your students you should be able to determine how to schedule your day.
     
  33. WhyBeNormal?

    WhyBeNormal? Rookie

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    Sep 10, 2006

    Data collection

    I was wondering if we could share ideas for data collection (of IEP objectives) and ways to make this process simpler.

    For example, which is better- notebooks for each student or clipboards for each staffmember?

    How do you make data sheets- tables in word, or in Excel, or handwritten?

    What kinds of directions do you put on your data sheets, do you get specific as to instructional procedures?

    I'm struggling with balancing ease of use with my need to be very specific as to procedures. I don't want to overwhelm, but I want to increase consistency.

    Any thoughts? How do you collect data for IEP progress reports?
     
  34. bcblue

    bcblue Comrade

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    I agree--any ideas to make this simpler would be amazing! I have a hard time consistently keeping up with ALL my data sheets!

    I use tables in Word for almost all my data, and I currently have data sheets all over the classroom--posted in locations relevant to the goals (ie "S will open her locker with verbal instructions only" is posted inside the door nearest the lockers). I try to make them as labor-light as possible, with abbreviations and checkmarks that we can use and a key typed onto the data sheet.

    For my academics I do clipboards for each staff member, then at the end of the day I sort out the data sheets into binder sections by student. My academic sheet is a generic Word table that I then fill in with specific goals for specific work sessions. We repeat tasks often, so once my staff and I are familiar with the instructional procedures, I tend to write them only briefly on the data sheets.
     
  35. dro

    dro Rookie

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    Sep 10, 2006

    feeding problem?

    Best bet is to talk to parent to see how they handle it. Next I would talk with your occupational and physical therapists for suggestions. Is it possible to adapt a chair that wraps around the head, sort of like a bean bag chair? That is what I use for one of my students. Her arms are flying also so I am trying to use a plastic spoon with velcro type fasteners around her wrist and thumb. I guide this hand so she can help eat. Her other hand she reaches out. If your student will grasp onto things I use a small plunger type piece of P.T. equipment for her to hold on to. Now there is a lot of repositioning hand on plunger until she realixes what to do.
    I still have difficulty with that and re positioning the beanbag around her head but it has made feeding a bit better for my student.
    good luck:love:
     
  36. WhyBeNormal?

    WhyBeNormal? Rookie

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    Sep 10, 2006

    data,feeding

    ::::happy sigh:::::

    See, that's why I love this thread!

    Thanks for the ideas! I will try them out: the data near the activity, the velcro spoon on his hand to both involve him in eating and keep his arm busy, the head support idea.

    I'll let you know how it goes.:thanks:
     
  37. Beeg

    Beeg New Member

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    Sep 11, 2006

    Preschool Anyone?

    I am at a dedicated center based facility and my population is preschool SXI. I teach ASD students, students that are medically fragile or severely health impaired, all are severely cognitively impaired and most are visually impaired... and I have two sessions each day, each approximately 2.5 hours in length. Between diaper changes and getting students into various pieces of equipment and doing some feeding or feeding type therapy (pre-feeding work) I am wondering how to structure my day. I have just started with this population this year and am thrilled and honored to teach these most amazing students. I have worked with this population before but in all day programs. I am really challenged to recreate my schedule given my current time restraints. I love all the ideas I have been reading and plan to do some internet research to learn more about Nielsen... I think that's the proper spelling. I too am so happy to have found my way here. I have never participated in a chat like this before, but I will check this one often!
     
  38. M's teacher

    M's teacher New Member

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    Great idea

    This is a great idea! I have a student with seizure disorder who is non verbal and non mobile. She is 8 years but functioning at a preschool level. Any ideas such as this would be SO appreciated>
    Thanx
    M's teacher

    gwat1aw,
    Have you ever done story boxes? This I picked up from a vision therapist I worked with during my student teaching. She would have a book on tape, and a box full of various items that were in the story, with as many sensory components as possible. First she would play the story and show the pictures, then she would go back through, reading a page at a time, and using the object props--something to smell, to feel, an action to do, something to taste--having each student touch it, smell it, perform the action, etc. I saw her do this with classes like yours, and it went over well. I've also used it in modified versions in my class, which is probably a little less involved than yours.[/QUOTE]
     
  39. short e

    short e Rookie

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    Dec 1, 2006

    Hi JessCentral28,
    I have just been hired to work with the moderate-severe population, grades K-5. The class is Academic Life Skills. I have a lot of the same questions you had at the beginning of the year. Although I have read all of the responses to your initial question, I was wondering, what did you finally come up with for a daily schedule? What are some examples of work time activities? I am asking for very general information because I have not yet started the job and so I don't know the funtional levels of my students, just the age range.

    Anyone else with advice, info, suggestions?
    Short e
     
  40. Beeg

    Beeg New Member

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    Dec 2, 2006

    HI. I am a teacher of SXI students and my classroom is a preschool classroom (youngest 1.10, oldest 5.4). In my student teaching I was placed for 1 year in a program of 5-8 year old SXI students which is where I developed my love for this population. I have a question for you, Short E. What age levels are your students and what state are you teaching in? That will help me reply to your question. If you work with older students I will share the schedule I used for my all-day students. If you work with preschoolers I will share my half day schedule with you. In either case, my schedules were developed over the years in a very successful and well respected program in Grand Rapids in Kent County for the Kent Intermediate School District so I am proud to share them and proud to be teaching with such knowledgeable and respected people in such wonderful facilities. I also have lots of questions too. I am only in my second year of this and my questions center around how other teachers get all their job responsiblities done in the course of a work day. I find that paperwork is very difficult to complete and often end up working on it after hours at home which I resent to a certain extent. Also, how do others cope with the physical exertion? That's it for now. Beeg
     

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