Program Evaluation Form


Happy New Year
I shared this form below today with a family who is looking for an appropriate school program for their student. It’s a great form and thought I should share it here.
I have also developed my own 4 page form that looks at curriculum, staff, specials, modifications and more. Email me at and I’ll send it to you.

Resource 6
Program Evaluation Form
Name of Program______________ Person making the rating___________
The following are key indicators of a quality program for students with autism.
Rating Scale                                                               Priority Ratings
0 = There is no or minimal evidence that this             A = Needs immediate attention, of the
 is happening                                                                      highest priority
1 = There is some evidence that this is happening      B = Important issue to address, but not
 with at least some of the staff or some of the time.            Immediate or urgent
2 = This clearly happening with most of the staff                     C = Not important or relevant now, but
most of the time.                                                                 need to monitor for the future
1. Goals and objectives emphasize the functional use of language and communication in natural contexts, not simply teaching isolated speech and language behaviors.
2. Goals and objectives are functional (the skill makes a difference in a child’s life) and match the developmental level areas of need.
3.  The child’s emotional regulation and its effect on communication and learning are consistently considered and arousal stated are monitored constantly.
4.  Approaches to problem behavior are fully integrated with social communication programming.
5.  Meaningful and purposeful activities are targeted daily.
6. More than one objective is targeted for each child within each activity, and each objective is targeted within more than one activity.
7. Data are collected regularly and tallied weekly so that all objectives are measured weekly.
8. There is sufficient time available for the team to meet regularly to coordinate programming.
9.  The team meets regularly to collaborate, (written records, jobs targeted, people responsible noted.)
10. Adjustments in programming are considered at least quarterly based on the data collected.
11.  The staff monitors the intensity of each child’s program and documents that each child is actively engaged in productive learning activities during school hours. 25 hours per week should be the goal.
12. Adults are responsive to children’s communication and emotional expression in all learning environments.
13. Adults encourage children’s initiation by offering choices, waiting, and facilitating shared control.
14. Breaks and time for problem solving is allowed.
15. Problem behavior is interpreted as meaningful.
16.  Protests are honored when appropriate and possible.
17. Adults adjust language complexity and quality to match each child’s developmental level.
18. Adults model appropriate language, communication, play, and behavior
19. Activities are structured throughout the day to encourage children’s active participation.
20. Augmentative systems are used to foster expression and understanding of language and emotion.
21. Adults use visual and organizational supports to encourage children to participate in activities and promote smooth transitions across activities.
22. Goals, activities, and the learning environments are modified to promote initiation of communication, emotional regulation, motivation, and independence.
23. A priority is placed on the development of mutually respectful, positive parent-professional relationships.
24. Staff participates in professional development activities within the school that are designed to further develop the staff members’ knowledge and skills.
25.  Staff participates in professional development activities outside the school setting, such as attending regional or national conferences and workshops.
26.  Professionals and paraprofessionals receive specific and direct instruction and supervision as needed regarding their responsibilities to students.
28.  Sufficient staff is available to provide the support necessary to accomplish IEP goals and carry out other programmatic responsibilities.
29.  Staff are monitored, evaluated, and given feedback regarding their effectiveness with students and participation as team members.
30.  Written behavior support plans are developed and implemented.
31. Reinforcement menus are posted
32 .A specific plan is in place for facilitating social interaction between  student with autism and peers.
33. Appropriate environmental modifications have been made.
34.  Materials and activities are developmentally appropriate and functional
35. Differential reinforcement is used as appropriate (circle)  (DRO  DRA DRI  DRL)
36. Plans are in place for fading prompts and reinforcement as appropriate.
37.  Discrete trial teaching is used as appropriate
38. Visual supports are present and consistently used.
39.  A plan is in place and implemented for regular communication with the parents/family
  1.  Staff displays a variety of teaching methods that are appropriate for each child in the class.  Describe:
An action plan should be formulated and a time line developed to improve any priorities with ratings of A or B.

This program evaluation is modeled on the SAP Quality Indicator Forms from Prizant, B, Wetherby, A., Rubin, E., Laurent, A, and Rydell, P. (2006).  The SCERTS Model: A comprehensive educational approach for children with autism spectrum disorder; Volume II Program Planning and Intervention. Baltimore:  Paul H. Brookes.  This form shares both some formatting and content with the SAP forms but is  considerably less detailed and comprehensive.

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