School Consultation Note (IEP/504 or Behavioral Support)

Student Name: [Student full name]

Date of Birth: [MM/DD/YYYY]

Grade: [Current grade level]

School/Site: [School name and campus/site]

Teacher/Case Manager: [Name and role]

Author Name, Credentials, Title, Organization: [Author full name, credentials, professional title, organization]

Note Date: [MM/DD/YYYY]

Encounter Date(s): [MM/DD/YYYY or date range]

Location(s) of Observation/Consultation: [Classroom / therapy space / playground / cafeteria / meeting room / virtual platform]

Consult Type: [IEP consultation / 504 consultation / behavioral support / observation / meeting attendance / record review] (Select all that apply)

Referral Source: [Name and role of referring party]

Referral Question(s): [Plain-language summary of questions the team seeks to answer]

Distribution: [Names and roles of intended recipients] (List only parties authorized to receive this note)

Consent and Scope

Consent Status: [Parent/guardian consent obtained / pending / verbal consent documented] (Include date obtained and any limits on sharing)

Information Sharing Parameters: [Categories permitted to share and any limitations]

Scope of Consultation: This consultation focuses on educational access and functional skills in the school context. This is not a comprehensive psychoeducational evaluation.

Sources of Information

• Direct Observations:
  • [Date | Setting | Activity | Duration]
• Interviews/Consultations:
  • [Person (role) | Date | Key topics discussed]
• Records Reviewed:
  • [Document type and date]
• Requested but Unavailable: [Key documents not available for review] (Omit if all requested documents were available)

Presenting Concerns and Educational Context

Referral Question: [Restated referral question in plain language]

Educational Setting: [General education / special education; placement details; relevant schedule features]

Existing Supports/Plans: [IEP/504 status, current accommodations, services, BIP summary if applicable]

Known Triggers/Challenging Contexts: [Task demands, environmental or interpersonal triggers]

Student Strengths and Interests: [Assets that can support intervention; include drama/arts-related interests when relevant]

Observation Narrative

(Include this section only if direct observation occurred; omit entirely if no observation)

Observation Conditions: [Setting, activity demands, group size, duration, adults present, sensory environment]

Behavioral Narrative: [Chronological description of observable behaviors and verbalizations using objective language; include frequency, duration, intensity when available; avoid interpretive labels]

Antecedent–Behavior–Consequence Patterns: [Notable ABC sequences observed] (Include when behavioral support is the focus)

Student Voice: [Brief direct quotes capturing self-advocacy or meaning-making] (Use sparingly; omit if none relevant)

Comparative Summary: [What remained consistent versus what varied by context] (Include only if multiple observations occurred)

Functional Impact in School

(Include only domains relevant to this student; for each domain note the impact, context, and data source)

• Access to Instruction: [Impact on initiation, persistence, help-seeking] (Context: [where/when]; Source: [observed / reported by role])
• Transitions and Routines: [Impact statement] (Context: [arrival, class changes, task shifts]; Source: [observed / reported])
• Peer Participation and Social Interaction: [Impact statement] (Context: [group work, unstructured times]; Source: [observed / reported])
• Communication: [Expressive, pragmatic, or nonverbal impact] (Context: [class discussions, requests]; Source: [observed / reported])
• Self-Regulation and Coping: [Impact statement] (Context: [frustration, sensory load, transitions]; Source: [observed / reported])
• Sensory Needs: [Impact statement] (Context: [noise, movement, lighting, touch]; Source: [observed / reported])
• Attendance and Engagement: [Impact statement] (Source: [observed / reported])
• Safety Concerns: [Impact statement relevant to school safety planning] (Source: [observed / reported])

Clinical Formulation

Working Hypotheses: [Hypotheses about skill deficits and possible functions of behaviors such as escape/avoid, obtain attention/access, sensory regulation, or communication of overwhelm] (Base on observed data; avoid diagnostic conclusions)

Contextual Contributors: [Environmental, task-related, and interactional factors that may influence performance]

Protective Factors: [Strengths, successful contexts, response to structure or cues]

Data Needed to Clarify: [What additional data would confirm or disconfirm hypotheses]

Recommendations

(For each recommendation, specify target need, strategy, implementer, setting, and measurement method)

Predictability and Transition Supports:

• [Target need] — [Strategy/tool] (Implementer: [role]; Setting: [where]; Measurement: [method])

Participation Supports:

• [Target need] — [Scaffold, role assignment, cueing strategy] (Implementer: [role]; Setting: [where]; Measurement: [method])

Regulation and Sensory Supports:

• [Target need] — [Movement/sensory strategy, break plan, co-regulation approach] (Implementer: [role]; Setting: [where]; Measurement: [method])

Communication Supports:

• [Target need] — [Sentence stems, visuals, role-play practice, communication aid] (Implementer: [role]; Setting: [where]; Measurement: [method])

Function-Based Behavior Strategies:

• [Function of behavior] — Replacement skill: [skill]; De-escalation approach: [steps] (Implementer: [role]; Measurement: [method])

Staff Guidance:

• What helps: [Specific approaches]
• What escalates: [Approaches to avoid]
• Consistent response approach: [Common language, sequence, and roles]

Family–School Coordination:

• [Communication plan and frequency; shared strategies] (Owners: [roles])

Safety Escalation Pathway: [Who to notify, immediate response steps] (Include only if safety concerns exist)

Drama Therapy Alignment

Rationale: [How drama therapy approaches address identified functional skills, such as self-regulation via embodied role practice, social communication via structured interaction, perspective-taking via role work, or executive functioning via rehearsal and sequencing]

Alignment with IEP Goals/504 Supports: [Map drama therapy objectives to existing goals or accommodations] (If proposing new services, label as proposed alignment for team consideration)

Service Delivery: [Individual / group]; [Push-in / pull-out]; Setting: [location]; Frequency: [sessions per week and duration]

Progress Monitoring Plan: [What will be measured and method: teacher tallies, therapist rubric, student self-rating, frequency counts]; Review interval: [timeframe]

Measurable Objectives:

• Given [specific context], the student will [specific observable behavior] with [level of support] in [number] of [opportunities/sessions], measured by [method].

Team Coordination and Follow-up

• Meetings/Contacts: [Dates, attendees/roles, key decisions]
• Roles and Responsibilities: [Who will implement which recommendations]
• Follow-up Plan: [Timeframe for effectiveness review, typically 4–6 weeks]; Triggers for earlier review: [safety incidents, significant escalation, lack of response]
• Planned Outreach: [Who will be contacted, purpose, and timeline] (Include if coordination is pending)

Risk and Safeguarding

(Include this section only when safety concerns are present)

• Observed/Reported Concern: [Brief, objective description relevant to school safety]
• Immediate Actions Taken: [Steps taken and by whom; notifications made]
• Current Disposition: [Safety plans, referrals, monitoring steps in place]

Summary and Priority Actions

Summary: [Key findings and impact on educational access/functioning in 1–2 sentences]

Priority Supports:

• [Priority action, owner, start date]
• [Priority action, owner, start date]
• [Priority action, owner, start date]

Data to Collect: [Specific metrics, frequency, and responsible party for evaluating effectiveness]

Signature

[Author name], [Credentials], [Title], [License number if applicable], [Organization]

Date Signed: [MM/DD/YYYY]