Section 8: Residential Placement Initial Referral Pre-Referral Local Education Agency (LEA) Responsibility
1. Convene an Individualized Education Program (IEP) meeting to confirm the student is eligible for special education services and determine a need for a referral for mental health evaluation. 2. Refer the student to the Desert/Mountain Children’s Center (DMCC) for a mental health evaluation to determine eligibility for residential placement. IEP attendees must include the SELPA Nonpublic School Coordinator and a DMCC representative. 3. If the student does not meet the baseline criteria for residential placement, the referral process ends. 4. If the IEP team determines that the referral is appropriate, the referral process continues. 5. Complete the Residential Placement Assessment Referral form (D/M 151). 6. Complete the Authorization for Use and/or Disclosure of Information form (D/M 63) and obtain the parent/guardian signature. Specify the receiving agency as the Desert/Mountain Children’s Center (DMCC). Referral Procedures Forward the following completed documents to the attention of the Nonpublic School Coordinator at the SELPA. • D/M 63 Authorization for Use and/or Disclosure of Information form • D/M 151 Residential Placement Assessment Referral form • IEP or IEP Addendum dated within one year referring the student for an assessment for residential eligibility • Most current complete annual or triennial IEP • Psycho-educational evaluation dated within three years from the time the student was identified as eligible for special education and related services • Any additional information in support of the referral
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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