Enclosure (1) to COMDTINST 1754.12
LEVELING OF SPECIAL NEEDS CASES:
Assign all cases a level in accordance with enclosure (2) of COMDTINST 1754.7A, Coast Guard
Special Needs Program, and enclosure (3) of this instruction. Assign a level to each case when
receiving it into each area of responsibility. Whenever reassigning a level, so note in the case
documentation. Reevaluate case levels at each staffing and review at least once a year.
THE CASE DICTATION MUST PROVIDE THE BASIS FOR THE LEVEL ASSIGNED
EACH CASE.
FINDINGS AND INTERVENTION RESULTS:
Contact with or about child and/or spouse with special needs. Give dates, places, how obtained
(phone, in person), pertinent information gained, how related to the special needs situation.
Contact with or about sibling(s) and other immediate family members. Give dates, places, how
obtained (phone, in person), pertinent information gained, how related to the special needs
situation.
Case-related contact with CO, XO, OINC, XPO, or command representative. Give dates,
places, how obtained (phone, in person), pertinent information gained.
Case-related contact with G-WPW-2 Program Managers. Give dates, places, how obtained
(phone, in person), pertinent information gained.
Collateral contacts, including other professionals, relatives, doctors, therapists, school
personnel. Give dates, how obtained (phone, in person).
Information and results of psychological or educational evaluations, Individual Educational
Plan (IEP), medical examinations, residential treatment facility placements, hospitalizations,
etc.
Any social history obtained which seems pertinent.
SERVICE PLAN
GOAL #1:
OBJECTIVES FOR ACCOMPLISHMENT OF GOAL #1:
GOAL #2:
OBJECTIVES FOR ACCOMPLISHMENT OF GOAL #2:
SIGNATURE:
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