OCDEL Expulsion/Suspension Support Request

This survey has been created to collect requests for support from parents and/or early childhood programs who are working hard to support children who are at high risk of being suspended or expelled due to behavioral or health challenges. The information collected helps the PA Key triage the best OCDEL support service that will benefit the child, family and program. Please answer as honestly as you can and know that the information provided helps us to meet the needs of all parties. This information will only be shared with staff and partners of the Office of Child Development and Early Learning for the purposes of providing linkages to the available supports to the provider and/or the child & family.

This survey is checked every Tuesday and Thursday. Your request for support will be triaged/reviewed and we will work to have you connected to available/applicable supports. It is our goal to respond to your request within 2 business days to the best of our ability.

This survey DOES NOT request mental health consultation or Early Intervention (0-5) services directly. Those programs have established referral/request for services pathways to follow.

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* 1. First and Last name of person completing this form

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* 2. Please provide your contact information

Email Address

Phone Number

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* 3. I am a parent/guardian requesting support.

Yes

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* 4. Are you a representative or business partner of OCDEL? (e.g. OCDEL, ELRC, EITA, PA Keys staff)

Yes

Not sure

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* 5. Early Learning Program Information (if unknown, please indicate)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 6. What county is your Early Learning Program in?

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* 7. Early Learning Program Type

Childcare

Pre K Counts

Early Head Start/Head Start/Migrant Head Start

Unsure

Other (please specify)

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* 8. Keystone STAR Level

STAR 1

STAR 2

STAR 3

STAR 4

Not a participant in Keystone STARs

Unsure

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* 9. Are you interested in general training or coaching around reducing Expulsion/Suspension due to behavioral or health challenges?

Yes

I would like parent resources shared with me.

Specify topics if applicable

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* 10. If you are seeking support for a child who is at risk for expulsion/suspension, what challenging behaviors are being observed? What happens right before and after the behaviors occur? How often does this occur?

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* 11. Age of child you are concerned about

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* 12. Has this child been expelled or suspended in the past?

Yes

Not sure

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* 13. Does the child you are concerned about have an Individualized Education Plan (IEP) or an Individualized Family Support Plan (IFSP)?

Yes

Unsure

Early Intervention Provider (if known):

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* 14. Please check any additional community supports the early childhood program or the child's family have accessed or are in the process of accessing.

Quality Coaching at the ELRC (Early Learning Resource Center)

Early Intervention 0-3

Early Intervention 3-5

Head Start/Early Head Start/Migrant Head Start

Home Visiting

Behavioral Health Services

Child Welfare

County Case Management

Unknown

Other (please specify)

OCDEL Expulsion/Suspension Support Request

Question Title

* 1. First and Last name of person completing this form

Question Title

* 2. Please provide your contact information

Question Title

* 3. I am a parent/guardian requesting support.

Question Title

* 4. Are you a representative or business partner of OCDEL? (e.g. OCDEL, ELRC, EITA, PA Keys staff)

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* 5. Early Learning Program Information (if unknown, please indicate)

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* 6. What county is your Early Learning Program in?

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* 7. Early Learning Program Type

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* 8. Keystone STAR Level

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* 9. Are you interested in general training or coaching around reducing Expulsion/Suspension due to behavioral or health challenges?

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* 10. If you are seeking support for a child who is at risk for expulsion/suspension, what challenging behaviors are being observed? What happens right before and after the behaviors occur? How often does this occur?

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* 11. Age of child you are concerned about

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* 12. Has this child been expelled or suspended in the past?

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* 13. Does the child you are concerned about have an Individualized Education Plan (IEP) or an Individualized Family Support Plan (IFSP)?

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* 14. Please check any additional community supports the early childhood program or the child's family have accessed or are in the process of accessing.

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* 15. Please describe how the family and early childhood program are working together to support the child who is struggling.