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Version2.0Copyright2017:ShawneeScientific

COMPREHENSIVEASSESSMENTRECORDBOOKLET

Learner:___________________________Location:___________________________

CompletionDate:__________

SAMPLE

Learner: AssessmentType

Initial:❏Follow-Up:❏

AssessmentDate: Assessor:

1.AssessmentScoreSummaryPEAK-DTTotalScore

PEAK-GTotalScore

PEAK-ETotalScore

PEAK-TTotalScore

PEAK-LCCA-2TotalScore

ModifiedAssessment

CBITotalScoreAssessment

Observations

PotentialImpact

onTreatment

YN

2.ModuleFactorProfilePEAK-DT Factor

ScoreAgeNormScore

DeviationScore

PEAK-G FactorScore

AgeNormScore

DeviationScore

FoundationalLearningSkills

FoundationalLearning&BasicSocialSkills

PerceptualLearningSkills

BasicVerbalComp,Memory,andAdvancedSocialSkills

VerbalComprehensionSkills AdvancedVerbalComp.,Basic

ProblemSolving,andAdvancedMathSkills

VerbalReasoning,Memory,andMathSkills

VerbalReasoning,AdvancedProblemSolving,andAdvancedReadingandWritingSkills

TotalScore TotalScore

3.Pre-AssessmentRelationalProfilePEAK-E: Relation

ScoreMaxScore

PEAK-T:Expressive

RelationScore

MaxScore

PEAK-T:Receptive

RelationScore

MaxScore

Reflexivity 12 Coordination 16 Coordination 16

Symmetry 12 Comparison 16 Comparison 16

Transitivity 12 Opposition 16 Opposition 16

Equivalence 12 Distinction 16 Distinction 16

TotalScore LongForm Hierarchical 16 Hierarchical 16

MaxScore 48 ShortForm Deictic 16 Deictic 16

OverallRelationalComplexityLevel

SensoryModalityDeficits?

TotalScore

96

TotalScore

96

R S T E YesNo AgeNormDeviation:Yes❏No❏ AgeNormDeviation:Yes❏No❏

PEAKRelationalTrainingSystemLanguageandCognitionComprehensiveAssessment:LCCA-2SAMPLE

1

5.AssessmentGrowthandCBIReductionProfileScoreSummaryPEAKTotalGrowthScore Pre-AssessmentGrowthScore

PEAK-DT PEAK-G PEAK-E PEAK-T PEAKTotal E-PA T-PA PA-Total

CBIReductionScoresAssessmentObservations

ReductionScore PotentialImpactonTreatmentReductionScore Combined

ReductionScore

LCCA-2FormCompletion:Section1:AssessmentScoreSummary

• RecordtheTotalScoreforeachPEAKModuleusingthePerformanceMatriceslocatedonpages3-6.• SumtheTotalScoresfromeachmoduleandrecordthatscoreasthePEAKLCCA-2TotalScore.• Indicatetheinclusionofassessmentmodificationsbycircling“Yes”[Y]or“No”[N].• RecordCBITotalScoresusingtheCBIratingscalelocatedonp.11.

Section2:ModuleFactorProfile• RecordtheFactorTotalScoresforthePEAK-DTand-GModulesusingtheFactorScoringGridslocatedonp.9.• ObtainAgeNormScoresandcalculatetheDeviationScoreusingup-to-datenormsavailableatwww.peakaba.com.• SumtheFactorandDeviationScoresandrecordtheseastheTotalScoreforeachmodule.

Section3:Pre-AssessmentRelationalProfile• RecordtheRelationScorefromeachcomponentofthePEAK-E-PAusingtheRecordFormlocatedonp.7.• SumtheRelationscorestorecordtheTotalScore,andindicatewhichformoftheassessmentwasconducted[Long/Short].• Mark[Yes]or[No]ifscoresonitemsrelatedtoanyoneormoresensemodality(e.g.taste)arelow.• RecordtheRelationScorefromeachcomponentofboththesubtestsofthePEAK-T-PAusingtheRecordFormlocatedonp.8.• SumtheRelationScoresofeachoftheindividualrelationsfortheReceptiveandExpressivetestsandrecordasTotalScore.• Obtainup-to-datenormsfromwww.peakaba.comandindicateanydeviationsbymarking[Yes]or[No].

Section4:ModuleRelationalProfile• RecordtheRelationTotalScoresforthePEAK-Eand–TModulesusingtheRelationScoringGridslocatedonp.10.• ObtainDeviationScoresbysubtractingeachRelationScorefromthecorrespondingMaxScore.• RecordtheTotalScorebysummingtheindividualRelationandDeviationScores.

Section5:AssessmentGrowthandCBIReductionProfileSummary• RecordtheGrowthScoresforeachPEAKassessmentandthecombinedPEAKandPEAK-PAGrowthScoresascalculatedontheAssessment

GrowthProfileandCBIReductionScoreslocatedonp.11.• GrowthandReductionscoresarenotcalculatedforInitialAssessments,butwillbecomputedforeachsubsequentFollow-Upassessment.

Foradditionalinformation,referencetheindividualPEAKModulesand/orvisitwww.peakaba.com.

4.ModuleRelationalProfilePEAK-E Relation

ScoreMaxScore

DeviationScore

PEAK-T RelationScore

MaxScore

DeviationScore

Reflexivity

9

Level1:Non-Arbitrary

36

Symmetry

62

Level2:Cultural

71

Transitivity

14

Level3:Arbitrary

37

Equivalence

97

Level4:ComplexTransformation

38

TotalScore 184 TotalScore 184 SAMPLE

2

AssessmentInformation:

Learner:

Instructor(s):

Location(s):

AssessmentDates/Score:

Date:

Score:

PEAKRelationalTrainingSystemDirectTrainingModulePerformanceMatrixSAMPLE

3


Learner:

Instructor(s):

Location(s):


Date:

Score:

PEAKRelationalTrainingSystemGeneralizationModulePerformanceMatrixSAMPLE

4


Learner:

Instructor(s):

Location(s):


Date:

Score:

PEAKRelationalTrainingSystemEquivalenceModulePerformanceMatrixSAMPLE

5


Learner:

Instructor(s):

Location(s):


Date:

Score:

PEAKRelationalTrainingSystemTransformationModulePerformanceMatrixSAMPLE

6

Score RelationalScoreProfile12 11 10 9 8 7 6 5 4 3 2 1 0 Reflexivity Symmetry Transitivity Equivalence

Learner:__________________________________________________ Date:_________________________________

Instructor(s):____________________________________________ Location:____________________________

Pre-AssessmentVersion:LongShort

Weremodificationsmadeforanytestitems?YesNo

TypeofRelation

SkillDifficulty Long-FormScore(x1.0)

Short-FormScore(x2.0)

TotalScoreBasic Intermediate Advanced

Reflexivity 1 012 012 012 2 012 012 012

Symmetry 1 012 012 012 2 012 012 012

Transitivity 1 012 012 012 2 012 012 012

Equivalence1 012 012 012 2 012 012 012

TotalScore: Max48

PEAKRelationalTrainingSystemEquivalenceTrainingModulePre-AssessmentRecordFormSAMPLE

7

PEAKRelationalTrainingSystemTransformationTrainingModulePre-AssessmentRecordForm

Learner:_______________________________________________ Date:__________________________________Instructor(s):__________________________________________ Location:_____________________________

Sub-TestsCompleted:ExpressiveReceptive

Weremodificationsmadeforanytestitems?YesNo

RelationalFrame ExpressiveSubtestScore

ReceptiveSubtestScore CombinedScore Maximum

ScoreCoordination 32Comparison 32Opposition 32Distinction 32Hierarchical 32Deictic 32

TotalScore: 192

Score RelationalScoreProfile31-32 • • • • • •29-30 • • • • • •27-28 • • • • • •25-26 • • • • • •23-24 • • • • • •21-22 • • • • • •19-20 • • • • • •17-18 • • • • • •15-16 • • • • • •13-14 • • • • • •11-12 • • • • • •9-10 • • • • • •7-8 • • • • • •5-6 • • • • • •3-4 • • • • • •1-2 • • • • • •0 • • • • • •

Frame COR COM OPP DIS HIR DTC

SAMPLE

8

Instructions:Circleeachskillwithintherepertoireoftheindividual.SumallcircleditemstoobtainindividualFactorscores.

DirectTrainingModule GeneralizationModule

FoundationalLearningSkills

PerceptualLearningSkills

VerbalComprehensionSkills

VerbalReasoning,Memory,&MathSkills

FoundationalLearningandBasicSocial

Skills

BasicVerbalComprehension,

Memory,&AdvancedSocialSkills

AdvancedVerbalComprehension,BasicProblem

Solving,&AdvancedMathSkills

VerbalReasoning,AdvancedProblemSolving,&AdvancedReading&Writing

Skills

1A1B2A2B3A3B3C3D4A4B4C4D4E4F5A5B5C5D5E5F5G5H6A6B6F6G6H6I6J7A7B7C7E7F

7D7G8A8B8C8D8E8F8I8J8K8L8M8N9A9B9C9E9F9G9K9L

6C6D6E7H7I7J7K7L8G8H9D9H9I9J9M9N9O9P10A10B10C10D10E10F10G10H10I10J10K10L10M10N10O10P10Q10R

11A11B11C11E11F11G11H11I11J11K11L11N11P11Q11R11S11T12A12B12C12D12E12F12G12H12I12J12K12L12M12N12O12P12Q12R12S

12T12U12V13A13B13C13D13E13F13G13H13I13J13K13L13M13N13O13P13Q13R13S13T13U13V13W13X14G

11D11M11O14A14B14C14D14E14F14H14I14J14K14L14M14N14O14P14Q14R14S14T14U14V14W14X14Y14Z

1A2B3D4A4B4E5A5B5E6A6C6E7C7G7H7L10D10L11A11D11G11J11O11R11T12E12U13H13J13K14A14E14I

1B2A3A3B3C4C4F5D5F5G6B6F6G6I7A7F7I7K8A8F8M9B9C9D9G9H9I9K9O10C10F10H10M

10P10R11B11H11I11K11L11M11N11Q11S12D12F12H12J12K12L13I13P13T13W13X14B14F14K14Z

6H7D7E7J8B8C8D8E8G8H8J8K8N9A9E9F9J9L9M9N9P10E10G10I10J10N10O10Q11C11E11F11P12A

12B12C12G12I12P12Q12R12V13A13B13F13L13R13S13U13V14C14D14G14H14J14O14P14R14S14T14U14V14W14X

4D5C5H6D6J7B8I8L10A10B10K12M12N12O12S12T13C13D13E13G13M13N13O13Q14L14M14N14Q14Y

Factor1Total:___(max34)








PEAKRelationalTrainingSystemDirectTrainingandGeneralizationAssessmentFactorScoringGridsSAMPLE

9

Instructions:Circleeachskillwithintherepertoireoftheindividual.Sumallcircleditemstoobtainindividualfactorscores.

EquivalenceModule TransformationModuleReflexivity Symmetry Transitivity Equivalence Level1 Level2 Level3 Level41A1B2A2B3A3B3C3D4A

4B4C4D4E4F5A5B5C5D5E5F5G5H6A6B6C6D6E6F6G6H6I6J7A7B7C7D7E7F7G7H7I

7J7K7L8A8B8C8D8E8F8G8H8I8J8K8L8M8N9A9B9C9D9E9F9G9H9I9J9K9L9M

9N9O9P10A10B10C10D10E10F10G10H10I10J10K

10L10M10N10O10P10Q10R11A11B11C11D11E11F11G11H11J11K11L11M11N11O11P11Q11R11S11T12A12B12C12D12E12F

12G12H12I12J12K12L12M12N12O12P12Q12R12S12T12U12V13A13B13C13D13E13F13G13H13I13J13K13L13M13N13O13P

13Q13R13S13T13U13V13W13X14A14B14C14D14E14F14G14H14I14J14K14L14M14N14O14P14Q14R14S14T14U14V14W14Y14Z

1A1B2A2B3A3B3C3D4A4B4C4D4E4F5A5B5C5D5E5F5G5H6A6B6C6D6E6F6G6H6I6J

7A7B7C7D

7E7F7G7H7I7J7K7L8A8B8C8D8E8F8G8H8I8J8K8L8M8N9A9B9C9D9E9F9G9H9I9J

9K9L9M9N9O9P10A10B10C10D10E10F10G10H10I10J10K10L10M10N10O10P10Q10R11A11B11C11D11E11F11G11H

11J11K11L11M11N11O11P

11Q11R11S11T12A12B12C12D12E12F12G12H12I12J12K12L12M12N12O12P12Q12R12S12T12U12V13A13B13C13D13E13F

13G13H13I13J13K

13L13M13N13O13P13Q13R13S13T13U13V13W13X14A14B14C14D14E14F14G14H14I14J14K14L14M14N14O14P14Q14R14S

14T14U14V14W14Y14Z

Relation

Total:___(max9)

Relation

Total:___(max62)

RelationTotal:___(max14)




Relation

Total:___(max37)

Relation

Total:___(max38)

PEAKRelationalTrainingSystemEquivalenceandTransformationAssessmentRelationScoringGridsSAMPLE

10

PEAKRelationalTrainingSystemAssessmentGrowthandChallengingBehaviorReductionProfiles

Learner: CurrentAssessmentDate: PriorAssessmentDate: Location: Location: Assessor: Assessor: *Note:IfInitialAssessment,placean“X”inthePriorScore.CalculateGrowth/ReductionscoresuponFollowUp.

AssessmentScoresGrowthProfile

PEAK-DTTotalScore PEAK-ETotalScore

PEAK-E-PATotalScore

CurrentScore

PriorScore

GrowthScore

CurrentScore

PriorScore

GrowthScore

CurrentScore

PriorScore

GrowthScore

- = - = - =

PEAK-GTotalScore PEAK-TTotalScore PEAK-T-PATotalScore

CurrentScore

PriorScore

GrowthScore

CurrentScore

PriorScore

GrowthScore

CurrentScore

PriorScore

GrowthScore

- = - =

- =

PEAKModuleTotalGrowthScore PEAKPre-AssessmentTotalGrowthScore

SumPEAKDT,G,E,TTotalGrowthScores. TotalGrowthScore:

SumPEAKE-PAandT-PATotalGrowthScores. TotalGrowthScore:

ChallengingBehaviorIndex(CBI)

Instructions:Responsestothesequestionsshouldbeprovidedforobservationsmadeduringtheassessmentaswellasclinicalinterpretationsforpossiblelimitationsduringtreatmentusingtheratingscale

provided.

Assessment

Observations

PotentialImpact

onTreatment

0=Never-5=Always 0=None-5=High

1.Challengingbehaviorimpactsperformanceonassessment/instructionaltasks. 0 1 2 3 4 5 0 1 2 3 4 5

2.Challengingbehaviorinvolvesanindifferencetopotentialreinforcersfortaskcompletion/performance. 0 1 2 3 4 5 0 1 2 3 4 5

3.Challengingbehaviorinvolvesattemptsatescapingfromassessment/instructionaltasks. 0 1 2 3 4 5 0 1 2 3 4 5

4.Challengingbehaviorinvolvesattemptstoobtainpositiveornegativeattentionfromothers. 0 1 2 3 4 5 0 1 2 3 4 5

5.Challengingbehaviorappearstohavenoenvironmentalcauses. 0 1 2 3 4 5 0 1 2 3 4 5

6.Challengingbehaviorinvolvesattemptstoaccessrestrictedtangibles. 0 1 2 3 4 5 0 1 2 3 4 5

7.Abiastowardsstimuli(e.g.position,color)mayimpactresponseaccuracywhencompletingtasks. 0 1 2 3 4 5 0 1 2 3 4 5

8.Limitationsincludescanningastimulusarray,sustainedattention,and/orremainingintheenvironment. 0 1 2 3 4 5 0 1 2 3 4 5

9.Thelearnershowsnointerestinwhetherresponsesthatareemittedarecorrectorincorrect. 0 1 2 3 4 5 0 1 2 3 4 5

10.Repeatedpromptsdonotappeartohaveaneffectonsubsequentperformance. 0 1 2 3 4 5 0 1 2 3 4 5

CurrentTotalScore:

CBIReductionProfile

CBI-AssessmentObservations CBI-PotentialImpactonTreatment

CBITotalScore

PriorScore

CurrentScore

ReductionScore

PriorScore

CurrentScore

ReductionScore

PriorScore

CurrentScore

ReductionScore

- = - = - =

SAMPLE

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