User Guide – Pre EYE-DA Individual Child Action Plan Template
This resource is meant to be used once your Pre EYE-DA child reports have been generated. It can be completed by you (the child’s educator) or during a collaborative meeting with your multidisciplinary team.
Modify or adjust this resource to reflect the supports that are available to you. Note that the cells are fillable and expandable when used electronically.
See the attached sample of a completed action plan.
Child Action Plan User Guide and Sample (pre-assessment)
Child Action Plan Template (pre-assessment)
Page 1 – Information and Results - This is where you will record the information you currently have for the child:
- Fill in the date and the child’s name, age, and group/educator information.
- In the table, record the child’s domain results.
- Below each result, add any notes pertaining to that domain.
- In the box at the bottom of the page, include information about the child that was not captured in the Pre EYE-DA assessment: results from other assessments, interests, information on homelife, etc.
Page 2 – Responding to Results - This is where you will outline your plan moving forward to help the child during the year:
- If applicable, review and discuss the information from Page 1 with your multidisciplinary team.
- Brainstorm action items and strategies that you feel will help strengthen the domains that are areas of concern for this child. Consider additional supports that might be available and the participation of families as you and your team develop your plan. Enter those in the ‘Action Items / Strategies’ column.
- Add information about timing / frequency / duration in the next column.
- Add any extra information or comments you might have in the ‘Notes’ column.
- Throughout the year, check off items in the ‘Complete’ column and adjust your strategies as required.
This resource along with the Post-Assessment results and accompanying template, can be used at the end of the school year to help you evaluate the effectiveness of your strategies: what worked well for this child as well as what did not work well. This is valuable information to share with the child’s next teacher.
