A structured tool for NYC CPSE providers documenting evidence of skill regression during treatment interruptions when recommending extended school year services. Captures skill attainment before and after interruption using a five-point progress scale, supporting clinical examples, duration of interruption, and days required to reattain baseline. Required documentation under NYSED Commissioner’s Regulations Section 200.6(j) when a child’s recoupment period is anticipated to exceed eight weeks.
