University of Vermont



VT-PBS Targeted Team Training

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Planning Worksheets

Activity #1:

Answer the following questions:

PBS Systems:

1. What will you do to ensure continued administrator commitment to school-wide PBS?

2. Who’s missing from the team?

3. What steps can you take to make the team have a higher profile in the school?

4. How will you use data to help in your planning?

PBS Practices:

5. Who will plan your Universal roll-out efforts for next year?

6. How will roll-out happen for staff, students, and families? (expectations, lessons, acknowledgements, etc.). Use attached planning sheets, if needed.

PBS School-wide Implementation Plan

Staff PBS Roll-Out

Date:

Time:

Location:

Materials Required (check or list all that apply):

Agenda ____ Handouts ____ Other _____________________________________

Technology Supports LCD ____ TV/DVD/VIDEO _____ Screen ______ Easel ______ Chart Paper ______ Markers ______ Other _______

Presenters: __________________ ; ___________________ ; ____________________ ;

______________________ ; ________________________; ______________________

Activities (attach work sheets, if needed) Amount of Time

1. ____________

2. ____________

3. ____________

4. ____________

Evaluation/ Feedback Method (check all that apply)

Survey _____ Process Activity _____ Interview ______ Other __ Describe __________

PBS School-wide Implementation Plan

Student PBS Roll-Out

Date:

Time:

Location:

Materials Required (check or list all that apply):

Agenda ____ Handouts ____ Other _____________________________________

Technology Supports LCD ____ TV/DVD/VIDEO _____ Screen ______ Easel ______ Chart Paper ______ Markers ______ Other _______

Presenters: __________________ ; ___________________ ; ____________________ ;

______________________ ; ________________________; ______________________

Activities (attach work sheets, if needed) Amount of Time

1. ____________

2. ____________

3. ____________

4. ____________

Evaluation/ Feedback Method (check all that apply)

Survey _____ Process Activity _____ Interview ______ Other __ Describe __________

PBS School-wide Implementation Plan

Family and Community PBS Roll-Out

Date:

Time:

Location:

Materials Required (check or list all that apply):

Agenda ____ Handouts ____ Other _____________________________________

Technology Supports LCD ____ TV/DVD/VIDEO _____ Screen ______ Easel ______ Chart Paper ______ Markers ______ Other _______

Presenters: __________________ ; ___________________ ; ____________________ ;

______________________ ; ________________________; ______________________

Activities (attach work sheets, if needed) Amount of Time

1. ____________

2. ____________

3. ____________

4. ____________

Evaluation/ Feedback Method (check all that apply)

Survey _____ Process Activity _____ Interview ______ Other __ Describe __________

Activity #2

Team Roles and Norms

Facilitator:

Recorder:

Timekeeper:

Reporter:

Team Norms:

AAAAAAA# 2:AAAAA What Targeted Supports do you have?

Activity # 3 and Activity #5: Team Profile and Meeting Schedule

|Targeted Intervention Team Roster |

|School Name: Grades: |

|Town/City: Supervisory Union: |

|Targeted Team – Systems Level |

|Team Member Name Building Role Team Member Role |

|(administrator, Coordinator, teacher, etc.) |

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|Day and Time of Monthly Meetings: |

|Targeted Team – Individual Student Level |

|Team Member Name Building Role Team Member Role |

|(coor., behavior spec., data spec.) |

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|Day and Time of Weekly Meetings: |

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|Activity # 4: Targeted Team Purpose Statement |

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|Activity # 6 |

|Who will you serve? |

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|Review your ODR data to identify who might benefit. |

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|What percentage of the student population does this group represent? |

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|How many students can you serve? |

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|Activity # 7 |

|Where will Check-In/Check-Out or TCCE be located? |

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Activity # 8: Create your Coordinator’s Check-In/Check-Out Form

Sample Check-In/Check-Out Form for Coordinator: Elementary School

|Student |Check-Out |Goal |Check-in |Delivered |Signed Parent Copy |

| |% of points earned | | |Contract |of DPR |

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|Activity # 9 |

|Create DPR Forms |

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|Consider the DPR Forms on the following pages and design your own. Answer the following questions: |

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|What will the behavioral expectations be? Are they positively stated? |

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|Is the DPR teacher friendly? |

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|Is the DPR age appropriate, and does it include a range of scores? |

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|Are the data easy to summarize? |

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|Is there a place to write each student’s goals (i.e., in case some students need to start with a lower goal)? |

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|Activity # 10: Check-In/Check-Out Reward System |

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|What will the students’ daily point goal be? |

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|What reinforcers will students receive for checking in and out (e.g., praise and lottery ticket)? |

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|What reinforcers will students receive for checking out and meeting their daily point goal? |

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|How will you ensure students do not become bored with the reinforcers? |

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|Determine what resources you will need to access reinforcers |

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|Activity # 11 |

|Develop a Request for Assistance System |

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|What are the criteria for placing students on Check-In/Check-Out? Other targeted interventions? |

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|How will students be referred? |

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|What is the process for screening students who transfer into the school? |

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|What is the process for determining whether students will start the next school year on the Check-in/Check-out? |

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|Create your Request for Assistance form (see samples below). Are the forms easy to access? Easy to complete? Contain the necessary information? |

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|Create a Student Agreement or contract (see sample below). |

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|Develop a parent consent form (see sample below). |

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|Activity # 12 |

|Create a system for managing the daily data |

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|Which computer system will you use? SWIS? Excel? Other? |

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|How frequently will you Team the daily Check-In/Check-Out data? (at least bi-weekly) |

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|Who is responsible for summarizing the data and bringing it to the meetings? |

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|How frequently will summary data be shared with staff? Parents? |

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|Activity # 13: |

|Plan for fading students off the Check-In/Check-Out intervention |

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|What are the criteria for fading students off of Check-In/Check-Out? |

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|How will the program be faded, and who will be in charge of helping students fade off the Check-In/Check-Out? |

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|Plan for student graduation celebrations |

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|Activity # 14: |

|Develop and Schedule Staff Training |

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|Schedule date and time for staff training: |

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|Who will plan and deliver the training? |

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|Training should include information on: |

|•How to make a referral |

|•How to fill out the DPR |

|•Types of feedback statements to be made to students |

|•Examples and activities that model staff rating of DPR |

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|Activity # 15: |

|Develop Student Training |

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|Who will meet with the students to train them on the intervention? When will this occur? |

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|Training should include: |

|•Overview of the program |

|•How to check in and check out daily |

|•Adding up daily points |

|•Determining whether daily point goals are met |

|•Accepting feedback –both positive and negative |

|•Procedure for taking the DPR home and bringing it back the next school day |

|Activity # 16 |

|Develop Parent Training |

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|How and when will the parents be trained on the intervention? |

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|Training should include: |

|–How to provide feedback to their children |

|–How to focus on the positive |

|–What to do if there is a bad day |

|Activity # 17 |

|PBiS Targeted Plan/Process for Simple FBA |

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|Who makes the referral? |

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|What form do they use? |

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|Where or to whom does the referral form go? |

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|Who or what group reviews the referral form to see if Simple FBA needs to be done? |

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|Who schedules the Simple FBA, informs teachers and others who need to know? |

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|Who completes the Simple FBA? |

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|Who or what group develops the testable hypothesis? |

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|Who or what group develops the simple behavior support plan? |

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|What is the proposed timeline from referral, decision, interview(s), summary of Simple FBA, testable hypothesis statement and development of simple behavior |

|support plan? |

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|When and by whom is BSP reviewed to see if it is working? |

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|Who else needs to be trained to complete Simple FBA? |

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