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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