SOCIAL, EMOTIONAL, BEHAVIORAL SKILLS CHECKLIST

NAME TEACHER DATE

If “no” please attach comments/documentation:

Social Behavioral Skills

Yes / No / Student has good eye contact with peers
Yes / No / Student is able to share and interact cooperatively with peers
Yes / No / Student is able to start conversations with peers
Yes / No / Student is able to ignore peers when he/she should
Yes / No / Student is passive with peers
Yes / No / Student is aggressive with peers

Social and General Problem-Solving Skills

Yes / No / Student understands the consequences of behavior
Yes / No / Student behavior is goal oriented
Yes / No / Student is aware when he/she is having a problem
Yes / No / Student learns from past mistakes and does not repeat them
Yes / No / Student uses appropriate strategies to solve interpersonal difficulties
Yes / No / Student uses aggressive solutions to solve disagreements with others

Ability to Cope with Anger

Yes / No / Student is aware that he/she is getting angry or frustrated
Yes / No / Student responds to anger with appropriate coping skills (uses coping skills)
Yes / No / Student keeps anger under-control (does not blow-up or have anger outbursts
Yes / No / Student can handle minor frustrations without adult assistance
Yes / No / Student is happy most days

Ability to Engage in Self-Directed Academic Behaviors

Yes / No / Student is able to organize school materials
Yes / No / Student effectively budgets his/her time
Yes / No / Student understands homework assignments (what is supposed to be done)
Yes / No / Student is usually on-task and gets work done at school
Yes / No / Student usually completes homework assignments
Yes / No / Student has good study skills/habits

Emotional Well-Being and Level of Self-Esteem

Yes / No / Student acknowledges his/her own feelings
Yes / No / Student expresses feelings in appropriate ways
Yes / No / Student is able to tell others about his/her concerns/troubles
Yes / No / Student thinks and verbalizes positive thoughts about self and others
Yes / No / Student seems to like himself/herself (can identify positive self qualities)
Yes / No / Student is able to take responsibility for achievements and mistakes

Please attach the following if applicable:

Incident reports / discipline records
Teacher reports
Parent reports and information provided by the parent
Developmental profiles
Previous behavior intervention plans
Anecdotal records

If a review indicates current concerns in the above areas, the student’s social / emotional / behavioral status is “at risk”. Documented, evidence-based intervention(s) appropriate to the student’s age and behavioral difficulties shall be conducted with fidelity for the length of time necessary to obtain sufficient data to determine their effectiveness. Interventions are required for students with a suspected emotional disturbance unless there is substantial documentation that the student is likely to injure himself/herself or others.

St. Landry Parish / September 2009