Statewide Autism Resources and Training (START)

EBP Implementation Checklist

Check when completed / Step / Information/Actions
Identify 1 building where you will implement the EBP project. / Name of District and Building:
Obtain administrator support. / Name of Administrator:
Identify a team and team leader for the project.
*See Team form / Name of Team Leader:
Other Team Members:
Identify 2 target students with ASD, preferably with different profiles of strengths and needs. If possible, choose two different teachers.
*See Student Summary form / Student #1:
Grade:
Teacher(s):
Student #2:
Grade:
Teacher(s):
Obtain written permission for target student participation from parents/guardians. / Student #1
Sent: / Received:
Student #2
Sent: / Received:
Identify 3 IEP goals for each target student with each from a different domain (e.g., 1 social, 1 academic, 1 independence). / Student #1
Goal 1:
Goal 2:
Goal 3:
Student #2
Goal 1:
Goal 2:
Goal 3:
Review target student IEP goals and ensure they are observable and measurable.
Note: If goals are not observable & measurable, modify them on the GAS chart. / Student #1
Goal 1 Goal 2 Goal 3
Student #2
Goal 1 Goal 2 Goal 3
Complete GAS on each IEP goal.
*See GAS form / Student #1
IEP Goal 1 with GAS
IEP Goal 2 with GAS
IEP Goal 3 with GAS
Student #2
IEP Goal 1 with GAS
IEP Goal 2 with GAS
IEP Goal 3 with GAS
Review EBP modules from NPDC website.
  • Antecedent-Based Interventions (ABI)
  • Computer-Aided Instruction
  • Differential Reinforcement
  • Discrete Trial Training
  • Extinction
  • Functional Behavior Assessment
  • Functional Communication Training
  • Naturalistic Intervention
  • Parent-Implemented Intervention
  • Peer-Mediated Instruction & Intervention
  • Picture Exchange Communication System (PECS)
  • Pivotal Response Training
  • Prompting
  • Reinforcement
  • Response Interruption/Redirection
  • Self-Management
  • Social Narratives
  • Social Skills Groups
  • Speech Generating Devices /VOCA
  • Structured Work Systems
  • Task Analysis
  • Time Delay
  • Video Modeling
  • Visual Supports
/ Assign modules to staff to review and report:
Note: Maybe added to Team form.
Select4 EBPs that your team will implement with your 2 target students (at least 2 EBPs per student). / EBP 1:
EBP 2:
EBP 3:
EBP 4:
Establish a system for regular data collection and data review to monitor progress toward goals. Include regular updates of progress toward GAS goals.
*See GAS Monitoring form

START EBP Implementation Project

Sample Calendar for the School Year

Prior to Fall / August / September
Identify a project building
Identify 2target students and get parent permission
Review IEP goals
Review EBPs
Complete online class / Training/planning for 1day
GAS
Review student IEP goals
Use GAS to expand goals
Match EBPs to student goals
Create EBP plan for target students / Monthly EBP team meeting
Finalize GAS goals
Collect baseline data
Complete USAPT and enter online
October / November / December
Monthly EBP team meeting
Complete classroom assessment
Review data/GAS / Monthly EBP team meeting
Review data/GAS / Monthly EBP team meeting
Review data/GAS
January / February / March
Monthly EBP team meeting
Review data/GAS / Monthly EBP team meeting
Review data/GAS / Monthly EBP team meeting
Review data/GAS
April / May / June
Monthly EBP team meeting
Review data/GAS / Monthly EBP team meeting
Complete USAPT and classroom assessment
Review data/GAS / Discuss plans for next year
Review end of the year data

START / EBP Implementation Project

Team Information

Site Team Leader / Contact Information:
Email / Phone / Professional Role
(e.g. EBP focus, team role) / Roles & Responsibilities
(e.g. EBP focus, team role)
Team Member / Contact Information:
Email / Phone / Professional Role
(e.g. teacher consultant) / Roles & Responsibilities
(e.g. EBP focus, team role)

SITE LOCATION:

Student Summary Form

Student name:Grade:

Building:Primary teacher:

Circle one: Highly verbalModerately verbalMinimally verbal EcholalicNon-verbal

What are the student’s primary behavior challenges?

Does the student exhibit self-injury? Y N

Does the student exhibit aggression? Y N

What is the student’s primary communication system(s)?

What is the student’s primary academic output?

How much time is the student spending in general education (in what subjects/activities)?

Time / Subjects/Activities:

How much time is the student spending in special education?

What are the student’s interests and talents?

Does the student have peersupports involved on a regular basis?

What is the family’s involvement?

GOAL ATTAINMENT SCALE FORM

Building Team:Date:

Student:DOB:

Level Of
Attainment / Goal 1: / Goal 2: / Goal 3:
-2
Much less
than expected
(Present Level)
-1
Somewhat less
than expected
(Progress)
0
Expected level of outcome
(Annual Goal)
+1
Somewhat more
than expected
(Exceeds annual goal)
+2
Much more
than expected
(Far exceeds annual goal)
EBP: / EBP: / EBP:

GAS Goal Update

Student & Goal / GASGoals
Date / GASGoals
Date / GAS Goals
Date / GAS Goals
Date / GAS Goals
Date / GAS Goals
Date / GAS Goals
Date
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3

Team: ______Date: ______

WHO / Will do WHAT / by WHEN