VTPBiS
UNIVERSAL TRAINING:
IMPLEMENTATION PLAN
Date: ______
School: ______
Team Members: ______
______
Working Smarter Team Matrix
Team/Committee/InitiativeRelated to School Climate / Purpose / Outcome / Target
Group / Staff
Involved / What School Action Plan Goal does it address?
Team Profile and Meeting Schedule
Universal/School-Wide Leadership Team RosterSchool Name: Grades:
Town/City: Supervisory Union:
Team Norms:
Team Member Name Building Role Team Member Role
(administrator, Coordinator, teacher, etc.)
Dates and Times of Monthly Meetings:
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
I. Common Approach/Statement of Purpose
What is your statement of purpose for your school-wide PBIS System?School-wide
Positive Behavior Interventions and Supports
Implementation Plan
II. School-wide Behavioral Expectations
What are the stated behavioral expectations in your school?1.
2.
3.
4.
5.
School-wide Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations –
School-Wide Expectations MATRIX
Rule/ Expectation / Routine/SettingSchool-wide
Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations –
Lesson Plan Template: 1
Universal Expectation: ______
Name of the Skill/Setting: ______
Purpose of the lesson/why it is important:1.
2.
Teaching examples:
1.
2.
3.
Kid activities/modeling/role-plays:
1.
2.
3.
Follow-up reinforcement Activities:
1.
2.
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations –
Lesson Plan Template: 2
SETTING:
PROCEDURES:
·
··
EXPECTATIONS:
/
/
TEACHING EXAMPLES:
POSITIVE EXAMPLES:
/NEGATIVE EXAMPLES:
1.2.
3.
4. / 5.
6.
7.
8.
STUDENT ACTIVITIES:
1.2.
3.
4.
5.
6.
AFTER THE LESSON:
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations –
Lesson Plan Template: 3
Location:
Grades: Time Required:
Objectives:Materials:
Preparation:
Procedure:
Direct Instruction
Modeling
Role-Play
Assessment:
Follow-up:
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations –
Insert Additional Lesson Plans for all settings here:
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
III. Procedures for Teaching Behavior Expectations
Schedule for Teaching Behavior Expectations
Date: / Lesson Taught: / Who’s Teaching: / Where: / Grades Involved:School-wide Positive Behavior Interventions and Supports
Implementation Plan
IV. Continuum of Procedures for Encouraging Expectations
Name of reward / Criteria for obtaining reward / Process for delivering reward(What, When, By Whom, How Often, How Many, Where)
School-wide formal recognitions
School-wide “quick” acknowledgements
Classroom reward system
Individual student reward system
Staff reward system
Sustainability: What is the procedure to inform new staff/students of the various reward systems.
Guidelines for developing your procedures for encouraging expectations:
A. Easy and quick form of acknowledgement (e.g. object, event) for all staff members to use
B. Considerate of strategies/procedures that already exist
C. Contextually appropriate name for acknowledgements
D. Back- or follow-up acknowledgements.
E. Schedule for daily, weekly, monthly, quarterly feedback to students and staff.
F. Use by all staff (e.g. office, supervisors, bus drivers).
G. Schedule for initial introduction of acknowledgements and for orientation to new faculty, staff and students.
H. Schedule for regular boosters or re-implementation of acknowledgements.
I. Included in school publications (handbooks, newsletters).
J. Instruction and practice pairing acknowledgements with positive social behaviors.
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
MINOR BEHAVIORS: / MAJOR BEHAVIORS:V. General Procedure for Dealing With Problem Behavior
T-Chart of Behavior: Defining Minors vs. Major
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
V. General Procedure for Dealing With Problem Behavior
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
V. General Procedure for Dealing With Problem Behaviors
Insert Procedural Flow Chart here.
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
VI. Procedures for record-keeping and decision making
Insert your school’s ODR form here.
Office Referral Form
Name: ______Location
Date: ______Time: ______ Playground Library
Teacher: ______ Cafeteria Bathroom
A B C
Grade: K 1 2 3 4 5 6 7 8 Hallway Arrival/Dismissal
Referring Staff: ______ Classroom Other ______
Minor Problem Behavior / Major Problem Behavior / Possible Motivation Inappropriate language
Physical contact
Defiance
Disruption
Dress Code
Property misuse
Tardy
Electronic Violation
Other ______/ Abusive language
Fighting
Physical aggression
Defiance/Disrespect
Harassment/Bullying
Dress Code
Inappropriate Display Aff.
Electronic Violation
Lying/ Cheating
Skipping class
Other ______/ Obtain peer attention
Obtain adult attention
Obtain items/activities
Avoid Peer(s)
Avoid Adult
Avoid task or activity
Don’t know
Other ______
Administrative Decision
Loss of privilege
Time in office
Conference with student
Parent Contact / Individualized instruction
In-school suspension (____hours/ days)
Out of school suspension (_____ days)
Other ______
Others involved in incident: None Peers Staff Teacher Substitute
Unknown Other
Other comments: ______
I need to talk to the students’ teacher I need to talk to the administrator
Parent Signature: ______Date: ______
All minors are filed with classroom teacher. Three minors equal a major.
All majors require administrator consequence, parent contact, and signature.
SWISTM OFFICE DISCIPLINE REFERRAL FORMStudent(s) ______Referring Staff ______Grade Level ____ Date ______Time ___
Location
Classroom
Playground
Commons/common area
Hallway/ breezeway
East West North South / Cafeteria
Bathroom/restroom
Gym
Library / Bus loading zone
Parking lot
On bus
Special event/assembly/ field trip / Other ______
Problem Behaviors (check the most intrusive)
MINOR
Inappropriate lang.
Physical contact
Defiance/disrespect/ non-compliance
Disruption
Dress Code
Technology violation
Property misuse
Tardy
Other ______/ MAJOR
Abusive lang./ inappropriate language
Fighting
Physical aggression
Defiance/disrespect/ insubordination/non-compliance
Harassment/ tease/ taunt
ability religious racial
gender sexual
Disruption
Inappropriate Display of
Affection
Technology Violation / Tardy
Skip class
Forgery/ theft
Dress code
violation
Lying/cheating
Tobacco
Alcohol/drugs
Combustibles / Off School
Location
Vandalism
Property damage
Bomb threat
Arson
Weapons
Other ______
Possible Motivation
Obtain peer attention Avoid tasks/activities Don’t know
Obtain adult attention Avoid peer(s) Other ______
Obtain items/ activities Avoid adult(s)
Others Involved
None Peers Staff Teacher Substitute Unknown Other ______
Administrative Decision
Time in office Detention Saturday School In-school suspension Days ______
Loss of privilege Parent contact Individualized instruction Out-of-school suspension Days _____
Conference with student Other ______
Comments:
Office Discipline Referral Form
Name: ______Grade: _____ Date: _____
Referring Person: ______Time: ______
Others involved: no one peers teacher staff substitute
unknown
Issue of Concern Location Possible Motivation
Major Problem Behaviors
Abusive lang Playground Attention from peer(s)
Fighting
Physical agg Cafeteria Attention from adult(s)
Harassment Hall Avoid peer(s)
Defiance/Disrespect Bathroom Avoid adult(s)
Tardy Entrance Avoid work
Dress code Classroom Obtain item(s)
Electronic violation Commons Don’t know
Disruption Other ______ Other ______
Other ______
What happened?______
______
Consequences
time out/detention loss of privilege______
conference w/ student in-school suspension days ______
parent contact out-of-school suspension days ______
other ______
Follow up Agreement
Name: ______Date: ______
1. What rule(s) did you break? (Circle)
Be Safe Be Respectful Be Responsible
2. What will you do differently next time?
Student signature: ______
Adult signature(s): ______
Procedure for Documenting Office Discipline Referrals SWIS™ Compatibility Checklist
Redesign your process, form and definitions until answers to all questions are “Yes.” When answers to all questions are “Yes”, readiness requirements 4 & 5 are complete.
School ______Date ______
SWIS Readiness Checklist:
SWIS Facilitator: School: Date:
School-wide
Positive Behavior Interventions and Supports
Implementation Plan
VI. Procedures for record-keeping and decision making
Team Initiated Problem Solving (TIPS) – Team Meeting Foundations Checklist
Completed?Checklist Item: The PBIS Team has… / Yes / No / Tasks Required for Completion / Who/ By When
1. a member assigned to serve the role of Facilitator
2. a member assigned to serve the role of Minute Taker
3. a member assigned to serve the role of Data Analyst
4. a member assigned to serve as a backup in case the Facilitator, Minute Taker, or Data Analyst is absent
5. a printed team roster that includes (a) the name of each team member; (b) each team member’s role, as applicable; (c) each team member’s email address
6. set its meeting schedule for the entire school year (date, meeting start time, meeting end time, location)
7. ensured meetings will be held in a location that guarantees access to the Internet
8. guaranteed access to a computer that allows Internet access (including access to SWIS database) for use at each meeting
9. guaranteed access to a LCD projector for use at each meeting (or some other method that ensures team members can see SWIS and other relevant data at team meeting)
10. As applicable, at least two team members who have the technical skills to…
a. connect the LCD to the computer
b. connect the computer to the SWIS database
c. produce the SWIS ODRs per day per month and the “Big 4” reports/graphs
d. produce SWIS “Custom Reports” on request
e. project the computer screen’s image for all team members to see via the LCD within 5 minutes of the start of a meeting
f. access and open the current electronic version of the Meeting Minutes and Problem-Solving Action Plan form, and complete the form during a meeting
g. email an electronic copy of the completed Meeting Minutes and Problem-Solving Action Plan form to each team member within 24 hours of the close of the meeting
PBIS Team Meeting Minutes and Problem-Solving Action Plan Form
Today’s Meeting: Date: Time: Location: Facilitator: Minute Taker: Data Analyst:
Next Meeting: Date: Time: Location: Facilitator: Minute Taker: Data Analyst:
Team Members (bold are present today):
Today’s Agenda Items Next Meeting Agenda Items / Potential Problems Raised01.
02.
03. /
03. / 01. Playground toys
02. Harassment on the playground
03. Gotcha System (assemblies, incentives)
Administrative/General Information and Issues
Information for Team, or Issue for Team to Address / Discussion/Decision/Task (if applicable) / Who? / By When? /Problem-Solving Action Plan
/ Implementation and Evaluation /Precise Problem Statement, based on review of data
(What, When, Where, Who, Why) / Solution Actions (e.g., Prevent, Teach, Prompt, Reward, Correction, Extinction, Safety) / Who? / By When? / Goal, Timeline,
Decision Rule, & Updates /
Evaluation of Team Meeting (Mark your ratings with an “X”)
Our Rating / Yes / So-So / No1. Was today’s meeting a good use of our time?
2. In general, did we do a good job of tracking whether we’re completing the tasks we agreed on at previous meetings?
3. In general, have we done a good job of actually completing the tasks we agreed on at previous meetings?
4. In general, are the completed tasks having the desired effects on student behavior?
If some of our ratings are “So-So” or “No,” what can we do to improve things?
PBIS 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 ______
PBIS School-wide Implementation Plan
Student PBIS 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 ______
PBIS School-wide Implementation Plan
Family and Community PBIS 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 ______
Notes: