VTPBiS

UNIVERSAL TRAINING:

Workbook

Date: ______

School: ______

Team Members: ______

______

Working Smarter Team Matrix

Team/Committee/Initiative
Related 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 Roster
School Name: Grades:
Town/City: Supervisory Union:
Team Norms:
Team Member Name Building Role Team Member Role
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/Setting

School-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:

STUDENT ACTIVITIES:

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:

  1. Easy and quick form of acknowledgement (e.g. object, event) for all staff members to use
  2. Considerate of strategies/procedures that already exist
  3. Contextually appropriate name for acknowledgements
  4. Back- or follow-up acknowledgements.
  5. Schedule for daily, weekly, monthly, quarterly feedback to students and staff.
  6. Use by all staff (e.g. office, supervisors, bus drivers).
  7. Schedule for initial introduction of acknowledgements and for orientation to new faculty, staff and students.
  8. Schedule for regular boosters or re-implementation of acknowledgements.
  9. Included in school publications (handbooks, newsletters).
  10. 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 FORM
Student(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 LocationPossible 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 SafeBe RespectfulBe 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…
  1. connect the LCD to the computer

  1. connect the computer to the SWIS database

  1. produce the SWIS ODRs per day per month and the “Big 4” reports/graphs

  1. produce SWIS “Custom Reports” on request

  1. project the computer screen’s image for all team members to see via the LCD within 5 minutes of the start of a meeting

  1. access and open the current electronic version of the Meeting Minutes and Problem-Solving Action Plan form, and complete the form during a meeting

  1. 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 Raised
01.
02.
03. / 01.
02.
03. / 01.Playground toys
02.Harassment on the playground
03.Gotcha System (assemblies, incentives)
04.
05.

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 / No
1. 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-wideImplementation Plan

Staff 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

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: