Steps and Tools to Develop Individualized Positive Behavior Supports (PBS)

Student E.J. Date initiated- September 30, 2017

School: Middle School Grade- 8th
Members of PBS team
___________Math Teacher_____________ _____________Principal_________________________
__________________Parents___________________ _____Education Specialist_________________

Steps and Accompanying Functional Behavioral Assessment (FBA) Tools

Check box when completed
Step l: Identify and Prioritize the Problem(s); Make a Safety Plan
Step lA: Identify the Problem(s) and Decide on Priorities
Step I A Worksheet: Problem Identification and Decisions About Priorities
Team Meeting Agenda and Minutes form (use at each team meeting)
Step lB (if necessary): Make a Safety Plan
Step 1B Worksheet: Safety Plan
Incident Record
Step 2: Plan and Conduct the Functional Behavioral Assessment (FBA)
Step 2A: Gather Descriptive Information
Step 2A Worksheet: Student-Centered Functional Behavioral Assessment Profile
Student Schedule Analysis
Step 2B: Conduct Direct Observations
Interval Recording or Scatter Plot
Antecedent-Behavior-Consequence Observation
Step 2C: Summarize Functional Behavioral Assessment and Build Hypothesis Statement(s)
Step 2C Worksheet: Summary of Functional Behavioral Assessment and Hypothesis Statement(s)
Step 2D (if necessary): Verify Hypotheses
Team Meeting Agenda and Minutes with plan for verifying hypotheses
Interval Recording or Scatter Plot and/or
Antecedent-Behavior-Consequence-Observation
Revision of Step 2C Worksheet
Step 3: Design a Positive Behavior Support Plan
Step 3 Worksheet: Positive Behavior Support Plan
Step 4: Implement, Monitor, and Evaluate the PBS Plan
Step 4 Worksheet: Implementing, Monitoring, and Evaluating the PBS Plan (decisions recorded on
Team Meeting Agenda and Minutes form)
 Team Meeting Agenda and Minutes
Student/ Team: E.J. Date October 2, 2017
People present Role for Today Absentees
Ed. Specialist Present recorded data and
observation, discuss curriculum
plan.
School Psych Present strategies that have
been successful with others with
similar disabilities.
Math Teacher Present recorded data and
observation, discuss curriculum
plan.
Principal Present PBIS strategies and
collaborate on the assessment
data.
Humanities teacher Present recorded data and
observation, discuss curriculum
plan.
Purpose of meeting

The Purpose of this meeting is to discuss behavior, triggers and behavioral interventions. It will also be
to create a safety plan.

Agenda Items Decision or action to be taken Who and when?

1. Discuss behavior and 1. After discussing the 1. IEP team

analyze data. behavior, triggers, and 2. TBD
2. Discuss interventions interventions, create a
that work. safety plan to address
3. Create safety plan. non-participating
behaviors.

Agenda items for next meeting Date: Time:

-Discuss the implementation of

the items discussed from the last
meeting (what has TBD TBD
changed/improved if anything,
what needs to be
changed/improved).
 Program-at-a-Glance
Student: E.J. Date October 5, 2017
IEP Goals IEP Accommodations

1. By November 31, 2017, E.J., will be able to 1. Checklists

use of a word bank and additional practice 2. Word banks
on how to extract the meaning of math 3. Safe space
terms using context clues in a word 4. Options to work in different environments
problem, E.J. will annotate a word
problem (draw symbols, underline
important information, etc.) to help him
determine what the first step should be on
3 out of 5 problems as measured by
student work.
2. By November 31, 2017, when given
written or verbal directions, during an
independent work session in the
classroom, (e.g. please pull out your
worksheets), E.J. will use their time
appropriately and leave the classroom no
more than twice for the bathroom 3 out of
5 days of the week, as measured by
teacher observations and input on student
support form.
3. By November 25, 2017, when E.J. is given a
checklist before the start of class,he will
no more than once, be prompted by an
adult to ensure he has all his materials, E.J
will come into class prepared in order to
be present for directions on 4 out of 5
days as measured by a checklist.
 Academic/social management needs Comments/ special needs

-Safety plan: for personal space, physical and -E.J. needs to remain positive with little to no
verbal communication. reinforcement.

-Some affirmations may be needed in order to set

the student up for success.

Step lA Worksheet: Problem Identification and Decisions About Priorities

Student E.J. Date October 15, 2017
As specifically as possible, describe each problem behavior - what it looks and sounds like, how intense it
is, and how long each has been a problem. Estimate the frequency and duration of each behavior. Label
the behaviors according to their level of priority.
Description of problem behaviors Level of priority

-When E.J. is feeling frustrated, sad, mad or overwhelmed, he does

not remove himself from mathematics class. Instead, these feelings
will manifest and he will display outbursts such as yelling, knocking Destructive
over chairs, etc. for approximately 10 minutes. During these 10 Disruptive
minutes, he is outside of the classroom in the common area or SpEd Distracting
office until can return to the classroom with confidence knowing
that he is in a calm state.

- E.J. currently engages in avoidant behaviors while in Mathematics. Destructive

When directed to begin an assignment, if no prompting is given, the Disruptive
student wont complete any problems 4 out of 5 times as measured Distracting
by student work and teacher observations.
By the end of the month, when given written or verbal directions,
during an independent work session in the classroom, E.J. will use
his time appropriately and leave the classroom no more than twice
for the bathroom 3 out of 5 days of the week, as measured by
teacher observations.

Decision and rationale: Which behaviors should be priorities for intervention and why?

Behaviors one and two are priorities for intervention because they are both disruptive and
distracting. In order for the student to help create a safe place and respect all of members of
the class, a safety plan needs be created.

Is a Safety Plan needed immediately? X Yes No

Step I B Worksheet Safety Plan

Student E.J. Date October 6, 2017
Behavior(s) that call for use of the Safety Plan

When E.J. is feeling frustrated, sad, mad or overwhelmed, he does not remove himself from
mathematics class. Instead, these feelings will manifest and he will display outbursts such as
yelling, knocking over chairs, etc. for approximately 10 minutes. During these 10 minutes, he is
outside of the classroom in the common area or SpEd office until can return to the classroom
with confidence knowing that he is in a calm state.

Who will intervene in a serious behavioral episode?

Education Specialist (me), Gen. Ed Teacher, School Psychologist, Principal, District Site Coordinator, SpEd
staff.

How to intervene and support the student during phases of the crisis cycle
l. Trigger Phase: Describe sign/s the student sends that indicate feeling threat/discomfort. Describe
antecedents known to trigger problems and how to eliminate them.

-Any of E.J.s signs are when he is feeling, frustrated, sad, mad or overwhelmed.
-Some of the triggers are: Giving E.J. an independent work task and not explicitly stating what needs to
be done and how, not allowing a safe space for E.J. to feel what he wants and not allowing him to take
time when needed.

2. Escalation Phase: Tell how to interrupt, redirect , and facilitate relaxation

-During independent seat work or any work independently, redirect E.J. when he is not on task.
-Allow only one to two timed bathroom breaks a week or so.
-Provide structure and affirmation of the quality of work he is producing.

3. Crisis Phase: Describe how to interrupt and protect the student and others

-The paraeducator of Special educator will remove E.j. from the classroom if he begins an outburst and
will not comply with the set directions in his general education classroom. Touching him as little as
possible and allowing him to find his own level of comfort and safe space, wherever it may be in the
school.

4. Begin Recovery Phase: Describe how to avoid re-escalating the behavior and continue to reach full
recovery.

-Allowing E.j. to have as much time needed to cool down as well as given the option to re-enter the
classroom as long as he can verbally state the steps he needs to take in order to remain safe in the
classroom (a check-in on his emotions).

5. Recovery Phase: Describe any processing/reflecting that should be done with the student and how lo
reinstate the PBS Plan.

-Remind him of the rules for expected behavior as well as expected interaction in the class and that you
know he can be more successful in the future.

-The PBS plan may include a strategy for E.J. to reflect on his goals and better ways for him to reach
them.

Directions for reporting and documentation: Give instructions for reporting the incident and completing
and filling Incident Records

-Complete an Incident Record. This needs to be done within 24 hours with as much detail as possible. Be
objective in describing the incident, but add your own ideas about why the incident happened and what
might prevent it in the future. Anyone who witnessed the behavior should complete an Incident record.
This allows for various points of view to be collected and documented. The case manager needs to be
alerted immediately about the incident.

Step 2A Worksheet: Student-Centered Functional Behavioral Assessment (FBA) Profile

Student E.J. Date: September 28, 2017-October 16, 2017
People providing initial information Other people who should be interviewed
SpEd Teacher/ Staff Humanities Teacher
School Psych Parents
Math Teacher
Directions: At a team meeting, summarize existing information about the student's problem behavior
and begin to analyze the possible relationships among the behavior, the student's wants and needs, and
the environment
SECTION II: QUALITY OF LIFE
Ratings
Good: Indicator is in place satisfactorily.
Fair: Indicator is partially in place but improvement is needed.
Poor: Indicator is in place to on unacceptable degree or not at all.
Indicator How is indicator in place? Rating G F P
Supportive people
a. Family He has one younger brother. Mom G
makes sures that he is doing well
in school (constantly contacts
teachers and even hired a tutor)
and Dad steps in when E.J. isnt
complying with what his Mom
wants.
b. Adults at school All of his day is spent in the F
general education classroom.
Once a week he meets with an
Inclusion Specialist or Academic
Coach to check in with him to
make sure he is doing okay.
c. Peers at school E.J. tries really hard to interact F
with his peers and get their
approval but sometimes has a
hard time doing so appropriately.
d. Peers outside of school All of his peers that he speaks F
about are ones that he associates
with in school.
Successful places and In drama class where he could G
activities at school hang out with friends and
incorporate activities such as
games they play at recess during
the class period.
Successful places and E.J. has told me that he loves to go G
activities at home and in the community to the skatepark across from his
house.

Interests and preferences Loves to interact on youtube (he G

Opportunities to make choices appropriate for age
has his own channel) and also
loves to play video games.
Based on informal and formal F
data, some of the choices made
are not age appropriate, for
example his lack of awareness in
knowing what everyone in the
 room is feeling.
Based on the quality-of-life indicators, list shortcomings that might be addressed in a PBS plan.
-Appropriateness of peer interaction(s)
-providing proper structure

SECTION lIl: ACADEMICS AND COMMUNICATION

Academic strengths
Given a safe space, E.j. can communicate
his thoughts and feelings openly.
Love to read and is open to reading
different types of literature (Woodcock
Johnson I V, Passage comprehension
Average level).
When given a quiet space and clear
expectations, can complete tasks, as long
as he is reminded.
Summarize the current fit between the student's educational programming and his or her academic
strengths and liabilities
Academic liabilities
Does not know the first step in order to
complete assignments.
Does not remove himself from
uncomfortable situations.
Doesnt realize when there should be quiet
moments.
Doesnt recognize when he should have
better control of his emotions.

-E.J.s learning goals are at a lower level than his classmates, but many of the regular lessons and
activities adapted for him, for example, the amount of questions he is given is about half of the amount
as everyone else. He struggles with math and removing himself to a safe space when he is getting
frustrated, sad, or overwhelmed. E.J. has difficulty with independent seat work and with unstructured
activities.

Communication
What is the student's primary mode of communication (e.g., speech, signs, gestures, electronlc
devices) and how successful is the student in using it?
-E.J. has good expressive language abilities but what he has difficulty with is removing himself when his
emotions begin to escalate. Although, now that he has the ability to go to a safe space when needed, he
has a better understanding of his own emotions and leaves when he needs to. E.J. also has access to a
graphic organizer to know what exactly he needs in order to be successful in the classroom.

How does the student accomplish these communicative purposes?

Gets attention/help/interaction: Usually makes a joke or remains quiet and doesnt let anyone know
that he needs help.

Gets preferred activities or tangible items: If he doesnt remember his graphic organizer, will just sit in
the class until the teacher or academic coach notices.

Avoids/escapes attention/interaction: Constantly makes jokes in class when they arent asked for in the
class. Tries to look for validation in his peers be making himself the center of attention.

Avoids/escapes activity or item: E.J. will draw or walk around the class when he is refusing to do
something, or will simply leave.

Calms self when agitated. upset, angry: When E.J. goes to a safe place but lets the teacher or academic
coach know where he is going.

Gets sensory stimulation: Plays with his pencil or chews on his pencil or plays with his chair.

SECTION lV : MEDICAL, HEALTH AND SENSORY CONCERNS

Describe any health concerns or medication that may be affecting the student's mood or behavior.
E.j. has a medical diagnosis of Attention Deficit Hyperactivity Disorder and has historically been
medicated. Characteristics that are associated with this diagnosis are believed to have negatively
impacted his cognitive processing.

Describe any of the student's sensory difficulties or needs.

E.J. seems to bite his pencils or play with them, not sure if this is completely sensory related.

Other important information about the student's medical and health history

Had the possibility of being classified as E.D. but the classification and data wasnt enough to do so.

SECTION V : TARGET BEHAVIOR(S)

From the Step I Worksheet, which behavior or behaviors will be targeted for intervention? Define the
behaviors as clearly and specifically as possible. These are the definitions that will be used to collect
any additional information and to develop the PBS plan.

-When E.J. is feeling frustrated, sad, mad or overwhelmed, he does not remove himself from
mathematics class. Instead, these feelings will manifest and he will display outbursts such as
yelling, knocking over chairs, etc. for approximately 10 minutes. During these 10 minutes, he is
outside of the classroom in the common area or SpEd office until can return to the classroom
with confidence knowing that he is in a calm state.

- E.J. currently engages in avoidant behaviors while in Mathematics. When directed to begin an
assignment, if no prompting is given, the student wont complete any problems 4 out of 5 times as
measured by student work and teacher observations.
By the end of the month, when given written or verbal directions, during an independent work
session in the classroom, E.J. will use his time appropriately and leave the classroom no more
than twice for the bathroom 3 out of 5 days of the week, as measured by teacher observations.

Describe any current interventions for the behavior(s) and summarize their effects. (Or attach any
behavioral intervention plan that is currently in use.)

-No current behavior plan

-He is reminded of the classroom rules and the safe places he has available to him.
What works to prevent or interrupt the What does not work to prevent or interrupt the
behavior(s)? behavior(s)?

-Constantly checking on E.J. to make sure he
is on task as shown by assignments that have
been completed when working with the
teacher.
-Working one on one with E.J because of the
constant encouragement to complete the
work.
-Allowing E.J. to know that he can leave the
classroom to check-in with his emotions and
feelings before starting on an assignment.
-Yelling at him from across the room as shown by data
that all of his teachers have taken to show that he is
defiant in class (tally sheet).
-Asking E.J. to get back on task in front of his peers
because he constantly feels like he had to try harder to
be friends with the friends he has (student interview) so
he would rather not be called out in front of them.
-Not having a graphic organizer
-Work that doesnt have explicit and clear directions on
what he is being asked to do.

SECTION VI : PRELIMINARY HUNCHES

When these Antecedents the student is and these Therefore the Function of
(Setting Events and/or likely to (Target Consequences the behavior may be
Triggers) occur Behavior/s) tend to occur
1. Independent seat Leave the Teacher redirects Avoid doing work because
work/ unstructured classroom or not the student, he doesnt have the self-
activities in Math class complete the work meetings with awareness to know that
parents and the he needs to ask for help.
requirement for
him to take a
math elective
course instead of
a chosen one.
2. The independent working Not complete the If the work is not Receives attention from
not being clear or displays work. clear and he does his parents for not
problem solving skills. not ask clarifying completing work and
questions, the avoids work that he is
teacher does not unclear about.
consistently
provide examples
which will
therefore lead to
meetings with
parents and E.J.
needing to take
the math elective
course rather than
a chosen elective.
SECTION Vl: DECISIONS AND NEXT STEPS
1. Should any other people be interviewed to ensure that the information on this Profile is complete
and accurate? X Yes No
lf "yes" list others who should be interviewed

Parents, SpEd Teacher, Academic Coach, Mathematics teacher.

2. Does quantifiable baseline data on the targeted behaviors need to be collected? X Yes No
lf "yes" when, where, and how will data be collected?

When E.J. is in mathematics class and data should be taken to see how often he is off task, how often he
leaves the classroom and for how long, and then how often he uses his safe space card.

3. ls additional information needed to determine if the current "hunches" about the antecedents,
consequences, and purposes of the behaviors are accurate? X Yes No
lf "yes," when, where, and how will data be collected?

Data needs to be collected of his mathematics work, of his interaction in other classes, and how
confident he feels on assignments (one on one interview).
 Student Schedule Analysis
Student _________E.J.______ Staff who work with the student on a regular basis
Date _October 16, 2017___ SpEd Teacher, Academic Coach, Mathematics Teacher and School Psychologist
Target behavior(s)
-When E.J. is feeling frustrated, sad, mad or overwhelmed, he does not remove himself from the environment. Instead, these
feelings will manifest and he will display outbursts.

- Frequently leaves the classroom due to lack of interest in the mathematics being taught in the classroom. Comes and goes as
he pleases.

Time Class/ Activity Rating & Grouping Task type Staff

(Flex behavior 1 = independent Paper/pencil
day/half + = mild/rare 1:1 = one-to-one Oral/listening
day) - = sg = small group Hands-on
excessive lg = large group activity/ routine
/ often Computer
v = variable
9:05-10:00 Advisory/Drama v sg Activity/routine Drama teacher
am
10:00-10:30 Math - 1 Paper/Pencil Math Teacher
am Academic Coach
10:30-10:45 Break + lg NA Staff
am
10:50-11:20 Humanities + lg Oral/listening Humanities
am Teacher
11:20-11:50 Humanities + lg Paper/Pencil Humanities
am Teacher
11:50- Science - sg Hands-on Science Teacher
12:20pm
12:20-1:00 Lunch + lg NA Staff
pm
 Antecedent-Behavior-Consequence (A-B-C) Observation
Student: E.J. Date October 16, 2017
Setting: Mathematics Class Observer: Marissa Santellano
Class/subject or activity: Math Packets
Target behavior:
-When E.J. is feeling frustrated, sad, mad or overwhelmed, he does not remove himself from the
environment. Instead, these feelings will manifest and he will display outbursts.
- Frequently leaves the classroom due to lack of interest in the mathematics being taught in the classroom.
Comes and goes as he pleases.
Antecedents Consequences
What was going What happened
Behavior Hypothesis
on before the after the
Time What did the About the function of
behavior? What behavior?
student do? the behavior
was being said and How did people
done? react?
10:10am The students were E.J. left the The Math teacher I believe that when
all receiving classroom right went up to him at the student saw that
instruction on after instruction his seat and it was independent
what they were was given. reminded him work, he was okay to
going to be what his task was. leave the classroom.
working on and Nobody was
then they were paying attention.
sent off to work
independently.

10:20 am The student just Student sat there At the end of class, Unless someone was
came back from and stared at the the Math teacher right there by the
his bathroom worksheet and came over to student, no matter if
break and was began to fiddle check to see how the other students in
reminded to get with his pencil and much he had the class were
back on task. not get back on completed and all working, he
task. that had been remained off task.
done was the first
problem. THe
math teacher then
reminded him
about Math xblock
and that he could
finish it there.
Step 2C Worksheet: Summary of Functional Behavioral Assessment and Hypothesis Statement(s)
Directions: Summarize the FBA information that has been gathered from all sources to build hypothesis
statement(s) about targeted problem behaviors. lf the student has appropriate alternative behaviors
that serve the same purpose as the problem behavior (alternative behaviors may be nonexistent or very
weak), describe those behaviors. Then determine if any data are missing and/or team members disagree
or are uncertain about their hypotheses. Make a plan for further data collection and verification of
hypotheses if necessary.
Student Date of Initial Summary Revision Date (if necessary)
Persons completing this form
_____SpEd Teacher/Staff___ _____October 16, 2017_______ __________________

FREQUENCY: On average, HOW OFTEN does the behavior occur?

Behavior 1: When E.J. Per hour? N/A Per day? N/A Per week? Once
is feeling frustrated,
sad, mad or
overwhelmed, he does
not remove himself
from mathematics
class. Instead, these
feelings will manifest
and he will display
outbursts such as
yelling, knocking over
chairs, etc. for
approximately 10
minutes. During these
10 minutes, he is
outside of the
classroom in the
common area or SpEd
office until can return
to the classroom with
confidence knowing
that he is in a calm
state.

Behavior 2:E.J. Per hour? N/A Per day? Once Per week? 5 days a
currently engages in week.
avoidant behaviors
while in Mathematics.
When directed to
begin an assignment,
if no prompting is
given, the student
wont complete any
problems 4 out of 5
times as measured by
student work and
teacher observations.
By the end of the
month, when given
written or verbal
directions, during an
independent work
session in the
classroom, E.J. will
use his time
appropriately and
leave the classroom
no more than twice
for the bathroom 3 out
of 5 days of the week,
as measured by
teacher observations.

DURATION: On average, HOW LONG does the behavior occur?

Behavior 1: Anywhere from 10 minutes to 20 minutes.

Behavior 2: 25 minutes of the 30 minutes of Math class on a flex day.

Describe chains of antecedents (both setting events and triggers) that predict that the target behavior
will occur, observable definitions of the target behaviors, and consequences that seem to be
maintaining the behavior. Then hypothesize about the function or purpose of the target behavior(s).
When these the student is and these Therefore the Function
Antecedents likely to (Target Consequences maintain of the behavior may be
(Setting Events and/or Behavior/s) the behavior
Triggers) occur
Setting event: Math E.J. currently engages Check-ins with the Independent work in
Class in avoidant behaviors student or the student Mathematics
while in Mathematics. going off to his safe
When directed to space.
begin an assignment,
if no prompting is
given, the student
wont complete any
problems 4 out of 5
times as measured by
student work and
teacher observations.
Trigger E.J. encounters When E.J. is feeling Working with the Independence and
a problem during frustrated, sad, mad or student, check-ins or responsibility.
independent work overwhelmed, he does the student going off to
not remove himself his safe space.
from mathematics
class. Instead, these
feelings will manifest
and he will display
outbursts such as
yelling, knocking over
chairs, etc. for
approximately 10
minutes. During these
10 minutes, he is
outside of the
 classroom in the
common area or SpEd
office until can return
to the classroom with
confidence knowing
that he is in a calm
state.
2. Describe alternative behaviors the student has demonstrated that serve the same purpose as the
problem behavior (alternative behaviors may be nonexistent or very weak).

By the end of the month, when given written or verbal directions, during an independent work
session in the classroom, E.J. will use his time appropriately and leave the classroom no more
than twice for the bathroom 3 out of 5 days of the week, as measured by teacher observations.

Learn and apply self-regulation skills when the student is experiencing the feelings of frustration,
sadness, anger, or overwhelmed in math class.

3. Are additional data needed to build hypothesis statement(s)? Yes No X

ls Step 2D: Verify Hypotheses, needed to confirm or refute hypotheses? Yes No X

lf "yes," use the Team Meeting Agenda and Minutes form to plan how, when, and by whom further FBA
data collection and/or verification tests will be conducted. Decide on a date for the next team meeting,
at which this Step 2C worksheet will be revised.

Step 3 Worksheet: Positive Behavior Support Plan

Student: E.j.
Date : October 16, 2017
Team members designing this plan: SpEd Teacher/Staff, Math Teacher, School Psychologist
Target behavior(s) and functions
Behavior 1: When E.J. is feeling frustrated, sad, mad or overwhelmed, he does not remove himself from
mathematics class. Instead, these feelings will manifest and he will display outbursts such as yelling,
knocking over chairs, etc. for approximately 10 minutes. During these 10 minutes, he is outside of the
classroom in the common area or SpEd office until can return to the classroom with confidence knowing
that he is in a calm state.

Behavior 2: E.J. currently engages in avoidant behaviors while in Mathematics. When directed to begin an
assignment, if no prompting is given, the student wont complete any problems 4 out of 5 times as measured
by student work and teacher observations.
By the end of the month, when given written or verbal directions, during an independent work session in the
classroom, E.J. will use his time appropriately and leave the classroom no more than twice for the bathroom
3 out of 5 days of the week, as measured by teacher observations.

Interventions and Support Strategies to be Implemented

Preventing Teaching replacement behaviors Responding
Setting events Triggers and other alternative skills

Math Class Independent work he -Group work or pair work
doesnt understand.
-Make sure that either the
The teacher not academic coach or Math teacher
checking for keeps a close eye on the student.
understanding with the
student. -Teach E.J. to know when he
needs to speak up and ask for
help or for him to know to work
with someone in the class in order
for him to get his work done.
Respond immediately when E.J.
needs help.
Automatically have partners to
complete independent work.
Be aware when one form of work
ethic is not working and be quick
to change for the need of the
student.
Explicitly teach self-regulation
skills.

Create a progress monitoring

sheet (self-monitoring with
guidance for what to do if he is
not working when the timer goes
off).
Is Safety Plan still needed? Yes No X
If so, attach Safety Plan that has been reviewed and updated as needed
 Step 4 Worksheet: Implementing, Monitoring, and Evaluating the PBS Plan
Student Date
Directions: Use the Team Meeting Agenda and Minutes form to list issues and decisions made and
actions to be taken in order to put the PBS plan into place, monitor its use, evaluate its effects and make
needed revisions. The first set of issues listed below relates to putting the plan into place and requires
immediate consideration. The second set of issues relates to monitoring and evaluating the plan and will
require ongoing consideration of future team meetings
Issues for immediate consideration (check boxes as issues are addressed)
X Materials to be made, purchased, or adopted
-Monitoring sheet, created and monitored by case manager.
X Communicating with others who need to know about the plan-How will I do that?

-Communicating with the Math teacher and case manager to check to see how successful these new
strategies are working for the student.

X Developing and sharing teaching plans for replacement skills and other alternative academic or social-
communication skills (how will I do that?)

-Through a google doc that is shared with the Mathematics teacher to show a spreadsheet of the
positive supports that work for the student and ones that have not worked, as well as the progress being
made with the student.

X Developing a schedule for putting various intervention strategies of the plan into place

-This will be discussed at the next meeting.

X Developing the in-service training, coaching, and/or modeling needed for team members and other
staff.

-This will be further discussed at the next meeting.

X Developing a system for monitoring whether the plan is being used as designed. Are prevention,
teaching, responding, and safety management strategies being used consistently?

-A google doc spreadsheet that is shared among the case manager, school Principal, and the
Mathematics teacher.

X Developing a team meeting schedule

Issues for ongoing consideration as the plan is implemented

X How often the use and effects of the PBS plan will be evaluated and the plan revised as necessary

-Meeting every week or two weeks, in order for all educators associated with the student can be aware
of what is working and what needs to be changed.
X The rote of improvement in targeted behaviors and the use of alternative skills that are acceptable
-Use of the spreadsheet shared through the google doc

X Parents, teachers, and other relevant peoples' judgments about the plan's effectlveness, efficiency,
and appropriateness for the student and the context, as well as their comfort level in implementing the
plan

-Meetings with the parents of E.J. in order to show them the progress that the student is making in the
classroom and to address any further concerns.

X The student's feedback about the acceptability of the interventions and progress toward his or her
goals

-Checking in with E.J. in order to get his feedback on whether or not the new interventions are ones that
he feels comfortable with.