Parent Implemented

Intervention (PII)

---PII Parent Data Log ---

Learner’s Name: Date/Time:
Observer(s):
Monitor your child and their use of the target skill during routines and
activities to determine if your child has made progress.

Target Behavior or Date / Routine/ Implementer EBPs Used (check)

Skill Time Activity (check) (check)
 Mealtime  Mom EBP:
 Family  Dad  Modeling
Outing  Grandma  Prompting
 Dressing  Grandpa  Visual Supports
 Bedtime  Caregiver  Other:
 Playtime  Other:
 Bath
time
 Other:
Results & Outcomes:

 Mealtime  Mom EBP:

 Family  Dad  Modeling
Outing  Grandma  Prompting
 Dressing  Grandpa  Visual Supports
 Bedtime  Caregiver  Other:
 Playtime  Other:
 Bath
time
 Other:
Results & Outcomes:

Parent Implemented Intervention National Professional Development Center on ASD 2017 1

 Parent Implemented
Intervention (PII)

Target Behavior or Date / Routine/ Implementer EBPs Used (check)

Skill Time Activity (check) (check)
 Mealtime  Mom EBP:
 Family  Dad  Modeling
Outing  Grandma  Prompting
 Dressing  Grandpa  Visual Supports
 Bedtime  Caregiver  Other:
 Playtime  Other:
 Bath
time
 Other:
Results & Outcomes:

Additional Notes:
How do you think that went?

Did you encounter any challenges implementing the EBP?

At which points did you see the EBP working?

What could you have done differently?

Do you feel comfortable implementing this EBP?

Did your child respond positively to reinforcers?

Did your child seem to enjoy the activity?

Other Notes:

For more
information, visit:
www.afirm.fpg.unc.edu

Parent Implemented Intervention National Professional Development Center on ASD 2017 2