Tier 3 (Individual) New Referrals Possible sources: Academic and Social Behavior data, teacher nomination, Request for Assistance form Standard procedure: Referral, family contact, functional assessment determination, Student Support Team defined, support plan developed, implementation Referral Referral Source Response Student IEP By Goal & Fidelity of Outcomes/ Grade Teacher Date & Relevant Actions Who? Initials/ID When? Timeline Implementation Updates Y/N Information & Next Steps Organization & Housekeeping Items Information for Team, or Issue for Team to Discussion/Decision/Task (if applicable) Who? By When? Address Tier 3 Case Managers/Coordinators: Tier 3 Problem Solving & Action Planning Possible fidelity, intervention/function mismatch, modifications needed, student meets criteria for fading/graduation Possible decisions: meet with teacher, change intervention, conduct FBA, fade to fewer check-in periods, exit intervention * All decisions should with the individual Student Support Team’s decision rules and recommendations. Precise Problem & Current Levels By Fidelity of Response Actions Goal & Outcomes/ Student Problems: Include Who, what, Grade Initials/ID & Next Steps Timeline Updates where, when, why, & how often Y/N Based on Student Support Team decision rules D.A.J. 4 Y Insufficient progress in D.A.J. student support M.R. 2/5 Revised Continue Update next mtg reducing disrespectful team is requesting plan in collecting behavior (e.g., harassment, district PBIS coach place by daily PAgg). identify low (Kent) to meet with 2/8 fidelity fidelity of plan DAJs team to identify scale data implementation & requested plan changes and contextual changes to provide training. procedures. Aimee Trenton
Tier 3 Problem Solving & Action Planning Possible fidelity, intervention/function mismatch, modifications needed, student meets criteria for fading/graduation Possible decisions: meet with teacher, change intervention, conduct FBA, fade to fewer check-in periods, exit intervention * All decisions should with the individual Student Support Team’s decision rules and recommendations. Tier 3 Case Managers/Coordinators: Student Initials/ID Grade Y/N Precise Problem & Current Levels Problems: Include Who, what, where, when, why, & how often Based on Student Support Team decision rules Response Actions & Next Steps By Goal & Timeline Fidelity of Outcomes/ Updates D.A.J. 4 Y Insufficient progress in reducing disrespectful behavior (e.g., harassment, PAgg). identify low fidelity of plan implementation & requested contextual changes to procedures. D.A.J. student support team is requesting district PBIS coach (Kent) to meet with DAJs team to identify plan changes and provide training. M.R. 2/5 Revised plan in place by 2/8 Continue collecting daily fidelity scale data Update next mtg Aimee Trenton Tier 3 (Individual) New Referrals Possible sources: Academic and Social Behavior data, teacher nomination, Request for Assistance form Standard procedure: Referral, family contact, functional assessment determination, Student Support Team defined, support plan developed, implementation Student Initials/ID Grade Teacher IEP Y/N Referral Date Referral Source & Relevant Information Response Actions & Next Steps Who? By When? Goal & Timeline Fidelity of Implementation Outcomes/ Updates Organization & Housekeeping Items Information for Team, or Issue for Team to Address Discussion/Decision/Task (if applicable) Who? By When?