Step 3: PTR Plan Assessment (Fidelity)—Option 2 Date: _____ Student:______________________ Observation Self-Assessment Interventions Was the Was it Did it have the intervention step implemented desired impact PREVENT implemented? correctly and on behavior? completely? (1 = no impact; 2 = some impact; 3 = great impact) Name of intervention 1 2 3 1. Y / N / NA Y / N / NA 2. Y / N / NA Y / N / NA 3. Y / N / NA Y / N / NA TEACH Name of intervention 1 2 3 1. Y / N / NA Y / N / NA 2. Y / N / NA Y / N / NA 3. Y / N / NA Y / N / NA REINFORCE Name of intervention 1 2 3 1. Y / N / NA Y / N / NA 2. Y / N / NA Y / N / NA 3. Y / N / NA Y / N / NA Behavior Plan Assessment: Y/Y + N total STEP 4: MONITORING/FOLLOW-UP Set a date for follow-up meeting (within 3 weeks) to evaluate effectiveness of behavior intervention plan Date and time Data-Based Decision Making Points Was the intervention successful – did behavior meet criterion levels? If yes, jump to question 5 below. YES NO NO, intervention not successful: Was the plan implemented as intended? What were the YES NO fidelity scores? _______________________
Step 3: PTR Plan Assessment (Fidelity)—Option 2 Date: _____ Student:______________________ Observation Self-Assessment Interventions PREVENT Was the intervention step implemented? Was it implemented correctly and completely? Did it have the desired impact on behavior? (1 = no impact; 2 = some impact; 3 = great impact) Name of intervention 1. 2. 3. Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA 1 2 3 TEACH Name of intervention 1. 2. 3. Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA 1 2 3 REINFORCE Name of intervention 1. 2. 3. Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA 1 2 3 Behavior Plan Assessment: Y/Y + N total STEP 4: MONITORING/FOLLOW-UP Set a date for follow-up meeting (within 3 weeks) to evaluate effectiveness of behavior intervention plan Date and time Data-Based Decision Making Points Was the intervention successful – did behavior meet criterion levels? If yes, jump to question 5 below. YES NO NO, intervention not successful: Was the plan implemented as intended? What were the fidelity scores? _______________________ YES NO