Vermont School-Wide Positive Behavior Support

Vermont Positive Behavior Interventions & Supports (VTPBiS) School and Supervisory Union / District Steps to Readiness: Intensive Level Wraparound (To be Completed Prior to VTPBiS Intensive Level Wraparound Training) School: SU: Date:

Documents / Evidence The Supervisory Union or School District commits to: Complete? 1. Participating in a three-year process of supporting schools to implement PBIS Wraparound at the Intensive level YES NO in their (PBIS) schools.

2. Establishing a SU/District Leadership Team that will convene 3-4 times per year to discuss intensive level data YES NO with the purpose of developing, monitoring, and action planning to facilitate the education of students with complex needs. The team should have broad representation including:  SU/District level administrator,  behavior specialist/clinician,  family member, and  school principals,  mental health agency  special education administrator.  SU/District Targeted/Intensive representative, level coordinator,  regular education teacher,

YES NO 3. Identifying a designated SU/District-wide Targeted/Intensive Level Coordinator with adequate FTE allocation.

4. Supporting an online student management data system (SIMEO to be introduced) to track the progress of YES NO students in intensive level interventions.

5. Sending the SU/District Leadership Team to participate in the one day Wraparound Overview training held in YES NO May.

Documents / Schools are “ready” to engage in development of the PBIS at the Evidence Complete? intensive level once they have: YES NO 1. Maintained a SET score of at least 80/80 for two consecutive years.

2. Fully implemented all elements defined in the VTPBiS Phases of Implementation (POI) - Level 2/Targeted - Phase I YES NO  POI available at: http://www.pbisvermont.org/resources/evaluation-tools/poi

Vermont Department of Education VTPBiS Readiness Checklist for Schools Adopting Intensive Level Wraparound 1 Documents / Schools are “ready” to engage in development of the PBIS at the Evidence Complete? intensive level once they have: 3. Been recommended by their school’s VTPBiS coach as ready to pursue PBIS Wraparound training at the Intensive YES NO Level based on implementation progress of PBIS at other levels and administrative commitment to process.

4. Committed to participating in a three-year process of supporting schools to implement PBIS Wraparound at the YES NO Intensive level in their (PBIS) schools.

5. Agreed to convene a PBIS Intensive Level School Team that will support wraparound. Members should include:  School administrator,  wraparound facilitator,  regular education teacher, and YES NO  behavior specialist,  special educator,  a family member of a student.  mental health agency provider,

6. Committed to identifying a PBIS Targeted/Intensive Level School Coordinator to actively participate in PBIS, and YES NO is assigned up to 0.1 FTE (4 hours per week) responsibility per school for this work.

YES NO 7. Committed to identifying wraparound facilitators to be trained in the process.

8. Agreed to use an information system to make data-based decisions regarding student behavior receiving YES NO supports at the PBIS intensive level (e.g., SIMEO).

9. Committed to following an action plan for stabilizing the targeted level of PBIS, including a targeted/intensive team that meets once a week and a well-defined Check-In/Check-Out (or Teacher Check, Connect and Expect) YES NO intervention system. Additionally there is a clear action plan that outlines the schools’ efforts to maintain and sustain fidelity of universal practices.

YES NO 10. The PBIS Intensive Level School Team agrees to participate in the following training and technical assistance sessions: (a) One-day Overview Training, (b) PBIS Intensive Level Wraparound Training, (c) Follow up & TA.

Principal: Printed Name Signature Date

Superintendent: Printed Name Signature Date

Adapted in conjunction with the May Institute, OSEP Center for PBIS, and University of Southern Florida. (3/11 version)

Vermont Department of Education VTPBiS Readiness Checklist for Schools Adopting Intensive Level Wraparound 2