School Counselors Involvement With a School-Wide Positive Behavior Support Intervention:

Addressing Student Behavior Issues in a Proactive and Positive Manner

For schools using School-Wide Positive Behavior Supports, the school counselor is an essential member of the implementation team. Moreover, the prevention model corresponds with the school counselor standards and the ASCA National Model. This article shows how a school counselor teams with school staff in a K-3 elementary school of 600 pupils to implement and manage a School-Wide Positive Behavior Support targeted intervention called Check-in/Check-out (CICO). The authors review current research relevant to CICO and provide sample student data, daily behavior report cards, referral forms, and home reports. The article gives suggestions on using CICO to support students with mental health concerns including using data to collaborate with other community professionals.

tudent misbehavior adversely affects instruction, the learning environment, and the overall school climate for all learners within the school. Behavior issues interrupt and displace classroom instruction when teachers are forced to redirect and consequence the misbehaving student. Furthermore, behaviors that require an ofce referral cost offending students additional instruction time while they wait in the ofce. Then, if the resulting consequence includes suspension, the student loses even more instruction time, potentially an entire day. In order to maximize instruction time and build a more positive school culture, schools need an action plan. School-Wide Positive Behavior Support is a three-tiered systems approach that proactively addresses behavior concerns by teaching behavioral expectations and includes strategic support for students with more severe behavior issues (Todd, Campbell, Meyer, & Horner, 2008). It is the behavioral component of Response to Intervention (RTI), a process used to quickly identify and address student behavior and academic concerns (Gruman & Hoelzen, 2011). The effectiveness of School-Wide Positive Behavior Supports is well documented in literature and implementation is widespread (Sugai & Simonsen, 2012); current statistics show that more than 18,000 schools are using this prevention model (www.pbis.org). The three tiers, (a) universal, (b) targeted, and (c) intensive, are implemented successively. Tier one contains ve main components: dened school-wide behavior expectations, a process for teaching and re-teaching those expectations, an acknowledgement system, a process for preventing and addressing problem behaviors, and a system for collecting and analyzing data (www.pbis.org).

Katie Martens is a school counselor at Jefferson Elementary School in New Ulm, MN. E-mail: kmartens@newulm.k12.mn.us Kelsey Andreen is a school counselor at Urban Middle School in Sheboygan, WI.
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When implemented with delity, 8085% of students respond positively to the universal tier (Gruman & Hoelzen, 2011; McIntosh, Campbell, Carter, & Dickey, 2009). The second tier is designed to support students who are unresponsive to the prevention strategies of the rst tier. Tier two interventions are characterized by their ability to serve 10-15% of the school population simultaneously; these interventions should be readily available and require little assessment prior to implementation for students, and are cost-effective in terms of both money and resources (McIntosh et al., 2009; Mitchell, Stormont, & Gage, 2011). The most intensive tier, tier three, provides support to students who are unresponsive to the previous two tiers. The interventions at this level are individualized and designed to support the needs of 3-5% of the student body (Gruman & Hoelzen, 2011; McIntosh et al., 2009). The goal of tier two interventions is to reduce the level of present problem behaviors and to prevent further escalation of problem behaviors (Mitchell et al., 2011; Sugai et al., 2010). Mitchell, Stormont, and Gage (2011) reviewed 13 existing studies to determine the outcomes of three tier two interventions within the context of School-Wide Positive Behavior Supports: Check-in/Check-out (CICO), social skill instructional groups, and academic instructional groups. Researchers found CICO to be effective in reducing problem behavior and

counselor worked with a School-Wide Positive Behavior Support team to support the implementation of the tier two intervention Check-in/Check-out and use data collected to help meet the mental health needs of K-3 students. The article also shares sample student data and usable resources.

THE CHECK-IN/ CHECK-OUT INTERVENTION

Check-in/Check-out establishes a structured daily routine for identied students in order to reduce and prevent the escalation of problem behaviors. The goals of CICO are to increase the opportunities adults have for prompting students to engage in positive behavior, provide behavioral feedback to the student at predictable times throughout the day, develop a meaningful adult-student relationship through positive interaction, and communicate behavioral challenges and successes with families daily (Filter et al., 2007; McIntosh et al., 2009). Once appropriate students are identied as participants for the intervention, they can begin participating in the CICO cycle. Check-in/Check-out provides structure to the student day by dening expectations and a daily routine. While participating, students begin their school day by checking in

Researchers found CICO to be effective in reducing problem behaviorCICO Was the onlY tier tWo intervention to be successfullY implemented bY school staff While also being vieWed as WorthWhile bY school personnel.
concluded that CICO was the only tier two intervention to be successfully implemented by school staff while also being viewed as worthwhile by school personnel (Mitchell et al., 2011). This article describes how a school with an adult. At this check-in, students receive a daily behavior report card that denes behavior expectations and includes a Likert-type scale to evaluate the students behavior (see Appendix A; Chafouleas et al., 2007;

Hawken, MacLeod, & Rawlings, 2007). Depending on the design, daily behavior report cards also have the potential to provide a visual schedule for students, space for written adult comments, and a reminder of the students daily behavior goals (Todd et al., 2008). Students carry their daily behavior report card throughout the day and use it to allow teachers to provide behavioral feedback in the form of points and/or positive comments at designated time intervals. At the end of the day, each student checks out with an adult. At the check-out, they graph the results of their day, receive praise (tangible and/or verbal), and obtain a copy of their daily behavior report card to take home. The cycle begins again the next school day when the student returns a signed copy of their previous daily behavior report card at the morning check-in. The data collected from the report cards are then used to make decisions about continuing, modifying, or discontinuing the intervention (see Figure 1; Filter et al., 2007). Similar to any effective and meaningful intervention, identifying the correct students is an essential factor for CICO. Parents/guardians, teachers, or staff members can refer students to CICO; however, the referral process requires evidence that the student does not respond to the universal tier preventions (e.g., ofce discipline referrals and suspensions) and that the identied student is not exhibiting dangerous behaviors (Filter et al, 2009; Hawken et al., 2007). Research also suggests that some students respond better to CICO based on factors that motivate their problematic behavior. Students behavior can be motivated (i.e., maintained) by a variety of factors, such as gaining attention, avoiding or escaping a task, and obtaining a tangible item (McIntosh et al., 2009). Several studies have demonstrated that students with behavior maintained by adult or peer attention are more responsive to CICO than students with behavior maintained by the ability of the behavior to allow escape from undesirable tasks. McIntosh et al. (2009)

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FIGURE 1

Graphic overvieW of the ChecK-In/ChecK-Out intervention.

Student progress is monitored weekly by the school counselor throughout the intervention, and decisions on graduating, continuing, or intensifying the intervention are made as a team.

Identify student for CICO

Student checks in with adult and sets daily goal

Adult provides feedback throughout the day on daily behavior report card Progress Monitor

Student responsive to intervention

Graduate from CICO

Student checks out with adult and reflects on the positives and areas for improvement for the day

Continue CICO Student is not responsive to intervention Move to Tier 3 intervention

A home report is sent home

Parent/guardian reviews the home report and signs it

Student returns signed home report to adult at check-in

compared a group of students with behavior maintained by attention (n=18) to a group of students with behavior maintained by escaping academic tasks (n=16). The attention-seeking students showed statistically signicant changes in all three measured areas (problem behaviors, prosocial behaviors, and fewer ofce discipline referrals). Students with escape-motivated behaviors did not produce statistically signicant scores in any area, but they did show

desirable change in prosocial behaviors and ofce discipline referrals, and conversely, undesirable change in problem behaviors. Researchers cautioned that the increase in problem behaviors for the latter group of students might indicate a harmful effect of the intervention for students with behaviors maintained by escaping tasks (McIntosh et al., 2009). Todd, Campbell, Meyer, and Horner (2008) also found that CICO was an

effective intervention for four boys with attention-maintained behaviors, one in each grade K-3. Using functional behavioral assessments (FBAs), the researchers determined that all four boys problem behaviors were maintained by adult attention. The third grade students and second grade students behaviors also were maintained by escaping difcult tasks and peer attention, respectively. All students showed a reduction in problem behavVOLUME 16, NUMBER 5 | ASCA

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iors averaging 17.5%; however, one student began a medication intervention partway through the study (Todd et al., 2008). Hawken, ONeill and MacLeod (2011) replicated research to determine the relationship between maintaining behavior and reduced ofce discipline referrals for elementary students participating in CICO.

effort was 5.5. Fairbanks et al. (2007) concluded the practicality of CICO less methodically with their observation of their studys implementers (a teacher and school counselor), [t]he fact that school personnel could design and implement interventions with high delity reinforces the potential usefulness of the CICO and function-based interventions (p. 307).

ChecK-in/ChecK-out establishes a structured dailY routine for identified students in order to reduce and prevent the escalation of problem behaviors.
The results of the study showed that all students with peer attentionmaintained problem behaviors and a student with behavior maintained by tangible rewards responded positively to CICO. On the other hand, only two of the ve students with behaviors maintained by adult attention were responsive; the researchers hesitated to make conclusions because two of the three unresponsive students had signicant needs and were referred for a more individualized intervention. Overall, research is reasonably conclusive that students with attentionmaintained behaviors respond well to CICO. Check-in/Check-out is also an appealing intervention for schools because of its relative ease of implementation. Todd et al. (2008) used the CICO Program Acceptability Questionnaire with 10 elementary teachers to measure perceptions in ve areas including ease and effort of implementation and whether or not teachers would recommend the intervention. Five staff members agreed that CICO was easy to implement, four were neutral, and one thought CICO was more effort than it was worth; nine staff members said they would recommend CICO. In a similar study, Hawken and colleagues (2011) found that median teacher ratings on a 6-point scale for ease of implementation and recommending CICO were both 6; the median rating for implementation Professionally, school counselors are responsible for recognizing and responding to situations that impede students academic success and for supporting school programs such as School-Wide Positive Behavior Support (American School Counselor Association [ASCA], 2012). The components of CICO correspond to the areas of practice of school counselors in several ways. First, in the area of responsive services, CICO serves as one way for school counselors to reach a moderately sized group of students in a meaningful way directly or through consultation (ASCA, 2012). In fact, several studies identied the school counselor as an integral member of the behavioral intervention team (Bradshaw & Pas, 2011; Ennis & Swoszowski, 2011; Fairbanks et al., 2007; McIntosh et al., 2009; Mitchell et al., 2011; Myers, Briere & Simonsen, 2010). Second, CICO has a strong emphasis on data-driven decision making, which falls directly into in the area of system support within the ASCA National Model (ASCA, 2012). For other reasons, school counselors are ideal candidates for working on the implementation of CICO. School counselors have signicant training and interactions working with students facing mental health challenges. The probability is high that some students referred to CICO will be dealing with mental health issues, likely those with externalizing behaviors due to the

fact that inclusion in the intervention is linked to ofce discipline referrals, which are written for externalizing behaviors. A schools CICO team will benet from members who understand students holistically, which is the specialty of school counselors. Moreover, school counselors have more exibility built into their schedules when compared to teachers and administrators (McIntosh et al., 2009). Given these connections to the roles of a school counselor, participation in the implementation of CICO seems both reasonable and practical.

STORY FROm THE FIELD

Jefferson Elementary School in New Ulm, Minnesota, is host to about 600 students, Kindergarten through third grade. The student population is 93.7% White, 4.8% Hispanic, 1% Asian, and .05% Black (Minnesota Department of Education, 2012). Jefferson implemented tier one of SchoolWide Positive Behavior Support in 2009, and is currently in its third year of implementation. All three tiers of support have been in place since 2010. For 2 years, the school has used CICO as a principal intervention for students whose behaviors are unresponsive to universal prevention methods. For the 2011-2012 school year, approximately 10.1% of students were identied as needing tier two support, which correlates well with the suggested target group of 10-15% of the school population (McIntosh et al., 2009; Mitchell et al., 2011). Of those students, 15 participated in CICO. Research recognizes the correct identication of students for tier two interventions as a crucial component to the interventions success (Filter et al., 2009; Hawken et al., 2007). At Jefferson, referrals are made during weekly grade-level team meetings that include an administrator, school psychologist, school counselor, and emotional behavior disorders teacher in addition to the grade level teachers.

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This team is referred to as Teachers Assisting Teachers, or the TAT team. When academic or behavior concerns arise, the classroom teacher completes a basic form, the Teacher Request for Assistance (Appendix B). Problem behaviors that are determined to be a barrier to academic success prompt a discussion regarding the need for a tier two intervention. Prior to making a recommendation for participation in a tier two intervention, several steps towards implementation have proven to be benecial. First, the school counselor reviews the school-wide behavior data (ofce discipline referrals). Students are considered for involvement if they have four or more ofce discipline referrals for the same problem behavior. Second, a functional behavioral assessment (FBA) is completed for the student in consideration. The FBA is a problem-solving process used to better understand behavior. Considering the function of the students behavior is important when looking to design behavioral interventions. For example, some students act out in class in order to escape (escape-maintained), while others act out to gain adult attention (attention-maintained). During the rst two years of CICO implementation, Jefferson did not use FBAs. However, the greater benet to students with attention-maintained behaviors as compared to those with escape-maintained behaviors became obvious. This observation is well researched and supported in the literature (Hawken et al., 2011; McIntosh et al., 2009; Todd et al., 2008). For this reason, the school counselor conducts an informal observational FBA in multiple settings (classroom, playground, music room, etc.). FBAs are now a prerequisite to participation in CICO; students with attentionmaintained behaviors are accepted, while those with escape-maintained behaviors are considered for alternate tier two interventions including small group counseling to addresses specic skill decits, parent/teacher meetings to discuss expectations and goals for behavior improvement, individual

counseling, or a teacher/student mentoring program (Gruman & Hoelzen, 2011). All decisions regarding student involvement in CICO are made within the context of the grade-level teams mentioned above; students begin CICO when the team recommends it, the intervention ts the problem behaviors,and the parent/guardian consents. Students involved in the CICO intervention begin their day with a check-in. As the CICO coordinator, the school counselor is available for 30 minutes before the start of the school day to check in the students. Students receive their daily behavior report card at the time of check-in and discuss their daily goals. Behavior expectations are reviewed and are also written across the top portion of the daily behavior report card. The school day is split into increments at the teachers discretion. During these increments, the student earns his or her points for

day. For example, the student may say that he or she wants to be good tomorrow. The counselor asks questions to prompt the student to describe the desired behaviors. The home report goes home with the student, and is returned the next day with a parent/ guardian signature. Having some way to document weekly progress and compare goal points to points earned is imperative. Statistical knowledge is helpful, but programs are available that will help with data analysis. For example, Microsoft Excel will graph and calculate a line of regression, or another schoolwide behavior data system can be used to help track data (Myers et al., 2010). At Jefferson Elementary, daily points earned were entered in a spreadsheet during the rst and part of the second year of the implementation of CICO. For the remainder of year two, weekly point totals were averaged and compared to averaged weekly goals. This

Similar to anY effective and meaningful intervention, identifYing the correct students is an essential factor for CICO.
displaying goal behaviors. At the end of the day, students check out with the school counselor. The counselor reviews the daily behavior report card and calculates the percentage of points earned. Students then receive a home report to take home that indicates whether or not they met their daily goal (Appendix C). The home report is also a tool to reect on the day and includes two discussion points: one thing that went well throughout the day, and one thing the student plans to work on tomorrow. The school counselor guides a reective conversation and writes down student responses on the home report. Together, the counselor and student identify specic behaviors that were positive throughout the students school day. Then, the school counselor uses the second section (one thing they will work on) to set a goal for the next modication made the graphing easier to read and assisted in seeing growth or lack of change. A key component of the intervention is that data are used to guide the decision-making process for the intervention. The school counselor reviews the data on a weekly basis and stays in communication with both the classroom teacher and the parents/guardians regarding the students progress. After a student has spent approximately one month on the program, the school counselor reviews the data and, if progress is not being made, begins the discussion of moving the student into the next phase in receiving assistance, which is a Child Study Team meeting. The classroom teacher uses several tools to identify the need for a team meeting including ofce discipline referrals, CICO progress reports, academic data and progress
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reports, attendance, and parent/guardian feedback. When students are consistently reaching daily behavioral goalsin other words, when the intervention is workingeither the intervention is continued in its current format, or modications are made. Ideally, students will graduate from CICO. Graduation is decided based on the students success and motivation to earn it. Acknowledging students accomplishment is important when they

and/or check-outs, students only attending the check-in or check-out as opposed to both, shifting the CICO coordinator responsibilities from the school counselor to the classroom teacher, or pairing the student with an adult mentor (not the CICO coordinator) and arranging opportunities for positive interactions. When data indicate that the intervention is not effective, the TAT team reviews the CICO data, attendance, academic data, and teacher input. The

has improved the classroom behavior of many students. Graduations have occurred for ve of the students, with several additional students maintaining appropriate behaviors while still participating in the program.

2011-2012 STUDENT DATA

Data related to students progress on CICO has improved decision making among student assistance teams. Student A began the CICO intervention near the beginning of the school year, after four ofce discipline referrals, a referral to the TAT team, and a brief assessment to the motivation of the behavior. Almost immediately, the intervention began to improve expected behaviors. The student graduated from the program after approximately 6 weeks. Baseline data was not documented, but the teachers feedback indicated an immediate increase in desired behaviors (see Figure 2). Student B was placed on the intervention due to inconsistencies with meeting school-wide behavior expectations. The student began with a very low goal in order to feel success on the program on a consistent basis. The goal percentage was adjusted as the student made progress. At approximately 8 weeks into the intervention, the student was successfully meeting the daily goal on a consistent basis. The student remained on CICO for the remainder of the school year due to the continued success of meeting the daily goal (see Figure 3). Another benet of the program is the use of the CICO data in mental health treatment of students. The CICO coordinator, with a signed release, shares data with out-of-school mental health practitioners. Counselors, doctors, and therapists have used the data to monitor effectiveness of medications, to assist with diagnosis, and in their therapeutic work with clients. CICO data has been helpful to both parents/guardians and practitioners in addressing the mental health needs of children.

A schools CICO team Will benefit from members Who understand students holisticallY, Which is the specialtY of school counselors.
graduate; graduations can include special guests and visitors, special lunch activities, and graduation certicates. However, for some students, the need for adult attention outweighs their desire to graduate. Continuing at least a modied form of the intervention is important for these students. Some options the team has tried at Jefferson Elementary are weekly checkins with or without the daily behavior report cards, students self-evaluating their behavior using a daily behavior report card and attending check-ins team then may decide to progress to a special education assessment. At Jefferson Elementary, adoption of CICO has limited inappropriate referrals for special education services; 100% of those tested to receive special education services for behavioral decits affecting academics qualied during the 2011-2012 school year. In previous years, at least one or two students would not qualify for special education after the testing process concluded. Identication of needs has improved, and the intervention

FIGURE 2
100 90 80 70 60 50 40 30 20 10 0 28-Sep 30-Sep

STUDENT A

% of Points Earned Goal %

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100 90 80 70 60 50 40 30 20 10 0 9-Nov 16-Nov

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% of Points Earned Goal % 11-Jan 18-Jan 23-Nov 30-Nov 25-Jan 4-Jan 1-Feb 8-Feb 14-Dec 21-Dec 28-Dec 15-Feb 7-Dec

CONCLUsION
The school counselor plays an important role in advocating for schoolwide systems that allow students to be successful. School-Wide Positive Behavior Support provides the framework to ensure all students receive the support they need to be successful in their relationships and academics. Although the majority of students will respond to school-wide interventions, some students have a need for more intense, research-based interventions. Check-in/Check-out is an intervention to assist those students. The school counselor can implement this targeted, individualized intervention with delity. School counselors knowledge and expertise on student issues, including mental health challenges that affect learning, make them an ideal component to the implementation of CICO. School counselors can use data collected through the daily behavior report cards to identify triggers and barriers to effective learning. School counselors can also provide feedback to parents, caregivers, teachers, and mental health professionals regarding the students behavior data. The program also provides the school counselor time to deliver individual counseling services to at-risk students.

The school counselor establishes a consistent, positive relationship with the student that promotes motivation toward growth and increased opportunities for learning. n

REFERENCEs
American School Counselor Association. (2012). The ASCA National Model: A framework for school counseling programs (3rd ed.). Alexandria, VA: Author. Chafouleas, S. M., Riley-Tillman, T. C., Sassu, K. A., LaFrance, M. J., & Patwa, S. S. (2007). Daily behavior report cards: An investigation of the consistency of on-task data across raters and methods. Journal of Positive Behavior Interventions, 9(1), 30-37. Ennis, R. P ., & Swoszowski, N. C. (2011). The top 10 things to consider when implementing secondary-tier PBIS interventions. Beyond Behavior, 20, 42-44. Gruman, D. H., & Hoelzen, B. (2011). Determining responsiveness to school counseling interventions using behavioral observations. Professional School Counseling, 14, 183-190. Fairbanks, S., Sugai, G., Guardino, D., & Lathrop, M. (2007). Response to intervention: Examining classroom behavior support in second grade. Council for Exceptional Children, 73, 288-310.

Filter, K. J., McKenna, M. K., Benedict, E. A., Horner, R. H., Todd, A. W., & Watson, J. (2007). Check in/Check out: A post-hoc evaluation of an efficient, secondary-level targeted intervention for reducing problem behaviors in schools. Education and Treatment of Children, 30(1), 69-84. Hawken, L. S., MacLeod, K. S., & Rawlings, L. (2007). Effects of the Behavior Education Program (BEP) on office discipline referrals of elementary school students. Journal of Positive Behavior Interventions, 9(2), 94-101. Hawken, L. S., ONeill, R. E., & MacLeod, K. S. (2011). An investigation of the impact of function of problem behavior on effectiveness of the Behavior Education Program (BEP). Education and Treatment of Children, 34, 551-574. March, R. E., & Horner, R. H. (2002). Feasibility and contributions of functional behavioral assessment in schools. Journal of Emotional and Behavioral Disorders, 10(3), 158-170. doi:10.1177/10634266020100030401 McIntosh, K., Campbell, A. L., Carter, D. R., & Dickey, C. R. (2009). Differential effects of a tier two behavior intervention based on function of problem behavior. Journal of Positive Behavior Interventions, 11(2), 82-93. doi:10.1177/1098300708319127 Minnesota Department of Education. (2012). Data for parents and educators [data file]. Retrieved from http:// education.state.mn.us/MDEAnalytics/ Reports.jsp Mitchell, B. S., Stormont, M., & Gage, N. A. (2011). Tier two interventions implemented within the context of a tiered prevention framework. Behavioral Disorders, 36(4), 241-261. Myers, D. M., Briere, D. E., & Simonsen, B. (2010). Lessons learned from implementing a Check-in/Check-out behavioral program in an urban middle school. Beyond Behavior, 21-27. OSEP Technical Assistance Center on Positive Behavioral Interventions & Supports Effective Schoolwide Interventions. (2013). Retrieved from http://www.pbis.org/ Sugai, G., & Simonsen, B. (2012, June 19). Positive behavioral interventions and supports: History, defining features, and misconseptions. pbis.org. Retrieved from http://www.pbis.org/ school/pbis_revisited.aspx Todd, A. W., Campbell, A. L., Meyer, G. G., & Horner, R. H. (2008). Journal of Positive Behavior interventions, 10(1), 46-55. doi:10.1177/1098300707311369

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appenDIX A

DailY Behavior Report Card

Todays Goal: Expectation 1 0 0 0 0 1 1 1 1 2 2 2 2 Expectation 2 0 0 0 0 1 1 1 1 2 2 2 2 Expectation 3 0 0 0 0 1 1 1 1 2 2 2 2

Date: Check-In Time: 9:00 10:00 1:00 2:00 Total Points Earned:____________ /24 Percentage of Points Earned:__________

Date: Check-In Time: 9:00 10:00 1:00 2:00 Key: Expectation 1

Todays Goal: Expectation 2 Expectation 3

L L L L

K K K K

J J J J

L L L L

K K K K

J J J J

L L L L

K K K K

J J J J

L = No K = Sometimes J = Yes

Total Points: _____________

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appenDIX B

Teachers ReQuest for Assistance Form

TAT Referral Please complete the top section prior to meeting

Date: ___________________________ Student: ____________________________________ Teacher: ____________________________________ Grade:_________ Concern: Academic Behavioral Social/Emotional Speech/Lang Other

Description of Concern:___________________________________________________________________________________ _______________________________________________________________________________________________________ Student Strengths: _______________________________________________________________________________________ What supports/interventions attempted:_____________________________________________________________________ _______________________________________________________________________________________________________ Summary & Date of parent contact on this issue:_____________________________________________________________ *Below completed at TAT Meeting*

TAT Notes/Action Plan Date of Grade level/TAT Meeting:____________________________________________________

Discussion:______________________________________________________________________________________________

Action Plan:
Intervention:____________________________________________________________________________________________ Where and when will it take place?_________________________________________________________________________ How will we measure the outcome?_________________________________________________________________________ Check-in Date & TAT member responsible__________________________________________________________________ Staff Involved: Responsibilities for Intervention:

TAT Team Follow-up Date _________________________________

Discussion:______________________________________________________________________________________________

Recommendation:
_____ Continue the intervention _____ Modify the intervention _____ End the intervention _____ Add another intervention _____ Referral to Child Study Team

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appenDIX C

Home Report

Check-in/Check-out Home Report

Name:_______________________________________________________________________ Date:______________________ My goal today was: ______________________________________________________________________________________ I met my goal today! I had a hard day.

One thing that went really well today was:___________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Something I will work on tomorrow is:______________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Comments: _____________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Parent/Guardian Signature: _____________________________________________

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