Class Pass Implementation Planning Worksheet
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| Name of Program: | |
| Intervention Coordinator: | Member of Tier 2 team who coordinates this intervention |
Student Selection
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| How will students be selected? | Tier 2 team will review
list of students that are either teacher reported or screened in as being escape motivated; task avoiders or highly anxious.
This intervention can also be used for students who need breaks to work on emotional regulation.
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| How many students can be served? | Ideally 1-2 per classroom, with possibly more if teacher is skilled at behavioral management. |
| How will parents be notified/consent gained? | Parents will be contacted by X via phone/email to invite student to participate and obtain parent consent. X will also provide training on the intervention to parents. |
Implementation
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| Example goal for Student Success Platform | As part of Class Pass Program X will meet established goal of X% on their Class Pass system 4 out of 5 days. (Note: Initial goal should be established after collecting 3-5 days of baseline data from teacher (goal level can increase from there over time). |
| When will the intervention occur during the day? | Teacher meets with student at beginning/end of day to provide passes. Student turns in tracking form and unused passes at the end of the day for a reinforcement item. |
| How long will it last? | Beginning and end of day greeting should take no more than 1 minute. Student feedback should happen frequently, as the student build the social emotional skills needed to regulate behavior on their own. |
| Who will provide intervention? | Classroom Teacher |
| Where will it occur? | Classroom |
| How will implementation fidelity be monitored/tracked? | Coordinator or Tier 2 team member will provide coaching and support to staff new to intervention (moving from daily, twice weekly, weekly) and Teachers will track their fidelity of use of the intervention. |
Progress Monitoring
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| How will student progress be monitored (PM)? | Class Passes, Class Pass weekly tracking form, office referrals, time on task attendance and time in the classroom. |
| How frequently will PM occur? | Teacher will review progress towards goal weekly with student. Tier 2 team will monitor overall progress every two weeks. |
| Who is responsible for PM? | Teacher
is responsible for student feedback;
Class Pass coordinator for overall Progress Monitoring.
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| When will the PM data be looked at by the team? | As part of Tier 2 team reviews every two weeks. |
| What is the average length of time in program? | 6-10 weeks. |
| How will the team determine if a student is ready to be exited? | Meeting goal of 70-80% on Class Pass over 2-3 weeks. Move to self-monitoring for one month to fade supports and check for stability of behavior change. |
| What will the team do if a student is not making progress? | Adjust goals for student, modify reinforcer plan, check for implementation fidelity |
Communication
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| What will parent and teacher communication look like?
| Teachers will report weekly progress home to parents via note, email or phone call. |