Home Note 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 ODR for students with 2-4 ODR in
a 8 week window and motivation listed for obtaining attention and/or obtaining material objects. Students identified via other school data such as attendance, low (but not yet failing grades) and/or systematic school screening.
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| How many students can be served? | Initially 3-5 students. Build up to 10-15 |
| 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 Home Notes Program X will meet established goal of X% on their home note 4 out of 5 days. (Note: Initial goal should be established after collecting 3-5 days of baseline data from teacher via DPR. 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. Student feedback occurs throughout the day via
Home Note, which is sent to parents at the end of each day.
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| How long will it last? | Beginning and end of day greeting should take no more than 3 minutes. Student feedback should happen frequently, at a minimum on the schedule laid out on the Home Note |
| Who will provide intervention? | Classroom Teacher and Parents |
| Where will it occur? | Classroom/Reinforcement at home |
| How will implementation fidelity be monitored/tracked? | Administrator or coordinator will provide coaching and walkthrough support to staff new to intervention (moving from daily, twice weekly, weekly) and Teachers and Parents will use intervention fidelity checklist to self-monitor at same frequency. |
Progress Monitoring
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| How will student progress be monitored (PM)? | Home Note form, office referrals, grades, attendance and other school data |
| 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;
Home Note coordinator for overall PM
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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? | 2-3 months |
| How will the team determine if a student is ready to be exited? | Meeting goal of 70-80% on Home Note over 3-4 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?
| Parents and teacher will be in close communication for this intervention with parents providing recognition and acknowledgement for progress. |