PBIS.org
Tier 2 Action Planner
2014-2015
Directions: Please enter your “Points” for each item, using the rubric; e.g., 0, 1, 2. Determine if each item is
high, medium or low priority.
Complete the Action Plan: What needs to be completed? Who will do it? When will it be completed?
Subscale
Features
Tier 2 Systems
Team
1. Team Composition: Tier II (or combined Tier
II/III) team includes a Tier II systems coordinator
and individuals able to provide (1) applied
behavioral expertise, (2) administrative authority,
(3) knowledge of students, and (4) knowledge
about operation of school across grade levels and
programs.
0 = Not implemented
1 = Partially
implemented
2 = Fully implemented
Priority
High
Med.
Low
2. Team Operating Procedures: Tier II team
meets at least monthly and has (a) regular
meeting format/agenda, (b) minutes, (c) defined
meeting roles, and (d) a current action plan.
Guiding Questions
Who currently coordinates and/or deliver Tier 2/Secondary Interventions? How can current
system be enhanced- Use activities to determine who will make up your “Secondary Systems
Planning Team/meeting” and the necessary enhancements that will occur to ensure core
features are in place.
Brainstorm Activity
Step 1: Take Inventory of all Teams/Committees
Can you combine/eliminate?
Can you organize to increase efficiency?
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Tier 2 Action Planner
2014-2015
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Tier 2 Action Planner
2014-2015
Tier 2 Role and Responsibilities
Assigned Team Member
Suggested Division of Essential Responsibilities
Tier 2 Coach:
Works with Coordinator to identify agenda items.
Tier 2 Team Leader
Responsible for agenda and meeting facilitation
Tier 2 Coordinator:
Organizes and/or oversees the specific interventions such as CICO,
S/AIG & Group with Individual Features
Roles include: scheduling meetings, works with data manage to review
& collect data to share during team meetings Establishes and manages
logistics of intervention
(e.g. location, personnel, etc.)
Action Plan Recorder:
Notify/remind team members of meeting time and location
Keeps record of decisions/actions/tasks including students eligible,
intervention applied and result of intervention
Distributes meeting notes to team members
Data Manager:
Accepts new referrals for Tier 2 support
Gathers additional data if needed
Presents intervention information during team meeting
Helps team summarize information to make intervention decision
Administrator:
Intervention
(list names):
Supports process by attending meetings, reallocating resources (time
and staff) and communicating with faculty and school community about
the program
Facilitators Introduces intervention to new staff, students, and parents
Provides intervention to student
Provides periodic feedback of progress to participating students,
parents, and staff
Family
Provide family voice on modifying interventions, need for additional
interventions, and improving family involvement with interventions
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PBIS.org
Tier 2 Action Planner
2014-2015
Quick Audit: What is available to support students who are not successful in school?
Based on your conversations, list at least 2 actions below.
WHAT NEEDS TO BE COMPLETED?
WHO
WHEN
A.
B.
C.
D.
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PBIS.org
Subscale
Tier 2 Action Planner
Features
0 = Not implemented
1 = Partially
implemented
2 = Fully implemented
2014-2015
Priority
High
Med.
Low
3. Screening: Tier II team uses decision rules and
multiple sources of data (e.g., ODRs, academic
progress, screening tools, attendance,
teacher/family/student nominations) to identify
students who require Tier II supports.
Tier 2 Systems
Team
Outcome Data and
process data used
by team
4. Level of Use: Team follows a written process
to track proportion of students participating in
Tier II supports, with at least 3% of students
participating.
5 Student Performance Data: Tier II team tracks
proportion of students experiencing success (% of
participating students being successful) and uses
Tier II intervention outcomes data and decision
rules for progress monitoring and modification.
Guiding Questions
6. Request for Assistance: Tier II planning team
uses written request for assistance form and
process that are available to all staff, families,
and students.
How are students identified as in need of Simple Tier 2/Secondary Interventions (by data-based
decision-rule/s, teacher request for assistance and/or universal screening)?
What are the Tier 1/Universal data sources used to identify this need (i.e. SWIS, Universal
screening, attendance, grades etc.)? Note: Multiple data points are necessary for a
comprehensive school-wide system of identification, however, each youth does not necessarily
need more than one data point to be identified for support.
Data-based decision rules for identification:
1) Data source #1: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
2) Data source #2: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
3) Data source #3: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
** Teacher/Family Request for Assistance enters youth (circle one): Yes
No
How does a Simple Tier 2/Secondary Intervention (ex. Check-In/Check-Out) for a student get
started (ex. contact with teacher, consent from family, teach student the process)?
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PBIS.org
Tier 2 Action Planner
2014-2015
What is the timeframe for the Simple Tier 2/Secondary Intervention (how long will a student
receive this intervention before student data is reviewed for progress)? How long is typical length
of intervention?
Review the Intervention Tracking Tool and Sample Agenda
Use the Guiding questions to identify gaps in Tier 2 process. How can you improve your
current system? List at least 2 actions below.
WHAT NEEDS TO BE COMPLETED?
WHO
WHEN
A.
B.
C.
D.
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Tier 2 Action Planner
Subscale
Features
Intervention,
Level I
CICO
2014-2015
0 = Not implemented
1 = Partially
implemented
2 = Fully implemented
Priority
High
Med.
Low
1. Coordinator and Team Identified
2. CICO Routine Established
3. Daily Progress Report in place and staff are
trained to use and deliver feedback
4. Student Identification in place
5. Student Participation and Training in place
6. Family participation and Training in place
7. Data Monitoring System in place
8. Evaluation System in place.
WHAT NEEDS TO BE COMPLETED?
WHO
WHEN
A.
B.
C.
D.
E.
F.
G.
H.
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Tier 2 Action Planner
School:
2014-2015
Date:
Check-In/Check-Out (CICO) Program
Summary Action Plan
People
CICO
Coordinator
Information
Behavior
Support
Team Members
Name /Position
Name/Position:
Responsibilities:
of Team
Members:
Role and
Function:
How are
students
identified for
CICO?
Data Criteria
for Selection:
What is the
criteria for
discontinuing
CICO
Data Criteria
for
Discontinuation
:
How are the
participating
student’s data
managed?
Process to
monitor
student
progress?
Process
How is the
student’s
progress
reported to key
stakeholders?
Communication
of success to
teachers of
students on
CICO:
Problem
Solving teams
What types of
materials/resources
are needed to
implement CICO?
·
Database
(spreadsheet,
etc.)
·
Weekly/monthly
charts
·
Acknowledgemen
t systems (tickets,
certificates, etc.
Where will the
CICO take place?
Location
morning and
afternoon:
Location of
midday if
needed:
Data ManagerInput and
Output of Data:
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PBIS.org
Tier 2 Action Planner
2014-2015
Tier 2: Level II
Guiding Question:
How will you know if students are responding to the Simple Tier 2/Secondary Intervention? What defines adequate
progress (ex. what % of possible Daily Progress Report points etc.)?
Data-based decision rule for defining “response”:
Data source: _________________________________________
Data Rule for Responding to Intervention: ___________________
Time Frame: __________________________________________
Next Steps:
When a student is responding adequately, the team will decide to keep the current intervention, modify intervention for
sustainability or exit student from intervention.
When a student is not responding adequately with a Simple Tier 2/Secondary Intervention the team may decide to
support youth with a Social/Academic Instructional Group (Tier 2/Secondary Level II) or more intensive support.
Subscale
Intervention,
Level II
SAIG
Features
0 = Not implemented
1 = Partially
implemented
2 = Fully implemented
Priority
High
Med.
Low
1. 3 Types of instructional groups are available to
students.
2. Reverse Request for assistance used to
determine next layer of support.
3. Enhanced DPR used to assess progress.
Guiding Questions
Level II: Social/Academic Instructional Groups: Student receives Tier 2/Secondary
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PBIS.org
Tier 2 Action Planner
2014-2015
support when Tier 1/Universal interventions and core curriculum are not meeting their
needs and/or when they have not responded to Simple Tier 2/Secondary Level I support
(ex. Check-In/Check-Out).
Schools should have multiple types of group interventions. Do you have one or more of
each of the following? What are the names of the groups?
Pro-social: __________________________________________
Problem-Solving: _____________________________________
Academic Behavior: _____________________________________
Academic Skills/Content area:
_____
1. What are the Tier 1/Tier 2 (Universal/Secondary) data sources used to identify this
need (ex. SWIS, attendance, Daily Progress Report (DPR) points, etc.)? Note: Each
youth does not necessarily need more than one data point to be identified for support.
Data-based decision rules for identification:
1) Data source #1: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
2) Data source #2: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
3) Data source #3: ______________
Rule for Inclusion in Intervention: ____________________
Time frame: ______________
** Teacher/Family feedback is used to help determine appropriate interventions
(i.e. Reverse Request for Assistance) enters youth (circle one):
Yes
No
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PBIS.org
Tier 2 Action Planner
2014-2015
Reverse Request for Assistance: Interventions Change
(Addressed to Student’s Teacher)
Student Name: ________________________________________
Date: __________________
IEP (circle one)
Grade: _________
Yes
No
Teacher: _____________________________________
Based on preliminary data, it has come to our attention that the _____________________ Intervention (CICO) is NOT
having a significantly positive effect on your student (i.e. he/she “is not responding” well to the intervention). Please
identify which additional support/s, you feel, would be the best fit for this youth.
1) ____No change in behavior support requested at this time, please continue CICO.
2) Social/Academic Instructional Groups:
____Problem-Solving: To learn replacement behaviors for fighting, arguing etc. (externalizing behaviors)
____Pro-social Skills: To learn replacement behaviors for avoidance, withdrawal etc. (internalizing
behaviors)
Academic:
____Academic Behavior: To learn replacement behaviors for calling out,
related to homework etc.
getting out of seat, behaviors
____Academic skills/content area
3) Individualized Check-In/Check-Out: Same CICO with one or more of the following changes:
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PBIS.org
Tier 2 Action Planner
2014-2015
____Change location of Check-In and/or Check-Out
____Change Check-In/Check-Out person (change adult or use a peer instead)
____Change Check-In and/or Check-Out time (or add addition time/s)
4) ____ Mentoring (Focus is on connection/relationship between one adult and youth,
designed/individualized based on youth needs)
WHAT NEEDS TO BE COMPLETED?
WHO
WHEN
A.
B.
C.
D.
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