Behavior Implementation Checklist/Tools
NH RESPONDS Assessment Instruments/Tools
Below are the tools used by NH RESPONDS Demonstration site schools, early child hood programs, and professional development providers. For more information on the NH RESPONDS grant go to: www.education.nh.gov/nhresponds/.
| Checklist/Tool Name | Administration |
|---|---|
| PBIS Team Implementation Checklist - 3.0 (TIC)
below is the link to view/download document: Assessment on the status and priority of various action items associated with the effective implementation of school-wide positive behavioral interventions and supports. |
2 times per year.
This checklist is completed collaboratively by the Universal Tier 1 team. To calculate a final score, divide the number of items marked “In Place” by 22 (the total number of items). The score should be between 0 – 100% |
| Response to Intervention Tier 2 Secondary Systems Team Self-Assessment and Action Planning Tool
below is the link to view/download document: Assessment on status and priority of various action items associated with blended Tier 2 systems. For use by teams to monitor activities for implementation of RTI for behavior and academics. |
2 times per year.
This checklist is completed collaboratively by the Tier 2 team. |
| Targeted Tier 2 PBIS Checklist
below is the link to view/download document: Assessment on the status and priority of various action items associated with the effective implementation of Tier 2 school-wide positive behavioral interventions and supports. |
2 times per year
This checklist is completed collaboratively by the Tier 2 team. To calculate a final score, divide the number of items marked “In Place” by 36 (the total number of items). The score should be between 0 – 100%. |
| Intensive Tier 3 PBIS Checklist
Below is the link to view/download document: Assessment on the status and priority of various action items associated with the effective implementation of Tier 3 school-wide positive behavioral interventions and supports. |
2 times per year.
This checklist is completed collaboratively by the Tier 3 team. To calculate a final score, divide the number of items marked “In Place” by 30 (the total number of items). The score should be between 0 – 100%. |
| School-wide Evaluation Tool (SET) for K -12
Below is the link to view/download document: External and validated assessment of critical features of school-wide PBIS including interviews and review of permanent products. |
Once per year, typically in Spring.
This assessment is completed by a trained external evaluator. Summary of Features Score/ Behavioral Expectations Taught Score |
| Behavior Support Team Checklist (high school use only)
Below is the link to view/download document: This checklist assesses the implementation of key features of Tier 2 behavior support systems, data and practices. |
2 times the first year and annually thereafter.
The High School Tier 2 behavior support team should collaboratively complete this checklist To calculate a final score, divide the number of items marked “In Place” by 27 (the total number of items). The score should be between 0 – 100%. |
| RENEW Integrity Tool (RIT)
Below is the lnk to view/dowload document: This checklist is to assess the fidelity of implementation of the RENEW model at the individual facilitator level. |
Administered 6 months after first youth are enrolled and every 12 months thereafter.
To calculate a final score, divide the number of items marked “In Place” by 44 (the total number of items). The score should be between 0 – 100%. |
Note: Schools complete either the RTI Tier 2 Assessment and Action Planning Tool or the Targeted Tier 2 PBIS Checklist depending on whether they are focused on academics and behavior or behavior alone.
Microsoft Word format. You can download a free reader from Microsoft.
New Hampshire Department of Education
101 Pleasant Street | Concord, NH | 03301-3494
Telephone: (603) 271-3494 | TDD Access: Relay NH 711