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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:
PBIS Team Implementation Checklist 3.0 Word 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:
RTI Tier 2 Sec sys team self assess Word 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:
Targeted Tier 2 PBIS Checklist 8/10/11 Word 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:
Intensive Tier 3 PBIS Checklist 3/5/11 Word 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:
School-wide Evaluation Tool Word 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:
Behavior Support Team Checklist High School Word 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:
RENEW Integrity Tool 1/20/12 Word 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 Symbol 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