Statewide Autism Resources and Training (START)
EBP Implementation Checklist
The START EBP Implementation Project is easy as 1-2-3-4
To remember the requirements of the project, just remember “1-2-3-4.”
“1” building for the project
“2” target students for participation
“3” IEP goals per target student to address through the project
“4” Evidence Based Practices (EBPs) to address the IEP goals
Check when
completed
Step
Information/Actions
Identify 1 building where you will
implement the EBP project.
Name of District and Building:
Obtain administrator support.
Name of Administrator:
Identify a team and team leader for the
project.
*See Team form
Name of Team Leader:
Identify 2 target students with ASD,
preferably with different profiles of
strengths and needs. If possible, choose
two different teachers.
*See Student Summary form
Student #1:
Grade:
Teacher(s):
Obtain written permission for target
student participation from
parents/guardians.
Student #1
Sent:
Student #2
Sent:
Other Team Members:






Student #2:
Grade:
Teacher(s):
Identify 3 IEP goals for each target student Student #1
with each from a different domain (e.g., 1 Goal 1:
Goal 2:
social, 1 academic, 1 independence).
Goal 3:
Received:
Received:
Student #2
Goal 1:
Goal 2:
Goal 3:
Review target student IEP goals and
ensure they are observable and
measurable.
Note: If goals are not observable &
measurable, modify them on the GAS chart.
Student #1
Goal 1
Student #2
Goal 1
Goal 2
Goal 3
Goal 2
Goal 3
Complete GAS on each IEP goal.
*See GAS form
Student #1
IEP Goal 1 with GAS
IEP Goal 2 with GAS
IEP Goal 3 with GAS
Student #2
IEP Goal 1 with GAS
IEP Goal 2 with GAS
IEP Goal 3 with GAS
Review EBP modules from NPDC website.
Assign modules to staff to review and report:
























Antecedent-Based Interventions (ABI)
Computer-Aided Instruction
Differential Reinforcement
Discrete Trial Training
Extinction
Functional Behavior Assessment
Functional Communication Training
Naturalistic Intervention
Parent-Implemented Intervention
Peer-Mediated Instruction & Intervention
Picture Exchange Communication System (PECS)
Pivotal Response Training
Prompting
Reinforcement
Response Interruption/Redirection
Self-Management
Social Narratives
Social Skills Groups
Speech Generating Devices /VOCA
Structured Work Systems
Task Analysis
Time Delay
Video Modeling
Visual Supports
Select 4 EBPs that your team will
implement with your 2 target students (at
least 2 EBPs per student).
Establish a system for regular data
collection and data review to monitor
progress toward goals. Include regular
updates of progress toward GAS goals.
*See GAS Monitoring form
Note: Maybe added to Team form.








EBP 1:
EBP 2:
EBP 3:
EBP 4:
START EBP Implementation Project
Sample Calendar for the School Year
Prior to Fall
Identify a project building
August
Training/planning for 1day
Identify 2 target students and get
parent permission
GAS
Review IEP goals
Review EBPs
Complete online class
October
September
Monthly EBP team meeting
Review student IEP goals
Use GAS to expand goals
Finalize GAS goals
Collect baseline data
Complete USAPT and enter online
Match EBPs to student goals
Create EBP plan for target
students
November
December
Monthly EBP team meeting
Monthly EBP team meeting
Monthly EBP team meeting
Complete classroom assessment
Review data/GAS
Review data/GAS
Review data/GAS
January
February
March
Monthly EBP team meeting
Monthly EBP team meeting
Monthly EBP team meeting
Review data/GAS
Review data/GAS
Review data/GAS
April
May
June
Monthly EBP team meeting
Monthly EBP team meeting
Discuss plans for next year
Review data/GAS
Complete USAPT and classroom
assessment
Review end of the year data
Review data/GAS
START / EBP Implementation Project
Team Information
Site Team Leader
Contact Information:
Email / Phone
Professional Role
Roles & Responsibilities
(e.g. EBP focus, team role)
(e.g. EBP focus, team role)
Team Member
Contact Information:
Email / Phone
Professional Role
Roles & Responsibilities
(e.g. teacher consultant)
(e.g. EBP focus, team role)
SITE LOCATION:
Student Summary Form
Student name:
Grade:
Building:
Primary teacher:
Circle one:
Highly verbal
Moderately verbal
Minimally verbal
Echolalic
What are the student’s primary behavior challenges?


Does the student exhibit self-injury?
Y N
Does the student exhibit aggression?
Y N
What is the student’s primary communication system(s)?


What is the student’s primary academic output?


How much time is the student spending in general education (in what subjects/activities)?
Time / Subjects/Activities:
o
o
o
How much time is the student spending in special education?
What are the student’s interests and talents?


Does the student have peer supports involved on a regular basis?
What is the family’s involvement?
Non-verbal
GOAL ATTAINMENT SCALE FORM
Building Team:
Student:
Level Of
Attainment
Date:
DOB:
Goal 1:
Goal 2:
Goal 3:
-2
Much less
than expected
(Present Level)
-1
Somewhat less
than expected
(Progress)
0
Expected level of
outcome
(Annual Goal)
+1
Somewhat more
than expected
(Exceeds annual goal)
+2
Much more
than expected
(Far exceeds annual goal)
EBP:
EBP:
EBP:
GAS Goal Update
Student & Goal
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3
Name
Goal # 1
Name
Goal # 2
Name
Goal # 3
GAS Goals
Date
GAS Goals
Date
GAS Goals
Date
GAS Goals
Date
GAS Goals
Date
GAS Goals
Date
GAS Goals
Date
ACTION PLAN
Team: _____________________________
WHO
Date: ________________________
Will do WHAT
by WHEN