Phase 3 Positive Behavioral Support (PBS) Recognition Application
Establishing Tier 2: Problem Solving Team
To apply for Phase 3, schools must have previously received Phase 2 which recognizes a strong
Tier 1 foundation.
This application is for Phase 3 of a multi-phase, DE-PBS recognition system. The complete
recognition system includes several levels of recognition that encompass all three tiers
(universal, targeted and intensive) of the school-wide triangle.
This application includes three sections: Tier 2: Problem Solving Team Program Components,
Products for Submission, and a Reflection Question. Please note that ALL requirements must be
submitted by the deadline. Teams will NOT be prompted to submit missing items.
INSTRUCTIONS:
1.
Complete ALL fields on this application.
2.
Complete and attach the required supporting documentation indicated on this application.
Supporting documentation may be emailed or the hard copy may be mailed. For either
method, applications are due by Friday, June 27, 2014. If a school does not receive a
confirmation of application receipt by July 17, 2014, they must contact project staff.
3.
If you chose to email your application, all materials must be attached in one email.
Separate emails will be considered incomplete.
Send emails and faxes to Sandi Bradford at:
Email: sandi@udel.edu
Fax: 302-831-4690
4.
Send hard copy submissions to:
Sandi Bradford
Center for Disabilities Studies
461 Wyoming Road
Newark, DE 19716
N420
5.
Inform your DE-PBS District Coach(es) of your application. Remember that coaches are
a great resource to help in preparation and review of applications!!
6.
Schools will be notified when project staff receives the application. Notification
regarding the receipt of Phase 3 Recognition will be sent to schools the week of
September 15, 2014.
7.
Questions may be directed to your PBS Coach(es) or Sarah Hearn at
skhearn@udel.edu .
Delaware PBS Project 2013-2014
Phase 3 PBS Recognition Application
DE-PBS Recognition Application for Phase 3:
Establishing Tier 2: Problem Solving Team
Please fill in the following information:
District
School Name
I. Phase 3: Establishing Tier 2: Problem Solving Team - Program Components
Please review the items below. Check off the components that were in place in the school during
the 2013-2014 academic year. Please note: You do not need to submit all of the items. Random
onsite document reviews may be conducted.
Tier 2 Problem Solving Team
Leader identified and trained
Prescheduled Problem Solving
Team meetings occur at least
monthly
Data-based decision rules are
established to identify students who are in
Tier 2 (e.g. ODRs per student, attendance,
grades)
Behavioral interventions are
tied to function of behavior and
are differentiated based on
student need
Parents are informed when
their student is involved in a Tier
2 intervention.
Staff receives information on
Tier 2 supports available and how
to access targeted team for
support
Process created to coordinate
with School-wide PBS team
Progress Monitoring System in place
that includes timely entering of data for
specific student data tracking
Administrator Initials: ___________
Graduation/intervention exit criteria
set and includes plan for post-intervention
support.
Team Leader(s) Initials: ____________
II. Phase 3: Establishing Tier 2: Problem Solving Team - Products for Submission
1)
Summary of decision rules used to identify students who are in tier 2 (e.g.
ODRs per student, attendance, grades), and process/forms created for requesting
assistance from Tier 2 problem solving team by teachers and families.
2)
List of Tier 2: Problem solving team members with roles; identify team leader
(e.g. Sally Smith – IST Coordinator).
3)
Tier 2 problem solving team meeting schedule for 2013-2014 SY.
4)
Describe at least one skill-building intervention and one relationship-building
intervention available to students with need that can be put into place within a
week.
5)
Describe how parents are informed about participation and progress for their
child.
Delaware PBS Project 2013-2014
Phase 3 PBS Recognition Application
III. Phase 3: Establishing Tier 2: Problem Solving Team - Reflection Question
Teams are asked to reflect upon the following question. A comprehensive written response in
essay format is REQUIRED to be submitted for this question. Please be sure to address each
component. (500 word limit per question)
Provide an unidentified case summary of a specific student (not your school’s process in
general) supported through Tier 2 targeted interventions.
Include the following information:
 how student was identified by the team,
 how supports were determined for the student,
 data collected/data source(s) for the student,
 support student successes and areas for improvement, and
 summary (including pre and post-intervention data).
Delaware PBS Project 2013-2014
Phase 3 PBS Recognition Application