Application and Readiness Checklist to become Wisconsin Pyramid Model implementation
site and to attend Pyramid Model Program Wide Implementation Academy
Program-wide adoption of the Pyramid Model refers to a systemic effort within a program for Pyramid Model
implementation fidelity. It is the most effective way to change practice and support social and emotional development
of children in your program. In program-wide adoption, a leadership team guides the implementation process and
develops the supports and infrastructure needed to ensure that adoption of the Pyramid Model can occur within the
classrooms and services provided to children and their families.
Programs selected to become WI Pyramid Model Implementation sites will send their leadership team to attend
Pyramid Model program wide implementation academy. The goal of the academy is to support and prepare teams for
planful implementation of the Pyramid Model in their programs.
Implementation Academy details:
When: July 30, July 31st, August 1st, August 2nd, 2012
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July 30th and 31st - external coaches and/or internal coaches*
*It is most beneficial for the implementation if both internal and external coaches attend the Coaches
training, but if funds are limited, please make sure that external coach attends the event
August 1st and 2nd - the entire program leadership team
Where: Jefferson Street Inn (check) http://www.jeffersonstreetinn.com/
A block of rooms is being held ($70 single/ $99 double) until July 9th under Pyramid Model.
Cost per participant $25/day: Breakfast, lunch and materials included in the cost
What:
Training for Coaches (July 30 and 31st, 2012)
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Day 1 & Day 2 (part 1) TPOT (Teaching Pyramid Observation Tool) reliability training
Day 2 (part 2) is evidence based coaching practices
Team Implementation meeting (August 1st and August 2nd, 2012)
This two-day meeting event is for program leadership teams that are committed and ready to implement Pyramid
Model practices and procedures. Teams will leave the meeting event with an understanding of and plan for
implementing the Pyramid Model in their program. It is vital that the entire leadership team attend this meeting.
Planning during this meeting will launch your program’s implementation of the Pyramid Model.
1|Page Program -wide implementation site application
The team implementation meeting event will cover these topics:
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Introduction to program-wide implementation of the Pyramid Model with content and planning for
How to
Team effectively for system change
Define roles, responsibilities & expectations to implement the Pyramid Model
Determine how to create and sustain buy –in for staff, children and families
Teacher fidelity data analysis
Outline the program system for supporting implementation, accessing support and aligning policies
Learn data-based decision making tools and how to use them to guide implementation
Learn how to report your data to the WI Pyramid Model State Leadership team
2|Page Program -wide implementation site application
Application & Readiness Checklist:
Application due date: April 1st, 2012
Programs must complete the following readiness checklist as part of the application to be considered a Pyramid Model
implementation site and to attend the Program Wide Team implementation Academy. This checklist process is
designed as a tool for self-reflection for programs to make informed decisions about participation. Program wide
implementation takes a great deal of commitment, time, effort and resources. An application review committee will
score the application to determine program’s readiness. Programs are asked to submit evidence for their ratings so
that the application review committee is able to assess program’s readiness and offer feedback. The Wisconsin
Pyramid Model project has found that program’s readiness is very important to successful implementation of the
Pyramid Model.
Demographic information:
Program/Center Name:
Contact Name:
Contact Title:
Contact email:
Contact phone number:
Address:
County:
Number of children attending the program:
Age range of children served by the program:
Average annual number of children with IFSPs?_ _
Average annual number of children with IEPs?__ _ __
Number of classrooms? _ _ __
Number of classroom staff?
Total number of staff members employed by the
program (including food services, custodial, secretarial,
administrative): _ _ __
Number of families in your program who use WI
SHARES or free/reduced lunch (if applicable) _ _ __
Memorandum of understanding:
A checkmark next to each item and a signature from program administration affirms the programs commitment to:
1. Staff willingness to participate in program wide implementation of the Pyramid Model
___ __ After viewing the program-wide Pyramid Model implementation overview webinar
(http://www.cesa11.k12.wi.us/speceduc/Pyramid_Model.cfm ) (you might consider viewing the webinar as a
group during one of your staff meeting), 80% of the entire program staff affirm their willingness to participate in
the program wide implementation, to be supported via coaching and observation, examine and change their
practices as necessary, and review data shared by the leadership team. The entire staff should be polled using the
survey as at: http://www.surveymonkey.com/s/staffreadinesssurvey
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Your staff will be asked these questions:
I am interested and willing to participate in the program wide implementation
I like the idea of program wide implementation, but want more training first
I like the idea of program wide implementation, but am not ready to commit
I don’t think that program wide implementation would be beneficial to me and/or the program
More information on the content can be accessed at: www.vanderbilt.edu/csefel or www.challengingbehavior.org
2. Training
___ Please indicate any training staff received on the Pyramid Model content. Participation in Pyramid Model
training prior to becoming an implementation site is a requirement. This allows for staff to make an informed
decision about participating in program wide adoption of the model, as well as eliminates the need for the
program to focus on initial training in the first year of the implementation.
Training date
Training Name/Title
Trainer
Number of staff
and number of
trained
hours
Has the program administrator (s) attended Pyramid Model
training? Yes/NO
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3. Program Leadership Team
Identify a program level Pyramid Model leadership team.
The program leadership team must include an administrator, teacher(s)/home visitor(s) representatives, the
internal coach and/or a person knowledgeable about behaviors and/or mental health. Applicants are encouraged
to think critically about the number of members of this team. It is important that this team be representational of
program staff while remaining concise enough to make decisions about implementation. Team members will
solicit input/feedback from the staff when making implementation decisions as guided by the data.
The internal coach is associated with the program and provides technical assistance to front line staff in
implementing practices and strategies. The behavior specialist may be external to the program and is responsible
for guiding team problem solving and intervention support for children who need individualized interventions.
Other team members could include a parent (non-staff person), teacher assistant(s), and a contact person for
disabilities, mental health, family support, and/or curriculum. All members of this team will attend the two- day
Program Wide Implementation meeting event and will be responsible for ensuring implementation of the action
plan developed during the meeting.
Name
Pyramid Model Program Leadership team
Role*
Agency
Number
of years
associate
d with the
program
Administrator-Principal-Director
(required)
Internal coach*
Behavior Specialist*
Teacher representative
Data coordinator *
External coach
* Certain roles could be served by the same person if time allocation and experience/skill allow
 Internal Coach
__ __ Identify and acknowledge time commitment for an internal coach. The amount of time commitment for the
internal coach varies with the scope of program implementation. At minimum, an internal coach spends 6 hours of
observation per lead teacher (3 hrs. baseline; 3 hrs. 6 months after) per year collecting TPOT/TPITOS data plus
approximately 45 min/month per teacher in regular meetings and prep work for action planning, individual teacher
support, other professional development activities. In addition to TPOT/TPITOS data collection, the internal coach
may coordinate program level and child level data collection. Internal coach will provide technical assistance to
individual teachers/providers through evidence based coaching strategies.
Internal coach is invited to attend the two days Training for Coaches held on July 30th and July 31st, 2012
Internal coach is invited to participate in the bi-monthly Coaches Connections web-based support meetings. More
information and details will be shared during the Implementation Academy.
5|Page Program -wide implementation site application
The internal coach will be supported by the external coach. The internal coach may also serve as the behavior
specialist.
List experience and qualifications of internal coach in coaching or mentoring:
 External Coach
___ __ Identify an external coach for your program. External coach will assist the leadership team in data collection
and analysis, support ongoing professional development and provide support to the internal coach to ensure the
program implements the Pyramid Model framework with consistency and fidelity. The external coach will access
technical assistance from the Wisconsin Pyramid Model coordinators. Ideally, your external coach should be wellversed in the Pyramid Model content and have prior experience in team facilitation.
The external coach is invited to participate in the bi-monthly Coaches Connections web-based support meetings.
More information and details will be shared during the Implementation Academy.
The external coach must attend the Training for Coaches. See information on page 1.
List potential external coach here:
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Behavior Specialist
It is important that your program has access to behavioral support for children with persistent challenging behavior
through an internal person on your team, mental health consultant, or behavior specialist. This specialist should have
experience in function based problem solving. The behavior specialist will assist in gathering information from the
child’s team, synthesizing that information into antecedent, behavior, maintaining consequence and function. The
behavior specialist will facilitate the team planning process to determine individualized prevention, intervention and
responding strategies. The behavior specialist will assist the child’s team in collecting data that measures a child’s
progress.
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How do you and how often do you access the services of the individual who will provide behavior specialist and/or
mental health consultation services? Is this person able to serve on your program leadership team?
4. Family Engagement
Describe your commitment to involve families in the Pyramid Model implementation. Describe how you currently
engage families in the activities, events and decision making in your program:
5. Community Collaboration:
___ __ Commitment to community collaboration and linkages- (examples: Birth to 3, 4K, Head Start, Early Head Start,
Tribal Programming, Spanish Community, Hmong Community, family resource centers)
Describe access here:
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6. Resource commitment:
Describe your plans to fund implementation. Some costs to consider: time allocation for internal coach, attending
the implementation academy, time for data collection/entry, family events, monthly program leadership team
meetings.
7. Data based decision making
___ ___ Understanding and commitment to collect and use data at the program, teacher and child level. Data
collection tools will be provided by the Pyramid Model initiative. Training in use of the tools will be provided at the
meeting event. Support in collecting and analyzing the data will be provided by the external coach. The process of
collecting and analyzing the data can be individualized to complement each program’s current data management
system. The leadership team should determine and indicate which member will serve as data coordinator for
implementation.
a. Program level data:
i. Benchmarks of quality
b. Teacher level data:
i. TPOT (Teaching Pyramid Observation Tool (ages 3-5)
ii. TPITOS (The Pyramid Infant Toddler Observation Scale (0-3).
c. Child level data:
i. ASQ SE (Ages and Stages Social-Emotional)
ii. Collecting data on the level of challenging behavior throughout the program using the
Behavior Incident Report.
8|Page Program -wide implementation site application
__ Percentage of staff members who have attended a minimum of 15 hours or more on the Wisconsin Model
Early Learning Standards (WMELS)
List percentage here
Describe your program curriculum:
Describe how your program monitors the development of children. Do you have a formal way to aggregate and
analyze data? How do you share information about child development with parents?
Describe how children with disabilities are supported in your program
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Please share your program’s YoungStar rating (if applicable) _______
Our program is located in a community that is implementing school wide Positive Behavioral Interventions and
Supports (PBIS): _Yes/No/Not sure______
Implementation Scope
There are several ways/levels of the program-wide implementation. Phased in implementation is definitely an
option. Depending on your resources and staff you might consider implementing in several pilot classrooms. It is
fine to have pilot classrooms of same age children or varied ages. Please indicate how many classrooms do you
currently intend to coach in the first year _________
This memorandum of understanding is submitted by:
___ ________________________________
Administrator’s signature
__________________________________
Date
Please, submit your completed application to Lana Nenide at lnenide@wiaimh.org on or before April 1st, 2012
Thank you for your interest in program wide implementation of the Pyramid Model. Your application will be
reviewed by an application review committee and your contact person will be notified on May 1st, 2012
10 | P a g e P r o g r a m - w i d e i m p l e m e n t a t i o n s i t e a p p l i c a t i o n