Selected/Intensive Multi-Level Action Plan
Name _____________________________________
District_________________________________________
Handout 6
Date__________________________
Reflect on the concepts discussed today relative to PBIS secondary and tertiary interventions/systems of support. Apply new learning by designing a plan for your
school or district that focuses on the development of secondary and tertiary interventions.
Directions:
School Name:
1. Use one action plan to coordinate all of the building’s PBIS implementation steps. This is a sample format; others can be used for the same purpose.
2. Sources of actions steps come from trainings and tools such as BoQ, SAS, SSS, School Profile, etc.
Tier/Topic
Repositioning staff/
modifying support
roles
Selected/intensive
continuum of supports
Strengths/Barriers
Next Steps
Action/Strategies
Who?
When?
Selected/Intensive Multi-Level Action Plan
Tier/Topic
Tools for data-based
decision making
(ODRs, screening,
CICO, etc.)
District-level databased decision making
(special education
placement, LRE)
Integrating related
initiatives
Strengths/Barriers
Next Steps
Action/Strategies
Who?
When?
Selected/Intensive Multi-Level Action Plan
Tier/Topic
Strengths/Barriers
Next Steps
Action/Strategies
Who?
When?