Tools
The implementation of the Tier-3 technical Assistance Model is a step-by-step process guided and monitored by the forms below. Please feel free to download and use the following documents:
Request for Assistance Form
Students with challenging behavior will be referred to the team via the Initial Referral Form from the classroom teacher or other staff that expresses concern with a student’s behavior, or from Office Discipline Referrals (ODR’s) that have been collected and tracked (over 3 ODR’s in 6 weeks will result in the TAT team beginning the referral process).
Universal Classroom Elements Form
The universal classroom elements form is used to guide the initial observation of referring classroom to see if universal classroom positive behavior supports are in place and being accessed by the student in question. In addition, this form allows the team member to record the initial priorities of the teacher for the team to focus, and to state any obvious functions being served by the behavior.
Student Intervention Monitoring Form
The universal supports suggested to the teacher by the team and or any other interventions should be recorded on the Student Intervention Monitoring From.
Functional Assessment Checklist for Teachers (FACTS)
A brief FBA will be completed when the behavior in question is not extreme or complex in nature. The team (with input from the referring teacher or staff member) will use the Functional Assessment Checklist for Teachers (Parts A & B) to complete the brief FBA.
Functional Assessment Interview (FAI)
Functional Assessment Interviews constitute an important component of a comprehensive FBA. (Adapted from: O'Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S.,1997)
Summary Statements Form
The information from the FAI, the direct observation data, and the student program assessment to hypothesize the primary maintaining consequence, setting event and antecedent/predictor factors that are influencing the challenging behavior(s). This information will be summarized on the Summary Statements Form.
Brainstorming and Competing Behavior Paths Form
This form is used to denote appropriate setting event/antecedent/teaching/consequence intervention strategies for minimizing the likelihood that the problem behavior occurs and is reinforced.
