On this page...

Student Wellness Program Timeline & overview

Step 1: Universal Screen process and resources

Step 2: Tier 2 Referral Forms (online & paper) & resources

Creating Classroom Matrix resources for in-person AND remote instruction

Step 3: TIPS meeting forms (Team Initiated Problem Solving for PBIS teams)

Step 4: Tier 2 decision rules matrix

Step 5: PBIS Parent Information brochures to accompany all consent forms

Step 6: Tier 2 progress monitoring forms & resources, progress report

Resources:

WCSD CICO handbook, guidance for adapting to distance learning, training video
Excel sheet to create your own Triangle report for all Tier 2 & 3 interventions
Resources from Wisconsin and Missouri PBIS Tier 2 programs

PBIS Tier 2 Team Resources

***NOTE: Videos, powerpoint slides, & handouts from all previous PD days are on the "Presentations" page of this Google Site

Student Wellness Program 2021-22

With a solid Tier 1 foundation based on PBIS core practices of explicit teaching and reinforcement of expected student behaviors, positive relationships, and trauma-sensitive logical consequences, Whittier City is ready to build strong Tier 2 supports for those students who need more.

The Student Wellness Program launched in the Fall of 2019 with a focus on early intervention. Based on crisis response data collected each school year, as well an input from early childhood teachers, the key components are:

- - Focus on Kinder through 2nd grade
  - Early identification of needs by conducting walk-throughs of Kinder & 1st grade classrooms and completing the Universal screen for social-behavior-attendance-academic risk
  - Social emotional learning curriculum in every TK-2nd grade classroom using Second Step, and SEL support for all other grades
  - Trauma-informed social emotional curriculum in every 4th & 5th grade classroom using Bounce Back curriculum, led by school social worker interns (winter trimester)
  - Tier 2 teams review referrals and universal screening information to match students to interventions and monitor progress using Tier 2 tracking systems (SWIS data, Check-In-Check-Out, Tier 2 google sheet)
  - Increase parent engagement by using Tier 2 Progress Report form & documenting interventions on the CUM Intervention Record

Universal Screen Process and links to documents: Distance Learning Versions

Teachers nominate students for Tier 2 Team to triage and monitor or connect with resources

Repeat regularly - monthly or each trimester

Tier 2 & SLC Referral Forms

During Distance learning, we have created an (optional) online form version of the Tier 2 Referral Form:

Post on your school's website under "Staff Resources" and "Parent Resources"
Post on your site's Wellness google site
Email link to staff and ask them to bookmark it

Google Form TEMPLATE:

1. 1. Make a copy & rename with your school's name
  2. Add your Tier 2 & 3 Team members as collaborators

https://forms.gle/zNxC3qEf8QLHtqhV6

Google Form TEMPLATE:

1. 1. Make a copy & rename with your school's name
  2. Add your Tier 2 & 3 Team members as collaborators

https://forms.gle/eDVkWMvnDBZ5XrFJA

SPANISH Parent Request for Assistance from Tier 2 Team or SLC

https://forms.gle/ME8CeJu8aspdmLCd9

This is a Google Doc Version - Please make a copy before renaming it using this format: "Tier 2 Referral for [student name]"

Tier 2 Referral Part 1 Behavior and Part 2 Social Emotional 1.14.20

Part 1 -Behavior & Part 2 -Social Emotional (Counseling)

**Attach a copy of your classroom matrix and circle the specific matrix behavior you would like to improve

See "How to build a classroom matrix," below

(updated January, 2020)

All SLC docs in shared folder

How to build a classroom matrix, with samples and a template

Classroom Matrix Descriptor.doc

Creating a PBIS Behavior Teaching Matrix for Remote Instruction.pdf

Creating a Behavior Teaching Matrix for Remote Instruction from the National Center for PBIS

Tier 2 Meeting Minutes - TIPS (Team Initiated Problem Solving)

Tier 2 Team Meeting Minutes with Cover Sheet

Tier 2 CICO Meeting Minutes

1. Schedule Tier 2 Team meetings (weekly, biweekly, at least monthly)

2. Decide on roles during the meeting and logistics for collecting and tracking progress monitoring data and referrals

3. Use the TIPS meeting agenda to track decisions

Image of Tier 2 Team Meeting Minutes

as they appear after the cover sheet

Tier 2 Flow Chart WCSD 2.16.18.pdf

More Counseling Resources on PsychCorner

Tier 2 Decision Rules:

CICO or Counseling?

Small group or individual?

Tier 2 Decision Rules Matrix.pdf

Decision Rules for Each Counseling Program

Counseling Program Curricular Guides and Pre/Post Tests

PBIS Parent Information Brochures

Send with all CICO or other Tier 2 Consent Forms

English

PBIS parent Brochure 2019.pdf

Spanish

PBIS parent Brochure 2019 SP.pdf

Progress Monitoring Tools

**Create A Progress Report for Every Student Discussed At Tier 2 Team Meeting & Add to the Team Binder

MTSS PBIS Tier 2 intervention Progress Report v3.pdf

Tier 2 Intervention Group Progress Worksheet.

Use this to track interventions groups using the Delaware Excel file titled, "Tier 2 intervention tracking with graphs- ADD SCHOOL NAME"

Tier 2 Intervention Group Progress Monitoring Worksheet .docx

Enter Progress Data into this Excel sheet for Tier 2 Team problem solving

Note:

• Converting to Google Sheets from the original Excel file loses formulas for creating graphs by month, but you can still see graphs by Intervention

Tier-2-Intervention-Tracking-with-Graphs-1.19.15-Sample-Data

Blank Excel Sheet for Tier 2 Tracking

• This workbook can track up to 10 interventions/groups. If you have more than 10, consider creating one workbook for academic groups and another for behavior interventions

Tier-2-Intervention-Tracking-with-Graphs-ADD-SCHOOL-NAME-1.xlsx

WCSD Check-In-Check-Out Team Handbook

Guidance on Adapting Check-in Check-out (CICO) for Distance Learning-1.pdf

Adapting CICO for Distance Learning

Check-In-Check-Out Handbook For WCSD 2.pdf

Decision Rules for CICO vs Counseling
Packets for Mentors, Classroom Teachers, Students, Parents (customize with your Matrix language)
Tier 2 Team meeting minutes and structures
Forms and templates to customize

Google Drive folder with PDF and Word versions of CICO documents

(Open in google docs, then download as a Word Dox)

Check In Check Out Video Tutorial Educational Behavior Intervention_854x480_MP4.mp4

CICO Video Demonstration

(8 Minutes)

Create your own 3-tier triangle graph for

Reading, Math, and Behavior!

Triangle MultiLevelSystemsTool.xlsx