Fillable Form 1: Student-Level Data-Based Individualization Implementation Checklists (National Center on Intensive Intervention)

Fill Online, Printable, Fillable, Blank Form 1: Student-Level Data-Based Individualization Implementation Checklists (National Center on Intensive Intervention) Form

Use Fill to complete blank online NATIONAL CENTER ON INTENSIVE INTERVENTION pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 1: Student-Level Data-Based Individualization Implementation Checklists (National Center on Intensive Intervention)

On average this form takes 27 minutes to complete

The Form 1: Student-Level Data-Based Individualization Implementation Checklists (National Center on Intensive Intervention) form is 5 pages long and contains:

  • 0 signatures
  • 8 check-boxes
  • 106 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your National Center on Intensive Intervention forms online.

BROWSE NATIONAL CENTER ON INTENSIVE INTERVENTION FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
National Center on Intensive Intervention Student-Level DBI Implementation Checklist—1
4651_12/15
Student-Level Data-Based Individualization
Implementation Checklists
Purpose: Intensive intervention teams can use these checklists to monitor implementation of the
data-based individualization (DBI) process during initial planning and ongoing review (progress
monitoring) meetings.
1
Instructions: Teams may complete the checklists during or soon after a meeting. Each checklist
contains questions to answer with Yes, No, or N/A (not applicable). Items answered with No
may indicate aspects of DBI implementation that can be improved. Additional information,
including explanations for “No” answers and plans for improvement, can be provided in the
Comments section at the end of each section.
Initial DBI Meeting Checklist
The team can use this checklist during or after the first intensive intervention planning meeting.
Date of Review: __________________________________________________________
Referral for Intensive Intervention
Does the referral describe the student’s current academic and behavioral supports?
Does the referral describe the student’s previous academic and behavioral supports?
☐ Yes
☐ Yes ☐ No ☐ N/A
☐ No ☐ N/A
Are progress monitoring graphs or other student data provided?
☐ Yes ☐ No ☐ N/A
Comments:
Student Needs Determined
Has the team documented the student’s need for intensive intervention based on the
information provided in the referral and by meeting attendees?
☐ Yes ☐ No ☐ N/A
1
To support conducting and documenting these meetings, see Tools to Support Intensive Intervention Data
Meetings (http://www.intensiveintervention.org/tools-support-intensive-intervention-data-meetings
), which include
guidance documents, sample agendas, and referral and note-taking templates.
National Center on Intensive Intervention Student-Level DBI Implementation Checklist—2
Has the team developed a hypothesis about the student’s underlying academic skill
deficit(s) and/or the function of behavior?
☐ Yes ☐ No ☐ N/A
Did the team consider possible interactions between academic and behavioral needs?
☐ Yes ☐ No ☐ N/A
If more information is needed to identify student needs, has the team developed a written
plan to collect that information?
☐ Yes ☐ No ☐ N/A
Comments:
Intervention Aligned With Student Needs
Does the current intervention reflect evidence-based practices aligned with the student’s
identified skill deficit or function of behavior?
☐ Yes ☐ No ☐ N/A
If the current intervention is an appropriate starting point for intensification, has the team
identified evidence-based or promising practices as adaptations to better address the
student’s needs?
☐ Yes ☐ No ☐ N/A
If the current intervention is not a good match, has the team identified an evidence-based
intervention and/or evidence-based strategies hypothesized to be better aligned with the
student’s needs?
☐ Yes ☐ No ☐ N/A
Comments:
Student Plan for Intensive Intervention and Progress Monitoring
Is the plan in writing?
☐ Yes ☐ No ☐ N/A
Does the plan include sufficient information on the intervention and adaptations to
implement the plan?
☐ Yes ☐ No ☐ N/A
National Center on Intensive Intervention Student-Level DBI Implementation Checklist—3
Does the plan specify the person(s) responsible for delivery of the intervention?
☐ Yes ☐ No ☐ N/A
Does the plan provide details for intervention schedule and dosage?
☐ Yes ☐ No ☐ N/A
Does the plan specify a method for progress monitoring?
☐ Yes ☐ No ☐ N/A
Does the plan identify the person(s) responsible for collecting progress monitoring data?
☐ Yes ☐ No ☐ N/A
Is a valid and reliable progress monitoring tool used (if available)?
☐ Yes ☐ No ☐ N/A
Will progress monitoring data be collected at least weekly?
☐ Yes ☐ No ☐ N/A
Will progress monitoring data be graphed?
☐ Yes ☐ No ☐ N/A
Does the plan indicate a progress monitoring goal with a date to be achieved?
☐ Yes ☐ No ☐ N/A
Please describe how the team selected the goal (e.g., using benchmarks or local norms):
________________________________________________________________________
Does the plan specify procedures for determining whether progress is sufficient (i.e.,
decision rules for determining when further adaptations should be considered)?
☐ Yes ☐ No ☐ N/A
Is there a plan for monitoring plan implementation? Consider intervention components,
intervention dosage, and data collection.
☐ Yes ☐ No ☐ N/A
Is there a plan for communicating the student’s plan to relevant staff, parents, and the
student, when appropriate?
☐ Yes No ☐ N/A ☐
Does the plan set a date for the next meeting to review implementation and student
progress? Date _____________ None set ☐
Comments:
National Center on Intensive Intervention Student-Level DBI Implementation Checklist—4
Progress Monitoring Meeting Checklist
The team can use this checklist during or after any meeting held to review the student’s plan and
progress. Teams may want to consider setting a schedule for completing the checklist for each
student receiving DBI based on the passage of time or when significant intervention adaptations
are needed or have been made.
Date of Review: __________________________________________________________
Was information on plan implementation brought to the meeting?
☐ Yes ☐ No ☐ N/A
Were graphed progress monitoring data brought to the meeting?
☐ Yes ☐ No ☐ N/A
Based on available progress monitoring data and the decision rules agreed upon in the
last meeting, is the student making sufficient progress?
☐ Yes ☐ No ☐ N/A
If the student is not making sufficient progress, did the team rule out factors other than
the appropriateness of the intervention that could be impacting progress? Consider:
o The quality of intervention implementation ☐ Yes No N/A ☐ ☐
o Student attendance and engagement ☐ Yes ☐ No ☐ N/A
o The sensitivity of the progress monitoring tool ☐ Yes ☐ No ☐ N/A
If new adaptations need to be made, did the team first revisit its hypothesis on student
needs and determine if new diagnostic or functional assessment data are needed?
☐ Yes ☐ No ☐ N/A
If new diagnostic data are needed, are they documented in the plan along with the
person(s) responsible for collecting this information?
☐ Yes ☐ No ☐ N/A
If the team decided to further adapt the intervention, did the team identify evidence-based
practices aligned with the latest, data-driven hypothesis on student needs?
☐ Yes ☐ No ☐ N/A
Are any changes in intervention or data collection plans documented in an updated
student plan?
☐ Yes ☐ No ☐ N/A
Is there a plan for providing updates on student progress and changes to the student’s
plan (if any) to relevant staff, parents, and the student, when appropriate?
☐ Yes ☐ No ☐ N/A
National Center on Intensive Intervention Student-Level DBI Implementation Checklist—5
Does the plan set a date for the next meeting to review implementation and student
progress?
Date _____________ ☐ None set
Comments:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 1: Student-Level Data-Based Individualization Implementation Checklists (National Center on Intensive Intervention)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document