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Behavior expectations & ladder of Referral Process
common planning week- august 25 – 29th, 2014
Mr. E. Figueroa – Wellness Coach
VALIDUS SOCIAL CONTRACT
LISTEN AND BE PRESENT COMMITMENT
Means . . . Be fully prepared for class every day Always aim to do your best work in school Pay attention in class by listening attentively Stay on task when working independently or in groups
FOLLOW SCHOOL RULES RESPONSIBILITY
Means . . . Attend school every day and be on time Wear the school uniform each day No hats or hoods in the building Maintain order in the hallway, bathroom, cafeteria and school yard Follow directions given by all school staff.
Non-negotiables: Cell phones or other electronic devices Fighting or conspiring to fight on or off school grounds Bullying by verbal, physical or cyber intimidation ( Facebook, Instagram, or Twitter) Defacing or stealing school or others’ personal property Threatening students or adults verbally or physically Leaving the classroom or school building without permission
BE A TEAM PLAYER COLLABORATION
Means . . . Wait your turn Participate in group and school activities Encourage each other to do well and be successfulNon-negotiables: Disrespect/insubordination/profanity/uniform
BE RESPECTFUL TO ALL COMPASSIONMeans . . . Treating others as you would like to be treatedNon-negotiables: Sexual harassment Profane words and actions towards peers or teachers
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LADDER OF REFERRAL
STEPS TO RESOLVING CONFLICT IN A HEALTHY COMMUNITY
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Verbal Warning(Teacher, Administration or
Support Staff)
WOW Form or Conversation with Crew Advisor
Conversation with Wellness Coach, Crew Advisor, Fairness Committee, or Peer Mediation
Phone Call Home
Referral to Wellness Staff ( Social Worker, Guidance Counselor)
Parent Conference with Wellness Coach and/or Parent Coordinator
Meeting with Ms. Frisco or Ms. Bruck
Suspension
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DISCIPLINE PROCEDURES FOR
MINOR INFRACTIONS
Consequence Verbal Warning
Description of Consequence
Student is spoken to about their behavior either in private or during the class. A verbal warning is given when student actions affect their ability to work independently or in a group. Students should get 2 warnings (preferably non-verbal) before they are directed to TAB.
Examples of Student Actions
Arriving to class late Calling out Delaying starting work Disrupting group work Head on the desk Making noises Sitting in wrong seat Side talking Throwing objects Unprepared for class
Expectations for Student Behavior
Abide by the Social Contract Explain their difficulty or challenge Resume work after being spoken to by teacher
Administrator Responsibilities including
Principal, Assistant Principal, Wellness
Coach and Guidance Counselor
None, unless teacher has difficulty and/or student becomes defiant/disrupts the classroom
Teacher Responsibilities
Address student actions as soon as possible Explain why student is being given a verbal warning Engage student in reflective conversation (using Developmental Designs
language [Appendix A]) about school expectations for student conduct, classroom expectations and consequences
Detain after class if needed and have student practice the procedure again Identify students who are causing behavior issues and proactively make
accommodations for their specific needs, especially students with disabilities (SwD).
If student becomes defiant/disrupts the classroom, call an Wellness Coach or AP Talk with Principal, AP or Guidance Counselor about Best Practices in
classroom management and professional development opportunitiesOther Staff
Responsibilities including Paraprofessionals and
School Aide
Depending on the student’s actions, get the teacher’s attention and explain what you observed
If the student’s actions pose a safety threat, get the Wellness Coach or AP or SSA
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Consequence Take a Break (TAB)
Description of Consequence
Students can choose to TAB independently or can be directed by the teacher. TAB time should be between 3 – 5 minutes and should not disturb the rest of the class. A student may be given at most 3 TABs before their name goes on the section sheet. After the 2nd TAB, the student must me invited back to the group by the teacher.
Examples of Student Actions
Continuing with disruptions after being given a verbal warning Needing a few minutes to refocus
Expectations for Student Behavior
Abide by the Social Contract Sit at the TAB station quietly Complete the reflection at the table Return to seat quietly within 3 -5 minutes Resume work after TAB Speak with teacher before leaving the classroom
Administrator Responsibilities including
Principal, Assistant Principal, Wellness Coach and Guidance Counselor
None, unless teacher has difficulty and/or student becomes defiant/disrupts the classroom
Teacher Responsibilities
Address student actions as soon as possible Explain why student was given a TAB or ask why they decided to TAB Engage student in reflective conversation (using Developmental Designs
language) about school expectations for student conduct, classroom expectations and consequences Explain a strategy for controlling off-task behavior
Work with student to set a goal for self-control/self-monitoring Detain after class if needed and have student practice the procedure Identify students who may continue to cause behavior issues and work with
other teachers to proactively make accommodations for their specific needs, especially students with disabilities (SwD)
If student becomes defiant/distrusts the classroom, call Dean or AP Talk with Principal, AP or Guidance Counselor about Best Practices in
classroom management and professional development opportunities
Other Staff Responsibilities including Paraprofessionals
and School Aide
Depending on the student’s actions, get the teacher’s attention and explain what you observed
If the student’s actions pose a safety threat, get the Wellness Coach or AP or SSA
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Consequence Take a Break Out & Back (TAB Out)
Description
Students in a TAB Out will be sent to a co-teacher’s room for 10-15 minutes. The purpose of a TAB Out is for a student to refocus to avoid serious disruption of the educational process. During the TAB Out time, the student must complete the reflection sheet (Appendix C) which should be returned to their classroom teacher.
Example of Student Actions
Disrespect or defiance towards the teacher like talking back or yelling Actions that could potentially lead to physical altercations with other students
Expectations for Student Behavior
Abide by the Social Contract non-negotiables including:o No fightingo No disrespect/insubordinationo No threatening students or adults
Students may not TAB Out themselves. A self-imposed TAB Out is considered cutting class and leaving a room without permission
Students may not roam the hallways, go to other classrooms or to the bathroom on their way to a TAB Out
Students may not disturb the students in the TAB Out room. If they disturb the classroom, the teacher will inform their classroom teacher via the reflection sheet
Students who violate a TAB Out will earn 10 minutes of detention for each infraction they amass during the time
Students who have to TAB Out more than 2 times in one day will meet with the Dean or AP
Administrator Responsibilities
including Principal, Assistant Principal, Wellness Coach and Guidance Counselor
Dean or AP can:o remove a student who is visibly angry or violent and disrupting the classroomo give detention to a student who violates a TAB Outo review TAB Out Reflections and determine next steps for intervention including
phone call home and/or Conduct Sheet (Appendix D )
Teacher Responsibilities
If the student is visibly angry or violent or leaves the room without permission, call the Wellness Coach or AP immediately
Student must be given TAB Out pass Communicate with TAB Out teacher during this process so that the student’s
whereabouts are always known and the TAB Out teacher must sign the sheet Record TAB Out the Section Sheet Collect TAB Out Reflection sheet when student returns. If the student does not return
take all steps to find out where they are and then inform the Dean or AP Keep all TAB Out Reflection sheets in the student portfolio Provide a copy to the Dean or AP Identify students who continue to cause behavior issues and complete Dean or AP
Referral (Appendix E).Other Staff
Responsibilities including
Paraprofessional and School Aide
Depending on the student’s actions, get the teacher’s attention and explain what you observed
If the student’s actions pose a safety threat, get the Dean or AP or SSA
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DISCIPLINE PROCEDURES FOR
MODERATE INFRACTIONS
Consequence Phone Call Home
Description
This can be done at any earlier stage in the discipline process, but must be done so that the parent is aware that the student is bordering on more severe disciplinary action. A phone call home is warranted for chronic behaviors that disturb the educational process, place the student in danger or pose a safety issue for the school.
Example of Student Actions
TABs and TAB Outs have not changed their behavior Accommodations made to help them self-regulate behavior and remain on task have
been unsuccessful Persistently missing homework, incomplete assignments and projects Leaving classroom without permission Profane actions and words Aggressive and bullying behavior
Expectations for Student Behavior
Abide by the Social Contract non-negotiables including:o No bullyingo No profane words or actionso No sexual harassmento No threatening students or adults
Be prepared for class every day Homework and all assignments must be completed in a timely manner and turned in Missed work should be made up and turned in per the teacher’s instructions
Administrator Responsibilities including
Principal, Assistant Principal, Wellness Coach and Guidance Counselor
Any administrator can call parents at any time, for any reason concerning their child’s academic progress, behavioral issues or safety
Log parent contact on referral forms and on the Parent Contact Google Doc
Teacher Responsibilities
Call parent concerning a child’s academic progress, behavioral issues or safety Call from the main office phone after 3:00 pm or from the AP or Principal’s phone
at any time Log calls on the Parent Contact Google Doc within 48 hours
Other Staff Responsibilities including Paraprofessionals
and School Aides
Depending on the student’s actions, get the teacher’s attention and explain what you observed
If the student’s actions pose a safety threat, get the Wellness Coach or AP or SSA Crisis Paraprofessionals should discuss concerns with classroom teacher before
contacting parents
Intervention AP/Wellness Coach or Guidance Referral
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Description Teachers can recommend further actions be taken to assist with classroom behavior issues when students have had little or no response to previous interventions.
Administrator Responsibilities including
Principal, Assistant Principal, Wellness Coach and Guidance Counselor
Wellness Coach and/or AP meet with:o student to discuss persistent misbehavioro teacher to discuss corrective actions implementedo Guidance Counselor to determine whether student issues are behavioral or
SEL Guidance Counselor will meet with student to discuss persistent misbehavior Wellness Coach/AP will inform teacher if it is determined that student may be
removed from classroom for any time period Before re-entering the class, student will be asked to complete a reflection to
discuss with Wellness Coach or Guidance Counselor AP/Wellness Coach and Guidance may determine that due to the types and
frequency of infractions a Student Intervention Team (SIT) case should be initiated.
Teacher Responsibilities
Fill out referral form (Appendix E) Provide all the relevant documentation to show that the LOR has been exhausted
and previous interventions have been used If SIT case is initiated, complete the SIT Referral Form (Appendix F) Meet with student upon re-entry to rebuild working relationship
Other Staff Responsibilities including Paraprofessionals
and School Aides
Crisis Paraprofessional should discuss issues with classroom teachers before a referral is filed.
Intervention Parent Meeting with Teacher, Assistant Principal and/or Principal
Description
A parent conference can be scheduled to convene the main parties concerned about the student’s academic progress, behavioral issues or safety concerns when little or no evidence that Wellness Coach or Guidance intervention has resulted in modified behavior or academic performance. This can occur at any time but is mandatory after an emergency situation involving their child.
Administrator Responsibilities including
Principal, Assistant Principal, Wellness Coach and Guidance Counselor
Review the teacher documentation and results of Wellness Coach or Guidance referral.
Administrators meet with the student and parent(s) to discuss behaviors, steps taken, and possible next steps.
Documentation of the meeting attendees, concerns and outcome will be kept on the Parent Conference Form (Appendix G)
Parents will also be informed of consequences of further misbehavior or of specific guidance interventions that will be implemented and be required to sign a Behavior Contract along with their child (Appendix H).
SIT case may be initiated.
Teacher Responsibilities Participate in conference Provide documentation of major concerns
Other Staff Responsibilities including Paraprofessionals
and School Aides
Crisis Paraprofessional should participate in conference to support classroom teacher.
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Intervention Student Intervention Team (SIT)
DescriptionTeachers still has concerns about student behavior or well-being even after all the previous interventions have been exhausted.
Administrator Responsibilities including
Principal, Assistant Principal, Wellness Coach and Guidance Counselor
SIT prioritizes the possible candidates and notifies referring teacher of meeting date and documentation to supply.
At SIT meeting, SIT committee, including chairperson, general education teacher, special education teacher and principal, meets with teacher and any other teachers with similar concerns about the student
SIT meeting goal is to analyze behavioral and academic difficulties; clarify student actions when in crisis; be apprised of teacher interventions; and to create a plan of action.
Referring teacher is expected to implement the plan, maintain anecdotal reports of student actions, and finally, report to the SIT within an agreed upon time.
SIT follows up with teacher and determines further actions that might be need whether on site or off site through community-based organizations, etc.
SIT updates parent(s) or guardian(s) regarding student progress.
Teacher Responsibilities Fill out SIT Referral Form (Appendix G) of a student to the SIT Implement the strategies suggested by SIT and track student progress for at least
2 weeks
Other Staff Responsibilities including Paraprofessionals
and School Aides
Crisis Paraprofessionals may be asked to attend SIT meetings.
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DISCIPLINE PROCEDURES FOR
MAJOR INFRACTIONS
Intervention Principal’s Suspension
Description
Relates to Level 4 infractions of the Discipline Code i.e. incidents involving Aggressive or Injurious/Harmful Behavior. After investigations confirm the student’s involvement, the student will complete this in-school suspension for 1 – 5 days. The length of suspension is determined by: the student’s intent the location in which the incident occurs the extent of injuries the student’s number of prior infractions the witness statements
Administrator Responsibilities including Principal, Assistant Principal, Wellness Coach and
Guidance Counselor
Wellness Coach and AP will investigate the incident and get take statements from victim(s), suspect(s) and witnesses
Wellness Coach or AP will contact parents immediately to inform them of their child’s involvement in the incident
Within 24 hours of the incident, Dean or AP will prepare a Letter of Suspension that states the reason for suspension and the date of a suspension conference. This letter will serve as parent notification and be delivered by express mail or by hand.
AP will conduct suspension conference with parent(s) and student Wellness Coach will notify the student’s teachers of the suspension and get
work that the student must completed Wellness Coach enters incident in OORS/SOHO and update Suspension Log
(Appendix I) Guidance or Wellness Coach will conference with student before he/she re-
enters the regular school routine.
Teacher Responsibilities
Check-in with student to explain the work they must complete during the suspension.
Give texts and any handouts of classwork and homework for each day that student is suspended to the Wellness Coach/AP on the morning of the suspension.
Collect work done during the suspension from the Wellness Coach/AP office, grade it and count it towards the student’s grade for that marking period.
Other Staff Responsibilities including Paraprofessionals and
School Aides
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Intervention Superintendent Suspension
Description
Relates to Level 5 infractions of the Discipline Code i.e. Seriously Dangerous or Violent Behavior. A Superintendent’s suspension can be immediate depending on the level of threat the student poses or the level of the infraction. Student will be removed from regular classes for 6 days to 1 year. A suspension hearing will be scheduled
Administrator Responsibilities including Principal, Assistant Principal, Wellness Coach and
Guidance Counselor
Wellness Coach and AP will investigate the incident and get take statements from victim(s), suspect(s) and witnesses
Wellness Coach or AP will contact parents immediately to inform them of their child’s involvement in the incident
Within 24 hours of the incident, Dean or AP will give the Letter of Suspension that states the reason for suspension; the alternate site where student must go during the suspension; and the date of a suspension hearing. This letter will serve as parent notification and be delivered by express mail or by hand.
AP will conduct suspension conference with parent(s) and student Wellness Coach will notify the student’s teachers of the suspension and
get work that the student must completed Wellness Coach enters incident in OORS/SOHO and update Suspension
Log Guidance or Wellness Coach will conference with student before he/she
re-enters the regular school routine. Guidance or Wellness Coach will conference with student before he/she
re-enters the regular school routine.
Teacher Responsibilities
Check-in with student to explain the work they must complete during the suspension.
Give texts and any handouts of classwork and homework for each day that student is suspended to the Dean/AP on the morning of the suspension.
Collect work done during the suspension from the Wellness Coach/AP office, grade it and count it towards the student’s grade for that marking period.
Other Staff Responsibilities including Paraprofessionals and
School Aides
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ADDITIONAL DISCPLINARY POLICIES & PROCEDURES
Detention
Description
Students can receive detention for the following infractions:o Not wearing the school uniformo Disobeying the directions of staff during passing, in the
cafeteria or in the school yard Detention can be completed:
o During lunch/recess in the cafeteria or in the school yardo During lunch with a classroom teacher who picks up the
student from the lunch roomo During the school day in lieu of suspensiono After school on Fridays between 2:50 and 3:30 pm
Expectations for Student Actions
Arrive at the detention room on time Make sure that your attendance is taken. If you are marked absent, you
will have to make up the time another day by sitting out lunch and recess or serving more time on Friday
Complete your work quietly and independently Clean up and leave the room at the teacher’s signal Go directly to after-school program or home
Expectations for Wellness Coach /AP
When students have detention, their names will be recorded on the Weekly Detention Log (Appendix J-1)
Teachers will be notified via the Daily Notes about the students who must serve detention
Expectations for Community Associate
Update the log on a daily basis at breakfast or at the end of the school day
Call home on the day of the infraction to inform parents On Friday mornings, give the Detention Notice (Appendix K-2) to
remind students about serving detention. Assemble students during PM Advisory and take them to the detention
room Give the Detention Supervisor the log and collect it on Monday
morning For students who were absent, schedule a detention make up and call
home to inform parents
Expectations for Detention Supervisor
Get the log from the Community Associate Meet students at the door Take attendance within the first 5 minutes and inform Dean/AP of any
missing students Direct students to quietly take out some independent work to do There is no bathroom privilege Dismiss students by walking them to the exit doors Return attendance sheet to Community Associate
Mediation
Description Students can choose, be referred or be required for mediation before or after an
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incident. Mediation will be conducted using the guidelines outlined in Appendix L 1-3).
Expectations for Student Actions
Abide by the rules of mediation Sign the agreement form Desist with conflict If other party does not uphold the agreement inform the mediator
Expectations for Dean /AP Assist teachers and students with learning the mediation process Conduct mediations Maintain records of mediations in student discipline portfolio
Expectations for Community Associate
Assist Wellness Coach/AP with mediation training Assist peer mediator with mediation sessions Communicate with families when their child is involved in a mediation
Expectations for Guidance Counselor
Assist teachers and students with learning the mediation process Conduct mediations File all mediation documents with Wellness Coach/AP student behavior
portfolio
Expectations for Mediation Supervisor
Review the mediation protocol before going through the process Ensure that disputants arrive at a resolution and sign the mediation agreement File all mediation document with Wellness Coach/AP student behavior
portfolo
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SAVE
Description
Students who are serving a principal’s suspension will receive instruction in an alternate location under the supervision of a teacher. Their day will be spent completing assignments given by their teachers and/or meeting with the Wellness Coach or AP or Guidance Counselor.
Expectations for Student Actions
Attend school each day of the suspension period Remain in the SAVE room unless escorted by the supervisor Complete all assignments Complete homework Attend AIS
Expectations for Wellness Coach /AP
Escort student to and from the SAVE room at arrival and dismissal Update the Suspension Log and inform Principal so Daily Notes can be
updated Collect assignments from teachers and turn it over to the SAVE supervisor
Expectations for Community Associate
Add student to the check-in schedule Communicate future check-in schedule with student’s parent/guardian Document each session with student
Expectations for Guidance Counselor
Meet with student before the end of the suspension period Determine whether further counseling is needed. If so, inform Principal and
AP Communicate future counseling schedule with parents Document each session with student Update counseling in OORS
Expectations for SAVE Supervisor
Keep student in the room unless they are using the bathroom Do not leave the student alone at any time Student must complete all the assignments given by their teachers. Assist the student with assignment completion to the best of your ability. If
the student is having difficulty, inform the Wellness Coach or AP or their teachers.
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APPENDIX A: DEVELOPMENTAL DESIGNS STUDENT CONVERSATION CHEAT SHEET
Directing LanguagePrecise and concise
Without speaking, line up at the door . . . Open your book to . . . Be ready to . . .
Reinforcing LanguageSpecific and descriptive
You remembered to . . . I notice that you . . . You were able to ___. How do you feel about that? You did it! What strategies did you use to accomplish that?
Reminding LanguageEncourages planning
Remind us how to . . . Who remembers . . . ? Who can show us . . . ? Tell me how you are going to . . . ? What’s one way we said we could . . . ?
Redirecting LanguageDirective, names the ideal, invokes different sources of authority
You have been late three times. What will you do differently to be on time tomorrow? Our rules say . . . or . . . We agreed to . . . Take a break, Charles. Show me a better way to do/say that. Find a different place to sit.
Reflecting LanguageOpen-ended, without judgment
How did you solve the problem? Think about ways you could do this differently. Can you name some things that went well(wrong)? What did you enjoy(dislike) most? In what ways did(didn’t) we follow our rules? Think about last time. What worked and what did we say we wanted to change?
Others I learned
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APPENDICES
APPENDIX B: DAILY OBSERVATION SHEET
Validus Preparatory Academy
Daily Observation Sheet
Class: ______ Grade ______ Date _________________
Subject/Teacher
Overall Behavior:Outstanding (O)Satisfactory (S)
Needs Improvement (N)
Comments
Student Sign-Out:Bathroom (B)
Nurse (N)Main Office (M)
TAB Out(T)Cutting (C)
Subject___
Teacher(s)_____________
O
S
NSubject___
Teacher(s)_____________
O
S
NSubject___
Teacher(s)_____________
O
S
N
Subject___
Teacher(s)_____________
O
S
N
Subject___
Teacher(s)_____________
O
S
N
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APPENDIX C: TAB OUT REFLECTION
Take a Break Out & Back Reflection Sheet
Name:__________________________ Date:________________
Class:_________________ Period:________________
Class Teacher:_________________
1. Today, I was not able to ___________________________________________________, so I was given a TAB Out. How do I feel about that? __________________________________________________________________________________________________________________________________________________________________________
2. Which school rule did I break? In what way(s) didn’t I follow our Social Contract? Be a team player Be respectful to all Follow school rules Listen and be present
3. How could I handle this situation differently next time? _________________________________________________________________________________________________________________________________________________________________________
4. What can my teacher do to help me make positive behavioral changes easier to accomplish? __________________________________________________________________________________________________________________________________________________________________________
5. How will I regain my teacher’s their trust in me and get back on track as I know I can? __________________________________________________________________________________________________________________________________________________________________________
6. What steps will I take to get the work that I missed during the TAB Out?
_____________________________________________________________________________________
Student Signature:____________________________________
TAB Out Teacher:____________________________________
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________________________________________________________________________________________________________________________________________________________________________________________________________
APPENDIX D: INDIVIDUAL STUDENT CONDUCT SHEET
WEEKLY CHART FOR MONITORING CLASSROOM BEHAVIOR
Directions: Student must take this to every class and give it to the teacher Teacher must rate the student on a scale from 1 to 5 based on the criteria below. Please initial. After each day, student must show sheet to Wellness Coach, AP or Guidance Counselor. Also, have a parent or
guardian sign it. At the end of the week, student must turn in the sheet to the Dean, AP or Guidance Counselor Student can earn rewards for successfully getting 4 and 5’s each day or improvement over the course of the week.
Student’s Name:
Advisor’s Name:
Dates:
Monday Tuesday Wednesday Thursday Friday
AM Advisory
Period 1
Period 2
Period 3
Period 4
LUNCH/Recess
Period 6
PM Advisory
Reward:___________________________________________________________________________________________________________________________________________________________________________
Criteria for Classroom Conduct:
Stays on task Works well with others Listens to teacher and follows directions Completes all work and hands in required homework, projects, etc. No fighting or arguing with the teacher or other students
APPENDIX E: WELLNESS COACH OR AP REFERRAL
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Classroom Referral Form to Assistant Principal/Wellness Coach
Date:___________________
Student Name:_______________________________________ Class:_____________
Submitted by:________________________________________
Brief description of Concerns
__________________________________________________________________________________________________________________________________________________________________________________
Example of student Infractions (Check all that apply)
Excessive use of or repeated TAB Out violations Cutting class Disrespect/insubordination Leaving class without permission Engaging in aggressive or disruptive behavior too often
Corrective Actions already taken by teacher to address the student’s infractions (Check all that apply)
Conduct sheet Discussed student with other teachers to determine interventions that work Moved student’s seat/ gave preferential seating Lunch detention Offered choices/prompts to self-correct or problem solve One-on-one conference Peer partnership or special grouping Periodic breaks to move and refocus Phone call or letter home TAB & TAB Out (Indicate # of times:_________________________)
FOR DEAN, AP OR GUIDANCE USE ONLY
Corrective Action taken by Wellness Coach (W) AP (A) or Guidance Counselor(G) (Indicate person who initiates action and date. Conduct sheet D A C Date_______________ Conference with student D A C Date_______________ Conference with student and teacher D A C Date_______________ Detention D A C Date_______________ Loss of privilege D A C Date_______________ Mediation D A C Date_______________ Parent conference D A C Date_______________ Phone call home D A C Date_______________ Referral to Guidance Counselor D A C Date_______________ Switch student’s class D A C Date_______________ Temporary removal from class D A C Date_______________
APPENDIX F: SIT REFERRAL FORM
STUDENT INTERVENTION TEAM REFERRAL FORM
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BIOGRAPHICAL INFORMATION
Student Name_________________________________________ Class__________________
OSIS #_______________________________
___General Education ___Hold over
___Special Education ___Over Age
___English Language Learner
Testing History
ELA: State Exam Score__________ Last class grade________
Math: State Exam Score__________ Last class grade__________
Science_________ Social Studies_________ Physical Education________
TEACHER KNOWLEDGE OF STUDENT
What are the student’s strengths? (Academic, social, behavioral)
______________________________________________________________________________________________
____________________________________________________________________________________
What are the student’s areas of interest? What does the student like to do?
______________________________________________________________________________________________
____________________________________________________________________________________
With whom does the student relate well or experience success? Supply evidence.
_________________________________________________________________________________________
BEHAVIOR IDENTIFICATION
Describe the student’s behavior that you experience as disruptive/concerning. Be specific.
______________________________________________________________________________________________
____________________________________________________________________________________
Give an example of this behavior and its impact on you and the group/class.
______________________________________________________________________________________________
____________________________________________________________________________________
Choose one specific behavior that you want to reduce/eliminate and state it in as few words as possible.
______________________________________________________________________________________________
____________________________________________________________________________________
Behavioral Interventions Used
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___separate work space ___consistent schedule ___silent cues___transition preparation ___clear rules and expectations ___stress balls___positive reinforcement ___opportunities for movement ___conduct sheet___conversation with staff___Other:_________________________________________________________________________Other:______________________________________________________________________
ACADEMIC IDENTIFICATION
Describe the student’s academic behavior that you find concerning?
______________________________________________________________________________________________
____________________________________________________________________________________
Give a specific example of this academic difficulty.
______________________________________________________________________________________________
____________________________________________________________________________________
Academic Interventions Used
___IEP recommendations ___individual conferencing ___separate work space ___modified material ___immediate feedback ___small group instruction ___advice from co-teacher ___opportunities for choice ___additional time___Other____________________________________________________________________________________Other_________________________________________________________________________________
PARENTAL CONVERSATIONS
Date_______________ Concerns_______________________________________________________ ____________________________________________________________________________________________________________________________
Date_______________ Concerns______________________________________________________ ____________________________________________________________________________________________________________________________
Date_______________ Concerns__________________________________________________________________________________________________________________________________________________________________________________
TRIGGER/PATTERN OF BEHAVIOR
Can the disruptive behavior be anticipated? If so, when?
______________________________________________________________________________________________
____________________________________________________________________________________
What conditions are present when the behavior occurs? Explain with reference to time, place, activity, peers, etc.
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______________________________________________________________________________________________
____________________________________________________________________________________
Does the student have any personal, emotional, or developmental issues that may be contributing to the behavior? If so, briefly describe.
______________________________________________________________________________________________
____________________________________________________________________________________
Mark the primary stressors or triggers that most influence this behavior below:
Trigger Category Check all that apply Comments
Structural
Transitions Time of day _______ Change of routine Unstructured/down time Large group work/activities Long periods of sitting/focusing Location/specific area in school Other:______________________________
Relational
Conflict with peer(s) (Who?_____________________________)
Conflict with adult(s) (Who______________________________)
Peer relationships (social influence)(Who?______________________________)
Relationship with teacher Issues at home/community
(Incident?___________________________) Authority figures saying NO or making
demands Other:______________________________
Learning Style/ Competencies
Lack of academic skill(s)(Example?___________________________)
Lack of academic challenge Not understanding instructions/expectations Instructional pacing (too slow/fast)
(Which?_____________________________) Learning disability/processing disorder Other:_________________________________
Level of Engagement
Lack of interest in subject matter Hunger Sleepiness Lack of student input/voice Teacher lack of enthusiasm Other:_________________________________
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STRATEGIES FOR BEHAVIORAL CHANGE
What strategies/approaches have been used that are NOT effective with this student?
______________________________________________________________________________________________
____________________________________________________________________________________
Mark the management techniques/strategies below that you will use to avoid or minimize this behavior.
______________________________________________________________________________________________
____________________________________________________________________________________
Keep in Mind . . .
Connect strategies to the strengths/interests of the student and choose strategies that will reduce/alter triggers The strategies in the behavior plan must be implemented consistently by all team members in order to effectively
alter behavior Use the Ramapo back pocket guide as a resource for strategies
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APPENDIX G: PARENT CONFERENCE LOG
DATE
STUDENT_________________ GRADE____ CREW________
PARENT(S) IN ATTENDANCE --
SCHOOL PERSONNEL IN ATTENDANCE ---
PURPOSE OF MEETING -
PRECIPITATING FACTORS-
OUTCOME/AGREEMENT-
PLAN OF ACTION -
SIGNATURES
SUPPORT STAFF ______________ PARENT________________
STUDENT __________________ INSTRUCTIONAL STAFF______________SCHOOL ADMINISTRATOR __________________
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APPENDIX H: WEEKLY DETENTION LOG
Student Name Class Infraction Mon
Tue
sday
Wed
nesd
ay
Thu
rsda
y
Frid
ay
Supervisor
Supervisor Comments
APPENDIX H-2: DETENTION NOTICE
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DETENTION NOTICESTUDENT:_____________________________ CLASS_____________
YOUR ARE SCHEDULED TO SERVE DETENTION TODAY IN ROOM ________________ AT 2:50 PM.
EXPECTATIONS FOR STUDENTS SERVING DETENTION Arrive at the detention room on time Give this paper to the teacher to make sure that your attendance is taken. If you are marked absent,
you will have to make up the time another day by sitting out lunch and recess or serving more time on Friday
Complete your work quietly and independently Clean up and leave the room at the teacher’s signal Go directly to after-school activity or home
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APPENDIX I 1 -3 : MEDIATION REFERRAL, PROTOCOL AND AGREEMENT FORMS
Mediation Referral (Appendix I-1)
Date: __________________________________
Names of students in conflict:
1. _______________________________________ OSIS# ______________________ 2. ______________________________________ OSIS# ______________________
3. _______________________________________ OSIS# ______________________
4. _______________________________________ OSIS# ______________________
Type of Conflict (circle one):
Rumors Name-calling Instigating Teasing
Other__________________________ Other________________________________
Briefly describe the conflict:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How long has this issue been a conflict? (check one):
1-3 days 2-4 weeks 3-7 days over 1 month 1-2 weeks
Mediation requested by (check one):
Administrator Peer mediator Counselor Student Dean Teacher Other (specify) _______________________
Signature: _____________________________________
Please return this form to Dean or APThank you for your referral.
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Mediation Protocol (Appendix I-2)
Introduction (by the Mediator):
1. Introduce yourself and explain that you will conduct the mediation. Explain that mediation will only work if all parties agree to follow the ground rules and to abide by the resolution which they come up with. The mediator will not take sides or provide a solution. The mediator is there to help both parties explain their concerns and to help them reach a mutual agreement.
2. Verify the students you have in front of you and record names and classes on the Mediation Agreement.3. Explain the ground rules for mediation which include the following Do’s and Don’ts: Do tell the truth Don’t interrupt each other Do listen actively Don’t point fingers or blame anyone Do explain how you feel Don’t go telling everyone what happened Do use the other person’s name Don’t shout, get out of your seat or walk out
Storytelling (by the Disputants):
1. Each party will have a chance to tell their version of the story.2. After the first person tells their story, the mediator will repeat what they heard.3. Each party will agree on what was paraphrased.4. The second party will have a change to tell their version of the story.5. The mediator will repeat what they heard.6. The mediator will summarize the incident or conflict and have both parties agree.
Problem Solving (by the Disputants):
1. Each person will say what they want from the other person.2. Each person will write what they want from the other person on the Mediation Agreement.
Agreement (by the Mediator):
1. Once all parties have stated what they want from each other, the agreement will be signed. 2. The mediator will remind all parties of their agreement and explain why it is important not to have any further
conflict that could lead to more serious problems and consequences.3. All parties will get a copy of the mediation agreement.
Mediation Documentation:
All documents relating to mediation will be maintained in the student behavior portfolio in the Wellness Coach/AP office which can be made available to all staff.
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Mediation Agreement (Appendix I-3)
Date______________________________
Mediation conducted by (check one):
Administrator Peer mediator Counselor Student Dean Teacher Other (specify) _______________________
Name of students in conflict:
1. _______________________________________ OSIS# _________________ 2. ______________________________________ OSIS# _________________
The students whose signatures appear below have decided on the following resolution.
Disputant 1: __________________________ agrees to ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Disputant 2: ___________________________ agrees to ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
We have made and signed this agreement because we believe it resolves the issue(s) between us.__________________________________ _________________________________
Disputant 1 Disputant 2
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