PENNSYLVANIA S. Positive Behavior Interventions and Support Network: Recognition Application

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2016-2017 PENNSYLVANIA S Positive Behavior Interventions and Support Network: Recognition Application Due November 2, 2016 Submit to: swpbis@pattan.net

Overview/Purpose The Pennsylvania Positive Behavior Support Network (Pa PBS) is proud to announce this year s Annual Pa PBS Network recognition process. The purpose of the Pa PBS Network recognition system is to identify and publicly recognize Pennsylvania s Program Wide (PW) Sites and School Wide (SW) Sites for successful implementation of Positive Behavioral Interventions and Supports (PBIS). It also affords PW Sites and SW Sites the opportunity to accurately selfreflect on their progress implementing and sustaining PBIS. PW and SW Sites that want to be recognized for their implementation of PBIS for the 2016-2017 school year are required to submit an application via email to swpbis@pattan.net by November 2, 2016. PW and SW Sites must also submit required 2015-2016 Annual Data by November 2, 2016 as defined by Pa PBS Network guidelines. Application Process PW and SW Sites may apply for recognition by completing the following steps: Download the Recognition Application located on the Pa PBS website under the School- Wide PBIS and/or Program-Wide PBIS drop down tabs: School Recognition. Submit Annual Data to your Pa PBS SWF or PWF. Complete the application electronically and email to: swpbis@pattan.net Your regional and/or local Pa PBS Network Facilitator can provide more complete information about the process, fidelity tools and requirements. Data Requirements School Wide: Submit their annual 2015-2016 in ptrack This data includes: Benchmarks of Quality score Total ODRs ODRs per 100 students ODRs per 100 students per day Days of out of school suspension served # of students expelled # of school days in session # of students enrolled Student attendance # referrals to Special Education # students placed in an out of district placement

Program Wide: Submit their annual data as specified in the Early Childhood Pa PBS Data Requirements Document. This data includes: Benchmarks of Quality TPOT/TPITOS Updated demographic information about classrooms and staff Categories for Recognition: PW and SW Sites must indicate one of the following categories they are applying: Universal (Tier One) Initial Implementation with Fidelity Universal (Tier One) Sustained Implementation with Fidelity Universal and Tier Two Implementation with Fidelity Implementation Fidelity at All Three Tiers Universal (Tier One) Initial Implementation with Fidelity: For PW and SW Sites that have not previously been recognized. The criteria that are used to measure fidelity to program implementation includes: a) Earn a score of 70% or above on the Benchmarks of Quality (BoQ), facilitated by a Network Facilitator, Spring of 2016. a. After the application is submitted, an outside evaluator will contact your SWF and building contact as identified on this application to schedule a Pre-SET or SET. c) Submit 2015-2016 Annual Data by November 2, 2016. d) Earn a score of 80/80 or above on the Pre SET or SET. e) BoQ, Annual Data and SET scores submitted by March 31, 2017. - For SW: PBIS Apps and p-track - For PW: Pa PBS Data Requirements Document

Universal (Tier One) Sustained Implementation with Fidelity: For PW and SW Sites that were recognized in the previous school year and want to apply to be recognized for continual fidelity of implementation at Universal/Tier 1 level. The criteria that are used to measure fidelity of program implementation include: a) Recognized the previous school year for High Fidelity of Implementation. c) Submit 2015-2016 Annual Data by November 2, 2016. d) Complete a BoQ for current year, facilitated by a Network Facilitator, and earn a score of 80% or above. e) Annual Data and BoQ score submitted by April 21, 2017. - For SW: PBIS Apps and p-track - For PW: Pa PBS Data Requirements Document Universal and Tier Two Implementation with Fidelity: The criteria that are used to measure fidelity of program implementation includes: a) Recognized the previous school year for High Fidelity of Implementation. c) Submit 2015-2016 Annual Data by November 2, 2016. d) Complete a BoQ for Spring 2017, facilitated by a Network Facilitator, and earn a score of 80% or above. e) With their Network Facilitator, complete the Tier II section of the Tiered Fidelity Inventory (TFI), and earn a score of 80% or above. f) With their Network Facilitator, complete the BoQ Walkthrough. g) Annual Data, BoQ and TFI scores and BoQ Walkthrough documentation submitted by April 21, 2017. - For SW: PBIS Apps and p-track. - For PW: Pa PBS Data Requirements Document. Recognition of Implementation Fidelity at all three Tiers: The criteria that are used to measure fidelity of program implementation includes: a) Recognized the previous school year for High Fidelity of Implementation. c) Submitted 2015-2016 Annual Data by November 2, 2016.

d) Site completes BoQ for Spring 2017, facilitated by a Network Facilitator, and earn a score of 80% or above. e) With their Network Facilitator, complete Tier II and Tier III sections of the Tiered Fidelity Inventory (TFI), and earn a score of 80% or above. f) With their Network Facilitator, complete the BoQ Walkthrough. g) Annual Data, BoQ and TFI scores and BoQ Walkthrough documentation by April 21, 2017. - For SW: PBIS Apps and p-track - For PW: Pa PBS Data Requirements Document AWARD RECIPIENTS MUST AGREE TO SERVE AS DEMONSTRATION SITES FOR THE PA PBS NETWORK. As a demonstration site, PW and SW Sites may be asked to share their success in one of, but not limited to, the following ways: (1) welcome representatives from programs, schools, or districts to visit your building to observe PBIS Leadership Team meetings; (2) share experiences and materials/resources related to implementation; (3) provide data and other artifacts of the implementation process for publication purposes; and (4) be willing to provide presentations, as requested. The PA PBS Network recognition awards will be presented at the annual Implementers Forum and posted on the Pa PBS website (www.papbs.org).

Section I: Please answer the following questions: Pa PBS NETWORK RECOGNITION APPLICATION Formal Name of School Wide (SW) or Program Wide (PW) Site/Building Name (as it is should appear on recognition banner or badge): School District (if SW): School/Program Website: Check which applies: Early Childhood Program PW or School District SW Program Age or Grade Levels served: Total number of students served: For Schools: Annual 2015 2016 Data submitted to ptrack: Yes or No For Programs: Annual 2015 2016 Data submitted as indicated in Data Requirements Document Yes or No Primary Contact Person: Name: Title: Building: Phone: ( ) Email: School Wide Facilitator or Program Wide Facilitator: Name: IU Name: Please check which level of recognition you are applying for: Tier One Initial Implementation with Fidelity Tier One Sustained Implementation with Fidelity Tier One and Tier Two Implementation with Fidelity Implementation with Fidelity at all Three Tiers

Section II: Please submit a narrative of no more than 250 words addressing: Your program/school age grade levels served, total number of students enrolled, percent of ESL students, percent of students with IEPs, percent of students eligible for free/reduced-price lunch and/or any other information that would be beneficial to include. How PW/SWPBIS has influenced the culture and/or climate. Areas of PW/SWPBIS in which your team/program/school excel (e.g., recognizing students/staff, teaching expectations, data-based decision-making, encouraging family involvement, etc.). Listed below are sample questions to help guide elements of your narrative. It is not a requirement to address all the questions. Systems: Data: 1. What makes your team work so well? Please discuss in detail (e.g., what is your administrator s role on the team, how is the staff represented, etc.?). 2. What do you see as the overall strengths of your team? 1. How does the team use data to identify status, need for change, and effects of interventions/strategies? 2. In what ways are the program/school-wide expectations and strategies communicated to all staff, students, community, and families? Practices: 1. What are some of the practices your program or school has adopted that have had a positive impact on students and how does your program or school measure effectiveness of implementation? 2. How do you teach the universal strategies to students and staff and support their use? Unique Features: 1. Any unique features or obstacles/hurdles related to implementing and sustaining PW/SWPBIS in your school and how these have been addressed.