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Individualized Positive Behavior Support (IPBS) Fidelity Checklist

Individualized Positive Behavior Support (IPBS) Fidelity Checklist

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This is a checklist that will help you with the implementation of the behavior support plan development process.
This is a checklist that will help you with the implementation of the behavior support plan development process.

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Published by: Pyramid Model Consortium on Jul 29, 2011
Copyright:Attribution Non-commercial No-derivs


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Individualized Positive Behavior Support (IPBS) Fidelity Checklist
Child’s Name: __________________ Date Initiated: ______________________ Child Care Center: _________________________________________________ Person(s) Completing Form: ____________________________________________ Before Starting IPBS: Date Completed
Primary Level of Pyramid Supports are in placeSecondary Level of Pyramid Supports are in placeDoes the Behavior Incident Report (BIR) data indicate that the child might needtertiary level of support?Is there a Flow Chart with timelines and steps for implementing the TertiaryLevel of Pyramid Supports?Are there Safety Net Procedures in place until the Support Plan can beimplemented?Is there an internal behavior coach or behavior specialist on-site to facilitate theIPBS process with the child’s teacher and family?Has the family met with the educational staff to talk about the IPBS process?Is there a release of information consent form signed?If video coaching will be done, has a video consent form been signed?Has a photo consent form been signed for individualized supports that mightcontain photographs?
Step 1: Establish a Collaborative Team and Develop Goals Date Completed
Team members are established: family, teacher(s), paraprofessional, therapist,administration, support staff, TA providers, internal behavior coach, and otherswho work with the childAgreed goals are established with the team members on:
the specific behaviors to target for intervention,
the routines where behavior is problematic, and
important outcome goals such as communication, peer interaction, play,etc.Internal staff person has been identified to facilitate IPBSDue dates have been established for functional assessment (based on flowchart timelines)Next team meeting date has been established to Behavior Support Plan (basedon flow chart timelines)
Step 2: Gathering Information Date Completed
 Data forms, to monitor behavior outcomes, are created and teacher beginsrecording data (continue through plan implementation)All records have been reviewedObservation cards by internal behavior coach(es) completedHome observation cards are offered to the family for completionFunctional Assessment Interview completed with familyFunctional Assessment Interview completed with educational staff
Step 3: Developing Hypotheses (your best guess) Date Completed
 All functional assessment data reviewedAll functional assessment data is coded for:
preferences and “things that work well for the child”

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