Instructions: Click on a field (gray area) and begin typing to complete that field. To go to the next field, push the Tab button, When you are finished, you can save or print your completed form, Learner: All students at SFCS Training Intervention: Coaching Boys into Men Date: August 15 Superviso Co-worker(s) My Support Team/Network ‘hris Moddelmog Trainer: Jon Gwin |: Teachers: Jesse Smith, Shielah Orchard Therapists: Ben Draper, Ed Dippel, and Cindy Monts respectful relationships (Think about distinct accomplishments and activities to be achieved.) Specific Areas to Improve: To teach/coach youn men about how to build healthy, have students approximately two months (Deseribe the barriers that must be eliminated or reduced and how this will be done.) Problems to Overcome: Youth that are not mature enough or ready to discuss/learn about themselves and building healthy relationships. Also due to the fact that we only Detailed Specific | Responsible | Resources | Date/Time* | Changes to Look Actions in Sequence | Person(s) For (include regular progress | reviews with the support | team as a part ofthe specific j tep 1. Establish rules | Jon Gw ‘Action Plan, | 8/31/15 to | Students to Team rules and expectations such as | Leader cBIM | oars | and expectations of respect all participants, | J. Smith, S. training group ensure confidentiality, | Orchard, cards, Poster | and focus on helping Draper, Board, | each other attain Dippel, and —_/ Colored individual and team Monts markers, | goals Time | Step 2. Define Personal | Gwin, Smith, | CBIM | SITS to | Students will start to | responsibility Orchard cards, time | 9/11/15 | take responsiblility for -Discuss how we hold | their actions and help ourselves accountable to | others take, | ourselves, team, and responsibility for their roche eee | actions. | -How do we represent | ourselves, team, and | family. L Gwin, Smith, | CBIM |SA4MS to | Students will start to Step 3. Discuss Inappropriate/insulting Orchard cards, flash | 9/18/15 change their[Language cards with vocabulary to reduce -Recognize that insulting inappropriate/insulting language canbe | language language. harmful | -Adapt language to show respect to others as welll as to yourself | Step 4. Disrespectful | Gwin, CBIM RATS to | Students wil behavior towards Orchard, cards 925s implement ways to girls/women. Monts have healthy -Recognize that certain relationships with behaviors toward girls/women and women/girls can be others. hurtful or abusive. -Refuse to engage in | lewd or foul behavior ‘Step 5. Digital Disrespect | Gwin, CBIM cards | 9/28/15 to | Siudents will create | Recognize that actions Draper, and cell 10/2/15 | safe and respectful aie et oa Dippel phones digital spaces for phones have real I themselves and others. | consequences, | -Refuse to participate in | | abusive digital behavior. | Step 6. Define and Gwin, Smith, | CBIM | TOSIIS to | Student will start to understand consent Dippel, Monts | cards, 10/9/15 create boundaries to | -Define consent and computer hhave safe and healthy iia iotde eee and relationships. ‘consent projector | | -Discuss what to do if j | you notice someone in a non-consensual | | situation | Step 7. Bragging about | Gwin, Smith | CBIMcards [10/19/15 t0 | Students will not sexual reputation Draper | 10/23/15 | spread private “Recognize that | information about self | bragging or lying about | | of other students. | sexual reputation is | wrong. | | -Rocognize that | | | spreading stories is harmful \ 4| Step 8. When Aggression | Gwin, Smith | CBIMcards [10/26/1St0 | Students will start to crosses the line. Dippel | 100/15 | decrease aggressive | | | | behaviors and learn to -Recognize different | : Pesgenorseres aa control their emotions. | -Identify when they are | becoming aggressive. | | Step», There's no excuse | win, CBiM cards | TV/iS to | Students will start forrelationship abuse, | Orchard, | [1/6715 reduce and eventaly Monts | | eliminate aggression -Reject the use of : : | intimidation in | | | and intimidation in | relationships relationships. | | Look at tools to | | monitor aggression and | when it erosses the line. | | ' Step 10. Modeling Gwin, CBiM cards [TIS to | Students will start to | respect and promoting | Orchard, | TW1B/15 | teat all people with -Treat others as you | wish to be treated. | Model respectful | | behaviors toward all | | people in language and | _ actions, | equality Monts, | | respect, | Step | | Commitment of Support Team/Network: All instructors will model all expectations on each of the training topics we discuss during this 10 week implementation of CBIM. | | will also continue to do this after the program concludes. | Signature of Learner: Dat | Signature of Supervisor: Signature of Trainer: Signature of Co-worke “Establish set day and time for ongoing activites.