Student Support Problem Identification Checklist by yIqCyW40

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                                           Student Support Problem Identification Checklist

Student Name: _______________________________ Completed By:______________________________ Date: ___________
                                                 The student     The student    The student    The student
                                                   always         frequently   occasionally       never
                                                demonstrates   demonstrates    demonstrates   demonstrates
                                                this behavior   this behavior  this behavior  this behavior

Disruptive (e.g., calls out; makes noises; talks with
peers; gets out of seat)

Disrespectful to adults (e.g., talks back; argues with
teacher; uses rude language; walks away when teacher
is talking)

Disrespectful to peers (e.g., teases, bullies, calls
names, argues, puts peers in awkward position)

Despondent (e.g., puts head down, withdraws from
conversation; does not participate)

Insubordinate (e.g., does not follow directions; repeats
behaviors previously told not to do; proceeds doing
something despite being told to stop)

Aggressive (e.g., pushes, shoves, hits, wrestles,
physically intimidates; threatens)

Other:




Sponsored by New Jersey Department of Education, Office of Special Education Programs (NJOSEP) in collaboration with the Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert
                                                            Wood Johnson Medical School. Funded by IDEA, Part B. www.njpbs.org
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                                                                           The student            The student            The student            The student            I’m Not
              School Success Indicators                                      always                frequently           occasionally               never                 Sure
                                                                          demonstrates           demonstrates           demonstrates           demonstrates
                                                                          this indicator         this indicator         this indicator         this indicator
Classroom Functioning Indicators
Arrives for class on time
Follows directions
Transitions between activities smoothly
Follows typical class routines
Comes to class prepared with materials
Keeps belongings organized

Academic Performance Indicators
Completes in class assignments
Completes homework and other projects
Pays attention in class
Can work on assignments independently
Participates in class discussions
Stays with a challenging assignment or problem

Social-Emotional Functioning Indicators
Tends to be quiet or stay to self
Makes friends easily
Observant of and responsive to social cues
Comfortable interacting socially with other students
Cooperative and respectful with adults
Responds well to constructive criticism
Appears confident in social situations
Has an identifiable group of friends
Is able to work through social problems
Holds conversation on a variety of topics
Expresses concern for others
Mood / disposition is consistent day to day
Manages stressful situations well
Tolerates mild friendly teasing
Sponsored by New Jersey Department of Education, Office of Special Education Programs (NJOSEP) in collaboration with the Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert
                                                            Wood Johnson Medical School. Funded by IDEA, Part B. www.njpbs.org
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Thinking about the problem behaviors you identified that occurred in your classroom, please review the following list and check off any
conditions that serve as triggers for the student’s problem behavior (i.e. set the student off):
    When asked to do a chore, or helping task, or academic work,    Transition at the beginning of a class/routine/activity
or something non preferred (e.g., reading out loud)                 Unstructured situations or settings
    When held to a time limit (e.g., finish a preferred activity)   When he/she can not have something they want
    Tasks that are difficult or confuse the student                 Preferred peer group present
    When working/playing/entertaining independently                 When given an ultimatum or a direction to follow
    When working in group activities                                When corrected, or told “no” or stop
    Not prepared with materials                                     When there is a change in routine (e.g., visitors in the class)
    Multi-step work or projects                                     When adult attention is on others
    Lecture: with note taking OR without note taking                Other:
    Being teased or being joked around with

When problem behavior occurs, how do you (or students in the class) typically respond?
  Give a non verbal cue (e.g., look at student)                  Send the student to an administrator
  Verbally correct the student or provide a reminder             Have the student take a break (e.g., go to guidance or
  Speak to the student after class or in a conference            bathroom)
  Call the student’s parents                                    Teacher assigned detention
  Help the student to get on task                                Moved seat
  Other students laugh or “egg” the student on                   Take a privilege away (e.g., loss of recess)
  Other:


What is your best guess as to why the problem behavior is occurring?
                To Get Out of / Escape Situations:                                                               To Get / Gain Access to:
  That are too difficult/challenging                                                        The validation of peers (reputation/ perceived popularity)
  That are perceived as boring / irrelevant                                                 Time alone
  Where the student is embarrassed or need to save face                                     Control over the situation and / or predictability
  Where the student is not sure what to do                                                  Adult attention (even if it is negative)
  That are too stimulating                                                                  Peer attention (even if it is negative)
  Other:                                                                                    To get something he/she wants
                                                                                            Other:




Sponsored by New Jersey Department of Education, Office of Special Education Programs (NJOSEP) in collaboration with the Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert
                                                            Wood Johnson Medical School. Funded by IDEA, Part B. www.njpbs.org
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Sponsored by New Jersey Department of Education, Office of Special Education Programs (NJOSEP) in collaboration with the Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert
                                                            Wood Johnson Medical School. Funded by IDEA, Part B. www.njpbs.org
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Sponsored by New Jersey Department of Education, Office of Special Education Programs (NJOSEP) in collaboration with the Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert
                                                            Wood Johnson Medical School. Funded by IDEA, Part B. www.njpbs.org

								
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