Transcript CICO - Tier 2 PBIS

Chris Borgmeier, PhD
Portland State University
[email protected]
www.tier2pbis.pbworks.com

SHOW & TELL

Review SW-PBIS Implementation

TIPS meeting process
◦ Successes
◦ Surprises
◦ Challenges/Questions
Recruit items for Agenda
Facilitator
Review data prior to the meeting
Data Analyst
Reserve projector and computer for
meeting
Keep discussion focused
Minute Taker
Record Topics and Decisions on
agenda/minutes
Ensure that problems are defined
with precision
Ensure that solutions have action
plans
Provide “drill down” data during
discussion
End on time
Minute taker
Prepare minutes and send to all
members
Minute taker
Facilitator
Facilitator
Facilitator
Data Analyst
www.uoecs.org
Person Responsible
Facilitator
TIPS II Training Manual (2013)
Reserve Room
Action
Facilitator
3
Where in the Form
would you place:
1.Staff will complete
weekly fidelity checks
2. Three students are
not meeting daily
CICO goal
3. Parents are not
signing CICO home
report
4.ORF scores are too
low for third graders
5. Plan for school
board report
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Go to www.pbisassessment.org
Enter your school code
Reference the MATT handouts to guide you
through questions
◦ Coaches Interview Guide (pp. 2-5)
◦ Team Scoring Guide (pp. 6-10)

Enter scores into www.pbisassessment.org
Chris Borgmeier, PhD
Portland State University
[email protected]
www.tier2pbis.pbworks.com

All specialized interventions are more
effective, and more durable, if they are done
with school-wide behavioral expectations as
a foundation.
5%
~15%
Primary
Prevention:
School/ClassroomWide Systems for
All Students,
Staff, & Settings
SCHOOL-WIDE
POSITIVE
behavior
SUPPORT
~80% of
Students
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Pre schools
 Sandy Chafouleas, et al 2007
Elementary Schools
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Middle Schools
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Anne Todd et al in press
Sarah Fairbanks et al, 2007
Amy Kauffman-Campbell, dissertation
Doug Cheney et al, 2006; 2007
Leanne Hawken et al. 2007
Filter et al., 2007
Leanne Hawken et al 2003
Rob March et al 2002
High Schools
◦
Jessica Swain-Bradway, in progress
CICO is an
Evidence-Based
Practice
1. At least 5 peer
reviewed studies
2. At least 3 different
researchers/settings
3. At least 20 different
participants
OREGON
2011-12
CICO-SWIS
TIER 2
CICO-SWIS IN OREGON
2011-12
Elem
MS
HS
Pre-8th
Others
TOTAL
Schools
114
35
1
6
1
157
Students
2001
674
33
97
66
2871
>=80%
Elem
1750
MS
510
HS
20
K-8
78
Other
57
TOTAL
2415
Over 84% of
CICO students
succeeding!

What constitutes a Tier 2 Intervention?
◦ An intervention that:
 Serves multiple students at one time (15-25 student at once)
 More efficient use of resources that 1 student at a time
 Students can get started with almost immediately upon
referral
 Requires almost no legwork from referring staff to begin
implementation of the intervention with a student
 All school staff know about, understand their roll with,
and know the referral process for
◦ SYSTEMS NOTE: Resources Required:
 If program is not self-sufficient… and requires significant
organization by referring staff… it’s not a targeted
intervention
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Intervention is continuously available
Rapid access to intervention (72 hr)
Very low effort by teachers
Consistent with school-wide expectations
Implemented by all staff/faculty in a school
Flexible intervention based on assessment
◦ Functional Assessment

Adequate resources (admin, team)
◦ weekly meeting, plus 10 hours a week
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Student chooses to participate
Continuous monitoring for decision-making
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Improved structure
 Prompts are provided throughout the day for correct behavior.
 System for linking student with at least one positive adult.
 Student chooses to participate.
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Student is “set up for success”
 First contact each morning is positive.
 “Blow-out” days are pre-empted.
 First contact each class period (or activity period) is positive.

Increase in contingent feedback
 Feedback occurs more often.
 Feedback is tied to student behavior.
 Inappropriate behavior is less likely to be ignored or rewarded.

Program can be applied in all school locations
 Classroom, playground, cafeteria (anywhere there is a supervisor)

Elevated reward for appropriate behavior
 Adult and peer attention delivered each target period
 Adult attention (and tangible) delivered at end of day
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Linking behavior support and academic support
 For academic-based, escape-maintained problem behavior incorporate
academic support

Linking school and home support
 Provide format for positive student/parent contact

Program is organized to morph into a self-management
system
 Increased options for making choices
 Increased ability to self-monitor performance/progress
Student Referred for CICO
CICO Plan/ Initial Meeting
Teach/Role Play Skills
Check In Check Out
(CICO)
CICO Coordinator
Summarizes Data
For Decision Making
Morning
Check-in
Parent
Feedback
BASIC CYCLE
Regular Teacher
Feedback
Bi-weekly
Progress Monitoring
Meeting
Afternoon
Check-out
Revise
Program
Exit
Program

1. Faculty and staff commitment
 Is problem behavior a major concern?
 Are staff willing to commit 5 min per day?
 Is CICO a reasonable option for us?
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More
CICO
CICO
CICO
than 5 students need extra support
is designed to work with 10-12% of kids in a school
typically “works” (50% reduction) with 67% of students.
Activity
1: individualized supports.
does NOT replace
need for
a) Assessment of need (ODR rates, staff assessment)
b) Readiness:
Is SWPBIS Tier 1 in place? (TIC = 80%; SET = 80/80)
Is there faculty commitment to work with tougher kids?
Are in-school resources available to implement?
Are district resources available to support start-up?
c) Team to manage CICO
•
Administrator; CICO Coordinator; Check In/Out staff
member(s), behavior Specialist (e.g. SPED/SPSY), Teacher

Complete the
CICO SelfAssessment &
Identify
Actions for
improved
implementatio
n
http://www.youtube.com/watch?v=UqMdy5-OSlQ
Student Recommended for
CICO
CICO
Plan
Morning
Check-In
Class
Check out
Morning Check-In
•Check student “status”
•Review home card
Weekly
CICO
•Provide Daily
Progress
Rpt
•Greet andMeeting
praise
9 Week Graph
Sent
Teacher
Program
Teacher
Checks Checks
Update
Home
CheckIn
Class
Check in
Afternoon
Checkout
•Student give card to teacher
•Teacher praise/ prime
•Provide Daily Progress Rpt
•Greet and praise
•End of class feedback
EXIT
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5. Morning Check-in Routine
 Teaching students when, when, how
 Teaching check-in coordinator
 Assess
 Reward  provided for checking-in; breakfast treat, etc.
 Set-up or Redirect
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6. Teacher Check-in/Check-out Routine
 Teaching staff/faculty
 Reward
 Set-up for success, positive momentum
 Evaluation
Activity 5:
a) Identify Check-in staff & location
b) Define Check-in routine & how to train check-in staff
c) Teacher check-in/check-out routine defined
Leading Systems Implementation

Coordinator
 Chair CICO meetings, faculty contact, improvement
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Specialist
 Check-in, check-out, meeting, data entry, graphs
 Together (Coordinator + Specialist) = 10 hours/wk
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Meeting 45 min per week
 Coordinator, Specialist, Sped faculty, Related Services
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All staff commitment and training
Simple data collection and reporting system.
WHAT FITS
YOUR
SCHOOL?
Combining these
roles/
responsibilities
across multiple
staff or not?
1. Who would be a good coordinator?
2. What duties/responsibilities will he/she
have?
3. Do we need to adjust schedules/time/
workload for this person?
4. How will we train the coordinator?
5. How will we evaluate the coordinators
effectiveness?
6. Who will be our back-up coordinator?
7. What steps do we need to take to
accomplish this?
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Establish rapport with students
Provide training to all students before they
begin CICO
Coordinate check-in and check-out
◦ Possibly do Check-in & check-outs
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Enter data daily (or monitor daily data entry)
Organize and summarize student data for
meetings
Contact person for caregivers
Process requests for assistance
Lead meetings
Problem-solve
Examples
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Social worker
Counselor
Special Education
teacher
Paraprofessional
Non-Examples
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Principal
Classroom teacher
Any individual
responsible for
discipline
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The coordinator should receive training in
the systems, practices, and the use of data
in the CICO program.
Connect w/ your District & Regional
Coaches
Be sure to train a “back-up” coordinator
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Plan for turn-over in the coordinator position
Increasing sustainability
◦ Document all procedures
◦ Active management from the
leadership team
◦ Write coordinator duties into a job
description
◦ Devote FTE to the coordinator
position
These individuals only do check-in/check-outs
w/ students only (data and organization is
the CICO Coordinator’s responsibility)
-
School custodian
-
School office staff members
-
“Specials” teachers
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In the building everyday
Available at the beginning and end of each
day
Someone students like and enjoy being
around
Enthusiastic
Organized
Positive
The effectiveness of implementation should be
examined on a regular basis
Evaluation Questions:
1.
Does the coordinator establish positive rapport with
students?
2.
Does the coordinator display effective behavior
management skills?
3.
Does the coordinator’s position allow all tasks to be
completed in a timely manner?
4.
Is the coordinator implementing the intervention with
fidelity?
◦
CICO Self Assessment, Benchmarks of Advanced Tiers, etc.
◦
Integrate CICO implementation fidelity within a district evaluation
plan

2. Team available / Coordinator available
 CICO Coordinator
 CICO Specialists (checking in & out w/ students daily)
 Team (meets at least once every two weeks)
Activity 2:
Plan CICO Roles & Responsibilities
a) CICO Coordinator
b) CICO Specialist(s)
•
Who is doing daily Check-ins & Check-outs?
c) behavior: Individual Student Systems
Data Team meetings
•
Training Day 2
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Use a School name, mascot, motto
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Sunshine Club
Hawk Report
HUG – Hello, Update, Goodbye
CnC – Check-n-Connect
CICO – Check-In/Check-Out
BEP – behavior Education Program

Try to use 1 card for the program
◦ Use common schedule if possible
◦ Use School-wide Rules

Keep it simple
◦ Card needs to be quick & easy for staff to complete
◦ Card needs to be small (half sheet) & easy to carry
around
Name:
Date:
Block 1
Block 2
Block 3
Block 4
Safety
0
1
2
0
1
2
0
1
2
0
1
2
Organization
0
1
2
0
1
2
0
1
2
0
1
2
Achievement
0
1
2
0
1
2
0
1
2
0
1
2
Respect
0
1
2
0
1
2
0
1
2
0
1
2
Name:
Date:
Pencil
sharpened
Homework
completed
Raise hand to Be on time
talk
Keep hands
to self
1. Check in
2.
3. Music on
MWF
4. PE on T
TH
5. Math
6. Lunch
7. Recess
8.
9. Language
arts
10. Snack
11. Research
projects
1 2 3 4
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Too
complicated…
Too many
ratings

Younger children (K-1st grade)
◦ Less words, more pictures
◦ More frequent checks during day
◦ Earn rewards more often
CICO Home Report
Name: _____________________
______ I met my goal today
Date: _____________
______ I had a hard day
One thing I did really well today was:_______________________
Something I will work on tomorrow is: _______________________
Comments:
Parent/Guardian Signature: ________________________________________________________
Comments:

7. Daily CICO progress report card
 Same expectations for all
 Common schedule
 All staff taught rules for accepting, completing and
returning the card.

8. Home report process
 Can be same as progress card or a separate reporting
form
Activity 6:
a) Daily Progress Report developed
b) Home report routine developed
c) Define how families will be informed of process
Student Referred for CICO
CICO Plan/ Initial Meeting
Teach/Role Play Skills
BASIC CYCLE
Request for Assistance
ODR Level
Family or Student request
Check In Check Out
CICO Coordinator
(CICO)
behavior support team
CICO Coordinator
Summarizes Data
For Decision Making
Morning
Check-in
Parent
Feedback
Regular Teacher
Feedback
Bi-weekly
Progress Monitoring
Meeting
Afternoon
Check-out
Revise
Program
Exit
Program

Multiple office referrals
◦ ID at-risk students at beginning of school year based on previous
years data
◦ ID students based on cumulative ODR in school year
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Referral
◦ by teacher
 Teacher Request for Assistance
◦ by parent

Time to action:
◦ 30 min to 7 days (goal is < 72 hours)

More than a minimum number of referrals
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Across several different settings
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Not dangerous to self/others
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Several minor referrals
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Adult attention is rewarding
◦ Disruptive
◦ Tardy
◦ Talks out
◦ Defiant
◦ Unprepared
◦ Refuses to do
work
◦ Talks back to
teacher
◦ Uses
inappropriate
language
◦ Difficulty taking
turns
◦ Refuses to share
◦ Out of seat
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Dangerous/violent students
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Students who bring a weapon to school
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Students who injure/may injure themselves
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Students with a high number of referrals
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Students with referrals from only one setting,
teacher, or time
Students who find adult attention aversive
George
• 17 referrals
• From multiple
classrooms,
cafeteria, hall,
and bus
Richard
• 5 referrals
John
• 5 referrals
• From playground • 2 from
classroom, 2
• Defiance,
from hall, 1 from
inappropriate
bus
language
• Disruption,
• Disruption,
defiance, fighting
defiance, tardy,
harassment
• Caught with box
opener
Start the year by reviewing last
years data:
CICO can help to start the year
off on the right foot
Office Discipline Referrals
- Typically referrals are examined every 2
weeks in a team meeting (school-wide,
CICO team, etc.)
-
Set Decision Rules
- Students with 2nd referral = TEAM REVIEW
- MS & Elem may have different criterion
- Print out an individual student report (SWIS) for
each identified student to examine patterns
(location, time, problem behavior, etc.)
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Develop a system
Teach staff how to use the system
Provide verbal and written instructions on
the referral system
Respond to referrals in a timely manner
System must be efficient
1.
2.
3.
4.
5.
How will we examine ODRs?
How will we integrate academic data?
How often?
Is there other data that we will use for screening?
What criteria will be use to determine if the
student is appropriate for CICO?
6. What will happen after we determine a student is
identified as needing CICO?
1. How will teachers refer students (form, email,
etc.) & who will the referral go to?
2. What data is needed after the referral is
received & who will gather it?
3. How will we determine if a student is
appropriate for CICO?
4. How will we inform teachers of this process?
5. What is our anticipated time frame for
examining and acting upon referrals?
6. What will we do if a student does not appear
to be a good fit?

3. Process for identifying a student who may
be appropriate for CICO
 Student is not responding to SWPBS expectations
 Request for Assistance
 Student finds adult attention rewarding
 Student is NOT in crisis.
Activity 3:
a) Develop a Request for assistance process
defined.
b) Define criterion for CICO support (Decision
Rules)
BASIC CYCLE
Student Referred for CICO
CICO Plan/ Initial Meeting
Teach/Role Play Skills
Check
InAgreements
Check Out
Initial
Meeting/
-Roles & Responsibilities
(CICO)
-Teaching
CICO Coordinator
Summarizes Data
For Decision Making
Morning
Check-in
Parent
Feedback
Regular Teacher
Feedback
Bi-weekly
Progress Monitoring
Meeting
Afternoon
Check-out
Revise
Program
Exit
Program
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How do you want to accomplish this?
◦ Formal meeting? – other communication?

Needs before starting the program
◦ Parental permission
◦ Student agreement
◦ Clear understanding of the program & agreement to
individual Roles/ Responsibilities
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
Parents
Student
CICO Coordinator or Specialist(s)
Teacher/Staff?
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School team
◦ Identify students who may benefit
◦ Monitor implementation
◦ Evaluate effects and modify/fade as needed
Coordinator
◦ Facilitate morning and afternoon checks (in & out)
◦ Get signed form from students, give new form
◦ Maintain positive, constructive environment
◦ Acknowledge successes
Teachers
◦ Obtain form from student each day
◦ Monitor student behavior and mark card accurately
◦ Provide feedback to student in positive and constructive manner
Students
◦ Check in and out each day
◦ Give form to teacher
◦ Meet expectations
◦ Take form home and have parents sign, bring to school the next day
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Be interested, encouraging & supportive
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Identify Incentives your child can earn at home for performing well on
CICO (daily &/or weekly)
◦ Incentives need to be reasonable and something parents can regularly deliver

VERY IMPORTANT!!!  Do NOT use punishers if your child does not
meet his/her goal
◦ if you do your child will not continue with the program… or will not bring reports
home to parents
◦ Just encourage your child: “Too bad today, but if you try hard you’ll do better
tomorrow!”

Before School

After School –
◦ Try to reduce “Tough Mornings” before school
◦ Encourage & Support  behavior & School Readiness
◦ Request to see student’s home report!
◦ Provide incentives (if the student has earned it), or encouragement

Agreement to succeed
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Student: Student chooses to participate
Parent
CICO coordinator
Teachers
Contract may be written or verbal
◦ Better if written
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Teach program logistics
◦ Responsibilities: Student, Teacher, Coordinator
◦ Where & with Whom to Check-in & Check-out

Teach Desired behaviors

Teach Point Card & Rating
◦ What behaviors = 0/1/2
◦ Role Play w/ student
◦ Have student be teacher & score your behavioral
examples

4. Establishing Agreements &
Communicating Roles & Responsibilities
 Permission to Participate
 Communicating Roles & Responsibilities
 Parent, Student
 Teaching Student Program Logistics
 Teaching Student Expected behaviors & Point Card
Activity 4:
a) Develop a plan for communicating agreements,
roles & responsibilities w/ parent & student
•
Will you hold an initial meeting? Develop a contract?
b) Identify how student will be taught program
logistics & behavioral Expectations
Student Recommended for
CICO
CICO
Home Check
•Student Plan
give card to parent
Morning
•Parent praise/ prime Check-In
•No negatives
Class
•Parent signs
Weekly CICO
Meeting
9 Week Graph
Sent
Check out
Home
CheckIn
Class
Afternoon checkout
Check in
•Review day
•Retrieve card
Afternoon
Check•Send copy to family
out
•Record points in SWIS
•Provide incentive if earned
Teacher
Checks
Program
Update
EXIT

Levels of Rewards:
o
Reward student for:
•
•
Checking-In  positive adult interaction & a breakfast
snack?
Checking-out & turning in daily progress card 
positive adult interaction & bonus point on card or a
piece of licorice?
◦ Earning points & making goal
 Make sure rewards are feasible & valued
 Might start with daily rewards for success… then fade
to turning in points earned
CICO Trading Post
Points
Required
Wants attention
note to
office/teacher
Ask a peer to
play/read/draw
Be a leader
Principles
recess
Trip
250 pts
Computer
More
400 pts
Out
100 pts
Take
Wants
item/activity
with a
friend
Extra sharing
time
to lunch
with TBA
Class recess,
free time, or
popcorn party
to treasure
chest
Choose a snack
Choose a 5 min.
activity
School wide
sticker
Principles
recess
time for
selected activity
Free ticket to
sporting event
New
school /art
supplies
Wants to escape
attention
Computer
by self
Time
time
alone
Independent
work space
Wants to avoid
something
Short
break
Alternative
activity
Alternative
assignment
Get
out of
school early
CICO Trading Post
Maintaining
Consequence
100 pts
250 pts
400 pts
Wants Attention
Complete assignment
with a peer
Wants something
Wants to escape
attention
Wants
to
something
Choose a snack / tangible
Computer time by self
Short break
Choose a 5 min. activity
Work in separate part of
room
Alternative activity
Time alone
Alternative assignment
Chose order of class
activities
School wide reward card
Class teaching
assistant for a
period.
More time for selected
activity
Lunch for peer and
student for FREE
New school /art supplies
Class reward: free
time, or pizza party
Free ticket to sporting
event / dance / etc.
avoid
Independent work space
Get out of school early

9. Afternoon Check-out Routine
 Identify Check-out Staff, Location & How to Check-out
 Teach Check-out staff to collect data, acknowledge
success, encourage improvement.
 Consider self-recording system for older students

10. Trading menu
 Reward for collecting and turning in daily progress card
 Reward for meeting daily goal
 Exchange system for points earned
Activity 7:
a) End of day check-out routine, location, staff defined.
b) Plan Rewards for: Check-in & out; meeting goal, etc.

An effective Data System is CRITICAL

Highly recommend CICO-SWIS
◦ www.swis.org
◦ Additional $50/year with SWIS account
◦ Cannot get CICO add-on without having SWIS account

Alternative = managing excel spreadsheets
◦ Gets challenging with many students
◦ CICO Coordinator must have substantial expertise in
Excel

Identify who will enter the data daily
◦ CICO Coordinator or CICO Specialist
◦ Train in CICO-SWIS accordingly & provide w/
account passwords

Can show student updated graph during
check-out

11. Collecting, summarizing and using data
 Daily updates
 Coordinator does regular data checks to make sure data
is being entered promptly & correctly
Activity 8:
a) Process for collecting, entering, summarizing and
reporting data is defined

Team will use data to monitor student
progress
◦ Some students will “graduate” from the program
◦ Some students will require the support on a
continuing basis
◦ Some students will not respond to the program &
need more or something different
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Set up processes for:
◦ Fading students off of the program
◦ Escalating intensity of intervention
◦ Maintain & monitor
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The GOAL is always to “Graduate” students
from our supports or Fade supports
◦ Do so gradually & Support the Transition
1) Increasing student responsibility

Transition into a Self-Management/ Self-Monitoring
program
2) Then, gradually removing or “Fading” components
of the intervention
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Student monitors own behavior
Student “checks in” with teacher to review
self-ratings and receive feedback
1.
2.
3.
4.
5.
Expected behaviors stay the same
Reinforcers stay the same
Student checks in same amount of times
Student monitors behavior using CICO card
Plan for teaching accuracy in monitoring
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2.
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4.
5.
Student and teacher record separately
Compare records; reinforce accuracy
Over time, compare less often
Reinforce appropriate behavior only
Periodically reinforce accuracy

Lucy has been on CICO for 3.5 months; she has earned 90%
of points each week for the last 10 weeks
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Coordinator provides rationale for self monitoring to Lucy
◦ Coordinator teaches Lucy to self monitor using examples and nonexamples
◦ When program begins, Lucy’s teacher goes over examples and nonexamples
◦ First week: Lucy and teacher monitor and compare records
 Teacher provides acknowledgement and feedback based on accuracy
 Ratings agree 95% of time
◦ Second week
 Teacher monitors appx. 60% of time; feedback based on accuracy
 Feedback at other times based on Lucy’s monitoring of behavior
◦ Coordinator
 Feedback based on accuracy (with teacher records)
 When Lucy monitors independently, feedback based on behavior
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
After Student is Successfully Self-Monitoring
Can begin removing components of the
program (removing staff responsibility)
◦ Gradually decrease # of check-ins during the day
w/ teachers; Student Self Checks (keep check in and
out)
◦ Fade from Daily check out to every other day then
1/week
◦ Remove check in

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Continue to monitor student behavior
through discipline referrals & teacher report
Celebrate continued success
◦ Some schools hold a monthly celebration for
students who are maintaining success after
Graduating from CICO
 Monthly “Alumni Club” Lunch

12. Fading Supports for Successful Students
◦ Transition to Self Management program
◦ Continued monitoring & celebrations for “Grads”

13. Substitute Teacher routine
◦ How to inform and orient new teachers
Activity 9:
a) Define self-management process.
•
•
Use card, but no teacher review
No, card, but still check in
b) Substitute teacher orientation materials
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Provide an introduction to CICO and the
referral process at a staff meeting
Sample PowerPoint presentation available
Communicate:
◦ Description of CICO
◦ Why it is important
◦ Roles & Responsibilities
◦ Rating the Point Card
◦ Importance of being positive
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School team
◦ Identify students who may benefit
◦ Monitor implementation
◦ Evaluate effects and modify/fade as needed
Coordinator
◦ Facilitate morning and afternoon checks (in & out)
◦ Get signed form from students, give new form
◦ Maintain positive, constructive environment
◦ Acknowledge successes
Teachers
◦ Obtain form from student each day
◦ Monitor student behavior and mark card accurately
◦ Provide feedback to student in positive and constructive manner
Students
◦ Check in and out each day
◦ Give form to teacher
◦ Meet expectations
◦ Take form home and have parents sign, bring to school the next day

14. Provide training to all staff on CICO
◦ School-wide system = train ALL staff
 Rationale
 Roles & Responsibilities
 How to score the point card
◦ Identify how to train assistants & duty staff
(recess, cafeteria, etc.) who are often not at staff
meetings
◦ Provide ongoing updates to staff re: CICO
implementation & outcome data
Activity 10:
a) Develop Staff Training/Orientation to CICO
b) Develop a plan for training assistants & duty staff

Fidelity

Student won’t carry card
◦ Assess teacher commitment/enthusiasm
◦ Re-teach
◦ Teacher self monitoring
◦ Student checks in and out
◦ Coordinator provides card to teacher and picks
up
 Student continues to receive feedback from teacher
◦ Self monitoring
◦ Computerized system

Student isn’t checking in or out
◦ Determine reason
◦ Identify preferred person to check in/out with
◦ Is this component needed?

Develop CICO System
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Referral process
Initial meeting & Agreements/contract
Check-In - procedures & personnel
Check-Out – procedures & personnel
Develop Point Card
Rewards menu & process
Data System & Data entry (training & personnel)
Plan for fading/graduating
Training for Staff
Pilot Implementation