□
Teacher provided precorrections about student’s behavior expectationsEnd of Class:
□
1. Rate student below□
2. Explain ratings to student□
3. Provide praise□
4. Provide corrective feedback, if needed Teacher Completes Section BelowSubject/ Class
Period Assignments and Positive Comments
Teacher Initials 2 1 0 2 1 0 2 1 0 Assignments: Wow, 2 1 0 2 1 0 2 1 0 Assignments:Wow, 2 1 0 2 1 0 2 1 0 Assignments:Wow, 2 1 0 2 1 0 2 1 0 Assignments: Wow, 2 1 0 2 1 0 2 1 0 Assignments:Wow, 2 1 0 2 1 0 2 1 0 Assignments: Wow, 2 1 0 2 1 0 2 1 0 Assignments:Wow, CICO Coordinator Completes Section Below:
Pts. Earned = _____ ÷ Pts. Possible = _____ * 100
Percentage Earned = _____________ % Met Goal of ________ % = Yes or No
Reward(s) Earned & Provided _________________
Parent/Guardian Completes Section Below: Parent/Guardian
Signature_________________________________ Comments:
_____________________________________________ ________________________________________________
APPENDIX E
CHECK IN & OUT PROCEDURES
Student: ________________________ Date: _______________________
Coordinator: Place a check in the box as each step is conducted or N/A if not applicable.
Check In:
_____Student attended check in.
_____Signed DBRC from previous day was collected, if applicable _____Student was provided new DBRC.
_____Student was precorrected about behavior expectations. Check Out:
_____Student attended check-out.
_____Student was provided praise for compliance with expectations.
_____Student was provided corrective feedback for noncompliance with expectations. _____Percentage of points earned on DBRC was calculated.
_____Determined whether student met goal.
_____Student provided incentive for meeting goal, if earned. _____Send DBRC home with student
APPENDIX F
PARENT/GUARDIAN AND STUDENT ORIENTATION
Explain purpose of CICO
Explain student’s goal percentage of points earned on the DBRC
Explain teachers’ role in CICO
Explain how points are scored on the DBRC
Explain how students will know if they are meeting their point goals
Explain how student checks in
Explain how student checks out
Explain how student gives DBRC to teacher
Explain procedure for getting DBRC signed by parent/guardian and returning to school
APPENDIX G
CHECK IN-CHECK OUT CONTRACT
I, _____________________________________, agree to work on these things.
1.________________________________________________________________ 2. ________________________________________________________________ 3.________________________________________________________________
I will work with ____________________________ to keep track of my progress. I understand that I will have an opportunity to earn a reward each day when I meet my goals. A list of rewards I would like to earn includes:
1.________________________________________________________________ 2. ________________________________________________________________ 3.________________________________________________________________
I will try hard to do my best to meet these goals every day.
________________________________ Signature of Student
APPENDIX H
THE INTERVENTION RATING PROFILE (IRP-15) Completed by: ___________________
The purpose of this questionnaire is to obtain information that will aid in the evaluation of the intervention for ___________________. Please circle the number which best describes your agreement or disagreement with each statement.
Strongly Disagree Slightly Slightly Agree Strongly Disagree Disagree Agree Agree
1 2 3 4 5 6
1. This was an acceptable procedure 1 2 3 4 5 6 for the child's problem behavior.
2. Most teachers would find this 1 2 3 4 5 6 procedure appropriate for
problem behaviors.
3. This procedure was effective in 1 2 3 4 5 6 changing the child's problem
behavior.
4. I would suggest the use of this 1 2 3 4 5 6 procedure to other teachers.
5. The child's problem behavior was 1 2 3 4 5 6 severe enough to warrant use of this
procedure.
6. Most teachers would find this 1 2 3 4 5 6 procedure suitable for dealing
with the child's problem behaviors.
7. I would be willing to use this 1 2 3 4 5 6 procedure again.
8. This procedure did NOT result in 1 2 3 4 5 6 any negative side-effects for the child.
Strongly Disagree Slightly Slightly Agree Strongly Disagree Disagree Agree Agree
1 2 3 4 5 6
9. This procedure would be 1 2 3 4 5 6 appropriate for a variety of children.
10. This procedure was consistent 1 2 3 4 5 6 with those I have used in the past.
11. This procedure was a fair way to 1 2 3 4 5 6 deal with the child's problem
behavior.
12. This was reasonable for the child's 1 2 3 4 5 6 problem behavior.
13. I liked the procedure. 1 2 3 4 5 6 14. This procedure was beneficial 1 2 3 4 5 6
in understanding this child's problem behavior.
15. Overall, this procedure was 1 2 3 4 5 6 beneficial for the child.
APPENDIX I
ADAPTED VERSION OF THE CHILDHOOD INTERVENTION RATING PROFILE Completed by: _____________________ I Definitely Agree I Agree Somewhat I Agree I Somewhat Disagree I Disagree Definitely I Disagree 1. The program used was fair. 2. I think my
teacher was too harsh on me. 3. Being in this program caused problems with my friends. 4. There were better ways to help me with my behavior. 5. This program
could help other kids too. 6. I liked the program we used. 7. Being in this program helped me do better in school.
APPENDIX J
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