School-Wide Positive Behavioral Interventions Supports Overview Presented

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School-Wide Positive Behavioral Interventions & Supports: Overview Presented by: Milt Mc. Kenna Horner & School-Wide Positive Behavioral Interventions & Supports: Overview Presented by: Milt Mc. Kenna Horner & Sugai OSEP Center on PBIS Universities of Oregon & Connecticut

My job today… To describe features of a systems approach to Positive Behavioral Interventions My job today… To describe features of a systems approach to Positive Behavioral Interventions & Supports…. . moving beyond classroom & behavior management.

Coordination/ Collaboration 1999 - 2010 Coordination/ Collaboration 1999 - 2010

9000 Schools across 46 states implementing school-wide positive behavior support 9000 Schools across 46 states implementing school-wide positive behavior support

So, …. what is PBIS? PBIS specific practiceon is a systems approach for Not So, …. what is PBIS? PBIS specific practiceon is a systems approach for Not a new…it’s based or Not establishing the social culture Not history toa limited of any curriculum…it’s long and behavioral supports needed particular be group & of for a school to behavioral practices general approach students…it’s an effectivepreventing effective instructional to learning environment for all students. design & behavior problem strategies

What does PBIS look like in a school? • >80% of students can tell What does PBIS look like in a school? • >80% of students can tell you what is • expected of them & can give behavioral examples because they have been taught, actively supervised, practiced, & acknowledged. Positive adult-to-student interactions exceed negative. Administrators are active participants. • • Data & team-based action planning & implementation are operating. • Function based behavior support is foundation for addressing problem behavior. • Full continuum of behavior support is available to all students.

Main Messages • Supporting social behavior is central to achieving academic gains. – Invest Main Messages • Supporting social behavior is central to achieving academic gains. – Invest in building a positive school-wide social culture • School-wide PBS is an evidence-based practice for building a positive social culture that will promote both social and academic success. • Implementation of any evidence-based practice requires a more coordinated focus than typically expected.

Challenge #1 Challenge #1

Challenge # 2 Challenge # 2

The Prognosis • Students with academic failure and problem behaviors likely will drop out The Prognosis • Students with academic failure and problem behaviors likely will drop out of school and: – be involved with the corrections system – be single parents – be involved with the social services system – be unemployed – be involved in automobile accidents Centers for Disease Control, 1993 – use illicit drugs Duncan, Forness, & Hartsough, 1995 Carson, Sittlington, & Frank, 1995 Wagner, D’Amico, Marder, Newman, Blackorby, 1992 Jay & Padilla, 1987 Bullis & Gaylord-Ross, 1991

Challenge # 3 Challenge # 3

Challenge # 4 Challenge # 4

Challenge # 5 Competing, Inter-related National Goals • Improve literacy, math, geography, science, etc. Challenge # 5 Competing, Inter-related National Goals • Improve literacy, math, geography, science, etc. • Make schools safe, caring, & focused on teaching & learning • Improve student character & citizenship • Eliminate bullying • Prevent drug use • Prepare for postsecondary education • Provide a free & appropriate education for all • Prepare viable workforce • Affect rates of high risk, antisocial behavior • Leave no child behind • Etc….

Challenges (cont. ) • Not enough time • Too much talk…not enough action • Challenges (cont. ) • Not enough time • Too much talk…not enough action • Unclear outcomes • Too few priorities • Too many opinions • Multiple competing experts • No experts • Too many diverse perspectives • Too much redundancy • Done it before • Never done it before • Lack of clear outcomes • Slow to get started • Unstructured • Unresolved conflicts • ………

A Main Message STUDENT ACHIEVEMENT Good Teaching Behavior Management Increasing District & State Competency A Main Message STUDENT ACHIEVEMENT Good Teaching Behavior Management Increasing District & State Competency and Capacity Investing in Outcomes, Data, Practices, and Systems

“Worry #1 “TEACHING” by Getting Tough Russell: “I hatedoesn’t If Russell this f____ing school, “Worry #1 “TEACHING” by Getting Tough Russell: “I hatedoesn’t If Russell this f____ing school, & you’re a dumbf_____. ” respond, we get If Russell STILL TOUGHER Teacher: “That is disrespectful doesn’t improve, we language. I’m sending you to the get REAL TOUGH office so you’ll learn never to say & enforce those words again…. starting now!” BOTTOM LINE!

Erroneous assumption that the student… • Is inherently “bad” • Will learn more appropriate Erroneous assumption that the student… • Is inherently “bad” • Will learn more appropriate behavior through increased use of “aversives” • Will be better tomorrow…….

Science of behavior has taught us that children…. ALL BEHAVIORS SERVE SOME FUNCTION • Science of behavior has taught us that children…. ALL BEHAVIORS SERVE SOME FUNCTION • Are NOT born with “bad behaviors” • Do NOT learn when presented contingent aversive consequences ……. . Do learn better ways of behaving by being taught directly & receiving positive feedback…. consider function

Non-examples of Function-Based approach “Function” = outcome, result, purpose, consequence • “Russell, you skipped Non-examples of Function-Based approach “Function” = outcome, result, purpose, consequence • “Russell, you skipped 2 school days, so we’re going to suspend you for 2 more. ” • “Jason, I’m taking your book away because you obviously aren’t ready to learn. ” • “You want my attention? ! I’ll show you attention, …let’s take a walk down to the office & have a little chat with the Principal. ”

Worry #2: “Train & Hope” WAIT for New Problem Expect, But HOPE for Implementation Worry #2: “Train & Hope” WAIT for New Problem Expect, But HOPE for Implementation Hire EXPERT to Train Practice REACT to Problem Behavior Select & ADD Practice

Enhanced PBIS Implementation Logic Enhanced PBIS Implementation Logic

BIG IDEAS • 3 -5 years • Organizational Framework • Critical Features same across BIG IDEAS • 3 -5 years • Organizational Framework • Critical Features same across schools – unique to the culture of the school • System investment in Coaching Capacity

PBIS Supporting Social Competence & Academic Achievement ST SY TA DA Supporting Staff Behavior PBIS Supporting Social Competence & Academic Achievement ST SY TA DA Supporting Staff Behavior EM S OUTCOMES PRACTICES Supporting Student Behavior Supporting Decision Making

CONTINUUM OF SCHOOL-WIDE PBIS ~5% ~15% Tertiary Prevention: Specialized Individualized Systems for Students with CONTINUUM OF SCHOOL-WIDE PBIS ~5% ~15% Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior APPLYING TRIANGLE LOGIC Primary Prevention: School-/Classroom- ADULT BEHAVIOR Wide Systems for All Students, Staff, & Settings ~80% of Students TO

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Establish Commitment • Administrator support and active involvement • Behavior Support is 1 of Establish Commitment • Administrator support and active involvement • Behavior Support is 1 of top 3 school improvement goals • 80% Faculty support • 3 year timeline

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Team Composition • Administrator • Grade/Department Representation • Specialized Support – Special Educator, Counselor, Team Composition • Administrator • Grade/Department Representation • Specialized Support – Special Educator, Counselor, School Psychologist, Social Worker, etc. • Support Staff – Office, Supervisory, Custodial, Bus, Security, etc. • Parent • Community – Mental Health, Business • Student Start with a Team that “Works. ”

Sample Teaming Matrix Initiative, Committee Attendance Committee Purpose int o Outcome Increase attendance Increase Sample Teaming Matrix Initiative, Committee Attendance Committee Purpose int o Outcome Increase attendance Increase % of students attending daily School Climate Committee Improve Climate Safety Committee Improve safety Predictable response to threat/crisis K y. P e Target Group All students Staff Involved Eric, Ellen, Marlee Enhance school spirit Improve morale All students Discipline Committee Improve behavior Decrease office referrals Bullies, antisocial students, repeat offenders S&DFS Committee Prevent drug use PBIS Work Group Implement 3 -tier model Goal #2 Marlee, J. S. , Ellen, Eric Goal #3 Has not met Ar. All students e ou tc Dangerous om students School Spirit Committee Goal #3 es m Has not met ea s Ellen, Eric, u r Goal #3 Marlee, Otis a bl e? High/at-risk drug users Decrease office referrals, increase attendance, enhance academic engagement, improve grades SIP/SID Don All students Eric, Ellen, Marlee, Otis, Emma Goal #2 Goal #3

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Gather Information AVAILABLE DATA: • Office Referrals, • Suspensions, • Attendance, • Academics SURVEY: Gather Information AVAILABLE DATA: • Office Referrals, • Suspensions, • Attendance, • Academics SURVEY: Staff, Students, Administration, Parents

Marketing Strategy • Integrate past school behavior plans • Assure clarity of target areas Marketing Strategy • Integrate past school behavior plans • Assure clarity of target areas • Incorporate school colors or mascot

Respectful Able Motivated Safe Respectful Able Motivated Safe

80% Staff Buy In • share/ present Data • start small • easy implementation 80% Staff Buy In • share/ present Data • start small • easy implementation • showcase success

Nuts and Bolts • Brainstorm classroom vs. office managed behaviors • Come to consensus Nuts and Bolts • Brainstorm classroom vs. office managed behaviors • Come to consensus on language to be used • Agree on behaviors to list

l-w o ho c S SWPBS de i Subsystems Classroom Non-classroom Student Family l-w o ho c S SWPBS de i Subsystems Classroom Non-classroom Student Family

Team GENERAL IMPLEMENTATION PROCESS Agreements Data-based Action Plan Evaluation Implementation Team GENERAL IMPLEMENTATION PROCESS Agreements Data-based Action Plan Evaluation Implementation

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

School Rules NO Food NO Weapons s NO Backpack g Drugs/Smokin NO NO Bullying School Rules NO Food NO Weapons s NO Backpack g Drugs/Smokin NO NO Bullying Redesign Learning & Teaching Environment

THE DO NOTs THE DO NOTs

Establish SW Expectations FRMS “High 5 s” • • • Be Respectful Be Responsible Establish SW Expectations FRMS “High 5 s” • • • Be Respectful Be Responsible Be There/Ready Follow Directions Hands & Feet to Self

3 -5 Positively Stated Behavioral Expectations 3 -5 Positively Stated Behavioral Expectations

3 -5 positive SW expectations defined, taught, & encouraged 3 -5 positive SW expectations defined, taught, & encouraged

Instructional Approach • Behavioral expectations are taught directly • Teach social behaviors like academic Instructional Approach • Behavioral expectations are taught directly • Teach social behaviors like academic skills • Academic engagement & success are maximized • Influence of instructional support is considered

The Power Of Teaching • “If a child doesn’t know how to read, we The Power Of Teaching • “If a child doesn’t know how to read, we teach. ” • • “If a child doesn’t know how to swim, we teach. ” “If a child doesn’t know how to multiply, we teach. ” “If a child doesn’t know how to drive, we teach. ” “If a child doesn’t know how to behave, we … … teach? … punish? ” Why can’t we finish the last sentence as automatically as we do the others? PBIS Philosophy

Teaching SW Expectations FRMS “Opening Day” • Teach directly in context (“teaching stations”) – Teaching SW Expectations FRMS “Opening Day” • Teach directly in context (“teaching stations”) – See/model – Practice – Acknowledge • 2 day intensive by all staff/students • Regular weekly/monthly review

Expectations & behavioral skills are taught & recognized in natural context Expectations & behavioral skills are taught & recognized in natural context

“Cool Tool” Skill Name Getting Help (How to ask for assistance for difficulty tasks) “Cool Tool” Skill Name Getting Help (How to ask for assistance for difficulty tasks) Teaching Examples 1. When you’re working on a math problem that you can’t figure out, raise your hand wait until the teacher can help you. 2. You and a friend are working together on a science experiment but you are missing a piece of lab equipment, ask the teacher for the missing equipment. 3. You are reading a story but you don’t know the meaning of most of the words, ask the teacher to read and explain the word. Kid Activity 1. Ask 2 -3 students to give an example of a situation in which they needed help to complete a task, activity, or direction. 2. Ask students to indicate or show they could get help. 3. Encourage and support appropriate discussion/responses. Minimize attention for inappropriate responses. After the Lesson (During the Day) 1. Just before giving students difficult or new task, direction, or activity, ask them to tell you how they could get help if they have difficulty (precorrection). 2. When you see students having difficulty with a task (e. g. , off task, complaining), ask them to indicate that they need help (reminder). 3. Whenever a student gets help the correct way, provide specific praise to the student.

 Teaching Matrix Activity Classroom Lunchroom Bus Hallway Assembly Use inside voice Eat your Teaching Matrix Activity Classroom Lunchroom Bus Hallway Assembly Use inside voice Eat your own food Stay in your seat Stay to right Arrive on time to speaker Respect Environment & Property Recycle paper Return trays Keep feet on floor Put trash in cans Take litter with you Respect Yourself Do your best Wash your hands Be at stop on time Use your words Listen to speaker Respect Learning Have materials ready Eat balanced diet Go directly from bus to class Go directly to class Discuss topic in class w/ others Respect Others

Reviewing Strive for Five • Be respectful. • Be safe. • Work peacefully. • Reviewing Strive for Five • Be respectful. • Be safe. • Work peacefully. • Strive for excellence. • Follow directions.

PBIS Matrix for Home I am respectful Listen to my parents Be truthful to PBIS Matrix for Home I am respectful Listen to my parents Be truthful to my parents Play cooperatively Speak nicely to others I am responsible Put away my toys, bike, and equipment Help with jobs at home Follow my parents’ directions Share Thursday folder with parents I am safe Play safely with others Stay in designated areas Stay away from strangers Wear bike helmet and equipment I am prepared Finish homework and share with parent • . Pack backpack at night for school the next day Go to bed on time Get up and get ready for school when called

Expectations Family Teaching Matrix Respect Ourselves SETTING At home Morning Routine Homework 1. SOCIAL Expectations Family Teaching Matrix Respect Ourselves SETTING At home Morning Routine Homework 1. SOCIAL SKILL Respect Others Respect Property Meal Times R IO AV ES EH PL B M 3. XA E In Car Play Bedtime 2. NA CO T NT UR EX AL T

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Acknowledging SW Expectations: “RATIONALE” • Humans require regular & frequent feedback on their actions Acknowledging SW Expectations: “RATIONALE” • Humans require regular & frequent feedback on their actions • Humans experience frequent feedback from others, self, & environment • W/o formal feedback to encourage desired behavior, other forms of feedback shape undesired behaviors

Are “Rewards” Dangerous? “…our research team has conducted a series of reviews and analysis Are “Rewards” Dangerous? “…our research team has conducted a series of reviews and analysis of (the reward) literature; our conclusion is that there is no inherent negative property of reward. Our analyses indicate that the argument against the use of rewards is an overgeneralization based on a narrow set of circumstances. ” – Cameron, 2002 • Cameron & Pierce, 1994, 2002 • Cameron, Banko & Pierce, 2001

Establish Procedures for Encouraging SW Expectations • FRMS: “High Fives” • Guidelines – Label Establish Procedures for Encouraging SW Expectations • FRMS: “High Fives” • Guidelines – Label specific expectation & behavior – Paired with social recognition – Culturally/contextually appropriate & considerate – Lots to less – Individual to group – External- to self-managed – Frequent to infrequent

Many schools use a ticket system Jose R. • Tied into school expectations • Many schools use a ticket system Jose R. • Tied into school expectations • Specific feedback on student’s behavior • Provides visible acknowledge of appropriate behavior for student • Helps to remind staff to provide acknowledgements Kalamazoo Central High School L. M.

Clever Variations • • Bus What really matters Bucks Super Sub Slips Is the Clever Variations • • Bus What really matters Bucks Super Sub Slips Is the positive social Golden Plunger G. O. O. S. E. acknowledgement First-in-Line & interaction!! Patriot’s Parking Pass Business Partner Discount

OMMS Business Partner Ticket 6 7 8 Date: ________ Student Name _________________ For Demonstrating: OMMS Business Partner Ticket 6 7 8 Date: ________ Student Name _________________ For Demonstrating: Safety Ethics Respect (Circle the trait you observed) Comments: ______________________ Authorized Signature: __________________ Business Name: ____________________providing a “reinforcer to kid Grand Junction CO 5/06

Discipline Works When …. Reinforcementcreates more Positive than Prevention (success) Negative consequences : 1 Discipline Works When …. Reinforcementcreates more Positive than Prevention (success) Negative consequences : 1 4 Punishment

Samples • • • High Fives, Gotchas Traveling Passport Super Sub Slips, Bus Bucks Samples • • • High Fives, Gotchas Traveling Passport Super Sub Slips, Bus Bucks Back/front of bus Free homework coupon Discount school store Grab bag Early dismissal/Late arrival First/last in Line Video store coupon, free fries • • • G. O. O. S. E 1 -Free Period Massage File stuffer Coffee Coupon Golden Plunger Give Em’ a Hand Kudos Positive Office Referrals Extra dessert Class event

“Good morning, class!” Teachers report that when students are greeted by an adult in “Good morning, class!” Teachers report that when students are greeted by an adult in morning, it takes less time to complete morning routines & get first lesson started.

Mc. Cormick Elementary School, MD Monitoring Dismissal Mc. Cormick Elementary School, MD Monitoring Dismissal

“Super Sub Slips” • Empowering subs in Cottage Grove, OR • Procedures – Give “Super Sub Slips” • Empowering subs in Cottage Grove, OR • Procedures – Give 5 per sub in subfolder – Give 2 out immediately

“Positive Office Referral” • Balancing positive/negative adult/student contacts in Oregon • Procedures – Develop “Positive Office Referral” • Balancing positive/negative adult/student contacts in Oregon • Procedures – Develop equivalent positive referral – Process like negative referral

“Traveling Passports” • Setting New Students up for success • Pre-correcting • Procedures – “Traveling Passports” • Setting New Students up for success • Pre-correcting • Procedures – Meet with key adults – Review expectations – Go to class • Student “ESCORTS” for new arrivals

REGULARLY ACKNOWLEDGE STAFF BEHAVIOR REGULARLY ACKNOWLEDGE STAFF BEHAVIOR

“GOLDEN PLUNGER” “ 1 FREE PERIOD” • Involve custodian • Procedure • Contributing to “GOLDEN PLUNGER” “ 1 FREE PERIOD” • Involve custodian • Procedure • Contributing to a safe, caring, effective school environment • Procedures – Custodian selects one classroom/ hallway each week that is clean & orderly – Sticks gold-painted plunger with banner on wall “G. O. O. S. E. ” • “Get Out Of School Early” – Or “arrive late” • Procedures – Kids/staff nominate – Kids/staff reward, then pick – Given by Principal – Principal takes over class for one hour – Used at any time “DINGER” • Reminding staff to have positive interaction • Procedures – Ring timer on regular, intermittent schedule – Engage in quick positive interaction

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Office Discipline Referrals (ODR) • Definition – Kid-Teacher-Administrator interaction – Underestimation of actual behavior Office Discipline Referrals (ODR) • Definition – Kid-Teacher-Administrator interaction – Underestimation of actual behavior • Improving usefulness & value – – – Clear, mutually exclusive, exhaustive definitions Distinction between office v. classroom managed Continuum of behavior support Positive school-wide foundations W/in school comparisons

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Pre Post Pre Post

Total Office Discipline Referrals (ODR) Total Office Discipline Referrals (ODR)

Avg. Ref/Day/Month Avg. Ref/Day/Month

# Ref by Problem # Ref by Problem

# Ref by Location # Ref by Location

# Ref by Time of Day # Ref by Time of Day

# Ref by would How long Students it take to answer big 5 SW # Ref by would How long Students it take to answer big 5 SW discipline questions in your school? 1. Who committed the offense? 2. What was he/she doing? 3. Where did it happen? 4. When did it happen? 5. Who else was involved?

10% N= 1679 443 163 Elementary Middle High 246 K (8 -12) 10% N= 1679 443 163 Elementary Middle High 246 K (8 -12)

N = 1679 Elementary 443 Middle 163 High 246 K (8 -12) N = 1679 Elementary 443 Middle 163 High 246 K (8 -12)

Do we need to tweak our action plan? + • How often? If many Do we need to tweak our action plan? + • How often? If many students If problem, same are making • Who? • Which mistake, consider changing systems students/staff? • What? …. not students system? • What • Where? + • When? by START • How much? rewarding • What teaching, monitoring intervention? • What outcome? …before increasing punishment &

Messages Repeated! 1. Successful Individual student behavior support is linked to host environments or Messages Repeated! 1. Successful Individual student behavior support is linked to host environments or schools that are effective, efficient, relevant, & durable 2. Learning & teaching environments must be redesigned to increase the likelihood of behavioral & academic success

ODR Administrator Benefit Springfield MS, MD 2001 -2002 -2003 2277 - 1322 = 955 ODR Administrator Benefit Springfield MS, MD 2001 -2002 -2003 2277 - 1322 = 955 42% improvement = 14, 325 min. @15 min. = 238. 75 hrs = 40 days of Administrator time

ODR Instructional Benefit Springfield MS, MD 2001 -2002 -2003 2277 - 1322 = 955 ODR Instructional Benefit Springfield MS, MD 2001 -2002 -2003 2277 - 1322 = 955 42% improvement = 42, 975 min. @ 45 min. = 716. 25 hrs = 119 days of Instructional time

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Critical Features • • • Establish Commitment Establish and Maintain Team Self-Assessment Establish School-Wide Expectations Establish On-Going System of Rewards Establish System for Responding to Behavioral Violations • Establish Information System • Build Capacity for Function-Based Support • Build District Level Support

PBIS Systems Implementation Logic Funding Visibility Political Support Leadership Team Active Coordination Training Coaching PBIS Systems Implementation Logic Funding Visibility Political Support Leadership Team Active Coordination Training Coaching Evaluation Local School Teams/Demonstrations

www. pbismaryland. org www. pbismaryland. org

Resources • • www. pbis. org www. pbismaryland. org www. swis. org mmckenna@msde. state. Resources • • www. pbis. org www. pbismaryland. org www. swis. org [email protected] state. md. us

www. pbismaryland. org www. behaviordoctor. org www. pbismaryland. org www. behaviordoctor. org




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