Child Assistance Team

Masonic Model

Twin Peaks Child Assistance Team Mission

StatementThe Twin Peaks Child Assistance

Team will collaborate with teachers to develop intervention action plans in order to promote

student success.

The CAT Team Consists of:

• Classroom Teachers

• Administration

• School Counselor

• Behavior Coach

• Special Education/Speech Teachers

• School Psychologist

• Reading Specialists

What Do I Do Now?

Intervention Ideas

(Multiple Pages)

Refer the Child to the Child Assistance Team

Purpose of the Child Assistance Team

• To brainstorm possible intervention ideas

• To provide an intervention action plan to the classroom teacher

• To provide follow-up and alternate intervention ideas

• When intervention is not successful, the Child Assistance Team may recommend a Step II Meeting

CAT Referral Process & Timeline

• Teacher collects informal documentation of area(s) of concern

• The classroom teacher submits the initial referral

• The student is assigned a child advocate• The child is assigned a CAT meeting date (2-

10 weeks after the initial referral)• The child advocate distributes the data

collection forms to all staff who have contact with the child

CAT Referral Process & Timeline Con’t

• Staff members complete and return the forms to the child advocate by the assigned due date

• The Child Advocate compiles all of the data collected onto a summary form

• The Child Assistance Team meets to discuss the child and to create an intervention plan

• The Child Advocate places a hot pink notice in the child’s cumulative folder to indicate that there is a CAT file for this child

Confidential: All information recorded must be specific, descriptive, observable, and factual. This form is a school record and may be requested by parents.

Twin Peaks Elementary School Initial Referral Child Assistance Team

Classroom Teacher: _________________________________ Date: ______________

Student: ______________________________________________

Reason for Referral (Observed Behaviors):

Attendance: Academics: Behavior: Health: Please list all teachers and specialists who have contact with this child:

Classroom:

Other subject teacher:

Remedial Reading:

Special Education:

PE:

Music:

Band:

Orchestra:

Other:

This student receives:

Special Education 504 Accommodations Counseling Behavior Coach

GEM Remedial Reading Speech SEI Language Instruction

TPE School Initial

Referral to C.A.T.

CAT

Initial Referral

Intervention Checklist

Confidential: All information must be specific, descriptive, observable, and factual. This form is a school record and may be requested by parents.

Initial Referral Prior Interventions Checklist

Student:................................................................................... Grade: ...................................

Please indicate what types of interventions you have tried prior to referral and when.

Date Outcome

1. Spoke to student privately after class. ................... ………………......................

• Explained class rules and expectations ................... ………………......................

• Explained concerns ................... ………………......................

2. Changed student’s seat ................... ………………......................

3. Spoke with parent on the telephone. Phone No. ................... ………………......................

4. Gave student special work at his/her level. ................... ………………......................

5. Checked cumulative folder. ................... ………………......................

6. Held conference with parent in school. ................... ………………......................

7. Sent home notices regarding behavior/school work. ................... ………………......................

8. Have set up behavior management program with student. ................... ………………......................

Please attach a copy.

9. Have given tiger tales? ................... ………………......................

How many? …………….. Reason(s) ……………………............................………………......................

10. Have given Roaring Reminders? ................... ………………......................

How many? …………….. Reason(s) ……………………............................………………......................

11. Assigned student after school detention. ................... ………………......................

How many?.................... Reason(s) ……………………............................………………......................

12. Have referred student to counselor. ................... ………………......................

13. Have referred student to principal. ................... ………………....................

*14. Gave student help after class/school. ................... ………………......................

*15. Have given student extra attention. ................... ………………......................

*Questions 14 & 15 may require additional information. Any attachment must be in the area(s) of

academics, behavior, health, and/or attendance. Any attachment must be specific, descriptive, observable,

and factual.

16. Other interventions: ......................................................................................................................................

.................................................................................................................... .........................................................

...................................................................................................................... .......................................................

................................................................................................................................................ .............................

Newman-Stecher International

Child Assistance Team Directions for the Classroom Teacher

Twin Peaks Elementary School

CAT #: ____________________ Student’s Name: ________________________________

Referring Teacher: ____________________ Child Advocate: _____________________

All Forms, Copies, and Work Samples are Due to the Child Advocate by: ______________

Responsibilities of the Classroom Teacher:

Keep the Child Assistance Team referral and all forms confidential.

Record only information that is specific, descriptive, observable, and factual. CAT forms

are school records and may be requested by parents.

Fill out all forms completely and return them to the Child Advocate on time

Attend all scheduled CAT meetings for the referred student.

Serve as the recorder at the CAT meeting during the brainstorming of intervention ideas

Keep the Child Advocate informed about the child’s progress or lack of progress

Classroom Teacher Checklist:

Classroom Teacher Data Collection Form Fully Completed

Discipline Form Completed

Work Samples Collected

Copied the Report Cards from the Past 2 Years

Copied Standardized Tests (AIMS, Terra Nova, DIBELS and/or ELSA) from the past 2

years

Copied all Pertinent Information Contained in the Cumulative Folder from Prior Schools

Spoke to Last Year’s Teacher

Scheduled a Peer to Observe the Student

Contacted the Parent to Inform them of CAT Referral

Held Parent Conference and Completed Pertinent Portions of the Parent Interview with

the assistance of the Child Advocate (If Needed)

CAT Directions for

the Classroom

Teacher

CAT Child Advocate

Checklist

Classroom Teacher Data Collection Form

Twin Peaks Elementary School

Directions: Return this form, fully completed, and all attachments in the sealed

envelope, safeguarding the confidentiality of the student, to the child advocate by

the due date listed below. Please attach: work samples, copies of report cards

from the last 2 years, copies of standardized tests from the last 2 years (AIMS,

Terra Nova, DIBELS and/or ELSA).

Child Advocate:______________________ Due Date: __________________

Classroom Teacher:________________________ Grade:_______________

Student:____________________________ Date of Birth: ________________

Reason for Referral: ______________________________________________

Subject Current Grades

Strengths Weaknesses

Reading

Writing

Math

Others

Classroom Teacher

Data Collection

Form

Specialist Data Collection Form

Twin Peaks Elementary School

Directions: Return this form, fully completed, in the sealed envelope, safeguarding the confidentiality of the student, to the child advocate by the due date listed below.

Child Advocate:______________________ Due Date: __________________

Classroom Teacher:________________________ Grade:_______________

Student:____________________________ Date of Birth: ________________

Reason for Referral: ______________________________________________

Specialist’s Name (One completing this form): __________________________

Choose one:

Remedial Reading

Speech/Language

Special Education

SEI

GEM

Music (General)

Band

Orchestra

Physical Education

Specify Other: ____________

Your Subject

Current Grades

Strengths Weaknesses

Specialist Data

Collection Form

Classroom Teacher Discipline Data Form

Twin Peaks Elementary School

Child Advocate:______________________ Due Date: __________________

Classroom Teacher:________________________ Grade:_______________

Student:____________________________ Date of Birth:________________

Tiger Tails

Date/Time Reason

Disciplinary Referrals to the Principal

Date/Time Reason Consequence

1. Number of detentions: _____________

2. Indicate the number of times the parent has been contacted regarding the child’s

behavior:_______

3. Other comments regarding behavior:

Classroom Teacher

Discipline Data

Counselor Form

Health Checklist

Attendance Checklist

CAT Student

Interview

(Optional)

CAT

Data Summary

Form

(Multiple Pages)

ConfidentialityPlease follow strict confidentiality guidelines when

referring a student to the Child Assistance Team.

• All information recorded on CAT forms must be specific, descriptive, observable, and factual

• CAT forms are school records and may be requested by parents

• Return forms to the designated Child Advocate in a sealed envelope

• Only discuss the child’s case with colleagues who have an “educational need to know”

Team Do’s & Don’ts

Do’s Don’tsBe factual & descriptive Admire the Problem

Stay School-based and

School-focused

Focus on issues that are beyond your control

Respect Time Limits Go Over Time Limits

Stay on Track Tell Stories

Remember Confidentiality Give Up on a Child

Team Meeting Format

• Child Advocate presents the case/information about the child (4 min)

• CAT members ask clarifying questions (1 min)• CAT members brainstorm intervention ideas.

Classroom teacher writes all ideas on chart paper. (7 min)

• Classroom teacher reviews the ideas and decides which ones he/she would like to try first. The intervention action plan is written for the child. (8 min)

Fish Bowl Activity

Writing an Action Plan

Year End Status

Checklist

Poem from Masonic Foundation for Children

It is not the action

Nor the fruit of the action that is important

You have to do the right thing.

It may not be in your power, or

It may not be in your time that there will be any fruit;

But that doesn’t mean you stop doing the right thing.

You any never know what results come from your action,

But if you do nothing, there will be no result.

Contact Information

Robert Shrager, Training Registration

Arizona Masonic Foundation for Children

9208 E. Bellevue Street

Tucson, AZ 85715

Fax (520) 885-8332

E-mail LBOB130709@MSN.COM

All Masonic SAT Trainings are Free