Wisconsin Pyramid Model Program-Wide Implementation Application

Activities Prior To Applying Checklist
We have completed the activities listed below:

Someone from our program has met with a regional lead or other training and technical assistance providers to discuss Program-Wide Pyramid Model ImplementationOur staff received information about Program-Wide Pyramid Model Implementation and completed the staff buy-in pollWe have determined who will sit on the leadership team

Professional Development
Please list any training staff received on the Pyramid Model content
Staff Buy In

If you haven't yet completed the staff survey, a printable survey can be accessed here: https://app.box.com/file/1843120327093

Please indicate your interest and willingness to address children’s social and emotional competence and challenging behavior through program-wide implementation of the Pyramid Model.

	Total
I'm all in: I believe we should continue to implement the Pyramid Model throughout our program. I’m ready to begin or continue to adjust and adapt my practices to ensure the best social and emotional outcomes for all children in our program.
I'm all in but I need more: Program wide implementation seems like a good fit for our program, but I need more training or information to get started or continue implementation in my role.
It's a fit for others, but not me: Program wide implementation seems like a good idea for our program, but I am not personally committed to implementation.
Program wide is not a good fit: Program wide implementation is not or will not be beneficial to me and/or our program.

Please indicate your interest and willingness to teach children as individuals by knowing their interests, their family and their community in our work of program-wide implementation of the Pyramid Model.

	Total
I'm all in: I believe we should continue to implement the Pyramid Model throughout our program. I’m ready to begin or continue to adjust and adapt my practices to ensure the best social and emotional outcomes for all children in our program.
I'm all in but I need more: Program wide implementation seems like a good fit for our program, but I need more training or information to get started or continue implementation in my role.
It's a fit for others, but not me: Program wide implementation seems like a good idea for our program, but I am not personally committed to implementation.
Program wide is not a good fit: Program wide implementation is not or will not be beneficial to me and/or our program.

Please indicate your interest and willingness to examineyour own thinking about children and development to learn how it might support-or get in the way of- children reaching the best social and emotional outcomesas part of our program-wide implementation of the Pyramid Model.

	Total
I'm all in: I believe we should continue to implement the Pyramid Model throughout our program. I’m ready to begin or continue to adjust and adapt my practices to ensure the best social and emotional outcomes for all children in our program.
I'm all in but I need more: Program wide implementation seems like a good fit for our program, but I need more training or information to get started or continue implementation in my role.
It's a fit for others, but not me: Program wide implementation seems like a good idea for our program, but I am not personally committed to implementation.
Program wide is not a good fit: Program wide implementation is not or will not be beneficial to me and/or our program.

Total Number of Staff Employed by the Program (including food services, custodial, secretarial, administrative, etc.)
Total Number of Staff Who Completed the Buy In Poll
Staff Buy-In Percentage

Leadership Team
Program-wide implementation is steered by a representative leadership team that meets at least monthly for years. This entire team attends the entirety of the Team Launch. Please list team members below.

*These roles are required to be filled before attending the team launch. Depending on the size of the program, the same person can fill multiple roles.
Please check the box to signify your agreement with each statement below:

We are able to make arrangements (ex. staff coverage, meet outside of work hours, releasing staff) so that identified members of the leadership team can attend monthly leadership team meetings and work on implementation projects between meetings as needed.
*Administrator
The administrator is responsible for allotting time, staff and resources towards Pyramid Model program-wide implementation. They ensure funding availability and policy alignment as an active member of the team. To do this effectively, the administrator needs to have a strong belief in the importance of enhancing children's social and emotional development through the use of Pyramid Model practices throughout the program.

*Please list at least 1 administrator to sit on your leadership team.
Please check each box to signify your agreement with each statement below:

The administrator(s) understand(s) the key components of program-wide Pyramid Model implementation (shared leadership team, practice based coaching and data based decision making) and is prepared to devote resources to the implementation of these componentsThe administrator(s) believe(s) in the importance of supporting adults to enhance the social and emotional development of young childrenThe administrator(s) feel(s) that implementing the Pyramid Model will make the program stronger
Administrator Name*
Email Address*
example@example.com
Number of Years at Program*
Administrator Name (2)
Email Address
example@example.com
Number of Years at Program
Administrator Name (3)
Email Address
example@example.com
Number of Years at Program
*Internal/Practitioner Coach:
The internal/practitioner coach is someone who is knowledgeable in the application of the evidence-based practices promoted by the Pyramid Model or and has the time to provide Practice Based Coaching to staff in the program. It is suggested, but not required, that the person identified as the internal/practitioner coach has some experience with supporting adults or is in a role to do so. Practice Based Coaching is a strength-based coaching model and includes completing TPOT or TPITOS observations, providing feedback, setting goals and action planning and monitoring progress over time. At minimum, the internal/practictioner coach will need 30 hours per teacher per year.
Please check each box to signify your agreement with each statement below:

We are prepared to allot time, staff and resources to allow the identified coach(es) to provide Practice Based Coaching to at least 1 teacher/classroomThe identified coach(es) have/has some experience and/or knowledge about applying Pyramid Model practices in the classroomThe identified coach(es) are committed to supporting adults to implement Pyramid Model practices in their classroom
The internal/practitioner coach must attend:
- either the TPOT or TPITOS Reliability Training
- Practice Based Coaching for Pyramid Model Programs
*Please list at least 1 internal/practitioner coach to sit on your leadership team.
Internal Coach Name*
Email Address*
example@example.com
Number of Years at Program*
Internal Coach Name (2)
Email Address
example@example.com
Number of Years at Program
Internal Coach Name (3)
Email Address
example@example.com
Number of Years at Program
*Data Coordinator
The data coordinator will oversee data collection in the program using data tools at the program, classroom and child level. Data coordinators require dedicated time to enter, review and pull information from the Pyramid Model Implementation Data System (PIDS) for the program leadership team to review.
Please check each box to signify your agreement with each statement below:

We are prepared to allot time, staff and resources to allow the data coordinator(s) the time to enter, review and pull data in time for program leadership team meetings.
The Data Coordinator must attend a 2-hour Data Coordinators Meeting.

*Please list at least 1 data coordinator to sit on your leadership team.
Data Coordinator Name*
Email Address*
example@example.com
Number of Years at Program*
Data Coordinator Name (2)
Email Address
example@example.com
Number of Years at Program
*Teacher Representative
It is imperative that the leadership team includes members that are responsible for directly using Pyramid Model practices with children and families. Teacher representatives are responsible for attending the monthly program leadership team meetings, helping to communicate information with staff and providing feedback to the leadership team from staff. Teams are encouraged to consider the number of staff in their program and ages served and invite more than one teacher representative as deemed appropriate.

*Please list at least 1 teacher representative to sit on your leadership team.
Teacher Rep Name*
Email Address*
example@example.com
Number of Years at Program*
Teacher Rep Name (2)
Email Address
example@example.com
Number of Years at Program
Teacher Rep Name (3)
Email Address
example@example.com
Number of Years at Program
Family Representative
Gathering family input and including families in decision making is a important part of program-wide implementation. It is recommended that teams include at least one family representative on their leadership team. If you do not currently have a person to serve as a family representative, you may leave these fields blank.
Family Rep Name
Email Address
example@example.com
Number of Years at Program
Family Rep Name (2)
Email Address
example@example.com
Number of Years at Program
Behavior Specialist
Your program will need access to behavior support for children with persistent challenging behavior through an internal person on your team, infant/early childhood mental health consultant or other individuals with behavior expertise. The behavior specialist attends the monthly leadership team meetings and guides teams of adults to problem solve and design interventions for children who need them. There is training available through the Wisconsin Pyramid Model for behavior specialists but it is not recommended within the first year of implementation.

If there is a staff member or someone you within your community that you have a relationship with who you believe can serve as an external coach, please list their information below. If you are unsure who will fill this role, you may leave the fields below blank and Wisconsin Pyramid Model and your external/program coach will work with you to identify a behavior specialist.
Behavior Specialist Name
Behavior Specialist Email Address
example@example.com
Behavior Specialist Relationship with Program
If you are unable to identify a behavior specialist, what resources are available in your community to support your program and families when children demonstrate persistent challenging behavior.
*External/Program Coach
The external/program coach is a technical assistance provider with a deep understanding of the elements of program-wide implementation of the Pyramid Model. For at least the first year of implementation, the external/program coach will mentor leadership team members, join the leadership team meetings, and support the internal/practitioner coach with completing TPOT and/or TPITOS observations and completing the Practice-Based Coaching cycle with practitioners. The fee for an external coach is waived for regulated, Youngstar participating programs.
Programs that are not regulated, Youngstar participating programs will need to contract with WI-AIMH for external/program coaching services annually.

We are prepared to contract with WI-AIMH at the cost of $5200 annually for external/program coaching services
We strive to honor already existing relationships for programs. If you are currently working with an individual or have an individual in the community who you believe can serve as an external coach, please list their information below. If you are unsure who will fill this role, you may leave the fields below blank and Wisconsin Pyramid Model will work with you to identify an external/program coach.
External/Program Coach Name
External/Program Coach Email Address
example@example.com
External/Program Coach Relationship with Program

Use of Developmentally Appropriate Practice
How many staff have attended professional development about developmentally appropriate practice (ex. WMELS)
Percentage of staff that have attended professional development about developmentally appropriate practice
List curriculums that are currently being used in your program, if any.
List assessments that are currently being used in your program, if any.

Resource Commitment
Please review the sample budget below. Please keep in mind that prices can change at anytime and this is really meant to be used as a planning resource.
Additional Costs to Consider:
- Materials to celebrate staff (food, gifts, etc.)
- Meals during training events or meetings
- Childcare during training events or meetings
- Compensation of staff with more responsibilities
- Time and compensation for data coordinator to have time to enter data and pull reports for the team
- Investing in materials (Discovery Source boxes, books, etc.)
- Compensation of travel if needed for training events
- Coverage of leadership team members to attend Pyramid Model Institutes (1 hour monthly)
- Possible Costs for Staff Turnover or Additional Staff
  - New Coach (TPOT/TPITOS, PBC)
  - Team Re-Launch
  - Additional PMII Facilitators
After reviewing the sample budget above, describe how you plan to allocate and/or prioritize funds and other resources to support implementation.

Summary

Please review the information below.

Program Information:

Program Name	{programName}
Address of Program	{addressOf}
Name of Staff Member to Serve as Application Contact	{nameOf}
Email Address of Application Contact	{contactEmail}
Phone Number of Application Contact	{contactPhone}

Staff Buy-In:

{totalNumber40} staff members completed the Staff Buy-In survey.

{staffBuyin} of staff that took the survey would agree that supporting social and emotional development is a priority for the program and the children and families served.

Leadership Team:

Name	Email Address	Role
{administratorName70}	{emailAddress}	Administrator
{internalCoach}	{emailAddress114}	Internal/Practitioner Coach
{dataCoordinator}	{emailAddress126}	Data Coordinator
{teacherRep}	{emailAddress168}	Teacher Representative
{familyRep}	{emailAddress177}	Family Representative
{behaviorSpecialist153}	{behaviorSpecialist154}	Behavior Specialist
{externalprogramCoach}	{externalprogramCoach124}	External/Program Coach

Other Members Listed:

{administratorName}

{administratorName160}

{internalCoach117}

{internalCoach121}

{dataCoordinator164}

{teacherRep170}

{teacherRep175}

{familyRep179}

This application is approved for submission by:
Signature of Administrator (owner, superintendent, etc.)

Clear
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Wisconsin Pyramid Model Program-Wide Implementation Application

Program Information

Activities Prior To Applying Checklist

Professional Development

Staff Buy In

Leadership Team

*Administrator

*Internal/Practitioner Coach:

*Data Coordinator

*Teacher Representative

Family Representative

Behavior Specialist

*External/Program Coach

Use of Developmentally Appropriate Practice

Resource Commitment

Summary