Pyramid Model Data Forms
http://csefel.vanderbilt.edu/resources/training_preschool
.html#mod3a
and
http://csefel.vanderbilt.edu/resources/training_preschool
.html#mod3b
Average Aggression
Child’s Name: ______________ Week of: _________________
Check the number of times the child is aggressive during the activity. Aggression includes: hits,
pinches, pulls hair, bites, kicks, & scratches.
Activity Mon. Tues. Wed. Thurs. Fri. Average
Arrival ___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___510times
___10-15
___15-20
___+20
Circle ___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
Lunch ___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
Average ___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
___0 times
___1-5 times
___5-10times
___10-15
___15-20
___+20
Monday Tuesday Wednesday Thursday Friday Saturday
4 4 4 4 4 4
3 3 3 3 3 3
2 2 2 2 2 2
1 1 1 1 1 1
Playtime
Child’s name: __________________________________Dates: ___________
4=Laughing, stayed 3=Cooperated,
stayed briefly
2=Fussed, took several turns 1= Cried, refused to play
On Task Behavior
Child’s Name: ____________ Week of: ______________
Rate of engagement at the end of each activity. Also note the average length (in minutes) of the
activity.
1=disruptive, 2=not engaged, 3= engaged some of the time, 4= engaged majority of the time
Activity Monday Tuesday Wednesday Thursday Friday Average
Circle 4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___ _________
Art 4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___ _________
Free Play 4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___
4
3
2
1
Length___ _________
Average
_____ _____ _____ _____ _____ _________
Average Cooperation
Child Name: ______________ Task: _______________________
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1 1 1 1 1 1 1
2 2 2 2 2 2 2
3 3 3 3 3 3 3
4 4 4 4 4 4 4
Date: Date: Date: Date: Date: Date: Date:
1: No resistance 2: Only a few verbal prompts
3: Lots of verbal prompts 4: Hand over hand assist
Average Cooperation: Self-Care
Child’s Name: ____________________ Week of: ______________
Circle the number that best represents the amount of resistance the child gave during each activity.
1= very cooperative, 2=somewhat cooperative, 3=not cooperative
Activity Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Get
dressed
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Brush
Teeth (am)
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Bathroom
(am)
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Bath 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Dress for
bed
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Brush
Teeth pm
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Bathroom
(pm)
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Average _______ _______ _______ _______ _______ _______ _______
Play Behavior
Child’s Name: _____________________ Week of: _________ Time: ___:___--___:___
Indicate play behavior at the beginning, middle, and end of each play period. Summarize play
behavior by placing totals in summary column.
Weekly Total
___Not Playing
___Play with toy alone
___Play with toy with peer
Day/Activity Beginning Middle End Summary
Date:_________
Activity:_______
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
Date:_________
Activity:_______
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
Date:_________
Activity:_______
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
___Not playing
___Play with toy
alone
___Play with toy
with peer
Peer Interaction
Child’s Name: ______________ Observer: ___________________
Check yes (Y) or no (N) at time one (T1) and time two (T2) to indicate whether the child
is interacting with a peer at the time of observation.
T1 and T2 observations should be at least 5 minutes apart.
Activity Date:____ Date:____ Date:____ Date:____ Date:____
Centers T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
Lunch T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
Outside T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
T1: T2:
__Y __Y
__N __N
Ratio: _____#yes
_____total #
observed
_____#yes
____total #
observed
_____#yes
____total #
observed
_____#yes
____total #
observed
_____#yes
____total #
observed
___physical aggression ___physical aggression
GOOD
DIFFICULT
EXTREMELY
DIFFICULT
Shade in the thermometer to indicate behavior.
Observer:_____________ Date:________
Morning Afternoon
GOOD
DIFFICULT
EXTREMELY
DIFFICULT
MORNING
CIRCLE
CENTERS OUTSIDE
PLAY
Shade in the thermometer to indicate ___________’s behavior.
Observer: _______________ Date: ___________
GOOD
DIFFICULT
EXTREMELY
DIFFICULT
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
30 30 30 30 30 30 30
28 28 28 28 28 28 28
26 26 26 26 26 26 26
24 24 24 24 24 24 24
22 22 22 22 22 22 22
20 20 20 20 20 20 20
18 18 18 18 18 18 18
16 16 16 16 16 16 16
14 14 14 14 14 14 14
12 12 12 12 12 12 12
10 10 10 10 10 10 10
8 8 8 8 8 8 8
6 6 6 6 6 6 6
4 4 4 4 4 4 4
2 2 2 2 2 2 2
Average Duration
Child’s Name: ______________________ Behavior: ________________
Week of: _________________ Average Duration for Week: _________ minutes
Starting from the bottom, shade the number of boxes that represent the length of the target behavior. Each
box represents TWO minutes.
Steps in Daily Routines
Routine Steps
Story time Sit in a circle, listen, look at pictures,
answer questions about story
Transition
•Time of the day
•Transition between which
activities
Strategies to use
before the
transition
Strategies to use
during the
transition
Strategies to use
after the
transition
8:20-8:25
Arrival from buses and go to the
classroom
Adult is present to greet and
wait for students; prompt
children to line up with a buddy
Teacher guides discussion
about things the children saw
as they rode the bus to school
Teacher gives the children a
“high 5” as they enter the
classroom

Data forms CSEFEL

  • 1.
    Pyramid Model DataForms http://csefel.vanderbilt.edu/resources/training_preschool .html#mod3a and http://csefel.vanderbilt.edu/resources/training_preschool .html#mod3b
  • 2.
    Average Aggression Child’s Name:______________ Week of: _________________ Check the number of times the child is aggressive during the activity. Aggression includes: hits, pinches, pulls hair, bites, kicks, & scratches. Activity Mon. Tues. Wed. Thurs. Fri. Average Arrival ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___510times ___10-15 ___15-20 ___+20 Circle ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 Lunch ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 Average ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20
  • 3.
    Monday Tuesday WednesdayThursday Friday Saturday 4 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 1 1 1 1 1 1 Playtime Child’s name: __________________________________Dates: ___________ 4=Laughing, stayed 3=Cooperated, stayed briefly 2=Fussed, took several turns 1= Cried, refused to play
  • 4.
    On Task Behavior Child’sName: ____________ Week of: ______________ Rate of engagement at the end of each activity. Also note the average length (in minutes) of the activity. 1=disruptive, 2=not engaged, 3= engaged some of the time, 4= engaged majority of the time Activity Monday Tuesday Wednesday Thursday Friday Average Circle 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ _________ Art 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ _________ Free Play 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ 4 3 2 1 Length___ _________ Average _____ _____ _____ _____ _____ _________
  • 5.
    Average Cooperation Child Name:______________ Task: _______________________ Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 Date: Date: Date: Date: Date: Date: Date: 1: No resistance 2: Only a few verbal prompts 3: Lots of verbal prompts 4: Hand over hand assist
  • 6.
    Average Cooperation: Self-Care Child’sName: ____________________ Week of: ______________ Circle the number that best represents the amount of resistance the child gave during each activity. 1= very cooperative, 2=somewhat cooperative, 3=not cooperative Activity Monday Tuesday Wednesday Thursday Friday Saturday Sunday Get dressed 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Brush Teeth (am) 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Bathroom (am) 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Bath 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Dress for bed 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Brush Teeth pm 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Bathroom (pm) 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Average _______ _______ _______ _______ _______ _______ _______
  • 7.
    Play Behavior Child’s Name:_____________________ Week of: _________ Time: ___:___--___:___ Indicate play behavior at the beginning, middle, and end of each play period. Summarize play behavior by placing totals in summary column. Weekly Total ___Not Playing ___Play with toy alone ___Play with toy with peer Day/Activity Beginning Middle End Summary Date:_________ Activity:_______ ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer Date:_________ Activity:_______ ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer Date:_________ Activity:_______ ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer ___Not playing ___Play with toy alone ___Play with toy with peer
  • 8.
    Peer Interaction Child’s Name:______________ Observer: ___________________ Check yes (Y) or no (N) at time one (T1) and time two (T2) to indicate whether the child is interacting with a peer at the time of observation. T1 and T2 observations should be at least 5 minutes apart. Activity Date:____ Date:____ Date:____ Date:____ Date:____ Centers T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N Lunch T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N Outside T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N T1: T2: __Y __Y __N __N Ratio: _____#yes _____total # observed _____#yes ____total # observed _____#yes ____total # observed _____#yes ____total # observed _____#yes ____total # observed
  • 9.
    ___physical aggression ___physicalaggression GOOD DIFFICULT EXTREMELY DIFFICULT Shade in the thermometer to indicate behavior. Observer:_____________ Date:________ Morning Afternoon
  • 10.
    GOOD DIFFICULT EXTREMELY DIFFICULT MORNING CIRCLE CENTERS OUTSIDE PLAY Shade inthe thermometer to indicate ___________’s behavior. Observer: _______________ Date: ___________ GOOD DIFFICULT EXTREMELY DIFFICULT
  • 11.
    Monday Tuesday WednesdayThursday Friday Saturday Sunday 30 30 30 30 30 30 30 28 28 28 28 28 28 28 26 26 26 26 26 26 26 24 24 24 24 24 24 24 22 22 22 22 22 22 22 20 20 20 20 20 20 20 18 18 18 18 18 18 18 16 16 16 16 16 16 16 14 14 14 14 14 14 14 12 12 12 12 12 12 12 10 10 10 10 10 10 10 8 8 8 8 8 8 8 6 6 6 6 6 6 6 4 4 4 4 4 4 4 2 2 2 2 2 2 2 Average Duration Child’s Name: ______________________ Behavior: ________________ Week of: _________________ Average Duration for Week: _________ minutes Starting from the bottom, shade the number of boxes that represent the length of the target behavior. Each box represents TWO minutes.
  • 12.
    Steps in DailyRoutines Routine Steps Story time Sit in a circle, listen, look at pictures, answer questions about story
  • 13.
    Transition •Time of theday •Transition between which activities Strategies to use before the transition Strategies to use during the transition Strategies to use after the transition 8:20-8:25 Arrival from buses and go to the classroom Adult is present to greet and wait for students; prompt children to line up with a buddy Teacher guides discussion about things the children saw as they rode the bus to school Teacher gives the children a “high 5” as they enter the classroom