THE SCHOOL DISTRICT OF PALM BEACH COUNTY SAFE SCHOOLS

Problem-Solving/School Based Team (PS/SBT) Tracking Report

SCHOOL/DEPT NAME

PROBLEM-SOLVING/SCHOOL BASED TEAM LEADER

Be sure the following information is entered on the L24 screen of the individual student.

REPORT DATE PAGE NUMBER

of

PBSD 2107 (Rev. 10/14/2015) ORIGINAL - Prevention Center Copy - School

NO.STUDENT'S FULL NAME

GRA

DE

REFERRALDATE

STA

FF

GU

IDA

NCE

OTH

ER

REASON FOR REFERRALPS/SBT

MEETING DATE

SCHOOL BASED TEAM INTERVENTIONS TAKEN

CASELIAISON3 DIGIT

ID CODE

APPROXCASE

REVIEWDATE

CASECLOSED

DATE

REFERRED BY

REF.3 DIGIT

ID CODESTUDENT ID #

1.STUDENT ID #

2.STUDENT ID #

3.STUDENT ID #

4.STUDENT ID #

5.STUDENT ID #

6.STUDENT ID #

7.STUDENT ID #

8.STUDENT ID #

9.STUDENT ID #

10.STUDENT ID #

IFCLOSED,

OUTCOMES

These codes should be utilized on the referral as well as on the SchoolBased Team Tracking Form.

These codes should be utilized on the referral aswell as on the School Based Team Tracking Form.

10 1112 13 14 21 22 23 24 25 26 27 28 29 31 32 33 34 41

42 43 44 45 50 51 52

AFARATBHCACB

CRECFCGR

IRMAMCPIRPPRRESMSNSPSRSTWIVCOT

Academic ConcernsAgency ReferralAttendance/TruancyBehavioral Health ProfessionalChange in AppearanceBehavior Concerns

Case ReviewEmotional ConcernsFamily ConcernsGrief

Issues ResolvedMandatory DisciplineMedical ConcernsPeer IssuesReferral by PeerParent ReferralRe-open Closed CaseStudent MovedSchool NurseSchool PoliceSelf ReferralStudent TransferredWeight IssuesVision ConcernsOther

Student ConferenceParent ConferenceHome VisitBehavior ContractAttendance ContractAcademic InterventionTutoringESOL supportPASSProgress Monitoring Plan (formerly AIP)After School ProgramADD/ADHD ChecklistStudent PortfolioSAIIndividual CounselingSmall Group CounselingPeer CounselingMentorSchedule Change

Anger Management ClassAlternative for ATOD offenseTruancy PlanAlternative Education PlanVision ScreeningSchool Based InterventionSchool Based Community Agency

504 ReferralMonitoringRtl Tier 2 planRtl Tier 3 planCST Referral

Community Agency ReferralDept. of Juvenile JusticeDept of Children and FamiliesOtherNo action Required

53 54 61 62 63

71 81 91 99 NA

Problem-Solving/School Based Team (PS/SBT) Intervention Codes

Problem-Solving/School Based Team (PS/SBT) Referral Codes

RtI Tier 3 moved back to Tier 2 64

RtI Tier 2 moved back to Tier 1 65

Foster CareCF

HomelessHM

These codes should be utilized on the referral as well as on the SchoolBased Team Tracking Form.

1 3 4

Improved Attendance Improved Behavior

Problem-Solving/School Based Team (PS/SBT) If Closed, Student Outcomes Codes

2 Improved Academics Other