OOEIA142 ATT 17 (REVISED 92020) COLLABORATIVE PROBLEM SOLVING TEAM

Student’s Name:__________________________________________ Date:____________

Referral Source: _____________________________________________________________

CPS Coordinator:____________________________________________________________

Describe the problem(s) through the presentation of a summary of all the gathered data and information

Review prior interventions to consider the effects of past efforts and the reasons for successes and failures

Develop a behavioral objective(s) which is a short-term, achievable, observable, and measurable description of the targeted behavioral outcome(s)

Discuss needed interventions and/or referrals to community resources include information on approval, source, and method of payment for any community provider

Document steps to be implemented including timeframes for completion of each

Define roles of all implementers specify who is responsible for assigned tasks

Provide support to the implementers to ensure that they have the necessary and sufficient knowledge and skills, access to applicable resources, and support by the CPS team and school administrator(s) to achieve the objective

Convene follow-up meeting for review of all relevant material, documentation of progress and determination of continuation/modification/termination of the process based on achievement of objective(s)