APPENDIX E: ASSESSMENT TOOLKIT
Complete 10-Tool Assessment System
This appendix contains all 10 assessment tools referenced throughout Calm Connections. Each tool includes administration instructions and reproducible forms.
Assessment Tools Included:
Tool 1: Pre/Post Skills Inventory
Tool 2: Weekly Emotional Literacy Tracker
Tool 3: Anecdotal Observation Form
Tool 4: Calm Corner Use Log
Tool 5: Skills Mastery Checklist
Tool 6: Family Feedback Form
Tool 7: IEP/504 Goal Progress Tracker
Tool 8: Monthly Progress Snapshot
Tool 9: Student Self-Assessment
Tool 10: Teacher Reflection & Fidelity Log
TOOL 1: Pre/Post Skills Inventory
PURPOSE: Measure student growth from beginning to end of 12-week program
WHEN TO USE: Week 0 (baseline) and Week 13 (post-assessment)
FREQUENCY: Twice per student per year
PRE/POST SKILLS INVENTORY FORM
Student: ______ Grade: _ Date: ____ Type: □ PRE □ POST
RATING: 1=Not Yet | 2=Emerging | 3=Developing | 4=Proficient
EMOTIONAL AWARENESS
Identifies own emotions _ (pre) _ (post)
Recognizes emotions in peers _ (pre) _ (post)
Connects body sensations to emotions _ (pre) _ (post)
Identifies emotional zones _ (pre) _ (post)
SELF-REGULATION
Uses breathing with prompt _ (pre) _ (post)
Uses breathing independently _ (pre) _ (post)
Requests calming tools _ (pre) _ (post)
Transitions between zones _ (pre) _ (post)
COMMUNICATION
Expresses emotions verbally _ (pre) _ (post)
Communicates needs spontaneously _ (pre) _ (post)
Uses AAC/visuals for emotions _ (pre) _ (post)
SOCIAL SKILLS
Shows empathy to peers _ (pre) _ (post)
Offers support to others _ (pre) _ (post)
Requests help appropriately _ (pre) _ (post)
SENSORY AWARENESS
Identifies sensory preferences _ (pre) _ (post)
Advocates for sensory needs _ (pre) _ (post)
TOTAL SCORE: _ (pre) / _ (post) GROWTH: ___ points
Notes: _______________________
TOOL 2: Weekly Emotional Literacy Tracker
PURPOSE: Track emotional identification accuracy weekly
FREQUENCY: Daily observations, summarized weekly
WEEKLY TRACKER FORM
Student: ______ Week of: __
Day | Situation | Student Response | Correct? | Notes
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WEEKLY TOTALS: __ correct / __ total = ___%
Patterns observed: ___________________
TOOL 3: Anecdotal Observation Form
PURPOSE: Document specific incidents with rich contextual detail
FREQUENCY: As needed (2-3 per student per week)
OBSERVATION FORM
Student: ____ Date: __ Time: __ Setting: __
WHAT HAPPENED (objective observation):
ZONE OBSERVED: □ Blue □ Green □ Yellow □ Red
STUDENT STRATEGIES USED:
ADULT SUPPORT PROVIDED:
NEXT STEPS: _____________________
TOOL 4: Calm Corner Use Log
PURPOSE: Track frequency and effectiveness of Calm Corner usage
CODES: I=Independent, P=Prompted, D=Directed
CALM CORNER LOG
Week of: __
Date | Time | Student | Type* | Tools | Duration | OK?
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WEEKLY: Total uses: _ Independent: _ Prompted: _ Directed: _
TOOL 5: Skills Mastery Checklist
PURPOSE: Track mastery of weekly skills
MASTERY CHECKLIST
Student: ________ Check (✓) when mastered independently
Week 1: Names sea friends / Matches to emotions ___
Week 2: Identifies zones / Uses colors correctly ___
Week 3: Demonstrates 3+ breathing techniques ___
Week 4: Explores swatches / Identifies calming textures ___
Week 5: Matches mood to situation / Uses emotion vocab ___
Week 6: Recognizes transitions / Uses strategies ___
Week 7: Expresses through journaling/drawing ___
Week 8: Identifies triggers / Completes puzzle ___
Week 9: Shows empathy / Recognizes others' emotions ___
Week 10: Uses Calm Corner independently ___
Week 11: Reflects on growth / Names effective strategies ___
Week 12: Teaches peer / Celebrates progress ___
Next steps: __________________
TOOL 6: Family Feedback Form
PURPOSE: Gather family input on home behaviors
FAMILY FEEDBACK FORM
Dear Family, Please share your observations about your child's emotional regulation at home.
Student: ____ Date: ____ Completed by: ______
- Has your child talked about Calm Connections at home?
□ Never □ Rarely □ Sometimes □ Often □ Very Often
- Which characters has your child mentioned? (check all)
□ Manny (tired) □ Stella (calm) □ Shelly (excited) □ Crabby (angry)
- Changes noticed at home? (check all)
□ Uses breathing
□ Talks about feelings more
□ Identifies emotions with characters/colors
□ Requests breaks
□ Uses calming strategies
□ Shows more empathy
- Strategies used at home: _________________
- Emotional regulation at home compared to before:
□ Much Worse □ Worse □ Same □ Better □ Much Better
- Additional support needed: _______________
TOOL 7: IEP/504 Goal Progress Tracker
PURPOSE: Monitor progress toward specific IEP/504 goals
IEP/504 PROGRESS TRACKER
Student: ____ IEP/504 Goal: __________
Baseline: __ Target: __ Timeline: __
Date | Opportunities | Successful | % | Notes
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QUARTERLY SUMMARY:
Baseline: Current: Progress: □ Mastered □ Adequate □ Insufficient
Narrative: _____________________
TOOL 8: Monthly Progress Snapshot
PURPOSE: Monthly overview of student progress across all domains
MONTHLY SNAPSHOT
Student: ____ Month: __ Weeks Completed:
EMOTIONAL AWARENESS: □ Not Yet □ Emerging □ Developing □ Proficient
Comments: ______________________
SELF-REGULATION: □ Not Yet □ Emerging □ Developing □ Proficient
Comments: ______________________
COMMUNICATION: □ Not Yet □ Emerging □ Developing □ Proficient
Comments: ______________________
SOCIAL SKILLS: □ Not Yet □ Emerging □ Developing □ Proficient
Comments: ______________________
OVERALL PROGRESS THIS MONTH:
Strengths: _____________________
Growth areas: __________________
Adjustments needed: ________________
TOOL 9: Student Self-Assessment
PURPOSE: Student reflection on own emotional regulation skills
STUDENT SELF-ASSESSMENT
My Name: ______ Date: __
How I Feel About the Sea Friends:
My favorite character is: □ Manny □ Stella □ Shelly □ Crabby
Because: _______________________
My Feelings:
I can name my feelings: □ Not yet □ Sometimes □ Yes!
I can tell when I'm in different zones: □ Not yet □ Sometimes □ Yes!
My Strategies:
My favorite breathing is: ________________
My favorite calming tool is: ______________
I use the Calm Corner: □ Not yet □ Sometimes □ Often
My Goals:
Something I'm good at: ________________
Something I want to get better at: ______________
Draw your favorite Calm Connections memory:
TOOL 10: Teacher Reflection & Fidelity Log
PURPOSE: Track lesson implementation and reflect on effectiveness
TEACHER FIDELITY LOG
Teacher: ____ Week: Lesson Topic: ____
IMPLEMENTATION CHECKLIST:
□ Lesson taught as written
□ All materials prepared
□ Character cards used
□ Students had hands-on materials
□ Differentiation strategies implemented
□ Check-in completed
□ Data collected
STUDENT ENGAGEMENT:
Overall engagement: □ Low □ Medium □ High
Students needing additional support: ____________
WHAT WORKED WELL:
WHAT TO ADJUST NEXT TIME:
NOTES FOR NEXT WEEK:
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END OF ASSESSMENT TOOLKIT - ALL 10 TOOLS COMPLETE
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