Dominican Student: XXXX

EDUC: 5306: Behavior Intervention Plan Template

STUDENT FIRST NAME: D

DATE: 4/26/2014

DATE OF BIRTH: 11/2003

AGE: 10

MALE/FEMALE: male

GRADE: 4th

STAFF PARTICIPATING IN ASSESSMENT:

DATE (S) OF ASSESSMENT:

Dominican Student: XXXX

Part I. Review of FBA Results
Attach FBA results:

D becomes anxious (tightens his body, folding his arms, grunts, repeats concerned questions, scrunches his
face, looks like hes going to cry, and sometimes paces) whenever there is a change to his expected
environment (this includes where his class is located, what he needs and uses throughout the day such as
his backpack, lunch or library books) or just prior to and during transition times.
This prevents him from engaging and accessing the curriculum and prevents him from engaging in
social/emotional interactions with teachers and peers.
Alterations to the Environment:
-Review posted chart How Important is a Problem:
- D can learn to identify the degree of importance a problem is. On a scale of 1-5, 1 being a small
problem (forgot pencil, someone else gets the ball first, not first in line), and 5 being a big problem
needing adult or possibly police assistance (someone is hurt, a fire, an accident).
-Staff should refer to chart and help D identify situations using the scale, asking what level a problem
is.
-Staff should allow wait time for D to think, feel and answer questions. Dont accept I dont know
-Staff should wait for D to ask for help using a raised hand instead of calling out repeatedly.
Replacement Behaviors:
-Learn and use Zones of Regulation-Occupational Therapist teaching this:
(red zone-angry, yellow zone-too much energy, green zone-balanced, blue zone-sad)
-D can learn strategies to recognize when he is and is not feeling balanced- in the green zone.
-D can learn calming strategies to balance and regulate himself: breathe, take a break, lie down.
-D can help create alternative choices for himself to do, to be balanced: run track, draw on white
board, play with putty
-Staff can have D help with an errand taking heavy books to another room, staying busy, if there will
be a delay.
-D can learn to ask for help by raising a hand quietly, waiting for an adults attention, say excuse me
and speak when an adult is listening. He can practice this in social skills.
- D can learn to advocate for himself if he is feeling out of the green zone. I need a break
-D will be able to identify if a problem is a big problem or a small problem.
Methods of Reinforcement-D has felt successful and wants to continue doing his best. He responds
to positive reinforcement.
-D should be given plenty of wait time to respond, in his own words, about a given situation
(whether it is what he did this weekend or an answer to an academic question or how he feels). He
should be given encouragement and support for his responses
-D should be praised and encouraged for using the zones to identify and help him regulate his bodily
energy.
-D should be encouraged to be flexible in his thinking about trying new things such as foods, going
new places or routes, talking to new friends, etc. He should be encouraged and praised when he
does this.
-D should be encouraged and supported for identifying and expressing his needs.
-D should be given encouragement and praise for identifying a small problem verses a big problem

Dominican Student: XXXX

Services:
D will continue to work in social skills with the Behavior Specialist
D will have a class OT group learning the zones of regulation.
Goal:
Goal #1:
By 4/2015, instead of becoming anxious by tensing his body, scrunching his face, looking like hes
going to cry and asking repeated concerned questions to get help from an adult to reduce his anxiety,
D will to independently initiate and use emotional self-regulation strategies when necessary (e.g.,
will identify his emotion using the Zones of Regulation visual support) and chose an appropriate
calming strategy to self-regulate with 1 prompt or less, 2/3 observed opportunities across his school
day as recorded by teacher and staff.
Goal #2: By 4/2015, instead of becoming anxious by tensing his body, scrunching his face, looking like hes
going to cry and asking repeated concerned questions to get help from an adult to reduce his anxiety,
D will identify the size of a problem (small, medium or big) and state what an appropriate /expected response
would be and generate one solution to the problem in social situations that occur within the school day, with 2
or less prompts, in 2/3 opportunities observed and recorded by teacher and staff.

Goal #3: By 4/2015, instead of calling out repeatedly to get the attention of an adult to help him with his
computer or iPad, D will raise a hand quietly and wait using calming strategies until the adult can help him, in
the classroom setting, with 1 or less prompts in 2/3 opportunities observed and recorded by teacher and staff.

Part II. Target Behavior Identified

Description of target behavior:
How? A. Frequency B. Intensity C. Duration
D is generally able to follow the regular instructional flow and directions given in the SDC classroom, aided by
a posted schedule, structured routines and priming provided ahead of time to prepare him for unusual
schedule changes. However, in 25% of opportunities, D refuses to follow directions even when repeated
priming has been provided, especially if this includes an unexpected change, D appears as if he may cry, paces
the room and needs 3 or more prompts before he comes to cooperating with instructions.
How severe is the behavior and the need for a Behavior Plan to address it?
D has made progress over this year and is gaining awareness of his own participation in his environment. He
is limited in the scope in which he gains a variety of educational input. The Behavior Plan will help to
accelerate his access to the curriculum and social relationships with peers and teachers.

Early stage intervention

Moderate: X
Serious
Extreme
Suspected function of the behavior (getting, avoiding, self-stimulation):

Ds use of this behavior is multi-functional. By demonstrating his anxiety, he is gaining the attention
of an adult to relieve (reduce or avoid) the anxiety he is experiencing. Due to his autism, D has little
3

Dominican Student: XXXX

flexibility in his cognitive thinking and perseverates on one topic. As a result of his hearing
impairment, D has used an adult as a barometer for his safety, and he has not had to monitor
situations himself. By gaining the attention of an adult instead of monitoring a situation himself, he
attempts to escape feeling anxious.

Part III: How to Manage, Prevent and Replace identified behaviors

Where? When?
Predictors of situations in which the behavior is

Curriculum:

If a technology system doesnt seem to be

working in an expected way- his iPad or
computer, D will tense his body, grunt, call
out repeatedly, saying I need help.

Instructional strategies:
When D needs help on an assignment in class, he
calls out impatiently and repetitively.

Changes needed to remove likelihood of behavior

likely to occur:
Curriculum: Review posted chart

How Important is a Problem:

- D can learn to identify the degree of
importance a problem is. On a scale of 1-5, 1
being a small problem (forgot pencil, someone
else gets the ball first, not first in line), and 5
being a big problem needing adult or possibly
police assistance (someone is hurt, a fire, an
accident).
-Staff should refer to chart and help D identify
situations using the scale, asking what level a
problem is.
-Staff should allow wait time for D to think, feel
and answer questions. Dont accept I dont
know
-Staff should wait for D to ask for help using a
raised hand instead of calling out repeatedly.
-D can use his strategies to remain calm if
needed.

Who will establish? Teacher

Who will monitor? Teacher/ staff

Instructional strategies:
Teach and provide opportunities for D to practice
social skills of asking appropriately for help.
Give praise for appropriate response

Dominican Student: XXXX

Environmental factors:

Teach D to use calming strategies and wait quietly

for teacher help.

Who will establish? Teacher

Who will monitor? Teacher/staff

Environmental factors:

-Learn and use Zones of RegulationWhenever there is an unexpected delay or change Occupational Therapist teaching this:
in his schedule, D will tense his body, fold his
(red zone-angry, yellow zone-too much energy,
arms, scrunch up his face and appear to begin to
green zone-balanced, blue zone-sad)
cry.
OR
-D can learn strategies to recognize when he is
and is not feeling balanced- in the green zone.
-D can learn calming strategies to balance and
regulate himself: breathe, take a break, lie down.
When he cannot find an item he uses, D will
-D can help create alternative choices for himself
become anxious
to do, to be balanced: run track, draw on white
board, play with putty
-Staff can have D help with an errand taking
heavy books to another room, staying busy, if
there will be a delay.
-D can learn to ask for help by raising a hand
quietly, waiting for an adults attention, say
excuse me and speak when an adult is listening.
He can practice this in social skills.
- D can learn to advocate for himself if he is
feeling out of the green zone. I need a break
-D can be helped to identify if a problem is a big
problem or a small problem.

Intra/interpersonal:
When D is placed in a group in his general
education class, he waits for others to initiate his
task.

Who will establish? Teacher

Who will monitor? Teacher/staff
Intra/interpersonal: D can learn through
interacting in his weekly social groups how to
participate with students in the general education
class
Who will establish? Teacher/Behavior specialist
Who will monitor? Teacher/staff

Dominican Student: XXXX

Describe and define an acceptable alternative behavior that meets the same function of the problem
behavior. (escape/avoid/get/stimulation):
D can learn skills to become more independent in using self-regulation skills when needed.
D can learn to identify the size of a problem (big, medium, or small), state what an appropriate/expected
response would be and generate one solution to the problem in a school setting
D can learn to ask appropriately for teacher assistance, using his calming strategies when needed.

The student has the skills to use the new behavior. Yes
No
D has shown that he is interested and is beginning to use self-regulating skills.
This is new for him, but he wants to do well and is using breathing tools to calm down.
As he becomes more familiar with being able to identify his feelings in real life situations, he can use the
Zones of Regulation to help him monitor his behavior.
This will be challenging for D, especially in unpredictable circumstances, but will help him become less
anxious in general.

What teaching strategies, necessary curriculum, or materials are needed to teach the replacement
behavior, successive teaching/reinforcing steps to learn the alternative behavior? (How to?)
Instruction in the Zones of Regulation and the chart associated with it.
Instruction and practice of calming strategies
Instruction in social skills: using social stories, role playing, social games with others in the SDC and
general education class.
Reviewing and using the How Big is a Problem chart.
Establishing a list of calming strategies specific for D to choose from for replacement behaviors: such as
asking to take a break, running the track, listening to calming music, playing with putty, etc,
Who will establish?
teacher
Who will monitor?
teacher/staff How will it be monitored?
scatter plot/A-B-C chart

STRENGTHS What strengths does the student have that will help him/her to be successful in
using/learning the new behavior(s)?
D has become very motivated to do well this year.
He is enjoying the benefits (fun) of having peers and more freedom in being flexible.
D has demonstrated readiness stating I like the Zones, to have further instruction in becoming flexible in
understanding his feelings and bodily awareness.
REINFORCEMENT? What are the reinforcement procedures to use for establishing, maintaining, and
generalizing the new behavior(s)?
D will receive positive praise for showing expected behaviors
D can help to earn a classroom party for his and everyones) expected behavior-he doesnt like to be
singled out and refuses awards that stand out.
D can earn a special prize of choice from the school store when he has demonstrated self-regulating
behaviors.
D can earn an activity choice or special food treat for showing expected behavior.

Dominican Student: XXXX

WHAT IF? What strategies will be used if the problem behavior occurs again? (e.g. - Prompt student to
switch to the replacement behavior, positive discussion/debrief with student after behavior ends, any
necessary classroom or school consequences)
a. review and discuss zones of regulation/ practice and review calming strategies
b. review how big is the problem/ discuss next time or different scenarios
Who will establish?
teacher Who will monitor?
teacher
Who will discuss/debrief with
student?
teacher

PART IV: Outcome: Behavioral Goals

Behavioral goals and objectives related to this plan:
x
New
Existing

Goal #1:
By 4/2015, instead of becoming anxious by tensing his body, scrunching his face, looking like hes
going to cry and asking repeated concerned questions to get help from an adult to reduce his
anxiety, D will to independently initiate and use emotional self-regulation strategies when
necessary (e.g., will identify his emotion using the Zones of Regulation visual support) and chose
an appropriate calming strategy to self-regulate with 1 prompt or less, 2/3 observed opportunities
across his school day as recorded by teacher and staff.

Who will collect assessment data? Teacher/staff

How will data be collected? Data record charts
The above behavioral goal is: x To reduce frequency of problem behavior x To increase use of
replacement behavior x
To develop new general skills that remove students need to use the problem
behavior
In IEP

Goal #2: By 4/2015, instead of becoming anxious by tensing his body, scrunching his face, looking like hes
going to cry and asking repeated concerned questions to get help from an adult to reduce his anxiety,
D will identify the size of a problem (small, medium or big) and state what an appropriate /expected
response would be and generate one solution to the problem in social situations that occur within the school
day, with 2 or less prompts, in 2/3 opportunities observed and recorded by teacher and staff.
Who will collect assessment data? Teacher/ staff
How will data be collected? Data record charts
The above behavioral goal is :x
To reduce frequency of problem behavior x
To increase use of
replacement behavior x
To develop new general skills that remove students need to use the problem
behavior
In IEP

Goal #3: By 4/2015, instead of calling out repeatedly to get the attention of an adult to help him with his
computer or iPad, D will raise a hand quietly and wait using calming strategies until the adult can help him,
in the classroom setting, with 1 or less prompts in 2/3 opportunities observed and recorded by teacher and
staff.

Who will collect assessment data?

Dominican Student: XXXX

How will data be collected?
The above behavioral goal is :x
To reduce frequency of problem behavior
To increase use of
replacement behavior
To develop new general skills that remove students need to use the problem
behavior
In IEP

Goal #4: By (date), instead of (problem behavior), to achieve (function), (student) will do (replacement
behavior) to achieve (function), under what conditions, at what level of proficiency, as measured by whom
and by what means.

Who will collect assessment data?

How will data be collected?
The above behavioral goal is:
To reduce frequency of problem behavior
To increase use of
replacement behavior
To develop new general skills that remove students need to use the problem
behavior
In IEP

PART V: Monitor Problem Behavior and Replacement Behavior

Evidence of Problem Reduction: If you have the opportunity to see a change of behavior, using above
interventions, write about it here. Use documented evidence graphs, frequency charts, etc. If you dont
have this evidence, indicate how you intend to monitor.
1) Target a level of problem reduction:
2) Establish benchmarks toward goal achievement
3) Show how you will track a level of problem reduction

PART VI: Maintaining Positive Behavior Change/Narrative Summary:

How will you provide a maintenance plan that:
Supports new skills
Contributes to positive changes in the students life and across setting
PART VII. PARTICIPANTS IN PLAN DEVELOPMENT:
Student:

Administrator:

Parent/Guardian:

Parent/Guardian:

Educator & Title:

Educator & Title:

Behavior Specialist:

Other (Occupational Therapist, Speech

Therapist, Psychologist, Counselor):