Welcome and Thank you for Being a Part of Our Classroom Today!

PLEASE DO NOT WRITE ON THIS AND RETURN IT TO THE RED

SUBSITUTUE FOLDER, THANK YOU!

My classroom is a multiple disabilities support classroom. We provide

services to students with severe disabilities. Each child in this classroom is
entitled to federal confidentiality protections. Please, do not share this
information provided to you about my students to anyone. Thank you!

Information:

1. A building map is located in the pocket of this binder, for your

convenience.
2. An Emergency folder is located in the clear pocket holder mounted
above the telephone. It contains procedures for fire drill, intruder
alerts, lock downs, weather emergencies, etc.
3. A copy of my schedule is enclosed in this binder for your convenience.
Please do not write on the schedule and return it to the binder. Thank
you!
4. The related service schedule is posted on the front board where the
students services are listed for the day. I have put an additional copy
in this binder.
5. The special schedule is located on the front board as well.
6. Alexander and Ryan require adult assistance/supervision in the
bathroom in the first grade wing.
7. Brandon and Amanda require changing of briefs/pull-ups in the MDS
bathroom.
8. Nicole, Caroline, and Connor have special health needs both have
an assigned nurse with them at all times to monitor their health.
Attached you will find their health plans.
9. ALL of my students must be escorted and supervised at ALL times.
10. I have bus duty at 3:40 at the tops of stairs days Tuesday,
Thursday, and Friday.

Student Information (I have 5 paraeducators who will answer student

specific, in-depth information about each student.)

1. Connor: Connor has an intellectual disability and requires immediate

and continuous supervision of an assigned aide and agency provided
nurse to ensure his medical safety. He requires significant adult
support to access his environment and education.
2. Nicole: Nicole is caretaker dependent and requires the immediate and
continuous supervision of an agency provided nurse to ensure her
medical safety. She requires significant adult support. Her
 participation in her daily schedule is at her nurses discretion based on
her medical status at that time.
3. Alexander: Alexander has Downs Syndrome and requires significant
adult supervision at all times. The implementation of a behaviors
intervention plan is used at all times. The implementation of a
behavior intervention plan is used please see paraeducator for
information.
4. Caroline: Nicole is caretaker dependent and requires the immediate
and continuous supervision of an agency provided nurse to ensure
her medical safety. She requires significant adult support. Her
participation in her daily schedule is at her nurses discretion based on
her medical status at that time.
5. Ryan: Ryan has Downs Syndrome and requires significant adult
support at all times. He requires immediate adult supervision at all
times to ensure his safety. Max uses a token economy to earn breaks
during academics. Please see attached Token Economy Cheat Sheet.
6. Amanda: Amanda has Cerebral Palsy and requires significant adult
support at all times to access her environment and education.
I utilize positive behavior support in this classroom through the research-
based strategy of differential reinforcement. We use token economy boards
to reinforce learning related behaviors such as sitting in their chair, quiet
mouth, listening ears. We reinforce students at the highest level necessary
to elicit the desired response. Please see the attached Token Economy
cheat sheet.

Please keep talking amongst adults to a minimum. It is important we

respect the learning environment and the need for quiet as many children
are learning and receiving instruction at on time in various areas. Thank
you!

Lesson Plans:

1. My schedule will show you when and where each child should be at all
times. You will teach items under Mistler and supervise the
paraeducators with their instructional groups.
2. As you can see on the schedule each time slot runs in 30-minute
intervals. The first 5 -10 minutes is student break and time to clean
up the previous lesson and set up for the next. Please provide
transitional cues to the students and paraeducators.
 3. A copy of my lesson plans can be found in a pink file folder in the top
drawer of my desk. I teach students in reading and math with
research based programs. If you are comfortable and have training in
the implementation of the programs, please teach them per the
scripted protocol of the program. If you are not familiar or untrained
in the programs, please use the reading and math review activities
located in the students independent work crates.
4. The locations of the lessons taught are identified on the classroom
schedule. All materials are located under the window closest to my
desk. If you need assistance locating the materials please ask staff.

Paraeducators:

I work with an exceptional group of ladies, please do not hesitate to ask

them questions as they are here to assist you! In our classroom the names
of the staff are Miss Deb, Miss Linda, Miss Lindsay, Miss Tina, Miss, Tanya,
Miss Carly, Miss Barbara (nursing staff), and Miss Rachael (nursing staff).
Connors nursing staff rotate daily so please be sure to introduce yourself to
the nurses upon their arrival.

My staff are working diligently to follow their schedules. Please

support them in this effort and read the schedule for all at the
transition of every half hour block. Many of our students are not
able to be left unsupervised, even for a minute. Please reach out to
the staff to see where you can best support them as they prepare
for the transition between activities.

If you have any questions or concerns you can feel free to reach me on my
cell phone at 610-297-0663. Thank you for supporting my students in my
absence! Erica

Fire Escape Plan/Individual Duties Multiple Disabilities Support

Room

Miss Deb and Miss Lindsay line the students up immediately and evacuate
the building through the kindergarten playground doors.

Student Aide
Brandon Miss Deb
Ryan Miss Lindsay
Alexander Miss Lindsay
Amanda Miss Tanya
Connor Miss Carly
Nicole See Below
Olivia See Below

Nicole and Caroline Fire Plan

Linda will locate and carry the two go bags, two backpacks, and two
suctions.

The assigned nurses for the day will first place Nicole in her chair and then
place Olivia in her chair with her vent.

Miss Mistler will assist with transfers and the carrying of various medically
required equipment as directed by the nurses and based on the students
current medical state.

If the girls are not in their chairs or are unable to be placed in their chairs
in a timely fashion proceed with the below plan.

1. Get the Med Sleds hanging on the wall left on the window.
2. Miss Mistler and Carolines nurse will open and secure Caroline into
the Med Sled.
3. Miss Linda and Nicoles nurse will open and secure Nicole into the Med
Sled.

** Please note that Miss Mistler and Linda have both been trained in how to
use the go bag if needed with Caroline.

MDS Schedule

8:50 9:00 Students Arrive

- Miss Tanya picks up Amanda in the front of the building
- Miss Deb gets Brandon off the bus
- Miss Lindsay gets Alexander off the bus
- Miss Carly gets Connor off the bus
- Miss Linda gets Ryan off the bus
Please make sure that doors are unlocked for the girls to come in

9:00 9:30
- Miss Linda and Ryan to Miss Daniels homeroom. Bathroom before
returning to rom
 - Miss Lindsay Alexander and Nicole to sign in/pick lunch and then to
Mrs. Snyders to gather and deliver mail. Bathroom before going to
homeroom
- Miss Deb and Brandon to Mrs. Murphys homeroom
- Miss Tanya and Amanda and Caroline to Mrs. Daniels homeroom.
Glasses on for 10 minutes following return to classroom and into the
next block.
- Miss Carly and Connor to Mrs. Moyers homeroom until 9:25. Right to
bathroom upon return to classroom
Sub to support Miss Deb with Brandons sensory schedule from 9:20
9:30

9:30 10:00 Daily 5 Group

All students sit at their desks. Day 4 & 6 special at 9:50 10:30
- Miss Lindsay and Alexander running behavior plan
- Miss Deb and Brandon running behavior plan
- Miss Tanya and Amanda glasses on for the first 10 minutes of group
- Miss Linda and Ryan and Nicole/Caroline Linda put Molly in stander.
- Miss Carly and Connor weighted vest on. Toweling to face

10:00 10:30
- Miss Linda and Ryan/Caroline to Mrs. Daniels Daily 5
- Miss Deb and Nicole (& Caroline on days she does not go to Daniels)
OT/Letter work in their area of the classroom. Deb support Alexander
in Math as needed
- Miss Lindsay and Brandon Daily 5 in Murphys room and letter work
at his desk
- Miss Tanya and Amanda Daily 5 in Daniels room Amanda to
bathroom at 10:20 with Deb as support
- Miss Carly and Connor OT/work bins/academic review provide
lotion before beginning task. Use first work/then preferred item
language. Prompt alternative behavior to crying. Increase
reinforcement as needed for Connor to elicit the desired response
- Sub & Alexander Math

10:30 11:10 Special

- Miss Linda with Ryan and Caroline
- Miss Lindsay with Alexander and Nicole
- Miss Deb and Brandon
- Miss Tanya and Amanda Please have Amanda wear her gales for 10
minutes if the special is highly preferred
- Miss Carly and Connor
- Sub if Nicole and Caroline are unable to attend special it is required
you stay in the room with them

11:10 11:30 Recess

 - Miss Linda with Caroline & to support keeping Brandon safe
- Miss Lindsay with Alexander and Nicole
- Miss Deb & Brandon
- Miss Tanya & Amanda
- Miss Carly & Connor
- Sub Ryan Math

11:30 12:00 Carly, Linda, and Connor nurse lunch

- Deb Brandon Math review (Mathcing/1:1 counting correspondence
desk purple table
- Lindsey/Tanya Connor/Amanda/Girls communication group
purple table
- *Tanya/Amanda if directed by PT please use this time to practice PT
goals
- Sub Reading with Ryan & Alexander brown table

12:00 Student Lunch

Sub Lunch Please eat in room, if able, as Nicole and Caroline must remain
in the classroom. Miss Lindsay will also be in the room at this time to
ensure your lunch is duty free
- Linda Ryan & Alexander Lunch
- Deb Brandon Lunch
- Tanya Amanda Lunch
- Carly Connor Lunch
- Lindsay Caroline stander

12:30 1:00 Circle Time

Deb, Lindsay, and Tanya Lunch
- Carly out to lunch with Connor peers should be modeling the use
of core words on Connors iPad with him. Connor should be
meaningfully participating in conversations with peers with assistance
as needed
- Linda between Brandon & Alexander. Please assist as needed
- Sub Amanda & Ryan, Caroline & Nicole

1:00 Language for Learning Group

- Linda Ryan and Amy
- Lindsay Alexander
- Tanya Amanda
- Deb Brandon (sensory incorporated)
- Carly: Connor Recess sensory incorporated when there for L4L

1:30 2:00
- Miss Linda Ryan Review: Reading (1, 3, 5) Math (2, 4, 6) Brown
Table
 - Lindsay Alexander Review: Reading (1, 3, 5) Math (2, 4, 6) brown
table
- Mistler Connor (Carly), Amanda (Tanya), Brandon (Deb), Caroline
and Nicole Reading (1, 3, 5) Math (2, 4, 6) purple table

2:00 2:30
- Mistler Connor (Carly), Amanda (Tanya), Brandon (Deb), Caroline,
and Nicole Reading (1, 3, 5) Math (2, 4, 6) desks
- Miss Lindsay/Linda Ryan & Alexander Handwriting brown table

2:30 3:00 Personal Information/Science

- Miss Linda Ryan, Nicole, and Caroline
- Miss Lindsay Alexander
- Miss Deb Brandon
- Miss Tanya Amanda Day 1, 3, 4 Recess with Angstadt student
- Miss Carly Connor

3:00 3:20 Rec/Leisure at Desks/Bathroom

- Miss Linda Ryan/Caroline/Nicole
- Miss Lindsay Alexander pack up
- Miss Deb Brandon pack up
- Miss Tanya Amanda pack up
- Miss Carly Connor pack up
 Token Economy Cheat Sheet:

A token economy emphasizes the use of positive reinforcement to target

behavior change. Token economies help students to visual progress, accept
and work for delayed reinforcement, self-monitor.

Do I have?
- Token Economy Board
- Timer to time duration of entire activity
- Gym boss timer on my being set to vibrate for a designated interval
- Behavior Data Collection Sheet
- Materials set up for activity

How to use it:

1. Identify the expected behavior
2. Determine what items or activities are motivating for the student.
3. Cue work time: start overall timer to clock the duration of the activity.
4. Begin timer (on vibrate).
5. Present activity/lesson as scripted. When timer vibrates pair specific
verbal praise (high five, pat on the back, awesome reading!) with
the presentation of the token.
6. Continue with the activity and repeat when timer vibrates again.
7. When all tokens are on the board the student can cash in for their
break time to receive the previously determined reinforcer.
8. If student engages in target behavior you are looking to decrease:
a. Withhold attention any extreme reactions
 b. Maintain a neutral facial expression/tone.
c. Neutrally prompt alternative behavior
d. Maintain student safety.
e. Call for help if needed.
f. When the student engages in the activity again start timer
up.

Behavior Intervention Plan

Date: March 15, 2016

Teacher:dMMMMB
Target Behavior:
School
Noncompliance:*BBBl^ may exhibit one or more 6f the following behaviors
including laying on the ground, climbing under the table, refusal to stand
up/walk, putting his head down and sucking his thumb, verbally saying no,
grunting/yelling at staff, not responding to known directives, and leaving
designated area without supervision

Bus

NoncomplianceaHMH_9_may exhibit one or more of the following behaviors

including refusal to stand up, saying no, ignoring directive, dropping to the
floor, scratching, hitting, and kicking.

Baseline:

Baseline Data of Target Behaviors in School: Data was collected 2/29/2016-

3/8/2016

Across the 7 days the behavior (Head down, saying no, dropping/laying on
floor) occurred 17 times averaging 2x per day. The average duration of the
behavior was 2 minutes per occurrence.

Baseline School Data of Target Behavior

Frequen cy
o/ yy o// </ y j? y
Baseline Bus Data: obtained from the behavior tracking as per the first
PBSP collected 11/19/2015-3/4/2016.

The data presented below provides the percentage of

compliance inJ transitions on /off the bus and during the bus
rides to and from school.

120
Compliance on Bus
100

80.

m% Compliance
%
Noncompliance

Physical Quiet Hands Seat Belt

On following
Aggression .

Directions

Hypothesis in the School Setting:

When presented with a demand or activity from a teacher or

paraeducatorj may exhibit one or more of the following behaviors
including laying on the ground, climbing under the table, refusal to stand
up/walk, putting his head down and sucking his thumb, verbally saying no,
grunting/yelling at staff, not responding to known directives, and leaving
designated area without supervision as a way to escape the presented
demand or activity.

When a highly preferred activity is terminated and flMH^ is given the

verbal cue to transition, NMPmay exhibit one or more of the following
behaviors including laying on the ground, climbing under the table, refusal
to stand up/walk, putting his head down and sucking his thumb, verbally
saying no, grunting/yelling at staff, not responding to known directives,
and leaving designated area without supervision as a way to gain access
to a highly preferred item or activity.

Hypothesis in the Bus Setting:

When transitioning on and off the bus or presented with a directive from
the bus staff, >may exhibit one or more of the following behaviors
including refusal to stand
up, saying no, ignoring directive, dropping to the floor, scratching, hitting, and
kicking as a way to gain attention from the bus staff.

Goals and Objectives:

School:

Goal 1: When presented with an academic demand/ directive in the school

setting, 4h____Mpwill remain seated and sitting up in his chair; following
directions from school staff to complete the presented academic task with
90% compliance during a 25 minute academic session, across 6 consecutive
weeks.

Objective:
When presented with an academic demand/ directive in the school setting,
WRwill remain seated and sitting up in his chair; following directions from
school staff to complete the presented academic task with 80% compliance
during a 25 minute academic session, across 6 consecutive weeks.

Objective:

When presented with an academic demand/ directive in the school setting,

_______^fc will
remain seated, sitting up in his chair, and following directions from
school staff to complete the presented academic task with 70%
compliance during a 25 minute academic session, across 6
consecutive weeks.
Goal 2: When a highly preferred activity is terminated andMH^Ptis given
the verbal directive to transition in the school setting,4H^witl stop
engaging in the highly preferred activity and walk to the specified location
90% of the given opportunities in a week across 6 consecutive weeks.

Objective:

When a highly preferred activity is terminated and .Mflfes given the

verbal directive to transition in the school setting, WVwi" stoP engaging in the
highly preferred activity and walk to the specified location 80% of the given
opportunities in a week across 6 consecutive weeks.

Bus:

Goal 1: When given a directive on the school bus, M9 will comply with the
directive by walking /sitting with his hands to himself and without verbal
protest (yelling, saying no) 80% of the given opportunities within a week,
across 6 consecutive weeks.
Objectives:
When given a directive on the school bus, HHBfcwill comply with the
directive by walking /sitting with his hands to himself and without verbal
protest (yelling, saying no) 70% of all given opportunities within a week,
across 6 consecutive weeks.

Objective:

When given a directive on the school bus,<fl_B__^wiII comply with the

directive by walking /sitting with his hands to himself and without verbal
protest (yelling, saying no) 50% of all given opportunities within a week,
across 6 consecutive weeks.

School Antecedent Strategies- What to do before the behavior occurs:

1. State expectations usin
beginning an academic ehavior board before transitioning
activity.
2. Remain in dose proximity and during transitions to
of compliance if needed.
physically prompt
3. State instructions simply and clearly______________________________________
4. Provide a fidget to occupy his hands and remove academic materials
if you need to step away to get something.____________________________
5. Ignore minor social behaviors that have not been targeted. IE:
Shaking his butt, saying he is watching you, sticking out tongue._______
6. Following a direction, provide assistance and prompting to set him up
for success and'create behavioral momentum._________________________
7. Verbally praise him for academic and transitional successes.______________
8. Have all items needed before prompting transitioning. _______________

School Procedures:

Differential Reinforcement of Other Behavior:

Provide positive reinforcement for replacement behaviors and

following directions. Reinforcement will be through social praise
(High five, pat on the back, fist bump) and the use of his
coins/stars on his token board.
Reinforcement will be provided on a varying interval schedule and/or
in a random fashion.
The frequency of reinforcement will change as data supports
consistent behavior change. Beginning with a high rate of
reinforcement and decreasing to a rate that will maintain the
behavior change.
 Minor social behaviors- including lightly bopping friends with his
finger, making the "I'm watching your hand sign", shaking his butt,
closing his eyes- will be placed on extinction through planned
ignoring.

Token/ Star Board:

1. We will set a timer for 2 /3:30 minutes (or other pre-determined

time by . teacher/aide based on the students need).
2. The timers are set to automatically go off in alternating intervals.
3. When the timer vibrates -Look at the students visual of their
replacement
behaviors and go over it with him. Give him the reinforcer(coin/star)
and specific
verbal praise about what he is doing correctlyl
a. Great job having quiet hands!
b. Wow, you are doing your best work identifying your
letters!
c. High five for sitting up in your chairl
4. Click the counter to mark compliance.
5. Repeat.
6. When 4________|i has earned 5 coins/ stars allow him a five minute
highly preferred
break.

When he engages in noncompliant behavior:

1. When putting his head down on his desk saying "no", or doing the
opposite of what you are request- WITHHOLD ATTENTION FOR THE
BEHAVIOR AND CONTINUE WITH DIRECTIVES- PHYSICALLY
PROMPTING TO COMPLETE, IF NEEDED. PROVIDE VERBAL PRAISE
AFTER A FEW SECONDS WHEN HE BEGINS TO COMPLY.
2. If grabbing -MOVE MATERIALS OUT OF THE WAY SO THAT HE IS
UNABLE TO GRAB THEM.
3. Throws himself on floor or under table: BRING HIS WORK TO THE
GROUND AND CONTINUE TO PLACE ACADEMIC DEMAND ON HIM. **
When he has begun to comply with the activity move his work back
to his seat an then verbally praise him for following directions.
1. Only physically intervene when he could hurt himself or others.
4. Reset timer or wait for the timer to reset to then monitor and
reinforce replacement behaviors- Sitting in and up in his chair
following directions.
2. Continue with his work or the activity.
 3. Bus Preventative Strategies- What to do behavior the behavior
occurs:
4. 1. The bus aide will sit within close proximity to<
5._____________________________________________________________________
_m__M in ill In i.ated no farther back than the middle of the bus.
_______________________________________________________________________
3. Allow additional time (30 seconds) to transition upand down the bus
steps.
4. Remain in close proximity offlHBPfc during transitions to physically
prompt compliance rf needed. Example: directing student to seat if
it is seen that he is beginning to go near a friend.
______________________________________________________________________
6._______________________________________________________________________
5! State instructions simply and clearly.
_________________________________________________________________________
6. Following a direction, provide assistance and prompting to set him
up for success and create behavioral momentum.
______________________________________________________________________
7. Ignore minor social behaviors that have not been targeted. IE:
Shaking his butt, saying he is watching you, sticking out tongue.
______________________________________________________________________
8. Provide fidgets, books, and tablet to occupy his hands during the bus
ride.

9. Verbally praise him for behavior compliance.

7. Bus Procedures: To be used until a tablet prepared and When tablet

is not available.

1. Using visual behavior board attached to timer, clearly state

instructions before 4Bi gets on bus.
2. _W_9 and/or the bus aide will start 1 minute timer immediately to
reward compliance with replacement behaviors (walking, shoes on,
hands to Self) by providing a highly preferred edible.
3. When timer goes ofl3_HM> will ask for the edibte. Bus aide provides
edible and praises^_B_(f saying "Great job- shoes on / quiet hands!"
Reset timer. Repeat.
8. a. If kfll^throws the timer-bus aide will keep the timer and start it as
soon as soon as4M__B 's sitting shoes on, hands to self. 4- If JM______[ is
doing nothing positive no words should be spoken to him.
9. 5. Physically (without any verbal prompting or commentary) redirect
as needed, (i.e. physically prompting to keep walking, keep hands to
himself).
10.
11.
12.
13.
 14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24. Bus Procedure:

25. 1. Using visual behavior board attached to timer, clearly

state instructions before
H______Bgets on bus. First walk then tablet.** GivevV_^}the tablet
upon
26. arriving at his seat.
2. The bus aide will start 1 minute timer immediately.
3. When timer goes off the bus aide will provide verbal praise
to4___H__l- Bus aide praises BJppsaying "Great job- shoes on /
quiet hands!" "Great walking- then iPad!" Reset timer.Repeat.
27. a. IfflB_m is engaging in problem behavior (on the
floor, shoes off, making
physical contact with others, ignoring) the bus aide will take
the tablet
away for a one minute interval or until Mi shows compliance
and
state one time in a neutral voice-sitting up, hands to self
(quiet hands),
shoes on.
28. b. Bus aide will represent the iPad and timer
after _MMp has sat with
hands to himself and shoes on for one minute.
4. If fl_H_B is doing nothing positive no words should be spoken to him.
5. Physically (without any verbal prompting or commentary) redirect as
needed.. (i.e. physically prompting to keep walking, keep hands to
himself).

6.
7.

8.

9.

10.

11. Functionally Equivalent Replacement Behaviors

12. Attention:

3.

13. will be explicitly taught to request attention from staff by

raising his hand.
14. ;will be taught appropriate ways to socially interact with
peers and staff in a structured learning environment through
modeling and prompting in naturally occurring situations followed by
reinforcement.

15. Requesting a Break:

4.

16. will be taught to request a break from a non- preferred

activity. ; will be explicitly taught to protest activities or items
though modeled communication on his AAC device and structured
practice opportunities.

17. Data Collection

 18. Data will be collected on _HSM behavior. Successful intervals
and unsuccessful intervals will be documented daily.

19. Implementation

20. The Behavior Intervention Plan will be implemented in the school

setting and on the bus . The plan will be implemented by all of the
individuals who work with^H^V on a daily basis.

21. BIP Evaluation Schedule

22. The BIP will be evaluated after six weeks of consistent

implementation to determine progress and modify the plan if needed.
During this evaluation we will reassess effectiveness of interventions,
fading of prompt levels and reinforcement schedule.

23._______________
24.
 25. S Jt . /

26. BUS DATA COLLECTION:

5.
6. Fo
llo
wi
27. Comments
28. Behavior Intervention Plan
29. NameMMto Date:
November 13, 2016
Teacher:1

30. Definition of Target Behavior:

31. Noncompliance: VBto may exhibit one or more of the following
behaviors including
32. sliding off his chair, eloping, dropping to the ground, pushing desk
over, grabbing
33. materials, and ripping up papers
34. Baseline:
35. Data was collected January 13-February 27 during academic
activities. The data shows
36. an average of 18 occurrences of the target behavior a day.

37. Hypothesis:
38. When presented with a demand from a teacher or personal care aide
during work times or transition periods;*W__Pmay exhibit one or more of
the following behaviors including sliding off his chair, eloping, dropping to
the ground, pushing desk over, grabbing materials, and ripping up papers
to escape the presented demand and obtain attention from the staff.

39. Goals and Objectives:

40. Goal 1: When presented with a demand in an instructional

setting including but not limited to his reading program/activities,
math program/activities, and any activities that include 1 step
directions including transition from one location to another<H_____.
will remain seated in his chair facing forward to complete the
task/directive without grabbing the materials with no more than one
verbal prompt over 5 minutes, across 6 consecutive weeks.

41. Objective: When presented with an academic demand in an

instructional setting, including but not limited to his reading
program/activities, math program/activities, and any activities that include
1 step directions, 4_____fc will remain seated in his chair facing forward to
complete the task/directive without grabbing the materials with no more
than one verbal prompt over 1 minutes, across 6 consecutive weeks.
42. Objective: When presented with an academic demand in an
instructional setting, including but not limited to his reading
program/activities, math program/activities, and any activities that include
1 step directions, VMH will remain seated in his chair facing
43. forward to complete the task/directive without grabbing the
materials with no more than one verbal prompt over 3 minutes, across
6 consecutive weeks.

44. GoaJL2: Within the Multiple Disabilities Support Classroom or

any other instructional setting and within the hallways during
transitibns,<__B_fwill transition and/or stay in the assigned work area
without running or throwing himself on the floor, with no more than
one verbal prompt for 75% of the daily opportunities, across 6
consecutive weeks.

45. Objective: Within the Multiple Disabilities Support Classroom or

any other instructional setting and within the hallways during
transitions,4NA will transition and/or stay in the assigned work area
without running or throwing himself on the floor, with no more than
one verbal prompt for 50% of the daily opportunities, across 6
consecutive weeks.

46. Objective: Within the Multiple Disabilities Support Classroom or

any other instructional setting and within the hallways during
transitions,WHfcwill transition and/or stay in the assigned work area
without running or throwing himself on the floor, with no more than
one verbal prompt for 30% of the daily opportunities, across 6
consecutive weeks.

47.
48.
Antecedent Strategies: What to do before the behavior occurs.
49. Antecedent 50. Method of Adjusting the Antecedent

51. Termination of a 52. 1 .Visual and/or auditory timer paired

highly preferred with a Promise: Three minutes before IJBfeis
activity or Item. expected to transition from a highly preferred
activity or item to non-preferred activity. A
visual and auditory timer will be set for to
prepare 0_____fc for the transition. When he
transitions without engaging in the target
behavior, immediate reinforcement will be
provided (examples include: a preferred
53. Presented 54. 1. Identification of a highly motivating
with an reinforcer: Teacher or Para educator will
academic allow^^BB t6 pick what he wants to work
activity. for as reinforcement and immediately give
him one piece of the edible or the tangible
for a minute or two while they set up. They
will then continue to reinforce him using a
random fashion delivery rather than fixed or
through differential reinforcement of other
behavior. 2..Provide opportunities for choice
55. * 56. academic tasks provide choices as to
increase the likelihood of academic
responding.
57. 3. Intersperse Highly Preferred/ easy
activities with
non-preferred/ harder tasks.
58. 4. Pair highly preferred items with
non-preferred
tasks.
59. 1. Pair a positive with a highly non-
preferred
activity. Example: Pointing to his sight
words
with the pretzel he is working for.
60. 5..Modify the expectation to set Hi up
for success:
61. 2. If he is not complying with the
direction to
expressively provide an answer, ask him to
receptively do so instead,
63. During Specials 64. 1.Provide access to fidget items
including art, library, during down time/
physical education, 65. transition times within the special
and music. setting:
66. During all specials,*M_ftwilt have
access to a fidget
67. 2. Actively engage 1MH in the use of
his fidget
increasing the value of it to him. and ensuring
you are
their to prompt communication as a
replacement
behavior to throwing and eloping. Example:
modeling 'help' when you see he is struggling
or
modeling 'all done' when you can see his
interest is
fading
68. 3, Clear and Concise
70. - 71. 4. Modify the expectation to set
Pierce up for success:
72. If he is not complying with the
direct to expressively provide an
answer, ask him to receptively do so
instead.

73. : Differential Reinforcement of Other Behavior -

Differential Reinforcement of Other Behavior (DROyOmission
Training is the delivery of reinforcement when the target
behavior has not occurred during a specific period of time.
DRO procedures provide reinforcement for the absence or
omission of a target behavior.

74. Procedure:
1. State expectation forflNA Sitting in chair, quiet hands, quiet
feet, listening. For transitioning: walk slow, quiet hands.
2. At the end of the timer period provide pierce with the reward if
he did not engage in the target behavior.
3. If 4BR engages in the target target behaviors follow the specific
reactive strategies below. When M__k does engage in the
target behavior, it is imperative that all staff do not
 reinforce this behavior by being aware of all comments,
reactions, facial expressions, and attitudes. We will
withhold attention for the target behavior and go above
and beyond to acknowledge appropriate incompatible
behavior.
75. Consequences: Reactive Strategies
76.

77. Behavior 78. Consequences

79. Throwing himself on the 80. The adult working

floor, running away, or sliding off withflMwill neutrally prompt him
chair. stand up at a rate of 1x per 15
seconds.Do not lift him off the
ground. Do no more than offer your
hand when you prompt him to
stand up. When standing, neutrally
prompt him to walk, prompting
"slowly" placing your arm in
81. front of him when he begins
to run. When back to the chair
82. *. 83. him to sit and
immediately prompt him
84. to raise his hand and
model assumed
85. request.
86. Break", "all done".
87. Be aware of your facial
expression and sounds of
frustration (sighing, comments
88. Grabbing, withholding, or 89. The adult working
ripping her work. withHBtowill calmly wait for him to
stop and take the paper back or
calmly take the item from him.
-State first work/ then window. First
work/then toy.State this 1 x.
Neutrally prompt expectation at a
rate of 1x per 15 mln.
Prompt__B_____p as needed to
complete the activity. Praise
specific behavior and provide
reinforcement after 5 seconds of
90. Engaging in loud noise or 91. Withhold attention for
screeching screaming, loud/exaggerated
vocalizations.
 4. When l__PBf has begun showing the target behaviors for at
least 10 seconds.Provide praise and direct ___ back to
task.
5. Begin at Step 1 and repeat.

92. Functionally Equivalent Replacement Behaviors:

93. Attention/Help Request:

1. Model asking for help/ look. When you begin to see l^Mb may
want your attention or needs help - Proactively verbally prompt
him by saying "help" or state the specific action he needs help
with example: "open" or "put in".
2. Immediately respond to the request by completing the request
and verbally praising the request itself." Open your pretzels-
great job asking me for help!".
3. Set up structured opportunities to practice making these requests.
94.
95.
96.
97. Break Request:
1. Model asking all done work/ break. When you begin to
see^BBft may be reaching boredom with the activitiy-
Proactively verbally prompt him by saying "all done" or state the
specific action he needs help with example: "all done cutting".
2. Immediately respond to the request by completing the request
and verbally praising the request itself." Wow, I like how you told
me you are ail done with cutting".
1. Set up structured opportunities to practice making these requests.

98. All of __ request for attention/ help or a break/ all done will
be honored consistently and immediately. This procedure will be
systematically faded when consistent behavior change has been
shown.

99. Data Collection:

100. Throughout the implementation of the behavior
intervention plan, data will be collect using observation by a
trained individual within the classroom, using an Interval timer
clicker, and a pencil and paper to document the total (count) the
frequency behavior in 30 minute increments, noting the activity,
individual, time and date.
 101. Individual Health Plan (EBB?)

102. NAME: _______# DOB: 02/29/2008

SCHOOL: Owatin Creek Elementary School
103. PARENTS:'
104. ADDRESS:)
105. PHONE:
106. PHYSICIAN:
107. Dupont Pediatric Neurology 302-651-5930
108. DIAGNOSIS: eizure disorder
109. Seizure Disorder- epilepsy - disorder of the central nervous system which
causes a sudden, uncontrolled episode of
110. abnormal electrical discharges in the brain. There are different types of
seizures and student has a history of_absence,
111. atonic, and generalized tonic-donic seizures. Students symptoms Inplude a
fine tremor, limp, bilateral eyes fixed for 15-2-
112. seconds, may fall with seizures.
113. Absence seizures - brief and last a few seconds. This Is the most comoon
type of seizure disorder in children and occur
114. frequently throughout day. Symptoms includes staring spells, eye blinking,
and mild facial twitching.
115. Complex partial seizures - confused, not fully responsive, unresponsive and
staring.
116. Complex partial w/secondary generalization- confused, not fully responsive,
unresponsive and staring, stiffness or
117. shaking, upper and lower extremities, stiffening, shaking and shallow
breathing.
118. Generalized tonEc/clonic- stiffness or shaking, upper and lower extremities,
stiffening, shaking, shallow breathing and
119. confusion, sleepiness afterwards.

120. MEDICATION:
121. Onfl: that must be reported to parent or physician mood or behavior
changes, anxiety, panic attacks, trouble sleeping, or If you feel Impulsive,
Irritable, agitated, hostile, aggresslve.restless, hyperactive (mentally or
physically), more depressed, or have thoughts about suicide or hurting yourself
122. Klonipln: (clonazepam) that must be reported to parent or physician
includes: drowsiness, clumsiness, behavior changes, tremor, and hair loss,
appetite loss, slurred speech, double vision, or increased salivation. Educational
implications of Klonipln may Include: sedation and behavioral changes, such as
self-destructive acts, complaints of persecution and worry, hostility, and
uninhibited behavior.
123. Vallum : (Dlastat) that must be reported to parent or physician include:
drowsiness, fatigue, clumsiness, depression .headache or tremor. Educational
implications of Valium may Include: sedation and behavioral changes, such as self-
destructive acts, complaints of persecution and worry, hostility and uninhibited
behavior.
124. Depakote and Depakene (valproate, valproic acid) that must be reported to
parent or physician can include: Skin rash, upset stomach, lack of coordination,
tiredness, yellow skin, unusual bleeding or bruising, hair loss, tremors. Common
side effects that should be reported if they become troublesome include:
Increased appetite or nausea and vomiting. Educational implications of Depakene
are few but may include: decreased testing-taking ability, deceased motor
performance and or impairment of concentration related memory.

125. ALLERGIES:
 126. No Known Allergies

127. HEALTH CONCERNS:

128. 1. Potential for Injury related to seizure activity
2. . Medication administration during school to prevent or administer during seizure
(per MD order)
3. Potential for injury related to seizure activity on bus

129. INTERVENTIONS:
1. Stay Calm
2. Turnip on his left side and protect his head
3. Monitoring and record seizure activity
130. a. School staff will be trained by school nurse on monitoring for seizure
activity, first aid, and recording of seizure activity.
 131. b. Record keeping, provide parents with important
documentation for physician evaluation.
132. c. Student should be allowed to participate In
physical education and other activity as doctor allows.
133. d. Generalize tonic clonic seizure Identification and
first aid Includes:
134. aa. Prevent injury by easing student to floor. Keep all
dangerous objects out of way.
135. bb. Do not restrain. You may palce a thin, soft towel or
soft item under head to decrease risk for head injury.
136. cc. Do not put anything in mouth or between teeth.
Student may bite tongue, do not put hands or fingers in
137. students mouth.
138. dd. Do not give fluids or food during or immediately
following a seizure.
139. ee. Loosen restrictive clothing or jewelry.
140. ff. Observe for injury; time seizure started (clock time);
color of lips, face and skin; breathing - NpTE IF NOT
141. BREATHING CALL 911
142. gg. If seizure lasts more than 5 (five) minutes call 911
and parent
143. hh. When seizure is finished, student may be sleepy.
This is normal. Allow student to rest In a comfortable area.
144. Tell the student where he/she is, the time and what
happened.
145. ii, Document all information if school nurse is not
available including time seizure started (clock time), injury,
color
146. of skin, breathing, what did you do, time parent was
notified and arrived and/or if 911 was notified. Make sure
147. administrator Is notified of seizure.

148. EXPECTED OUTCOMES:

1. Staff will be verbalize understanding of identification of
seizure, providing proper first aid, recording, and reporting
seizure activity. Seizure log Is attached to IHP;
1. Staff and parent will verbalize early recognition and reporting of
side effects via IHP
149. 3. Students bus driver will verbalize understanding of
identification of seizure, providing proper first aid,
recording and reporting seizure activity via IHP.

150.__________________________________________________HP written
by: ________________________________________________
_______________________________________________________Date:
10/10/2016

151. Cc: School/Carcgiver

152. P
hon
Fax:
3'
153. November 23,2016
154. RI
155. ToSvTSoTrrirrtray concern:
156. Seizure Action Plan
157. jtffts being treated for a seizure disorder at the Nemours.
The information below should assist
158. you if a seizure occurs during school hours.
159. *^Jhas been known to experience the following:
160. Seizure Type(s)
161. Absence: staring, blinking and loss of awareness
162. Complex partial: confused, not fully responsive,
unresponsive and staring
163. Complex partial w/ secondary generalization: confused, not
fully responsive, unresponsive and
164. staring, stiffness or shaking, upper and lower extremities,
stiffening, shaking and shallow
165. breathing
166. Generalized tonic/clonic: stiffness or shaking, upper and
lower extremities, stiffening, shaking,
167. shallow breathing and confusion, sleepiness afterwards
168. Basic First Aid for a generalized type seizure;
169. Stay calm and track time
170. TurntUPbn his left side/protect head
171. Keep him safe
172. DO NOT restrain
173. DO NOT putanything into mouth
174. Stay with tftuntil fully conscious
175. Basic first aid for partial or absence seizure:
176. Stay clam and track time
177. Keep safe
178. Protect form injury
179. DO NOT restrain
180. Stay withjVNfttll fully conscious
181. Reorient to surroundings
182. Seizure Emergency
183. Any seizure that Is more than 5 minutes
184. Repeated seizures without regaining consciousness
185. Injury occurs, student is diabetic or is having breathing
difficulties
186. First time seizures
187. Seizure occurs in water
188. Seizure Emergency Protocol
189. Administer emergency medication as follows: Diastat
10mg for convulsicve seizures greater than
190. 5 minutes
191. Klonopin .5mg for seizure clusters (5 seizures In 5 minutes
192. Call 911 if emergency medication does not stop
seizure within 10 minutes
193. Notify his parents or emergency contact
194. Does^Bp_iave a Vagus Nerve Stimulator? no
195. DoesjKneed to leave class after seizure? no
196. May tfBP rest, than return to class? yes
197. Special ConsldeStopfi/Precautions? (school activities,
sports, trips, etc.): Diastat on field trips
198. Malntain_seizurp cajengar and communicate
with4____F family
199. Name and

199. Address:

Health Care Plan for

DOB:_n_HB Parent/Guardian
200. ((previously April 29,2016
201.
202.

7.

8.

203. Phone: Mark: (H) (C)

204. Description of the Medical Condition:

1. hydrocephalus (an Increase In the fluid In the brain
that can lead to Increase in pressure),
2. history of meningitis,
3. seizure disorder, convulsions
4. gastroesophageal reflux,
5. Ventriculoperitoneal shunt,
205.
6. sensorineural hearing loss,
7. nystagmus (involuntary, rhythmic movement of the
eyes),
8. hip dislocation,
9. encephalomalacia (softening or loss of brain tissue),
10. Respiratory Distress Syndrome (developmental
insufficiency of the lungs at birth)
11. history of sepsis,
12. severe developmental delays,
13. Incontinence.
14. W_l requires total care including diapering,
feeding by GJ tube, suctioning, oxygen,
nebulizer treatments, cough-assist
tracheostomy care, administering medications
and repositioning.

15. 16. Medication = Prescription medication

m administered at school with a current, signed
order from a physician On record with the school
n e maintained and administered by student's
u agency nurse.
17.

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 18. Tvoe 19. Purpose 20. Dosage
21. NaCl 3% 22. Post Aerosol, 23. 1 vial BID
prior to cough assist
24. Fi0ventMFA44m 25. Assist 26. 2 Puffs BID
27. Omeprazole 28. Reflux 29. 15 mg
30. Clonazepam 31. Anti-seizure 32. 1.0mg BID -
33. Calcium 34. Control of 35. 625 mg
36. Glycopyrrolate 37. Secretion 38. lmgQlD-GT
39. 40. 41.
42. Depakene 43. Anti-seizure 44. 250mgQ8hr
45. Phenobarbitol 46. Anti-seizure 47.-GT 48mg BID -
48. Docusate 49. Laxative 50. 50mg prn
sodium
51. 52. 53.
54. Diastat 55. Seizures lasting 56. 7.5mg PRN
longer than 5 once, rectally
57. Albuterol minutes
58. Relieve 59. 2.5mgq2hB
60. Gastrojejuno 61. Caloric 62. 650ml Pediasure
stomy Tube Feed intake side Kick with 340 ml
H20 and 260m!
63. 64. Pedialyte
65. at 60ml/hr -
66. 67. 68.
69. 70. 71.

72. Medication = Non- Prescription medication

administered at school with a current, permission slip from
a parent or guardian on record with the school nurse (Type,
purpose, dosage of each). All are maintained and
administered by student's agency nurse.
73.

74. Type 75. Purpose 76. Dosage

77. Saline spray 78. Relief 79. PRN
80. Miralax 81. Relief 82. 4.25 GM daily
constipation In 60ml of H20 -GT
83. Multivitamin with 84. 85. 10 mg Daily-GT
86. Acetamino 87. Temperatu 88. 313.6mg
89. Nystatin 90. Relief of 91. Thin layer
irritation at trach T1D PRN
stoma

92. Side Effects of Medications: Describe symptoms,

persons responsible for monitoring symptoms, and any
interventions or limitations on activities that will be
implemented when symptoms are present:
93.
 94. Medi 95. Svm 96. Pers 99. Inter
cation otoms onfs) vention or
97. Resp 100. Limit
102. NaCI 103. Abdo onsible
104. for
Age 105. ationObs
of
minal ncy nurse erve, refer
107. Baclofen 108. Rash, 109. Age 110. Observ
dark urine, ncy nurse e, refer as
111. seizures necessary
112.
113.
-V

114. Medi 116. Svm 117. Pers 120. Inter

cation ptoms on(s) vention or
115. *. 118. Resp 121. Limit
123. Keppra 124. onsible
125. for ation of
126. D/C 8/3/15
127. Baclofen 128. Rash, 129. Age 130. Observ
dark urine, ncy nurse e, refer as
131. Desmopres seizures
132. Decreas 133. Age necessary
134. Observ
sin ed urine ncy nurse e, refer as
output, fast or necessary
irregular
heartbeat,
135. Prevacid swelling
136. Nauseof 137. Age 138. Observ
a, stomach ncy nurse e, refer as
ache, necessary
diarrhea,
139. Hydrocorti constipation,
140. Anxiet 141. Age 142. Obs
sone y, irregular ncy nurse erve, refer
144. Calcium heart beat
145. Constip 146. Age 147. Obs
carbonate ation, ncy nurse erve, refer
headache, as
149. Clonidine allergic
150. rashIrrita 153. Age 154. Observ
Patch tion at ncy nurse e, refer as
site, dry necessary
155. Advair 156.151.
Thrush,mou 157. Age 158. Obs
fungal ncy nurse erve, refer
infection of as
160. Pediasure thro at,
161. Non 162. 163.
164. Lorazepam 165. Diz 166. Age 167. Observ
ziness, ncy nurse e, refer as
168. Albuterol constipati
169. Trem 170. Age necessary
171. Generally
or ncy nurse no intervention
172. Atrovent 173. Cough, 174. Age required
175. Observ
diarrhea, dry ncy nurse e, refer as
176. Hydro mop rn6uth
177. Dry 180. Age necessary
181. Observ
hone mouth, ncy nurse e, refer as
shallow necessary
182. Diazepam 183. 178. brea
Constipati 184. Age 185. Observ
on, nausea, dry ncy nurse e, refer as
186. Solu^corte mouth
187. Facia 188. Age necessary
189. Observ
f l flushing, ncy nurse e, refer as
sweating necessary
190. 5. Medical Treatments or Procedures Performed at School: for
each treatment or procedure a current, signed order must be on
record with the school nurse; describe each treatment or
procedure, when or under what circumstances it should e
implemented, and the role of each school staff member
responsible for implementing all or any part of the treatment or
procedure:
191. 194. Treatment 195. Circu 196.Role of each
\ or Procedure mstances for School Staff
~ 197. Gastrojejunosto Implementati
198. Continual Member
199. Agency
- 200. Secretion care 201. Increased 202. Agency
- 203. Trach care 204. Secretions 205. Agency
r 206. Trach change 207. Accidental 208. Agency
209. Pulse oximetry 210. Continual 211. Agency
212. Oxygen 213. Maintain sp02 214. Agency
administration (0.5 greater than 90% or nurse
-2.01pm if distress

215. 6. Describe Student Limitations or

Restrictions: 4(B__ development is significantly
delayed, and
216. she requires total care. According to the
Evaluation Report, her parents report that she is
aware of other people, she can stretch and move
her arms and grasp one's finger.

217. 7. Describe Staff Training Required: Agency

nurse will provide all care. Parents report they will
keep^Bfct home if the agency nurse Is not
available.

192.
193.
#
 218.
219.
# 220. Individualized Health Plan
221. Grade 3^|M_BMHfe
222. 2016-2017

223. i has a seizure disorder. His seizures

are controlled with medication which he takes at
home.^B_t may experience the following types of
seizures: absence, atonic, and generalized tonic-clonic
seizures evidenced by a fine tremor, limp, bilateral eyes
fixed for 15-20 seconds, may fall with seizures.

224. !_____. has a G-tube in place and feedings and/or

water will be administered as ordered by the physician.
Precautions, should be taken to not dislodge the tube. If
the G-tube becomes dislodged, notify the school nurse
immediately.

225. If seizure activity (i.e. shaking or becomes

unresponsive) is observed*.
Stay calm and note the time the seizure started and
ends.
Keep"^, safe and turn on his left side. Protect his
head.
Call for assistance (nurse-5179 or office- 5711)
Do not restrain or put anything in his mouth.
Stay with (B until fully conscious.
The nurse in the classroom carries Diastat 7.5 mg
and will administer for seizure lasting longer than
5 minutes,
Call 9-1-1 if seizure does not stop with Diastat within
10 minutes.
Call 9-1-1 if Diastat is not available.
Communicate any seizure activity to parent

226. Allov^BR to rest as needed and return to class

when he is back to his baseline. He does not need to
leave the classroom.

227. flft should wear a fitted helmet when engaged in

wheeled activities. No climbing in high places.

228. Emergency contact information: Mother:

229.

230.
231.
232.