Name: Grade Age:

School:
Date Written:

Strengths of Student:

Individualized Information About the Student:

Previously Implemented Interventions:

Problematic Behaviors:
Behavior 1:

Replacement Behavior:

Interventions:
A. He

Documentation:

Amount of Improvement Expected:

Behavior 2:

Baseline:

Function of the Behavior:

Replacement Behavior:

Intervention:
A. Stud

Documentation:

Amount of Improvement Expected:

Behavior 3: Using profanity around younger students

Baseline: average of 8 incidents per week for last 5 weeks Function
of the Behavior:
-attention-getting
-relieving feeling of anxiety due to Tourettes or Obsessive/Compulsive Disorder
-vent anger/frustration in a situation less threatening than with staff/peers
Replacement Behavior:
-get attention by interacting appropriately with peers
-recognize anxiety or anger/frustration and get help to vent appropriately (cool down
time, removing self from situation, talking with staff/peer) Intervention:
A. Provide opportunities for him to practice interacting appropriately with younger students (i.e.
reading to them, tutoring...)
B. Praise for appropriate verbal interaction
C. When he is verbally inappropriate, he is directed to remove himself to a different location
and is not allowed to participate in the activity (i.e. recess...) for 5 minutes.
Documentation:
-record number of times he’s verbally inappropriate with younger students
-record number of times he asks for help with anxiety or anger/frustration
Amount of Improvement Expected:
-no more than an average of 4 incidents per week for 3 consecutive weeks.

Schedule for Review:

-documentation review at least each nine weeks when grade cards are distributed

Provisions for Home Coordination:

-assignment notebook sent home daily. Assignments will be marked as attempted, completed or
not attempted.
-on Fridays a note will be sent home with weekly grade for each class number of inappropriate
verbalizations toward younger students and number of times student requested resource room
and/or cool down.

Crisis Management Plan:

(For behaviors which may lead to suspension or expulsion)

(Let’s say, for example, Johnny had a history of throwing chairs when he gets frustrated.)
 1. Johnny will be given a cue that he can use with staff to indicate that he is getting upset and needs to
cool down. Once he gives the cue, he can choose from the following options: -walking in the hall or
outside (a staff member will accompany him but not talk to him) -go to resource room
-ask to see a support staff member
2. If staff sees that Johnny is becoming upset and he is not using the cue for help, staff will say, “I see
you’re getting upset. I need you to choose (list the options in number 1). If Johnny is unable to make a
choice, he will be directed to go to time-out where he will remain until he can demonstrate compliance
with a simple request.
3. If Johnny is not able to demonstrate compliance within 30 minutes or if he has had more than 3 time-
outs, he will be seen by a support staff member as soon as possible.
4. If Johnny throws furniture or otherwise endangers himself or others, he will be isolated from his peers
and Mom (or her designee) will be called. Johnny will remain in isolation until it is determined
that he is no longer in imminent danger of hurting himself or others. He will finish his school day
in the resource room.
5. If Johnny endangers himself or others while in isolation, physical restraint will be used by staff
members trained in Mandt procedures.
6. If an injury or property damage occurs as a result of Johnny’s behavior, a police report will be made
and
he will be suspended according to district policy (You might need to spell that out here). The IEP
team will meet as soon as possible within 10 days to review the Behavior Intervention Plan and
make modifications where necessary.
Sample Behavior Plan, Format #2

Name: Jimmy Smith Date: 11/04/98

Age: 11 yrs. 0 mo. Grade: 5 School: Greenbush Elementary

Referred by: Diana Peterson, school psychologist

Special Education Staff Implementing Plan: Linda Hierophant

Likes/Dislikes: Likes: Teachers report that Jimmy seems to enjoy his job breaks
in the afternoon, eating lunch with the general education 5th grade, computer
time, exchanging his points for tangible items at the “class store”, and breaks
with the other two boys in his classroom. His favorite educational subjects appear
to change depending on the assigned activity and his mood. Dislikes: It has been
observed that Jimmy’s educational dislikes also change, depending on his mood
and the assigned activity.

Target Behavior(s): Jimmy will decrease the use of aggressive behaviors such
as kicking, hitting, spitting, pulling hair, throwing objects (books, pencils, chair)
biting and scratching, threatening and/or aggressive comments to staff and
peers, and destruction of property. Jimmy will additionally decrease the use of
profanity.

Definition of Behavior(s):
Property Destruction: When Jimmy destroys or physically damages school
property. Property destruction does not include materials such as Jimmy’s
personal property.
Threatening or aggressive comments to staff or peers: These include
comments which state Jimmy’s intent to inflict or cause bodily injury or death
to a staff member or peer.
Profanity: The use of language which is socially unacceptable for children to use
around adults. Examples which would not be considered as profanity would
include: Darn, Crap, Sucks, Stinks, Shut-up. Aggressive Behaviors Include:
Kicking: When Jimmy’s foot or leg makes contact with another person, or an
inanimate object (excluding walking surfaces of objects involved in play
activities, such as a ball) with sufficient force to hear the contact at a distance
of 5 feet.
Hitting: When Jimmy’s hand or arm makes contact with another person, or an
inanimate object (excluding objects involved in play activities, such as a
ball) with sufficient force to hear the contact at a distance of 5 feet.
Spitting: The act of expelling liquid (saliva, water, juice, etc.) from the mouth.
Pulling hair: When Jimmy grasps hair on the top of the head and pulls the hair in
a direction away from the head.
Throwing objects: The act of grasping or holding any object in the hand and
propelling the object a distance from the hand at least 6 inches
(excluding objects involved in play activities, such as a ball or Frisbee).

Rates of Behavior(s) & Description of Analysis:

•Rates of problematic behaviors (including aggression, profanity and

property destruction) did not seem to be affected by time of day or by the
individual working with Jimmy.

•Rates of problematic behaviors (including aggression, profanity and property

destruction) were affected by the setting. Rates of problematic behavior were
higher in time out and when Jimmy was expected to process his inappropriate
behaviors following the incident.

•Rates of problematic behaviors were higher when it was unclear to Jimmy what
it was he was supposed to be working on, and when he was expected to wait for
assistance.

Intervention(s) Previously Attempted and Resulting Effectiveness:

Currently waiting for this information from Linda Hierophant.

Functional Analysis of Behavior:

Currently the team has been unable to ascertain the exact function(s) of Jimmy’s
behavior. At this time, the team speculates that the functions of Jimmy’s behavior
are three-fold, including: 1) Control of the setting, 2) To minimize fear, and 3)
Avoidance of unpleasant stimuli. These functions may not be inclusive of all
functions of behavior.
Description of Intervention(s):

Academic Restructuring - The data indicates that Jimmy requires

modification in the presentation style of his academic work. Frequent breaks
coupled with frequent reinforcement (via staff praise and appropriate attention
and/or bonus tickets) will assist Jimmy in maintaining a lower frustration level.
The goal of academic restructuring is to avoid the use of more intrusive
interventions. Allowing Jimmy to make choices as appropriate and incorporate his
interests and preferences is an essential component of the behavior plan. When
appropriate, Jimmy will be provided with choices in his academic work such as
mode of output, choice of assignment, independent projects, etc. Jimmy will be
provided with a daily schedule. If Jimmy chooses not to work, the staff will
provide him the opportunity to go to the safe space area. When Jimmy’s behavior
is appropriate and he indicates that he is ready to work the staff will assist Jimmy
as necessary in completing the assignment.

Classroom Management System

Behavioral Expectations:

1. Raise hand to ask for assistance or to visit

2. Ignore the inappropriate behavior of others
3. Stay on task
4. Make positive comments (about self and others)
5. Participating appropriately in present activity
6. Remain in own personal area
7. Work without distracting others
8. Follow directions
9. Complete assignments

Jimmy will earn tickets for exhibiting behavioral expectations numbers 1-4 and
will earn points on his point sheet for exhibiting behavioral expectations numbers
5-9. Jimmy will be given the opportunity to exchange his tickets in for snacks or
breaks at 3 pre-determined times throughout the day. Additionally, Jimmy will be
given the opportunity to exchange his points at the “class store” at the end of the
day on Wednesday and Friday, contingent on him not having been sent to time-
out since the last time the “class store” was open. If Jimmy is sent to time out on
either Monday, Tuesday, or Wednesday, he will not be eligible to cash in his
points at the store on Wednesday. Likewise, if he is sent to time out on Thursday
or Friday, he will not be eligible to cash in his points at the store on Friday. Any
earned points will not be lost as a function of being sent to time-out.

Earning Points
Jimmy will start out with four points in each of the five behavioral expectations
categories (participating appropriately in present activity, remain in own personal
area, work without distracting others, follow directions, and complete
assignments) at the beginning of each class period. If he has to be reminded to
exhibit appropriate behaviors in one of these areas, he will lose one (1) point in
that area and a timer will be set for two (2) minutes. Jimmy has until the timer
rings to begin doing what was originally requested of him. During this two
minutes, staff will not prompt or remind Jimmy. If the timer rings and Jimmy has
not already begun doing what was requested of him, he will receive a second
reminder, lose another two (2) points (total of three), and the timer will be reset
for another two (2) minutes. If the timer rings and Jimmy has not begun the
requested activity/behavior, he will lose the remaining point (total of four) and
need to go to the safe space area.

At the end of each class period, any remaining points will be recorded on his
point sheet.

The Safe Space

The purpose of the safe space period is to provide Jimmy with a chance to re-
focus and regroup. The location of the safe space is behind the pink dividers, in
front of Mrs. Hierophant’s office window. During this time, Jimmy is expected to
be quiet and keep all parts of his body or any materials in the safe space area,
not going outside of the pink divider. Likewise, the staff are not to engage Jimmy
in conversation, as long as he is following the safe space rules.

A timer will be set by a staff at the beginning of the safe space period to 10
minutes. At the end of the 10 minutes, Jimmy will have the option to request a
second 10-minute safe space period. If a second safe space period is desired by
Jimmy, he will need to hang up the red card on the outside of the pink divider
within the first 10 minute period. If he does so, the staff will reset the timer to
another 10 minutes, once it has rung at the end of the first 10 minute period. Staff
will not engage Jimmy in conversation during his safe space periods.

At the end of the second safe space period (or the first period, if he does not
choose to have a second safe space period), Jimmy will come out and resume
working in what he was supposed to be doing before he went into the safe space
area. Jimmy can, if he wants to, end his safe space period before the 10 minutes
is up by placing the green card outside of the pink divider. If this happens, he will
be expected to begin working in what he was supposed to be doing before he
went into the safe space area. If Jimmy refuses to begin working in what he was
supposed to be doing, or does not follow the rules while in the safe space area,
the Time-Out door will be opened as a visual prompt.

Jimmy may request to go to the safe space area, with the same conditions as
stated above, if he begins to become frustrated.

Jimmy can also be sent automatically to the safe space area if he uses profanity.
Time Out

The use of time out will be avoided if possible and will be reserved for destruction
of property, aggressive behaviors, or threatening or aggressive comments to staff
and/or peers. Additionally, it will be reserved for times in which Jimmy is refusing
to follow directions after he has been in the safe space area. The window on the
Time-Out door will be covered with a 1-way mirror contact-paper, to be supplied
by Mr. and Mrs. Smith. This paper will serve to minimize stimuli presented to
Jimmy while he is in Time-Out, while allowing the staff to monitor Jimmy’s safety.

Time-Out with the Door Closed:

Once in Time-Out, Jimmy needs to complete the following steps to come out of
the Time-Out room and return to his work/assigned activity:

1) Knock on the door using a neutral knock. Loud, aggressive, or repetitive

knocks or kicks on the door will be ignored.

2) Go to the back of the Time-Out room.

3) A staff member will look in the window to 1) acknowledge to Jimmy that the
knock was appropriate and, 2) to verify he is in the back of the Time-Out
room. Once this is done, the staff member will set a timer for 8 minutes.
Verbal instructions will be made, if necessary, to prompt him on what he
needs to do (be fully dressed, in appropriate place). Jimmy will be notified
once the timer is set.

4) During these 8 minutes, Jimmy needs to remain calm, not talking or

making noises, and remain fully dressed. At the end of the 8 minutes, the
staff member will look in the window to verify that Jimmy is calm, fully
dressed, and in the back of the Time-Out room. If he is ready, proceed to
step 5. If he is not calm, he will be told what it is he needs to do, and will
proceed back to step 1.

5) The staff member goes to the closed Time-Out door and tells Jimmy what it
is he needs to do. Jimmy must be able to repeat those steps back to the
staff member.

6) Jimmy then has 2 minutes to come out of the Time-Out room and go to his
seat. If Jimmy does not comply within 2 minutes, the Time-Out door is shut
and the Time-Out procedures start again.
Time-Out with the Door Open:

The Time-Out door will remain open if Jimmy goes into the Time-Out room on his
own and sits/stands at the back wall and does not talk or make noise. The timer
starts when Jimmy is quietly sitting or standing at the back of the Time-Out room.
The same procedures (as for Time-Out with the door closed) are followed at this
point. The Time-Out door will be closed if his behavior escalates (raising voice at
staff, removing articles of clothing, etc.) or if he does not follow the above stated
procedures.

With either situation (Time-Out door open or closed), the staff will monitor Jimmy
by looking in the Time-Out window as needed to monitor safety concerns. Staff
will document the use of Time-Out by documenting the number of times the
Time-Out procedure is used, the length of time Jimmy was in Time-Out, the day
and time of day each Time-Out episode occurs, and specifying Jimmy’s
antecedent behaviors which led to the Time-Out.

If Jimmy is in Time-Out repeatedly during a school day, in cases where he will not
cool down but he is safe, he will remain in the Time-Out room until he does cool
down. If he is in Time-Out during the lunch period, he will not be able to eat lunch
if he ends his session in Time-Out after lunch is over. During the lunch period,
staff should keep their verbal exchanges with him limited to “Feel free to join us if
you can follow the rules. Lunch is served from X time to X time. After that, lunch
is over.”

If, while Jimmy is in the Time-Out room, he requests to go to the rest room, he
will need to be fully and appropriately dressed before he will be allowed out of the
Time-Out room to go to the rest room. If he is not fully and appropriately dressed
and/or is refusing to become fully and appropriately dressed, staff should limit
their verbal exchanges with him to “I don’t trust you yet. Your mom has told us
you can wait long enough to get fully dressed and calmed down before using the
bathroom.”

While in Time-Out, Jimmy’s inappropriate behavior will be ignored.

A debriefing will NOT follow a time out session.

Coordination with the Home:

Mrs. Smith will be called to be informed of any serious behavior, although Jimmy
will stay in school.
Physical Restraint

Restraint will be only be used in those situations where time out is not available
or until Jimmy can be escorted to the time out room. All efforts will be
implemented to avoid the use of restraint; however if Jimmy becomes out of
control or violent and is a threat to the safety of himself or others, physical
restraint may be used by trained staff.

Crisis Plan
The crisis plan is currently under construction, as team members are looking into
possibilities.

Monitoring of Behavior Plan

The behavior plan will be monitored by the IEP team and will be evaluated every
6 weeks for effectiveness, via phone or meeting. The team will reconvene prior
to the 6-week meeting in the event that Jimmy is sent to time out three times in
a given three-week period.
 Sample Behavior Plan, Format #3

Name: Jake Campfield Grade: 4th Age: 10 years 2 months

School: Greenbush Elementary

Strengths of Student: Jake has excellent productive verbal skills. He has many animals
at home and likes to share stories about them. He is very caring towards his
animals. He likes to draw and has stated he wants to be an architect when he
grows up. His mother is very involved in his school.

Individualized Information About Student: Jake has difficulty reading the same content
level as his peers. He is very willing to be read to by his paras, and is receptive
to taking tests and completing worksheets orally. At times Jake may not
understand academic instructions, especially if working without adult help. Be
careful to not interpret these behaviors (typically non-responsiveness or
socially inappropriate behaviors) as defiance, as they often result from
frustration or confusion.
Additionally, it is currently under medical evaluation as to whether Jake suffers
from seizures. He is currently taking medication for ADHD, which, if not
administered at the same time each day, can result in an increase in problematic
behaviors.

Previously Implemented Intervention*: (1) Jake’s teacher has reported using a point
system with Jake. Jake earned points for desired behaviors which he was able to
turn in for a variety of reinforcers. His teacher reported that initially the point
system was effective, however after approximately 2 weeks, Jake was no longer
responding to the point system and it was discontinued. (2) Time Out was used,
with little success.
(3) When Jake had problematic behaviors, he was sent to the principal’s office.
This typically led to a reduction in inappropriate behaviors for between 1-2 hours.
(4) Curriculum materials have been adapted to his current level of functioning.
This has been met with some success.

*Try to include as much information about previously attempted interventions. However, if you have
only limited information to include, be certain to include it to provide as comprehensive a plan
as possible.

Problematic Behavior: Hitting

Definition(s): Hitting - Forceful application of hands. Jake usually hits peers with an open
hand. If Jake hits with a closed hand or fist, or pushes, this is also recorded as a
‘hit’.
Function of Hitting: Jake appears to hit others when he has to work on his own, without
adult supervision. Oftentimes after hitting a peer, Jake will look up at the teacher
or a para. If Jake is not attended to by an adult, he will continue to hit. Once he
has been attended to by an adult, his hitting will stop. It is determined the function
of Jake’s hitting is to get adult attention. Jake gets very frustrated while reading
and might demonstrate hitting to avoid frustrating reading situations.
Replacement Behavior: Jake will raise his hand when he wants adult attention. If, after
counting to 10, an adult has not responded to Jake, Jake will go up to the teacher
or para and ask for help. These replacement behaviors are to occur at the same
rate as his peers.
Intervention: For one week Jake will have a full-time para. She will step away from him
(across the room) 2 times per hour, for 5 minutes each time. Jake will be told that if
he has a question, he will need to raise his hand and wait for the para to come over.
The para will continuously watch Jake during the 5-minute periods and will
respond to him immediately when he raises his hand. During this week, Jake will
not have any peers directly next to him or in front or behind him. In subsequent
weeks, the para will have more frequent periods away from him and for longer
duration of time. The goal is to fade Jake’s need for 1:1 para support to a
minimum, while still addressing his academic needs. The time the para responds to
his raising hand will gradually be increased. During this fading process Jake will
be required to work independently even if the work is difficult. Students proximity
will be gradually increased. The para will socially reinforce him for trying
problems even when they are not completed accurately if he tries them
independently. When Jake does the replacement behaviors he should be praised for
using the replacement behavior. Jake’s curriculum will be modified (by the special
education teacher) to meet his academic abilities. The mother will not be
consequating academic problems. Jake will be pulled out once a day with a para
where he will choose something to read and the para will give him their full
attention throughout this period. This period of time will be gradually shift from
being directed by Jake to teacher directed Small group activities under the context
of enjoyable activities will be employed twice a week to help strengthen peer
relations. If Jake does hit, peers will be moved to a safe distance, during which
time they will continue to work. Jake will be given alternate, yet academically
comparable, work to complete. If Jake’s hitting escalates, see Crisis Plan, below.
Method of Recording: An hour-by-hour (see sample, attached) data sheet will be used to
record the frequency of hits. Each hit will be recorded by the para on the data
sheet as it occurs.
List of Measurable Changes: Hitting should be reduced by half of it’s current level
within two weeks from initial intervention. It is expected that the behavior be
reduced to once a month within two months.
Schedule for Review: The effectiveness of this intervention will be reviewed by the
para, general education and special education teachers two weeks from the initial
date of implementation. The effectiveness of the intervention will be reviewed
monthly, with summaries of each review being sent home to the parents.
Provisions for Home Coordination: Parents can have access to any of Jake’s data, at any
time. They will be given summaries of each review, as stated in Schedule for
Review, above. The behavior management team will reconvene in two months to
discuss current status of hitting behaviors, and make any changes to the behavior
plan, if necessary.
Crisis Management Plan: If Jake’s safety, or the safety of others, is in question, Jake will
be asked to leave the area and go to the counselor’s room to calm down. If Jake
will not leave when given three consecutive verbal requests by an adult, he will be
escorted to the counselor’s room. If the Crisis Management Plan has to be used
more than once a month, the behavior management team will meet to address the
problematic behaviors and discuss possible solutions.