Behavioral Intervention Plan Form

Name: School: __________________________ __ Date: DOB: ____ CIF: _____

This Behavioral Intervention Plan (BIP) is being created in response to exhibited persistent and/or severe behavior that 1) interferes with the students learning or the learning of others and 2) warrants interventions to positively redirect the targeted behavior. This BIP identifies the type and cause of the behavior, the replacement behavior, positive interventions and support to reinforce the replacement behavior, and appropriate consequences. The plan defines a how the student will be taught the skills needed for behavior modification, and provisions for monitoring progress and crisis management. Problem Behavior (As described in FBA): Frequency: Intensity: Duration: Is this behavior a: __Performance Deficitis student able to perform the expected behavior? __Skill Deficit Academic __work is too hard __not enough practice __not enough help __not generalized skill Behavior __Lacks ability to perform expected behavior __needs practice or modeling __Requires more structure __Cannot apply across settings Communication __to request assistance __to request a break __to indicate a need __to indicate frustration

FUNCTION (cause) of the Behavior: What purpose does the identified behavior(s) seem to serve for the child? Escape ____ _____Avoid a demand or request _____Avoid an activity _____Avoid a person _____Escape the school _____Other ________ Sensory/Perceptual____ _____Automatic sensory stimulation _____Perceptual reinforcement Attention/ Control_____

_____Gain adult attention _____Gain peer attention _____Get sent to a preferred adult _____Other ______________ Gain Desired Item______ _____Get desired item/activity/area _____List:______________________ Hypothesis: The function of the behavior is to

Intervention Strategies 1. Environment and/or Circumstances How can the environment or circumstances that trigger the behavior (or the result of it) be adjusted? Staff Responsibility: Student Responsibility: 2. Curriculum and/or Instruction What changes in the curriculum and/or instructional strategies will be helpful, and who will make it happen? Staff Responsibility: Student Responsibility: 3. Other Strategies or Positive Supports (including school personnel, peers, or family) Staff Responsibility: Student Responsibility: Desired Replacement Behavior What behavior will be taught to replace the targeted behavior? How will it be taught/re-taught/reinforced, and by who?

Rewards and/or Motivators How will the student be reinforced so that the replacement behaviors are more motivating than the problem behavior?

Consequences What consequences will be implemented for repeated occurrences of the problem behavior? 1st Occurrence 2nd Occurrence 3rd Occurrence

Crisis Plan How will an emergency situation or behavior crisis be handled? (Define possible scenarios, including the use of inschool or out-of-school suspension, or aversive techniques, as appropriate)

Monitoring of Behavior (How the behavior will be assessed and evaluated): What data will be collected: How it will be collected: Who will collect it: Case Manager, ______________________ Date the plan will be reviewed:_________________________

Adapted from the New Mexico Public Education Department Technical Assistance Manual: Addressing Student Behavior