Daytime Interventions

Column 1 Column 2 Column 3 Column 4 Column 5

Medical Frequency-how often does it occur Duration-How long Intensity-what is the injury to Intervention-See
Condition or does it last self or others-consequence of Appendix B, enter
Behavior no intervention code number of
(see intervention here.
Appendix A
for examples)
Self – X Every 15 Daily 10 minutes Inappropriate touching of self in 50,63,,65
stimulating minutes public
Weekly
behaviors Every hour
Monthly
Every two hours
Hallucinations x Every 15 Daily 30 minutes Property damage, 50,54,55,57,76,79
minutes aggressiveness ,and escalating
Weekly
Every hour violent behavior
Monthly
Every two hours
Being rough Every 15 Daily 20 minutes Injury to siblings, injury to cat 50,54,55,62,63,64,
with siblings minutes 79
Weekly
and cats x Every hour
Monthly
Every two hours
Violent talk/ Every 15 Daily 20 minutes Self talk and violent talk 50,63,79
self talk minutes becomes increasingly louder,
Weekly
Every hour
Monthly Becomes hostile and ends up
Every two hours with aggressive behavior
Overflows Weekly 20 minutes Flood bathroom/damage to 50,63.79
toiler toilet/bathroom
Puts things in Every 15 Daily 5 minutes Choking, spitting, possible death 50,51,63,65,68,75,
his mouth minutes 76,77
Weekly
Every hour
(dirt, sand, Monthly
toys, rocks, x Every two
leaves, hours
weeds, and
grass)
Pacing, x Every 15 Daily 30 minutes Property damage, exhaustion, 50,51,52,55,63,65
jumping, minutes memory problems
Weekly
banging in the Every hour
Monthly
walls
Every two hours
Refusal to x Every 15 Daily 2 -30 minutes Becomes hostile and ends up 3,4,50,63,64,68
follow minutes with aggressive behavior
Weekly
directions Every hour
Monthly
Every two hours
Picky eater- 3x day Daily 40 minutes Throws food, choking, 27,50,51,64,65,68,
very limited malnutrition 79
on what food
he will eat
Grabbing Every two hours Daily 10 minutes Others do not want to work with 50, 65,66,79
others Harley or be near him, people
inappropriatel are afraid of him
y
Digs holes in Every hour Daily 10 minutes Eating dirt,/leaves (PICA), 50,63,75,76,79
yard/beats/de destruction of property
stroys
trees/bushes
Paces front Every 15 mins Daily 30 mins Distresses neighbors and traffic 50,51,52,63,76,79
yard, battling driving by, danger of him being
his hit by a car
hallucinations
Destroys Every hour Daily 30 mins Property destruction 50,51,63,79
mailbox,
removes
siding from
house
Hides in van Every two hours Daily 60 minutes Flight risk, suffocation, lack of 50,54,63,75,79
safety awareness, property
damage
Cuts phone Every two hours Monthly 10 minutes Cuts, electrocution, property 50,51,52,63,79
cords/electric damage
al cords (cell
phone
chargers,
small
appliances
Tries to self Every two hours Daily 10 minutes Overdose, death 50,51,52,54,57,63,
medicate 75,79
Throws chairs Monthly 3 hours Threatened suspension, injury 4,50,51,53,63,66,6
at school at to self/others 8,69
other
students/teac
hers
Overturns Weekly 1 hour Injury to self/others, property 50,63,64,65
tables in the damage, public safety
community
Does not Every 15 minutes Daily 5 minutes (driver Injry to self others, safety of 80 parent pulls
remain pulls over) public, driver distraction over, 63,74,51
seated in
moving
vehicle
Rips and Every 30 minutes Daily Continuing, as Property damage, mold, insect / 50,51,54,55,79
removes replaced. animal infestations, weather
screens from
windows
Overeats until Every 30 minutes Monthly 20 minutes Obesity, malnutrition, public 50,63,66,79
vomits safety/nuisance, health
(community) concerns, choking
Scratching Every 15 minutes Daily 15 minutes Skin infection, bodily fluids 50,65,80 frequenty
eczema til leaking applying lotions
bleeding

Nighttime Interventions-on a weekly average how many nights does intervention occur?__Multiple times every hour every
night

Column 1 Column 2 Column 3 Column 4 Column 5

Medical Frequency-how often does it occur Duration-How long Intensity-what is the injury to self Intervention-See
Condition or does it last or others-consequence of no page 5, enter
Behavior (see intervention number of
Appendix A for intervention here.
examples)
Stays awake/ Every 15 Daily 5- 7 hours Decreased learning ability, 50,51,53,54,55,57,
Cyclic sleep minutes decreased attention span, 60,62,63,75,76,79
Weekly
patterns Every hour irritability leading to
Monthly
aggressiveness, overnight
Every two hours
Five out of behavior (see below) disruption
seven nights of sleep for siblings and parents
Obsessive X Every 15 Daily 40 minutes Choking, constipation, diarrhea, 50,51,52,54,55,57,
eating minutes ingestion of harmful substances/ 60,62,63,64
Weekly
Every hour items, death
(overnight), Monthly
overeating Every two hours
certain foods
Obsession Every 15 Daily 20 minutes Cuts, bleeding, cutting off 21,22,50,51,57,62,
with sharp minutes eyelashes/ eyebrows, 63,79
Weekly
objects Every hour electrocution hazard( cuts power
Monthly
cords to appliances), injury to
(scissors and, Every two hours
self or others
knifes, etc)
pens/pencils
Will try to Every 15 Daily 20 minutes Getting lost, injury to self, 52,54,55,57,62,63,
escape the minutes unaware of danger, death if hit 79
Weekly
house at night Every hour by a car
Monthly
Every two hours
Flooding Every 15 Daily 20 minutes Property damage, slip and fall 57,63,75,79
bathroom, minutes hazard, ingestion of harmful
Weekly
dumping Every hour substances
Monthly
soap, making
Every two hours
messes in 2 x’sa night
bathroom
Dismantles Every 15 Daily 15 minutes Property damage 50,51,57,63
vacuum, minutes
Weekly
carpet Every hour
Monthly
cleaner, other
Every two hours
household
appliances
Turning off Every 15 Daily 10 minutes Rotten food, property damage 51,52,57,63,79
knobs on minutes
Weekly
fridge Every hour
Monthly
Every two hours
1-2 times per
night
Scratching Every 15 minutes Daily 15 minutes Skin infection, bodily fluids 50,65,80 frequenty
eczema til leaking applying lotions
bleeding
Hallucinations Every 15 Daily 30 minutes Property damage, 50,54,55,57,76,79
/ constant minutes aggressiveness ,and escalating
Weekly
vocalizations Every hour violent behavior
Monthly
Every two hours
Pacing, Every 15 Daily 30 minutes Property damage, exhaustion, 50,51,52,55,63,65
jumping, minutes memory problems
Weekly
banging in the Every hour
Monthly
walls
Every two hours
Refusal to Every 15 Daily 2 -30 minutes Becomes hostile and ends up 3,4,50,63,64,68
follow minutes with aggressive behavior
Weekly
directions Every hour
Monthly
Every two hours
Wets bed Every 3 hours Weekly 10 minutes Unsanitary conditions, disease, 60,66.79
(urine)/spits odor
water on
mattress

Agitation Every 2 hrs Weekly 20 minutes Property damage, injury to 4,50,52,54,57,63,

leads to self/others, spoiled foods 79
breaking
refrigerator
door
Breaks faucet Monthly 10 minutes Property damage, mold 4, 50,
from main 52,54,57,63,79
water valveq
Steals and Every hr Daily 30 minutes Unsanitary conditions, choking 4, 50,
Hides food in 52,54,57,63,79
his room
Rips and Every 30 minutes Daily Continuing, as Property damage, mold, insect / 50,51,54,55,79
removes replaced. animal infestations, weather
screens from
windows