Individual Safety Plan

Identifying Information
Student: Age (if known):
XXX 5 years old
School: Grade: Senior
ABC Kindergarten
School

Safety Concerns
(highlight) Description of Behaviour(s) that Presents a Risk of Physical Injury:
Physical Aggression
Kicking
Hitting
Self-Abuse Throwing
Punching

Putting self/others in danger Description of Trigger Events:

Transition time from preferred activity to a non-preferred activity

Not being first on line
Other: Sharing materials
Seeking some sensory outputs
Receptive and expressive language skills
Social skills
Self-regulation
Not getting her way or the toy she wants or sitting beside her preferred friend
Unstructured environment (like play time or outside time)

Escalation Cycle
Observed Behaviour: Staff Response:
Describe what you see/hear at each of Describe appropriate staff responses at each stage.
the following stages. *Refer to your class notes/PPT for suggestions.

Stage 1: Anxiety (Increased agitation Supportive:

or excitement e.g. losing self-regulation)

Notice her body getting tighter and
tense (squeeze your body together).
Invite her to colouring – painting – do arts & crafts – jumping from
one wooden table to the next while being in the playground – play
outside with sand – building the alphabet or counting up to
hundreds (gives her different options and activities on things that
she likes) to prevent the behaviour from escalating.

Stage 2: Defensive (Beginning stages Directive:

of the loss of rational control)

She turns on the EA or the teacher Guiding her by placing teacher’s arms under her armpits.
Observed Behaviour:
Describe what you see/hear at each of
the following stages.
classroom or anyone else in the area.
When she is in an unstructured play
time outside and she wants something,
she takes it forcefully from another
person.
Stage 3: Acting Out (Unsafe
behaviour)
She will scream – hit – kick - cry –
punch – push no matter if it’s another
adult or a peer.
Harmed peers or adults (being
aggressive).
Stage 4: Tension Reduction (How to
rebuild rapport)
Offer her back to be rubbed (deep
pressure).
Gets her weighted vest put on her.
Staff Response:
Describe appropriate staff responses at each stage.
*Refer to your class notes/PPT for suggestions.
Requires constant and consistent support when turn taking is
required.
The EA takes the item that she wants out of her hands and gives
it back to the peer and tells her “That is not what we do”.
Non-violent Physical Crisis How to Summon
Intervention: Based on the student’s Immediate
file, or previous experience with the Assistance:
student, what can you do and what do
you need to avoid doing? Calling assistance by
classroom phone or
Guiding her from the situation and walkie-talkie.
bringing her inside.
She is put on a time out.
Therapeutic Rapport: Reduction (Re-establishing Rapport and
Debriefing Staff Interventions)
Uses sensory bins (sand-rice-water table with soap-sensory
path).
Making a calming and safe zone in the back of the classroom.
Reflection on what happened: “What happened? How do you feel
about this situation? How do you think the other feel? What can
we do to make it better? (offers options)”
Put in her desk a Social Script:
“When I am frustrated…
Independent: I can walk away or ignore
Semi-Independent: I can ask for a break
Rely on others: I can find an adult to ask for help!
Catch her being good and praise the expected behaviour.
Use some or all (depending on the case) of the strategies from
DR. MTCH PPP:
Observed Behaviour: Staff Response:
Describe what you see/hear at each of Describe appropriate staff responses at each stage.
the following stages. *Refer to your class notes/PPT for suggestions.

Directive Statement
Redirect

Manage environment
Time away and space
Caring gesture
Hurdle help

Proximity
Planned ignoring / positive attention
Prompting

Authors of Report:
Andrea Castaneda & Miguelina Bisono.