Note: Numbers correspond with the scoring system on the BIP Quality Evaluation Guide
This form
CO NFI DE NTI A L – DO NO T DIS P L AY
B E H AV I O R I N T E RV E N T I O N P L A N
For Behavior Interfering with Student’s Learning or the Learning of His/Her Peers
This BIP attaches to: IEP date: 504 plan date: Team meeting date: 07/13/17
Student Name John Hamilton Today’s Date 07/13/17 Next Review Date
1. The behavior impeding learning is (describe what it looks like) Refusal to do school work.
2. It impedes learning because not engaged in academic activities.
3. The need for a Behavior Intervention Plan early stage intervention moderate serious extreme
4. Frequency or intensity or duration of behavior Many times daily in math and language arts.
reported by Team and/or observed by Shawn Stewart, Mary Hudson
PREVENTION PART I: ENVIRONMENTAL FACTORS AND NECESSARY CHANGES
What are the predictors for the behavior? (Situations in which the behavior is likely to occur: people, time, place, subject, etc.)
Observation &
5. In math and language arts classes.
What supports the student using the problem behavior? (What is missing in the environment/curriculum or what is in the
Analysis
environment curriculum that needs changing?)
6. Other students, phone and headphones. Disengaging curriculum.
Remove student’s need to use the problem behavior-----
Intervention
What environmental changes, structure and supports are needed to remove the student’s need to use this behavior?
(Changes in Time/Space/Materials/Interactions to remove likelihood of behavior)
7. Allow 5 minutes of music to every 25 minutes of engaging curriculum.
Who will establish? Math and Language Arts Teachers Who will monitor? " " Frequency? Daily
ALTERNATIVES PART II: FUNCTIONAL FACTORS AND NEW BEHAVIORS TO TEACH AND SUPPORT
Team believes the behavior occurs because: (Function of behavior in terms of getting, protest, or avoiding something)
Observation &
8. Avoidance.
Accept a replacement behavior that meets same need-----
Analysis
What team believes the student should do INSTEAD of the problem behavior? (How should the student escape/protest/
avoid or get his/her need met in an acceptable way?)
9. Allow 5 minutes of music to every 25 minutes of work.
What teaching Strategies/Necessary Curriculum/Materials are needed? (List successive teaching steps for student to learn
Intervention
replacement behavior/s)
10. Direct instruction, multi sensory instruction, consistant procedures.
Who will establish? Teachers Who will monitor? " " Frequency? Daily
Intervention
What are reinforcement procedures to use for establishing, maintaining, and generalizing the replacement behavior(s)?
11. Listening to music.
Selection of reinforcer based on: student interest
reinforcer for using replacement behavior reinforcer for general increase in positive behaviors
By whom? Teachers Frequency? Daily
Diana Browning Wright, Behavior/Discipline Trainings 1
For the electronic expandable version, see www.pent.ca.gov/forms.htm.
EFFECTIVE REACTION PART III: REACTIVE STRATEGIES
What strategies will be employed if the problem behavior occurs again?
12.
1. Prompt student to switch to the replacement behavior when trigger is recognized.
2. Describe how staff should handle the problem behavior if it occurs again Staff shold be consistent in enforcing behaviors and
BIP.
3. Positive discussion with student after behavior ends Reminder of established procedures. Student survey.
Optional:
4. Any necessary further classroom or school consequences
Personnel?
OUTCOME PART IV: BEHAVIORAL GOALS
Behavioral Goal(s)
13.
Required: Functionally Equivalent Replacement Behavior (FERB) Goal
For the Instead of For the As
Will do X Under what At what
purpose of Z purpose of measured
By when Who behavior contingent level of
y behavior y by whom
(line 9) conditions proficiency
(line 8) (line 1) (line 8) and how
Beginning John Allow 5 Avoidance Refusal to Avoidance Each time he 4/5 times Math and
of 8th minutes of do school is observed to per week. Language
Grade music to work. be Arts
every 25 disengaged. teachers.
minutes of
work.
Option 1: Increase General Positive or Decrease Problem Behavior
Will do what, or At what level of Under what Measured by
By when Who
will NOT do what proficiency conditions whom and how
Beginning of 8th John Will not refuse to 4/5 times per During math and Math and
grade do school work. week. language arts Language Arts
classes. teachers.
Option 2: Increase General Positive or Decrease Problem Behavior
Will do what, or At what level of Under what Measured by
By when Who
will NOT do what proficiency conditions whom and how
The above behavioral goal(s) are to: Increase use of replacement behavior and may also include:
Reduce frequency of problem behavior Develop new general skills that remove student’s need to use the problem behavior
Observation and Analysis Conclusion:
Are curriculum accommodations or modifications also necessary? Where described: More engaging.............. yes no
Are environmental supports/changes necessary?................................................................................................. yes no
Is reinforcement of replacement behavior alone enough (no new teaching is necessary)?.................................. yes no
Are both teaching of new replacement behavior AND reinforcement needed?..................................................... yes no
This BIP to be coordinated with other agency’s service plans?............................................................................. yes no
Person responsible for contact between agencies ...................................................................................... yes no
Diana Browning Wright, Behavior/Discipline Trainings 2
For the electronic expandable version, see www.pent.ca.gov/forms.htm.
COMMUNICATION PART V: COMMUNICATION PROVISIONS
Manner and content of communication
14.
2. Under what
3. 6. How will this be
condition(s) 4. Expected
1. Who? Delivery 5. Content? two-way
(Contingent? Frequency?
Manner communication
Continuous?)
Math In their respective Verbal Daily Engaging with consistent Communication with
Teacher classroom. procedures. SPED teacher.
2. Under what
3. 6. How will this be
condition(s) 4. Expected
1. Who? Delivery 5. Content? two-way
(Contingent? Frequency?
Manner communication
Continuous?)
Languag In their respective Verbal Daily Engaging with consistent Communication with
e Arts classroom. Procedures. SPED teacher.
Teacher
2. Under what
3. 6. How will this be
condition(s) 4. Expected
1. Who? Delivery 5. Content? two-way
(Contingent? Frequency?
Manner communication
Continuous?)
PARTICIPATION PART VI: PARTICIPANTS IN PLAN DEVELOPMENT
Student
Parent/Guardian
Parent/Guardian
Educator and Title
Educator and Title
Educator and Title
Administrator
Other
Other
Diana Browning Wright, Behavior/Discipline Trainings 3
For the electronic expandable version, see www.pent.ca.gov/forms.htm.
