Note: Numbers correspond with the scoring system on the BIP Quality Evaluation Guide

This form
CO NFI DE NTI A L DO NOT DIS P LAY

B E H AVI O R I N T E R VE N T I O N P L AN
For Behavior Interfering with Students Learning or the Learning of His/Her Peers

This BIP attaches to: IEP date: 504 plan date: Team meeting date:

Student Name John Hamilton Todays Date 12/9/16 Next Review Date 12/9/17
1. The behavior impeding learning is (describe what it looks like) Verbal outbursts and academic refusal
2. It impedes learning because He loses 30% of academic instruction in 60 days
3. The need for a Behavior Intervention Plan early stage intervention moderate serious extreme
4. Frequency or intensity or duration of behavior Daily
reported by Donna Barry and/or observed by Lana Sorenson

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. At school, specifically math and language arts class

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. Getting out of class/ assignemnts for giving beavior

Remove students need to use the problem behavior-----

Intervention

What environmental changes, structure and supports are needed to remove the students need to use this behavior?
(Changes in Time/Space/Materials/Interactions to remove likelihood of behavior)
7. Academic responsibilities
Who will establish? Lana Sorenson Who will monitor? Lana Sorenson 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. He has no known friends, and refusses authority

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. Leave for 5 minute increments and return to classroom

What teaching Strategies/Necessary Curriculum/Materials are needed? (List successive teaching steps for student to learn
Intervention

replacement behavior/s)
10. Self regulation
Leaving when feeling triggered

Who will establish? Lana Sorenson Who will monitor? Lana Sorenson Frequency? Daily
Intervention

What are reinforcement procedures to use for establishing, maintaining, and generalizing the replacement behavior(s)?
11. Positive reinforcement when he comes to class, and removes headphones upon arival. Positive reinforcement will
be set amount of time to listen to his music.

Selection of reinforcer based on:

reinforcer for using replacement behavior reinforcer for general increase in positive behaviors
By whom? Lana Sorenson 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 I can see that you are upset. Would you like to take a 5 minute cool
down session?
2. Describe how staff should handle the problem behavior if it occurs again Encourage him to move to the hall to do a 5 minute
cool down session.
3. Positive discussion with student after behavior ends I know that you were frustrated with the assignement that you received
in class. Can you please tell me what made you upset with this assissnment? What can you do next time you are upset?
Optional:
4. Any necessary further classroom or school consequences
Personnel? Donna Berry and Lana Sorenson

OUTCOME PART IV: BEHAVIORAL GOALS

Behavioral Goal(s)
13.
Required: Functionally Equivalent Replacement Behavior (FERB) Goal
For the For the As
Will do X Instead of Z Under what At what
By purpose of purpose of measured
Who behavior behavior contingent level of
when y y by whom
(line 9) (line 1) conditions proficiency
(line 8) (line 8) and how
12- IEP Complete He has no Verbal He has no He exhibits He will Lana
09-16 Team classwork with known outbursts known these work 7 Sorenson
no verbal friends, and and friends, and behaviors in out of 10
outburst within refuses academic refuses language arts
general authority refusal authority or math class
education
classroom.

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

12-09-17 John Hamilton Increase his time 75% of the time John will stay Lanna Sorenson
in the classroom seated in the daily
classroom

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

12-09-17 John Hamilton Remove himself 75% of the time John will keep Lanna Sorenson
when feeling comments to Dialy
triggered himself

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 students need to use the problem behavior

Observation and Analysis Conclusion:

Are curriculum accommodations or modifications also necessary? Where described: .............................. yes no
Are environmental supports/changes necessary?................................................................................................. yes no
Is reinforcement of replacement behavior alone enough (no new teaching is necessary)?.................................. yes no
Diana Browning Wright, Behavior/Discipline Trainings 2
For the electronic expandable version, see www.pent.ca.gov/forms.htm.
 Are both teaching of new replacement behavior AND reinforcement needed?..................................................... yes no
This BIP to be coordinated with other agencys service plans?............................................................................. yes no
Person responsible for contact between agencies ...................................................................................... yes no

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?)

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?)

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.