Did the behavior intervention plan include at least one strategy that prevented the behavior from occurring by addressing the antecedent in the hypothesis? YES NO Was the prevention strategy written in sufficient detail so that another adult who was not at the meeting could implement the strategy? YES NO Did the behavior intervention plan include at least one strategy that taught the student a new, appropriate behavior that would replace the problem behavior? YES NO Was the replacement behavior strategy written in sufficient detail so that another adult who was not at the meeting could implement the strategy? YES NO Did the behavior intervention plan include at least one strategy that reinforced the replacement behavior and no longer reinforced the problem behavior, linking back to the consequences/function in the hypothesis? YES NO Was the reinforcement strategy written in sufficient detail so that another adult who was not at the meeting could implement the strategy? YES NO Did the teacher and the student (if applicable) come to consensus on the plan strategies? YES NO Did another school-based consultant/team member train the teacher and the student to do the plan? YES NO Was in-class support provided to the teacher after the plan began to be implemented? YES NO Was there a plan for collecting behavior plan implementation fidelity? YES NO Was there a follow-up meeting to review the fidelity and the data to determine whether the behavior plan was effective? YES NO
Step 1: Broad Goal-Setting Goals for: ____________________________ (Student’s Name) Behavioral Social Academic PTR Form 3b
Step 2: PTR Functional Behavior Assessment Summary Table: “Cheat Sheet” Student: ____________________________ School: ___________________________________ Date: _____________________ Behavior Prevent (Antecedent) Data Function (Teach) Data Consequences (Reinforce) Data Problem behavior Name of problem behavior Include information from the Prevent component of the PTR assessment (items #1a, 2a, 3a, 4, 5, 6) Include information from the Teach component of the PTR assessment (items #1 through #6) Include information from the Reinforce component of the PTR assessment (items #1 & 4) Appropriate behavior Name of pro-social or replacement behavior Include information from the Prevent component of the PTR assessment (items #1b, 2b, 3b) Include information from the IBRST or other sources that provide the replacement behaviors; (if student PTR used, items #7, 8, 9). Include information from the Reinforce component of the PTR assessment (items #2, 3, & 5) Possible Hypotheses When…. He/she will….. As a result, he/she …… Problem Behavior Include the relevant data from the problem behavior prevent data above Behavior being evaluated Function (from problem behavior teach data) Replacement Behavior Copy what you have in the row above (problem behavior when) Write in the new behavior/skill or, replacement behavior Copy what you have in the row above (problem behavior function).
Step 3: PTR Interventions Checklist-SECONDARY Version-Student Student: _________________ School: __________________ Date: _______ Behavior: _______________ Completed by: ________ Directions: Under each category, check 2-4 interventions you think would work and would be okay with you to try. Prevention Interventions Teaching Interventions (behaviors that will help you reach your goals) Reinforcement Interventions Given Choices **Replacement Behavior _______________________ **Reinforce Replacement Behavior Escape, avoid, delay Get attention, specific activity/item Helping with transitions between classes/activities Study Skills/Test-taking Strategies **Having the teacher not let me escape or get attention for my problem behavior Visual reminders/checklists Social Problem Solving Strategies Change tasks/activities to make less difficult, more interesting General Coping Strategies Get More Opportunities to Respond and Get Positive Comments Cognitive Behavior Therapy Whole Classroom Management Plan Learning Strategy Instruction Interventions that address the days that I come to school angry/unhappy because of things that have happened at home or with friends Self-Management Have more positive comments from your teacher(s) Basic Academic Skills Classmate Support/Cooperative Grouping Activities Specific Social Skills Training When you do (problem behavior) can it hurt you or others (teachers, classmates)? Yes No If yes, do you need a crisis management plan? Yes No
3. Yes No 4. Yes No 5. Yes No 6. Yes No REINFORCE Component 1. Yes No 2. Yes No 3. Yes No 4. Yes No 5. Yes No 6. Yes No TOTAL (# Yes / # Total) Percent Score Step 3: PTR Plan Assessment (Fidelity)—Example Teacher: Student: Date: Observation Self-Assessment Interventions PREVENT Implemented Impact (1 = no impact; 5 = great impact) Transition Supports—visual checklist Visual checklist provided to Isaiah Choice of reinforcement presented and described on checklist Y / N / NA Y / N / NA 1 2 3 4 5 TEACH Replacement behavior—academic engagement Checklist reviewed during study skills class Goal set Gave 1 minute at end of class for Isaiah to self-assess Reviewed Isaiah’s self-assessment and gave feedback Replacement behavior—escape by asking to be excused Prior to non-preferred activity, provided a verbal prompt/cue to remind Isaiah that he can ask to be excused. Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA 1 2 3 4 5 1 2 3 4 5 REINFORCE Reinforce academic engagement Presented choice reinforcement menu to Isaiah when goal met Y / N / NA 1 2 3 4 5