5. Is the problem behavior exhibited in order to avoid or escape a non-preferred (difficult, boring, repetitive) task or activity? Yes No If yes, specify: 6. Is the problem behavior exhibited in order to avoid or escape a non-preferred classmate or adult? (e.g., teacher, instructional assistant, coach) Please remember not to specify names. Yes No If yes, specify: 7. Is the problem behavior exhibited in order to obtain or gain sensory stimulation? Yes No If yes, specify: 8. Is the problem behavior exhibited in order to avoid or escape sensory stimulation? ___ Yes ___ No If yes, specify: Hypothesis Antecedent: Summarize items marked in Antecedent section 1-7. Problem Behavior: Copy and paste from Problem Behavior section 1. Consequence: Summarize items marked in Consequences section 8. Replacement Behavior: The replacement behavior developed must allow the student to achieve the same function as the problem behavior (e.g. escape, gain attention, etc.) 1. Antecedent 2. Problem behavior 3. Consequence 4. Replacement Behavior When… Ex: When Johnny is denied access to a preferred item… The student will… Ex: Johnny will repeatedly bang his head on the floor and scratch his face leaving red marks In order to… Ex: Obtain preferred object from adult or peer Instead, the student will … Ex. Johnny will verbally express his or needs for an item. Behavior Intervention Plan Demographics Student name: ID#: School: DOB: Plan date: Implementation date: Revision date: Discontinued date: Does the student’s problem behavior require implementation of a Crisis Plan? Yes No If the team indicates a Crisis Plan is needed, develop a plan on the Crisis Plan form. Intervention Data Collection 1. What social skills(s) could the student learn in order to reduce the probability of the problem behavior occurring in the future? Accepting a compliment Joint or shared attention Play skills Adult interaction skills Listening Skills Sharing attention Conversation skills Losing gracefully Sharing objects Gaining attention appropriately Making pro-social statements Taking turns Giving a compliment Peer interaction Other: 2. What problem-solving skill(s) could the student learn in order to reduce the probability of the problem behavior occurring in the future? Accepting consequences Ignoring peers Self-control / management Asking for help Goal setting Conflict resolution Making Choices Organizational skills Working independently Perspective-taking Staying engaged Working with a peer Cause & effect
Who is responsible? Teacher, instructional assistant When will it occur? Whenever student attempts to take a or leave the class without permission 3. Redirect student to a neutral task 4. When the student has worked for 1 minute without exhibiting the head banging behavior, prompt the student to request desired item and then provide it Consequence Intervention # 1 What will be done? Who is responsible? When will it occur? Task Analyses/List each individual step of the consequence intervention: 1. 2. 3. 4. 5. 6. Consequence Intervention # 2 What will be done? Who is responsible? When will it occur? Task Analyses/List each individual step of the consequence intervention: 1. 2. 3. 4. 5. 6. Develop a plan to collect data on the interventions To assess the effectiveness of the BIP, data on the replacement behavior and problem behavior are required. This plan to collect the data should include both types of data collection. What will be done? Who is responsible? When will it occur? (Include date) How will support be provided to the teacher/staff? Fidelity Plan Develop a plan to assess the fidelity of the BIP implementation. Set a date within four weeks for the team to meet and review the fidelity of implementation and data collected. What will be done? Who is responsible? When will it occur? (Include date) How will support be provided? Fidelity Observation Directions: Use the task analysis for each of the interventions listed above to complete the chart below. During the fidelity check observation (the person implementing the plan should not be conducting their own fidelity check), use the chart to determine if each step of the intervention was implemented as planned. If additional steps are needed, please add additional rows to the chart. Date of observation: Task Analysis Did the implementer complete the step? Task Analysis Did the implementer complete the step? Antecedent Intervention #1 Antecedent Intervention #2 1. Yes No 1. Yes No 2. Yes No 2. Yes No 3. Yes No 3. Yes No 4. Yes No 4. Yes No 5. Yes No 5. Yes No 6. Yes No 6. Yes No Teaching Intervention # 1 Teaching Intervention # 2 1. Yes No 1. Yes No 2. Yes No 2. Yes No 3. Yes No 3. Yes No