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Student Name: Student

Behavior Intervention Plan School: Stepping Stones Grade: 4 Date: 4/30/2013

Date of birth: 07/23/2002

Describe student’s strengths and when he is successful: Student is a very enjoyable student whom is has great physical athletic ability. Student has a great smile and is capable of doing well in all subject areas. Student loves working towards a goal. Student enjoys a routine and schedule and likes to be prompted of any change in his day. Student has made great gains in the area of reading fluency this year. He seems to enjoy reading. Student loves to play card games and play basketball in school. Student enjoys games on electronics such as computer, iPod or iPad. He also does very well when his academics is on a computer. Team members creating and implementing plan: Parent Parent School Staff County Court Services Special Education Coordinator –County Social Services – School Nurse Contacts for Pick-up 1. Parent #1 2. Parent #2

3. Social Worker 4. Family Member

MEDICAL INFORMATION: Student does have a prescription medication that will be take at 10:30 a.m. each day. Medical Condition: Mood disorder, Reactive Attachment Disorder, Fetal Alcohol Effects, Attention Deficit Hyperactive Disorder (ADHD). No Known Allergies. Current Medication: Focalin and Clonidine

Emergency Medication: Benadryl 25 mg once, if there is not an improvement in 20 minutes may repeat x1 for a total of 50mg.

Behavior Intervention Team: The team listed on this behavior plan will respond to Student’s behaviors. However, if deemed necessary any person from the program staff whom is CPI trained will assist with behaviors.

Starting Date: 4/30/2013 Review Date: 10/3/2013 Review Date: 11/20/2013 Review Date: Describe the specific results of intervention and any modifications needed: Date Results

Modifications (if needed)

1. 2.

A Behavior Intervention Plan is developed because Student has engaged in behaviors that result in intervention such as physical restraint and seclusion. Background data on the behavior: What is it; when does it occur, and what happened as a result of the behavior (list as many as applicable): When Then As a result (What’s happening in the (The problem behavior) (The function) environment at the time; antecedent)  Hunger  Work Refusal  Overwhelmed  Denial of preferred activity  Increased breathing  Agitation  Change in schedule  Pounding desk  Confusion  Change in staff  Pacing  Anxiety  transition  Swearing/profanity  Over-stimulated  Unclear expectations  Threatening  Angry  Missed Medication Dose  throwing items  Upset  Bothered by a specific  physical aggression  Escape of task or situation person/peer  Property Destruction  Unresolved conflict at home  unknown

3.

Prevent (Interventions) Intervention Type: communication with home/parents Schedule Timer 1:1 staff snack breaks

sensory/gross motor breaks

shortened school day Visual choice board of calming strategies

Teach Interventions Intervention Type: one to one time with staff (teacher/social worker/paraprofessional) Paraprofessional support direct instruction of friendship/social skills Student participates in outside therapy Breathe Relax App on the ipad/ipod Teach Student to appropriately request to leave the classroom and go the calming space Teach Student to appropriately request assistance with, or modification to, a difficult task Teach Student to appropriately request a snack Teach Student to participate in deep breathing exercises Teach Student to request sensory items/activities

Reinforce Interventions Intervention Type: Token Economy System (Bucks, School Store, and weekly activities) Earn MAG time Computer/iPod time Free time in gym or outside Free snack Play a game with staff

Comments

Positive verbal praise/feedback positive calls to mom or dad Student gets to call mom or dad

Specific Steps to Specific Steps to positively positively reinforce reinforce behavior behavior  Staff will give  Student will identify personal Student reminders issues and coping strategies throughout his day in his 1:1 individual time with and reinforce program staff. positive behaviors  Student will be reinforced as they occur. each class period with school bucks for appropriate class  Student will have a specific daily behavior. schedule that will  Student will have the include 30 minute opportunity to earn 10 bucks work periods and per day. 15 minute breaks.  Student will have the  A timer will be used opportunity to earn additional to help Student bucks throughout his day for predict transitions. his weekly behavior goals.  Consistent staffing  Student will be able to earn patterns will be end of the week activities. used throughout his  Student will be able to earn school day. MAG time and choice time for  Student will have a completing classwork within reduced school day given timelines. with a 1:00pm  Student will be able to save dismissal as up $200 school bucks to take afternoons have a staff out to lunch. historically been difficult for him.

Specific Steps

4. Responding to Problem Behavior-Describe the adult responses to challenging behavior. When Student ... Staff will... Refuses to work in the classroom Have Student to go to his own workspace without peers to complete his work. Mom will be notified via email or phone as soon as possible. Student will remain in his own space for the rest of the day. Refuses to work (while in his own working space) give 2 clear choices/expectations, give reminder of next break options Starts to talk off topic using inappropriate words Redirect, give 2 clear choices, give reminder of next break options, and the BIP team will be notified of current status. starts to use profanity or sexual comments Staff will redirect Student and offer a different activity, sensory option, gross motor option, snack, etc. Staff will set a timer for a 3 min. PTO. Call for BIP Team member to observe situation. The PRN will be administered and notify Staff will contact Parent to let her know that the PRN has been administered. starts to use verbal threats Call for additional staff to observe situation, The PRN will be administered (if it hasn’t already) and Staff will contact Parent to let her know that the PRN has been administered. Parent will come to school to help de-escalate or take Student home for the day. escalates or obsesses over any topic or situation Staff will be notified and call Parent to take Student home for the day. starts to get upset about a situation at school Staff will be notified. Parent will be called and notified of the situation. Staff will work to re-direct Student to another activity. does not want to transition to next activity Give clear choices, set a timer for 1 minute, and redirect Student to the next activity. uses verbal threats with “intent to harm” Mental Health Personnel in the building, will assess the mental health status. Parent will be called and County Crisis team will be called if mental health staff deem necessary. Mental health personnel may proceed with hospitalization. Use of direct profanity toward a staff or student. The PRN will be administered and notify Staff will contact Parent and she will (fucking bitch, racial slurs, etc.) come and pick up Student from school. Refusal of PRN Parent will be called and come and pick Student up from school. refuses to leave school with mom Student will refuse for up to 30 minutes and then an ambulance will be called. walks away from staff Follow Student, notify Staff whom will contact Parent to come to school and help de-escalate Student or take him home. refuses to eat a snack Staff will offer a variety of snacks, staff will offer juice or even a piece of candy. PHYSICAL rips up his work Work will be re-copied and completed during that work time the following day. throws things from his work space Call for additional assistance. Staff will observe and offer Student de-escalation choices (mat, quiet time, music, headphones) starts to bang the table Offer Student a 3 minute quiet break. starts to kick things Notify Staff, whom will contact Parent to come to school and help de-escalate Student or take him home.

throws things from around the room starts to inflict harm upon himself (Biting, throwing his body against the wall, etc.) RESTRAINT/SECLUSION Behaviors that result in CPI restraint Secluding for up to 45 minutes or when Parent arrives Two restraints before Parent is able to arrive; up to 4 minutes for each restraint. Student becomes a public safety concern

Notify Staff, whom will contact Parent to come to school and help de-escalate Student or take him home. The PRN will be administered and notify Staff will contact Parent and she will come and pick up Student from school. Parent will be contacted to come and pick up Student. The PRN will be administered. Ambulance will be called. The PRN will be administered. Ambulance will be called. Administrator will be called and make the final decision on involving the local authorities. The PRN will be administered. Parent will be called to come and pick up Student if that is an option.

5.

Measurement System: Describe what date will be collected when and by whom: Daily Behavior Charts Stepping Stones Staff

Medication Plan Emergency Medication: Benadryl 25 mg once, if there is not an improvement in 20 minutes may repeat x1 for a total of 50mg. Actions for the teacher to take: 1. 2. 3. 4. 5. 6. 7. Monitor Student’s behavior Notify school nurse ext: 8055 Notify Parent that medication will be administered; ask when the last Benadryl dose was given at home. Give Benadryl 25 mg- wait 20-25 minutes Administer 25mg again for a total of 50 mg. Monitor Student closely Parent will bring Student home Doctor:

Hospital: