POSITIVE SUPPORT PLAN



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Clare-Gladwin RESD

BEHAVIOR INTERVENTION PLAN

|NAME: |SCHOOL: |

|BIRTH DATE: |GRADE: |

|DATE INTIATED: |TEACHER: |

|DATE REVISED: |BLDG: |

|ELIGIBILITY: |DATE OF LAST IEP: |

List at Least Three Positive Things Student is Able to do or Student Strengths:

(Should be behaviors that the student is able to engage in on their own)

1.

2.

3.

Target Behaviors:

(List up to 3 behaviors)

1.

2.

3.

Team Consensus of the Function(s) of the Target Behavior(s):

(Escape, Avoid, Attention Seeking, Power & Control, or a combination. Usually difficult behaviors occur when the needs are not met)

Goals:

(Stated in positive terms – What do you want the student to do?)

1.

2.

3.

Positive Behavior Intervention Strategies:

(List of pro-active strategies you will use with the student. It can be related to environment, social psychological or biological situations.

Instructional Strategies:

(What skills will the student need to be taught in order to successfully demonstrate the goal behavior.)

Parent and/or Outside Agency Input:

(Make sure you have parent input in putting the plan together. If the student is involved with an outside agency, get input from these professionals.)

Pre-Crisis Plan:

(What is it that the staff will do when the student appears to be going into crisis?)

Crisis Intervention Plan:

(What will you do when the student goes into or gives indication that he is going into crisis?)

Reward Schedule:

(What is the payoff for the student when they get it right? How will the student’s behavior be monitored? Who is responsible to deliver the reinforcement?

Consequence for Continuation of Inappropriate Behavior:

(Student calls home, time outs, loss of goals toward reward, have to review PBIP and develop a plan, 1. Name the behavior 2. What will change next time? 3. Identify what lead up to the incident and how that will change. 4. Be willing to apologize or have the person accept the plan.)

Implementation and Monitoring System

Data Collection:

(How will data be collected to determine effectiveness of the plan? Who will collect it? Frequency of data collection? Who will monitor and evaluate the data collected?)

Date for Review of Plan: ____________________________________

My signature indicates that I was present at the discussion of the Behavior Plan and understand what was discussed.

|Student: |_____________________________ |Teacher: |_____________________________ |

| |_____________________________ |Principal: |_____________________________ |

|Parent: | | | |

| |_____________________________ |Other: |_____________________________ |

|Other: | | | |

| |_____________________________ |Other: |_____________________________ |

|Other: | | | |

| | | | |

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