Worksheet #1



Worksheet #1

Summary Statement

Antecedent Behavior Consequence

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Behavior Support Strategies

|Prevention |Teaching |Reinforcing appropriate behavior |

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| | |Minimizing reinforcement for problem |

| | |behavior |

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Worksheet #2

Summary Statement

Antecedent Behavior Consequence

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| | | |

| | | |

| | | |

Behavior Support Strategies

|Prevention |Teaching |Reinforcing appropriate behavior |

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| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |Minimizing reinforcement for problem |

| | |behavior |

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Worksheet #3

Summary Statement

Antecedent Behavior Consequence

| | | |

| | | |

| | | |

| | | |

Behavior Support Strategies

|Prevention |Teaching |Reinforcing appropriate behavior |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |Minimizing reinforcement for problem |

| | |behavior |

| | | |

| | | |

| | | |

| | | |

| | | |

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|Critical Elements of the |No |Yes |

|Behavior Support Plan | | |

|Operational description of problem behavior |0 |1 |

|Identification of the antecedent(s) to problem behavior |0 |1 |

|Identification of the consequence(s) to problem behavior |0 |1 |

|Identification of the function of the problem behavior |0 |1 |

|Statement about the relation between the FBA and BSP (summary statement) |0 |1 |

|Strategies for preventing the problem behavior(s) from occurring |0 |1 |

|Instructional strategies for teaching “alternative” behaviors/routines |0 |1 |

|Strategies for minimizing rewards for problem behaviors |0 |1 |

|Strategies planned for reinforcing desired behavior(s) |0 |1 |

|The person(s) responsible for the implementation of each intervention has been identified. |0 |1 |

|Documentation of a formal and regular (at least twice a month) system for assessing the fidelity with which the plan|0 |1 |

|has been implemented is clear. | | |

|Documentation of a formal and regular (at least twice a month) system for assessing the impact of the plan on |0 |1 |

|student outcomes is clear. | | |

|Technical adequacy score for this behavior support plan |/ 19 |

|Note: Is the child’s problem behavior dangerous or severe enough to warrant a crisis plan? If so, the behavior | |

|support plan must include documented procedures for such an event. If applicable, please evaluate the plan for this| |

|additional feature. | |

|Documentation of safety/crisis procedures |0 |1 |

|Technical adequacy score for a behavior support plan in need of a crisis plan |/ 20 |

BEHAVIOR SUPPORT PLAN SCORING GUIDE

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