BEHAVIOR SUPPORT PLAN
for Behavior Interfering with Learning of Student or Peers
Behavior impeding learning is Student X is bothering other students, including saying inappropriate things, and making physical contact (hitting and poking others) inappropriately, medical irresponsibility, not arriving to class on time, inability to read socio-emotional cues
It impedes learning because Student X and those he is bothering are unable to complete their assignments in class.
Team estimate of need for behavior plan: (write plan date in space)
MM/DD/YY extreme _____serious ______moderate ____needing attention, early stage intervention
Current Frequency/Intensity/Duration of Behavior various throughout the week
Any current predictors for behavior? Student X turning around in his seat, talking to students when he should be working (for example: turning to another student and saying "Hush up."
Team believes behavior occurs because (team hypothesis-behavior function) Student X has been diagnosed ADHD, and part of his behavior is a result of this. He has also been diagnosed as bi-polar, and this may contribute to his behavior as well. Also, Student X is diabetic and his blood sugar levels fluctuate which affects his behavior.
What team believes student should do instead of this behavior (match to hypothesis) Student X should follow his teachers' directions
Behavior Goals/Objectives related to this plan: Student X will: (1) not say inappropriate things to other students, and (2) not poke or touch other students (3) use only timed hall passes with an escort when out of class
Teaching strategies and necessary curriculum or materials for new behavior instruction
(1) Time-out seat for times that Student X is especially fidgety.
(2) Seat change away from students that he has histories with of inappropriate behavior.
(3) Laminated reminder card:
Front side:
(1) stop--> what you're doing;
(2) think--> about what's happening; are they smiling?
(3) act--> let it go -or- approach an adult
Back side:
Appropriate
- let it go and let an adult know; move if necessary
- "Please be quiet"; "Please don't talk to me"; "Please don't bother me."
- Notify teachers of where you need to go and use hall passes with an escort
Inappropriate
- poking or bothering other students
- saying "Shut up"
- not being where you're supposed to be
(4) Concrete emotional messages. For example: "I am not happy that you."; "I am happy that you."
(5) Nurse's notes with explicit directions regarding snacks, etc.
(6) Frequent checks for understanding and for attitude of Student X.
(7) Diary for Student X to write his stories in, to write in when he is frustrated, to chart his visits to the school nurse, nurse (and teacher) / parent communication
(8) Permission by mother to check Student X'sbackpack, due to Student X's previous possession of sodas in his backpack.
By Whom? Teachers and Student X
How Frequent? As needed
Environmental structure and supports to be provided (time/space/materials/interactions)
Modified day: (1) Drop P.E. (which is Period 1); report to Teacher A for this class and work on other classwork. (2) For Wednesday Period 5 and Thursday Period 3, Student X to check in with Teacher A in the morning; Teacher A will assess whether Student X remains with her or attends class
--Permanent pass for Student X to see school nurse before lunch.
--Time-out seats in each class
Who establishes? Nurse, Vice-Principal, Teamleader, Mother, Student X
Who monitors? Teachers and Student X
Reinforcement procedures
(1) Verbal praises
(2) Make contact with Student X daily. For example: "How are you today, Student X?"
By Whom? Teachers
How Frequent? Daily
How to respond or react if behavior occurs again
--Verbal reminder of behavior and to look at laminated card.
--Move Student X to a seat away from those he is having difficulties with (time-out)
--(2a) Time out in class
--(2b) Time out to Nurse, and contact mother.
--Detention
--Referral to team leader
--Referral to vice-principal, with possibility of suspension and expulsion
Process for communicating student progress to parents/student and reviewing this behavior plan(Daily/weekly reports/record keeping)
--Keep log of detentions and referrals assigned to Student X (individual who assigns consequence)
--Checklist at village meetings of his behaviors (see attached)
Parent signature __________________________ Student signature ______________________
Team leader _______________________________ Administrator _________________________
Other team members present__________________________________________________________
form revised 9/21/00
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Weekly Behavior Checklist For Student X
Rate the student in the areas below in the following scale:
Excellent =4, Good = 3, Fair = 2, Poor = 0.
Detention = D, Time-out = T, Referral = R
Week of ____________ Class Period...
1 2 3 4 5 6
DESIRED BEHAVIORS
(1) Let it go and ____ _____ _____ _____ _____ _____
let an adult know;
move if necessary.
(2) Use appropriate words ____ _____ _____ _____ _____ _____
(3) Notify teachers of
whereabouts and use ____ _____ _____ _____ _____ _____
timed hall passes.