Form Bip
Form Bip
(Optional Form)
Student ID:
Date of Implementation: 4/
16/15
District Name
Grade: 5th
Sources of Information:
List sources of information used in the FBA, both formal and informal, to develop this plan.
Donalds IEP and teacher comments/concerns were used to help create the FBA. Furthermore, whole interval recording,
data collection, was beneficial in creating Donalds FBA.
Strength Based Profile
Identify skills and interests, positive relationships, pro-social behaviors, family and community supports.
Donald is interested in all types of games. He enjoys video games and playing out doors. He also likes candy and
receiving recognition for his accomplishments. He has a strong relationship with Mrs. Schlanser, the special education
teacher, and his speech teacher. Donald interacts well with his classmates and has many friends. At home his older sister
helps him with his homework.
Functional Behavioral Assessment (FBA) Summary Statement
Describe the specific problem behavior as outlined on the FBA and create a hypothesis/summary statement about the specific behavior utilizing the
information on the FBA.
Donald engages in the off task behavior of starring around the room and talking to a neighbor when reading demands are
placed on him. This off task behavior occurs in multiple classroom settings, but can prodominately be seen in his
Language Arts class because that is when the most reading demands are placed on him. Donald is off task seventeen
minutes of the forty-five minute class. He engages in these off task behaviors to avoid work because it is above his
reading level, therefore he engages in these behaviors to pass time until a teacher is able to make themselves available
to him. The teachers respond to Donald by saying he needs to raise his hand to ask for assistance. Donald has been
doing this more, but the teachers have to assist others before they can sit with Donald and help him.
BIP Strategies/Outcomes Worksheet
Based on hypothesis, in the table below, identify the strategy, what will be done, when and where the strategy will occur.
Setting Event Strategies
(reducing impact of setting events)
Antecedent Strategies
(decreased likelihood that behavior will
occur)
Reinforcement Strategies
[Consequence]
(when student demonstrates the desired
behavior, the need behind the behavior is
met.
The behavior occurs in multiple settings, but primarily in his Language Arts
class because that is when the most reading demands are placed on him.
When reading demands are placed on Donald the behavior occurs because the
work is above his level. To prevent the behavior from occuring longer stories
can be read aloud, or simplier versions of the story can be given to Donald with
key points highligted. Furthermore, positive behavior supports can be put in
place. If Donald is on task for 15 minutes he will earn a ticket and get a two
minute break. Tickets can be traded in on Fridays for a treasure chest prize.
The replacement behavior will be for Donald to increase his ORF by focusing on
phonemic awareness, word reading, sight words and letter-sound so he
becomes a more capable reader. Which inturn will help ensure Donald is on
task more; therefore, his off-task behavior will decrease. Voyager is an evidence
based reading program that will help ensure his success.
To reinforce the desired behavior Donald will receive a ticket for every fifteenminutes he is on task. Furthermore, he will be rewarded a two-minute break,
from reading, where he can engage in video games, on the classroom IPad. As
time goes on, we will build Donald's stamina by saying after twenty-minutes of
work you may receive your ticket and a two-minute break. This will continue
until we are able to fade out the reinforcements.
Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.
Page 1
District Name
Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.
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District Name
Person responsible:
Date/Frequency:
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.
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Print Name
Parent provided a copy of plan
District Name
Other
Signature
Instructions:
What are behavior intervention plans?
Behavior intervention plans are teaching tools.
There are four areas of focus in a behavior intervention plan: (1) Adjustment of environmental factors; (2) Decrease of
interfering behaviors; (3) Acquisition of replacement behaviors; and (4) Strengthen existing skills. All behavior
intervention plans should include proactive approaches to changing behavior. The purpose of a behavior intervention
plan is to ensure the environment is conducive to learning and to teach the student what to do instead.
The design of behavior intervention plans leads to positive outcomes for students.
The behavior intervention plan is developed as a means of coordinating intervention activities. Discipline, when used as
a proactive approach in the behavior intervention planning process, addresses the cause of the behavior and helps to
create a safe, positive learning environment for all. Effective discipline provides appropriate logical consequences for
behavior and results in long-term positive behavioral changes. Discipline does not focus on the behavior in isolation or
quick fixes. Rather, it is a learning process that provides the child with an opportunity to learn new skills so that he/she
can be an effective student.
The behavior intervention planning process is a collaborative problem solving approach involving all
stakeholders.
A behavior intervention plan serves as a communication tool developed by a team that is made up of stakeholders.
Stakeholders, as used in this context, may mean the student, the parents/family members, general and special educators
who work with the student, peers, a key administrator and support service providers who may provide support services.
These individuals know the student best and are essential to behavior planning.
How should the functional behavioral assessment be conducted in the behavior intervention planning process?
Functional behavioral assessment is a collaborative problem-solving process that is used to describe the function or
purpose that is served by a students behavior. Understanding the function that an impending behavior serves for the
student assists directly in designing educational programs and developing behavior plans with a high likelihood of
success.
The collaborative problem-solving process is the foundation for many team processes in education including the IEP
planning process, functional behavior assessment, behavior intervention planning process and intervention-based
assessment.
The following sections outline a systematic collaborative problem solving process to guide behavior intervention planning,
either as a component of the IEP or as an intervention plan for a student with or without a disability.
Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.
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