Functional Behavioral Assessment – Behavior Intervention Plan (FBA

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Functional Behavioral Assessment – Behavior Intervention Plan (FBA Powered By Docstoc
					                                                             Glynn County School System
                                                                 Brunswick, Georgia

                                    Functional Behavioral Assessment – Behavior Intervention Plan (FBA/BIP)


 Student                                                   School                                  Grade               Date of Plan

    Parent Present                Student Present                                                  Review BIP no Later Than

Information Obtained from FBA                                                Intervention Plan
I. Target Behavior #                                                         III. Replacement Behavior (desired outcome)




II. A. Environmental Conditions That Affect Behavior                         IV. Proactive Positive Interventions (may include antecedent and/or
                                                                                 instructional modifications, and all other relevant interventions.)
   Physical Setting:
                                                                                Teacher will…

   Time of Day/Day of Week:


   Persons Involved (audience, peers, authority):                            V. Reinforcers (What will maintain the replacement behavior (payoff)? (ex.
                                                                                Rewards, privileges, token economy, checksheet)


B. Additional Factors Impacting Behaviors: (health, tired, pain,
  sensory issues, meds, no meds, etc.)




C. Observed Antecedent(s): (What triggers the behavior?)




D. Determined Function of Target Behavior: (What is maintaining the
   behavior (payoff)?
                                                                   Glynn County School System
                                                                       Brunswick, Georgia

                                               Other Considerations for the Behavior Intervention Plan (BIP)

VI.     Consequences for the reoccurrence of the Target Behavior (undesirable behavior):




VII.    Is the STAR program an appropriate intervention for this student?                       yes              no
        Rationale for this decision:




VIII.   Crisis Plan:
        Describe in detail the specific plan for crisis intervention for this student. Include the position (not names) of personnel responsible for implementing this
        plan. (Note: If the student transfers to another school, this plan must be reviewed and updated to correlate with the structure of the new school setting:
        i.e. determining the new personnel to be involved, new locations for intervention to occur, etc.)




IX.     Action Plan:
        BIP to be reviewed no later than:
        (This section may include any unusual circumstances or responsibilities for actions to be taken by teachers or parents prior to the review date.)