Behavior Intervention Plan Form
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1BEHAVIOR INTERVENTION PLAN
Student Information:
Name:
Date:
School:
Grade:
BIP Report By:
Problem Behavior:
Inappropriate behavior(s)
Replacement Behavior:
What is expected of
the student?
⟡ direct instruction, by: ______________
⟡ social skills training, by: _______________
Method of Teaching
Replacement Behavior
⟡ anger management, by: ____________
⟡ providing cues, by: _______________
and By Whom:
⟡ role playing, by: __________________
⟡ modeling, by: _______________
How will we teach the
⟡ behavior contract, by: ______________
⟡ stress management, by: _____________
desired behavior and who
⟡ decision-making lesson, by: _________
⟡ use of mentor(s), by: _______________
will teach it?
⟡ other __________________________________________, by: __________________
Accommodations to assist the student in displaying the replacement behavior:
Accommodations,
⟡ clear, concise directions
⟡ supervise free time
Interventions, and
Who’s Responsible for
⟡ frequent reminders/prompts
⟡ avoid strong criticism
Them:
⟡ frequent breaks/vary activities
⟡ predictable, routine schedule
What help will we give
⟡ teacher/staff proximity
⟡ specified study area
the student to help him/her
⟡ reprimand the student privately
⟡ preferential seating
succeed?
⟡ modify assignments
⟡ avoid power struggles
⟡ review rules & expectations
⟡ specifically define limits
It is VERY important that
⟡ provide alternate recess
⟡ avoid physical contact
these accommodations
⟡ provide cooling off period
⟡ provide highly-structured setting
and/or recommendations
⟡ communicate regularly with parents
⟡ other _____________________
be followed consistently
by teacher(s), aides, and
Interventions & Who’s Responsible for Them:
school staff.
1.
2.
3.
4.
⟡ direct observation
⟡ daily behavior sheet
⟡ weekly behavior sheet
Method of Measuring
Progress: How will we
⟡ charting/graphing
⟡ self-monitoring
⟡ number of discipline referrals
know if it’s working or not?
⟡ other: ___________
Length of behavior plan ⟡ one week
⟡ two weeks
⟡ other: ___________
⟡ verbal praise
⟡ immediate feedback
⟡ computer time
Positive Consequences
⟡ earned privileges
⟡ earned tokens/points
⟡ positive call or note home
for Appropriate Behavior
What can the student
⟡ tangible rewards
⟡ free time
⟡ positive visit to office
earn?
⟡ other _________________________________
⟡ loss of points/tokens
⟡ loss of privileges
⟡ time out
Negative Consequences
for Inappropriate
⟡ phone call home
⟡ work detail
⟡ detention
Behavior: What happens
⟡ send to office
⟡ in-school suspension
⟡ out-of-school suspension
if student does not be-
⟡ escort to another area
⟡ other _____________________________________
have?
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