Student

NK
Age
12
Sex
Male
Teacher(s)
Maddy Smith
Grade
7th grader
Reason for intervention plan:
When denied access to a preferred action or event Nate will become increasingly frustrated and
exhibit behaviors such as ripping, kicking objects, pushing objects, yelling and self harm.
For example when Nate is denied access to being first in line he will push kids and yell at them.
When Nate wants to do a preferred activity (example draw a picture in art class when class should be
listening to instruction), Nate will start ripping paper, cutting paper, throwing things.
When Nate does not want to participate in class he will leave learning area and do the following;
climb up on chin up bar and push ceiling tiles, get scissors and cut pants, shoe laces ect, put scissors
up to face/tongue. When attention is doing given for redirection Nate will start attention seeking
behavior of yelling out or making noises.

Participants (specify names):

() student_________________________
( ) family member _________________
( x) special educator_________________
( ) general educator ________________
( ) peer(s) ________________________

( ) special education administrator____________

( ) general education administrator ___________
( ) school psychologist_____________________
( ) other agency personnel_________________

( ) other (specify)
Fact Finding
1. General learning environment:
Describe the
students school class schedule, including any

special programs or services. The student is a seventh grader at Whitnall Middle School. Nate
is involved in general education science, and elective classes (Art and Phy Ed). He is in the
inclusive setting for core skills, math, language arts, support and life skills.
2. Problem behavior:
Define the problem
behavior(s) in observable, measurable, and countable

terms (i.e., topography, event, duration, seriousness, and/or intensity). Include several
examples of the behavior.
When denied access to a preferred action or event Nate will become increasingly
frustrated and exhibit behaviors such as ripping, kicking objects, pushing objects, yelling and
self harm. Behavior will start by student putting head down or continuing an activity when
directed to transition. When engaged by an adult or peer, the student will turn away, start to
tear paper, or leave learning environment to continue prefered task. If student does not get

attention from peers or adults, Nate will start to make noise or present unsafe behavior (roll
back in chair). Behavior outbursts can last anywhere from 5 - 45 minutes depending on what
behavior student in engaged in.

3. Setting events:
Describe
important things that are happening in the students life that may be

causing the behavior(s) of concern.

Nate is a new student to Whitnall Middle School. His mother has shared that they
moved to the district because of an eviction. Mom sights that Nates behavior is erratic and
unpredictable at home. Nates mom is continue to find balance in his medication routine, she
feels that more medication would decrease his outbursts, but his present doctors are
researching alternatives.
4. Review existing data:
Summarize previously collected information (records review,
interviews, observations, and test results) relevant to the behavior(s). Attach additional sheets
if necessary.
- observation
- communication with regular education teachers
- communication with support staff
- FBA profiler (2 teachers and parent)
- Doctors notes
Possible Explanations
5. Identify likely antecedents (precipitating events) to the behavior(s).
- Denied access to preferred objects
- Denied access to preferred events
- Activities that are not engaging
- When he feels he is being treated unfairly
6. Identify likely consequences that may be maintaining the behavior(s).
- Preferred objects being taken away
- Attention
7. Identify and describe any academic or environmental context(s) in which the problem
behavior(s) does not occur.
Nate is able to engage in the learning environment more so in the mornings. In the
morning Nate has core skills, science in the general education classroom, math and an elective
class (alternating Phy. Ed and Art). Although Nate has had problem behaviors in these learning
environments, they are less frequent than in the afternoon.
Validation
8. Functional assessment:
Do you already have enough information to believe that the possible
explanations are sufficient to plan an intervention?

a. If yes, go to Step 9, if no, then what additional data collection is necessary?

b. ( ) Review of IEP goals and objectives
c. ( ) Review of medical records
d. ( ) Review of previous intervention plans
e. ( ) Review of incident reports
f. ( ) ABC (across time and situations)
g. ( ) Motivational analysis
h. ( ) Ecological analysis
i. ( ) Curricular analysis
j. ( ) Scatter plot
k. ( ) Parent questionnaire/interview
l. ( ) Student questionnaire/interview
m. ( ) Teacher questionnaire/interview (specify who) ______________________
n. ( ) Other (explain) _______________________________________________
Summarize data. Attach additional sheets if necessary.

Planning
9. Formulate hypothesis statement:
Using the table below, determine why
the student engages

in problem behavior(s), whether the behavior(s) serves single or multiple functions, and what
to do about the behavior(s).
When denied access to a preferred action or event Nate will become increasingly
frustrated and exhibit behaviors such as ripping, kicking objects, pushing objects, yelling and
self harm.
Internal

External

Obtain Something
Avoid Something
10. Current level of performance:
Describe problem behavior(s) in a way the team will recognize
onset and conclusion of behavior.
When Nate is about to engage in a problem behavior his social- emotional behavioral stage will drop
from meta- cognitive to behavioral.
Behaviors will include:
-Furrowed brow, frowning
-Defiant language: I dont have to do that, My mom says I dont have to do that
-Rips paper
-Runs around classroom/hallway
-Climbs
-Kicks objects/people near him
-Self harm: bites himself, scissors to face
-Pushes objects off of tables
-Pushes furniture

-Unable to keep body in learning environment

-Throwing objects
-Will respond to simple verbal questions
-Attempts to leave learning environment/classroom, -Announces that he is leaving
-Yelling
-Guarding his belongings

When Nate has been able to self- regulate and return to being ready to learn or in the metacognitive state he can be observed:
-Questioning why other people have what they have: (keyboards, chewelry, etc)
-Asks to bring things home to show his mom
-Wants to share information that he is excited about with others
-Shows concern for others
-Sitting quietly and calmly
-Answering questions
-Asking questions of peers
-Attends to task

11. Describe replacement behavior(s) that are likely to serve the same function as the behavior(s)
identified in Step 9.
Nate will use a break card when he needs to remove himself from the learning
environment. If Nate feels his body is not ready to learn he can remove himself, and as long as
he remains safe he can still earn preferred break. Nate can use chewerly, a hand squeeze or
other fidgets to get out physical frustration.
12. Measurement procedures for problem behavior(s) and replacement behavior(s):
a. Describe how (e.g., permanent products, event recording, scatterplot), when, and
where student behavior(s) will be measured.
Student will have a behavior checklist in the form of a Break Ticket . Support
Staff asks Nate what he wants to work for at the beginning of the hour and writes it on
the top of his sheet. Staff reviews the ticket with NK and gives plusses for the class
period (one for each section) at the end of the class. Staff gives NK the ticket and
verbally says turn this in in RM117. NK returns to 117 and turns in his ticket to a staff
member in RM 117. That staff member tells him he can have either the break he
picked or visually presents two other choices (not including the break he picked).
Tickets will be compiled and put on a spreadsheet to find similarities in behaviors, the
time of day and classroom expectations.
Ms. Smith will write daily in a notebook that is sent home for Nates mom to
read and write back. This is an informal way for Ms. Smith to keep data.
b. Summarize data by specifying which problem behavior(s) and replacement behavior(s)
will be targets for intervention.
The targeted behavior will be using a break card to communicate needing a break
rather than leaving the learning environment.

13. Behavioral intervention plan:

a. Specify goals and objectives (conditions, criteria for acceptable performance) for
teaching the replacement behavior(s).
When Nate becomes upset, frustrated, or angry, he will use a self-regulation/coping strategy
(squeeze, chewie, get a drink, zones strategies.) to avoid engaging in an unexpected behavior, with
one reminder, on 4 out of 5 opportunities, as measured by observations and documentation.
b. Specify instructional strategies that will be used to teach the replacement behavior(s).
Nate will always have access to a break area without negative consequence. The goal is for Nate to
anticipate behaviors and independently remove himself without the fear of getting in a negative
consequence.
c. Specify strategies that will be used to decrease problem behavior(s) and increase
replacement behavior(s).
-Verbal praise
-School wide PBIS blue slips
-Staff responds to his questions/comments
-In task schedules
-Behavior checklist
-Breaks between classes

d. Identify any changes in the physical environment needed to prevent problem

behavior(s) and to promote desired (replacement) behavior(s), if necessary.
e. Specify extent to which intervention plan will be implemented in various settings;
specify settings and persons responsible for implementation of plan.
All staff that work with Nate will be aware of the implementation of the behavior plan.
Staff will know what actions precede a behavior and what steps to take to regulate the
Nate.
14. Evaluation plan and schedule:
Describe the plan and timetable
to evaluate effectiveness of

the intervention plan.

a. Describe how, when, where, and how often the problem behavior(s) will be
measured.
The behavior will be measured daily during his science class in
general education as well during his inclusive Language Arts class. These classes were
chosen because one is the morning and one is in the afternoon.
b. Specify persons and settings involved.
All of Nates special education teachers, support staff, the principal and Dean
of Students
c. Specify a plan for crisis/emergency intervention, if necessary

If Staff observes a behavior of unsafe hands, feet, or mouth, staff will show NK the
visual checklist to remind him of the expectations. If Staff observes another behavior of
unsafe hands, feet, or mouth, staff will call Ms. Smith

d. Determine schedule to review/modify the intervention plan, as needed. Include dates

and criteria for changing/fading the plan.
The team will meet as needed, and again at the end of the semester (January) to review data
collection.
15. Describe plan and timetable to monitor the degree to which the plan is being implemented.
By next meeting the team will come with data of Nates behaviors will meet to
address his behaviors.