Behavior Plan Intervention (Rough Draft)

Behavior Intervention Plan Template

Student: ________________________

School: _________________________

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Date Developed: ______________

Grade: ______________________

Philosophy of Behavior Management

(A statement of your philosophy of behavior management to meet student needs.)

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Description of Student

(From the information provided.)

Baseline Data

(From the information provided.)

Identification of the Target Behavior

(What is the inappropriate behavior the plan is designed to change? Identify one.)

Hypothesis Statement

(This should identify the function of the target behavior.)

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Intervention Goal

(What is the expeted outcome of the intervention.)

Intervention Strategies (Include at least 3 strategies that address the target behavior. Be sure to address positive and negative consequences, and include a crisis plan. Attach a sample behavior contract.)

Schedule for Implementation

(Identify when, where, and by whom plan will be implemented and if it will be implemented in stages or in multiple settings/situations at one time.)

Data Used to Measure Progress

(Identify the behavior that is to be tracked and the information that is to be collected to measure progress)

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Record-keeping System

(How data is collected/recorded & by whom. Include/attach an example.)

Evaluation Schedule

(Identify how often plan will be evaluated and who will be involved.)

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Communication with Parents

(Explain the system for communicating with parents and provide/attach an example.)

Next Steps: Discuss the next steps. What happens if the plan is successful? What happens if it is not successful?