IF22 Behavioral Intervention Plan

BEHAVIORAL INTERVENTION PLAN

Title

Initial Intervention Plan or Amended after Review? *
Initial Intervention Plan
Amended after Review

Student Name *

School *

Grade *

Date (mm/dd/yyyy) *

Alternative Skills / Replacement Behaviors to be Taught *

How, Where, & Who Will Teach Alternative Skills *

Reinforcements for Child Use of Alternative Skills *

Consequences of Problem Behaviors *

Supports Needed for Team Members Implementing Behavioral Intervention Plan *

Outcome

Increases in Child Use of Alternative Skills - Methods for Measuring Progress *

Increases in Child Use of Alternative Skills - Timelines for Measurement of Progress *

Reduction of Problem Behaviors - Methods for Measuring Progress *

Reduction of Problem Behaviors - Timelines for Measurement of Progress *

BEHAVIOR INTERVENTION PLAN REVIEW DATE *

1. Signature *

2. Signature *

3. Signature *

4. Signature *

5. Signature *

6. Signature *

7. Signature *

Format adapted by Maria R. Perusek, Ed.S. Geauga County Educational Service Center 440.285.2222 x6267