Brentwood Union Free School District
Brentwood, NY 11717
Behavior Intervention Plan (BIP)
Date of Plan _______________________
Student Name __________________________________ ID # _________________ DOB _____________________
Current School _________________________ Teacher and/or Guidance ______________________ Grade ______
Student Address _________________________ [ ] Brentwood [ ] Bay Shore Phone ____________________
Parent and/or Guardian _____________________________ Agency ____________________________________
Agency Address ________________________________________ Agency Phone ______________ ext. _______
Agency Contact and/or Caseworker ________________________________
Current Educational Program
This student is a [ ] Regular Education Student (not classified) [ ] Special Education Student (has a classification)
If a Special Education student, current classification is ___________________________________
Current Related Services: [ ] None [ ] Speech [ ] Counseling [ ] PT [ ] OT [ ] Other ______________
Current Placement: Student is currently placed in:
[ ] General Education Program with related service(s) only
[ ] Resource Room Program
[ ] CWC (class within a class) setting
[ ] Self-Contained Setting within district ____ level I (15:1) ____ level III (15:1) level IV (12:1:1)
[ ] Self-Contained Setting OOD ____ BOCES ____ Other ______________________________________
Goals of this BIP
Based upon the results of the Functional Behavioral Assessment (FBA) it was decided to address the following goal(s).
The stated goal(s) must be measurable and observable and be derived directly from the targeted FBA behaviors.
Goal 1: ___________________________________________________________________________________
_________________________________________________________________________________________
Goal 2: ___________________________________________________________________________________
__________________________________________________________________________________________
Goal 3: ___________________________________________________________________________________
__________________________________________________________________________________________
Behavior Intervention Plan
Page 2a
Targeted Behavior # ___ (Goal # ___)
BIP for Behavior # ___: ____________________________
Behavior Identification
The following was identified as a primary problematic behavior for this student. It was agreed that this behavior is
preventing this student from achieving success in their current educational setting.
Operational Definition of Behavior #___ to include frequency, duration, intensity and/or latency of the targeted
behaviors:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Hypothesized Function of Targeted Behavior
Based upon the information and data obtained from the FBA, _______________________________ was determined
to be the hypothesized function of the above noted targeted behavior.
Summary of hypothesized function of behavior
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Intervention Procedures
Antecedent Modification: Based upon the FBA, the following were found to be antecedent and/or environmental
variables that are triggering the targeted behavior: _____________________________________________________
These variables will be modified in the following manner: ________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
The following staff will be responsible for this intervention: ________________________________________________
______________________________________________________________________________________________
Behavior Intervention Plan
Page 2a – cont..
Replacement Behavior: The following functionally equivalent behaviors (behaviors that serve the same function as
the targeted behavior and are socially more acceptable or appropriate) will be taught to this student: ___________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
The following staff will be responsible for this intervention: ________________________________________________
______________________________________________________________________________________________
Reinforcement Procedures: This student will be reinforced when the above noted replacement behaviors occur in
the following manner:
[ ] Social Praise
Schedule of Reinforcement: _____________________________________________
[ ] Token Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Prize / Tangible reward
Schedule of Reinforcement _______________________________________
[ ] Primary Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Activity Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Time with _____________ Schedule of Reinforcement _____________________________________________
[ ] _____________________ Schedule of Reinforcement _____________________________________________
[ ] _____________________ Schedule of Reinforcement _____________________________________________
The following staff will be responsible for this intervention: _______________________________________________
_____________________________________________________________________________________________
Reactive Procedures: The following intervention(s) will be implemented when the targeted behavior occurs:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
The following staff will be responsible for this intervention: ____________________________________________
___________________________________________________________________________________________
Behavior Intervention Plan
Page 2a – cont..
Data Collection: To ensure the effectiveness of the above prescribed BIP, data on the targeted behavior will be kept
in the following manner:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
The following staff will be responsible for data collection:______________________________________________
___________________________________________________________________________________________
Monitoring of Plan
This Behavior Intervention Plan will be monitored as outlined in the schedule below. The BIP team should review the
effectiveness of the intervention(s) including a review of the frequency, duration and intensity data of the targeted
behavior.
Monitoring Schedule: ______________________________________________________________________
The BIP team has established the following person to facilitate the progress monitoring: ___________________
Progress Report To Parent
The parent will be provided a written progress report on this BIP on a ____ Quarterly ____ Other basis.
Behavior Intervention Plan
Page 3a
Targeted Behavior # ___ (Goal # ___)
BIP for Behavior # ___: ____________________________
Behavior Identification
The following was identified as a primary problematic behavior for this student. It was agreed that this behavior is
preventing this student from achieving success in their current educational setting.
Operational Definition of Behavior #___ to include frequency, duration, intensity and/or latency of the targeted
behaviors:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Hypothesized Function of Targeted Behavior
Based upon the information and data obtained from the FBA, _______________________________ was determined
to be the hypothesized function of the above noted targeted behavior.
Summary of hypothesized function of behavior
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Intervention Procedures
Antecedent Modification: Based upon the FBA, the following were found to be antecedent and/or environmental
variables that are triggering the targeted behavior: _____________________________________________________
These variables will be modified in the following manner: ________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
The following staff will be responsible for this intervention: ________________________________________________
______________________________________________________________________________________________
Behavior Intervention Plan
Page 3a – cont..
Replacement Behavior: The following functionally equivalent behaviors (behaviors that serve the same function as
the targeted behavior and are socially more acceptable or appropriate) will be taught to this student: ___________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
The following staff will be responsible for this intervention: ________________________________________________
______________________________________________________________________________________________
Reinforcement Procedures: This student will be reinforced when the above noted replacement behaviors occur in
the following manner:
[ ] Social Praise
Schedule of Reinforcement: _____________________________________________
[ ] Token Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Prize / Tangible reward
Schedule of Reinforcement _______________________________________
[ ] Primary Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Activity Reinforcement
Schedule of Reinforcement _____________________________________________
[ ] Time with _____________ Schedule of Reinforcement _____________________________________________
[ ] _____________________ Schedule of Reinforcement _____________________________________________
[ ] _____________________ Schedule of Reinforcement _____________________________________________
The following staff will be responsible for this intervention: _______________________________________________
_____________________________________________________________________________________________
Reactive Procedures: The following intervention(s) will be implemented when the targeted behavior occurs:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
The following staff will be responsible for this intervention: ____________________________________________
___________________________________________________________________________________________
Behavior Intervention Plan
Page 3a – cont..
Data Collection: To ensure the effectiveness of the above prescribed BIP, data on the targeted behavior will be kept
in the following manner:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
The following staff will be responsible for data collection:______________________________________________
___________________________________________________________________________________________
Monitoring of Plan
This Behavior Intervention Plan will be monitored as outlined in the schedule below. The BIP team should review the
effectiveness of the intervention(s) including a review of the frequency, duration and intensity data of the targeted
behavior.
Monitoring Schedule: ______________________________________________________________________
The BIP team has established the following person to facilitate the progress monitoring: ___________________
Progress Report To Parent
The parent will be provided a written progress report on this BIP on a ____ Quarterly ____ Other basis.
Behavior Intervention Plan
Page 4
Agreement
The below have participated in the development of the Behavior Intervention Plan (BIP). All of the undersigned agree
that BIP was developed to address the targeted behavior(s) in relation to the hypothesized function of the behaviors
and/or the effects of the environment.
Team Members (please print name)
Signatures of Team Members
Date
______________________________
_________________________________
____/____/____
______________________________
_________________________________
____/____/____
______________________________
_________________________________
____/____/____
______________________________
_________________________________
____/____/____
______________________________
_________________________________
____/____/____
______________________________
_________________________________
____/____/____
Attachments:
Informed Consent
Summary of Parent Conference (if parent did not attend the FBA meeting)
Revised 9/22/08