BOX ELDER SCHOOL DISTRICT
Ronald F. Wolff, Superintendent
BOARD OF EDUCATION
Connie Archibald
Lynn Capener
Karen Cronin
James Fuller
Nancy Kennedy
Bryan Smith
Heather Young
BEHAVIORAL INTERVENTION SUMMARY
Student Name ________________________________________________ Date ___________________
School ___________________________________________ Grade _______ DOB _________________
CHECK IMPLEMENTED INTERVENTIONS WITH OUTCOME DATA (ATTACH ADDITIONAL
SHEETS AND GRAPHS AS NEEDED)
ALL Universal Interventions (Level I)
□ 1. Appropriate and Motivating Curriculum
□ 2. Assistive Technology
□ 3. Behavior Momentum
□ 4. Chaining/Sequencing
□ 5. Contingent Observation
6. Differential Reinforcement of:
6(a). Other Behaviors (DRO)
6(b). High Rates (DRH)
6(c). Low Rates (DRL)
6(d). Alternative or Replacement
Behavior (DRA)
6(e). Incompatible Behavior (DRI)
6(f). Functional Communication
Behavior (DRC)
□ 7. Direct Instruction
□ 8. Environmental Engineering
□ 9. Fading
□ 10. Group Reinforcement Response
Contingency
11. Modeling/Differential Reinforcement
of Another Person’s Appropriate
Behavior
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12. High Rates of Positives
13. Home Notes
14. Instructional Pacing
15. Monitoring Performance/CurriculumBased Measurements
16. Parent Conference
17. Parent Training
18. Precision Requests
19. Reinforcement:
a. Continuous Schedule of Reinforcement
b. Intermittent Schedules of Reinforcement:
(i) Ratio Schedules of Reinforcement
(ii)Variable Time or Events
20. Prompting/Cueing
21. Redirection
22. Rules/Expectations
23. Social Skills Instructions
24. Staff Training (Ongoing)
25. Stimulus Cueing
26. Structured Daily Schedule
27. Supervision
Results and Adjustments:
__________________________________________
Comments:
__________________________________________
__________________________________________
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O. Jay & Tamra Call Education Center
960 South Main, Brigham City, UT 84302
“Learning Is
Everything”
Phone: (435) 734-4800
Fax: (435) 734-4833
SOME Mildly Intrusive Contingent Procedures (Level II)
□ 1. Administrative Intervention
□ 2. Behavior Contracting
□ 3. Check-in, Check-out (Behavior Education
Program)
□ 4. Detention Before and After School
□ 5. Detention, Lunch
□ 6. Food Delay
□ 7. Functional Communication
□ 8. Graduated Guidance
□ 9. In-School Suspension (ISS)
□ 10. Mentoring
□ 11. Peer Tutoring
□ 12. Planned Ignoring
13. Over-Correction:
13(a). Restitutional Over Correction
13(b). Positive Practice
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14. Required Relaxation
15. Response Cost
16. Self-Management
17. Structured Non-instructional Periods,
Including Recess
18. Time Out, Exclusionary
19. Time Out, Inter-Class
20. Time Out, Non-Seclusionary
21. Token Economy
22. Tracking
23. Verbal Reprimand/Correction of Behavioral
Error
24. Video Modeling
25. Work Detail
Results and Adjustments: ______________________________________________________________
___________________________________________________________________________________
Comments: _________________________________________________________________________
___________________________________________________________________________________
Few Intensive, Individual Interventions (Level III)
1. Contingent Intrusive Substances and
Stimuli:
a. Taste Aversion
b. Aromatics
c. Water Mist
2. Enforced Relaxation
3. Extinction
4. Forceful Physical Guidance
5. Inhibiting Devices
6. Manual Restraint
7. Mechanical Restraint (for Bus)
8. Mechanical Restraint
9. Over-Correction, Full Cleanliness Training
10. Satiation
11. Startle
12. Time Out Seculsionary
13. Visual Screen
Results and Adjustments: ______________________________________________________________
___________________________________________________________________________________
Comments: _________________________________________________________________________
___________________________________________________________________________________
Signatures:
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