<p> BEHAVIORAL SUPPORT PLAN</p><p>Name: Date of Birth:</p><p>Parent or Guardian: Team Contact:</p><p>School Address:</p><p>Home Address: </p><p>Phone:</p><p>Phone: Fax: E-mail:</p><p>Classification/Diagnosis: Gender (Circle one): Male Female</p><p>PRIORITIES</p><p>List challenging behaviors, definition, and summary of data in order of priority, from highest to lowest priority for change:</p><p>Behavior Definition Approximate Severity (1-5) Frequency 1=mild concern</p><p>5=life </p><p> threatening</p><p>1. </p><p>2. </p><p>3. </p><p>Identify intervention target(s) from above list:</p><p>Rationale for priority decision:</p><p>TEAM MEMBERS</p><p>List persons to be involved in student's program planning:</p><p>Who Role Relationship to Student</p><p>1. </p><p>2. </p><p>3. </p><p>4. </p><p>5. </p><p>6. </p><p>7. </p><p>8. </p><p>Student Strengths:</p><p>Relevant History (e.g., social factors, health conditions, medications, previous treatments):</p><p>FUNCTIONAL ASSESSMENT</p><p>List the assessments conducted for each behavior, and the general conclusions (i.e., what is motivating these behaviors) drawn from these data:</p><p>Behavior Assessments Conclusions</p><p>. </p><p>Hypothesis: [Provide a summary hypothesis stated in terms that under these conditions a specific behavior occurs that results in these outcomes.] IMPLEMENTATION PLAN</p><p>1. Prevention Strategies</p><p>Are short-term prevention procedures needed (e.g., temporarily changing schedules, tasks)? If so, describe what should be changed, and how it fits in given the assessment information. Be sure to include who is responsible for each procedure.</p><p>At School:</p><p>At Home:</p><p>2. Environmental and Instructional Enhancements</p><p>Do long term changes need to be made in goals or activities? If so, describe what needs to be changed and how these accommodations are consistent with prevention strategies. Be sure to include who is responsible for each procedure. 3. Immediate Consequences</p><p>Based on the assessment information, describe how people should react to the challenging behavior each time it occurs. Is a crisis plan needed for severe outbursts? If so, describe this plan. </p><p>At School:</p><p>At Home:</p><p>Crisis Plan (if needed):</p><p>4. Teaching Alternative Behaviors</p><p>A. School:</p><p> a. Which behavior is the team going to target for skills training?</p><p> b. How will this alternative behavior serve as a functionally equivalent replacement for the problem behavior?</p><p> c. In what situations will training occur?</p><p> d. Who will be responsible for conducting the training sessions?</p><p> e. Describe how the team will evaluate whether and when the student uses the new response: B. Home: a. Which behavior is the team going to target for skills training?</p><p> b. How will this alternative behavior serve as a functionally equivalent replacement for the problem behavior?</p><p> c. In what situations will training occur?</p><p> d. Who will be responsible for conducting the training sessions?</p><p> e. Describe how the team will evaluate whether and when the student uses the new response:</p>