A Sample Complex BIP Form

Student Name:  Student Name       ID:  #######

COMPLEX BIP FORM

Team Members: ______________________________________________________________________________________

Functional Behavior Assessment:

Strengths: What are the student strengths as they relate to school?

Environmental Factors we can mitigate: What factors outside of school contribute to the student’s problem behavior?

Trigger: What happens immediately before the problem behavior?

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Problem Behavior: Describe the problem behavior in objective and measurable terms (for example:  “Susie makes academically unrelated comments to peers 10 times per class period”, instead of “Susie is off-task”).

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Consequences: What happens after the problem behavior? Removal from class? Students give attention student?

Function of Problem Behavior: What is the “reward”/payoff of the student’s behavior?  What are they gaining/obtaining from engaging in the problem behavior?

BIP Strategies

Minimizing Trigger Strategy: What strategies are there for minimizing the impact of the student’s trigger?  Meaning, how can I either avoid the trigger all together or how can I make the trigger less threatening or alarming to the student. For example, if the student’s trigger is a teacher made request to engage in independent work, a helpful strategy may be first asking the student what which questions the student knows the answer to.

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Replacement  Behavior Strategy: What is the replacement behavior? (a more socially appropriate alternative behavior that obtains the same function as the problem behavior) How do we teach them the alternative behavior?  What strategies can be taught that would allow them to obtain the same function, but through socially appropriate means? How can the teacher teach the replacement behavior? How can the support staff (counselor/social worker, etc) teach the replacement behavior?

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Consequence Strategy: If student uses replacement behavior student gets… What are the rewards and positive consequences for using the replacement behavior? If student exhibits problem behavior… What can I do to redirect the student? How will problem behaviors be documented?

Goal:

Current Frequency/Intensity/Duration of the Target Behavior:  How often does the problem behavior occur?

Goal: By [Date] of the 2015/2016 school year, [Student’s Name] will reach their goal (Which will be a reduction in either the Frequency, Intensity or Duration of the Current Target Behavior).

Crisis Plan

Escalation: Observable Signs: What observable signs that will signal the student is beginning to escalate? Teacher Response: What can the teacher do to minimize this escalation?	→	De-Escalation: Observable signs: What are the observable signs that the student is beginning to calm down and de-escalate? Teacher Response: What should the teacher do to help them calm down?	→	Calm: What should the teacher to do help them transition back into the classroom or prepare them to enter the classroom in the immediate future?
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		Crisis: Observable Signs: What behavior will you see when the student is in a crisis? Teacher Response: How should the teacher respond when the student is in crisis?

Support Personnel

• Who are the team members? (Case Manager, Social Worker, School Psychologist, etc).

Data Collection/Methods:

• How will the team collect data?

Provisions for Coordination with Caregivers:

• How will the team contact parent/guardian with updates/information.