Monterey County Special Education Local Plan Area

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Dec 5, 2013 (3 years and 10 months ago)

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Monterey

County Special Education Local Plan

Area

Behavioral Intervention Checklist, Page
1

of
4

GDE 1 (11/09)

Distribution: LEA of Service, LEA of Residence, Case Manager, Service Providers

Student:








Date of Birth:








Date:








Case Manager:








BICM:








This checklist is intended to assist IEP teams in determining the actions necessary for addressing th
e needs of students who
exhibit problem behaviors that have not responded to preventative or typical classroom behavior management techniques.
Please check the box in section A that applies to the student and then complete the action indicated in bold pri
nt for each
item. For actions in sections B
-
F the responsible person should enter the date that each activity was completed and his/her
initials.

A.

DESCRIPTION OF BEHAVIOR

1.


Student exhibits behaviors that are self
-
injurious, assaultive,

or cause severe property damage; an emergency
intervention has been employed.

Proceed to section B of this checklist.

2.


Student exhibits behaviors that are self
-
injurious, assaultive, or cause severe property damage; an emergency
interven
tion has
not

been employed.

Proceed to section C of this checklist.

3.


Student exhibits pervasive and maladaptive behaviors for which instructional and behavioral approaches specified in
the IEP and/or BIP are no longer effective.
Proceed
to section D of this checklist.

B.

PROCEDURES FOR FOLLOW
-
UP TO EMERGENCY BEHAVIORAL INTERVENTION

Date

Initials

Procedures













Emergency intervention employed.













Notify parent of em
ergency intervention as soon as possible and within one school day.













Complete
Notice of Behavioral Emergency

(NC 10) and provide copies to the site
administrator, case manager, and parent within 24 hours of incident.













Check one:



A BIP exists


schedule IEP meeting to review the plan.
Proceed to section F of this
checklist.


A BIP does not exist


within 2 days of behavioral emergency, schedul
e an IEP team
meeting to determine need for Functional Analysis Assessment (FAA).













Convene the IEP team, and use
Determination of Need for a FAA

(IEP 6I). Check one:


Functional Analysis Assessment
(FAA) is needed.
Develop an
Interim Behavioral
Intervention Plan
(IEP 6E), if needed.

Proceed to section E of this checklist.


Functional Analysis Assessment (FAA) is
not
needed.
Consider adding behavioral
strategies (e.g., behavioral goal
s, behavioral interventions, and/or an
Escalation
Cycle Management Plan
(IEP 6E) to the IEP.

C.

PROCEDURES FOR STUDENTS EXHIBITING BEHAVIORS THAT ARE SELF
-
INJURIOUS,
ASSAULTIVE, OR CAUSE SERIOUS PROPERTY DAMAGE (No Emergency Intervention was Employed)

D
ate

Initials

Procedures













Check one:



A BIP exists


schedule IEP meeting to review the plan.
Proceed to section F of this
checklist.


A BIP does not exist.
Consider developing an
E
scalation Cycle Management Plan
(IEP 6E)
.

Proceed to section E of this checklist.


Monterey

County Special Education Local Plan

Area

Behavioral Intervention Checklist, Page
2

of
4

GDE 1 (11/09)

Distribution: LEA of Service, LEA of Residence, Case Manager, Service Providers


Student:








Date of Birth:








Date:








Case Manager:








BICM:








D.

PROCEDURES F
OR STUDENTS EXHIBITING BEHAVIORS THAT ARE SEVERE, PERVASIVE AND
MALADAPTIVE (No Emergency Intervention was Employed)

Date

Initials

Procedures













Case manager/IEP team member reviews IEP:


Current IEP
does not include behavioral strategies (e.g., behavioral goals and/or an
Escalation Cycle Management Plan
).
Convene the IEP team to

develop behavioral
strategies for inclusion in the IEP and discontinue this checklist unless and until
strategies are found

to be ineffective. When and if strategies are found to be
ineffective, proceed to section E of this checklist.


Current IEP includes behavioral strategies.
Convene the IEP team.













IEP team reviews existing behavioral strategies (check one):



Strategies are effective as written.
Continue implementing IEP and discontinue
this checklist.


Strategies are ineffective. Studen
t has a serious behavioral problem
; a

FAA is
required by law.

Proceed to section E of this checklist.

E.

PROCEDURES FOR CONDUCTING A FUNCTIONAL ANALYSIS ASSESSMENT (FAA) AND
DEVELOPING A BEHAVIORAL INTERVENTION PLAN (BIP)

Date

Initials

Procedures













Request for Specialist Assistance

(RE 3) completed indicating need for a Behavioral
Intervention Case Manager (BICM) to conduct FAA.













BICM added to IEP team.













Notice of Referral and Proposed Action

(NC 2) as well as
Assessment Plan

(NC 3)
completed; “Social/Emotional/Behavioral Development” checked on assessment plan and
BICM listed under “Title of Assessor” (other areas of assessment and assessors ma
y also
be listed, as appropriate).













Notice of Referral and Proposed Action

(NC 2) and
Assessment Plan

(NC 3) sent to parent.













Written consent for assessment received from paren
t. IEP Meeting due:















FAA conducted by or under the supervision of BICM













FAA report completed













Proposed BIP drafted (within 50 days o
f receiving parental consent)













IEP team meeting scheduled (within 60 days of receiving parental consent)













IEP team meeting held with the BICM in attendance; FAA reviewed. One o
f the following
actions was taken (check one):


Behavioral Intervention Plan (IEP 6F) is required.
Revise or amend IEP to include
BIP.
Implement BIP and evaluate its effectiveness at intervals specified in the
BIP. Proceed to section F o
f this checklist.


Behavioral Intervention Plan (IEP 6F) is not required. Behavior may be addressed
effectively with
behavioral strategies such as behavioral goals and/or an
Escalation
Cycle Management Plan
.
R
evise or amend IEP to include

behavioral strategies.
Implement behavioral strategies and discontinue this checklist.

Monterey

County Special Education Local Plan

Area

Behavioral Intervention Checklist, Page
3

of
4

GDE 1 (11/09)

Distribution: LEA of Service, LEA of Residence, Case Manager, Service Providers


Student:








Date of Birth:








Date:








Case Manager:








BICM:








F.

PROCEDU
RES FOR REVIEWING AND MODIFYING A BIP

Date

Initials

Procedures













BIP implementation documented through data collection sheets













Current frequency, duration, and intensity of targ
eted behavior measured and compared to
measures from initial and/or previous review data













BIP effectiveness reviewed as specified in the plan and (check one):


Plan continues to be effective; no modi
fications needed.
Continue with plan and
discontinue this checklist.


Minor modifications needed.
Notify parent and proceed to next step.


Major modifications needed.
Proceed to section E
.













BICM, or designee, with parent consent, made minor modifications and documented them
on the BIP or an attachment (implement modified BIP and discontinue this checklist)

ADDITIONAL INFORMATION/COMMENTS







Monterey

County Special Education Local Plan

Area

Behavioral Intervention Checklist, Page
4

of
4

GDE 1 (11/09)

Distribution: LEA of Service, LEA of Residence, Case Manager, Service Providers