Sample Behavioral Intervention Plan

Student: Joan

Clarifying concerns:

After completing the forms from Behavioral Intervention and Support for Children and Young Adults who are Deafblind or have Visual and Multiple Impairments the team has compiled the following information.

• • Physical aggression towards self:
  • Joan exhibits the following signs of distress: scratching her face, hitting her legs, pinching her arms and neck, attempting to bang her head against surfaces.
  • Physical aggression towards others:
  • Joan exhibits the following signs of distress that she directs towards others: hitting, kicking, throwing objects, pulling hair, attempts to bite or head butt.

Additional information related to her specific disabilities

After responding to the questions in Behavioral Intervention and Support for Children and Young Adults with Deafblindness or Visual and Multiple Impairments, the team felt the following were important factors that contribute to moments of distress:

1. 1. Joan has light perception in her right eye and low vision in her left eye. She has a profound hearing loss.  The combined effects of Joan’s vision and hearing loss make it difficult for her to access information about what is happening around her.  This affects her ability to communicate, anticipate events, and understand other’s expectations of her.
   2. Joan was born with agenesis of the corpus coliseum. She takes medicine for attention deficit hyperactive disorder, and a seizure disorder.  She had corneal transplants in both eyes and has extremely dry eyes that require lubricant drops about every hour for protection.  She has a habitual cough that worsens in the springtime, as she is allergic to mold. Joan travels with her walker and moves well but her shaky movements combined with her visual impairments can sometimes cause her to be off balance.
   3. Joan’s family reports she has difficulty settling down at night and sleeping in a room by herself. She demonstrates anxiety near bedtime and typically sleeps 4-5 hours.
   4. Joan is very interested in her peers and wants to interact with them but lacks the appropriate social skills to do so. She often becomes overstimulated around other students especially in crowded or confusing environments.  Sometimes she hits or throws things to interact with others or get their attention.  Joan tends to target certain staff or students she likes or is interested in.
   5. Sometimes Joan has a difficult time at the competition of activities, especially if it is an exciting or stimulating activity. She has difficulty moving on to the next activity.
   6. Some of Joan’s distress happens when there is unstructured time.
   7. Joan becomes attached to staff and has a hard time switching back and forth between different people. She becomes confused sometimes when she doesn’t know whom she is supposed to be paying attention to and working with.
   8. During certain weather conditions such as windy days, when traveling outdoors, Joan may experience distress. If the wind causes Joan to become off balance, she may smile or laugh followed by self-abuse or aggression.

Summary of conclusions

Joan experiences moments of distress which potentially can be explained by:

• • being repeatedly misunderstood when expressing needs, choices, or concerns
  • confusion/anxiety from receiving incomplete, distorted, or fragmented information
  • panic
  • balance difficulties, glare (physical difficulties)
  • physical and/or emotional pain
  • feelings of isolation, loneliness, regret, grief, etc.

Sources of data:

• • Review of records
  • Observation
  • Information from instructional team
  • Information from family

Recommendations

Using the Behavioral Intervention and Support for Children and Young Adults who are Deafblind or have Visual and Multiple Impairments the team determined that many of the Tier 2 proactive strategies are currently being used to support Joan, but some strategies have not been implemented or implemented consistently. The team will continue to implement these specific Tier 2 strategies. Additional Tier 3 responsive strategies are included to address episodes of extreme distress.

Proactive Strategies (Tier 2) Fostering Feelings of Safety

• • Follow the child’s lead
  • Provide activities based on her interests and infuse turn taking, conversation (on her language level), and teach necessary vocabulary to allow her to request these activities as well as have conversations with others about her topics of interest. Look for opportunities to follow Joan’s lead.
  • Mark your entries and exits from the child’s world with greetings and parting rituals
  • Mark entries and exits from Joan’s world with greetings and parting rituals that are consistent and specific to each person.
  • Acknowledge the child’s emotions and share yours with them
  • Acknowledge Joan’s emotions expressed by her body language and facial expressions in ways that teach her about managing her emotions without causing further distress. Conversations about emotions related to her distress should not occur during times when she is experiencing distress. 

Responsive Strategies (Tier 3) Fostering Feelings of Safety

• • Alter activity schedules to reduce stress.
  • Decrease length of time of activity or allow Joan to watch the end of an activity rather than continue to participate, and/or accept partial participation.
  • Take a time-out to practice stress-reducing yoga activities; then try to resume routine.
  • Make sure there is structure, routine and predictability throughout the child’s school day.
  • Joan needs a consistent routine for each activity she engages in so that she can anticipate what is happening and feel more comfortable. This includes for example, riding in the van, nighttime routines, shopping, laundry, meals, calendar, school day activities and leisure time.
  • Each routine should have a clear beginning and ending and it is often best to represent each step with a picture or photo. For example, when Joan makes tacos, the first step is always to grate the cheese, and the last step is to wash the dishes and place the dishes in the drying rack. All of the steps in between are in the same order each time she participates in the activity.
  • When Joan has OT class, she does the same sequence of activities each time: 1.) Spin in the egg chair; 2.) Spin on the spin board; 3.) Rock on the rocker board; 4.) Roller skate; 5.) Swing. Each of these steps is represented by a photograph. In music class, Joan first plays the guitar, then plays the accordion and finishes by playing the drum.
  • Novelty and changes to the routine should be added gradually (once the routine is established) by showing the changes to Joan using pictures, and simple sign language.
  • For activities that do not have a clear beginning or ending, such as computer time or playing with the Wii, teach Joan a way to mark time such as setting a timer for herself.

Proactive Strategies (Tier 2) Fostering Feelings of Success

• • Design activities based on the child’s interest.
  • When Joan is engaged in interesting activities, she is less likely to have problems with behavior. Activities such as work, cooking, music, art, and PE have rarely been a problem for Joan. Look for opportunities to infuse Joan’s interests into consistent routines. Joan likes to be busy and enjoys a wide variety of activities such as simple crafts, looking at experience stories she has helped to create, and simple
  • Staff should provide direct instruction on recreation and leisure activities based on Joan’s interests. She should be given time during her day to make choices and participate in these types of activities toward the goal of accessing them during unstructured time.
  • Provide many opportunities for the child to explore and experiment with objects and materials.
  • During independent play, let Joan explore and experiment with objects and materials she will use in other situations and activities. Let her explore in any way she chooses. This is a way to introduce novelty slowly without making any specific demands on the child to perform in a specific manner.
  • Utilize an appropriate calendar system that stays in a defined location.
  • Use calendar systems with real photographs and pictures that have been drawn with Joan. Use a daily calendar and 2-week calendar to give Joan important information about her schedule (daily schedule, choice time, weekly activities and trips in the community). 
  • Keep it in a defined location so she can learn to move towards it independently when requesting information and conversations as it helps to clarify and identify her wants and needs.
  • Return to the calendar between each activity to “finish” previous activity and discuss what is next, whenever possible. If unable to return to the calendar, carry pictures with you to allow discussion of each activity so Joan is sure of her next destination.
  • Provide only the support needed by the child so he/she learns to cope with successes and failures.
  • Make sure she has information about where she is going and whom she’ll be working with before transitions from one activity to the next.
  • Attach a photograph or picture to her walker using Velcro strips to give her information about her next activity. Although Joan can understand many signs, she has difficulty following signed instruction while walking due to her balance.
  • Engage in expectant waiting to help signal Joan that it is her turn, and has enough time to attempt an action, process information, and respond.
  • Provide structure and guidance when introducing new routines. Joan needs this support to be successful. Expectations about her role are very important and need to be thought through ahead of time. Materials should be set up and in place before starting any activity.
  • Remind her of coping strategies she might use if she needs a break, such as her yoga routines.

Responsive Strategies (Tier 3) Fostering Feelings of Success

• • Increase the level of support so the child is not frustrated by difficult activities
  • Sign “help” to let Joan know she can request assistance when she begins showing signs of frustration.
  • Deliver information to the child in a form that is accessible, understandable and accurate
  • Use calendar systems with real photographs and pictures that have been drawn with Joan.
  • Provide consistent sign language vocabulary at her level.
  • Redirect Joan with a picture or by pointing to what she’s supposed to be doing. In some situations, fingerspelling can help calm Joan, but lots of animated signing or facial expressions usually causes more distress.

Proactive Strategies (Tier 2) for Fostering Feelings of Independence

• • As much as possible do “with not for” when engaging the child
  • Provide adequate “wait time” before offering help when Joan does not engage with a person or activity.
  • Designate specific areas of the classroom to store belongings and for doing regular activities
  • Provide a consistent location within each instructional environment where Joan can park her walker.
  • Keep the location of specific activities consistent from day to day.
  • Develop a communication system that allows for reciprocal communicative interaction
  • Joan’s team should continue to evaluate how often conversations are adult-led. Allow time and provide appropriate materials so that conversations can become balanced or reciprocal.
  • Acknowledge and record meaningful experiences in books or story boxes to share with others.
  • Provide opportunities for experience stories to be shared with familiar staff who are able to communicate with Joan both expressively and receptively.
  • As much as possible, allow the child to make choices about activities and the daily schedule.
  • Give Joan time during her day to make choices and participate in preferred recreation and leisure activities toward the goal of accessing them during unstructured time.
  • Incorporate opportunities for choice-making within familiar routines and activities.
  • When scheduling the day in her calendar system, allow Joan to have some flexibility in choosing the sequence of activities. For example, when two activities are scheduled back-to-back in her classroom, let her determine which activity she will do first.

Responsive strategies (Tier 3) for independence

• • Teach coping skills and provide opportunities to practice these skills in structured and safe environments
  • Make time each day for Joan to practice her yoga routine in a structured and safe environment. For Joan, this is an example of a coping skill.
  • Encourage Joan to express her feelings with words when she starts to feel frustrated or upset.
  • Encourage Joan to ask for “help” or request a break when she starts to feel frustrated or upset.
  • Provide direct instruction in social skills
  • Model appropriate social skills by using cross talk with other staff. For example, asking for help from another staff member to complete a task.
  • Provide direct instruction in social skills by using scripts that allow Joan to communicate with others during routines. Such as during the routine in which she makes and sells tacos, “hi” “do you want to buy a taco?” “thank you”.
  • Demonstrate the emotional state you want the child to achieve.
  • When you sense that Joan is becoming distressed be sure to interact with her in a calm and deliberate manner.
  • Be very mindful of your pacing.
  • Demonstrate using some of the yoga breathing techniques she knows that may help her self-regulate.

Proactive Strategies (Tier 2) for Fostering Feelings of Connectedness

• • Develop a communication system that allows for reciprocal communicative interaction
  • Facilitate interactions between Joan and her peers (especially those she demonstrates some interest in).
  • Acknowledge and record meaningful experiences in books or story boxes to share with others.
  • Coactively collect materials from Joan’s experiences and build consistent times to make and share experience stories.
  • Build connections through membership in a community.
  • Assist Joan in making gifts for others (birthdays and holidays).
  • Encourage her to share experience stories with a favorite peer or staff who are able to communicate with her both expressively and receptively.

Responsive Strategies (Tier 3) for Fostering Feelings of Connectedness

• • Encourage participation through the projection of a positive affect
  • Model enthusiasm and enjoyment about shared activities.

  • Celebrate milestones with Joan through high fives and positive language like “you did ____!” “Yay!”