Behavior Intervention Plans, Contracts & Check Sheet

Roosevelt · Oakland Unified – Bundle for meetings / printing

Behavior Intervention Plan – Walter Martin Carrillo

Student: Walter Martin Carrillo

School: Roosevelt · Oakland Unified    Grade: 7

Case Manager: Aris Tunson    Date of BIP: ______________________

Basis for BIP

Problem Behavior Impeding Learning

FERB & Key Strategies (Summary)

Student Behavior Contract (Walter)

Why we are making this contract: concerns with skipping, tardies, disruption, verbal abuse, and property damage. Before considering changes like a minimum schedule, we are agreeing on this plan to help Walter stay successful in school.

Goals (4 weeks)

Slack Behavior Intervention Notes (this week)

Walter:
8:39 AM [Missing / Location]: Hector missing; Walter seen before school.
8:55 AM [Status]: Cancel — they in class now.
9:56 AM [Missing]: Missing Walter.
10:02 AM [Search]: Checked blacktop/gym/courtyard — still no Walter.
12:52 PM [Left Without Permission]: Walter left class without permission (not sure where).
12:53 PM [Status]: Walter back.
2:38 PM [Missing / PE]: Missing Eduardo, Walter and Hector in PE.

Signatures

Student – Walter: ________________________    Date: __________

Parent/Guardian: ________________________    Date: __________

Case Manager (Aris Tunson): ________________________    Admin/Counselor: ________________________

Behavior Intervention Plan – Hector Panjoj Juarez

Student: Hector Panjoj Juarez    Grade: 8

School: Roosevelt · Oakland Unified    Case Manager: Aris Tunson

Problem Behavior (Summary)

Function & Replacement Behaviors

Student Behavior Contract (Hector)

Goals (4 weeks)

Slack Behavior Intervention Notes (this week)

Hector:
8:39 AM [Missing / Location]: Missing Hector.
8:55 AM [Status]: Cancel — they in class now.
12:43 PM [Sent Home]: Sending Hector Home now; therapist checking in.
2:38 PM [Missing / PE]: Missing Eduardo, Walter and Hector in PE.

Signatures

Student – Hector: ________________________    Date: __________

Parent/Guardian: ________________________    Date: __________

Case Manager (Aris Tunson): ________________________    Admin/Counselor: ________________________

Behavior Intervention Plan – Ty'auna Johnson

Student: Ty'auna Johnson    Grade: 8

School: Roosevelt · Oakland Unified    Case Manager: Aris Tunson

Problem Behavior (Summary)

Function & Replacement Behaviors

Student Behavior Contract (Ty'auna)

Goals (4 weeks)

Slack Behavior Intervention Notes (this week)

Tyanna:
10:23 AM [Not Going to Class]: Ty (Tyanna) hanging out by Tunson class — not going to class.
10:29 AM [Not Following Directions]: Ty not following directions; not moving seat; inappropriate language.
10:40 AM [Disruption]: Ty keep talking and won’t stop; talking about other student.
10:43 AM [Left Without Permission]: Ty left class without permission.
12:43 PM [Therapist Check-in]: Ty with therapist now.
12:57 PM [Left Without Permission]: Ty left class without permission.
12:58 PM [Safety Concern]: Scissors in hand; kept playing with them.

Signatures

Student – Ty'auna: ________________________    Date: __________

Parent/Guardian: ________________________    Date: __________

Case Manager (Aris Tunson): ________________________    Admin/Counselor: ________________________

Behavior Intervention Plan – Kierre White

Student: Kierre White    Grade: 6

School: Roosevelt · Oakland Unified    Case Manager: Aris Tunson

Problem Behavior (Summary)

Function & Replacement Behaviors

Student Behavior Contract (Kierre)

Goals (4 weeks)

Slack Behavior Intervention Notes (this week)

Kierre:
7:58 AM [Disrespect / Harassment]: Kiare outside taunting; continuously calling him “fat”.
9:19 AM [Left / Walked Out]: Kiare walked out.
10:23 AM [Not Going to Class]: Ty, Kiare, Tatiana hanging out by Tunson class — not going to class.
12:24 PM [Disrespect / Disruption]: Kiare came in disrespectful; staring; not doing work; loud noises; not following expectations; says he needs food.
12:32 PM [Disrespect]: Kiare said mean stuff to Kylah in period 1 math (from calm corner); told her to go back to her old school.
12:56 PM [Phone Violation]: Kiare didn’t follow expectations during block 5; on phone and hiding it.
1:40 PM [Noncompliance / Bathroom]: Ignoring directions; now in bathroom.

Signatures

Student – Kierre: ________________________    Date: __________

Parent/Guardian: ________________________    Date: __________

Case Manager (Aris Tunson): ________________________    Admin/Counselor: ________________________

Behavior System — Universal Daily Behavior Check Sheet

Teachers: complete daily and return to case manager.

Student: _____________________________ Date: ____________
Grade: ____________ Case Manager: _____________________
Teacher: __________________________ Class/Period: _____________________

0 = Not yet / many problems    1 = Mixed / some problems    2 = Met goal for this block

Block GOAL 1: Stayed in class / in assigned area GOAL 2: Followed directions / accepted redirection GOAL 3: Used school language / kept hands & feet safe Notes (brief)
012 012 012
________________________
________________________
________________________
________________________

Slack staff responses (this week)

Slack actions (this week):
Walter: missing/went missing; left class w/o permission; missing in PE.
Hector: missing; sent home; missing in PE.
Tyanna: not going to class; not following directions/inappropriate language; left class w/o permission; safety concern with scissors.
Kierre: taunting/disrespect; walked out; not going to class; phone hiding; noncompliance; in bathroom.

Teacher Summary (end of day)

Circle one and add brief comments.

Overall day:   0 = Very difficult    1 = Mixed    2 = Mostly successful

What went well: ____________________________________________________________

___________________________________________________________________________________________

Needs / concerns: __________________________________________________________

___________________________________________________________________________________________

Teacher signature: ____________________________    Time: __________