BEHAVIOR LOG
NAME:
MONTH/YEAR: MAY 2017
BEHAVIOR: Physical Aggression: Hitting, kicking, biting, pulling hair, grabbing.
AGGRESSION (How many times the behavior occurred): 1, 2, 3, ...9, if the behavior occurred 10 or more times make an “X”
INTERVENTION (How many times was the intervention effective): 1, 2, 3, ...9, if 10 or more make an “X”
PROACTIVE PROCEDURES: Engage me in a recreational activity. I enjoy playing basketball, listening to music (sit and talk or dance with me)
playing Uno, helping staff complete chores)
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Restraint
Y/N?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Restraint
form filled
out? Y/N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Restraint
Y/N?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Restraint
form filled
out? Y/N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Restraint
Y/N?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Restraint
form filled
out? Y/N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Proactive
Procedures:
Recreational
activity
Aggression
1st Initials
Proactive
Procedures:
Recreational
activity
Aggression
2nd Initials
Proactive
Procedures:
Recreational
Activity
Aggression
3rd Initials
BEHAVIOR LOG
NAME:
MONTH/YEAR: MAY 2017
BEHAVIOR: Threatening: Threatening staff with violence
THREATENING (How many times the behavior occurred): 1, 2, 3, ...9, if the behavior occurred 10 or more times make an “X”
INTERVENTION (How many times was the intervention effective): 1, 2, 3, ...9, if 10 or more make an “X”
PROACTIVE PROCEDURES: Staff will help me complete a domestic activity. I love to help around the house and feel needed.
Proactive
Procedures:
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
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1
7
1
8
1
9
2
0
2
1
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3
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5
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6
2
7
2
8
2
9
3
0
3
1
1
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3
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5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Domestic
Activity
Threateni
ng
Intervention
1st Initials
Proactive
Procedures:
Domestic
Activity
Threateni
ng
Intervention
2nd Initials
Proactive
Procedures:
Domestic
Activity
Threateni
ng
Intervention
3rd
Initials
BEHAVIOR LOG
NAME:
MONTH/YEAR: MAY 2017
BEHAVIOR: Blank Stare/Acting confused (precursor behaviors)
CONFUSED (How many times the behavior occurred): 1, 2, 3, ...9, if the behavior occurred 10 or more times make an “X”
INTERVENTION (How many times was the intervention effective): 1, 2, 3, ...9, if 10 or more make an “X”
PROACTIVE PROCEDURES: 1:1 time
Proactive
Procedures:
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1:1 time
Confused
Intervention
1st Initials
Proactive
Procedures:
1:1 time
Confused
Intervention
2nd Initials
Proactive
Procedures:
1:1 Time
Confused
Intervention
3rd
Initials
BEHAVIOR LOG
NAME:
MONTH/YEAR: MAY 2017
BEHAVIOR: Verbal Aggression –cursing at staff.
VERBAL AGGRESSION (How many times the behavior occurred): 1, 2, 3, ...9, if the behavior occurred 10 or more times make an “X”
INTERVENTION (How many times was the intervention effective): 1, 2, 3, ...9, if 10 or more make an “X”
PROACTIVE PROCEDURES: Education: Remind me and prompt me on proper communication and manners
Proactive
Procedures:
1
2
3
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5
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8
9
1
0
1
1
1
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3
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1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Education
Cursing
Intervention
1st Initials
Proactive
Procedures:
Education
Cursing
Intervention
2nd Initials
Proactive
Procedures:
Education
Cursing
Intervention
3rd
Initials