Behavior Support Plan
Professional Behavior Support Plan template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Behavior Support Plan
TEMPLATE • Inspection-Ready AFH Standard
1. Behavior Identification & Triggers
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. De-Escalation & Redirection Strategies
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Prohibited Actions & Safety Safeguards
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (4 Sections)
Behavior Identification & Triggers
Specific behaviors observed, known triggers, time patterns, and communication barriers.
De-Escalation & Redirection Strategies
Non-pharmacological interventions, calming techniques, and staff responses.
Prohibited Actions & Safety Safeguards
Strict adherence to non-restraint policies and emergency safety plans.
Staff Briefing & Evaluation Log
Caregiver acknowledgment log and monthly progress review notes.
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