Request a sensory break with a card
When to use this goal
For students who leave the area, cover their ears, shut down or get upset when input builds up, and who do not yet ask for a break before that point. Fits students who can use words, a break card, a sign or a device, decided by present levels and the OT's sensory profile, not grade.
- Baseline
- For one to two weeks, log the moments when the student showed early signs, what they did, and whether they asked, an adult offered, or the moment escalated. The early signs come from the OT, the family and the student; agree on them before counting.
- Tips
- Breaks are honored every time and never earned; a break that has to be earned stops being a regulation tool. Keep the break spot ready and short to reach. Pair with a return-from-break template once requesting is steady.
- Limits
- A request goal does not change a room that is too loud for most students; adjust the environment too. Counting depends on agreeing what an early sign is, so use the same list for every observer. Not a goal for reducing any movement the student uses to regulate.
Original IEP Atlas template based on general measurement principles; not copied from any goal bank. ID mt-sen-001.
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Goal
By the annual IEP review date, during whole-group lessons or independent work, when the student shows the early signs listed in their sensory plan (such as covering ears, moving more or going quiet), the student will request a sensory break using words, a break card, a sign or a device, and go to the agreed break spot with no adult prompts in at least 4 of 5 opportunities, on 4 of 5 observed days, as measured by frequency recording collected daily.
Baseline: 1 of 5 opportunities.
- Condition
- Observable behavior
- Criterion
- Measurement method
Measurability check11 of 11 met
Met: Observable behavior. Stated as an action.
Met: Condition. Stated.
Met: Unit fits the behavior. Opportunities fits this behavior.
Met: Explicit criterion. Number and unit stated.
Met: Mastery rule and schedule. Both stated.
Met: Method produces the metric. Frequency (event) recording gives opportunities data.
Met: Review timeframe. Stated.
Met: Baseline and target compatible. Same unit, change in the right direction.
Met: Aligned with area of need. Still about Sensory Processing & Regulation.
Met: Level of support. Defined.
Met: Blanks filled in. Nothing left to fill in.
Checks structure and wording only. Whether the goal fits the student is the team's call.
Short-term objectives (optional)
When are objectives required?Required for students on alternate assessments (34 CFR §300.320(a)(2)(ii)); some states require them for everyone.
Paste into your IEP system
Most district systems have a separate box for each part of a goal. Copy them one at a time, or all at once as labeled text.
- Area of need
- Motor & Sensory Skills (OT, PT & Adapted PE) - Sensory Processing & Regulation
- Baseline
- 1 of 5 opportunities.
- Annual goal452 characters
- By the annual IEP review date, during whole-group lessons or independent work, when the student shows the early signs listed in their sensory plan (such as covering ears, moving more or going quiet), the student will request a sensory break using words, a break card, a sign or a device, and go to the agreed break spot with no adult prompts in at least 4 of 5 opportunities, on 4 of 5 observed days, as measured by frequency recording collected daily.
- Timeframe
- By the annual IEP review date
- Condition
- During whole-group lessons or independent work, when the student shows the early signs listed in their sensory plan (such as covering ears, moving more or going quiet)
- Behavior
- The student will request a sensory break using words, a break card, a sign or a device, and go to the agreed break spot with no adult prompts
- Criteria
- In at least 4 of 5 opportunities, on 4 of 5 observed days
- Evaluation method
- Frequency recording
- Schedule
- Daily
Copied as plain text, with straight quotes and plain dashes.
Matching data sheet
Opportunity tracker. One box per opportunity in each session.
Opportunity tracker
Opportunities- Student label:
- Target:
- in at least 4 of 5 opportunities
- Mastery rule:
- on 4 of 5 observed days
- Collection schedule:
- daily
- Method:
- Frequency (event) recording
- Data collector:
Goal: By the annual IEP review date, during whole-group lessons or independent work, when the student shows the early signs listed in their sensory plan (such as covering ears, moving more or going quiet), the student will request a sensory break using words, a break card, a sign or a device, and go to the agreed break spot with no adult prompts in at least 4 of 5 opportunities, on 4 of 5 observed days, as measured by frequency recording collected daily.
Key: + demonstrated independently · P demonstrated with a prompt (note type) · − not demonstrated · NA no opportunity occurred
| Date | Activity / context | 1 | 2 | 3 | 4 | 5 | # + (of 5) | Notes |
|---|---|---|---|---|---|---|---|---|
Preview shows 4 of 12 rows.
- Record up to 5 opportunities per session, matching the goal's denominator.
- Define in advance what counts as an opportunity so every data collector records the same thing.
- Count only + marks toward the criterion unless the goal specifies prompted responses.
The CSV opens in Excel or Google Sheets, with formulas. Sheets print blank; no student data is stored.