Functional Behavior Assessment

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2 Student: School: Date: Functional Behavior Assessment Step 1: Defining Behaviors and Component Selection Parental Consent for Formal Functional Behavior Assessment (Date Received : ) **Must have signed consent form in order to conduct a Formal FBA which includes direct measures, attach consent to this form. Baseline data collection MUST be completed within 65 days of receiving consent. Behaviors Targeted for Decrease (Identify a maximum of 3 behaviors on which to collect data. Define in specific, observable, and measurable terms) Evaluation Data: (attach copies of collected data to this form) Indirect Measures Includes collection of information related to the behavior through the review of existing documentation, interviews, surveys, and inventories. File Review Learning Style Student Interview Student Reinforcement/Interest Survey Parent Interview Staff Interview, Position: Other: Other: Other: Direct Measures Involves observation of the behavior and the conditions surrounding the behavior Antecedent-Behavior-Consequence Scatterplot Latency Duration Frequency: Other: Other: Other: Person Responsible (Title Only) Person Responsible (Title Only) Date Completed Date Completed Meeting date to review collected data and develop BIP: Parent will attend will contribute by an alternate method other: Step 2: Summarize and Interpret Baseline Data Parent/Student Contributed Information: Previously Attempted Strategies/Interventions: Ineffective Somewhat Effective Effective 1

3 Student: School: Date: Summarize and Interpret Baseline Data Student strengths: Academic area(s) (list): Creative/Artistic Good sense of humor Athletic ability Outspoken Musical abilities Additional strengths: Good Memory Works well with others Kind and/or empathetic Likes to be a helper Respectful toward peer/adults Works well with computers/technology Works well with hands Able to fix things; mechanically inclined Resourceful Works well with animals Works well with younger children Family/community supports Good leadership skills Follows directions well Completes class assignments Attends school regularly Resilient/Perseveres Enthusiastic Team Considerations: Possible Student Motivators (Utilize Student Reinforcement Survey to identify) Factors for Consideration (Skills needed, changes to the environment, sensory needs, medical diagnoses, learning style, support systems such as positive relationships with staff, etc. obtained from interviews and file review) Behavior Targeted to Decrease 1: Definition written as an Operational Definition-observable, specific, and measurable terms: Frequency: Duration: Intensity: # (behavior count) per (hour, day, week, etc.) Setting Events Conditions that can influence the reaction to an antecedent (Example: lack of sleep, hunger, diagnosis, illness, medication, argument at home, etc.) Seconds Minutes Hours Triggers/Antecedents What is most likely to be happening before the behavior occurs (Example: unstructured time, transition, negative interaction with peer/adult, denial/delay of requests, change of routine, etc.) Mild (disruptive but not dangerous) Moderate (verbal/physical treats and/or destructive to physical environment) Severe (poses a physical danger to student and/or other) Consequences What happens after the behavior occurs (Example: behavior ignored, reprimand/ warning, time out, teacher attention, peer attention environmental changes, student emotional state, etc.) Function What does the student seem to obtain/avoid from the behavior (Example: avoidance of activity/request/ person, escape of classroom/schoolwork, get desired Attention, vengeance, intimidation, relief of fear/ boredom, etc.) Obtain or Avoid What is the student attempting to obtain/avoid? Hypothesis (When Antecedent the student will Behavior Targeted for Decrease in order to Function): Desired Replacement Behaviors (Operational definition of the goal behavior for which you intend to replace the behavior targeted to decrease): 2

4 Student: School: Date: Behavior Targeted to Decrease 3: Definition written as an Operational Definition-observable, specific, and measurable terms: Frequency: Duration: Intensity: # (behavior count) per (hour, day, week, etc.) Setting Events Conditions that can influence the reaction to an antecedent (Example: lack of sleep, hunger, diagnosis, illness, medication, argument at home, etc.) Seconds Minutes Hours Triggers/Antecedents What is most likely to be happening before the behavior occurs (Example: unstructured time, transition, negative interaction with peer/adult, denial/delay of requests, change of routine, etc.) Mild (disruptive but not dangerous) Moderate (verbal/physical treats and/or destructive to physical environment) Severe (poses a physical danger to student and/or other) Consequences What happens after the behavior occurs (Example: behavior ignored, reprimand/ warning, time out, teacher attention, peer attention environmental changes, student emotional state, etc.) Function What does the student seem to obtain/avoid from the behavior (Example: avoidance of activity/request/ person, escape of classroom/schoolwork, get desired Attention, vengeance, intimidation, relief of fear/ boredom, etc.) Obtain or Avoid What is the student attempting to obtain/avoid? Hypothesis (When Antecedent the student will Behavior Targeted for Decrease in order to function): Desired Replacement Behaviors (Operational definition of the goal behavior for which you intend to replace the behavior targeted to decrease): Behavior Targeted for Decrease 3: Definition written as an Operational Definition-observable, specific, and measurable terms: Frequency: Duration: Intensity: # (behavior count) per (hour, day, week, etc.) Setting Events Conditions that can influence the reaction to an antecedent (Example: lack of sleep, hunger, diagnosis, illness, medication, argument at home, etc.) Seconds Minutes Hours Triggers/Antecedents What is most likely to be happening before the behavior occurs (Example: unstructured time, transition, negative interaction with peer/adult, denial/delay of requests, change of routine, etc.) Mild (disruptive but not dangerous) Moderate (verbal/physical treats and/or destructive to physical environment) Severe (poses a physical danger to student and/or other) Consequences What happens after the behavior occurs (Example: behavior ignored, reprimand/ warning, time out, teacher attention, peer attention environmental changes, student emotional state, etc.) Function What does the student seem to obtain/avoid from the behavior (Example: avoidance of activity/request/ person, escape of classroom/schoolwork, get desired Attention, vengeance, intimidation, relief of fear/ boredom, etc.) Obtain or Avoid What is the student attempting to obtain/avoid? Hypothesis (When Antecedent the student will Behavior Targeted for Decrease in order to function): Desired Replacement Behaviors (Operational definition of the goal behavior for which you intend to replace the behavior targeted to decrease): Data does not support a need for BIP development 3

5 Behavior Intervention Plan: Alternate Pathways Chart Directions: Use the information collected through the FBA to complete the chart. Insert a new Alternate Pathways Page for each identified behavior targeted to decrease. When completing the chart begin by filling in the Behavior Targeted for Decrease. Arrows indicate the flow of the occurrence of the behavior. Behavior Targeted to Decrease #1 Hypothesis: Setting Events: According to the FBA, conditions that can influence the reaction to an antecedent. Antecedent: According to the FBA, what happens right before the behavior (triggers). Desired Behavior: the desired replacement behavior) Identify incentives that outweigh the student s current pay off for the behavior targeted to decrease. 1 Behavior Targeted to Decrease the identified behavior of concern) Planned Consequences Identify teaching consequences to replace the current maintaining consequences. These consequences should aid in extinguishing the target behavior. Acceptable Alternative Behavior: the behavior that will be accepted as s/he progresses toward the desired behavior) Identify incentives that outweigh the student s current pay off for the target behavior. Strategies for Setting Events and Antecedent/Triggers Preventative Modifications/Accommodations What changes can be made to when and where the behavior occurs, assigned task, supervision and special equipment (including sensory tools)? How can strengths be built upon to empower the student? What changes can be made to minimize the effects of setting events? (Consider wait time, alternative task, transition routines, home/school communication, etc.) Strategies to Teach Based on identified skill deficits, what skills related to the setting events and/or antecedent/triggers does the student need to be taught at baseline in order for the student to successfully demonstrate the desired replacement behavior? 1

6 Behavior Intervention Plan: Alternate Pathways Chart Directions: Use the information collected through the FBA to complete the chart. Insert a new Alternate Pathways Page for each identified behavior targeted to decrease. When completing the chart begin by filling in the Behavior Targeted for Decrease. Arrows indicate the flow of the occurrence of the behavior. Behavior Targeted to Decrease #2 Hypothesis: Setting Events: According to the FBA, conditions that can influence the reaction to an antecedent. Antecedent: According to the FBA, what happens right before the behavior (triggers). Desired Behavior: the desired replacement behavior) Identify incentives that outweigh the student s current pay off for the behavior targeted to decrease. 1 Behavior Targeted to Decrease the identified behavior of concern) Planned Consequences Identify teaching consequences to replace the current maintaining consequences. These consequences should aid in extinguishing the target behavior. Acceptable Alternative Behavior: the behavior that will be accepted as s/he progresses toward the desired behavior) Identify incentives that outweigh the student s current pay off for the target behavior. Strategies for Setting Events and Antecedent/Triggers Preventative Modifications/Accommodations What changes can be made to when and where the behavior occurs, assigned task, supervision and special equipment (including sensory tools)? How can strengths be built upon to empower the student? What changes can be made to minimize the effects of setting events? (Consider wait time, alternative task, transition routines, home/school communication, etc.) Strategies to Teach Based on identified skill deficits, what skills related to the setting events and/or antecedent/triggers does the student need to be taught at baseline in order for the student to successfully demonstrate the desired replacement behavior? 2

7 Behavior Intervention Plan: Alternate Pathways Chart Directions: Use the information collected through the FBA to complete the chart. Insert a new Alternate Pathways Page for each identified behavior targeted to decrease. When completing the chart begin by filling in the Behavior Targeted for Decrease. Arrows indicate the flow of the occurrence of the behavior. Behavior Targeted to Decrease #3 Hypothesis: Setting Events: According to the FBA, conditions that can influence the reaction to an antecedent. Antecedent: According to the FBA, what happens right before the behavior (triggers). Desired Behavior: the desired replacement behavior) Identify incentives that outweigh the student s current pay off for the behavior targeted to decrease. 1 Behavior Targeted to Decrease the identified behavior of concern) Planned Consequences Identify teaching consequences to replace the current maintaining consequences. These consequences should aid in extinguishing the target behavior. Acceptable Alternative Behavior: the behavior that will be accepted as s/he progresses toward the desired behavior) Identify incentives that outweigh the student s current pay off for the target behavior. Strategies for Setting Events and Antecedent/Triggers Preventative Modifications/Accommodations What changes can be made to when and where the behavior occurs, assigned task, supervision and special equipment (including sensory tools)? How can strengths be built upon to empower the student? What changes can be made to minimize the effects of setting events? (Consider wait time, alternative task, transition routines, home/school communication, etc.) Strategies to Teach Based on identified skill deficits, what skills related to the setting events and/or antecedent/triggers does the student need to be taught at baseline in order for the student to successfully demonstrate the desired replacement behavior? 3

8 Behavior Intervention Plan: Detailed Intervention Description The detailed description included in the following page should enable individuals not involved in its development to effectively implement the plan. Use the strategies identified on the previous Alternate Pathways Chart and explain in detail their implementation. Please be as specific as possible in describing how it should be implemented. Add additional pages to continue explanations if necessary. Preventative Interventions Strategies to address the setting events and antecedents that will reduce the occurrence of the behavior targeted for decrease. Consider strategies to address the behavior related to: when and where the behavior occurs, modifications to task, supervision and special equipment (including sensory tools). Also incorporate opportunities to empower the student that build on student strengths (school or classroom jobs, responsibilities, etc.) Educative Strategies Skills the student will need to be taught at baseline in order for the student to successfully demonstrate the replacement behavior. Consider: social skills, communication skills, clarifying/re-teaching expectations, and academic skills. Staff Support Needs Identify any education and materials the staff will need to effectively implement the identified strategies. Reinforcement What will be done to INCREASE the occurrence of the replacement behavior? IDENTIFY REINFORCERS Preferred items, activities, and/or people. (refer to Possible Student Motivators on page 2 of FBA) Frequent (incentives that can be given immediately following the desired replacement behavior) Intermittent (incentives that can be given less frequently when the desired replacement behavior has been demonstrated over a specified time period) Intervention(s)/Strategies Frequency Location Person(s) Responsible BEHAVIOR CRITERIA Exactly what the student must do to earn the incentive. REINFORCEMENT SCHEDULE How often the student can earn the incentive. Monitoring How interventions will be tracked DELIVERY SYSTEM What will be used to monitor the behavior and incentives? Self-Monitoring System Point System Other: Continuum of Correction Procedures What will be done to DECREASE the occurrence of the behavior targeted for decrease. Explain the continuum of consequences that will be followed. Include who will be contacted (administration, counselor, parent, etc.) and when. (Examples: Planned ignoring, nonverbal reminder, private redirection, in-class separation, out-of-class separation, failure to earn privileges, administration referral, etc.) First Occurrence of the Behavior Second Occurrence of the Behavior Third Occurrence of the Behavior Staff Responsible for Teaching Plan: Date Plan Taught to Student: Date Plan Communicated to Staff: 4

9 Participants Behavior Intervention Plan: Evaluation Plan *Parental Signature Denotes permission to implement this BIP Date Signature, title Signature, title Signature, title Signature, title Evaluation Plan Data Monitoring: HOW frequently will data be reviewed and communicated to parents and team members? HOW will progress updates be communicated to parents and team members? WHO will communicate progress updates? WHEN will the team meet to evaluate the Intervention s effectiveness? WHAT criteria will determine the need to modify the plan? Review Updates: Review Date Summary of Data Analysis of data shows Action to be Taken Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Continue plan Modify plan Plan for generalization Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization 5

10 Review Updates: Review Date Summary of Data Analysis of data shows Action to be Taken Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Continue plan Modify plan Plan for generalization Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Desired decrease in target behavior Undesired increase in target behavior No change in targeted behavior Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization Continue plan Modify plan Plan for generalization 6