FUNCTIONAL BEHAVIORAL ASSESSMENT
BEHAVIOR INTERVENTION PLAN

								 review date(s) 	modifications made
Student:  							__________	yes____no____       
School:   							__________	yes____no_____    
Grade:	   							__________	yes____no_____     
Date:	   							__________	yes____no_____     
								__________	yes____no_____ 
I.  PROBLEM IDENTIFICATION	    
	
A.	Description of Problem Behavior(s)

	B.  Impact on school functioning

II.  PROBLEM ANALYSIS

A.	Antecedents

	B.  Consequences

	C.  Summary Statement(s)
      (Include supporting data)

	D.  Influences

1.	Skill or cognitive deficits

2.	Health or medical status

3.	Ecological factors

4.	Affective regulation/emotional reactivity

5.	Cognitive distortions

6.	Identified disorders

7.	Screening for possible disorders

8.	Motivational characteristics

9.	Student strengths	

III. INTERVENTION PLANNING AND IMPLEMENTATION

	A.  Goals or Expected Changes in Behavior

	B.  Interventions

	Ecological:  Specific ways of altering the student’s physical, programmatic [including  curriculum and 	
	instruction] and/or interpersonal environment for the purpose of preventing the problem behavior/s from 	
	occurring.

	Alternative Skills:  Specific instructional strategies to help the student develop more effective ways of 	
	accessing the function of their behavior, i.e. teach appropriate communication skills [social skills, refusal 	
	skills], teach choice making and schedule building strategies, increase the student’s ability to tolerate or 	
	cope with unavoidable, naturally occurring aversive events in an appropriate manner.

	Direct Treatment:  Intervention strategies are made with the objective of producing the most rapid 	
	reduction in problem behavior. Examples include reinforcement for not engaging in problem behavior, as 	
	well as stimulus control [removal of stimuli known to cause behavior], instructional control, providing 	
	attention and stimulus satiation strategies like attention given noncontingently.  Other examples would 	
	include strategies that would be used for typical ‘general education’ students; i.e. reinforcing appropriate 	
	behavior, chances to earn time with preferred activities,  earning time with preferred individuals, etc.

	Reactive Strategies:  Recommendations are made for positive means of responding to behavioral 
	episodes.  Examples include active listening and stimulus change strategies.  These de-escalation strategies 	
	are designed to help the student regain self-control without the use of isolated time-out or physical restraint.

	Emergency Management: