FUNCTIONAL BEHAVIORAL ASSESSMENT
BEHAVIOR INTERVENTION PLAN

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

____ talks to peers during instruction		____ verbal/written threats to harm others
____ is easily distracted by others			____ verbal/written threats to harm	self		 
____ property destruction, other’s or school’s	____ profane/threatening gestures uses 
____ elopement (attempting to or running away)	____ inappropriate noises (i.e., tapping desk, shuffling papers)
____ lack of respect for authority figures		____ rude/profane/inappropriate language 
____ self-stimulation				____ is picked on by other students
____ stealing					____ daydreams 
____ excessive tardies				____ sleeping in class
____ absenteeism					____ (circle what applies) inattention, impulsivity, over-activity				
____ self-injurious behavior
   
 Associated academic problems (these have been suspected or demonstrated):

____ poor reading skills				____ poor hearing
____ poor writing skills				____ appears to process things slowly
____ poor math skills				____ poor eyesight
____ poor memory				____ poor cognitive/learning ability
____ blocks of information/knowledge missing	____ boredom (material too difficult)
____ boredom (material too easy)			____ boredom (student feels material is irrelevant)
____ boredom (intolerant of continuous presentations of materials he/she feels has already been mastered)							
____ passively refuses to do academic work as directed
____ actively/aggressively refuses to do the assigned academic work
____ incomplete work or homework
____ seems overly frustrated by the academic work
____ speech and/or language difficulties (describe): ___________________________________________________
_____________________________________________________________________________________________
____ may try to comply with demands, but lacks the skills in knowing how to do this appropriately
               
B.	Impact on school functioning

How the behaviors affect participation in the general ed. class, extracurricular activities and ability to conform to schools discipline code.  The student’s responses to disciplinary methods should be described.  How do the behaviors affect the learning of the student or others?

II.  PROBLEM ANALYSIS

A.	Antecedents

When do these problem behaviors occur?			Locations/Settings

____ asked to do something (academic/social) new		____ general classroom
____ asked to engage in a difficult task			____ resource room
____ asked to do something learned			        ___ reading			
____ hallways / transition times				        ___ language			
____ asked to go somewhere				        ___ spelling					
____ stopped from doing something			        ___ math							
____ teacher reprimand					        ___ social studies/science							        
____ a change/interruption in classroom routine		____ playground / recess / breaks							        
____ lack of social attention				____ other unstructured settings
____ when peer/s act out					____ lunchroom /	breakfast		
____ transition from task to task				____ music/art/library/gym (circle which one applies)
____ transition between settings				____ independent seat work
____ peer teasing/bullying					____ small group instruction
____ positive social interaction from others 			____ one on one instruction
____ consequences imposed for inappropriate behavior	____ unstructured class activity
____ student is alone					____ associated with peer attention
____ unknown cause (“out of the blue”)			____ associated with adult attention

Setting Events:

____ medication related (i.e., lack of, side effects)
____ lack of sleep
____ illness, not feeling well
____ physical pain
____ hunger
____ trouble at home
____ fight/conflict with peers
____ noise in environment/distractions
____ class demands too hard
____ class demands are boring
____ teacher instructions are unclear/inconsistent
____ teacher instruction is long
____ expectations/routine of classroom unclear 

	B.  Consequences
 
	Payoffs for the student						Environmental reactions (these usually maintain or reinforce the problem behaviors)

____ Power/control (when student’s outcome is			____ student is ignored (at desk or time-out used)
the control of events and/or situations,				____ student given attention (from other
characterized by student acting out to stay			students or teacher talks to student about behavior/task)
in situation and keep control or to obtain			____ redirects student back to task			
certain objects or to obtain a feeling of power)			____ verbal reprimand or warning given			
								____ loss of card/points/activity				
____ Avoid/Escape (when student’s outcome is			____ sent outside room				
to avoid a task/activity/person; to escape a 			____ sent to office
consequence; or to terminate or leave a situation)		____ in-school suspension			 
								____ out-of-school suspension						
____ Attention (when the student becomes the focus of		____ immediate verbal reactions just prior				
a situation; draws attention to self; result is that			to an expected behavior or during behavior
he/she puts self in the foreground of the situation;			 
discriminates self from group for a period of  time				
distinguishing feature is that becoming the focus		
is the end product of the behavior)
								 
____ Activity or Item (outcome for student is to gain 
access to a game, toy, food, money or a preferred task)

____ Acceptance / affiliation (when outcome for the		        
student is to connect/relate with others; mutuality
of benefit is present)						 
								 
____ Expression of self (outcome for the student is a
form of expression; could be statement of needs	
or perceptions, or a demonstration of skill/talent)
								
____ Gratification (outcome for student is self-reward/enjoyment;
distinguishing characteristic is self-directed; others may play 
a role, but self-reward is the outcome of the activity / behavior)

____ Justice / Revenge (outcome for student is settling a difference; restitution or     
contrition are usually involved; settling the score)

____ Sensory / Stimulation _________________________________________________

____ Initiates social contact _______________________________________________

____ Allows expression of emotions to reduce stress _____________________________
	
	C.  Summary Statement(s)
      (Include supporting data)

	D.  Influences

1.	Skill or cognitive deficits

Any skill or cognitive deficits that might relate to the problem behavior are described and the relationship to the problem behavior discussed.  Include here, when appropriate, if the problem behavior itself might be a skill deficit, or possibly a performance deficit.

2.	Health or medical status

As it helps understand the problem behavior, the general health of the student is described.  Any recent illness, operations, seizure activity, blank or staring spells, etc. are discussed at they might relate to the problem behavior.  Medications the student is taking are listed with purpose and possible side-effects considered.

3.	Ecological factors

Aspects of the physical environment, social system, and educational program as they possibly conflict with the student’s needs and characteristics are described.  Consider…number of people present, reinforcement and preference value of materials available, nature of instructional strategies used in programming, expectations of others in classroom concerning the student, difficulty level or interest level of activities, noise, crowding, etc.

4.	Affective regulation/emotional reactivity

Emotional factors; anxiety, depression, anger, poor self-concept; that play a role in organizing or directing problem behavior(s), are identified.

5.	Cognitive distortions

Any distorted thoughts; inaccurate attributions, negative self-statements, erroneous interpretations of events; that play a role in organizing or directing problem behavior(s) are identified.  Examples are:  trouble accepting responsibility, perception that others are out to get him.  

6.	Identified disorders

Any known disorders the student has that could help explain the problem behavior(s) are stated and relationship to problem behavior(s) discussed.

7.	Screening for possible disorders

File contains records of interviews, behavior rating scales or other methods used to screen or possible disorders that might help explain the problem behavior(s).  Included are methods for screening ADHD, depression, autism spectrum disorder, oppositional defiant disorder, anxiety disorder, etc.

8.	Motivational characteristics

Preference, likes and dislikes, are described.  Satiation levels are indicated and or further assessment in this area are described and recommended.  What rewards does student have access to at home?  Do rewards need to be presented immediately or can they be delayed?  Can student work for long periods of time or does the student require frequent breaks.

9.	Student strengths
	
The strengths of the student, especially those that can be tapped and supported to help reduce problem behavior or gain alternative skills are identified.

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.

	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:
  
	Examples may include isolated time-out, physical restraint, calling police, etc.

10.	Assignment of Responsibilities 
(Include analysis of resources)

IV. MONITORING AND EVALUATION

TEAM:

Name:				Position:	        Name:				Position:

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