Functional Behavior Assessment

Section I: Description
Observation

Data Sources:
Student interview Parent interview (check Observation)

Date: _____October 19, 2015______

Subject/Activity: _____ELA/Independent Activity______
Assessed by: _________Megan Duffard______________
Student: ______Ron Smith_____________
Grade: _________Third Grade__________________
Location: ______Greens Prairie Elementary_________
Description of the behavior
Ron displays disrespectful/off-task behavior (gets out of seat or tells the teacher no).
Antecedent(s)
When Ron is given instructions to complete an independent work task, told to get back to work or
otherwise follow directions during class.

Setting(s) in which the behavior occurs

ELA, when he is seated at the small group table doing independent work.
Frequency of behavior
Every fifteen to twenty minutes as the teacher instructs him/redirects him.

Duration of behavior
On average, 3-5 minutes.
Consequences to peers, staff members, or instructional environment
Causes major distraction for peers, distraction for teacher, takes away valuable instruction/work
time.
Descriptions of or references to previous interventions
For independent work teacher usually assigns a paraprofessional to sit next to him and help him
complete his assignment.

Functional Behavior Assessment

Section II: Analysis of Function
Assessed by: _______________________________
Gain attention
Definitely wants attention from peers and wants to make people laugh. That is more fun to him
than doing the work.
Gain a tangible consequence
Gain a sensory consequence

Escape from or avoidance of an undesirable situation

This is an escape method for Ron because he does not want to do his work.
Affective regulation / emotional reactivity
Make a comment or declaration
Release tension
Fill a habitual need
Other

Type your hypothesis here using the format below:

When independent seatwork occurs in the context of the teacher giving directions/redirects, the student
exhibits disrespectful or off-task behavior in order to gain peer and teacher attention. The behavior is
likely to occur when the student is required to do independent seatwork for ELA.
When _______________________ occurs in the context of ________________________________
(antecedent)
(problematic setting)
the student exhibits ________________________ in order to __________________________________.
(target behavior)
(perceived function)
This behavior is more likely to occur when _________________________________________________.
(setting event/context variables)

Functional Behavior Assessment

Section III: Replacement Behavior
Assessed by: ______Megan Duffard_______

Replacement or competing behavior that could still serve the same function for the student:
___ Following teacher directions immediately, staying in seat and raising hand to ask for help
__________________________________________________________________________
Is the replacement behavior in the students repertoire, or will it need to be taught directly?
__It will need to be taught directly______________________________________________________
______________________________________________________________________________________
If so, how will it be taught? _______________________________________________________________
Explain to Ron that there are better ways to get attention such as raising his hand to ask a question or share
a comment/idea. Explain to him as well that if he does his independent work then the teacher will provide
opportunities for him to share his work with the class. Demonstrate and model for Ron what this looks like
and then have him practice. Show him what it will look like for him to receive positive attention as a
reward.
List some potential motivators for student:
Earning time to play an educational game with a friend, share completed assignment with class
_______________________________________________________________________________

Behavior Intervention Plan

Your Name: __________Megan Duffard________________________________
Student: _______Ron Smith______________________ Age: ____8_____ Grade: ______3rd____
School: ____Greens Prairie Elementary___ Special Education Teacher: __Erin Albers___________
Targeted problem behavior:
The student gets out of seat and refuses to follow
directions when given independent work to complete
Hypothesized function of the problem behavior:
The reason he chooses to remain off task and refuse to
follow directions is due to his desire to avoid work and
gain attention from peers.
Desired replacement behavior:
Ron will follow teacher directions immediately, stay in
his seat and raise his hand when he needs to ask a
question or wants to share a comment/idea.
Methods of teaching the replacement behavior:
direct instruction
anger management
providing cues
modeling
stress management
Other:
___________________________________________

social skills training

use of mentor(s)
role playing
behavior contract
decision-making
training

Methods of measuring progress:

direct observation
self-monitoring
charting/graphing
Other:_______________________________________

weekly behavior sheet

daily behavior sheet
number of discipline referrals

Positive consequences for displaying the replacement behavior:

verbal praise
immediate feedback
positive phone call home
tangible rewards
Other:_______________________________________

computer time
earned privileges
free time
positive visit to administrator

Behavior Intervention Plan (continued)

Your name: ______________Megan Duffard______

Negative consequences for displaying inappropriate behavior:

phone call home
time out
loss of privileges
physical management
in-school suspension
Other:
___________________________________________

send to office
level drop/loss of points (token economy)
detention
escort to another area
out-of-school suspension

Accommodations to assist the student in displaying the replacement behavior:

clear, concise directions
provide alternate recess
avoid strong criticism
frequent breaks/vary activities
provide cooling off period
specified study area
reprimand the student privately
communicate regularly with parents
avoid power struggles
modify assignments
Other:
____________________________________

supervise free time

frequent reminders/prompts
avoid physical contact
predictable, routine schedule
teacher/staff proximity
provide highly-structured setting
preferential seating
review rules & expectations
specifically define limits

Persons responsible for implementing the plan:

General education teacher(s)
Classroom assistant
Special education teacher
behavior intervention specialist
Other:
____________________________________
Additional Information:
At first, student may require hand over hand
assistance such as putting his hand and pencil
to the paper to redirect him along with verbal
directions. Student also will need frequent
reminders of rewards to motivate him to
choose positive behavior.

School administrator
Related service
provider (e.g., school
psychologist)
Parent

Persons involved in developing/approving

plan:
Title

Date

continue interventions

discontinue
interventions

Signature

Review date:

outcome
achieved

FBA/BIP Scoring Rubric

Criteria
FBA: Section I
Complete:
Data sources (youll check observation)
The information from Date to Location (use a pseudonym
or just your students first name)
All of the information in the box
FBA: Section II
Complete:
All of the information in the box
Each part of the hypothesis statement
FBA: Section III
Complete:
All of the information in the box*
*The only exception is if your student does not need to be directly
taught the replacement behavior. In this case, you wouldnt answer
the question If so, how will it be taught?
BIP
Complete:
The information from Your Name to Special Education
Teacher
All of the information in each of the boxes**
**The only exception is that you dont have to fill out the
Signature or Review date sections.

Possible
Points

Points
Earned

10
POINT TOTAL
Note: Half a point will be deducted from any one part of the form that is not completed. If you
complete each section, you will earn full credit (5 points) for each of the assignments.