Preliminary Functional Behavioral Assessment



VTPBiS Intensive Level: Behavior Support PlanStudent: ________________________Grade: ______School: _________________________SU: _________________________Stages for Creating Behavior Support PlanStage 1: Teaming Individual Student Team RosterTeam Member NameTeam Member Role(e.g., student, parent, teacher)Day and Time of Scheduled Meetings: Recommended Meeting Agenda: Start with positives!Review all relevant dataBrainstorm ideas based on dataDiscuss, prioritize, make data-based decisionsGain consensus and implement agreed upon stepsStage 2: GoalsTeam identifies broad goals that they all agree will be focus for assessment & intervention.Broad Goal (positive, long-term goal for student)Pro-Social Behaviors to Increase (prioritize what behaviors you want to increase)Problem Behaviors to Decrease (prioritize what behavior to focus on in FBA)Stage 3: AssessmentFunctional Behavioral Assessment Behavior Support Plan (F-BSP) ProtocolFunctional Behavioral Assessment Interview –Teachers/StaffStudent Name ____________________________________ Age:____ Grade:____ Date:__________________Person (s) interviewed:____________________________________________________________________________Interviewer: ____________________________________________________________________________Student Profile: What is the student good at or what are some strengths that the student brings to school?________________________________________________________________________________________________STEP 1: INTERVIEW TEACHER/STAFF/PARENTDescription of the Behavior What does the problem behavior(s) look like?How often does the problem behavior(s) occur?How long does the problem behavior(s) last when it does occur?How disruptive or dangerous is the problem behavior(s)?Description of the AntecedentWhen, where, and with whom are problem behaviors most likely?Schedule(Times)ActivitySpecific Problem BehaviorLikelihood of Problem BehaviorWith Whom does Problem OccurLow High1 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 6 Summarize Antecedent (and Setting Events)9144019050What situations seem to set off the problem behavior? (difficult tasks, transitions, structured activities, small group settings, teacher’s request, particular individuals, etc.) When is the problem behavior most likely to occur? (times of day and days of the week)When is the problem behavior least likely to occur? (times of day and days of the week)Setting Events: Are there specific conditions, events, or activities that make the problem behavior worse? (missed medication, history of academic failure, conflict at home, missed meals, lack of sleep, history or problems with peers, etc.)00What situations seem to set off the problem behavior? (difficult tasks, transitions, structured activities, small group settings, teacher’s request, particular individuals, etc.) When is the problem behavior most likely to occur? (times of day and days of the week)When is the problem behavior least likely to occur? (times of day and days of the week)Setting Events: Are there specific conditions, events, or activities that make the problem behavior worse? (missed medication, history of academic failure, conflict at home, missed meals, lack of sleep, history or problems with peers, etc.) Description of the Consequence 91440152400What usually happens after the behavior occurs? (what is the teacher’s reaction, how do other student’s react, is the student sent to the office, does the student get out of doing work, does the student get in a power struggle, etc.)00What usually happens after the behavior occurs? (what is the teacher’s reaction, how do other student’s react, is the student sent to the office, does the student get out of doing work, does the student get in a power struggle, etc.)- - - - - - End of Interview - - - - - -STEP 2: PROPOSE A TESTABLE EXPLANATIONSetting EventAntecedentBehaviorConsequence1.2.Function of the Behavior For each ABC sequence listed above, why do you think the behavior is occurring? (to get teacher attention, to get peer attention, gets desired object/activity, escapes undesirable activity, escapes demand, escapes particular people, etc.)1._____________________________________________________________________________________________2._____________________________________________________________________________________________How confident are you that your testable explanation is accurate?Very sure So-soNot at all 6 5 4 3 2 1Functional Behavioral Assessment Interview – StudentsStudent Name _____________________ Age:____ Grade:____ Date:_________________Interviewer ______________________________________________________________________Student Profile: What are things that you like to do, or do well, while at school? (E.g. activities, classes, helping others, etc.)______________________________________________________________________________________________________________________________________________________________________________________STEP 1: INTERVIEW STUDENTDescription of the Behavior What are some things you do that get you in trouble or that are a problem at school? (e.g. talking out, not getting work done, fighting, etc.)How often do you _______________ ? ( Insert the behavior listed by the student)How long does __________________ usually last each time it happens?How serious is _________________? (Do you or another student end up getting hurt? Are other students distracted?)Description of the AntecedentWhere, when and with whom are problem behaviors most likely?Schedule(Times)ActivityWith Whom does Problem OccurLikelihood/Intensity of Problem BehaviorSpecific Problem BehaviorLow High1 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 61 2 3 4 5 6 Summarize Antecedent (and Setting Events)9144019050What kind of things make it more likely that you will have this problem? (difficult tasks, transitions, structured activities, small group settings, teacher’s request, particular individuals, etc.) When and where is the problem most likely to happen? (days of week, specific classes, hallways, bathrooms)When is the problem behavior least likely to occur? (days of week, specific classes, hallways, bathrooms)Setting Events: Is there anything that happens before or after school or in-between classes that make it more likely that you’ll have a problem? (missed medication, history of academic failure, conflict at home, missed meals, lack of sleep, history or problems with peers, etc.)00What kind of things make it more likely that you will have this problem? (difficult tasks, transitions, structured activities, small group settings, teacher’s request, particular individuals, etc.) When and where is the problem most likely to happen? (days of week, specific classes, hallways, bathrooms)When is the problem behavior least likely to occur? (days of week, specific classes, hallways, bathrooms)Setting Events: Is there anything that happens before or after school or in-between classes that make it more likely that you’ll have a problem? (missed medication, history of academic failure, conflict at home, missed meals, lack of sleep, history or problems with peers, etc.) Description of the Consequence 5143517780What usually happens after the problem occurs? (what is the teacher’s reaction, how do other student’s react, is the student sent to the office, does the student get out of doing work, does the student get in a power struggle, etc.)00What usually happens after the problem occurs? (what is the teacher’s reaction, how do other student’s react, is the student sent to the office, does the student get out of doing work, does the student get in a power struggle, etc.)- - - - - - End of Interview - - - - - -STEP 2: DEVELOP A TESTABLE EXPLANATIONSetting EventAntecedentBehaviorConsequence1.2.3.Function of the Behavior For each ABC sequence listed above, why do you think the behavior is occurring? (to get teacher attention, to get peer attention, gets desired object/activity, escapes undesirable activity, escapes demand, escapes particular people, etc.)1._____________________________________________________________________________________________2._____________________________________________________________________________________________3._____________________________________________________________________________________________STEP 3: RATE YOUR CONFIDENCE IN THE TESTABLE EXPLANATION9144015240If you completed both interviews, was there agreement on these parts? (Y/N)(a) Setting Events ___ (b) Antecedents ___ (c) Behaviors ___ (d) Consequences ___ (e) Function ___ How confident are you that your testable explanation is accurate?Very sure So-soNot at all 6 5 4 3 2 100If you completed both interviews, was there agreement on these parts? (Y/N)(a) Setting Events ___ (b) Antecedents ___ (c) Behaviors ___ (d) Consequences ___ (e) Function ___ How confident are you that your testable explanation is accurate?Very sure So-soNot at all 6 5 4 3 2 1STEP 4: CONDUCT OBSERVATIONS (IF NECESSARY)If student has an identified disability and is at risk of suspension, expulsion, or change in placement you must conduct an observation of studentIf student does not meet above criteria, but confidence rating is 1, 2, 3, or 4 you should conduct observations to better understand when, where, and why the problem behavior is occurring. If student does not meet above criteria, and confidence rating is 5 or 6, you may go directly to Step 6Summarize Observation DataSetting EventAntecedentBehaviorConsequence1.2.3.Function of the Behavior For each ABC sequence listed above, why do you think the behavior is occurring? (to get teacher attention, to get peer attention, gets desired object/activity, escapes undesirable activity, escapes demand, escapes particular people, etc.)1._____________________________________________________________________________________________2._____________________________________________________________________________________________3._____________________________________________________________________________________________STEP 5: CONFIRM/MODIFY TESTABLE EXPLANATIONWas there agreement between the Teacher Interview and the Observation? Y/Na) Setting Events ___ (b) Antecedents ___ (c) Behaviors ___ (d) Consequences ___ (e) Function ___ Was there agreement between the Student Interview and the Observation? Y/Na) Setting Events ___ (b) Antecedents ___ (c) Behaviors ___ (d) Consequences ___ (e) Function ___ Based on the interviews and observations, what is your working testable explanation for why the problem behavior occurs?____________________________________________________________________________________________________________________________________________________________________________________________________STEP 6: BUILD A COMPETING BEHAVIOR PATHWAY402336031242000265176030480Desired Behavior00Desired Behavior438912030480Consequence00Consequence210312049530005652135119380Function00Function2636520116205Problem Behavior00Problem Behavior-548640116205Setting Event00Setting Event1051560105410Antecedent00Antecedent4389120105410Consequence that meets the Function00Consequence that meets the Function64008012446000224028012446000402336012446000=41662354318000201168026670002661920140970Alternative Behavior00Alternative BehaviorSetting Event StrategiesAntecedent StrategiesBehavior Teaching StrategiesConsequence StrategiesSTEP 7: SELECT INITIAL INTERVENTION STRATEGIESStage 4: InterventionTasks (Organized by intervention strategy)Person ResponsibleBy WhenReviewDateDecisionMonitorModifyDiscontinueSetting Event StrategiesAntecedent StrategiesBehavior Teaching StrategiesConsequence StrategiesReinforcing alternative behaviorExtinguishing problem behaviorProactive Crisis Plan (from VT Coordinated Services Plan / Act 264)Teams are strongly encouraged to develop a proactive crisis plan if the child or youth is medically fragile, at risk for, or has ever been hospitalized in a psychiatric setting, or demonstrates risky and unsafe behaviors. Situation (triggers/stressors)Coping strategies (Describe skills, strategies, to prevent, reduce or de-escalate crisis)What is needed to feel safe in crisis?Key support people to contact – include names, relationship and contact information.What to do to manage the crisis?What NOT to doConditions for emergency room, police, hospitalPLEASE NOTE: There may be special or unusual circumstances that will require the responsible adults to modify the plan. Stage 5: EvaluationSTEP 8: EVALUATE PLAN Long & Short-Term Behavioral Goals Expected Date Long-term Goal increase replacement behaviorShort-term goal increase alternative behaviorShort-term goal decrease problem behaviorEvaluation ProceduresData to be CollectedProcedures for Data CollectionPerson ResponsibleTimelineIncreasing alternative / desired behaviorDecreasing problem behaviorFidelityPlan review date:_________________We agree to the conditions of this plan:_____________________________________________________________Student (date)Parent or guardian (date)_____________________________________________________________Teacher (date)Teacher (date)_____________________________________________________________Action Team member (date)Action Team member (date) ................
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