Functional Behavioral Assessment Worksheet
Perry Central School District Functional Behavioral Assessment Worksheet
Student Grade Date
Referral Source Evaluator
Identify and define up to two target behaviors that most interfere with the child’s functioning in the classroom. Assess or directly observe the frequency (how often), intensity (high, Medium, low), and duration of each.
|Behavior(s) |Frequency |Intensity |Duration |
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List distant predictors identified during interviews/observations (e.g., hunger, lack of sleep, problems on the bus).
Identify any precursor behaviors (behaviors exhibited before larger, more intense behavioral episodes), including the reported behavior chain (typical sequence of events).
Immediate Antecedents and Consequences
From the following list, select the conditions that appear to predict and support each problem behavior. Include the triggers, problematic settings and activities, and consequences.
Triggers/Antecedents Problematic settings/activities Consequences
( Lack of social attention ( Independent seatwork ( Behavior ignored
( Demand/request ( Group instruction ( Reprimand/warning
( Difficult task ( Crowded setting ( Time-out
( Transition (task/setting) ( Unstructured activity ( Loss of incentives
( Specific time of day ( Unstructured setting ( Sent to office
( Interruption in routine ( Academic downtime ( Home communication
( Negative social interaction ( Special subject ( In-school suspension
( Consequences imposed ( Specific task/subject ( Out-of-school suspension
( Specific people (list) (List) ( Restraint
( Other ( Other
( Other ( Other
Comments
Instructional and Communicative Needs
Is the student’s problem behavior believed to be related to skill deficit or communication needs? (Check any that apply.)
Skill deficits Communication Needs
Academic deficit Behavioral deficit Communicative intent
( Work is too hard ( Lacks the expected behavior ( To request assistance
( Not enough practice ( Needs practice/modeling ( To request a break
( Not enough help ( Requires more structure ( To indicate a need
( Skill not generalized ( Can’t apply skill across settings ( To indicate frustration
( Other ( Other ( Other
Comments
Functions of Behavior
What function(s) do the identified behavior(s) seem to serve for the child?
Attention/control Gain desired item, activity, area Sensory/perceptual feedback
To gain something:
( Gain adult attention ( Gain access to a desired item ( Gain automatic sensory
( Gain peer attention ( Gain access to a desired activity stimulation
( Get attention of a preferred adult ( Gain access to a desired area ( Gain Perceptual reinforcement
( Other ( Other ( Other
To escape or avoid something:
( Avoid a demand or request ( Avoid a person ( Other
( Avoid an activity/task (if known)( Escape the school ( Other
Comments
Functional Theory Statement
State hypothesis about behavior in the following form:
When occur(s) in the context of ,
(triggers/antecedents) (settings/activities)
The student displays in order to ,
(target behavior(s)) (perceived function)
and these behavior(s) may be related to .
(skill deficit/communicative intent, when present)
Replacement behaviors, problem-free times, and potential motivators
Replacement behaviors: What competing adaptive behavior could replace each target behavior and still serve the same function for the student?
When, where, and with whom is the target behavior typically not displayed?
List some potential incentives or motivators for the student.
Assessment-to-Intervention Worksheet
Student Grade Date
|Assessment Information |
|Predictive Conditions |Behavior |Consequences/Function |
|Distant: |Desired: | |
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|Precursor behavior: |Problem: | |
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|Antecedents: |Replacement: | |
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( ( (
|Intervention Components |
|Prevention |Teaching/support |Alter Consequences |
|Distant: |Address skill deficits: |New consequences for problem behavior: |
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|Precursor behavior: | | |
| |Teach replacement behaviors: |Reinforcement and monitoring ideas to promote replacement behavior: |
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|Antecedents: | | |
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Behavior Intervention Plan Worksheet
Student Grade Date
Behavioral Goals
State in observable, measurable terms, related to target behaviors.
Detail changes made to prevent the problem (antecedent and setting manipulations):
Indicate teaching and support plan to teach replacement behaviors and address identified skill deficits:
Intervention Steps/Components
Include each step of the interventions, persons responsible, and where and when it will occur. Attach specific intervention forms as applicable. For each intervention:
• Indicate replacement behavior/roles and how they will be reinforced.
• Identify new consequences imposed for each negative behavior.
• Include a crisis plan for unsafe behavior (if applicable).
Monitoring Student Progress
How will progress be monitored, how often, and by whom?
Monitoring Plan Integrity
How will plan implication be monitored, how often, and by whom?
Number of instructional weeks before plan will be evaluated
Plan review date
Plan Evaluation
Indicate student progress toward identified goals.
Indicate the extent to which the intervention was implemented as designed.
How many instructional weeks was the intervention applied?
Plan Revisions
Indicate any revisions made to plan.
Next review date
Analyzing Behavior Problems: Assessment Chart
Consider Skill Deficit ( Consider Communicative Intent ( Behavior Functions (“Payoff” for negative behavior(s))
(
( Behavioral Skill Deficit
• Not motivated
• Does not know the expected behavior
• Not enough practice
• Not enough structure
• Not able to generalize behavior across settings
( Academic Skill Deficit
• Not motivated
• The work is too hard – the student can’t accurately respond; instructional mismatch
• Not enough practice – needs more time to build fluency
• Not enough help – needs more support to build fluency
• Not had to do it that way before – needs to generalize skills
( Communicative Intent
The student uses negative behavior to communicate needs, desires, and emotions. Target behavior appears intended to:
• Request assistance
• Indicate physiological discomfort
• Request a break
• Indicate frustration
• Request a preferred activity/item
• Other
( Attention
The student finds the social attention gained from peers or adults for misbehavior to be rewarding.
( Gain Desired Item, Activity, Area
The student uses inappropriate behavior as a strategy to gain access to desired items, activities, or area.
( Sensory/Perceptual
The student uses self-simulative, self-injurious, or stereotypic behavior as a source of automatic sensory or perceptual reinforcement.
( Escape/Avoidance
The student uses inappropriate behaviors as a strategy to stop or avoid unpleasant academic or social demands
Analyzing Behavior Problems: Intervention Chart
Consider Skill Deficit ( Consider Communicative Intent ( Behavior Functions (“Payoff” for negative behavior(s))
(
( Behavioral Skill Deficit
Teach, model, and reinforce the desired behavior.
• Provide motivator to increase performance.
• Teach expected behavior through modeling, practice, and feedback.
• Provide opportunities to practice and receive positive feedback.
• Modify setting to optimize correct performance.
• Provide opportunity for feedback across settings.
( Academic Skill Deficit
Use instructional techniques to promote accuracy, fluency, and generalization of skills.
• Provide motivator to increase performance.
• Too hard? Assess student’s skills, modify curriculum, ensure instructional match.
• Need more practice? Increase active responding opportunities, use drill and practice techniques and structured teaching tasks.
• Need more assistance? Increase performance feedback. Consider use off response cards, choral tasks, and peer tutors.
• Need to generalize skills? Design applied tasks, promote recognition of when to apply the skill (and when not to), ensure curricular demands to promote skill mastery.
( Functional Communication Training
Teach the specific verbal phrases (or if nonverbal, use appropriate communicative cues) to address each of the areas identified in the assessment stage (e.g., solicit adult attention, request assistance, request a break from task).
( Steps
• Instruct student in the use of communicative phrase/cues.
• Differentially reinforce (e.g., with praise, attention, task assistance, a break) the functional communication.
• Ensure that negative behavior is no longer reinforced with a functional consequence (see Behavior Functions column).
( Attention
Teach adaptive behavior/appropriate ways to solicit attention. Use praise and opportunities for social attention as a reinforcement for adaptive behavior (consider peer tutoring/mentoring, reading to younger students, and enlisting the student in a special role as potential reinforcers). Also ignore or decrease attention for negative behavior (e.g., use time-out).
( Gain Desired Item, Activity, Area
Turn desired item, activity, area (or person) into an incentive for positive behavior. Teach adaptive behavior that will result in access to identified reinforcer. Ensure that negative behavior does not result in access to reinforcer.
( Sensory/Perceptual
Interrupt automatic reinforcement. Teach alternative/adaptive behavior. Provide incentives offering sensory stimulation (e.g., furry item, Koosh ball, music) as reinforcers to promote positive competing/alternative behaviors.
( Escape/Avoidance
Teach cues to solicit assistance with difficult tasks. Increase support for student to persist; reinforce effort. Look for ways to increase attractiveness of unpleasant demands. Ensure that negative behavior does not result in avoidance of work demands (e.g., student can make up incomplete assignments during free time or after school).
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