Page of Brevard Public Schools Functional Behavioral Assessment

Page ___ of ___ Brevard Public Schools Functional Behavioral Assessment (FBA) and Behavioral Intervention Plan (BIP) Student: Student #: Exceptionalities: D. O. B: Grade: Date of Implementation: Records Review: Participants (Print names of those involved in assessment/interventions) Name School: Title (check those which apply) Academic/Cum/Audit Disciplinary Records Anecdotal Records Evaluations/Assessments Previous Interventions Progress Notes to Family IPST Notes Samples of Student’s Work Other: Records reviewed by: Relevant Information: Include: medications, med administration issues, medical diagnoses, any Pertinent family information. Rational for Assessment and Interventions Student is engaging in behavior that places the student or others at risk of harm and/or results in substantial property damage. Behavioral concerns are resulting in exclusion from participation in activities or settings with peers. Educational team is considering a more restrictive placement due to behavior concerns. Current intervention involves excessively intrusive interventions (e. g. restraint, isolation. ) Student’s behavioral difficulties persist despite consistently implemented behavior management strategies based on a less comprehensive or systematic assessment. Motivators/Reinforcers: List items, activities, persons that are preferred by the student Review of FBA/BIP by CBA: (Reviewers must date and sign at the time of review_ This section is for the Behavior Analyst Other: (signature and date) 12/19/12 FBA/BIP - Comprehensive

Student: Student #: Date: School: Page __ of __ Target behavior #1: Name the behavior of interest Define target behavior: (What does it look like? ) Be specific: describe the behavior so it can be observed & measured – you can’t measure frustration How often does it occur? This can be an estimate but best to have some initial How long does it last? Momentary or include (i. e. 2 x’s a day, 5 x’s per week) baseline numbers (% correct, freq. , duration) (i. e. 3 -5 minutes, 30 seconds) duration data Severity of behavior: The duration is for behaviors that occur over periods of time : off-task; if Mild: Little risk to property or health/disruption to class 5 minutes or less per hour Moderate: Property damage or minor injury/disruption to class 5 – 10 minutes per hour behaviors are single events look at threat to safety. Severe: Profound threat to health or safety/disruption to class 10 minutes or more per hour Situations when the behavior is most likely to occur: (i. e. times of day, activity, subject, specific people present) List environments, classes, subjects, times of day, people that behavior occurs around. This may give an idea of behaviors occurring in the presence of particular persons, places, things, activities. Antecedents: What happens immediately before the target behavior occurs? List everything you can think of that happens right before the behavior occurs. Function/purpose of behavior: Student receives attention (+/-) from peers Situations when the behavior is least likely to occur: (i. e. times of day, activity, subject, specific people present) List environments, classes, subjects, times of day, people that are present when the behavior does not occur or is likely not to occur. Consequences: List everything that occurs when the behavior is exhibited. Include staff and peer reactions, discipline measures, administrative actions, etc. Student receives access to: Student receives attention (+/-) from adults Behavior is self stimulating/entertaining and/or feels good Behavior relieves discomfort or pain 12/19/12 What happens immediately after the target behavior occurs? Student avoids/escapes: (Specify/Describe) Preferred items/materials Preferred activities What is accessed? Preferred people/social situations (Specify/Describe) Non-preferred tasks/demands Non-preferred activities What is avoided? Non-preferred people/social situations FBA/BIP – Comprehensive

Student: Student #: Date: School: Page __ of __ Target behavior #2: Define target behavior: (What does it look like? ) How often does it occur? How long does it last? (i. e. 2 x’s a day, 5 x’s per week) (i. e. 3 -5 minutes, 30 seconds) Severity of behavior: Mild: Little risk to property or health/disruption to class 5 minutes or less per hour Moderate: Property damage or minor injury/disruption to class 5 – 10 minutes per hour Severe: Profound threat to health or safety/disruption to class 10 minutes or more per hour Situations when the behavior is most likely to occur: Situations when the behavior is least likely to occur: (i. e. times of day, activity, subject, specific people present) Antecedents: Consequences: What happens immediately before the target behavior occurs? Function/purpose of behavior: Student receives attention (+/-) from peers Student receives access to: Student receives attention (+/-) from adults Behavior is self stimulating/entertaining and/or feels good Behavior relieves discomfort or pain 12/19/12 Student avoids/escapes: What happens immediately after the target behavior occurs? Preferred items/materials Preferred activities Preferred people/social situations (Specify/Describe) Non-preferred tasks/demands Non-preferred activities Non-preferred people/social situations FBA/BIP – Comprehensive

Student: Student #: Date: School: Page __ of __ Target behavior #3: Define target behavior: (What does it look like? ) How often does it occur? How long does it last? (i. e. 2 x’s a day, 5 x’s per week) (i. e. 3 -5 minutes, 30 seconds) Severity of behavior: Mild: Little risk to property or health/disruption to class 5 minutes or less per hour Moderate: Property damage or minor injury/disruption to class 5 – 10 minutes per hour Severe: Profound threat to health or safety/disruption to class 10 minutes or more per hour Situations when the behavior is most likely to occur: Situations when the behavior is least likely to occur: (i. e. times of day, activity, subject, specific people present) Antecedents: Consequences: What happens immediately before the target behavior occurs? Function/purpose of behavior: Student receives attention (+/-) from peers Student receives access to: Student receives attention (+/-) from adults Behavior is self stimulating/entertaining and/or feels good Behavior relieves discomfort or pain 12/19/12 Student avoids/escapes: What happens immediately after the target behavior occurs? Preferred items/materials Preferred activities Preferred people/social situations (Specify/Describe) Non-preferred tasks/demands Non-preferred activities Non-preferred people/social situations FBA/BIP – Comprehensive

Student: Student #: Date: School: Page __ of __ Target behavior #4: Define target behavior: (What does it look like? ) How often does it occur? How long does it last? (i. e. 2 x’s a day, 5 x’s per week) (i. e. 3 -5 minutes, 30 seconds) Severity of behavior: Mild: Little risk to property or health/disruption to class 5 minutes or less per hour Moderate: Property damage or minor injury/disruption to class 5 – 10 minutes per hour Severe: Profound threat to health or safety/disruption to class 10 minutes or more per hour Situations when the behavior is most likely to occur: Situations when the behavior is least likely to occur: (i. e. times of day, activity, subject, specific people present) Antecedents: Consequences: What happens immediately before the target behavior occurs? Function/purpose of behavior: Student receives attention (+/-) from peers Student receives access to: Student receives attention (+/-) from adults Behavior is self stimulating/entertaining and/or feels good Behavior relieves discomfort or pain 12/19/12 Student avoids/escapes: What happens immediately after the target behavior occurs? Preferred items/materials Preferred activities Preferred people/social situations (Specify/Describe) Non-preferred tasks/demands Non-preferred activities Non-preferred people/social situations FBA/BIP – Comprehensive

Student: Preventative Interventions: What environmental adjustments will be used to make the student’s problem behavior no longer necessary? • Modifying physical settings or routines • Modifying staff approaches • Clarifying expectations • New processes of monitoring/reporting progress Interventions for Replacement Behaviors: What behaviors will you teach so that the student no longer needs to engage in the target behavior(s) to get this need met? 12/19/12 Student #: Date: School: Page __ of __ This section is for changes in the environment that make the behavior unnecessary • Provide choices (places to sit, assignments to complete, etc) • Transition supports: timers, cues, warnings • Environmental Supports: visual schedules, timers, Rearrange seating/class set up • Curricular Modifications: smaller assignments, easy tasks before more difficult. • Adult Verbal Behavior: positives vs. reprimands, do’s vs. don’ts. • Communication with caregiver: knowledge is power. Ex: lack of sleep, argument with family/peer. • Provide non-contingent opportunities for pro-social behavior: leadership duties • Peer modeling, • Provision of manipulatives to assist with hyperactivity/increased motor movement. • Set expectations prior to times behavior is most likely to occur. • Match instructional level to student’s academic level. • Provision of clear and consistent routines & schedules. • Provision of prompts to request help/ ask for breaks List the behaviors that are more acceptable than the target behavior and serve the same hypothesized function. List any skills that the student may lack (skill deficits – these are behaviors that will need to be taught as the student does not have them in their repertoire). Examples: • Specific academic skills: i. e handwriting • Problem solving strategies: asking for assistance • Anger management strategies: breathing, counting, etc. • General coping strategies: relaxation, calm area • Specific social skills: appropriate communication, respect, consideration • Teacher pleasing Behaviors: passive listening, hand raising, in-seat behavior, etc. • Learning skills strategies: acronyms, memorization • Self-Management (self-monitoring): personal checklist • Delayed gratification: fading out schedule of rewards • Independent responding • Increased engagement time (time on-task) FBA/BIP - Comprehensive

Student: Functional Interventions: How will the environment change when the student engages in the desired replacement behavior(s)? • Student will receive access to preferred items, activities, social situations • Positive attention from others • Free time • Tokens, stickers, special recognition How will the environment change when the student engages in the problem behavior? • Student is ignored • Student not permitted access to preferred items, activities, social situations Student #: Date: School: Page __ of __ This section should include how to reinforce the student when the replacement behavior occurs & what to do when the target behavior occurs. • Reinforce replacement behavior: (praise for attention, tangibles for access, breaks for escape) • Examples: praise, positive phone calls home, points/stickers, Daily Progress Reports, Check In/Check Out, Proximity control, attend to hand raising, provision of breaks upon work completion, token systems, access to preferred activities upon on-task behavior, First/Then. • Discontinue hypothesized reinforcement of problem behavior (ex. if attention typically follows the behavior then minimize attention). This must occur otherwise interventions will not be successful. • Group Interventions for additional training: • Social skills, Anger management, Coping, Problem Solving, Conflict Resolution, group contingencies, token systems • School to home reinforcement systems • Establish crisis intervention (what is going to be done when the behavior occurs). • Examples: Time Out, Removal Time Out, Planned Ignoring, Blocking/Redirection/Set Limits, Response –Cost measures, Administrative action, phone call home, loss of privilege Crisis Management Plan: District approved techniques will be used as warranted to prevent crisis situations from arising, facilitate de-escalation of potentially dangerous behavior, and to ensure safety of self and others. Monitoring (By whom and how will data be collected to monitor progress? ): Teacher will maintain daily data collection on form attached. Evaluation (By whom and when will the Behavioral Intervention Plan be reviewed and/or revised? IPST/IEP Team will review data and modify interventions in this plan: 12/19/12 FBA/BIP - Comprehensive