Functional Behavior Assessment

Section I: Description
Data sources: Observation
Date: October 7, 2015
Grade: 1st
Assessed by: Sarah Emmott

Student interview Parent interview

Subject/Activity:
Student: Damien
Location: College Hills Elementary

Description of the behavior

Kicking teachers and peers
Antecedent(s)
Unstructured free time with little or no teacher attention
Setting(s) in which the behavior occurs
Classroom
Playground
Lunch room
Frequency of behavior
Often when he is not receiving any teacher attention
Times per day on 10/5: 9 times
Duration of behavior
1 Kick = > 3seconds
Consequences to peers, staff members, or instructional environment
Check on injured student
Ignore the targeted behavior
Redirect to new activity
Descriptions of or references to previous interventions
Helpful interventions:
Specific praise for appropriate interactions
Positive reinforces (i.e. Bread, marshmallows, fidgets)
Interventions proven to not be helpful:
Ignoring targeted behavior with no redirecting

Functional Behavior Assessment

Section II: Analysis of Function
Assessed by: Sarah Emmott

Gain attention

Gain a tangible consequence

Gain a sensory consequence
Escape from or avoidance of an undesirable situation
Affective regulation / emotional reactivity
Make a comment or declaration
Release tension
Fill a habitual need
Other

Hypothesis:
When unstructured/free time occurs in the context of the classroom or recess the student
exhibits kicking in order to gain attention form the teacher. This behavior is more likely to occur when
the teacher is in low proximity.

Functional Behavior Assessment

Section III: Replacement Behavior
Assessed by: Sarah Emmott

Replacement or competing behavior that could still serve the same function for the student:
Prompting Damien to ask for high fives when he is with his peers to show what an
appropriate interaction looks like.

Is the replacement behavior in the students repertoire, or will it need to be taught directly?
Giving high fives is in Damiens repertoire. However, getting him to ask other peers for a
high five and teaching him how to play with them appropriately needs to be taught directly.

If so, how will it be taught?

Teaching Damien how to ask other peers for a high five and how to play with them
appropriately needs to be taught using an I do, we do, you do type of instruction. By
modeling and practicing with Damien about how to play appropriately with peers will help
get him in the habit of waving/giving high fives instead of kicking.

List some potential motivators for student:

Swing
iPad
Marshmallows
Bread

Behavior Intervention Plan

Your Name: Sarah Emmott
Student: Damien

Grade: 1st

Age: 7

School: College Hills Elementary

Special Education Teacher: Mrs. Henderson

Targeted problem behavior:

Kicking peers and teachers
Hypothesized function of the problem behavior:
Attention seeking
Desired replacement behavior:
Request attention appropriately
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: Sarah Emmott

Negative consequences for displaying inappropriate behavior:

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

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

Other: Ignore targeted behavior and redirect

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 (Recess)

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:
____________________________________

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

Additional Information:
n/a
Persons involved in developing/approving
plan:
Title

Date

continue interventions

discontinue
interventions

Signature

Review date:
achieved

outcome

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.