Functional Behavior Assessment (FBA)

Student’s Name:

Student’s Date of Birth:

Gender:

Date of Interview:

Interviewer:

Respondents:

1. For EACH of the behaviors of concern, define the topography (how it is performed), frequency (how often it occurs per day, week, or month), duration (how long it lasts when it occurs), and intensity (how damaging or destructive the behaviors are when they occur).

Behavior

Topography

Frequency

Duration

Intensity

a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

2. Which of the behaviors described above are likely to occur together in some way? Do they occur about the same time? In some kind of predictable sequence or “chain”? In response to the same type of situation? Discuss in detail.

1. What medications is the person taking (if any), and how do you believe these may affect his or her behavior?

2. What medical or physical conditions (if any) does the person experience that may affect his or her behavior (e.g., asthma, allergies, rashes, sinus infections, seizures, problems related to menstruation)?

3. Describe the sleep patterns of the individual and the extent to which these patterns may affect his or her behavior.

4. Describe the eating routines and diet of the person and the extent to which these may affect his or her behavior.

5.

a. Briefly list below the person’s typical daily schedule of activities. (Check the boxes by those activities the person enjoys and those activities most associated with problems.)

Time

Activity Description

Enjoys

Problems

6:00 AM

7:00

8:00

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4;00

5:00

6:00

7:00

8:00

9:00

10:00

b. To what extent are the activities on the daily schedule predictable for the person, with regard to what will be happening, when it will occur, with whom, and for how long?

c. To what extent does the person have the opportunity during the day to make choices about his or her activities and reinforcing events? (e.g., food, clothing, social companions, leisure activities)

6. How many other persons are typically around the individual at home, school, or work (including staff, classmates, and housemates)? Does the person typically seem bothered in situations that are more crowded and noisy?

7. What is the pattern of staffing support that the person receives in home, school, work, and other settings (e.g., 1:1, 2:1)? Do you believe that the number of staff, the training of staff, or their social interactions with the person affect the problem behaviors?

1. Times of Day: When are the behaviors most and least likely to happen?

Most likely:

Least likely:

2. Settings: Where are the behaviors most and least likely to happen?

Most likely:

Least likely:

3. People: With whom are the behaviors most and least likely to happen?

Most likely:

Least likely:

4. Activity: What activities are most and least likely to produce the behaviors?

Most likely:

Least likely:

5. Are there particular or idiosyncratic situations or events not listed above that sometimes seem to “set off” the behaviors, such as particular demands, noises, lights, clothing?

6. What one thing could you do that would most likely make the undesirable behaviors occur?

7. Briefly describe how the person’s behavior would be affected if...

a. You asked him or her to perform a difficult task.

b. You interrupted a desired activity, such as eating ice cream or watching TV.

c. You unexpectedly changed his or her typical routine or schedule of activities.

d. She or he wanted something but wasn’t able to get it (e.g., a food item up on a shelf).

e. You didn’t pay attention to the person or left her or him alone for a while (e.g., 15 minutes).

1. Think of EACH of the behaviors listed in Section A, and try to identify the specific consequences or outcomes the person gets when the behaviors occur in different situations.

Behavior

Particular situations

What exactly

does he or she get?

What exactly

does she or he avoid?

a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

Problem Behavior

Low Efficiency

High Efficiency

a.

1

2

3

4

5

b.

1

2

3

4

5

c.

1

2

3

4

5

d.

1

2

3

4

5

e.

1

2

3

4

5

f.

1

2

3

4

5

g.

1

2

3

4

5

h.

1

2

3

4

5

i.

1

2

3

4

5

1. What socially appropriate behaviors or skills can the person already perform that may generate the same outcomes or reinforcers produced by the problem behaviors?

1. What are the general expressive communication strategies used by or available to the person? These might include vocal speech, signs and gestures, communication boards and books, or electronic devices. How consistently are the strategies used?

2. On the following chart, indicate the behaviors the person uses to achieve the communicative outcomes listed:

Communicative

Functions

Complex speech (sentences)

Multiple-word phrases

One-word utterances

Echolalia

Other vocalizing

Complex signing

Single signs

Pointing

Leading

Shaking head

Grabbing/reaching

Giving objects

Increased movement

Moving close to you

Moving away or leaving

Fixed gaze

Facial expression

Aggression

Self-injury

Other

Request attention

Request help

Request preferred

food/objects/activities

Request break

Show you something

or some place

Indicate physical pain (e.g., headache, illness)

Indicate confusion

or unhappiness

Protest or reject a

situation or activity

3. With regard to the person’s receptive communication, or ability to understand other persons...

a. Does the person follow spoken requests or instructions? If so, approximately how many? (List if only a few.)

b. Does the person respond to signed or gestural requests or instructions? If so, approximately how many? (List if only a few.)

c. Is the person able to imitate if you provide physical models for various tasks or activities? (List if only a few.)

d. How does the person typically indicate yes or no when asked if she or he wants something, wants to go somewhere, etc.?

1. What things can you do to improve the likelihood that a teaching session or other activity will go well with this person?

2. What things should you avoid that might interfere with or disrupt a teaching session or activity with this person?

1. Food items:

2. Toys and objects:

3. Activities at home

4. Activities/outings in the community

5. Other

Behavior

How long has this been a problem?

Programs

Effects

a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

Distant Setting Event

Immediate Antecedent

(Predictor)

Problem Behavior

Maintaining

Consequence

a.

Write summary statement A in a complete sentence:

b.

Write summary statement B in a complete sentence.

c.

Write summary statement C in a complete sentence.

d.

Write summary statement D in a complete sentence.

e.

Write summary statement E in a complete sentence.

f.

Write summary statement F in a complete sentence.

g.

Write summary statement G in a complete sentence.

h.

Write summary statement H in a complete sentence.

i.

Write summary statement I in a complete sentence.

j.

Write summary statement J in a complete sentence.

How confident are you that Summary Statement A is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement B is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement C is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement D is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement E is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement F is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement G is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement H is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that Summary Statement I is accurate?

Not very confident Very Confident

1 2 3 4 5 6

How confident are you that this Summary Statement J is accurate?

Not very confident Very Confident

1 2 3 4 5 6

Student’s Name:

Student’s Date of Birth:

Gender:

Date Plan Developed:

Description of Target Behavior (operationally defined, easily observable and measurable, include examples, as well as duration, frequency, and intensity):

Hypothesis/Summary Statement of the Function of the Behavior (developed based on information gathered from the FBA):

Antecedent Modifications (What can be done to support the student and prevent the occurrence of this behavior? What changes can be implemented to create a safe, inclusive, and culturally responsive learning environment that engages the student in meaningful learning activities and social interactions? Describe the modifications in enough detail for them to be implemented):

Replacement Behaviors (What new behavior will be taught or what current behavior will be increased that

serves the same function as the behavior targeted for reduction and allow the student to achieve the same outcome). How will the replacement behavior be taught to the student?

Strategies for Reinforcing Replacement Behavior (What is the immediate benefit to the student? How will the student be rewarded for engaging in the new or emerging behavior in a way that addresses the function of the behavior?):

Strategies for Reducing the Target Behavior (What will be the response should the target behavior occur? This response should not maintain the behavior):

Crisis Plan (How should others respond if the strategies for reducing the target behavior are not effective or if the target behavior occurs in a manner that jeopardizes the safety of the student or others? Include the procedures for safely and appropriately intervening when the student is in crisis):

Laws (Describe the laws and procedures required for suspending a student with a disability. Specifically describe the Manifest Determination Review (MDR) as it relates to the FBA/BIP.)

Benefits of the Plan (How does this BIP encourage the student’s emotional well-being, positive social interactions, and self-determination? independence, self-awareness, self-management, self-control, self-reliance, self-esteem, and self-advocacy?)

Culturally Responsive Practices: How does the plan demonstrate an understanding of the student’s language, culture, and family background?

Generalization (How can this plan be carried out in different settings? Emphasize the development, maintenance, and generalization of behavioral skills and teaching the student to adapt to different environments):

Progress Monitoring: Data Collection and monitoring of the target and replacement behaviors (What type of data will be collected, when, and by whom? Once the data are collected, how often will the data be monitored and by whom? Based on the data, how often will updates be made to the BIP?

Communication: How will the BIP be communicated to other teachers and paraprofessionals? How will daily and weekly progress be communicated with parents/guardians?