Functional Behavior Assessment

Part I: Functional Behavior Assessment

Overview

In this assignment, candidates will selct a student that has been identified with a disability (student must have IEP) that exhibits ONE of the following social skills deficits: taking turns, conversational skills, interacting with peers, making positive choices, following directions, completing tasks/chores, organization and/or transition skills. Students will not address violent behaviors or work with students who demonstrate aggressive behaviors (hitting, elopement, profanity).

Learning Outcomes

Know and demonstrate professional roles and responsibilities relevant to ethical and legislative requirements as related to Council of Exceptional Children (CEC) Code of Ethics, professional certification standards, and confidentiality.

Gather, interpret, and communicate background and assessment information from a variety of sources to make educational decisions and design individualized instruction.

Administer and analyze appropriate formal and informal assessment to make educational decisions for exceptional learners.

Understand and adhere to legal and ethical guidelines for assessing, identifying, and monitoring diverse learners with exceptionalities.

Directions

1. Select a student with an exceptionality that displays a social behavior deficit listed above.

2. Complete parent survey, student survey, motivational assessment, and social skills checkslist.

3. Complete Student Profile Sheet.

4. Complete Student Observation using ABC Chart (2 observations for a minimum of 30 consecutive minutes).

5. Write and turn in to Blackboard a Functional Behavior Analysis paper template with the completed student profile information, motivational assessment, and social skills checklist).

Candidates will use the template provided that addresses APA formatting (includes a title page, headers, and page numbers). The paper should be written as a report and not in first person.

a. Summarize the student’s profile.

b. Identify the student’s target behavior

c. Summarize the ABC (state the antecedent, behavior, consequence)

d. Hypothesize the function of the behavior

Functional Behavior Assessment

1. Parent Interview

2. Student Profile Information Sheet

3. ABC Student Observation

4. Student Interview

5. Motivational Assessment

6. Social Skills Checklist

FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)

PARENT INTERVIEW
Directions: Please complete and return this form to your child’s school. The information will be used to help develop a

behavior intervention plan for your child. Please return the completed form to ______________________.

Please contact the school/teacher if you have any questions.

Child’s Name ___________________________________________ Age _______ Today’s Date _____________

Address ________________________________________________ Phone __________________________________

Person completing form ________________________________________ Relationship to child __________________

Does your child have any medical or physical conditions? __________________________________________________

List any current medications your child is taking: _________________________________________________________

Describe your child. (check all that apply)

· easily distracted cooperative talkative angry

· stubborn impulsive shy/quiet friendly

· self-abusive physically aggressive often fidgety shy

· overactive verbally aggressive bossy mean

· moody easy to please cries easily pouts

· polite/kind funny/clever prefers to be alone sad

· eager to please others withdrawn sociable passive

Self-concept: Good Fair Poor Relations with parents: Good Fair Poor

Relations with peers: Good Fair Poor Relations with teachers: Good Fair Poor

Relations with sister/brother: Good Fair Poor Accepts responsibility for behavior? Yes No Some

List his/her favorite things to do/places to go: ____________________________________________________________

What motivates your child to behave well? ______________________________________________________________

What usually causes your child to misbehave? ___________________________________________________________

How often does your child misbehave? _________________________________________________________________

List the specific problem behaviors your child has at home: _________________________________________________

List the specific problem behaviors your child has at school: ________________________________________________

What efforts have you taken to assist the school in dealing with your child’s behavior? ___________________________

________________________________________________________________________________________________

When were you first aware of behavioral problems at school? ______________________________________________

________________________________________________________________________________________________

List all community services, doctors, psychologists, social workers, etc that have been helping with these problems:

Agency

Address

Phone Number

Start/End Date

Please attach any additional information you would like the school to consider in planning a behavior intervention.

Parent/Guardian Signature _______________________________________________ Today’s Date _______________

Functional Behavior Assessment

Student’s Profile Sheet

(Complete ALL Sections)

Student’s Name: _______________________ Exceptionality: ______________________

Grade: ______________________ Date of Birth: _______________________________

1. List behaviors of concern.

2. What does the student do well and when does it occur?

3. What does the student struggle with and when does it occur? Does there appear to be a skill deficit or do you feel that the student sometimes chooses not to use the skills that they have?

4. What is reinforcing and enjoyable for this student?

5. Are there good days and bad days? If so, does there seem to be a pattern?

6. How does the student communicate his/her needs (verbally, nonverbally, written, etc.)

7. What is his/her learning style (visual, auditory, tactile, kinesthetic)?

8. What type of instruction is the most successful for the student (direct, group/cooperative learning, lecture, independent/seatwork)?

9. Does academic failure or difficulty with materials appear to produce behaviors?

10. What are settings that negatively affect the behaviors?

11. What are triggers that negatively affect behaviors (lack of social attention, demands/requests, task transition, setting transition, interruption in routine, negative social interactions, when limits are set or consequences are imposed, redirected, embarrassment, sleep patterns, eating routines, medications, health, life stressors, etc.)?

12. What are the warning signs that the student exhibits that indicate that a behavior is about to occur (restless, withdrawal, loud voice, blurting out, change in mood, etc.).

13. How does the student respond after the behavior has occurred?

14. What interventions/strategies have been used with the student?

15. What consequences have been implemented and which ones have been effective (warnings, timeouts, ignore behavior, loss of privileges, sent to office, suspension, write-up?

16. Is attendance or tardiness a concern?

FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA))

STUDENT INTERVIEW
Student _________________________________ Date ___________

I have many friends at school

Yes

No

Not Sure

I like coming to school

Yes

No

Not Sure

My classmates like me

Yes

No

Not Sure

I like the other students in my class

Yes

No

Not Sure

I complete my homework most of the time

Yes

No

Not Sure

My parents love me

Yes

No

Not Sure

I get into trouble at school

Yes

No

Not Sure

My home is a happy place

Yes

No

Not Sure

My teachers like me

Yes

No

Not Sure

I get in trouble at home

Yes

No

Not Sure

I get into fights

Yes

No

Not Sure

I have been suspended this year

Yes

No

Not Sure

I have been sent to the office for misbehaving

Yes

No

Not Sure

I usually do what my teacher(s) ask me to do

Yes

No

Not Sure

My classmates tease and pick on me

Yes

No

Not Sure

What do I do that gets me in trouble at school? ___________________________________________________

_________________________________________________________________________________________

What do I do that gets me in trouble at home? ___________________________________________________

_________________________________________________________________________________________

What would help me to behave better in school? __________________________________________________

_________________________________________________________________________________________

What would help me to behave better at home? ___________________________________________________

_________________________________________________________________________________________

*** IDENTIFYING REWARDS ***

Name 3 things you most like to do at school: Name 3 things you most like to do at home:

1. ______________________________________ 1. _____________________________________

2. ______________________________________ 2. _____________________________________

3. ______________________________________ 3. _____________________________________

Name 3 classmates with whom you would like to work: Name 3 special jobs that you would like to do at school:

1. ______________________________________ 1. _____________________________________

2. ______________________________________ 2. _____________________________________

3. ______________________________________ 3. _____________________________________

If you had 15 minutes of free-time at school to do what you wanted, what would you do? ________________

ELSE 6163 Positive Behavior Interventions and Supports

Adapted from LCD (6-1-99) 1

1

6

MOTIVATION ASSESSMENT SCALE

Name_______________________________________________ Rater________________________________________ Date___________

Behavior Description____________________________________________________________________________________________________

Setting Description______________________________________________________________________________________________________

Instructions: The Motivation Assessment Scale is a questionnaire designed to identify those situations in which an individual is likely to behave in certain ways. From this information, more informed decisions can be made concerning the selection of appropriate reinforcers and treatments. To complete the Motivation Assessment Scale, select one behavior that is of particular interest. It is important that you identify the behavior very specifically. Aggression, for example, is not as good as a description as hits his sister. Once you have specified the behavior to be rated, read each question carefully and circle the number that best describes your observation of this behavior.

Never=0 Almost Never=1 Seldom=2 Half the Time=3 Usually=4 Almost Always=5 Always=6

1. Would the behavior occur continuously, if this person were left alone for long periods of time, for example, several hours?

0 1 2 3 4 5 6

2. Does the behavior occur following a request to perform a difficult task?

0 1 2 3 4 5 6

3. Does the behavior seem to occur in response to your talking to another person in the room?

0 1 2 3 4 5 6

4. Does the behavior ever occur to get a toy, food, or activity that this person has been told that he or she can’t have?

0 1 2 3 4 5 6

5. Would the behavior occur repeatedly in the same way for very long periods of time if no one were around, for example rocking back and forth for over an hour?

0 1 2 3 4 5 6

6. Does the behavior occur when any request is made of this person?

0 1 2 3 4 5 6

7. Does the behavior occur whenever you stop attending to this person?

0 1 2 3 4 5 6

8. Does the behavior occur when you take away a favorite toy, food, or activity?

0 1 2 3 4 5 6

9. Does it appear to you that this person enjoys performing the behavior? (It feels, tastes, looks, smells, and sounds pleasing.)

0 1 2 3 4 5 6

10. Does this person seem to do the behavior to upset or annoy you when you are trying to get him or her to do what you ask?

0 1 2 3 4 5 6

11. Does this person seem to do the behavior to upset or annoy you when you are not paying attention to him or her, for example, if you are sitting in a separate room, interacting with another person?

0 1 2 3 4 5 6

12. Does the behavior stop occurring shortly after you give this person the toy, food, or activity he or she has requested?

0 1 2 3 4 5 6

13. When the behavior is occurring does this person seem calm and unaware of anything else going on around him or her?

0 1 2 3 4 5 6

14. Does the behavior stop occurring shortly after (one to five minutes) you stop working or making demands of this person?

0 1 2 3 4 5 6

15. Does this person seem to do the behavior to get you to spend some time with him or her?

0 1 2 3 4 5 6

16. Does this behavior seem to occur when this person has been told that he or she can’t do something he or she had wanted to do?

0 1 2 3 4 5 6

Scoring Sheet

Sensory

Escape

Attention

Tangible

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Total Score