This assignment will be formatted using APA Guidelines that include a title page with headers, page numbers, and a reference page.
Part I: Functional Behavior Assessment
Summary of Student Profile
Name:
Date of Birth:
Grade:
Exceptionality:
Summary of 16 questions form Student Profile Information Sheet
Interviews – Provide a detailed summary of the parent and student interviews
Summary of Results of Social Skills Checklist and Motivation Assessment Scale
Provide summary of the results of Social Skills Checklist and Motivation Assessment Scale
Target Behavior
State the behavior that you want to change (increase or decrease)
ABC Charts
Observation 1
A-B-C Recording Form
Date: _____________________Location: ____________________________________
Observer’s name _____________________________Length of time observed: ___________
Date / Time
Antecedent
Behavior
Consequence
Observation 2
A-B-C Recording Form
Date: _____________________Location: ____________________________________
Observer’s name _____________________________Length of time observed: ___________
Date / Time
Antecedent
Behavior
Consequence
Antecedent, Behavior, Consequence Summary Statement
1. The antecedent is…..
2. The behavior is……
3. The consequence
Function of the behavior
Based on the ABC charts provided and the results of the Behavior Rating Scale the function of the behavior is……
Part II: Behavior Intervention Plan
Behavior Objective
State the ONE behavior that you want the student to exhibit positively. Make sure you include the 4 components of an objective (Learner, Condition, Behavior, and Criterion)
Operational Definition
Provide a detailed description of the behavior that you will be targeting. Provide an example and non-example of the behavior.
Intervention Plan
Description of intervention selected supported by evidenced based research. Rationale of why this intervention is selected.
Description of individuals that will be involved and their roles in implementing the plan.
Proactive Strategies
Describe what strategies will be implemented to avoid triggering the BOC. This is not the intervention.
Replacement Strategies
Replacement behaviors to be taught
How the behaviors will be taught
When and how will the replacement skill will be taught
Consequence Strategies
Criteria for token economy system
Brief crisis intervention plan
Generalization
Setting(s) the behavior will be generalized in
Timeline of intervention for generalization
Identify strategies that will be used to maintain positive behavior skills
Monitoring
How will progress be monitored during and after the intervention is implemented
How the team will monitor or revise the intervention if needed
INSERT BIP AT A GLANCE HERE
Part III: Intervention Implementation and Results
Summary Analysis of Results and Recommendations
-Provide a detailed summary of the results of the interventions.
-Links behavior change and the use of data collection to make educational decisions.
– Provide detailed recommendations for the target student and to personnel involved based on the results of the intervention and the present level of performance of the student.
Baseline and Intervention Chart
Include a graph to show the data collected from BOTH baseline and Intervention phase. A minimum of 10 data points is needed.
Defensible Stability Statement
Write a statement of stability (state how baseline data was collected and if the behavior was consistent). This shows that the targeted behavior is continuous.
Reflective Journals
BASELINE
INTERVENTION
Observation 1
Date
Observation 1 Date
Observation 2
Date
Observation 2
Date
Observation 3
Date
Observation 3
Date
Observation 4
Date
Observation 4
Date
Observation 5
Date
Observation 5
Date
I mpact on Student Learning
Include summary statement(s) of how the project has impacted student learning and recommendations for the future.
Final Reflection of Experiences
Include a final reflection about this entire project. Answer the following questions within this section. What have you learned? What was the most difficult part of the project? What was the easiest? How do you think this experience has impacted you personally and professionally? If you had to do it all over again, what would you do differently? What would you keep the same?
References
Appendices
Scan Interview Forms Here
Scan Motivational Assessment Scale Here
Scan in Social Skills Assessment
Scan in Data Collection Sheets here
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