PURPOSE: A Functional Behavioral Assessment (FBA) is used to gather information about a students behavior to determine the need

for, and provide the foundation for, a Behavioral Intervention Plan (BIP). An FBA is required to be conducted if the students violation of
a code of conduct (resulting in a change of placement) is determined to be a manifestation of the students disabilit.
FUNCTIONAL BEHAVIORAL ASSESSMENT
!tudent name" !tudent #eeting $ate"
!tudent I$ %" $isabilit" &rade"
'ome !chool" (ase #anager"
Team Members Present at Meeting:
Name/Title Name/Title
Name/Title Name/Title
Name/Title Name/Title
Students Strengths (include a description of the students behavioral strengths, such as positive interactions with staff, ignoring
the inappropriate behavior of peers, accepts responsibility, etc.):
Addition (standard algorithm ) linear format) * and + digits
,eading-decoding . /
th
and 0
th
grade level
!pelling . multisllabic vo1els, blends
$ra1ing . representation of electronic screens (e.g. phones and monitors)
,esponds-motivated b re1ards (tic2ets)
Description of Behavior(include a description of the frequency, duration, and intensity of the behavior(s)):
After 34 minutes (ma5) looses interest and searches the room for other stimulating ob6ects-activities. Approaches
areas in the room li2e a circuit7 vocali8es 1hile running.
$oes not attend to requests or redirection the first time (academic and social interaction)
$oes not follo1 the directions of adults
Setting(s) (include a description of the setting(s) in which the behavior occurs, i.e. physical setting, time of day, persons involved):
(lassroom . stor (carpet4 and 3"3 completing lessons
Plaground .big to
(afeteria
'all1a
At onset of da attends for 9:0 minutes, ho1ever, as da progresses plas and 1or2s independent of adults-peers
Antecedent(s) (include a description of the relevant events that preceded the behavior):
Form 7a - Functional Behavioral Assessment Page 1 August *44;
(ontinuance of an activit < 0 minutes. Activit does not allo1 for hands:on use of manipulatives.
Activit does not include letters.
Consequences and Educational Impact (include a description of the result of the behavior (i.e. removed from class, not
able to complete assignments/tests, etc.), and the impact on the student, peers, and the instructional environment):
Other Potential Variables (include a description of any other factors/variables that may affect the behavior, such as
medication, weather, diet, sleep, substance abuse, attendance, social factors, etc.):
#ore familiar 1ith IA . see2s him out 1hen ccling or attending to different stimuli
Interests include letters, hands:on activities
#otivated b re1ards (of his choosing)
#a be t1ice e5ceptional (gifted, disabled) due to splinter s2ill levels for age
Prior Interventions (include a description of the behavioral interventions that have been implemented in the past, including the
date(s) of implementation, length of intervention, the impact of the intervention on the students behavior, etc. Attach data summary, if
appropriate):
I=P doesnt clearl spell out details of intervention, ho1ever, =!> observations support short lesson-activit
duration (?34 mins), frequent changes in activities, read directions and provide them verball, utili8e technolog,
e.g. ipad or computer.
Hypothesis of Behavioral Function (describe the teams hypothesis of the relationship between the behavior and the
environment in which it occurs what function is this behavior serving for the student? What is the student trying to get? What is he/she
trying to avoid?):
Avoidance of or escape from requests that are counter to his current preservation or non:preferred repetitive
behaviors.
&oal-ob6ective . maintain his preservation (academic and social interactive settings).
Summary/Recommendations (Provide recommendations for prevention of the target behavior, replacement skills/behavior(s)
to be taught, reinforcements for positive behaviors, etc.):
@essons-introduction ? 9:0 minutes
Ase introduce visual stimuli (such as" assistive technolog)
Incorporate letters (manipulatives) into the lesson
Ase computer-cellular vocabular to help the student connect to the content and shift focus.
Form 7a - Functional Behavioral Assessment Page 2 August *44;
Form 7a - Functional Behavioral Assessment Page 3 August *44;