MARQUETTE-ALGER REGIONAL EDUCATIONAL SERVICE AGENCY

321 East Ohio Street

Marquette, Michigan 49855

Phone: (906) 226-5100

DISCUSSION GUIDE FOR FBA

(Functional Behavioral Assessment)

Student Name:
Date of Birth:
CA:
School:
Teacher(s):
Grade:
Eligibility:
Participants:
Date of Meeting:

STATEMENT OF CONCERN: (General)

STUDENT STRENGTHS/INTERESTS/RESOURCES: (Child. Family, School, and Community.)

SIGNIFICANT HISTORY : (Such as: Discipline, Medical, Previous Evaluations, Family concerns, Significant Educational Interventions, etc.)

BEHAVIORS OF CONCERN: (List)

PRIORITY TARGET BEHAVIORS TO BE ADDRESSED: (no more than 2)

OPERATIONAL DEFINITION OF TARGET BEHAVIORS:

(Such as: Description, intensity, duration, rate, etc.)

PAST INTERVENTION FOR IDENTIFIED TARGET BEHAVIORS: (Both what worked and what did not.)

PRECURSORS OF UNWANTED TARGET BEHAVIOR:

(Such as: When homework assigned, when asked to transition, etc.)

VARIABLES: (Time of day, whether in structured settings or not, is this consistent behavior in any identified pattern, etc.)

WHAT HAPPENS AFTER THE BEHAVIOR OCCURS: (Natural consequences, time-out, classroom rules enforced, responses of student & others, etc.)

SUSPECTED FUNCTION: (Often described in terms of what the student is getting or obtaining, and/or escaping or avoiding as a result of the behavior. i.e. attention, stimulation, control.)

APPROPRIATE REPLACEMENT BEHAVIOR:

RECOMMENDATIONS: (May include: BIP, referral to doctor for more information, gather more data, evaluation necessary, more extensive behavioral assessment, etc.)

The FBA process assumes one member from the student assistance team has reviewed the student record.

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TEAM BEHAVIORAL PLANNING GUIDE FOR FUNCTIONAL BEHAVIORAL ASSESSMENT

Jodi Ball

2007-10-05

MAPS