Functional Behavior Assessment/Behavior Intervention Plan Instructions
PART 1: Functional Behavior Assessment (FBA)
During the course of your educational journey, you will encounter students who exhibit behavior that impedes the teaching/learning process. After trying unsuccessful strategies, a functional behavior assessment may be necessary. The primary goal of the FBA is to identify the purpose of the inappropriate or impeding behavior. One important data collection tool used in the FBA process is the Functional Assessment Interview (FAI). 
For this assignment you will gather data from a provided student scenario or through student observations in the field to complete the provided Functional Assessment Interview (FAI) form. You MUST use the provided FAI Interview Form for this assignment. Each section of the form must be thoroughly completed using professional terminology and address the student data provided or collected. 
If you are gathering data from a field observation, the observed student must have diverse learning needs and specific behavior difficulties.   
Student Description
If you are using data collected from student observations in the field, a thorough description of the observed student must be provided on the FAI Interview Form. You will include a description of the students social interactions, overall academic performance, gender, and other relevant data. If the student has a documented disability, the description of the student should depict a clear understanding of the students disability, the criteria/characteristic for having a disability, and how this disability impacts their academic achievement and functional performance in the learning environment. 
PART 2: Behavior Intervention Plan (BIP)
Once difficult behaviors have been identified through the FBA, a Behavior Intervention Plan (BIP) will be created in an attempt to decrease those behaviors and increase (i.e., reinforce) replacement behaviors. For this part of the assignment you will create a Behavior Intervention Plan (BIP) for the student identified in Part 1 of the assignment. You must use the provided BIP template to complete this portion of the assignment. 
Attachments
You will complete two attachments that support the content of the BIP. The first attachment will be the method of record keeping that will be used by anyone identified in the BIP as responsible for the collection of data related to the students behavior. The second attachment will be a letter to the students parent(s)/guardian(s) that briefly explains the plan and describes a system of ongoing communication regarding the students behavior. 

  
Functional Behavior Assessment (FBA) Interview Form
  
Students   Name: 

Students   Date of Birth:
 
Gender:   

Date   of Interview:
 
Interviewer:

Respondents:
A. Describe the behaviors
  
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. 
 
B. Define ecological events (setting events) that predict or set up the problem behaviors
  
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 persons 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?
 
        
C. Define specific, immediate antecedent events that predict when the behaviors are likely and not likely to occur.
  
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 persons 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 wasnt able   to get it (e.g., a food item up on a shelf).
 
 
e.  You didnt pay attention to the person or   left her or him alone for a while (e.g., 15 minutes).
 
  
D. Identify the consequences of outcomes of the problem behaviors that may be maintaining them (i.e., the functions they serve for the person in particular situations)
  
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.  

E. Consider the overall efficiency of the problem behaviors. Efficiency is the combined result of (1) how much physical effort is required, (2) how often the behavior is performed before it is rewarded, and (3) how long the person must wait to get the reward
  
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
F. What functional alternative behaviors does the personal already know how to do?
  
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?
 
G. What are the primary ways the person communicates with other people?
  
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 persons 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.?
 
H. What are things you should do and things you should avoid in working with and supporting this person?
  
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?
 
I. What are things the person likes and are reinforcing for him or her?
  
1.  Food   items:
 
 
2.  Toys   and objects:
 
 
3. Activities   at home
 
 
4. Activities/outings   in the community
 
 
5. Other
 
J. What do you know about the history of the undesirable behaviors, the programs that have been attempted to decrease or eliminate them, and the effects of those programs?
  
Behavior

How long   has this been a problem?

Programs

Effects
 
a.  

 
b.  

 
c.  

 
d.  

 
e.  

 
f.  

 
g.  

 
h.  

 
i.  

 
j.  

  
K. Develop summary statements for each major predictor and/or consequence
  
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

  
Functional Behavior Assessment Student Scenario
Background
Jill Smith is a 12-year-old girl in 5th grade attending Washington Intermediate School. Jill has been diagnosed with Autism Spectrum Disorder (ASD). Jills school is a full inclusion school; there are no pull-out or self-contained classrooms. All of the special education services and supports that Jill receives during the day are provided to her in the general education classroom. Jill participates in the classroom activities on a modified curriculum. Academically, she functions at a level much lower than her same age peers. Jill accesses the standard curriculum on approximately a kindergarten level. Jill has a part-time paraprofessional assigned to her to assist with transitions and personal needs. Jill also receives speech and language services in the classroom 3 days a week for 30 minutes.
Jill was diagnosed with ASD just after her 3rd birthday. Jill is a healthy child but large for her age. She is 53 and weighs approximately 134lbs. Parents report an uneventful pregnancy and a normal delivery. Jills mother reported that she was a colicky baby and cried frequently. She was also easily startled as a child. Yet, Jill met all of her developmental milestones on time up until about two years old. Her mother reports that Jill always seems to be distant and appeared to be easily agitated. Her parents reported that she slowly stopped progressing, as if she hit a wall. Her hearing and vision are considered to be normal. Jill can communicate with short phrases such as Jill, yes or Hi, Jill. Although she has many phrases in her vocabulary, Jill prefers not to use these.
Jill is the youngest of three siblings. Her older sisters attend the local high school. While they report feeling embarrassed by their sisters behavior in public, they both agree that their mother is doing all she can. Jills father is in the military and currently serving a 6 month deployment. The family anticipates his return in about 5 months. Jills face lights up when her father enters the room. He is very patient and tends to hold firmer boundaries than Jills mother. Jills mother works part-time during the day and one Saturday a month. She earned an AA degree in general studies at the local college. Her father earned a bachelors degree in engineering from the state college and entered the military full time just after graduation. He is currently serving as an officer in the Navy. There is no history of mental illness in the family.
Jills parents have not sought pharmaceutical interventions for Jills ASD symptoms. Instead, they have altered the family diet to include only organic, all natural foods and dietary supplements. Jill is only offered healthy, organic food options at home and school. She has very little access to sweets and treats. Jill prefers to eat white rice to anything else. She does not like foods with a loose consistency such as pudding or sauces.
Jill has her own bedroom on the main floor of the house. She dislikes climbing the stairs. Jill shares a bathroom with her parents. Jills room is very colorful and she often saves small tokens such a bottle caps and twist ties. Jill is very protective of her collections and will carry them with her throughout the day. Jill will spend hours searching the house for items missing from her collections, often forgoing sleeping and eating. She frequently will not rest until she finds the missing item or it is replaced by a new one. Jill has experience night terrors in the past, sleeping only a few hours at a time. However, the parents have allowed her to watch TV in the evenings and she typically will fall asleep within an hour. She loves watching The Tom and Jerry Show with the sound off. If Jills day was particularly upsetting she may not sleep at all in the evening. Instead she will rock on the floor and sometimes hits her head on the bedpost. Yet, her mother states this is a rare occurrence.
A typical morning for Jill begins when the sun rises. She typically wakes herself and sits at the kitchen counter waiting to be served breakfast. Her sisters make sure Jill has cereal before they leave for school. Jills mother drives her to school each morning because Jill dislikes the school bus. On mornings when there are interruptions to the routine, such as her sisters getting up late, Jill will cry or moan loudly until someone attends to her needs. Jills teachers feel that she is capable of getting her own cereal in the morning but her mother reports that it is much easier and less messy to serve her. Jill often appears confused on the weekends and repeats the word school throughout the day. Her family members try to ignore her behaviors and tell her No school today.
At school, Jill˜s social interactions are parallel in nature. She seldom makes eye contact with her classmates. While she will say hello to students and call them by name, she does not engage others in play very often. She will sit in a group and walk with the class most days but seldom talks to her classmates. Overall Jill appears to enjoy the presence of her classmates but seldom interacts with them directly. If asked a specific question on her level, Jill can contribute one word answers to a group discussion. Yet a great amount of prompting is necessary. She enjoys going to recess and playing on the swings. She often wanders the perimeter of the playground area humming to herself.
Jill is a student obsessed with order and routine. She can become easily agitated with changes to the routine or environment. For example, fire drills, classroom visitors, or ½ days tend to frustrate Jill. Jills desk is neat and organized. She will often stop during the day to ensure all of her things are in order according to color and size. If other students bump her desk or move her things, she will cry, and say No, no, Jill. Additionally, Jill becomes especially upset if she thinks something is missing from her desk. Her teachers must show her all items are present before Jill will move to a new task.
Jill enjoys being outside. She also likes to color and to draw. She is especially fond of bright colors and shiny objects. Jills teachers have provided her with brightly colored manipulatives to use throughout the day. They have also allowed her to have more freedom to move around the classroom. Jill is especially fond of her paraprofessional.
Events
Recently Jills teachers have noticed an increase in several concerning behaviors. She appears to be developing an aversion to the cafeteria although she generally enjoys eating her lunch. Since the weather has turned cooler the students must eat inside. Her teachers have noticed that when the students are instructed to prepare for lunch, Jill will sit still and stare at her desk. When prompted to get her things together for lunch, she often begins to rock back and forth humming. The paraprofessional who assists Jill with transitions typically gathers her things and leads her to the lunchroom. Many days Jill will comply with little resistance. Yet over the last month, Jill has displayed an increase in vocalizations and repeats short phrases. When Jill is particularly upset, she will also rock or sway back and forth while walking. Once the rocking begins, her teachers note that Jill typically ignores verbal redirection. Often just outside of the cafeteria, Jill will begin to slap her leg repeatedly while humming and rocking. In one observation a teacher noted, The look in Jills eyes becomes distant and she appears to disconnect from all communication. Its as if she has retreated into herself and closed the door to the world. Once inside the cafeteria, Jill will cup her ears, rock and repeatedly cry No, no Jill. Her behaviors are tenacious. At times she may hit other students when engaged in her slapping behaviors or knock into small children when rocking. Once Jill is removed from the cafeteria her behaviors tend to deescalate, although the rocking and humming may continue throughout the day.
Jills mother has noted that she displays similar behaviors when the family attends church. Jill does not like attending the childrens service, nor the worship portion of the adult service. Jill is easily startled when the congregation claps. Volunteers have offered to sit with Jill in the vestibule while her mother and siblings attend church. Mrs. Smith reports that she is reluctant to allow others to assist with Jill because she is easily upset by change.
This week a guest speaker came to the music classroom to demonstrate various instruments used in the orchestra. The paraprofessional accompanied Jill to the classroom. Jill was hesitant about the stranger and remained on the side of the classroom, attentive but not looking at the speaker. While demonstrating the string instruments, Jill seemed to enjoy the presentation. However, immediately when the trumpet was sounded, Jill was startled. She began to shout out, No, no Jill and rock violently back and forth. The music teacher tried to calm Jill but her presence only made things worse. The paraprofessional tried to coax Jill into the hall but she refused to communicate and seemed as if she could not hear instruction. As Jills fit continued, her classroom teacher and special education teacher were called to assist. When they arrived they reported seeing Jill slapping herself in the head with an open palm, screaming, No, no Jill and rocking violently. With the assistance of the paraprofessional, the teachers carried Jill into a private room and spoke quietly to her. They also held her arms so that she could not hit herself. It took almost an hour to calm Jill enough for her to return to the classroom. Not long afterward, Jills mother checked her out of school early and brought her home to rest in her room.
Jills mother has noticed that each incident at school and home seems to be worse than the previous and that the recovery time is longer each time. She has also noted that Jill seems to withdraw further into herself after each incident. She is very concerned that she will lose Jill if things do not change.
Problem
Jills teachers are concerned that if her outbursts continue or become worse she may not be able to participate in the general education classroom. Jills mother is adamant about keeping her in a general education classroom. All staff members who interact with Jill and her parents are meeting together to discuss the change in her behavior and develop an intervention plan to assist Jill. As a part of the assessment team, you must complete the Functional Assessment Interview form to facilitate this discussion.

  
Behavior Intervention Plan (BIP)
  
Students   Name: 

Students   Date of Birth:
 
Gender: 

Date Plan   Developed:
  
1. Description of   Target Behavior (Operationally   defined, easily observable and measurable; include examples as well as duration,   frequency, and intensity):
 
2. Hypothesis/Summary   Statement of the Function of the Behavior (Developed based on data   analyzed from the FBA):
 
3. 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):
 
4. Behavioral   Goal (Develop   a behavioral goal that includes the condition, student, replacement behavior,   criterion, and timeframe):
 
5. 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? How will the student be rewarded for engaging in the   new or emerging behavior in a way that addresses the function of the   behavior?):
 
6. Strategies for   Reducing the Target Behavior (What will be the response should the   target behavior occur? This response should not maintain the behavior):
 
7. 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):
 
8. Laws   (What   are the laws impacting decisions about students with disabilities? Describe the   procedures (law) required for suspending a student with a disability   demonstrating a clear understanding of MDR and its relationship to the   FBA/BIP):
 
9. Benefits of the Plan (How does this BIP encourage the   students emotional well-being, positive social interactions, and   self-determination, independence, self-awareness, self-management,   self-control, self-reliance, self-esteem, and self-advocacy?)
 
10. Culturally Responsive Practices (How   does the plan demonstrate an understanding of the students language,   culture, and family background?):
 
11. 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):
 
12. 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?):
 
13. Collaboration & Communication (How will the   BIP be communicated to other teachers and paraprofessionals? How will the   plan involve and be communicated to parents? How will daily and weekly   progress be communicated with parents?):
 
14. Appendices (Required items: (a) Behavioral   Contract; (b) Self-monitoring plan for student use; (c) Record keeping   document(s); (d) Communication with other educators; (e) Communication with   family):