Education 5306/5406

Dominican Student: XXXXX

FBA template, 2014

EDUC 5306/5406: FUNCTIONAL BEHAVIOR ASSESSMENT PLAN TEMPLATE

Complete an FBA for EACH BEHAVIOR that is interfering
with the students academic and social potential
STUDENT FIRST NAME: Sally

DATE: 10-09-14

DATE OF BIRTH: 1/15/07

AGE: 7-9

MALE/FEMALE Female

GRADE: 2nd

STAFF PARTICIPATING IN ASSESSMENT: SDC teacher, student teacher

DATE (S) OF ASSESSMENT: 8/30-9/15

I.
REASON FOR FBA
Explain the target behavior in specific, observable terms, describing what the behavior looks like and the
reason for this referral. (If there is more than one behavior, complete additional forms.)
Sallys target behavior is that she refuses to work or participate in structured activities. She shows
refusal by sitting/laying on the floor or screaming and crying instead of participating and cooperating
in class. The target behavior occurs 2-6 times per day and more so on Mondays after a weekend away
from the routines and structure of the classroom.

II.

STUDENT PROFILE

Gather background information in order to assess the behavior in each of the following categories:
IEP
Medical
Family consultation (family interviews)
Previous interventions
Defining and prioritizing behavior
Assessing student environment

Education 5306/5406
Dominican Student: XXXXX

FBA template, 2014

IEP: Since preschool, Sally has had an IEP for an intellectual disability. This is Sallys first year in a public
school SDC setting.
MEDICAL: Sally has down-syndrome and asthma. As an infant, she experienced feeding problems due
to her asthma. Her family history is significant for Attention Deficit Hyperactive Disorder (ADHD).
FAMILY INTERVIEWS: According to a parent questionnaire and previous reports, Paola is the product of
a healthy, full-term pregnancy. She was born via a normal, uncomplicated delivery. She has 4 older
siblings and lives with her mother and older brother who is still at home. She speaks and understands
both English and Spanish at home. Her mother is learning English but Spanish is her first language.
According to her mother and her educational history, this is Sallys first year in a public school SDC
setting. Prior to enrolling at *****, Sally went to a SDC at MCOE. Her schooling was mostly based around
the use of computers and technology and was with other students with intellectual disabilities. Sallys
mother felt it important for Sally to be around other students and peers her own age and also wanted
Sally to have the experience of being in a general education setting for part of the day to help with her
socio-emotional development.
PREVIOUS INTERVENTIONS: Sally received home based 1:1 Developmental Programming from an
Early Interventionist at Easter Seals, Speech/Language therapy and Physical therapy. Sally attended a
head start program in Novato 5 days a week, 8 hours a day. It is recommended that she continues
intervention focusing on all developmental areas including cognitive, self-help, motor and language skills.
DEFINING/PRIORITIZING BEHAVIOR: Sallys struggles the most with staying focused and staying on
task during structured academic activities. She will avoid work by sitting/laying on the floor or
screaming or crying.
ASSESSING STUDENT ENVIRONMENT: Sally becomes easily distracted in whole group instruction and
works best in 1:1 instruction. She is a very curious girl and if the opportunity presents itself she will want
to explore her surroundings and has strong urges to pick up whatever is in her reach and examine it. She
does not like loud noises (unless she is creating them) and will often cover her ears if classmates are
speaking loudly, saying that it is loud or annoying. She also has been observed putting tissues and
other small objects in her mouth so she should be closely monitored at all times.
Sally enjoys learning through games and play-based activities. For example, she is much more receptive
to participating if counting plates to give to dolls at a tea party than just counting token pieces on a 1:1
board. She enjoys visuals, music and other multimedia.
Because she can get easily overwhelmed or overstimulated, Sally has a designated quiet spot in the room
where she can go to rest or reset. This is where she is encouraged to go if she is refusing to do work.

III.
ASSESSING THE BEHAVIOR
Describe briefly (include data collection forms):
Interviews (student, teacher, paraprofessional, support staff, school psychologist, counselor. . . )
Observation (ABC Chart, scatter-plots, interval/duration/frequency recording, incident log, etc.)
Checklists

Education 5306/5406
Dominican Student: XXXXX

FBA template, 2014

INTERVIEWS: Special Day Class instructor was interviewed on 10/7/14. Based on this interview, Sallys
most concerning behavior is her refusal to do her classwork or participate. The target behavior is least
likely to occur when Sally is engaged in a preferred activity, like playing with a special item or toy (doll,
Spiderman action figure, beanie babies ect). The conditions that are mostly likely to trigger Sallys target
behavior are distractions in the environment, being asked to engage in a non-preferred activity and
transitioning from one activity to another, especially if it involves moving from outside to back inside the
classroom.
OBSERVATIONS: I observed Sally daily over a 3-week period. The target behavior happens much more
often on Mondays, after a weekend away from the classroom routine. She is a very bright, sweet girl.
Sally has a strong curiosity about the world around her and can become easily distracted and also easily
bored if presented with repetitive activities. She has a strong imagination and responds to instruction
that has an element of play or make-believe involved. Also, Sally enjoys being around different people
and transitions happen more smoothly if another adult Sally has not interacted with a lot that day or class
period comes over to help. She is working on being able to work independently as she prefers a teacher or
aide to work with her (You and me?)
ABC CHARTS: (see attached) Sallys ABC chart reinforces what was explained by her SDC teacher.
Target behavior was most prevalent when Sally was asked to participate in a non-preferred activity
(mostly academic work such as phonics, language skills and math), when there were distractions in the
environment and during transitions from one activity to another or when moving from outdoors to inside
the classroom.

IV.

ANALYZING THE BEHAVIOR RESULTS

Describe and synthesize the following from the multiple sources of data (Provide data collection or record review):
Predictors/triggers:
Setting events
Antecedents
Consequences: What happens after the behavior occurs?
Consequences that maintain the behavior
What other consistent consequences were found?
Frequency, Intensity, and duration of behavior:
When does the behavior occur?
How long does the behavior continue?
How often does the behavior occur?

Education 5306/5406
Dominican Student: XXXXX

FBA template, 2014

Other:
What setting events or antecedents identified are associated with low rates of target behavior?

PREDICTORS/TRIGGERS:
Setting events: Target behavior happens during all academic subjects with the exception of music
and art class. A behavior predictor is if Sally is asked to do something she doesnt want to do,
activities that require repetition, or sitting still for a prolonged period of time.
Triggers: environmental distractions, non-preferred activities, transitions from one activity or
classroom to another.
Antecedents: see above
CONSEQUENCES:
Consequences that maintain the behavior: After the target behavior occurs, Sally is presented
with two choices- she can either participate in class work or go to her quiet spot in the room.
Other consistent consequences: Sally either receives attention from peers and teachers or target
behavior is ignored.
FREQUENCY, INTENSITY AND DURATION OF BEHAVIOR:
When the behavior occurs: The behavior occurs with higher frequency in the mornings and
afternoons. It occurs when Sally is asked to participate in a non-preferred activity, is distracted by
her classroom environment or is transitioning from one activity to another.
Length of behavior: Behavior lasts until Sally is presented with her classwork/quiet spot
prompts or for as long as Sally is receiving attention for the behavior. She might need another
adult to come and prompt her to change behavior.
Frequency of behavior: Sallys non-compliant target behavior occurs at least once or twice
throughout the school day. It mostly occurs in the mornings when Sally is still tired and in the
afternoons when she is worn out from the length of the school days activities.
Target behavior is also more frequent on days when Sally is transitioning to classes outside the
SDC classroom (from the SDC room, to the music room and then back again) because she gets
distracted by the railings, the benches, playground equipment, ect).
OTHER:
Settings or events associated with low rates of target behavior:
Settings where there is a low rate of target behavior are as follows: 1:1 instruction or activities,
activities that have a play-based component, instruction that is turned into a story, music class, art
class, coursework that incorporates multimedia, working with different adults in different areas
of the classroom, working towards a goal (First, you work for 10 minutes, then you get to play
with the school bus, ect).

V.

HYPOTHESIS OF THE FUNCTION OF BEHAVIOR

Education 5306/5406
Dominican Student: XXXXX

FBA template, 2014

Identify function of behavior: obtain, avoid/protest, or self stimulation

Within the context of the hypothesis, describe the following:
Setting events
Antecedents
Consequences

FUNCTION OF BEHAVIOR: The function of the target behavior for Sally is to avoid working
on tasks she finds challenging or not stimulating enough. It is also to obtain attention.
Setting Events: Target behavior typically occurs when Sally is asked to sit in an academic
setting doing desk work such as counting, letter identification, language for learning, ect.
Antecedents: Sally is asked to sit down and participate, or asked a question regarding a group
activity.
Consequences: Sally is given her choices (classwork/quiet spot) and has to pick one.
Sometimes she will still refuse and climb under tables, continue to cry, ect. Sally is told no by
aide. Told she cant do that.
VI.

FBA SUMMARY AND RECOMMENDATIONS

Describe:
What alterations in the environment, instruction or interactions could prevent the behavior from
recurring?
Identify functionally equivalent replacement behaviors.
Describe current methods of reinforcement and recommend any changes of reinforcement.
What goals, services, etc. are you recommending?

ALTERATIONS IN THE ENVIRONMENT: Sally should be taught in a relatively distraction free

environment. The less noise and movement around her the better, in order to keep her full attention on
what the instructor is explaining or asking of Sally.
ALTERATIONS IN INSTRUCTION: Sally enjoys being around other students but is easily distracted by
them during instruction. For fundamental academic skills (phonics, counting ect) Sally benefits the most
from 1:1 instruction instead of small or whole group. She works well in whole group settings for math
circle, ect but should only be expected to participate, with the bulk of her targeted instruction in a 1:1
setting. Also, Sally really enjoys and is receptive to play-based learning. She is also very visual and
sensory oriented. The more a lesson or concept can be integrated with play-based sensory learning
opportunities the more Sally will thrive.
ALTERATIONS IN INTERACTIONS: Sally is a sensitive child. She responds best and most appropriately
when expected behaviors are modeled for her. Sally does not do well with multi-stepped directions and
will shut down if not given enough time to process what has been asked of her. Sally responds positively

Education 5306/5406
Dominican Student: XXXXX

FBA template, 2014

to positive reinforcement and warm tone and demeanor.

Keep directions as simple as possible and give her adequate time to respond. (Use: First we do
classwork, then we play with Kinetic Sand.instead ofSally if you want to play with the sand first
you need to listen to instruction. Repeat after me, I will listen to the teacher.)
FUNCTIONALLY EQUIVALENT REPLACEMENT BEHAVIORS:
Instead of using the target behavior to avoid participating in classroom activities or to get attention, Sally
could chose her quiet spot as a way to refocus and calm down. That way, instead of crying and screaming
to avoid work, Sally could avoid work for a brief time in her quiet spot. This would serve the same
purpose but would be distracting to the rest of the class like her current target behavior is.
CURRENT METHODS OF REINFORCEMENT/CHANGES IN REINFORCEMENT: Sallys replacement
behaviors are being reinforced with verbal praise and recognition. She also earns a reward when she
works for an allotted amount of time. There is follow-through with her rewards system because she
knows she will actually get to play with something or use something she really likes if she stays on task
like she is suppose to.
RECOMMENDED GOALS/SERVICES/ECT:
For Sally, I recommend as many sensory/play based academic activities as possible through out the day.
Even if they are to break up regular skill and drill activities. Sally also needs a 5 minute and 2 minute
warning to help her transition easier from one activity to the next. Those who work with Sally must be
patient and try to give as much praise as redirection. Make learning fun! As it is Sallys first year it is
important that she learn to love the classroom, routine and school staff and that she is made to feel safe
and nurtured in an academic environment.