Functional Assessment/Behavior Intervention Form

General Information
Student:

Racari

School:

Parkview Elementary

Caseload Teacher:

Birthdate:

1/3/2009

Eligibility Status:

Medication:

Chelsea Bashore

Date:

10/16/2014

- in the midst of evaluation-

Previous Funct Assess?

Yes

No

September 8th,
2014

When:

I. Student Strengths, Skills, and Difficulties

Racari is eager to learn and is incredibly
intellitent. Racari is able to read some sight
words and add small number problems. He
has strong gross motor skills and a high
enthusiasm for movement.John is highly
detailed orientated. Lately he is trying very
hard to make friends.
List Student Strengths
and Skills:

List Student
Difficulties:

Racari has a hard time in situations he cannot be in

control of or that he has not chosen to be apart
of.When John does not get his way or isn't sure what to
do in a social situation he exhibits physical behaviors
including; kicking, hitting, biting, breaking objects,
throwing materials, running away from room/center
location. Racari has a difficult time picking up on social
ques and what is appropriate in terms of giving
personal space. Racari has strong impulse behavior
consisting of spitting, repetitive noises, rocking. When
John does not want to complete his work he will say "I
can't" or "I don't want to", he doesn't seem to be able to
move through the thought process. John has not been
able to complete full school day, attend specials, or
lunch since the second day of school. Racari is no
longer allowed to ride the bus because of his physical
behavior, and from physical alterations with three
safteys.,

II. Behavior(s) of Concern

Description - Observable/Measurable
The biggest concern right now is the physical behavior ( hitting, kicking, breaking
materials, throwing objects) Racari is exhibiting when he doesn't get his way or
doesn't understand what to do with his anger/in social settings.
Is this behavior addressed in the School Handbook? Y

How Often
8-10 times a
day

Duration
brief - 1 min
to 10 mins
when
breaking/thr
owing
things

Intensity
high level
physicall
y
harming
things,
and
breaking
all of his
classrom
.

Problem has
Existed (length
of time)Since
the first day of
school.

III. Environmental Issues and Situational Variables

What triggers or causes the behavior? What happens before the behavior?

It seems that the behavior happens when Racari

is not in control of a situation. For example when he does not want to do an activity or does not understand how to in a social setting.

What happens immediately after the problem behavior occurs?

(student reactions, staff reactions, environmental changes)

If the behavior is small enough to be redirected, his classroom teacher gives him reminders. If the reminders get to be too much, he is asked to leave
and sit in his spot. If the behavior is too physical/harm has happended to another student he is asked to leave/taken away from the room for an
intervention immediately. Generally this a discussion with social worker/behavioral specialist regarding his behavioral plan/goals, a heavy work activity,or
if serious enough- a call home.

In what settings/situations is the behavior of concern most and least likely to occur?
Settings/Situations
Most Likely
Least Likely
Adults?

Occurs when trying to get attention during a

group setting or when he does not like what is
happening in terms of activity.

Duringa one on one attention

Peers?

During large group settings, to get the attention

of indivuals he likes (i.e Marile, Josue),

When he is sitting next to Marile, a girl he likes

very much, generally female students, when he
is a positive mood.

During large or small group settings when he

isn't getting all attention focused on him. This
also can happen individually during centers
when he has to work at an activity
independently, hand writing activities.

When he has an individuals one on one

attention during an activity, when he is in a peer
activity group he enjoys, during technology
based centers (Ipad, Computer),

Settings?

It could be anything, there really isn't a setting

Time of Day or Class (morning, end of

during times of transition

all times of the day, but also a reminder that

Racari is currently only attending school from
8:40-8:30

(personality characteristics, teaching

style, gender, disciplinary style, etc., no names)
(personality characteristics, gender,
etc., no names)

Certain Activities?

(independent work,
lecture, writing activities, small group)
(playground, math, science, lunch,
school bus, unstructured time)
class, afternoon)

Other?

(home issues, bus, medication, health,

sleep, etc.)

Racari has spent most of his life in home, away

from social settings, out of fear of him running
away.

IV. Childs Exposure to Rules

Racari has had sleep difficulty since attending

school and has anxieties/highly distracted when
waking up
Governing This Behavior Check One or More and List How Often
depending on day
Behavior Plan
everyday at
3-5 times
the end of the
day

Posted Classroom Rules

classroom
contract

Class Discussions

10+ times aday

1-1 Discussions

Assemblies

Handbooks

Check Sheet

8 times a day

Other

Social Work
Support
Behavioral Support
Contracts
Other

1-3 times a day

Conflict Resolution

everday

Anger Management

everyday

V. Previous Interventions and Supports

Loss of Privilege
Parental Notification
Other

Staff/Student Awareness
Regarding BIP

4+ times
everyday(working towards
staying at school
for lunch/recess)
everyday in
person
Working towards
use of Xbox if he
has no physical
behavior

Check One or More and Indicate Frequency of Use

Referred to Office

Detention

In-School
Suspension/Suspension

Work Detail/Restitution

Behavior Ignored

20+

Reprimand/Warning

*Attached Documentation

VII. Needs Being Met Through This Behavior

Escape/Avoidance

Sensory Stimulation

Relief of Fear/Anxiety

talking about
what to do if
angry or
overwhelmed
instead of running
away, how to get
help when he
doesn't
understand work
in front of him.
(social skills)
Practiced with
weighted belt,
running in
gym/puships to
give physical
energy breaks
during the day to
help with
impulsivity,
weighted pillow
during desk
activity/sit spot.
Racari and his
Momhave also
started walking to
and from school
in the morning to
have more
physical work
built into his day.

Attention

reinforcing good
behavior, one on one
breaks

Power/Control

Giving Racari controlled

options/ choices with
his work,

Other

Racari has recently

started counceling and
will be evaluted by a
psychiatrist in the next
month

Check One or More and Explain

Expression of
Anger/Frustration

Social
lessons on
how to
express
anger
appropriately

Tangible

If he can
complete his
day without
physical
behavior he
extends his
day to lunch
and is
allowed
outside for
recess with
peers. He
also gets
bring his
Xbox back
home if he
has an all
around
postitive day
of at least
75% of the
time making
good
choices.

VIII. Goal to Appropriately Address Need(s)

Goal
:

parent contact/pick
up

VI. Previous Consequences and Disciplinary Measures

Time Out

Check One or More and Indicate Frequency

Peer Mediation

John will complete his day without harming/touching others in the classroom or breaking classroom materials.

IX. Preferred Activities and Reinforcers

List preferred activities: Playing ipad, going outside with friends at
recess, taking breaks running in the gym/helping move items for
Mrs.Jobson, getting a sticker at the end of the day,choosing who he gets
to sit with, attening Mind Meets Music.

List preferred reinforcers: Redirection, reminders that he is working

towards eating lunch at school/playing with a friend at recess, adding
physical pieces to the day to work burning some of the impulse energy,
social lessons.

X. Skills Needed to be Taught to Replace Behavior of Concern

What Behaviors Do You Want the Student to Engage in to Replace the Behavior?
Racari needs to work on learning what to do when he is angry or frustrated rather than harming those/or materials around him. We also need to help
teacher him the social skills, that are not present, when he wants attention from peers. (instead of the physical choices)

XI. Behavior Plan

Preventative Strategies
Classroom Accommodations, Approach
Strategies, Seating Arrangements, Instructional
Strategies, etc.

Racari will have a permenant sit spot

in the front of the group. Behaviors will
be ignored or redirected as much as
possible in effort to keep him class.
John's desk will be separate from the
groups. His desk will have a tension
rubber band on the legs that he will be
able to kick when angry or needing a
physical break.Racari will be taken out
of the room three times a day to run
around the gym/a physical activity.
John's directions for tasks will be one
step, to build on confidence and avoid
a physical breakdown.Racari will be
given extra on one one time with
teacher to build positive relationships.
John's center group will be built with
students who will give him a positive
example, and who he is already
comfortable with.

Procedures to Follow When

Behavior Occurs

Reinforcement Strategies
Methods of Teaching and Reinforcing
Appropriate/Replacement Skills

Specific Steps to Take When Behavior Occurs

Racari will be given as much positive

reinforcement as possible when he is
making good choices in his behaviors.
His classroom teacher will continue to
build social skills and his confidence in
class through activity involvement and
volunteering in class. Mrs. Lauer will
also remind Racari of classroom rules
and model desired behavior.
Reminders will also be given in terms
of reaching goals and desired tangible
items for the end of the day ( lunch,
xbox).Racari will be pulled for items
such as social skill instruction, social
interaction practice ( modeling, social
stories, practicing with a friend), anger
management practice, and therapy.

If possible redirect behavior as much

as possible. When too much
distraction occurs, remind/model good
behavior and ask him to go to his
desk. If the behavior cannot be
redirected/escalates/becomes
physically dangerous he will be
immediately removed from the
classroom seting for intervention with
social worker or behavior
interventionist. Depending on severaity
Racari will not bring home his xbox or
stay later for lunch. He will call Mom
and explain why he is not staying for
lunch. Racari will not be using the clip
up/down chart.

Deviation of School Handbook?

Yes
No

XII. Data Collection

Describe how systematic/measurable data will be collected for Behavior Plan:
This will be recorded through data google doc shared by all apart of this process.

Attach Sample Data Sheet

Chelsea Bashore

will inform the following staff of BIP:

Micah Bell, Elissa Lauer, Katie Jobson, Michelle Pena

Signatures below indicate the plan has been reviewed and agreed upon for implementation:

Parent/Guardian

Teacher

Social Worker/Psychologist

Special Education Teacher

Student

Administrator

Other

Other

Date(s) plan reviewed:

*Attachments may include point sheets, contracts, token cards,
progress notes, referrals, parent contacts.

Date plan terminated:

MAISD 2/00