PRACTICE ACTIVITY: Complete the following Brief Behavioral Assessment ABC

statement and referral form based on a problem behavior incident of the student you identified.
Specifically identify the Possible Motivation for your student based on the ABC information you
collected.

BRIEF BEHAVIORAL ASSESSMENT-ABC

We have the most problems during

(time of day/class/Activity/Routine)

Antecedent

Problem Behavior

Consequence

(Trigger/Predictor)

(Student Behavior of concern)

(Response that benefits student)

the student will

and this happens

So, the function of

behavior is to:
Access / Avoid / Escape

Because

this

When

Function/Pay Off

(circle one)

Office Referral Form

Name: ____________________________
Date: _____________ Time:
Teacher: __________________________
Grade: K 1 2 3 4 5 6 7 8
Referring Staff: _____________________

Problem Behavior
Minor
Inappropriate language
Physical contact
Defiance
Disruption
Property misuse
Other ______________
Major
Abusive language
Fighting/ Physical
aggression
Overt Defiance
Harassment/bullying
Disruption
Other ______________

Location
Playground
Cafeteria
Hallway
Classroom

Library
Bathroom
Bus
Other ________

Possible Motivation

Administrative Decision

Obtain peer attention

Obtain adult attention
Obtain items/activities
Avoid Peer(s)
Avoid Adult
Avoid task or activity
Dont know
Other ________________

Loss of privilege
Time in office
Conference with student
Parent Contact
Individualized instruction
In-school suspension
(____hours/ days)
Out of school suspension
(_____ days)
Other ________________