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Meeting Date:




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A Functional Behavioral Assessment (FBA) is used to gather information about a students behavior to determine the need for, and
provide the foundation for, a Behavioral Intervention Plan (BIP). An FBA is required to be conducted if the students violation of a
code of conduct (resulting in a change of placement) is determined to be a manifestation of the students disability.

Case Manager:

Overlake Specialty School

Participants in the Functional Behavioral Assessment:

- Special Education Teacher, - Teacher, - Paraeducator - Behavior Intervention Specialist, Counselor.
S t u d e n t S t r e n g t h s (include a description of the students behavioral strengths, such as positive interactions with staff,
ignoring the inappropriate behavior of peers, accepts responsibility, etc.):
STUDENTs teachers made note in the Student Profile section of the Functional Assessment Checklist for Teachers and Staff
STUDENTs strengths were assessed using a [modified] Behavior Anchors Assessment (Kratochwill & Bergan, 1990), which
looks at 14 of the most common student behaviors that receive focus for development in students with identified behavioral issues:
verbal and nonverbal communication, following directions, safety, social interaction, respect for authority, participation in learning,
honesty and dependability, problem recovery, expression of feelings, sexual issues and sexuality (body boundaries), time outs, and
personal care. Student behaviors are rated on a four point scale with scores of 4 or 3 given for acceptable behaviors and scores of 2
or 1 for unacceptable behaviors.
According to observations from STUDENTs teachers, STUDENT shows behavioral strengths in the following areas:

Tier 1 (Scores of 4/4): [Behavior was appropriate for the students developmental stage.]

Tier 2 (Scores of 3/4): [Behavior was acceptable for the students developmental stage.]

Areas To Target
Tier 3 (Scores of 2/4): [Behavior was problematic.]

Tier 4 (Scores of 1/4): [Behavior was unacceptable major problems.]

D e s c r i p t i o n o f b e h a v i o r (include a description of the frequency, duration, and intensity of the behavior(s)):

STUDENT engages in the following behaviors as described using Student Incident Reporting (SIR) categories:
While attending Overlake Specialty School (20XX 20XX school year), STUDENT engaged in the following range of behaviors;

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R e c o m m e n d a t i o n s (provide recommendations for prevention of the target behavior, replacement skills/behaviors to be

taught, reinforcements for positive behaviors, etc):
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staff that work with STUDENT should develop systematic response routines for responding to the target behaviorsPage
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provide as consistent an approach as possible. This response routine should positively reinforce any pro-social self-management
and communication strategies / systems that are utilized by STUDENT, and deny access to reinforcement for a continuance of
negative self-management and communication strategies / behaviors; by providing systematic attention specifically when
STUDENT is engaging in productive self-management / pro-social attention seeking.

Describe behaviors that could serve as functional alternatives to the target behavior:
Positive and productive communication and self-management strategies, as demonstrated through: STUDENT will engage in pretaught coping strategies; using appropriate language to discuss problems with peers and staff, use socially appropriate verbal tone
and content while discussing problems with staff and peers; use safe nonverbal interactions with others- i.e. providing personal
space to others; and remaining in the designated area.
Specific goals for STUDENT could include:

1. STUDENT will use classroom appropriate social interactions to communicate with staff-- i.e. raising hand, or calling staff
over to speak privately; measured by number of successful instances out of 60 minute period.

2. When needing a break, STUDENT will independently engage in pre-taught/decided coping strategies like taking a 5
minute break, taking deep breaths at her desk, or collaborate/problem-solve with a classroom staff; to deal with low-level
problems; measured by number of successful instances out of 60 minute period.

3. When finished engaging in a pre-taught coping strategy, STUDENT will return to her assigned task and engage in his
schedule/activity within (2 prompts or 5 minutes); measured by number of successful instances within a 60 minute period.

Setting Event Strategies:

Staff should provide visually routines of expectations; a concrete schedule that alternates non-preferred activities with preferred
activities; specific self-management criteria to access the preferred activities; an individualized learning environment in which
STUDENT can complete academic and / or social behavioral work and coaching; organizational checklists that assist with
transitional times of her school day and that provide visual aids or written expectations about his area; access to a support room (i.e.
isolated area) or learning room to take a "self-break" or to complete a verbal check-in with a staff member; clearly defined physical
boundaries for the spaces STUDENT can access.
Antecedent Strategies:
Staff should provide scheduled conversations concerning behavioral goals and expectations, with direct emphasis on successful
approximations; at times when STUDENT is not escalated, preferably before the identified situations or academic times when the
target behaviors are more likely to occur.
Teaching Strategies:
Staff should provide crisis-debrief teaching strategies directed toward the ineffectiveness of the maladaptive target behaviors.
Staff should provide values-based teaching strategies will be implemented and directed toward the intent of the maladaptive target
behaviors within the collective learning environment (Classroom/Community Social Skills Groups; Classroom
Expected/Unexpected behavior coaching; Staff check-in process).
Staff should provide post-crisis interviewing following behavioral events with STUDENT, which emphasize on the pattern of
behaviors and the impacts / consequences.
Staff should provide in-vivo re-direction/focus on: emotional regulation and social-skills (positive social reinforcement for
approximated and alternative behaviors) and the impact of individual perceptions and interests; and the impact of patterns of selfdefeating/maladaptive behaviors.
Reinforcement Strategies:

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Student Signature: _______________________________ Date: ________________

Parent/Guardian Signature: ________________________ Date: ________________
District Signature: ________________________________ Date: ________________
Teacher Signature: ______________________________ Date: ________________
Behavior Specialist Signature: _____________________ Date: ________________

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