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Functional Assessment Checklist for Teachers and Staff (FACTS-Part A)

Step 1Student/ Grade KINDERGARTEN _____________ Date: _JULY 2,2019__________________

Interviewer: April C. Cisneros___________________ Respondent(s): _JOHN HITLER AFREDA ____________

Step 2Student Profile: Please identify at least three strengths or contributions the student brings to school.
___________________________________________________________________________________
The pupil is active, participative and intelligent .

Step 3Problem Behavior(s): Identify problem behaviors

___ Tardy _✓__ Fight/physical __✓_ Disruptive ___ Theft

Aggression
___ Unresponsive ___ Inappropriate Language ___ Insubordination ___ Vandalism
___ Withdrawn ___ Verbal Harassment ___ Work not done ___ Other ________________
___ Verbally Inappropriate ___ Self-injury
Describe problem behavior: ____________________________________________________________
Step 4
Identifying Routines: Where, When and With Whom Problem Behaviors are Most Likely.

Schedule Activity Likelihood of Problem Behavior Specific Problem Behavior

(Times)
9:10-9:20 Meeting time 1 Low High Fight physical aggression
1 2 3 4 5 6
9:30-9:55 Work period 2 Disruptive
1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

Step 5
Select 1-3 Routines for further assessment: Select routines based on (a) similarity of activities (conditions) with ratings of 4, 5 or 6 and (b) similarity of problem behavior(s).
Complete the FACTS-Part B for each routine identified.
1. The pupil fight with physical agression
2. He is disruptive both in class and classmates
3. Keeps on roaming around

March, Horner, Lewis-Palmer, Brown , Crone, Todd & Carr (2000) 4/24/00
 Functional Assessment Checklist for Teachers & Staff (FACTS-Part B)

Step 1Student/ Grade: KINDERGARTEN__________________ Date: __JULY 2,2019____ _____________________

Interviewer: _______APRIL C. CISNEROS___________ Respondent(s): JOHN HITLER AFREDA______________

Step 2Routine/Activities/Context: Which routine(only one) from the FACTS-Part A is assessed?

Routine/Activities/Context Problem Behavior(s)
Writing workshop
very disruptive_

Step 3
Provide more detail about the problem behavior(s):

What does the problem behavior(s) look like? John Hitler is a child that can be describe as always roaming
and running around the classroom.

How often does the problem behavior(s) occur? The behavior occurs Every after his work. It means when
he has nothing to do.

How long does the problem behavior(s) last when it does occur? The behavior of John Hitler may last 15-
20 mins

Step 4 What is the intensity/level of danger of the problem behavior(s)? )? The intensity level of his behavior is
high.

What are the events that predict when the problem behavior(s) will occur? (Predictors)
Related Issues (setting events) Environmental Features
___ illness Other:__food __✓_ reprimand/correction ___ structured
intake____________ activity
___ drug use ______________________ ___ physical demands ___ unstructured time
Step 5 ___ negative social ______________________ ___ socially isolated ___ tasks too boring
___ conflict at home ______________________ ___ with peers ___ activity too long
___ academic failure ______________________ ___ Other ___ tasks too difficult
__________________

What consequences appear most likely to maintain the problem behavior(s)?

Things that are Obtained Things Avoided or Escaped From
__✓_ adult attention Other: ________________ ___ hard tasks Other: ___________________
___✓ peer attention ___ reprimands ________________________
Step 6 ______________________ ___ peer negatives ________________________
___ preferred activity ______________________ ___ physical effort ________________________
___ money/things ______________________ ___ adult attention ________________________

SUMMARY OF BEHAVIOR
Identify the summary that will be used to build a plan of behavior support.
Setting Events & Predictors Problem Behavior(s) Maintaining Consequence(s)
Step 7
 The learner starts to run
The teacher is supervising the class and disturbing classmates Give the learner more
worksheets to do and
sometimes reprimand of what
he is doing

How confident are you that the Summary of Behavior is accurate?

Not very confident Very Confident
1 2 3 4 ✓5 6

What current efforts have been used to control the problem behavior?
Strategies for preventing problem behavior Strategies for responding to problem behavior
___ schedule change Other: ________________ __✓_ reprimand Other:
___✓ seating change ___________________
______________________ ___ office referral _________________________
___ curriculum change ______________________ ___ detention _________________________

March, Horner, Lewis-Palmer, Brown , Crone, Todd, & Carr (2000) 4/24/00
 The Functional Assessment Checklist for Teachers and Staff (FACTS):
Instructions

The FACTS is a two-page interview used by school personnel who are building behavior support plans. The FACTS is intended to be an efficient
strategy for initial functional behavioral assessment. The FACTS is completed by people (teachers, family, clinicians) who know the student best, and
used to either build behavior support plans, or guide more complete functional assessment efforts. The FACTS can be completed in a short period
of time (5-15 min). Efficiency and effectiveness in completing the forms increases with practice.

How to Complete the FACTS-Part A

Step #1: Complete Demographic Information:

Indicate the name and grade of the student, the date the assessment data were collected, the name of the person completing the form (the
interviewer), and the name(s) of the people providing information (respondents).
The interviewer is John Hitler Afreda a Kindergarten pupil interviewed on July 2, 2019 by April C Cisneros who is his adviser.

Step #2: Complete Student Profile

Begin each assessment with a review of the positive, and contributing characteristics the student brings to school. Identify at least three strengths
or contributions the student offers.
The pupil is active and participative in class and intelligent too.

Step #3: Identify Problem Behaviors

Identify the specific student behaviors that are barriers to effective education, disrupt the education of others, interfere with social development or
compromise safety at school. Provide a brief description of exactly how the student engages in these behaviors. What makes his/her way of doing these
behaviors unique? Identify the most problematic behaviors, but also identify any problem behaviors that occur regularly.

He is very disruptive and sometimes involves physical agression.

Step #4: Identify Where, When and With Whom the Problem Behaviors are Most Likely

A: List the times that define the student’s daily schedule. Include times between classes, lunch, before school and adapt for complex schedule
features (e.g. odd/even days) if appropriate.

The behavior of the pupil usually occurs during meeting time 1 ( 9:10-9:20) and work period 2 (9:30-9:55)
 B: For each time listed indicate the activity typically engaged in during that time (e.g. small group instruction, math, independent art, transition)
Meeting time 1 –(9:19-9:20) = Fight physical agression
Work period 2 (9:30-9:55) = disruptive

C: Use the 1 to 6 scale to indicate (in general) which times/activities are most and least likely to be associated with problem behaviors. A “1”
indicates low likelihood of problems, and a “6” indicates high likelihood of problem behaviors.

Fight physical agression-5

Disruptive-5

D: Indicate which problem behavior is most likely in any time/activity that is given a rating of 4, 5 or 6.
Among the two behavior the most likely happens most of the time is being disruptive

Step #5: Select Routines for Further Assessment

Examine each time/activity listed as 4, 5 or 6 in the Table from Step #4. If activities are similar (e.g. activities that are unstructured; activities that
involve high academic demands; activities with teacher reprimands; activities with peer taunting) and have similar problem behaviors treat them as
“routines for future analysis”.
Select between 1 and 3 routines for further analysis. Write the name of the routine, and the most common problem behavior(s). Within each
routine identify the problem behavior(s) that are most likely or most problematic.
For each routine identify in Step #5 complete a FACTS-Part B
Give the learner more worksheets to do and sometimes reprimand him of what he is doing

How to Complete the FACTS-Part B

Step #1: Complete Demographic Information:

Identify the name and grade of the student, the date that the FACTS-Part B was completed, who completed the form, and who provided
information for completing the form.
The interviewee is John Hitler AFREDA who was interviewed last July 2,2019
Step #2: Identify the Target Routine

List the targeted routine and problem behavior from the bottom of the FACTS-Part A. The FACTS-Part B provides information about ONE
routine. Use multiple Part B forms if multiple routines are identified.
The target routine is writing workshop
John Hitler has a disruptive behavior in which it cause physical agression towards others.
Step #3: Provide Specifics about the Problem Behavior(s)
 Provide more detail about the features of the problem behavior(s). Focus specifically on the unique and distinguishing features, and the way the
behavior(s) is disruptive or dangerous.
The problem is being very disruptive
Step #4: Identify Events that Predict Occurrence of the Problem Behavior(s)

Within each routine what (a) setting events, and (b) immediate preceding events predict when the problem behavior(s) will occur. What would
you do to make the problem behaviors happen in this routine?
The teacher is supervising the class.

Step #5: Identify the Consequences that May Maintain the Problem Behavior

What consequences appear to reward the problem behavior? Consider that the student may get/obtain something they want, or that they may
escape/avoid something they find unpleasant.
Identify the most powerful maintaining consequence with a “1”, and other possible consequences with a “2” or “3.” Do not check more than three
options. The focus here, is on the consequence that has the greatest impact.
When problems involve minor events that escalate into very difficult events, separate the consequences that maintain the minor problem behavior
from the events that may maintain problem behavior later in the escalation.
Adult attention and peer attention
I will give him more activities to do to lessen his behavior. Since he likes to write and draw.

Step #6: Build a Summary Statement

The summary statement indicates the setting events, immediate predictors, problem behaviors, and maintaining consequences. The summary
statement is the foundation for building an effective behavior support plan. Build the summary statement from the information in the FACTS-A and
FACTS-B (Especially the information in Steps #3, #4, and #5 of the FACTS-B). If you are confident that the summary statement is accurate enough to
design a plan move into plan development. If you are less confident, then continue the functional assessment by conducting direct observation.
Procedures for completing the functional assessment, and for designing behavioral support are described in the following references.
While the teacher is supervising the class, the pupil started to disrupt others . since the pupil like to write and draw, I will just let him do it to lessen his
misbehavior.

Step #7: Determine “Level of Confidence”

Use the 1-6 scale to define the extent to which you, the interviewer or the team are “confident” that the summary statement is accurate.
Confidence may be affected by factors such as (a) how often the problem behavior occurs, (b) how long you have known the focus person, (c) how
consistent the problem behaviors are, (d) if multiple functions are identified, and (e) if multiple behaviors occur together
Disruptive- 5.
The behavior occurs during work period 2 and usually last for 15-20 minutes
Step #8: Define what has been done to date to prevent/control the problem behavior

In most cases, school personnel will have tried some strategies already. List events that have been tried, and organize these by (a) those things that
have been to prevent the problem from getting started, (b) those things that were delivered as consequences to control or punish the problem behavior (or
reward alternative behavior).
Change of seating arrangement and reprimanding

Examples of completed FACTS-Part A and FACTS-Part B are provided below

Discussions: (citations)

Out‐of‐seat and talking‐out behaviors were studied in a regular Kindergarten class that includes only one child, named John Hitler Afreda. The
purpose of this study is to know what is the reason of being hyper or disruptive of John Hitler. Also to have some ideas on how to prevent this kind of
behavior. Through this research the possible causes of misbehavior of John Hitler may be defined.

References

 Good Behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom

Harriet H Barrish, et. al, Volume 2, Issue 2

 Methylphenidate Response in Aggressive and Nonaggressive ADHD Children: Distinctions on Laboratory Measures of Symptoms
Kristin Mariet, B.S, et. al, Volume 1

 Evidence-Based Psychosocial Treatments for Children and Adolescents With Disruptive Behavior
Sheila M Eyberg, et. ,Volume 37, 2008 - Issue 1

 A meta-analysis of interventions to decrease disruptive classroom behavior in public education settings

Stage, S. A., & Quiroz, D. R. (1997).,

 Parenting Practices and Child Disruptive Behavior Problems in Early Elementary School
 Elizabeth A Stormshak, et. al, Journal of Clinical Child Psychology  Volume 29, 2000 - ,issue 1,

Behavioral Invention Plan

ALPINE BEHAVIORAL INTERVENTION PLAN

Student Name: JOHN HITLER AFREDA Grade:KINDERGARTEN. Date of Plan:Today Date of Plan Review: 8/1/2019

I. Target Behaviors and II. Functional III. Antecedent Intervention Strategies (Positive IV. Reinforcers and Consequences V. Progress
Definitions (Copy from the Behavioral Behavioral Interventions and Supports) Monitoring of BIP
FBA.) Assessment and What data? What progress
monitoring tool? Who will collect
Identified Function A. Context & B. Alternative A. Individualized B. Consequences
the data?
of the Target Antecedent Behaviors/Behavior Reinforcers for Target
Modifications Skills Training Behavior
Behavior (Hypothesis
from the FBA)
1. Physical class disruption‐John During work period 2 , 1. Give more Desired Alternative: 1.Preferred Activity 1.Extra math during # of physical class disruptions
Hitler engages in disruptive when I conduct a short recess/free time (teacher)
work Participate and be more
behaviors. This looks like discussion, John Hitler
hitting his classmates physically disrupts the sheets/hand attentive
intentionally. He is very happy class which leads to s on
every time he did such. He classroom disturbance. activities to Acceptable Alternative:
keeps on roaming and running do John Hitler will be given a
around the classroom without
2. Reprimand chance to play and an activity he
tiredness.
of what he is likes to do
doing

1. Steps in playing in the

given time
2. Steps for participating in
class
Crisis Plan:

How will an emergency situation or behavior crisis be handled? (Define possible scenarios, including the use of in‐school or out‐of‐school suspension, or aversive
techniques, as appropriate)

John Hitler continues to disrupt and disturb classes. John Hitler never fails to hit any one of his classmates.

1) reprimand

Conclusions:
__John Hitler is a child who has a disruptive behavior which he only can control with it. He needs more attention and he needs to do more on hand
activities.__ In this study, it was found out that the case of John Hitler is somewhat the same with ADHD. This study suggests that the food eaten by
John will be monitored. Because it might be one of the influences on the development of Disruptive Behavior Disorders
_______________________________________________________________________________________

References:

 Harriet H Barrish, et. al, Volume 2, Issue 2

 Kristin Mariet, B.S, et. al, Volume 1

 Sheila M Eyberg, et. ,Volume 37, 2008 - Issue 1

 Stage, S. A., & Quiroz, D. R. (1997).,

 Elizabeth A Stormshak, et. al, Journal of Clinical Child Psychology  Volume 29, 2000 - ,issue 1,