Carmen Boyer 743 Fabi With Feedback 1

Completion Checklist
Step 5: Testing the Intervention
School Hypothetical High District

: School : Hypothetical Date: 12/06/2021
Team Members:
1 Carmen Boyer
.
2 Makenzy Hearn
.
3 Rebecca Hunt
.
Coach: Scott Fluke

Directions: Complete step give, see notes in RED.
Note:
(1) *Shaded rows are not required for SPED 743, but are recommended as regular practices.
(2) You may elect to proceed further in the process and withdrawal (B2), or withdrawal and
reintroduce the intervention (A2-B2) as time permits.
Check when Item

completed
x Implement Intervention
Attached below.
x Collect Treatment Integrity data daily (teacher perspective) with IOA for
25% of sessions (outside team observer).
The treatment integrity is attached below (secondary observer data).

x Collect Min of 5 data points (behavior measurement – same behavior and
measurement system as baseline) – with 25% IOA [Report as number of
sessions, % of sessions, and actual IOA %]
*SPED 743: Collect minimum of 3 data points.
B1
Session 1: 11/22/2021
Session 2: 11/23/2021
Session 3: 11/24/2021
Session 4: 11/29/2021
Session 5: 11/30/2021
B2
Form Updated (ci3t.org): 04/18/2016
Reference: Lane, K. L., & Oakes, W. P. (2014). Functional assessment-based interventions (FABI): Training
Materials – Step-by-step checklists.
Copyright © 2015 by Kathleen Lynne Lane.
1
Session 1: 12/08/2021
Session 2: 12/09/2021
Session 3: 12/10/2021
Session 4: 12/13/2021
Session 5: 12/14/2021
x 10 data How many intervention data points did you collect?
points
10 data points were collected for the intervention. Attached below.
x How many intervention data points included IOA?
4 pts with
IOA 4 data points included IOA. Attached below.
x What was your IOA for intervention?
98.53% Smaller count/larger count x 100= IOA % (Cooper et al., 2007, p. 115)
80/85 x 100 = 94.12%
90/90 x 100= 100%
90/90 x 100= 100%
100/100 x 100 =100%
x Graph your intervention data. (Coaches’ review for support for deciding
when to withdrawal the intervention)
SPED 743: Graph your intervention data next to baseline data with a phase
change line.
Function-Based Intervention: Katie

2
x Withdrawal of the intervention with at least 3 data points (1 IOA)

*Note phase change decisions for each phase are guided by student
performance on variables measured
Click or tap here to enter text.

x Complete Treatment Integrity Form
(daily by interventionist [teacher] 25% IOA)

x Graph withdrawal data
(Coaches’ review for support for deciding when to reintroduce the
intervention)

x Reintroduce the intervention.
*Note phase change decisions for each phase are guided by student
performance on variables measured

x Collect Treatment Integrity data daily (teacher perspective) with IOA for
25% of sessions (outside team observer).

x Collect min of 3 data points (behavior measurement – same behavior and
measurement system throughout all phases) – with 25% IOA [Report as
number of sessions, % of sessions, and actual IOA %]

x Plan for follow up data collection to assess maintenance. HO 6 FABI
Planning and 6.1 Behavior Intervention Plan (BIP)
SPED 743: Complete p. 11 (data to be collected). This will be finalized and
placed in the BIP.
Attached below.
x Work with your coaches to complete behavior intervention plan and graphed
data to share with teacher and parents.
x Conduct final check of ethical considerations HO 14 Ethics Checklist
Attached below.

3
x After reviewing final graph, assess POST social validity. Adapted-IRP-15

and Adapted-CIRP
*SPED 743: Review final graph with teacher and student
For both Katie and the teacher, social validity data showed there was buy-in
from both stakeholders. Overall, both parties expressed approval for the
intervention and did not note any major concerns in regards to the designed
program.
IRP-15 Pre-Test 11/19/2021

IRP-15 Post-Test 01/20/2021
CIRP Pre-Test 11/19/2021
CIRP Post-Test 01/20/2021
x Complete and turn this checklist into your coach.
Suggested Readings
1. In the Beyond Behavior Special Issues, read the method, results, and discussion section
of articles 2-4 to see how the intervention was design, implemented, and evaluated
2. Read the following chapters in
Umbreit, J., Ferro, J., Liaupsin, C., & Lane, K. (2007). Functional behavioral assessment
and function-based intervention: An effective, practical approach. Upper Saddle River,
N. J.: Prentice-Hall.
a. Chapter 10 to learn how to test the intervention
b. Chapter 13 to learn how to monitor the intervention and analyze intervention
outcomes
Step 5 Tips:
1. Be sure you use an experimental design to make certain you can actually demonstrate a
function relation between the introduction of the intervention and changes in student
performance.
2. Phase changes are determined by examining data (e.g., stability, level, and trend) and are
not determined by the amount of time a student spends in each phase.
3. Phase changes should not occur before or after breaks in the school year calendar.
4. Be certain to collect treatment integrity data with each introduction of the intervention.

4
5. The post-intervention social validity measures are completed by stakeholders after the
intervention has been tested and the outcomes (e.g., graph and other data) have been
shared with and explained to the stakeholders.
6. When you complete HO 6.1, remember it will be used by the current and future teachers.
Be certain to include a blank copy of the treatment integrity form for future use as well as
a completed graph showing the complete intervention outcomes.
Ethics Checklist
Ethical Consideration Explain how each consideration
was addressed in the FBA and
BIP
Is the intervention warranted? The intervention is warranted. Katie’s low

(Does the target behavior interfere with levels of work completion present a barrier
the individual’s ability to learn new to her academic success making it a vital
skills, to participate in activities, or does target behavior to address with appropriate
it diminish potential for community interventions.
integration?)
Was the student interviewed and results Yes, the student was interviewed and the
considered in designing the BIP? Why results (in conjunction with teacher
or why not? interview, ABC and baseline data
collection, function matrix and ARE
planning components) were taken into
account when planning interventions based
on her function of behavior. Her interview
was utilized to better create an intervention
that matched Katie’s needs and behavior
functions.
Were the interventions selected Yes the behavior was selected

systematically? What Method did you use? systematically using Function Based
Intervention Decision Model. Because
Katie is capable of performing the
replacement behavior of turning in work at
75% completion, but antecedents did not
represent effective practice, Method 2 was
chosen to improve the environment.
Did the interventions follow from the The interventions did follow from the
FBA. Using the FBA, it was decided that
5
FBA? Explain the primary function of Katie’s behavior is

avoid
Did the intervention include a The replacement behavior is turning in

replacement behavior to increase a work that is 75% or more completed. This
positive skill? What is the replacement is a positive skill as it entails Katie doing
behavior and how is it connected to the something, rather than not behaving a
FBA? What skill does it build? certain way. The function of Katie’s
behavior is mainly avoidance of work, so
higher levels of work completion combat
this to build the skill of following through
with work.
Does the intervention address problems Yes; Katie regularly refuses to turn in
in the classroom environment? Why or independent work that she does not feel
why not? confident in. By allowing cooperative
learning groups, online resources, and a
CICO system, the environment of the
classroom becomes more supportive of
learners with Katie’s needs.
Does the intervention target a socially Yes, the socially significant skill is work
significant goal? What is it? Why do completion. Not only is this skill vital in a
you think it’s socially significant? school setting, it will be vital in a work or
cooperative setting in the future. Inability
to complete work could become a barrier
for Katie in high school, college, and her
career.
Does the procedure stigmatize the No, all of the procedures, antecedent
student socially? adjustments, reinforcers, and extinguishers
can be done quietly and privately. Some of
the classroom environment alterations
affect all students, but specific
interventions for Katie are not obvious,
stigmatizing, or ostracising. They are well
blended into the classroom.
Does the intervention provide Yes. Katie can choose to talk to peers for
opportunities for the student to make support and online resources. Katie can
choices? Explain. also choose between phone or social time,
or to save these coupons for a “Free
Assignment Pass.”
6
Does the intervention include an aversive Yes, if Katie decides to take home work to
or restrictive procedure? Explain. complete it, there is a 10% late fee
deduction to the assignment score. This is
to discourage Katie from low levels of
work completion.
Were incentives selected based on Yes, based on Katie’s interview it was

the student’s wants and needs? decided that phone or social time would be
Explain. a reward for completing work. She could
exchange three of these coupons to avoid
turning in one assignment. Katie’s
motivation, expressed interests, and
behavior function were taken into account
to draft incentives.
Functional Assessment-based Intervention (FABI)

HO 14
Ethical Consideration Explain how each consideration
was addressed in the FBA and
BIP
Did you address the integrity of Yes, a treatment integrity checklist was
implementation (i.e., treatment created for two observers to monitor the
integrity)? Explain. fidelity to the intervention. This was then
used to retrain and revise interventions and
personnel.
Was there systematic and scheduled Hypothetically, data was reviewed weekly
review of the data? by all stakeholders. This was done in zoom
meetings at 3:00pm every Friday.
If the target behavior did not improve, Hypothetically, target behavior improved
was additional information collected to after implemented intervention. When
assist with revision? Describe how the target behavior was not improving as
decision was made to continue or drastically as expected, the team
change the BIP. reevaluated treatment integrity and noted
not all components of the intervention
were being addressed in class. The team
met with the teacher and Katie to review

7
intervention components.
Was the plan revised in a timely manner? Plan was revised and approved by all
stakeholders once data showed stagnancy;
these revisions were implemented the
following Monday.
Updated: 04/20/2016
Ferro, J. B., Umbreit, J., & Liaupsin, C. J. (2010). Ethics checklist - R. Unpublished measure,
University of Arizona, Tucson, AZ. Permission granted from first author (April 20,
2016).
Check in/Check out Sheet:

Check in:
Monday ● Review content and assignment for today
Initial:
Teacher: ______ Student: ________
Check out:
● Review today’s assignment
● Hand in assignment
● Preview tomorrow’s content
Initial:
Check in:
Tuesday ● Review content and assignment for today
Initial:
Check out:
Initial:
Check in:
Wednesday ● Review content and assignment for today
Initial:
Check out:
Initial:
Check in:
Thursday ● Review content and assignment for today
Initial:
Check out:
Initial:

8
Check in:
Friday ● Review content and assignment for today
Initial:
Check out:
Initial:

9
Treatment Integrity Checklist
Behavior Intervention Plan

Student Name: Katie Student ID: Hypothetical
School: Hypothetical Date of Birth: Hypothetical
Current Grade Level: 9th Grade Special Education: ☐ Yes x No
Gender: Female Disability Eligibility: N/A
Parent(s): N/A Parent(s) Contact Number: N/A
Date of Assessment: ABC (10/21/13) Planning Form (11/18/2021)

10
Classroom teacher: Spanish Class- Mr. David

Persons conducting the assessment:
Role: ☐ Classroom teacher ☐ SPED Teacher ☐ Teacher (Other) ☐ Teacher (Other)
☐ School Psychologist ☐ Counselor ☐ Behavior Specialist ☐ Intern
x University Student ☐ BCBA/ ABA ☐ Other: Click or tap here to enter text.
Behavioral Definitions
Target Behavior:
Label: Low levels of work completion
Definition: Low levels of work completion refers to any behavior that involves working exclusively on
one component of an assignment, resulting in a failure to attempt subsequent portions of
task
Examples: Redoing a problem multiple times after double checking it, erasing and rewording a
response without necessarily changing the content, getting stuck on a question and
attempting multiple times without moving on to the next question, and attempting less than
50% of an assignment. Taking classwork home to turn it in at a later date.
Nonexamples: Asking for help with any portion of the assignment, turning the assignment in on-time with
75% or more completed.
Operational Definition (include label, definition, examples, and nonexamples):

Label: Work Completion
one component of an assignment resulting in a failure to attempt subsequent portions of task. Does she
always attempt the task?
Examples: Redoing a problem multiple times after double checking it, erasing and rewriting a response
without necessarily changing the content, getting stuck on a question and attempting multiple times
without moving onto the next question, and attempting less than 50% of an assignment, taking classwork
home to turn it in at a later date.

11
Non-examples: Asking for help with any portion of the assignment, turning the assignment in on-time
with 75% completion
Dimension of behavior : Frequency
Replacement Behavior:
Label: Completing independent work
Definition: Completing independent work includes the student working on the assignment until 75%
complete within the allotted class time.
Examples: Student focusing on each question, answering each question completely within the class
time, skipping challenging problems and revisiting them if time allows,
Nonexamples: Continuous checking of conjugation or other content, redoing portions of the assignment,
not attempting the assignment, refusal to turn in assignment, taking assignment home to
turn in late

Definition: Completing independent work includes the student working on the assignment until totally
Examples: Student focusing on each question, answering each question completely within the class time,
skipping challenging problems and revisiting them
Non-examples: Continuous checking of conjugation or other content, redoing portions of the assignment,
not attempting the assignment, refusal to turn in assignment, taking assignment home to turn in late.
Rationale for Replacement behavior (e.g. Why do you want to teach this behavior or increase the
likelihood of this behavior occurring?):

12
In order for Katie to see increased academic success, work completion is vital. Her inability to complete
and turn in work in a timely manner are negatively affecting her grades and academic achievement. Katie
needs to be able to turn in work consistently and in a timely fashion in order to increase her achievement
in Spanish class. For this reason, work completion was chosen as a replacement behavior for Katie. These
two behaviors cannot coexist; the goal is for Katie’s replacement behavior (work completion) to take the
place of the target behavior (low levels of work completion).
Baseline Statement:
Baseline (e.g. number of observations, level, trend, stability to describe present levels of student
performance and to inform the development of behavior objective)
Number of Observations: 5
Trend: Katie currently does not complete or turn in work, and this is evident in the graph as each
observation day Katie received 0 points.
This baseline data implies a need for the intervention.
Baseline Descriptive Statistics describing level and trend for baseline:
Mean (SD): mean= 0 ➗5=0 SD (0)
Slope (SE YX): Slope (0)
Baseline Statement:
Currently, Katie is not completing 75% of work and turning it in to her Spanish teacher; each observation
day, Katie received a score of 0 points. Because of this evident trend, there is a need for behavior
intervention in Katie’s work completion.
Behavioral Objective:
After intervention, Katie will complete 75% of work and turn it in on 4 out of 5 observation days (Katie
will receive 4 out of 5 possible points on data collection sheets).
Positive Reinforcement Negative Reinforcement
(Access Something) (Avoid Something)
Attention Click or tap here to enter text. Click or tap here to enter text.
Tangibles Teacher Interview Direct Observation A-B-C
Activities ● (1.1, 1.2, 1.3, 1.4, 2.1, 2.2, 2.3,

3.1, 3.2)

13
● Question 3e: Katie wants access Student Interview

to more time to create a perfect ● Question 13: Avoiding written
assignment work, Katie feels like speaking
Student Interview Spanish will benefit her more in
● Question 10b: Katie wants the real world
access to technology to help Teacher Interview
doing assignments ● Question 22a: Teacher prompts
● Question 13a: Katie wants Katie to turn in assignments, Katie
access to more time to complete avoids turning in the assignment
assignments
● Question 13b: Katie wants
access to an online textbook
Sensory Click or tap here to enter text. Click or tap here to enter text.
Source: Umbreit, Ferro, Liaupsin, & Lane (2007).
Rating Scales Summary Statement:

Unavailable.
Outcome of Function Matrix: Hypothesized Function:
When Katie was required to complete independent assignments and was not receiving opportunities, such as extra
time and discussion, to practice and grow comfortable with content, she exhibited low levels of work completion to
avoid turning in imperfect assignments (negative reinforcement: avoid tangibles/activities) and access more
opportunities to practice and use tools such as online textbooks, additional time, technology (positive reinforcement:
access tangibles/activities).
Functional Behavioral Assessment:

Determining the Intervention Procedure
☐ Method 1: Teach the Replacement Behavior

x Method 2: Improve the Environment
☐ Method 3: Adjust the Contingencies
☐ Method 1 & 2: Teach the Replacement Behavior and Improve the Environment
Adjust ● Check in/check out system with teacher: The teacher briefly reviews the work
Antecedents
and content for the day during check in. During check-out, Katie hands in work
and the teacher briefly reviews tomorrow’s content.

14
● Cooperative groups or peer discussion for the last 10 minutes of class. This
gives an opportunity for Katie to gain peer support and confidence to complete
and turn in her assignment.
● Access to an online textbook to complete in-class assignments.
Reinforcemen ● Katie will earn a 5-minute coupon for phone or social time during class after
t
turning in 4 of 5 assignments with 75% or more completed. If Katie does not
Rates
meet her goal the coupons will be withheld.
● She can save the coupons and trade 3 5-minute coupons for an excuse from
turning in one assignment.
● Katie will track her progress on a tracker
Extinguish ● Katie will gradually need to complete more assignments to earn the reward.
Target
After successfully meeting the daily goal 9 times, she will need to turn in 6
Behavior
assignments out of 7 to earn the assignment pass, then 9 out of 10.
● Scheduling time for in-class small group work on the assignments provides
opportunities for Katie to practice the skills and eliminates the need to avoid
turning in the assignment.
● If Katie takes the assignment home to complete, she will not be able to earn
the coupon for that assignment and she will lose 10% of her score. Since Katie
is motivated by grades, turning the assignment in late will not allow her to
earn an ‘A’ on the assignment.
Data to be collected:
Student Outcome (What behavior(s) is (are) being measured? What measurement system? When/ Where?)
Target Behavior: Levels of work completion
Label: Low levels of work completion
one component of an assignment, resulting in a failure to attempt subsequent portions of
task
Examples: Redoing a problem multiple times after double checking it, erasing and rewording a
response without necessarily changing the content, getting stuck on a question and

15
attempting multiple times without moving on to the next question, and attempting less than
50% of an assignment. Taking classwork home to turn it in at a later date.
Nonexamples: Asking for help with any portion of the assignment, turning the assignment in on-time with
75% or more completed.

Label: Work Completion
one component of an assignment resulting in a failure to attempt subsequent portions of task. Does she
always attempt the task?
Examples: Redoing a problem multiple times after double checking it, erasing and rewriting a response
without necessarily changing the content, getting stuck on a question and attempting multiple times
without moving onto the next question, and attempting less than 50% of an assignment, taking classwork
home to turn it in at a later date.
Non-examples: Asking for help with any portion of the assignment, turning the assignment in on-time
with 75% completion

Replacement Behavior: Completing independent work.
Definition: Completing independent work includes the student working on the assignment until 75%
Examples: Student focusing on each question, answering each question completely within the class
time, skipping challenging problems and revisiting them if time allows,
Nonexamples: Continuous checking of conjugation or other content, redoing portions of the assignment,
not attempting the assignment, refusal to turn in assignment, taking assignment home to
turn in late

16

Definition: Completing independent work includes the student working on the assignment until totally
Examples: Student focusing on each question, answering each question completely within the class time,
skipping challenging problems and revisiting them
Non-examples: Continuous checking of conjugation or other content, redoing portions of the assignment,
not attempting the assignment, refusal to turn in assignment, taking assignment home to turn in late.
Treatment Integrity (e.g., Checklist)

Treatment Integrity: Within the checklist, it is determined that the interventions are utilized correctly. The teacher
will independently rate himself daily in reference to the implementation of the intervention. At least 30% of sessions
will include an independent observer to collect IOA. This is to ensure reliability and ultimately determine the
fidelity to which the program is being implemented. Treatment Integrity Checklist
Social Validity (e.g., IRP-15, CIRP)

Social Validity: Social validity data will be collected by the behavioral specialist from an independently done
survey that both the teacher (IRP-15) and the student (CRP) complete before and after the implementation of the
intervention. This data will be evaluated by the team and utilized to make revisions or continue with
implementation.
IRP-15 Pre-Test Date: 11/19/2021
IRP-15 Post-Test Date: 01/20/2021
CIRP Pre-Test Date: 11/19/2021
CIRP Post-Test Date: 01/20/2021
Supporting Success (e.g., Evaluating the intervention)

Fading and Generalization: Once Katie begins completing work at a higher rate, and she achieves her behavioral
objective, the teacher will increase the necessary assignments to earn coupons and decrease cooperative learning
group activities.
Program Review Date: All team members will review the effectiveness of the intervention four weeks after the
implementation. The teacher and behavior specialist will meet weekly to discuss effectiveness and concerns.
Personnel and Roles:
Teacher: Implement the intervention, collect frequency data

17
Behavior Specialist: Teach the intervention to the student and teacher, monitor treatment integrity, hold
reevaluation meetings and suggest revisions to implementation, collect treatment integrity and social validity data.
Emergency Procedures: In case of an emergency, the team will follow district mandated policies and procedures for
emergency situations.

18
References
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper
Saddle River, NJ: Pearson.

19

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Completion Checklist

Step 5: Testing the Intervention

School Hypothetical High District

Coach: Scott Fluke

Step 5: Testing the Intervention

Check when Item

The treatment integrity is attached below (secondary observer data).

Function-Based Intervention: Katie

Form Updated (ci3t.org): 04/18/2016

x Withdrawal of the intervention with at least 3 data points (1 IOA)

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

x Conduct final check of ethical considerations HO 14 Ethics Checklist

Form Updated (ci3t.org): 04/18/2016

x After reviewing final graph, assess POST social validity. Adapted-IRP-15

IRP-15 Pre-Test 11/19/2021

2. Read the following chapters in

Form Updated (ci3t.org): 04/18/2016

Is the intervention warranted? The intervention is warranted. Katie’s low

Were the interventions selected Yes the behavior was selected

FBA? Explain the primary function of Katie’s behavior is

Did the intervention include a The replacement behavior is turning in

Were incentives selected based on Yes, based on Katie’s interview it was

Functional Assessment-based Intervention (FABI)

Form Updated (ci3t.org): 04/18/2016

Check in/Check out Sheet:

Form Updated (ci3t.org): 04/18/2016

Form Updated (ci3t.org): 04/18/2016

Treatment Integrity Checklist

Behavior Intervention Plan

Form Updated (ci3t.org): 04/18/2016

Classroom teacher: Spanish Class- Mr. David

Label: Low levels of work completion

Operational Definition (include label, definition, examples, and nonexamples):

Form Updated (ci3t.org): 04/18/2016

Dimension of behavior : Frequency

Label: Completing independent work

Operational Definition (include label, definition, examples, and nonexamples):

Dimension of behavior : Frequency

Form Updated (ci3t.org): 04/18/2016

Tangibles Teacher Interview Direct Observation A-B-C

Activities ● (1.1, 1.2, 1.3, 1.4, 2.1, 2.2, 2.3,

Form Updated (ci3t.org): 04/18/2016

● Question 3e: Katie wants access Student Interview

Source: Umbreit, Ferro, Liaupsin, & Lane (2007).

Rating Scales Summary Statement:

Functional Behavioral Assessment:

☐ Method 1: Teach the Replacement Behavior

Form Updated (ci3t.org): 04/18/2016

Label: Low levels of work completion

Form Updated (ci3t.org): 04/18/2016

Operational Definition (include label, definition, examples, and nonexamples):

Dimension of behavior : Frequency

Label: Completing independent work

Form Updated (ci3t.org): 04/18/2016

Operational Definition (include label, definition, examples, and nonexamples):

Treatment Integrity (e.g., Checklist)

Social Validity (e.g., IRP-15, CIRP)

Supporting Success (e.g., Evaluating the intervention)