Instructions for Completion of Functional Behavioral Assessment (Fba)

FBA – PAGE 1

INSTRUCTIONS FOR COMPLETION OF FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)

* The teacher of record, team leader or the referring teacher is responsible for initiating the

FBA/BIP process.

Presenting Behavior (s):

¨  Describe presenting behaviors – Identify no more than 2 or 3 target behaviors that are observable and define them in specific, concrete terms.

Data Collection

¨  Check all methods used to gather data

¨  Problem Behavior Questionnaire(s) and Student Questionnaire should be completed at this time

¨  Distribute Problem Behavior Questionnaire(s) to appropriate staff.

¨  TOR and/or appropriate staff list observable problem behavior(s)

¨  TOR will oversee the completion of the Student Questionnaire.

¨  Student may give feedback on FBA pages 3 and 4.

¨  Additional Background Information

Past Experiences

Family Changes/Issues

Health/Medication Issues

Legal Issues

Environmental Components

¨  Check all that apply

Conditions and Responses

¨  Check all that apply or rate as indicated

¨  Check what typically occurs immediately prior to the behavior including setting, time, others present, etc. – is there a pattern?

Possible Behavior Function

¨  What do you think might be a logical reason for the student’s behaviors?

¨  Check all that apply

Summary

¨  Review all data collected and summarize results

¨  FBA pages 3, 4, 5 should be completed after data collection

Identified Behavioral Concern(s):

¨  Based on summary information list no more than three behavioral concerns

¨  Indicate intensity (what is the magnitude of the behavior – mild, moderate, severe)

¨  Indicate frequency (%of time – see Problem Behavior questionnaire)

Results and Interpretations of Existing Data & Functional Assessment/Additional Data Determinators

¨  Check appropriate determination

Note: * The FBA and BIP must be attached to case conference paperwork:

1.  when the BIP is first developed and

2.  at the ACR.

* Forms required at case conferences are FBA 2, 3, 4, 5 and BIP 2 and 3. There must be a form (amendment or 5A.5)

for parent signature to approve the BIP.

FBA_Instructions 8 / 2004