Child/Youth: / Pseudonym or Initials only / Birthdate: / Age:
mm/dd/yyyy
School: / Pseudonym or Initials only / Submitted by: /

Your Name Here

FBA Summary

Highlight all of the following text and write a summary statement about what the FBA you conducted for the student revealed. When you are done be sure change the font color to black.

Target Behaviors

•  Highlight all of the following text and describe one or more target behavior(s) using a “General Category followed by Specific Descriptors” format. When you are done be sure change the font color to black.

Complete one of the following Competing Behavior Models; delete this sentence and the other Competing Behavior Model that you do not use.

Competing Behavior Model 1

Setting Event
/
Antecedent/Predictor
/ Desired Behavior / Maintaining Consequences
Replacement Behavior
/ Problem Behavior

Competing Behavior Model 2

Setting Event
/
Antecedent/Predictor
/ Desired Behavior / Maintaining Consequence(s)
/ Replacement Behavior
/
Problem Behavior

Recommended Intervention(s):

Behavioral Goal 1
•  Highlight all of this text and specify one long term/annual goal addressing the targeted behavior. When you are done be sure change the font color to black.
Behavioral Objectives for Goal 1 (minimum 2)
•  Highlight all of this text and specify at least two behavioral objective addressing the targeted behavior (who – will do what – under what circumstances – how many times or to what degree of success or given specific circumstance – who – will do what -- how many times or to what degree of success). When you are done be sure change the font color to black.
Behavioral Goal 2
•  Highlight all of this text and specify one long term/annual goal addressing the targeted behavior. When you are done be sure change the font color to black.
Behavioral Objectives for Goal 2 (minimum 2)
•  Highlight all of this text and specify at least two behavioral objective addressing the targeted behavior (who – will do what – under what circumstance(s) – how many times or to what degree of success or given specific circumstance(s) – who – will do what – how many times or to what degree of success). When you are done be sure change the font color to black.

Interventions/Routines to be Implemented

Explanation of intervention program
•  Highlight all of this text and specify at least two interventions you would implement to assist in changing (increasing or decreasing) the target behavior. When you are done be sure change the font color to black.
Instructional components/routines to be provided
•  Highlight all of this text and describe the instructional components/routines to be provided. When you are done be sure change the font color to black.
Reinforcers and Fading of Reinforcers to be provided
•  Highlight all of this text and describe how you will reinforce target behavior(s) & how you will fade the reinforcers over time. When you are done be sure change the font color to black.
Ensuring Generalization of Skills
•  Highlight all of this text and describe how you will ensure the student generalizes what s/he has learned. When you are done be sure change the font color to black.

Setting Event Strategies

•  Highlight all of this text and list strategies that would make the problem/target behavior irrelevant, ineffective or inefficient. When you are done be sure change the font color to black.

Predictor Strategies

•  Highlight all of this text and list strategies that would make the problem/target behavior irrelevant, ineffective or inefficient. When you are done be sure change the font color to black.

Consequence Strategies

•  Highlight all of this text and list strategies that would make the problem/target behavior irrelevant, ineffective or inefficient. When you are done be sure change the font color to black.

Generalization Strategies

•  Highlight all of this text and list strategies that would maximize the likelihood that the student will generalize the techniques/strategies taught. When you are done be sure change the font color to black.

Monitoring & Evaluation

•  Highlight all of this text and describe how you will: gather data to know the planned intervention is working; evaluate the effectiveness of the BSP/BIP. When you are done be sure change the font color to black.

Recommendations

Special Educator Program

Appendices

A. BSP Forms

B. Other Forms

Special Educator Program

Appendix A

BSP Forms

Special Educator Program

Appendix B

Other Forms

SpEd 623 BSP Report April 5, 2011 7