Free Functional Behavior Assessment Template

Functional Behavior Assessment

Prepared by [YOUR NAME], [YOUR COMPANY NAME]


Section 1: General Information

  • Student Name: Erica Price

  • Date of Assessment: March 15, 2086

  • School/Program Name: Horizon Academy for Advanced Learning

  • Evaluator Name: [YOUR NAME]

  • Evaluator Role/Title: School Behavior Specialist

  • Reason for Referral: Frequent disruptions during group learning activities, including verbal outbursts and leaving the classroom without permission.


Section 2: Background Information

  1. Relevant History

    • Academic Performance: Erica Price performs above average in math but struggles with reading comprehension.

    • Medical/Mental Health Concerns: Diagnosed with ADHD in 2082. No other significant medical history reported.

    • Developmental Milestones: Achieved major milestones within typical age ranges.

  2. Sources of Data

    • Interviews: Conducted with Erica Price’s parents, classroom teacher, and special education coordinator.

    • Direct Observations: Observed during three 45-minute sessions over two weeks.

    • Records Review: Reviewed academic records from 2084–2086 and behavior incident logs.


Section 3: Target Behavior(s)

  • Specific Behavior(s) of Concern:

    1. Verbal Outbursts: Includes shouting, interrupting peers, and making inappropriate comments.

    2. Leaving Classroom: Exiting the classroom without permission, often during structured tasks.

    3. Noncompliance: Refusal to follow teacher instructions during group activities.

  • Frequency and Duration:

    • Frequency: Verbal outbursts occur 4–6 times per day; leaving the classroom happens 2–3 times weekly.

    • Duration: Outbursts last approximately 1–3 minutes; leaving the classroom results in a 5–10-minute absence.


Section 4: Assessment Criteria

Criterion

Description

Rating

(if applicable)

Frequency of Behavior

Verbal outbursts occur daily; leaving the classroom occurs 2–3 times weekly.

High

Intensity of Behavior

Verbal disruptions significantly interfere with peers' focus and group activities.

Moderate

Duration of Behavior

Outbursts and off-task behaviors average 5–10 minutes per incident.

Moderate

Triggers/Antecedents

Structured activities requiring focus or group participation often precede the behaviors.

High

Consequences of Behavior

Behaviors typically result in removal from group settings, providing temporary escape.

High

Setting Factors

Noisy or overstimulating environments appear to exacerbate behaviors.

Moderate

Replacement Behaviors

Using hand signals to request breaks instead of leaving the classroom or shouting.

Developing


Section 5: Observational Data

Observation Summary

  • Date(s): March 8, 10, and 12, 2086

  • Location(s): Classroom and cafeteria

  • Observation Notes:

    • March 8: Verbal outburst occurred during a group math task after being asked to wait for his turn. Erica Price shouted, "This is stupid!" and left his seat.

    • March 10: During reading time, Erica Price left the classroom without asking and was found wandering the hallway.

    • March 12: During art, Erica Price refused to follow instructions, repeatedly saying, "No, I don’t want to," disrupting peers.


Section 6: Hypothesis of Behavior Function

Based on the data collected, the likely function(s) of the target behavior(s) are:

  • Escape/Avoidance: Erica Price’s behaviors often occur when tasks feel overwhelming or require sustained focus.

  • Attention-Seeking: Some behaviors, particularly verbal outbursts, appear to elicit attention from peers and adults.


Section 7: Recommendations

  1. Intervention Strategies:

    • Implement a visual schedule to prepare Erica Price for transitions.

    • Teach Erica Price to use a “break card” or similar tool when feeling overwhelmed.

    • Increase opportunities for positive reinforcement when Erica Price remains engaged.

  2. Behavior Intervention Plan (BIP):

    • Design a structured plan outlining steps to support Erica Price in replacing problematic behaviors with functional alternatives.

  3. Ongoing Monitoring:

    • Conduct weekly observations for the next six weeks to track progress and adjust interventions as needed.


Section 8: Notes and Additional Comments

  • Erica Price responds well to praise and individualized attention; incorporating these into interventions may improve compliance.

  • Ensure all staff working with Erica Price are trained in implementing the recommended strategies.

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