Free Functional Behavior Assessment Template
Functional Behavior Assessment
Prepared by [YOUR NAME], [YOUR COMPANY NAME]
Section 1: General Information
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Student Name: Erica Price
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Date of Assessment: March 15, 2086
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School/Program Name: Horizon Academy for Advanced Learning
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Evaluator Name: [YOUR NAME]
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Evaluator Role/Title: School Behavior Specialist
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Reason for Referral: Frequent disruptions during group learning activities, including verbal outbursts and leaving the classroom without permission.
Section 2: Background Information
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Relevant History
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Academic Performance: Erica Price performs above average in math but struggles with reading comprehension.
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Medical/Mental Health Concerns: Diagnosed with ADHD in 2082. No other significant medical history reported.
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Developmental Milestones: Achieved major milestones within typical age ranges.
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Sources of Data
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Interviews: Conducted with Erica Price’s parents, classroom teacher, and special education coordinator.
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Direct Observations: Observed during three 45-minute sessions over two weeks.
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Records Review: Reviewed academic records from 2084–2086 and behavior incident logs.
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Section 3: Target Behavior(s)
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Specific Behavior(s) of Concern:
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Verbal Outbursts: Includes shouting, interrupting peers, and making inappropriate comments.
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Leaving Classroom: Exiting the classroom without permission, often during structured tasks.
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Noncompliance: Refusal to follow teacher instructions during group activities.
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Frequency and Duration:
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Frequency: Verbal outbursts occur 4–6 times per day; leaving the classroom happens 2–3 times weekly.
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Duration: Outbursts last approximately 1–3 minutes; leaving the classroom results in a 5–10-minute absence.
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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
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Date(s): March 8, 10, and 12, 2086
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Location(s): Classroom and cafeteria
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Observation Notes:
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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.
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March 10: During reading time, Erica Price left the classroom without asking and was found wandering the hallway.
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March 12: During art, Erica Price refused to follow instructions, repeatedly saying, "No, I don’t want to," disrupting peers.
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Section 6: Hypothesis of Behavior Function
Based on the data collected, the likely function(s) of the target behavior(s) are:
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Escape/Avoidance: Erica Price’s behaviors often occur when tasks feel overwhelming or require sustained focus.
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Attention-Seeking: Some behaviors, particularly verbal outbursts, appear to elicit attention from peers and adults.
Section 7: Recommendations
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Intervention Strategies:
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Implement a visual schedule to prepare Erica Price for transitions.
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Teach Erica Price to use a “break card” or similar tool when feeling overwhelmed.
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Increase opportunities for positive reinforcement when Erica Price remains engaged.
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Behavior Intervention Plan (BIP):
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Design a structured plan outlining steps to support Erica Price in replacing problematic behaviors with functional alternatives.
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Ongoing Monitoring:
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Conduct weekly observations for the next six weeks to track progress and adjust interventions as needed.
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Section 8: Notes and Additional Comments
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Erica Price responds well to praise and individualized attention; incorporating these into interventions may improve compliance.
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Ensure all staff working with Erica Price are trained in implementing the recommended strategies.