FUNCTIONAL BEHAVIORAL ASSESSMENT
Continued

LOUDOUN COUNTY PUBLIC SCHOOLS

A Team Approach to:
FUNCTIONAL BEHAVIORAL ASSESSMENT
Student: / Date of Birth: / Date: / Review/Follow-Up Date(s)
School: / Grade: / Reason for FBA/BIP:
initial intervention revision discipline
TEAM MEMBERS – If not present as a team member specify input from: teacher parents student other sources

Name/Position Name/Position

Name/Position Name/Position

Name/Position Name/Position
1. REASON FOR MEETING – Overview of Behavioral Concerns
Identify and prioritize behaviors of concern / Frequency
How often: per hour, day, week or month? / Intensity
Rate from 1 – 5
1 = less severe
5 = most severe / Duration
How long does each
episode last?
After identifying primary behavior of concern,
Describe in measurable, observable and objective terms.
What will typically de-escalate the behavior? / What will typically escalate the behavior?
2. FACT FINDING
Relevant Information: Summarize existing data. Include referral concerns, social and behavioral challenges and weaknesses, academic challenges, levels of academic performance, and information regarding ability/skills.
Setting Events or slow triggers – Describe relevant events, medical information and environmental factors within school, home and/or community setting.
Learning Environment –. Include recent instructional changes and/or any special programs or services. Describe classroom structure, (e.g., school within school, self-contained, lecture, cooperative groups) where targeted behavior is most likely to occur

3. POSSIBLE EXPLANATIONS

ABCs of Targeted Behavior – Identify probable antecedents and probable consequences of targeted behavior.
Antecedents
Precipitating conditions or fast triggers – place, time or other situations that typically impact the targeted behavior. / Targeted Behavior
Describe exactly what student does or does not do. / Maintaining Consequences
What does student get or get away from following the targeted behavior?
Identify and describe any academic or environmental context(s) in which targeted behavior does not occur or is least likely to occur.
Possible Functions – Consider what needs are being met and/or maintained through behavior.
What does the targeted behavior allow the student to access and/or avoid/escape?
escape/avoid
Who? / gain/access
Who?
What? / What?

4. HYPOTHESIS STATEMENT

Probable Function(s) of Behavior – Following the format below, identify probable function or purpose behavior serves.
Under A conditions, student does B, to get or avoid C.
E.g., “When given a written assignment, student crumples the paper and yells at his teacher to avoid writing task.”

5. VALIDATION

Based on Steps 1-4, is a Behavioral Intervention Plan (BIP) needed at this time? YES NO

If YES, do we have enough information on probable function of behavior to plan an effective intervention?

YES Proceed to BIP

NO Specify additional data needed below:

data probe sheet teacher interview
tally sheet student interview
frequency chart parent interview
checklist other:
Date team will reconvene: to:
Develop BIP Review collected data / continue FBA
Person responsible for reconvening team:
/ If NO, what is the rationale for decision not to proceed with BIP:
Student supports/interventions currently in place:
Data to be collected to monitor progress:
Date team will reconvene to review supports/interventions:
Person responsible for implementing supports/interventions:

FBA Page 2