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Functional Behavioral Assessment

FBA (Page

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FUNCTIONAL BEHAVIORAL ASSESSMENT

AND

BEHAVIORAL INTERVENTION PLAN

Student’s Name:

Grade:

School:

Teacher:

Exceptionality:

Date:

FUNCTIONAL BEHAVIOR ASSESSMENT

Define the student’s strengths (academic and behavioral)?

Complete the chart below:

•

Problem Behavior: Identify the problem behaviors that most interfere with the student’s

functioning.

•

Concrete Definition: Define behavior in concrete terms that are easy to communicate and simple

to record and measure.

•

Frequency: Examples: every 10 minutes, 4 of 4 days, 4 x per hour, 1 x per day, etc…

•

Intensity: On a scale of 1 to 10 (1 being low intensity and 10 high intensity).

•

Ex: 3=touched kid gently, 10=gave kid black eye

•

Duration: How long does the entire episode last? Example: Fred gets upset, leaves class, and

runs through the halls yelling and screaming. The episode begins when Fred gets upset and ends

when he is able to get control of himself.

Duration=approximately 35 minutes.

Problem Behavior

Concrete Definition of Behavior

Frequency

Intensity

Duration

Circle or highlight the problem behavior, from the concrete definition list, that the

committee would like to work on changing. Most likely, this will be the behavior that is

highest in frequency, intensity and duration.

Functional Behavioral Assessment