Transcript Slide 1

Functional Behavioral Assessment
(FBA)
Behavioral Intervention Plan
(BIP)
• These recommendations on the FBA and BIP meet or exceed
federal and state standards.
• All of the materials presented are the work of a committee
representing the Vigo County School Corporation, Southwest Parke
Community School Corporation, Rockville Community School
Corporation, South Vermillion Community School Corporation, and
Covered Bridge Special Education District. This effort was initiated
at the request of the Vigo County Teachers Association and Covered
Bridge Special Education District.
Table of Contents
This presentation is in four parts:
1.
2.
3.
4.
Philosophy and Rationale
Compliance
The FBA
The BIP
Philosophy/Rationale
FUNCTIONAL BEHAVIORAL ASSESSMENT/
BEHAVIORAL INTERVENTION PLAN
COMMENTS
Philosophy/Rationale
The process of teaching and learning is dependent on a school’s ability to manage students effectively and engage them in
learning activities. Challenging behaviors sometimes restrict opportunities for students to benefit from their education
experiences and create interruptions in the education process. At times, these behavior problems do not respond to classroom
management plans or typical reinforcement strategies.
In cases where behavior problems are interfering with the education process, it is the school’s responsibility to intervene in a
positive way to make desirable changes. This is not only sound educational practice, in the case of special education rules, it
is a compliance issue.
(5ll IAC 7-17-38, 511 IAC 7-17-8, 511 IAC 7-29-5)
Functional Behavioral Assessment by definition is a comprehensive and individualized approach to examining conditions
that result in a specific behavior or patterns of behavior. Functional assessment refers to the behavior assessment methods
used to identify the functional relationship between behaviors, the circumstances that lead to those behaviors, and the events
that follow. The process is intended to help educators understand why a problem behavior occurs in order to maximize the
effectiveness and efficiency of interventions.
•
•
•
A functional behavioral assessment consists of a systematic collection and analysis of data that will vary in length and scope
depending on the severity of a student’s behavior. The collected data is used to develop a descriptive analysis of the
behavior(s) and a functional analysis of the behavior(s).
Descriptive analysis refers to identifying specific elements of behavior. The behavior is described in detail by multiple
observers, and gives a picture of what the behavior looks like when it occurs. The descriptive analysis also takes into account
what variables, conditions and antecedents are present when the behavior occurs, and leads to and informed sense
(hypothesis) of the relationship between the behavior and the factors that may cause them to occur.
•
Functional analysis refers to the process of identifying what the behavior achieves and how it is maintained. The functional
analysis describes the outcome or purpose of the behavior and what supports it. The functional analysis pinpoints the reason
a behavior occurs in terms of what function it serves and what it gets for the student.
After a functional behavioral assessment has been developed and completed, the school will convene a case conference
meeting to develop a behavioral intervention plan.
A Behavioral Intervention Plan by definition is a plan that describes the strategies that will be used to shape or change a
student’s behavior. The behavioral intervention plan includes details about how the student’s environment will be altered and
identifies positive strategies that will be implemented across people and settings in which the student is involved.
•
The behavioral intervention plan also specifies which skills will be taught in an effort to change a behavior or pattern of
behavior and replace it with a more appropriate behavior.
The behavioral intervention plan is a written plan that is agreed upon by the case conference committee and is incorporated
into the student’s individualized education program. The plan is linked to information gathered through a functional
behavioral assessment. The behavioral intervention plan is treated as a working document and there is likely to be a need to
revisit the plan, review its contents, and make changes deemed appropriate by the case conference committee.
•
In cases where behavior problems are interfering
with the education process, it is the school’s
responsibility to intervene in a positive way to
make desirable changes.
Functional Behavioral Assessment by definition
is a comprehensive and individualized approach
to examining conditions that result in a specific
behavior or patterns of behavior.
Descriptive analysis refers to identifying specific
elements of behavior. The behavior is described
in detail by multiple observers, and gives a picture
of what the behavior looks like when it occurs.
The descriptive analysis also takes into account
what variables, conditions and antecedents are
present when the behavior occurs, and leads to
and informed sense (hypothesis) of the
relationship between the behavior and the factors
that may cause them to occur.
Functional analysis refers to the process of
identifying what the behavior achieves and how it
is maintained. The functional analysis describes
the outcome or purpose of the behavior and what
supports it. The functional analysis pinpoints the
reason a behavior occurs in terms of what function
it serves and what it gets for the student.
A Behavioral Intervention Plan by definition is a
plan that describes the strategies that will be used
to shape or change a student’s behavior. The
behavioral intervention plan includes details about
how the student’s environment will be altered and
identifies positive strategies that will be
implemented across people and settings in which
the student is involved.
The behavioral intervention plan is a written plan
that is agreed upon by the case conference
committee and is incorporated into the
student’s Individualized Education Program.
Compliance Recommendations for Functional Behavior Assessment (FBA)
and Behavior Intervention Plan (BIP)
COMPLIANCE RECOMMENDATIONS FOR:
FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)
BEHAVIORAL INTERVENTION PLAN (BIP)
“Start early if the person has a previous history of challenging behaviors –
avoid at all costs having to start the process under time constraints or in the midst of crisis.”
Dr. Cathy Pratt
At a minimum, the following standards from Article 7 must be met:
511 IAC 7-17-38 Functional Behavioral Assessment (Page 7)
Section 38. “Functional Behavioral Assessment” means a systematic collection and analysis of data that will
vary in length and scope depending on the severity of a student’s behavior. Results and analysis of the data
collection are used in developing the student’s behavioral intervention plan. A functional behavioral
assessment shall identify patterns in the student’s behavior and the purpose or function of the behavior for
the student.
511 IAC 7-17-8 Behavioral Intervention Plan
Section 8 “Behavioral Intervention Plan” is a plan, agreed upon by the case conference committee and
incorporated into a student’s individualized education program, that describes how the student’s
environment will be altered, identifies positive behavioral intervention strategies, and specifies which skills
will be taught in an effort to change a specific pattern of behavior of the student. The plan shall be linked to
information gathered through a functional behavioral assessment. To ensure transference, the behavioral
intervention plan seeks to maximize consistency of implementation across people and settings in which the
student is involved.
511 IAC 7-29-5 Functional Behavioral Assessment and Behavioral Intervention Plan Procedures
Section 5
(a)
Either before but not later than ten (10) business days after either first suspending the student for
more than ten (10) cumulative instructional days in a school year, placing the student in an interim
alternative educational setting, expelling the student, or otherwise commencing a removal that
constitutes a change of placement, the public agency shall convene a case conference committee
meeting for one (1) of the following purposes:
1. To develop a plan for assessing the student’s functional behavior if no functional behavioral
assessment was conducted or behavioral intervention plan was implemented prior to the
occurrence of the behavior that resulted in the removal.
2. To review a student’s existing behavioral intervention plan and its implementation and to
modify the plan and its implementation as necessary to address the behavior.
(b)
After an assessment plan has been developed as described in subsection (a)(1) and the assessments
required by the plan are completed, the public agency shall convene a case conference committee
meeting within ten (10) instructional days of the completion of the assessments to develop a
behavioral intervention plan and provide for its implementation.
“Start early if the person
has a previous history
of challenging
behaviors – avoid at
all costs having to
start the process under
time constraints or in
the midst of a crisis.”
-- Dr. Cathy Pratt
Compliance Recommendations for Functional Behavior Assessment (FBA)
and Behavior Intervention Plan (BIP)
COMMENTS
(c)
If a student has an existing behavioral intervention plan and has been removed from the
student’s current placement for more than ten (10) cumulative instructional days in a school
year and is subjected to a removal that does not constitute a change of placement, the case
conference committee shall review the behavioral intervention plan and its intervention to
determine whether modifications are necessary.
(d)
If one (1) or more of the case conference committee members believe that modifications to an
existing behavioral intervention plan are needed, the case conference committee shall meet to
modify the plan and its implementation, to the extent the case conference committee
determines necessary.
Because the above standards begin too late in the behavioral/disciplinary process to help the student
benefit from a free and appropriate public education in his/her home school, the following standards
are recommended as preventive steps to special education referral and identification, as part of the
referral process, and as intervention prior to expulsion or a more restrictive placement.
1. When a student is referred to a Student Assistance Team (SAT) or grade level academic
team for a behaviors issue, an FBA/BIP may be developed based on group
recommendation. The referring teacher or team leader may initiate and complete the
required forms.
2. When a student is referred for evaluation to Covered Bridge Special Education District
as a result of behavioral concerns, an FBA/BIP will be developed as part of the
assessment.
Because state standards begin too late in the
behavioral/disciplinary process to help the student benefit
from a free and appropriate public education in his/her
home school, the following standards are recommended as
preventive steps to special education referral and
identification, as part of the referral process, and as
intervention prior to expulsion or a more restrictive
placement:
1.
2.
3.
4.
3. No later than the student’s 5th day of cumulative suspension, an FBA will be initiated if
there is none or the FBA/BIP will be reviewed. This initiation or review will be the
responsibility of the Teacher of Record (TOR).
4. When a student in special education is experiencing attendance problems as outlined
by your corporation’s attendance policy, an FBA must be initiated in addition to your
corporation attendance guidelines.
5. In the event of excessive referrals, the TOR will review the student file to determine if
an FBA/BIP is needed, or if in place, is up to date.
6. Prior to a more restrictive change of placement to an alternative program an FBA/BIP
will be developed.
7. There must be a minimum of two conferences before going to a manifestation
determination conference. The FBA/BIP must be considered at each.
5.
6.
7.
8.
9.
8. No FBA/BIP is required for first time Zero Tolerance Issues.
When a student is referred to a Student Assistance
Team (SAT) or grade level academic team for a
behavioral issue, an FBA/BIP may be developed based
on group recommendation. The referring teacher or team
may initiate and complete the required forms.
When a student is referred for evaluation to Covered
Bridge as a result of behavioral concerns, an FBA/BIP
will be developed as part of the assessment.
No later than the student’s 5th day of cumulative
suspension, an FBA will be initiated if there is none, or
the FBA/BIP will be reviewed. This initiation or review will
be the responsibility of the Teacher of Record.
When a student in special education is experiencing
attendance problems as outlined by your corporation’s
attendance policy, an FBA must be initiated in addition to
your corporation attendance guidelines.
In the event of excessive disciplinary referrals, the
Teacher of Record will review the student file to
determine if an FBA/BIP is needed, or if in place, is up to
date.
Prior to a more restrictive change of placement to an
alternative program an FBA/BIP will be developed.
There must be a minimum of two conferences before
going to a manifestation determination conference. The
FBA/BIP must be considered at each.
No FBA/BIP is required for first time Zero Tolerance
Issues.
The BIP and FBA must be attached to the student’s IEP.
There is not BIP without an FBA.
FBA Page 1
INSTRUCTIONS FOR COMPLETION OF FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)
COMMENTS
*The teacher of record, team leader or the referring teacher is responsible for initiating the
FBA/BIP process.
Presenting Behavior (s):
 Describe presenting behaviors – Identify no more than 2 or 3 target behaviors that are
observable and define them in specific, concrete terms.
Data Collection
 Check all methods used to gather data
 Problem Behavior Questionnaire(s) and Student Questionnaire should be completed at this time
 Distribute Problem Behavior Questionnaire(s) to appropriate staff.
 TOR and/or appropriate staff list observable problem behavior(s)
 TOR will oversee the completion of the Student Questionnaire.
 Additional Background Information
Past Experiences
Family Changes/Issues
Health/Medication Issues
Legal Issues
Environmental Components
• The special education
Teacher of Record,
team leader, or the
teacher referring the
student for services is
responsible for initiating
the FBA/BIP process.
 Check all that apply
Conditions and Responses
 Check all that apply or rate as indicated
 Check what typically occurs immediately prior to the behavior including setting, time, others
present, etc. – is there a pattern?
Possible Behavior Function
 What do you think might be a logical reason for the student’s behaviors?
 Check all that apply
Summary
 Review all data collected and summarize results
Identified Behavioral Concern(s):
 Based on summary information list no more than three behavioral concerns
 Indicate intensity (what is the magnitude of the behavior – mild, moderate, severe)
 Indicate frequency (%of time – see Problem Behavior questionnaire)
Results and Interpretations of Existing Data & Functional Assessment/Additional Data
Determinators
 Check appropriate determination
• This page is for
information only; no
action is needed
FBA Page 2
COMMENTS
FUNCTIONAL BEHAVIORAL ASSESSMENT
STUDENT_____________________________________BIRTHDATE_______________________DATE______________________________
•
SCHOOL______________________________________GRADE_______________ELIGIBLITY____________________________________
MEDICATION(S) AND OTHER HEALTH ISSUES:_______________________________________________________________________
I.
PRESENTING BEHAVIOR(S):____________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
II.
DATA COLLECTION
DATE
METHODS
Review of Records
Interview(s)
Rating Scale(s)
Observation:
Structured/Less Structured
Setting/ABC/Charting
DATE
to stay in class,” rather than,
“poor attitude.”
METHODS
Problem Behavior Questionnaire
Student Questionnaire
Other:
•
DATA COLLECTION:
– These are some methods for
data collection; the committee
may create other methods as
needed.
•
BEHAVIORS REPORTED BY
PARENT(S):
– This is desirable but optional.
The parents may be involved in
the creation of an FBA or the
school may initiate the FBA
unilaterally.
Based on the student’s behavioral history, social skill deficits and/or discipline record, there is a history of the following
behaviors:
___previous misbehavior
___social skill deficits
___unexcused tardies
___leaving class/campus
___stealing/possession of other’s property
___substance abuse
___disruption of classroom/school activities
___behavior symptomatic or associated with gangs
___physical aggression
___inappropriate sexual behavior
___actions/threats against students/staff
___smoking/possession of tobacco products
Behaviors reported by parent(s):
Additional background information:
___truancy
___disruption on bus
___fighting
___dress code violations
___inappropriate language
___violation of classroom rules
___verbal abuse/confrontations
___self-injuries
___vandalism/destruction of school property
___violation of school rules in cafeteria
___violation of school rules in extracurricular activities
___Other:___________________________________
PRESENTING BEHAVIORS:
– Select no more than three
behaviors that are observable
and define them in specific,
concrete terms that can be
agreed upon by all observers.
For example:“Curses; refuses
FBA Page 3
III.
ENVIRONMENTAL COMPONENTS
COMMENTS
Where/when is the behavior(s) LEAST likely to occur?
___English/language arts class
___Math class
___Social Studies class
___Science class
___Reading class
___Electives (specify):______________
___PE
___School Grounds
___Hallway
___Bus
___Cafeteria
___Counseling/OT/PT/Speech
___Restroom
___Field Trips/Work Experience
___Before/after school
___Preceding/following holidays/weekends
___Other:_________________________________________
With whom is the behavior(s) LEAST likely to occur?
___Teachers (specify class):________________
___Educational Assistants
___Parents
___Student Teachers/Substitute Teachers
___Students
___Administrators
___Counselors
___Psychologist/Intern
___Siblings
___Males
___Females
___Others: (specify):_______
_________________________
Where/when is the behavior(s) MOST likely to occur?
___English/Language arts class
___Math Class
___Social Studies class
___Science class
___Reading class
___Electives (specify):_______________
___PE
___Hallway
___Cafeteria
___Restroom
___Before/after school
___CBI
___School Grounds
___Bus
___Counseling/OT/PT/Speech
___Field Trip/Work Experience
___Preceding/following holidays/weekends
___Other:_______________________________
With whom is the behavior(s) MOST likely to occur?
___Teachers (specify class):_____________________________
___Educational Assistant (specify class):__________________
___Parents
___Student Teacher/Substitute
___Students
___Administrators
___Counselor
___Psychologist/Intern
___Siblings
___Males
___Females
___Other (specify):__________________________
• ENVIRONMENTAL
COMPONENTS:
– This page may be
completed by the Student
Assistance Team, grade
level team, Case
Conference Committee
or Teacher of Record.
The more participants,
the better.
FBA Page 4
III.
CONDITIONS AND RESPONSES
COMMENTS
Describe the conditions that typically PRECEDE the presenting behavior: (antecedents)
___independent work
___off-task
___after privately praised
___1:1 with an adult
___after earning a reinforcer
___after praised in front of others
___classroom
___emotionally upset or anxious
___when peer is reinforced
___bus
___after receiving a consequence
___provoked by peers
___hallway
___redirected from activity
___when peer is corrected
___cafeteria
___response to stimuli outside of school
___request or directive from adult
___restroom
___sensory overload
___with unfamiliar adults
___large group activity
___being ignored
___when peer/adult give attention
___small group activity
___change in school routine/schedule
___medication is no longer effective
___transition
___teacher uses nonverbal signals
___ medication is not consistently
___less structured setting
___presented with an academic task
used
___violation of personal space
(easy/moderate/difficult)
___denied an activity
___structured setting
please circle
___pace of classroom activity
___crowded setting
___engaged in academic task
___other_________________________
___physical discomfort
(easy/moderate/difficult)
_____________________________
___thirst/fatigue/medical
please circle
_____________________________
(circle one)
___no observed conditions seem to
precede the problem behavior
•
CONDITIONS AND RESPONSES:
– Describe the conditions that
typically PRECEDE the
presenting behavior
(antecedents)
– This section may be
completed by the Student
Assistance Team, grade level
team, or Case Conference
Committee. The more
participants, the better.
•
POSSIBLE BEHAVIOR
FUNCTION:
– This section may be
completed by the Student
Assistance Team, grade level
team, Case Conference
Committee, or Teacher of
Record. The more
participants, the better.
Describe the events that typically FOLLOW the presenting behavior and their effectiveness:
NONE (N)
___attention from adults
___ignored misbehavior
___moved to quieter area
___sent to office
___detention
___parent involvement
___in-school suspension
___police involvement
___citation
___therapeutic restraint
___restitution
___parent phone call
V.
LOW (L)
HIGH (H)
___time-out/cool down
___completes assignments
___room cleared
___loss of privileges/reinforcers
___overcorrection
___alternate passing period
___attention from peers
___being held/restrained by adults
___assigned task not finished
___desired item/activity obtained
___visually based discipline system
___other:________________________
POSSIBLE BEHAVIOR FUNCTION: Identify the possible function(s) that the behavior(s) may serve.
___to gain attention
___to obtain access to activity/task
___to gain power
___to escape a person
___to obtain access to a person
___to avoid or escape an activity/directive
VI.
MODERATE (M)
___suspension
___use of crisis room
___isolated instruction
___isolated lunch
___other isolation:_________________
___private discussion
___verbally corrected
___redirection
___removed from class/group
___sent home
___reduced day
___to communicate needs/emotions/wants
___to gain social acceptance
___to control situation
___to retaliate
___other:___________________________________
SUMMARY
Summarize data and observations:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
FBA Page 5
COMMENTS
Current baseline
V.
IDENTIFIED BEHAVIORAL CONCERN(S):
Intensity
(mild,
moderate,
severe)
Frequency
(% of time)
•
IDENTIFIED BEHAVIORAL
CONCERNS:
– Behaviors that are
observable and defined in
specific, concrete terms
that can be agreed upon by
all observers. For example:
“Curses; refuses to stay in
class,” rather than, “poor
attitude.”
•
ADDITIONAL DATA
DETERMINATIONS
– If additional data may be
needed, please consult with
the school psychologist in
advance of a Case
Conference or invite the
psychologist to the
conference.
1.
2.
3.
VI.
RESULTS AND INTERPRETATIONS OF EXISTING DATA & FUNCTIONAL ASSESSMENT:
_____ _____ The student is capable to understanding and following the school rules as outlined in the District’s
YES
NO disciplinary policies. If “No,” the committee should develop/review/modify an Individualized
Behavioral Intervention Plan.
_____ _____ The student’s behavior impedes student learning or the learning of others. If “YES”, the committee
YES
NO should develop/review/modify an individualized Behavioral Intervention Plan.
ADDITIONAL DATA DETERMINATIONS
_____ _____ Based on consideration of existing data, the committee determines that additional
YES
NO emotional/behavioral data is needed. If “YES”, the following type of additional data is requested:
__________________________________________________________________________________________
__________________________________________________________________________________________
The District must seek parental consent for any evaluation. A meeting will be held upon completion
of the assessment report, including additional data.
FBA Page 6
FUNCTIONAL BEHAVIORAL ASSESSMENT
PROBLEM BEHAVIOR QUESTIONNAIRE
COMMENTS
Name:________________________________Birthdate:_______________Grade:________Date:________________
Class/Location:___________________School:___________________Completed by:________________________
Teacher of record and/or appropriate staff identify observable problem behavior(s).
STUDENT BEHAVIOR – ONE___________________________________________________________
_______________________________________________________________________________________
•
STUDENT BEHAVIOR - ONE:
– Observable behavior described in specific,
concrete, easily agreed upon terms. The
goal is to increase inter-rater reliability.
_______________________________________________________________________________________
Considering a typical episode of the problem behavior, circle the frequency at which each of the following statements are true.
0-24% of
the time
25-49% of
the time
50-74% of
the time
75-100% of
the time
_______________________________________________________________________________________________
1.
Does the problem behavior occur and persist
when you make a request to perform a task?
1
2
3
4
2.
When the problem behavior occurs do you
redirect the student to get back on task or
follow the rules?
1
2
3
4
3.
When the problem behavior occurs do peers
verbally respond or laugh at the student?
1
2
3
4
4.
Does the problem behavior occur to get your
attention when you are working with other
students?
1
2
3
4
5.
Does the problem behavior occur in the
presence of specific peers?
1
2
3
4
6.
Does the problem behavior occur during
specific academic activities?
State Activity:__________________________
1
2
3
4
7.
Does the problem behavior stop when peers
stop interacting with the student?
1
2
3
4
8.
If the student engages in the problem behavior,
do you provide one-to-one instruction to get
the student back on task?
1
2
3
4
9.
Is the problem behavior more likely to
occur following unscheduled events or
disruptions in the class routine?
1
2
3
4
1
2
3
4
10. If behavior is observed at any other time
or circumstance than mentioned above,
please specify below.
0 – 24%
of the time
–
–
25 – 49%
of the time
50 – 74%
of the time
75 – 100%
of the time
This percentage refers to a predefined time
period such as: per class, day, week, grading
period, etc. This is a less accurate
measurement than a frequency tally sheet,
however charting or tally sheet may be used
to determine the percentage.
Responsibility for this form:
• Distribution
– Teacher of Record or referring
teacher
• Completion
– Multiple respondents across
multiple settings; may include
any school employee.
FBA Page 7
STUDENT BEHAVIOR - TWO
Teacher of record and/or appropriate staff identify observable problem behavior(s).
_______________________________________________________________________________________________
COMMENTS
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Considering a typical episode of the problem behavior, circle the frequency at which each of the following statements are true.
0-24% of
the time
25-49% of
the time
50-74% of
the time
75-100% of
the time
_______________________________________________________________________________________________
1.
Does the problem behavior occur and persist
when you make a request to perform a task?
1
2
3
4
2.
When the problem behavior occurs do you
redirect the student to get back on task or
follow the rules?
1
2
3
4
3.
When the problem behavior occurs do peers
verbally respond or laugh at the student?
1
2
3
4
4.
Does the problem behavior occur to get your
attention when you are working with other
students?
1
2
3
4
5.
Does the problem behavior occur in the
presence of specific peers?
1
2
3
4
6.
Does the problem behavior occur during
specific academic activities?
State Activity:__________________________
1
2
3
4
7.
Does the problem behavior stop when peers
stop interacting with the student?
1
2
3
4
8.
If the student engages in the problem behavior,
do you provide one-to-one instruction to get
the student back on task?
1
2
3
4
9.
Is the problem behavior more likely to
occur following unscheduled events or
disruptions in the class routine?
1
2
3
4
1
2
3
4
10. If behavior is observed at any other time
or circumstance than mentioned above,
please specify below.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
•
STUDENT BEHAVIOR – TWO:
– Observable behavior described in specific,
concrete, easily agreed upon terms. The
goal is to increase inter-rater reliability.
0 – 24%
of the time
–
–
25 – 49%
of the time
50 – 74%
of the time
75 – 100%
of the time
This percentage refers to a predefined time
period such as: per class, day, week,
grading period, etc. This is a less accurate
measurement than a frequency tally sheet,
however charting or tally sheet may be
used to determine the percentage.
Responsibility for this form:
• Distribution
– Teacher of Record or referring
teacher
• Completion
– Multiple respondents across
multiple settings; may include
any school employee.
FBA Page 8
STUDENT BEHAVIOR - THREE
COMMENTS
Teacher of record and/or appropriate staff identify observable problem behavior(s).
_______________________________________________________________________________________________
_______________________________________________________________________________________________
•
_______________________________________________________________________________________________
Considering a typical episode of the problem behavior, circle the frequency at which each of the following statements are true.
0-24% of
the time
25-49% of
the time
50-74% of
the time
75-100% of
the time
_______________________________________________________________________________________________
1. Does the problem behavior occur and persist
when you make a request to perform a task?
1
2
3
4
2.
When the problem behavior occurs do you
redirect the student to get back on task or
follow the rules?
1
2
3
4
3.
When the problem behavior occurs do peers
verbally respond or laugh at the student?
1
2
3
4
4.
Does the problem behavior occur to get your
attention when you are working with other
students?
1
2
3
4
5.
Does the problem behavior occur in the
presence of specific peers?
1
2
3
4
6.
Does the problem behavior occur during
specific academic activities?
State Activity:__________________________
1
2
3
4
7.
Does the problem behavior stop when peers
stop interacting with the student?
1
2
3
4
8.
If the student engages in the problem behavior,
do you provide one-to-one instruction to get
the student back on task?
1
2
3
4
9.
Is the problem behavior more likely to
occur following unscheduled events or
disruptions in the class routine?
1
2
3
4
1
2
3
4
10. If behavior is observed at any other time
or circumstance than mentioned above,
please specify below.
STUDENT BEHAVIOR – THREE:
– Observable behavior described in specific,
concrete, easily agreed upon terms. The
goal is to increase inter-rater reliability.
0 – 24%
of the time
–
–
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
25 – 49%
of the time
50 – 74%
of the time
75 – 100%
of the time
This percentage refers to a predefined time
period such as: per class, day, week,
grading period, etc. This is a less accurate
measurement than a frequency tally sheet,
however charting or tally sheet may be
used to determine the percentage.
Responsibility for this form:
• Distribution
– Teacher of Record or referring
teacher
• Completion
– Multiple respondents across
multiple settings; may include
any school employee.
FBA Page 9
STUDENT BEHAVIOR - FOUR
Teacher of record and/or appropriate staff identify observable problem behavior(s).
_______________________________________________________________________________________________
COMMENTS
_______________________________________________________________________________________________
_______________________________________________________________________________________________•
Considering a typical episode of the problem behavior, circle the frequency at which each of the following statements are true.
0-24% of
the time
25-49% of
the time
50-74% of
the time
75-100% of
the time
_______________________________________________________________________________________________
1. Does the problem behavior occur and persist
when you make a request to perform a task?
1
2
3
4
2.
When the problem behavior occurs do you
redirect the student to get back on task or
follow the rules?
1
2
3
4
3.
When the problem behavior occurs do peers
verbally respond or laugh at the student?
1
2
3
4
4.
Does the problem behavior occur to get your
attention when you are working with other
students?
1
2
3
4
5.
Does the problem behavior occur in the
presence of specific peers?
1
2
3
4
6.
Does the problem behavior occur during
specific academic activities?
State Activity:__________________________
1
2
3
4
7.
Does the problem behavior stop when peers
stop interacting with the student?
1
2
3
4
8.
If the student engages in the problem behavior,
do you provide one-to-one instruction to get
the student back on task?
1
2
3
4
9.
Is the problem behavior more likely to
occur following unscheduled events or
disruptions in the class routine?
1
2
3
4
1
2
3
4
10. If behavior is observed at any other time
or circumstance than mentioned above,
please specify below.
STUDENT BEHAVIOR – FOUR:
– Observable behavior described in specific,
concrete, easily agreed upon terms. The
goal is to increase inter-rater reliability.
0 – 24%
of the time
–
•
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Additional Comments:___________________________________________________________________________
_______________________________________________________________________________________________
25 – 49%
of the time
50 – 74%
of the time
75 – 100%
of the time
This percentage refers to a predefined
time period such as: per class, day, week,
grading period, etc. This is a less accurate
measurement than a frequency tally sheet,
however charting or tally sheet may be
used to determine the percentage.
– Responsibility for this form:
• Distribution
– Teacher of Record or
referring teacher
• Completion
– Multiple respondents across
multiple settings; may include
any school employee.
Note: While it is recommended that only three
behaviors be tracked, a fourth behavior, for
example one that may occur in only one setting
or one easily tracked behavior might be tracked.
The three behavior recommendation is to help
maintain focus on the greater concerns.
FBA Page 10
STUDENT QUESTIONNAIRE
NAME:_____________________________________________________________DATE:____________________________
TEACHER:_________________________________SCHOOL:_______________________________GRADE:___________
INTERVIEWER:_______________________________________________DATE OF BIRTH_________________________
Teacher of record, team leader or referring teacher will oversee the completion of this form.
Circle the answer for each question.
1.
Is your work too hard for you?
Always
Sometimes
Never
2.
Is your work too easy for you?
Always
Sometimes
Never
3.
When you ask for help appropriately, do you get the help you need?
Always
Sometimes
Never
4.
Are you able to pay attention in class?
Always
Sometimes
Never
5.
When doing assignments, do you do better when someone works with you?
Always
Sometimes
Never
6.
Do you think people notice when you do a good job?
Always
Sometimes
Never
7.
Do you think you get the points and rewards you deserve when you do
good work?
Always
Sometimes
Never
8.
Do you think you would do better in school if you received more rewards?
What kind?_________________________________________________________
Always
Sometimes
Never
9.
Do you find your schoolwork interesting?
Always
Sometimes
Never
10. Are there things in the classroom that distract you?
Always
Sometimes
Never
If so, what?______________________________________________________________________________________________________
11. What do you find difficult about school? Why?______________________________________________________________________
____________________________________________________________________________________________________________________
COMMENTS
• Teacher of Record, team
leader, or referring
teacher will oversee the
completion of this form.
• This is an important
opportunity for the
student to give the team
input.
12. What do you like most about school? Why?_________________________________________________________________________
____________________________________________________________________________________________________________________
13. What makes learning new things easier for you?______________________________________________________________________
____________________________________________________________________________________________________________________
14. When do you think you have the most problems in school?____________________________________________________________
____________________________________________________________________________________________________________________
15. What can we do to make your school day better?______________________________________________________________________
____________________________________________________________________________________________________________________
Reading
Math
Spelling
Handwriting
Science
English
Not at All
1
1
1
1
1
1
Rate how much you like each of the following subjects:
Fair
Very Much
Not at All
Fair
Very Much
2
3
Social Studies
1
2
3
2
3
Music
1
2
3
2
3
Art
1
2
3
2
3
PE
1
2
3
2
3
Computers
1
2
3
2
3
Other:___________ 1
2
3
_________________________________________________
• The interview is the
responsibility of the
Teacher of Record or
referring teacher.
BIP Page 1
COMMENTS
INSTRUCTIONS FOR COMPLETION OF BEHAVIORAL INTERVENTION PLAN (BIP)
•
Must be completed and
signed by the parent as a
part of a Case Conference
Committee meeting.
•
Teachers may request
Covered Bridge staff attend
any/all BIP conferences.
•
A BIP may be drafted prior
to a conference by the
Teacher of Record based
on his/her evaluation of
FBA data, a grade level
team meeting, SAT
meeting, and/or staffing.
* Must be completed as a part of a case conference committee. Teachers may request Covered
Bridge staff attend any/all BIP conferences.
Target Behavior Objectives
 List what you want the student to be able to do
 Objectives must be measurable
Plan of Action
* Examples of Intervention Strategies and Reinforcers are attached.
 Behavioral Interventions – Ensure that the positive behavioral supports for behavior reinforcement are
immediate and powerful.
 Consequences – Identify consequences for targeted behavior
 Persons Responsible – Identify who will be responsible for implementing the intervention
 Criterion – Select mastery criterion
 Evaluation Procedures – List evaluation procedures to be used
 Date for Review – Indicate date of review (must be reviewed at least once in twelve months)
 Outcome/Follow-Up – This column should be completed when the BIP is reviewed
 Identify Skills to be Taught and Indicate Person(s) Responsible – Identify skills to be taught and
indicate person(s) responsible for teaching. It is not the sole responsibility of the special education
teacher to teach all necessary skills.
Assurance and Approval




Severe Clause – Complete all pertinent information.
Signatures – Obtain signatures from committee members to ensure ownership of the BIP.
Distribution – Specify personnel who will receive copies of the BIP.
Implementation Agreement – Check appropriate box.
BIP Page 2
BEHAVIORAL INTERVENTION PLAN (BIP)
STUDENT______________________________________________________________________D.O.B._______________DATE___________________
COMMENTS
GRADE______________________SCHOOL______________________________________________ELIGIBILITY_____________________________
MEDICATION(S) and other health issues________________________________________________________________________________________
REVIEW DATES
I.
II.
_______________
_______________
_______________
_______________
Target Behavior Objective(s): (List what you want the student to be able to do.)
1._________________________________________________________________________________________________________
2._________________________________________________________________________________________________________
3._________________________________________________________________________________________________________
Plan of Action:
Behavioral Interventions
Persons
MC
EP
Date for
Outcome/
Responsible
Review
Follow-up
Positive Behavioral Supports:
Behavioral Interventions
Persons
Responsible
MC
EP
Date for
Review
Outcome/
Follow-up
• Target Behavior Objectives
• Positive Behavioral
Supports:
– This is a point of special
emphasis to increase
desirable behavior.
• Consequences
Consequences:
• MC and EP columns need
to reference each of the
target behaviors.
Mastery Criterion: (MC)
a. 60-70% c. 81-90%
c. 81-90%
e. Other________________
b. 71-80%d. 91-100%
d. 91-100%
_______________________
_______________________
Evaluation Procedures: (EP)
1) Observation
3) Meetings with teachers
2) Daily data collection 4) Progress reports frequency
Identify Skills to be Taught and Indicate Person(s) Responsible:
Stress Management________________________
Academic_________________________________
Organizational_______________________ _____
Communication______________________ _____
Other____________________________________
Social___________________________________________
Anger Management______________________________
Drug Prevention_________________________________
Sensory Processing_______________________________
Other____________________________________________
5) Discipline/Attendance
BIP Page 2 Example
BEHAVIORAL INTERVENTION PLAN (BIP)
STUDENT______________________________________________________________________D.O.B._______________DATE___________________
GRADE______________________SCHOOL______________________________________________ELIGIBILITY_____________________________
MEDICATION(S) and other health issues________________________________________________________________________________________
REVIEW DATES
I.
_______________
_______________
_______________
_______________
Target Behavior Objective(s): (List what you want the student to be able to do.)
1._Reduce_defiant responses to teacher requests resulting in discipline referral.________
2._________________________________________________________________________________________________________
3._________________________________________________________________________________________________________
II.
Plan of Action:
Behavioral Interventions
Persons
MC
EP
Date for Outcome/
Responsible
Review Follow-up
Positive Behavioral Supports:
1. Teacher recognition of cooperation (possible
Teacher
D
1
2. Private discussion of request away from peers
Teacher
D
1
3. Allow flexibility in task initiation (give the
Teacher
D
1
School or
outside
agency
counselor
D
1
CCC
D
1
Agency
counselor/
TOR
D
1
Persons
Responsible
MC
feedback example: “Thank you”)
student time to cool down and get started)
4. Referral to anger management counseling
5. Parent meeting to report success
6. Collaboration with agency counselor
Behavioral Interventions
EP
Date for
Review
Outcome/
Follow-up
Consequences:
Teacher/
dean
Teacher
1. Class removal
2. Referral to dean/principal
3. Parent meeting to discuss lack of progress
4. Progressive discipline
Mastery Criterion: (MC)
a. 60-70% c. 81-90%
c. 81-90%
e. Other________________
b. 71-80% d. 91-100%
d. 91-100%
_______________________
_______________________
Identify Skills to be Taught and Indicate Person(s) Responsible:
Stress Management________________________
Academic_________________________________
Organizational_______________________ _____
Communication______________________ _____
Other____________________________________
Social___________________________________________
Anger Management______________________________
Drug Prevention_________________________________
Sensory Processing_______________________________
Other____________________________________________
Positive Behavioral Supports
•
Interventions that do not involve or result in disciplinary actions
Examples:
•
Cooling off time and place, and designated person to see
•
Schedule changes including more special education contact, more
or less restrictive placement
•
Referral to in- or out-of-school counseling, group or individual*
•
Referral to community resources
•
Exchanges of information with service providers
•
Behavior management/modification point and reward systems
•
Incentives such as credit recovery, honor jobs/positions, earning
passing periods, recess, and less supervised lunch
•
Parent contact/conferences
Consequences
•
Progressive discipline
•
Removal from classes
•
Loss of driver’s license
•
Loss of work permit
•
Loss of recess
•
Loss of passing periods
•
Loss of unrestricted lunch
•
Parent contact/conferences
•
Loss of privileges
•
More restrictive educational environment
Date for Review
•
Natural breaks – grading periods, Annual Case Reviews, etc.
Parent/
CCC
Deans
Evaluation Procedures: (EP)
1) Observation
3) Meetings with teachers
2) Daily data collection 4) Progress reports frequency
COMMENTS
Outcome Follow-Up
•
Notes written by Case Conference Committee members
5) Discipline/Attendance
*Note: Counseling may include school staff, outside agency staff,
individual, group, transition group for incoming students to a new
level (such as elementary to middle school, or middle to high
school), anger management groups (CODA supported), healthy
relationships, smoking cessation groups, substance abuse
groups, social skills groups, law enforcement, consultation, wraparound, family preservation, juvenile probation consultation
BIP Page 2 Example
BEHAVIORAL INTERVENTION PLAN (BIP)
STUDENT______________________________________________________________________D.O.B._______________DATE___________________
GRADE______________________SCHOOL______________________________________________ELIGIBILITY_____________________________
MEDICATION(S) and other health issues________________________________________________________________________________________
REVIEW DATES
_______________
_______________
_______________
_______________
I.
Target Behavior Objective(s): (List what you want the student to be able to do.)
1._Reduce peer conflict.______________________________________________________________________________
2._________________________________________________________________________________________________________
3._________________________________________________________________________________________________________
II.
Plan of Action:
Behavioral Interventions
Persons
MC
EP
Date for Outcome/
Responsible
Review Follow-up
School/
Positive Behavioral Supports:
agency
1. Counseling
counselor
2. Structuring peer interaction opportunities
Teacher
3. Immediate reinforcement of desired behavior
Counselor
(example: “I’m proud of your decision.”)
4. Allow increased contact with positive peers
All staff
(lunch, recess, before school)
Behavioral Interventions
Persons
Responsible
Principal
/dean
Consequences:
1. Progressive discipline
2. Isolation from peers
TOR
3. Preferred seating
TOR/Staff
4. Parent conferences
Parent/
CCC
MC
EP
Date for
Review
Outcome/
Follow-up
COMMENTS
Positive Behavioral Supports
•
Interventions that do not involve or result in disciplinary actions
Examples:
•
Cooling off time and place, and designated person to see
•
Schedule changes including more special education contact, more
or less restrictive placement
•
Referral to in- or out-of-school counseling, group or individual*
•
Referral to community resources
•
Exchanges of information with service providers
•
Behavior management/modification point and reward systems
•
Incentives such as credit recovery, honor jobs/positions, earning
passing periods, recess, and less supervised lunch
•
Parent contact/conferences
Consequences
•
Progressive discipline
•
Removal from classes
•
Loss of driver’s license
•
Loss of work permit
•
Loss of recess
•
Loss of passing periods
•
Loss of unrestricted lunch
•
Parent contact/conferences
•
Loss of privileges
•
More restrictive educational environment
Date for Review
•
Natural breaks – grading periods, Annual Case Reviews, etc.
Outcome Follow-Up
•
Notes written by Case Conference Committee members
Mastery Criterion: (MC)
a. 60-70% c. 81-90%
c. 81-90%
e. Other________________
b. 71-80% d. 91-100%
d. 91-100%
_______________________
_______________________
Evaluation Procedures: (EP)
1) Observation
3) Meetings with teachers
2) Daily data collection 4) Progress reports frequency
Identify Skills to be Taught and Indicate Person(s) Responsible:
Stress Management________________________
Academic_________________________________
Organizational_______________________ _____
Communication______________________ _____
Other____________________________________
Social___________________________________________
Anger Management______________________________
Drug Prevention_________________________________
Sensory Processing_______________________________
Other____________________________________________
5) Discipline/Attendance
*Note: Counseling may include school staff, outside agency staff,
individual, group, transition group for incoming students to a new
level (such as elementary to middle school, or middle to high
school), anger management groups (CODA supported), healthy
relationships, smoking cessation groups, substance abuse
groups, social skills groups, law enforcement, consultation, wraparound, family preservation, juvenile probation consultation
BIP Page 3
COMMENTS
ASSURANCE AND APPROVAL
SEVERE CLAUSE:
If a pattern of misbehavior develops to the degree that it significantly interrupts the educational process or becomes
a safety issue for ________________________ or others, __________________________ may be sent
student
Student
home with his/her work until a case conference can reconvene to determine appropriate changes in his/her IEP or
appropriate changes in his/her educational placement.
•
Severe clause:
– For Zero Tolerance offense, for
example, continued charting of
behavior is not required.
•
School policy and practices
regarding discipline will be
reinforced for all offenses not
addressed by this plan or student’s
IEP.
•
The committee mutually agreed to
implement the BIP developed by this
committee.
– Parent/guardian must approve
the plan to go into effect.
– All staff serving the student
should be made aware of the
provisions made in the BIP
•
The same procedure for
disseminating goals and objectives
and other IEP information to staff will
be used to inform staff of the BIP.
School policy and practices regarding discipline will be reinforced for all offenses not addressed by this plan or
______________________’s IEP.
student
My signature indicates that I was involved in the development of this plan.
(* signifies the person who wrote the plan)
NAME
POSITION
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
The plan was distributed to the following school personnel on
______________________________________________
______________________
Date
_____________________________________________
_______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
______________________________________________
_____________________________________________
Check one of the two boxes below:
The committee mutually agreed to implement the BIP developed by this committee.
The committee has not reached agreement and will recess for not more than 10 school days. During the recess
the members agree to gather additional information, obtain additional resources or professional assistance,
and/or consider alternative approaches. This recess does not apply if the student presents a danger of
physical harm to himself/herself or others, or if the student has committed an expellable offense.
If an agreement is not reached, the committee will reconvene at___________________on___________________________.
Time
Date
BIP Page 4
INTERVENTION STRATEGIES
Note: For staff use only as resource for completing BIP.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
Positive Behavior Strategies for Increasing
Prosocial Behaviors
Consequences Designed to Improve Behavior
And Enable Student to Receive Instruction
Remove distracters
Provide a structured environment
Set well-defined limits, rules, and task expectations
Establish consistent routine
Simplify activities
Review consequences before behavior escalates
Allow time to process information
Use visual cues and supports
Visual/written schedules
Offer choices
Set attainable daily goals
Premack principle (If…, then…)
Earn activities/privileges
Cooling off period/”Cool Down” pass
Planned ignoring of minor inappropriate behavior
Provide frequent positive feedback
Verbal/visual reminder
Proximity control
Nonverbal signal for appropriate behavior
Referral to counselor
Point/level system
Home/school reward system
Behavioral graphs/charting
Model/coach in problem-solving situations
Role play alternative behaviors
Contracts
Model and practice social skills
Set up and reinforce social interaction
Use timer for self-monitoring
Redirect overactivity into productive tasks
Provide student with a safe area to regain control
Permit student to engage in appropriate physical
activities
Token system
Peer/buddy system
Social stories
AM/PM reinforcers
Participation in general education activities
Group activities
Time with preferred adults
Positive reinforcers:
(List:_________________________________________
_____________________________________________
_____________________________________________)
***Consequences should be determined based upon
the functioning level of the student and the
severity of behaviors exhibited.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Over correction
Loss of/failure to earn activities/privileges
Response Cost (Token system)
Teacher-initiated cooling off period
Supervision during transition periods
Parent conference
Use conflict management and mediation steps
After school detention
Lunch detention
In school suspension
_____________period/days
Suspend student for the remainder of the day
Suspension for up to three consecutive days
Saturday School/Tuesday Extension
Office/Dean referral
Regroup/Cool down
Time-out
Restitution
Isolated instruction/lunch
Apology/essay
Therapeutic restraint
Involve law enforcement
Citations
File truancy
Verbal and written reminders/warnings
Morning detentions
Lunch detentions
Other
consequences:__________________________
___________________________________________
___________________________________________
___________________________________________
COMMENTS
• This page is for
information only; no
action is needed.
BIP Page 5
REINFORCERS FOR ELEMENTARY STUDENTS

Jobs in the class (pass out papers, collect papers, put attendance slip on door, feed animals, put away materials, water
plants, etc.)
 Jobs outside the class (carry attendance or notes to office, take messages to other teachers, collect teacher’s mail,
give announcements, etc.)
COMMENTS
 “First” club (called first to get in line, be dismissed, etc.)
 “No homework” coupons
 “Extra credit” coupons
 Read to younger students or listen to students read
 Sit in teacher’s chair
 Sit next to a friend
 Visit principal, counselor, custodian, secretary, etc.
 Good news note home
 Phone call home
• This page is for
information only; no
action is needed.
 Use special markers or other materials
 Tangible rewards (food, drinks)
 “Catch’em being good” tokens
IDEAS FOR MOTIVATING SECONDARY STUDENTS

Jobs in the class (pass out papers, collect papers, put attendance slip on door, put away materials, water plants, etc.)
 Jobs outside the class (carry attendance or notes to office, take messages to other teachers, collect teacher’s mail,
give announcements, etc.)
 “No homework” coupons
 “Extra credit” coupons
 Read to younger students or listen to younger students read
 Work as peer tutor
 Preferred seating/Encouragements
 Visit principal, counselor, custodian, secretary, etc.
 Good news note home
 Phone call home
 Use special materials
 Work in office or other parts of school
 Restroom or water pass
 Choice of task
 Entry pass for extracurricular activity (e.g. football game, plan, etc.)
 Tangible rewards (food, drinks)

“Catch’em being good” tokens
• This may be used
as a reinforcer
assessment during
the student
interview.