Functional Analysis Assessment/Behavior Intervention (PDF)

BEHAVIOR SUPPORT SERVICES
FUNCTIONAL ANALYSIS / ASSESSMENT AND
BEHAVIOR INTERVENTION FORM
With this form you can:
Prioritize which behaviors are the most important to address
Identify the who, what, when, where and how’s
Record behaviors
Develop a hypothesis on why a student is behaving a certain way
Develop a behavior plan
A team of people who know the student well best completes this tool. Parents, teachers,
administrators, counselors, psychologists etc.)
This document was adapted and designed by the following Capital Region BOCES staff
members:
Marie Brander (Special Education Training and Resource Center Trainer)
Ellen Burns (Early Childhood Direction Center Coordinator)
Dr.Wilma Jozwiak (Special Education Training and Resource Center Trainer)
Julie Magnano (Behavior Support Services)
Dr. Barbara Zimmerman (Behavior Support Services)

STEP 1: TARGETING SPECIFIC BEHAVIORS
List behaviors/concerns below. Rate each and prioritize which behavior to work on first.
(The most intrusive behaviors should always be targeted first.)
1. __________________________________________ _____(Destructive)
__________________________________________
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_____(Disruptive)
_____(Distracting)
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2. __________________________________________ _____(Destructive)
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_____(Disruptive)
_____(Distracting)
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3. __________________________________________ _____(Destructive)
__________________________________________
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_____(Disruptive)
_____(Distracting)
__________________________________________
__________________________________________
For example:
Destructive (hitting, hurting others)
Disruptive (disturbs materials, provokes others)
Distracting (loud noises, noncompliance)
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STEP 2: ANSWERING KEY QUESTIONS
HOW OFTEN DOES THE BEHAVIOR OCCUR?
Per hour?____ Per day?____ Per week?_____
How long does the behavior occur per episode?
Is there a time, place, or person that seems to decrease the behavior?
Who is present when the behavior occurs?
ANTECEDENTS
What is going on when the behavior occurs?
When does the behavior tend to occur?
When does the behavior tend not to occur?
Where does the behavior tend to occur?
Where does the behavior tend not to occur?
What happens after the behavior occurs?
CONSEQUENCES
What does the staff do?
What do the other students do?
What does the individual who had engaged in the behavior do?
What do you think increases the likelihood of the behavior occurring again?
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STEP 3: RECORDING BEHAVIORS
When? Describe behavior. What happened before? What happened
Date? after? [intensity, duration and frequency]
Time?
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STEP 4: DEVELOP A THEORY
The checklist below is helpful in figuring out the purpose of a specific behavior. Some
behaviors may serve more than one purpose.
The purpose of the behavior may be ATTENTION if it occurs....
• When you are not paying attention to the student (e.g. you are talking to
someone else in the room, or are on the phone.)
• When you stop paying attention to the student.
The purpose of the behavior may be ESCAPE/AVOIDANCE if it occurs....
• When you ask the child to do something that he or she does not seem to like or
want to do. (e.g., complete a task, put materials away)
• The behavior stops after you stop “making demands”
The purpose of the behavior may be GETTING SOMETHING if it occurs....
• When you take away an object or activity.
• It the behavior stops soon after you give the student materials, or the student has
requested an activity that is desirable to the student.
• When the student can not have an object, or activity that has been requested.
The purpose of the behavior may be SELF - REGULATION if it tends....
• To be performed over and over again, in a rhythmic or cyclical manner.
• Happens when there is either many things going on in the area or very little going
on in the area. (e.g., noise, movement, people, activity...)
• The student can still do other things while performing the behavior.
The purpose of the behavior may be PLAY if it tends....
• To be repeated when no one else is around
• To be enjoyed by the student performing the behavior (e.g., smiling, laughing)
• The student cannot do other things while performing this behavior.
THE MAIN PURPOSE OF THIS BEHAVIOR IS:
_____________________________________________________________________
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STEP 5: DEVELOP A BEHAVIOR INTERVENTION PLAN
Preventing:
Teaching:
Reacting:
How will you change the environment in which the problem
behavior occurs that seem to be associated with that behavior?
(Who, What, Where, When)
What other appropriate behavior or skill will be taught that will meet
the purpose of the problem behavior.
How will you react to the inappropriate behavior in a way that
doesn’t escalate the behavior or “feed into” the student’s purpose?
PREVENTING
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TEACHING
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REACTING
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What materials are needed?
STEP 6: USING THE PLAN
Who needs to be part of the plan:
(Teacher, Student, Parent(s), Psychologist
Social Worker, Educational Aide,
Administrator, Lunch monitor, Bus Driver,
Specialist, Physician, Other)
Responsibilities:
PERSON TASK DATE TO INITIATE
AND/OR COMPLETE
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STEP 7: EVALUATING THE PLAN
For Preventing:
For Teaching:
For Reacting:
Do you still feel that your “theory” about the purpose of the behavior is correct?
What positive changes have you seen?
What areas of the plan do you need to continue?
What areas need to be changed?
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