Muskegon Area ISD Functional Assessment/Behavior Intervention Form

General Information
Student:

Birthdate:

School:

Caseload Teacher:

Eligibility Status:

Date:

Medication:

ASD

Previous Funct Assess?

Yes

No

When:

I. Student Strengths, Skills, and Difficulties

List Student Strengths
and Skills:

can repeat a sound

able to entertain himself during choice time
initiates positive physical contact
enjoys interacting with adults
uses iPad to communicate wants and needs
follows a visual schedule
understands when he is being corrected

List Student
Difficulties:

transition from one activty to another, especially when

routine changes
when he is presented with an undesired activity (such
as books or some other structured teaching tasks)

II. Behavior(s) of Concern

Description - Observable/Measurable
applies hard pressure to the flesh or pulls clothing and sometimes hair.
members/adults recongnize that he may or may not actually be angry when he does
the "agitated grab"
J will reach toward another person's (adult or peer (but typically adult)) body and
apply hard pressure to the flesh or pull clothing and sometimes hair: aka "Agitated
Grab"
Biting an adults arm or leg when agitated
Is this behavior addressed in the School Handbook? Y

How Often
3-4 times a
day

Duration
could
involve
multiple
grabs in a
single
event; lasts
until his
needs are
met

Intensity
intense
enough
to elicit
an
emotiona
l
response
from
recipient

Problem has
E
x
i
s
t
e
d
(l
e
n
g
t
h
o
f
ti
m
e
)

throughout his
y
e
a
r
s
t
h
a
t
h
e
h
a
s
b
e
e
n
i
n
s
c
h
o
o
l.

III. Environmental Issues and Situational Variables

What triggers or causes the behavior? What happens before the behavior?
outdoor recess is cancelled due to weather
the swing is not available at sensory time
his routine is changed or interrupted
he is working with an unfamiliar person (such as a substitute)
requested a schedule change that did not get changed (something that he wants that does not go according to plan)

What happens immediately after the problem behavior occurs?

(student reactions, staff reactions, environmental changes)

he is prompted to remove grab, and follow his current behavior plan with the break options; he is prompted to choose a break option, however, J has not
preferred this option.
elicits an emotional response from the recipient of the bite or grab
J has recently been choosing the "I want to be done" choice on his iPad at least once a day

In what settings/situations is the behavior of concern most and least likely to occur?
Settings/Situations
Most Likely
Least Likely
Adults?

(personality characteristics, teaching

style, gender, disciplinary style, etc., no names)
Peers? (personality characteristics, gender,
etc., no names)

paraprofessional; an unfamiliar person such as

a substitute

adults that he does not work closely with

whoever is part of the situation or nearby

less likely to grab a peer compared to an adult

Certain Activities?

structured teaching time that requires direct

instruction from a paraprofessional
transitions between instruction
general education classroom
special education classroom
throughout the day when presented with
undesired activites

(independent work,
lecture, writing activities, small group)

Settings?

(playground, math, science, lunch,

school bus, unstructured time)
Time of Day or Class (morning, end of
class, afternoon)
Other? (home issues, bus, medication, health,
sleep, etc.)

when he struggled at home that morning

when he has chosen the activity to participate in

during instructional times in certain classrooms
that he enjoys
choice time
when he had a good nights sleep

IV. Childs Exposure to Rules Governing This Behavior

Check One or More and List How Often

Behavior Plan

Class Discussions

1-1 Discussions

Assemblies

Handbooks

Check Sheet

Other

Social Work
Support
Behavioral Support
Contracts
Other

Conflict Resolution

Anger Management

Posted Classroom Rules

V. Previous Interventions and Supports

Check One or More and Indicate Frequency

Peer Mediation

Staff/Student Awareness
Regarding BIP

VI. Previous Consequences and Disciplinary Measures

Time Out

Loss of Privilege

Parental Notification

Other

Referred to Office
In-School
Suspension/Suspension
Behavior Ignored

Check One or More and Indicate Frequency of Use

Detention

Work Detail/Restitution

Reprimand/Warning

*Attached Documentation

VII. Needs Being Met Through This Behavior

Escape/Avoidance

Attention

Sensory Stimulation

Power/Control

Relief of Fear/Anxiety

Other

Check One or More and Explain

Expression of
Anger/Frustration
Tangible

VIII. Goal to Appropriately Address Need(s)

Goal:

When J is feeling angry or upset, he will grab a designated rather than a person's arm.

IX. Preferred Activities and Reinforcers

List preferred activities: choice time
outdoor recess

List preferred reinforcers: computers

music
iPad

X. Skills Needed to be Taught to Replace Behavior of Concern

What Behaviors Do You Want the Student to Engage in to Replace the Behavior?
By June 2015:
-instead of using the angry grab, help him realize when he is getting upset by using cards with examples of emotions for him to use to express his
feelings 3 out of 5 times.

XI. Behavior Plan

Preventative Strategies
-provide ample opportunities to make
his own choices
-give him easy access to whatever he
wants to grab
-provide ongoing training and Anger
Replacement Training

Procedures to Follow When

Behavior Occurs

Reinforcement Strategies

Classroom Accommodations, Approach

Strategies, Seating Arrangements, Instructional
Strategies, etc.

Methods of Teaching and Reinforcing

Appropriate/Replacement Skills

-a behavioral contract will be

developed to outline incentives and
expectations.
-J will receive computer or iPad time
when he makes a good choice and
uses one of his designated objects to
grab rather than grabbing an adult's
arm

Specific Steps to Take When Behavior Occurs

When J grabs someone the following

procedure will be utilized:
Step 1: ask him to remove his grasp
Step 2: redirect him to the object he is
supposed to grab
Step 3: help him identify his frustration
by using his "emotions" cards
Step 4: after he has successfully been
redirected 3 out of 5 times, he will be
rewarded with choice time.
Deviation of School Handbook?
Yes
No

XII. Data Collection

Describe how systematic/measurable data will be collected for Behavior Plan:
record the number of angry grabs
in each instance, record whether redirection was successful or not
identify who he grabs, if they follow the redirecting plan, and the success of the redirection
a copy of all of this data will be sent on a daily basis to J's parents/gauradians

Attach Sample Data Sheet

will inform the following staff of BIP:

Signatures below indicate the plan has been reviewed and agreed upon for implementation:

Parent/Guardian

Teacher

Social Worker/Psychologist

Special Education Teacher

Student

Administrator

Other

Other

Date(s) plan reviewed:

*Attachments may include point sheets, contracts, token cards,
progress notes, referrals, parent contacts.

Date plan terminated:

MAISD 2/00