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Meeting Date:
Disability:
Name:
D R AFT D O C U M E N T
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PU R PO S E:
A Functional Behavioral Assessment (FBA) is used to gather information about a students behavior to determine the need for, and
provide the foundation for, a Behavioral Intervention Plan (BIP). An FBA is required to be conducted if the students violation of a
code of conduct (resulting in a change of placement) is determined to be a manifestation of the students disability.
School:
Case Manager:
Tier 1 (Scores of 4/4): [Behavior was appropriate for the students developmental stage.]
Tier 2 (Scores of 3/4): [Behavior was acceptable for the students developmental stage.]
Areas To Target
Tier 3 (Scores of 2/4): [Behavior was problematic.]
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Describe behaviors that could serve as functional alternatives to the target behavior:
Positive and productive communication and self-management strategies, as demonstrated through: STUDENT will engage in pretaught coping strategies; using appropriate language to discuss problems with peers and staff, use socially appropriate verbal tone
and content while discussing problems with staff and peers; use safe nonverbal interactions with others- i.e. providing personal
space to others; and remaining in the designated area.
Specific goals for STUDENT could include:
1. STUDENT will use classroom appropriate social interactions to communicate with staff-- i.e. raising hand, or calling staff
over to speak privately; measured by number of successful instances out of 60 minute period.
2. When needing a break, STUDENT will independently engage in pre-taught/decided coping strategies like taking a 5
minute break, taking deep breaths at her desk, or collaborate/problem-solve with a classroom staff; to deal with low-level
problems; measured by number of successful instances out of 60 minute period.
3. When finished engaging in a pre-taught coping strategy, STUDENT will return to her assigned task and engage in his
schedule/activity within (2 prompts or 5 minutes); measured by number of successful instances within a 60 minute period.
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