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Functional behavior assessment template: Fill out & sign online ... - Free Printable

Functional behavior assessment template: Fill out &  sign online ...

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- The image displays a Functional Behavioral Assessment (FBA) template for an individual student.
- It is structured as a flowchart with numbered boxes (1 through 8) that guide the user through analyzing problem behavior.
- Box 1 identifies the Problem Behavior(s) with Baseline Data, requiring concrete, observable terms and data on frequency, duration, intensity, or latency.
- Box 2 identifies the Trigger/Antecedent, detailing what happens prior to the problem behavior.
- Box 3 identifies the Maintaining Consequence, describing the probable consequences that serve to maintain the behavior.
- Box 4 identifies the Setting Event, which are conditions under which the behavior usually occurs.
- Box 5 defines the Desired Behavior in concrete terms, specifying what the student should be doing instead.
- Box 6 lists the Reinforcing Consequence(s) for the Desired Behavior, based on the student’s preferences.
- Box 7 details Alternative Acceptable Behaviors/Skills to be Taught, linking the desired behavior to teachable skills.
- Box 8 determines the Function of the behavior, explaining why the student engages in behaviors that impede learning.
- A Hypothesis Statement (Competing Behavior Pathway) connects the antecedents, behavior, and consequences to form a predictive statement.
- The template includes sections for information sources (observation, interviews, records), student strengths and preferences, and a determination of whether a Behavioral Intervention Plan is required.
- It requires signatures from the School Psychologist and includes adaptation credits to Deanne A. Crone & Robert Horner, February 2003.
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