Functional Behavior Assessment - Liberty University- Educ 624

646 Words Feb 28th, 2013 3 Pages
FBA FORM

|Functional Behavioral Assessment |
| |
|Fictional Student Name: Michael Grand Caymen DOB: 07/30/2005 Date: 03/03/2013 |
|Data Sources: X( Observation | X( Student Interview | X( Teacher Interview | X( Parent Interview | ( Rating Scales | ( Normative Testing |
|Description of Behavior:
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|Intensity (Consequences of problem behavior on student, peers, instructional environment): |
|Student disrupts all students in the room. It causes reduction in instructional time for himself and his peers, as well as a reduction in completion of |
|assignments in class that are required. This behavior also causes other students to get off-task which makes it harder for classroom management. |
|Duration: |
|The duration of this behavior is exhibited daily in 3 out of 6 class periods. |
|Describe Previous Interventions: |
|Parent conferences, professional counseling, verbal redirection, medications, student one-on-one counseling, intervention plan from team, in/out-of-school |
|suspension, and differentiated
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