STEP 1: FUNCTIONAL ASSESSMENT INTERVIEW

Instructions: IEP team interview including team members who have observed the behavior of the student
for an extended period of time in a variety of settings and conditions. When the answer is YES, add
details on the line provided.
I. Description of the Behavior of Concern (specifically describe what the behavior looks like):
a. What does the behavior look like from start to finish? What does the chain or sequence of
behaviors look like?
The student will stare at the wall, stare at the ceiling, play with the carpet/objects/hands/others, talk to
others, stand up, move away from the group, grab other students and sing during group story/reading
activities. These behaviors occur most often when he is asked a question.
b. How often does the behavior occur (hourly, daily, weekly)?
Hourly
c. How much time passes between behavior incidents?
Approximately 10-50 seconds.
d. Compared with peers, rate the severity of the behaviors (mild, moderate, severe)

Moderate to severe
II. Physiological and Medical Factors:
1. Could the behavior be a result of a medical condition or any form of physical discomfort (asthma,
allergies, rashes, sinus infections, seizures, diabetes, etc)
The students mother denied that child has been diagnosed with any medical conditions. However, she
suspects that he may have Attention-Deficit/Hyperactivity Disorder like his brother.
2. Could the behavior be related to a side effect of medication? (Check with school nurse or medical
professional)

The students mother denied past and current use of medications.

3. Could the behavior be the result of some physical deprivation condition (sleeping routine and diet.)?

The students mother reported that the family keeps a daily routine. However, the student
sometimes refuses to fall asleep and often has difficulty waking up in the morning. The student is
reported to be a picky eater. He eats a lot of the same foods (i.e., spaghetti, pizza, peanut butter
and jelly). He does not like fruits or vegetables and prefers drinks with flavor.
III. Other outside events that may influence behaviors (family circumstances, etc.):
The students father is in the Army and is often deployed. His parents are currently separated. His mother
has a new boyfriend. The students 10 year-old brother is diagnosed with Attention-Deficit, Hyperactivity
Disorder and is taking medication. The students mother works late 3 nights out of the week, the student
is cared for by a babysitter. The students babysitter has changed 3 times since the school year began. The
student says his brother causes the babysitters to quit.

IV. Antecedents (Setting Events):

1. Are there circumstances in which the behavior always occurs?
During reading activities and tasks which require more than 10 minutes.
Time of Day:
Most Likely: Schoolwork
Least Likely: Free play
N/A:
Day of Week:
Most Likely: Monday, Tuesday, Friday
Least Likely: Saturday, Sunday
N/A:
Settings (Locations):
Most Likely: Classroom
Least Likely: Outside, in the community (mall, park, restaurant)
N/A:
Social Circumstance (alone, small group, large group)
Most Likely: Large group
Least Likely: Small group
N/A:
Environment (structured v. unstructured):
Most Likely: Unstructured, indoors, chaotic/loud, whole-group activities, unsupervised
Least Likely: Structured, quiet
N/A:
Changes (transitions, schedule change, personnel change, etc.):
Most Likely: Whole-class activities, transitions, changes in schedule, changes with staff
Least Likely: Small-group activities
N/A:
2. Does the behavior occur only or more often during particular activities?
Leisure/Solitary:
Most Likely: Reading, writing
Least Likely: Math, science, physical education, music
N/A:
Leisure/Social:
Most Likely: When there are inflexible rules
Least Likely: When he is allowed to do what he wants
N/A:
Transitions:
Most Likely: Changes in schedule/routine, transition to reading
Least Likely: Transition to physical education, music, science
N/A:
Academic work alone:
Most Likely: silent reading, independent writing
Least Likely: science, work incorporating games
N/A:
Academic work small group:
Most Likely:
Least Likely:
N/A: Students tends to stay on-task when in a small group

Academic work large group:

Most Likely: Reading
Least Likely: Science
N/A:
Academic work with teacher:
Most Likely:
Least Likely:
N/A: Student stays on task during one-to-one instruction
Subjects:
Most Likely: Reading
Least Likely: Science
N/A:
Specials: Centers
Most Likely:
Least Likely:
N/A: Student stays on task and gets along well with others
3. Does the behavior occur with (or more likely with) certain people:
School Personnel:
Most Likely: Substitute teachers, aides
Least Likely: Consistent staff
N/A:
Peer:
Most Likely: Peers who also engage in this behavior
Least Likely: Peers who stay on task
N/A:
V. Trigger Events:
1. Does the behavior occur in response to certain stimuli?
Types of demands: Student will engage in many different behaviors to avoid tasks involving
reading and writing.
Most Likely: Group reading assignments, when asked many questions
Least Likely: Small group, one-to-one assignments, drawing
N/A:
Termination of preferred activity: Student will complain and sometimes refuse to terminate
preferred activity.
Most Likely: Termination of centers, games
Least Likely: Termination of reading
N/A:
Tone of voice:
Most Likely: Angry, loud
Least Likely: Calm, firm
N/A:
Noise level:
Most Likely: Loud
Least Likely: Low volume
N/A:
When ignored:
Most Likely:
Least Likely:
N/A: Being ignored does not affect his behavior.

Change in routine:
Most Likely: Change to regular schedule, days when there are not free-choice activities
Least Likely: Days when there is change due to special school activities (i.e. parades,
parties)
N/A:
Transitions:
Most Likely: Transition to activities he does not enjoy (reading, writing)
Least Likely: Transition to physical education, music
N/A:
Number of people in room:
Most Likely: many people in the room
Least Likely: small groups
N/A:
Attention given to others:
Most Likely:
Least Likely:
N/A: This does not affect his behavior
Denied access to preferred object/activity:
Most Likely: When toys are taken away
Least Likely:
N/A:
Provoked by peer:
Most Likely:
Least Likely:
N/A: The student is assertive and is not affected by being provoked.
Types of peer interactions:
Most Likely:
Least Likely:
N/A: The student does not seem to be affected by peer interaction.
Types of teacher interactions:
Most Likely: When he gets in trouble.
Least Likely: When he is given choices.
N/A:
2. Could the behavior be related to any skill deficits:
a. Communication: Examples: The student appears off track and loses his/her train of thought.
The students volume and/or tone of voice are inappropriate. The student has difficulty getting messages
across successfully and/or lacks the social skills to function productively in group activities. The student
has difficulty processing verbal messages. The student does not use active listening habits such as eye
contact, head nods, asking, clarifying, or verifying questions.
b. Sensory Processing: Examples: The student has difficulty interpreting sensory information
(i.e., sights, sounds, movements, touch, tastes, smells) and/or organizing multiple sensory information.
The student seems unable to ignore irrelevant sensory information and/or focus on relevant sensory
information.
c. Task requirements are too difficult:
No:
Yes: This student has some difficulty with reading and writing assignments. However, when the
activities are completed one-to-one or in small groups, he is able to perform at the level of his
peers. The student has called reading boring.

VII. Consequence Factors:

1. Does the behavior allow the student to GAIN anything?
A. Preferred activities or items?
Indicators: The behavior often occurs when you take a particular item away from the student or
when you terminate a preferred activity. The behavior often occurs when you inform the student
that he/she cannot have a certain item or cannot engage in a particular activity. The behavior
rarely occurs when you give the student free access to his or her favorite items or activities.
No:
Yes:
B. Peer or adult attention?
Indicators: The student frequently approaches you or others. The student frequently initiates
social interaction. When the behavior occurs, you or others usually respond by interacting with
the student in some way. The behavior rarely occurs when the student is receiving lots of
attention.
No:
Yes:
2. Does the behavior allow the student to postpone, avoid, or escape anything (demands, social
interaction, etc.)?
Indicators: The behavior often occurs when you place demands on the student. The behavior
often occurs when the immediate environment is very noisy or crowded. The behavior rarely
occurs when you place few demands on the student or when you leave the student alone. The
student is often noncompliant when asked to complete tasks.

No:
Yes: The behavior often occurs when the student is asked questions during whole-group
reading/writing activities. The behavior rarely occurs if there are little or no expectations of the
student.
3. Does the behavior provide stimulation activity (an alternative to a lack of active engagement in
activities)?
Indicators: the behavior occurs frequently when the student is alone or unoccupied. The student
seems to have few known reinforcers or rarely engages in appropriate object manipulation or
play behavior. The student is generally unresponsive to social stimulation. When the student
engages in the behavior, you and others usually respond by not attending to the behavior.
No:
Yes:

Hypothesis Statement:
The off-task behaviors (staring at the wall, staring at the ceiling, playing with carpet/objects/hands/others,
talking to others, standing up, moving away from the group, grabbing other students and singing during)
may be related to the following physiological and medical concerns: Attention-Deficit/Hyperactivity
Disorder.
These behaviors are most likely to occur during the following circumstances:

Whole-group reading and writing activities

In the morning

When many demands are placed on student

These behaviors are more likely to occur during the following activities:

Reading

Writing
The behaviors are more likely to occur with the following people (dont name other students):

Students who engage in similar behaviors

The behaviors are more likely triggered by the following events:

Being asked many questions during reading activities

The probable function of this behavior is: escape/avoidance of reading and writing activities.

Functional Assessment Checklist for Teachers and Staff (FACTS-Part A)

Step 1

Student/ Grade: Kindergarten___________________

Interviewer: Lili Carrasco

Step 2

Student Profile: Please identify at least three strengths or contributions the student brings to school.
He is friendly, assertive and shares with others. He is on-time to school and has not been absent.

Date: Nov 18, 2013__________________

Respondent(s): Collaborative Teachers__

Problem Behavior(s): Identify problem behaviors

Step 3
___ Tardy

___ Fight/physical Aggression

_X_ Disruptive

___ Theft

_X_ Unresponsive
_X_ Withdrawn

___ Inappropriate Language

___ Verbal Harassment

___ Insubordination
_X_ Work not done

___ Vandalism
___ Other ________________

___ Verbally Inappropriate

___ Self-injury
Describe problem behavior
The student will do whatever he thinks he needs to do to avoid the work he does
cycle in observable terms:
not want to do.

Baseline Data:
Graph at least one weeks worth of frequency, interval, duration, or latency data

Partial Interval Data: Off-Task Behavior

9/25/13

9/26/13

9/27/13

9/30/13

10/1/13

Step 4. Identify Setting Events

Identifying Routines: Where, When and With Whom Problem Behaviors are Most Likely.
Schedule
(Times)

Activity

8:00-8:10

Morning announcements

8:15-8:30

Journal (Independent)

8:30-9:00
9:00-9:15

Reading/ Story time

(Whole-group)
Word Work
(Independent)

9:15-10:00

Physical Education

10:05-10:50

Social Studies

10:50-11:20

Lunch

11:30-12:15

Computer Lab

12:25-1:10

Math

1:15-1:2:00

Science

2:00-2:30

Centers

2:30-3:00

Intervention

Likelihood of Problem Behavior

Low
1
2

High
6

Specific Problem Behavior

Student is talking when he
should be listening.
Student is talking to others
and/or walking around.
The student is off-task most
often during this time.
Student is talking to others
and/or walking around.

Select 1-3 Routines for further assessment: Select routines based on (a) similarity of activities (conditions)
with ratings of 4, 5 or 6 and (b) similarity of problem behavior(s). Complete the FACTS-Part B for each
routine identified.

March, Horner, Lewis-Palmer, Brown , Crone, Todd & Carr (2000)

4/24/00

Functional Assessment Checklist for Teachers & Staff (FACTS-Part B)

Step 1

Student/ Grade: Kindergarten___________________

Interviewer: Lili Carrasco

Step 2

Routine/Activities/Context: Which routine(only one) from the FACTS-Part A is assessed?

Routine/Activities/Context
Problem Behavior(s)
Reading- Whole group/individual responses
Student does not respond when asked questions.
Student will talk to others or play with objects.

Step 3

Provide more detail about the problem behavior(s):

Date: Nov 18, 2013__________________

Respondent(s): Collaborative Teachers__

What does the problem behavior(s) look like? The student is looking everywhere but the teacher. He plays
with things and/or talks to others.
How often does the problem behavior(s) occur? Frequently during whole-group reading.
How long does the problem behavior(s) last when it does occur? It could last a few seconds to the entire
reading session. It varies depending on who is sitting next to him, where he is sitting and what the story is
about.
What is the intensity/level of danger of the problem behavior(s)? The behavior is not dangerous but it is
disruptive at times. The teacher fears that he will not learn and may not advance.

Step 4

Step 5

What are the events that predict when the problem behavior(s) will occur? (Predictors)
Related Issues (setting events)
Environmental Features
___ illness
Other: seating (who is next
___ reprimand/correction ___ structured activity
___ drug use
to him or where he is seated) ___ physical demands
___ unstructured time
___ negative social
distractions in the class_____ ___ socially isolated
_X_ tasks too boring
___ conflict at home ______________________
_X_ with peers
_X_ activity too long
___ academic failure ______________________
___ Other
___ tasks too difficult
__________________
What consequences appear most likely to maintain the problem behavior(s)?
Things that are Obtained
Things Avoided or Escaped From
___ adult attention
Other: ________________
_X_ hard tasks
Other: ___________________
_X_ peer attention
______________________
___ reprimands
________________________
___ preferred activity ______________________
___ peer negatives ________________________
___ money/things
______________________
___ physical effort ________________________
___ adult attention ________________________
SUMMARY OF BEHAVIOR

Step 6

Identify the summary that will be used to build a plan of behavior support.
Setting Events & Predictors
Problem Behavior(s)
Maintaining Consequence(s)
Selecting interesting reading materials
Talking, playing with
Less work
Minimizing distractions
objects, staring at
Adjust seating
wall/floor/ceiling

Step 7

How confident are you that the Summary of Behavior is accurate?

Not very confident
1

Step 8

Very Confident
5

What current efforts have been used to control the problem behavior?
Strategies for preventing problem behavior
Strategies for responding to problem behavior
___ schedule change
Other: ________________
_X_ reprimand
Other: loss of free-choice____
_X_ seating change
______________________ ___ office referral _________________________
___ curriculum change ______________________ ___ detention
_________________________
March, Horner, Lewis-Palmer, Brown , Crone, Todd, & Carr (2000)

10

A-B-C Recording Form

Student: Kindergarten student

Observer: Lili Carrasco

Setting: Classroom

School: EPISD Elementary

Date:

Time Begin: 8:30 am

Oct. 22, 2013

A-Antecedent

B-Behavior

Time Ended: 9:00 am

C-Consequence

Reading time began- teacher asked

predictions

Stared at ceiling

Avoided giving a prediction

Asked about what story is about

Began to talk about something else Avoided answering question

Asked to underline sight word

Ignored request; played with

fingers and shoes

Did not stand

Asked question about story

Asked to use the bathroom

Went to the bathroom (avoided

answering question)

Asked if predictions were accurate

Faced wall

Avoided question

Another story was started

Lied down facing the floor (looked Avoided the story/questions

asleep)

11

A-B-C Recording Form

Student: Kindergarten student

Observer: Lili Carrasco

Setting: Classroom

School: EPISD Elementary

Date:

Time Begin: 8:30 am

Oct. 24, 2013

A-Antecedent

Time Ended: 9:00 am

B-Behavior

C-Consequence

Asked about predictions after

seeing book

Played with carpet

Avoided giving prediction

Asked about content of story

Played with another student

Avoided question

Story began about baseball

He paid attention and answered

questions

Received praise

Student: Kindergarten student

Observer: Lili Carrasco

Setting: Classroom

School: EPISD Elementary

Date:

Time Begin: 8:30 am

Oct. 28, 2013

A-Antecedent

Time Ended: 9:00 am

B-Behavior

C-Consequence

Story time began

He played with objects around him He avoided looking at teacher

He was asked for predictions

Was off-topic

Avoided giving prediction

Asked to underline sight word

Said, I dont know.

Avoided work

Asked follow-up question about

story

Began to speak to another student

Did not respond (avoided

question)

Asked to read words by lettersound

Grabbed another student

He was sent away from the group

Another story continued; he was

asked more questions

He ignored teacher

He avoided questions.

12

Summary of FBA
Student: Kindergarten student
Date: Nov. 7, 2013
Age: 5 years old
Grade: Kindergarten
School: EPISD
Teacher(s) Collaborative Classroom
Team members/role: Collaborative setting with General Education Teacher, Special
Education Teacher and Paraprofessional.
1. Operationally define the behavior(s) and/or behavior cycle:
The student will stare at the wall, stare at the ceiling, play with the carpet/objects/hands/others, talk to
others, stand up, move away from the group, grab other students and sing during group story/reading
activities. These behaviors occur most often when he is asked a question.

2. Provide behavioral observation data showing baseline levels (graphs of frequency,

interval, duration, etc.):
Baseline Data:

Partial Interval Data: Off-Task Behavior

9/25/13

9/26/13

9/27/13

9/30/13

10/1/13

13

3. Physiological and Medical Factors:

Mother suspects that student has Attention-Deficit/Hyperactivity Disorder.

Mother states student is a picky eater.
Mother reports students sometimes has problems going to sleep and waking up early.

4. Other outside events that may influence behaviors (family circumstances, etc.):

Mother informed that she and her husband are separated.

Students father is in the Army and is often deployed.

Student reported that his mother has a new boyfriend.

Students brother is diagnosed and treated for Attention-Deficit/Hyperactivity Disorder.

5. Antecedents (Setting Events): Include setting events in which the behavior frequently occurs and
those in which the behaviors infrequently occur:
Frequently
Infrequently
Reading Time
Physical Education
Writing
Science
Lunch
Music
Computer Lab
Centers and Free-Choice
6. Trigger antecedents: Include triggers that frequently occasion the behaviors and those that do
not occasion behaviors:
Triggers
Infrequently
Reading activities
Kinesthetic tasks
Writing activities
Games
Being asked to answer
Small-group and individual tasks
questions regarding story
7. Could the behavior be related to any skill deficits?
A skill deficit is a factor but not significantly. The student struggles at time with reading and
writing. However, he is able to perform at the level of his peers when he is given instruction
individually or in a small group.

8. Consequence Factors: What is the perceived function of the behavior(s)?

The function of the behavior is escape/avoidance of reading and writing activities. He
especially engages in the behavior when he is asked a question.
9. Hypothesis Statement: (If focusing on more than one behavior or behavior cycle, develop a
hypothesis statement for each):
The off-task behaviors (staring at the wall, staring at the ceiling, playing with carpet/objects/hands/others,
talking to others, standing up, moving away from the group, grabbing other students and singing during)
may be related to the following physiological and medical concerns: Attention-Deficit/Hyperactivity
Disorder.
These behaviors are most likely to occur during the following circumstances:

Whole-group reading and writing activities

In the morning

14

When many demands are placed on student

These behaviors are more likely to occur during the following activities:

Reading

Writing
The behaviors are more likely to occur with the following people (dont name other students):

Students who engage in similar behaviors

The behaviors are more likely triggered by the following events:

Being asked many questions during reading activities

The probable function of this behavior is: escape/avoidance of reading and writing activities.

15

Behavior Intervention Plan

Nov. 18, 2013
1. (a) Identify replacement behaviors: Identify behaviors that the student already exhibits
Verbal response to questions such as:
I dont know.
Ask me later.
I need help.
I need a break.
(b) Develop a lesson plan for teaching replacement behaviors:
1. The teacher will speak to student about appropriate behavior during reading activities.
2. The student will be informed of changes to expectations.
3. The teacher will model responses which student will demonstrate.
4. The student will be provided of behaviors which are not appropriate.
5. The teacher and student will role-play appropriate behavior prior to lesson.
6. The student will be provided with feedback and praise as suitable to the situation.
7. The student will be observed and will be provided with a visual cue informing of correct
or incorrect behavior (i.e., sad face/thumbs down visual for poor behavior; happy
face/thumbs up for appropriate behavior).
8. The student will be allowed to take a break during reading activities when he
demonstrates appropriate behavior.
2. Develop setting event interventions:
The student will be sat at the front and center of the group (close to the teacher).
The students who engage in similar inappropriate behaviors will sit away from this
student.
The teacher will use reading material which is interesting to the group.
The teacher will minimize or eliminate distractions in the classroom.
The teacher will use precorrection before activities.
3. Develop trigger antecedent interventions:
The student will be given choices when feasible and appropriate.
The level of difficulty of questions posed will be adjusted as needed.
The teacher will prepare the students for the type of questions which will be asked,
preparing the students for a response.
The teacher will ask questions which spark the students interest.
4. When student exhibits replacement behaviors, describe how consequences will support the
replacement behaviors. Describe the schedule of reinforcement.
When he answers a question appropriately, he will not be asked further questions for that
interval.
When student appropriately asks for a break, he will be granted one.

16

5. Describe how environment will be arranged so that it cannot continue to reinforce the problem
behavior:
The student will be seated next to students who will not encourage the behavior and who
will ignore the behavior.
Objects will be removed from students reach.
The teacher will not move on until he answers the question.
6. Develop Details and Routines for Implementation
Before each reading activity, the teacher will remind the student of all expectations and
consequences.
The teacher will practice appropriate behaviors with student during free time if he does
not appropriately display them during lessons.
The consequences will be implemented consistently to include substitutes in the
classroom.
Expectations will become more intense in nature as student accomplishes simpler
behaviors. For example, any response will be accepted at first but later the student will
have to answer questions correctly.
7. Develop Charts, Contracts, Visuals

The following pictures were used to show when he was behaving appropriately (thumbs up,
happy face) and when he is not (thumbs down, sad face).

17

Visual reminders:

8. Develop System for Monitoring Progress

The following charts may be used to track behaviors throughout the day.

18

Behavior Chart
Mon
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45

to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to

Tue

Wed Thur

Fri

8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00

19

BUILD A COMPETING BEHAVIOR PATHWAY

Consequence:

Desired
Behavior:

Pay attention and

answer questions
appropriately

Setting
Event:
Whole-group
story and
reading time

Antecedent:
Being asked
question

Problem Behavior:
Off-task
Disruptive class

Learn
Praise
Good report card
Sense of
accomplishment

Consequence:
Teacher asks
another student a
question

Function:
Avoid
work

Alternative
Behavior:

Setting Event Strategies

Antecedent Strategies

The student will be sat at

the front and center of the
group (close to the
teacher).

The student will be given

choices when feasible and
appropriate.

The students who engage

in similar inappropriate
behaviors will sit away
from this student.

The level of difficulty of

questions posed will be
adjusted as needed.

The teacher will use

reading material which is
interesting to the group.

The teacher will prepare the

students for the type of
questions which will be
asked, preparing the
students for a response.

The teacher will minimize

or eliminate distractions
in the classroom.

The teacher will ask

questions which spark the
students interest

The teacher will use

precorrection before
activities.

Any response
No disruptive
behavior

Behavior Teaching Strategies

Consequence Strategies

The teacher will speak to

student about appropriate
behavior during reading
activities.

When he answers a question

appropriately, he will not be
asked further questions for
that interval.

The student will be informed of

changes to expectations.

When student appropriately

asks for a break, he will be
granted one.

The teacher will model

responses which student will
demonstrate.
The student will be provided of
behaviors which are not
appropriate.
The teacher and student will
role-play appropriate behavior
prior to lesson.
The student will be provided
with feedback and praise as
suitable to the situation.

20

The student will be observed

and will be provided with a
visual cue informing of correct
or incorrect behavior (i.e., sad
face/thumbs down visual for
poor behavior; happy
face/thumbs up for appropriate
behavior).
The student will be allowed to
take a break during reading
activities when he demonstrates
appropriate behavior

21

Interval Data: Off-Task Behavior

9/25

9/26

9/27

9/30 10/1

11/19

11/20 11/21 11/22

12/3

12/4

12/5

12/6

22