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TemplateforFunctionalBehavioralAssessmentsFBA-1

The FBA Worksheet is designed to gather indirect and direct data on a target behavior through records review, behavior interviews, and a routines inventory. It includes sections for assessing the context, antecedents, and consequences of the behavior, as well as a motivational assessment scale. The goal is to create a hypothesis regarding the perceived function of the behavior to inform interventions.

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allisonj
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3 views

TemplateforFunctionalBehavioralAssessmentsFBA-1

The FBA Worksheet is designed to gather indirect and direct data on a target behavior through records review, behavior interviews, and a routines inventory. It includes sections for assessing the context, antecedents, and consequences of the behavior, as well as a motivational assessment scale. The goal is to create a hypothesis regarding the perceived function of the behavior to inform interventions.

Uploaded by

allisonj
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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FBA Worksheet

Target Behavior 1: ____________________________________

Indirect Data Gathered

Records Review:

• Current schedule and routines


• Any recent changes
• Relevant health or medical information
• Attendance history
• When was the last time student did not demonstrate significant challenging
behavior?
• Previous interventions
• Have any strategies been effective in preventing the challenging behavior?
• Strengths
• Possible reinforcers – what is the student interested in?
• Previous testing
• Grades
• Services receiving
• Family involvement or family needs

Behavior Interviews:

Teacher:

• Description of behavior (What does it look like?)


• Academic Information (Does the student appear frustrated when presented with
instructional tasks?)
• Identify events that may affect the behavior (Are there any setting events or conditions
that affect the behavior? (e.g., medication, illnesses, diet, etc.)?
• Identify events that may precede (or trigger) the behavior (Settings and times, who is
present when it occurs?)
• Identify events that may follow (or maintain) the behavior (What is the typical result
of the behavior?)
• Identifying the function of behavior (In your opinion, why do you think the behavior is
occurring? What is the student trying to communicate to you?)
• Identify preferences (what does the student enjoy at school?)
• Identify strengths (what are strengths of the students?)
Caregiver:

• Describe the behavior when it occurs in environments outside of school (What


does it look like?)
• Response the student gets from the behavior (What do they get or get away
from?)
• Reinforcement used with the student (What does the student really like?)
• Identify the function of the behavior (In your opinion what may be reason the
behavior occurs? What is the child trying to communicate to you?)

Routines Inventory

Schedule (Time) Activity Likelihood of Specific Problem


Problem Behavior Behavior
(1=low, 6=high)
1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

Motivational Assessment Scale (MAS)

Person Completing Highest Scored Second Highest Third Highest Score


MAST Score
Direct Data

ABC Data (See video for instruction) https://youtu.be/jAoBpEzL6Eo

Data was collected by staff from __________________ school for _________ days (date range)
on the identified behaviors. A total of _______ behavior events were recorded. The charts
below are summaries of the information collected on the daily ABC data sheets.

Behavior #1- __________ Total number of occurrences ________

Context/Activity Number of times

Antecedents/Setting Events Number of times


Person/Staff Member Number of times

Consequences Number of times Number of times


stopped behavior

TRIANGULATE THE DATA

Source 1 Source 2 Source 3


Summary: Summary: Summary:
CREATE THE HYPOTHESIS

Perceived Function:

____________ Gain/Obtain _____________ Or __________ Escape/Avoid


_____________

Example: When this occurs……….(describe circumstances/antecedents), the student


does……..(describe target behavior) to get/to avoid……………(describe consequences).

Hypothesis: When _________________________________, the student does


____________________________ in order to ________________________________.

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