Muskegon Area ISD - Functional Assessment/Behavior Intervention Form

Muskegon Area ISD Functional Assessment/Behavior Intervention Form
General Information
Student: School: Kurt Birthdate: 4/2/2004 Medication: Previous Funct Assess? Eligibility Status: Yes No When: Date:
Caseload Teacher:
I. Student Strengths, Skills, and Difficulties

List Student Strengths and Skills: * Considerate and helpful (When confident) to other students who are struggling. *Musicaly talented -> String instruments. *Realtionship oriented. List Student Difficulties: *lacks confidence and skill level. * struggles to verbally respect teacher and peers. *frequently produces disruptive loud noises. * Has difficulty expressing approriate interaction with peers. These include physical and verbal interactions. Duration 5 sec -2 min 3-5 min 2-3 per month 1-5 min High Intensity High Mild Problem has E x i s t e d (l e n g t h o f ti m e ) 3 times per week
II. Behavior(s) of Concern

Description - Observable/Measurable
1.) Verbal - Student says, "oh my god"," Jesus Christ, this is bogus" and/or makes repetitive loud noises during instructional times and when he is redirected. Kurt has disrespectful verbal outbursts when challenged academically during structured and unstructured times to avoid task. At times, when presented an undesired task, Kurt will manipulate the situation by having verbal outbursts or shutting down (hood over head, stops talking, failure to make eye contact) to avoid the activity or seek an adult/peer's attention. 2.)Nonverbal (i.e. physical) Disrespect Toward Adults - Kurt rolls his eyes, walks away, stares deliberately away from the speaker, slits his eyes, and/or plugs his ears with his fingers toward adults. 3.) Inappropriate Interactions with Peers - Kurt slaps peers, calls them names (e.g., the b-word), makes profane gestures that are sexual or body-function related, and/or touches other students in a pseudo sexual manner. He also makes negative comments about other student to decrease their status and increase his own. 4.) Other Occurances - Frequently late to school. Kurt is very disorganized and is easily influenced by negative peers and initiates/joins in on negative behaviors (i.e. talking back to teachers, name calling, refusing to follow directions, mumbling under breath "that's bogus!" Is this behavior addressed in the School Handbook? Y N How Often 10 times/ph 7 times /ph
III. Environmental Issues and Situational Variables

What triggers or causes the behavior? What happens before the behavior?
The behavior occurs when Kurt is frustrated by his teachers or peers. The behavior usually occurs when Kurt does not want to accept a consequence,when he is corrected, and is told to do a non perfered activity. Kurt is very sensitive to the facial cues of his peers. He can interpret staring and certain facial expressions to be threatening or teasing. All of these activities can trigger a reation from Kurt.
What happens immediately after the problem behavior occurs?

After an inappropriate interaction Kurt recieves . . . *redirection *Loss of points on a behavior chart *Attention from adults and peers *the opportinity to repeat the activity without the neagative behavior. *Removal from classroom *Administrative intervention (About two times per week)
(student reactions, staff reactions, environmental changes)
In what settings/situations is the behavior of concern most and least likely to occur? Settings/Situations Most Likely Least Likely Adults? Peers?
(personality characteristics, teaching style, gender, disciplinary style, etc., no names) (personality characteristics, gender, etc., no names) Occurs most likely when adults are present. When adults help Kurt see the consequences of his actions or when Kurt is being redirected on a task. Occurs most likely when peers are present. Peer who he percieves to be acting inapropriately toward him (e.g. eye rolling, staring.) When Kurt is being excluded from an When Kurt feels connected with his teacher and can manage the work load. Least likely to occur when peers are not around and when Kurt feels like he is a part of the group. If Kurt percieves more postive interactions with peers.
activity with peers.
Certain Activities? Settings?
(independent work, lecture, writing activities, small group) (playground, math, science, lunch, school bus, unstructured time) Time of Day or Class (morning, end of class, afternoon) Other? (home issues, bus, medication, health, sleep, etc.) Class Discussions Assemblies Check Sheet Social Work Support Behavioral Support Contracts Other Behavior Chart
Any academic work that he does not feel confident with his own skills or in group activities. Instruction times/classroom, bathroom, playgroud, hallway, and lunch Occurs sporatically across the day When home is chaotic and unstructured 1-1 Discussions Handbooks Other Conflict Resolution Anger Management
In activities were he has a strong skill set. Specials such as art and gym. Times when Kurt is alone and not in the presence of other adults and peers When home is more stable and consistent Check One or More and List How Often Behavior Plan Posted Classroom Rules
IV. Childs Exposure to Rules Governing This Behavior
V. Previous Interventions and Supports
Check One or More and Indicate Frequency Peer Mediation Staff/Student Awareness Regarding BIP
VI. Previous Consequences and Disciplinary Measures

Time Out Loss of Privilege Parental Notification Other Referred to Office In-School Suspension/Suspension Behavior Ignored
Check One or More and Indicate Frequency of Use Detention Work Detail/Restitution Reprimand/Warning *Attached Documentation
VII. Needs Being Met Through This Behavior

Escape/Avoidance Sensory Stimulation Relief of Fear/Anxiety Stress Ball Attention Power/Control Other Counting/Breathing Technique
Check One or More and Explain Expression of Anger/Frustration Tangible
VIII. Goal to Appropriately Address Need(s)

Goal: Kurt will use appropriate strategies such as using a stress ball, to deal with frustration in 3/5 situations. Kurt will use age appropriate language in conversations with peers in 3/5 situations.
IX. Preferred Activities and Reinforcers

List preferred activities: (1) Helping others, (2) Playing his instrament, (3) Interactions with adults and small groups of studnets List preferred reinforcers: Kurt responds well to verbal praise. He wants to feel included in his classroom and needs to feel welcomed by his teacher and peers. Positive reinforcement increase his participation in class and decreases his inappropriate behavior.
X. Skills Needed to be Taught to Replace Behavior of Concern

What Behaviors Do You Want the Student to Engage in to Replace the Behavior? Stress management skills will be taught to Kurt for coping with stress. Kurt will be taught to use a stress ball when he feels frustrated. He will be taught the counting technique where he will be asked to count silently up to the number 10 when he feels stressed. Social skills will be taught to Kurt for improving appropriate peer interactions. Finally, Kurt will be taught how to interact with small groups of students. Kurt will be taught intra-personal skills to cope with inner emotions and stress.
XI. Behavior Plan Preventative Strategies

Classroom Accommodations, Approach Strategies, Seating Arrangements, Instructional Strategies, etc.
Reinforcement Strategies
Methods of Teaching and Reinforcing Appropriate/Replacement Skills
Procedures to Follow When Behavior Occurs

Specific Steps to Take When Behavior Occurs
* Breaks for all students. 1-2 minutes of time. *Schedule on his desk or posted somewhere for him to have points of reference. *Seat student next to teacher or within a close proximity. Find peers who he can interact approriately with. * Letting him know ahead of time when things might be changing. *Student will write down any questions that need extra explaining by the
* Praise "liked how you used your stress ball today". * Prompt to look at scheduel. * Thumbs up or a non-verbal signal of affirmation where he will not feel singled out. * Give student private time to practive and lean intrapersonal management skills. *Teacher and student will reflect on inappropriate behaviors and discuss solutions to the problem.
1.) Prompt student to use stress ball. 2.) Give K the opportunity for a break and separation from others. 3.) Talk independently with student 4.) Send a note to parents and parents of other students who are involved. 5.) Parent, teacher, and student confrerences. Crisis: 5.) Remove other students from his way and try to effectively restrain and selcude the student.
teacher.
6). Teacher, parent, and student conferences.

Deviation of School Handbook? Yes No
XII. Data Collection

Describe how systematic/measurable data will be collected for Behavior Plan:
We would like to use a log to record K's behaviors in class. Special attention should be paid to the frequency of incidents. Progress should be noted as well as any reinforcement strategies that seem to work.
Attach Sample Data Sheet will inform the following staff of BIP:
Signatures below indicate the plan has been reviewed and agreed upon for implementation:
Parent/Guardian Social Worker/Psychologist Student Other Date(s) plan reviewed:

*Attachments may include point sheets, contracts, token cards, progress notes, referrals, parent contacts.
Teacher Special Education Teacher Administrator Other Date plan terminated:

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Muskegon Area ISD Functional Assessment/Behavior Intervention Form

I. Student Strengths, Skills, and Difficulties

II. Behavior(s) of Concern

III. Environmental Issues and Situational Variables

What happens immediately after the problem behavior occurs?

(student reactions, staff reactions, environmental changes)

activity with peers.

Certain Activities? Settings?

IV. Childs Exposure to Rules Governing This Behavior

V. Previous Interventions and Supports

VI. Previous Consequences and Disciplinary Measures

VII. Needs Being Met Through This Behavior

Check One or More and Explain Expression of Anger/Frustration Tangible

VIII. Goal to Appropriately Address Need(s)

IX. Preferred Activities and Reinforcers

X. Skills Needed to be Taught to Replace Behavior of Concern

XI. Behavior Plan Preventative Strategies

Procedures to Follow When Behavior Occurs

6). Teacher, parent, and student conferences.

XII. Data Collection

Parent/Guardian Social Worker/Psychologist Student Other Date(s) plan reviewed:

Teacher Special Education Teacher Administrator Other Date plan terminated:

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