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SAT/RtI Team Student Name:____________________________

Date: ______________________

FUNCTIONAL BEHAVIOR ASSESSMENT CHECKLIST ____Review of school records AND ____available outside agency professional records ____Systematic, direct observations of student across school settings ____Interviews with the ____student AND ____parent/caregiver AND ____teachers AND ____other appropriate school personnel AND ____appropriate community service providers ____Completion and review of behavior rating scales and/or other assessment tools ____Target behavior is operationally defined in specific, observable, and measureable terms ____Information is collected across respondents AND ____settings ____Collected information allows determination of patterns of ____frequency AND ____duration AND ____intensity ____Antecedent events that serve as a stimulus for the target behavior are identified and described ____Consequences that follow and maintain the target behavior are identified and described ____Function or purpose of the target behavior is identified ____Reinforcers are identified ____Hypothesis is generated about the relationship between the target behavior, antecedents and consequences, AND ____specific variables to be manipulated are identified ____Intervention is developed based upon hypothesis ____Acceptable replacement behaviors are identified ____Alternative skills needed for replacement behavior are identified ____Determination is made whether student has alternative skills in his/her behavior repertoire and if not, which skills must be taught


SAT/RtI Team Student Name:____________________________

Date: ______________________

BEHAVIOR INTERVENTION PLAN CHECKLIST ____Functional behavior assessment was conducted prior to plan development ____Target behavior is operationally defined AND ____Measureable AND ____Observable ____Target behavior description includes measures of frequency AND ____duration AND ____intensity ____Proactive strategies such as setting/antecedent changes are included ____Proactive strategies outnumber reactive strategies by a ratio of at least 3 to 1 ____Reactive strategies specify consequences to be delivered following occurrence of target behavior ____Plan includes alternative skills to be taught ____Plan identifies who will teach alternative skills ____Replacement behaviors are included in plan ____Reactive strategies specify consequences for replacement behaviors/demonstration of alternative skills ____Consequences include types and schedules of reinforcers for alternative/replacement behaviors ____Crisis intervention plan is included, if appropriate ____Crisis plan identifies crisis team AND ____Communication system AND ____Specific de-escalation/reduction procedures to be used AND ____Sequence of emergency contacts AND ____Documentation of emergency contacts ____Plan evaluation includes provisions for monitoring reduction of target behaviors AND ____Increases in alternative skills AND ____Criteria for successful reduction of target behaviors AND ____Criteria for meaningful increases in replacement behaviors


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