INDIVIDUAL STUDENT FBA / BIP TEMPLATE

FUNCTIONAL BEHAVIOR ASSESSMENT / BEHAVIOR INTERVENTION PLAN

Student Name: Steven Murgth Referred by: Ms. Santin, AP Date: 2/13/2013

The Competing Behavior Pathway

Student Strengths: Body control, quietly sitting Work completion, positive praise,
He is very bright, he has the ability to do the in designated area, following etc
tasks, he participates verbally directions, completing work,
Can be helpful and friendly using appropriate tone of
voice

5 Desired Behavior Current Consequence

Hypothesis Statement
Classroom When asked to Making noises
(pounding on things, Attention – adult
instruction/lesson complete work – with mouth, with Redirect him, 1:1
paper/pencil, group objects), moving arms counseling, sent to
work around, touching things, recovery Avoidance - work
constant movement

Trigger/Antecedent WeProblem
would Behavior(s)
like to see Function
2
Setting Event Steven use body control,
not make noises, be on Maintaining Consequence
task, follow directions,
and use an appropriate
voice 50% of the time

Replacement Behavior

List all team members involved in building the intervention plan:

_______________________________________________________________________________________________________
1. Brainstorm possible elements of behavior support [Make problem behavior irrelevant, inefficient and ineffective]
2. Select strategies that are contextually appropriate for final plan and list them below. Try to have one or more strategies
for each section. Multiple stakeholders should share in implementing the strategies (i.e. not just the classroom teacher).
Teaching/Instructional
Setting Event Strategies Antecedent Strategies Consequence Strategies
Strategies
Steven participates in a SAIG When he is causing a problem
Before entering the classroom group working on classroom in the classroom, he will be
Steven is escorted on a quick Remind student of survival skills (body control, sent to recovery 230 or 232.
walk around the building by expectations of work time and not making noises, being on When he is asked to go to
safety aide Mr. Frank. Mr. ensure Steven has all task, following directions, and recovery, he refuses and
Frank talks to Steven and appropriate materials and is using appropriate ). He needs to be escorted by
make a connection and also ready to work. participates 1x per week administration/safety.
walks with Steven to allow starting 2/12/2013.
Steven to release some energy Offer Steven time to relax and Steven will be acknowledged
and stress before entering the compose himself before Steven will have a specialized verbally and with a Cougar
classroom. working (walking to back of behavior form where he can Ticket when he is engaged
room, getting a drink of earn points for demonstrating appropriately in the lesson.
water, talking to a friend or the behaviors listed
teacher for 3 minutes before
working)

Page 1
IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 Background Information:

Steven goes to his father’s house after school. He stays overnight there some days. Other days his
mother comes to pick him up after she is done with work between 5-7 pm.

Mom has scheduled a therapy appointment on March 1. She signed consent for the school to be able to
talk with the therapist. Mom has also talked with her pediatrician about Steven being tired. Mom reports
that he has an appointment on 2/19 to be seen by a doctor to discuss the possibility of sleep apnea.

Information provided by the teacher:

Steven is a bright boy but he is not showing his potential in the classroom. He is not completing his
work. He has a difficult time controlling his body, being respectful during instruction (making noises
with his mouth, tapping, etc), following directions, and using an appropriate voice.

If he earns 50% of his specialized CICO form, he can pick a reward off of reward menu

Earn a reward at home.

Behavior Intervention Plan Specifics

1. Strategies to prevent problem behavior from occurring

a. Modifications to setting event

b. Modifications to trigger/antecedent

2. Strategies to teach new behaviors

a. Teach the replacement behavior

Steven is participating in a Small Academic Instructional Group once a week to practice the
replacement behaviors in a small group setting.

b. Teach the desired behavior

Steven is participating in a Small Academic Instructional Group once a week to practice the
replacement behaviors in a small group setting.

IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 3. Strategies to reinforce appropriate (replacement and desired) behavior

a. Steps to reward during initial instruction and skill building (what you will do now)

At school: Steven can earn a reward off a reward menu when he is able to earn 50% of the points on
his daily behavior chart.

b. Steps to reward appropriate behavior over time to maintain new skills

At school: We hope that Steven will be able to reach this goal and with the success we can increase
the amount of points he needs to earn to earn a reward.

4. Steps to minimize rewards for problem behavior

When Steven is disrupting the learning environment, he will be sent to recovery in room 230 or 232. He
will need an escort to make sure he gets their safely.

5. Disciplinary consequences for problem behavior, if needed / appropriate:

We will continue to follow the district’s policy regarding behavior infractions.

6. Safety procedures/Crisis Plan (if needed): Steps to ensure the safety of all in a dangerous situation

When steven is feeling stressed or that he is going to have a bad incident he should grab his green “Go
card” and walk out of the classroom and go to the main security desk. Once there someone will find Mr.
Frank who will take Steven on a walk throughout the building and see what he needs to calm himself
and return to the classroom. Mr. Frank will return him to the classroom and inform the classroom
teacher of the situation.

IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 Page 2

Practices for Implementation

1. Target date to begin implementation:

Tuesday February 18, 2013

2. Getting the intervention plan started (what materials/resources are needed? what training is
needed?):

Mrs. Carpenter will create the behavior plan and have Mrs. B look it over to approve it.

Mrs. B will go over the plan with Mrs. K and Steven. Mrs. B will talk with Mr. D regarding the
reward menu as he was included on some of the rewards that were used in the past.

Mrs. Carpenter will have a conference with Ms. B who needed to leave early from the meeting and
with Mr. M who did not attend.

3. Process for communicating and partnering with other district/school stakeholders and team members
(who, what, when):

Those that work with Steven will receive a copy of his plan

4. Process for communicating and partnering with families, community members and stakeholders
(who, what, when):

The daily note will be sent home daily for the parents to review and also complete regarding his
behavior at home.

IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 5. Others who need to be informed (Who else might intervention impact?):

N/A

6. Plan for notifying substitutes of intervention:

A copy of the plan should be placed in the sub folder

Page 3

Evaluation, Review and Adaptation

1. How will we know if the plan is being implemented? (What information will be collected, by whom, how
summarized, and when reviewed?)

We will have completed behavior sheets and/or log of the points earned each day.

2. How will we know if the plan is being successful? (What student outcomes will be monitored, by whom, how
summarized, and when reviewed?)

We will see Steven meet his goal of earning 50% of the points and we will be able to increase his goal. We will also see
a decrease in office incident referrals and suspensions.

*Only report on relevant items below Baseline data: 2nd reporting 3rd reporting 4th reporting
period: period: period:

% Daily Progress Report points (DPR) for 11/29/12 – 1/29/13 2/12/13 – 5/3/13 5/4/13-6/10/13
period 7/24 18/33 7/18
29% 55% 39%

Office Discipline Referrals (ODRs) (total # 8 3 4

for period)
Suspensions (total # of ISS & OSS for 1 suspension 1 in house 2 suspensions
period) 3 in house suspension
1 pending 1 suspension

86% 89% 83%

% Attendance for period 7 excused, 7 6 additional 2 additional
unexcused absences absences
2 suspensions
6 5 1
Tardies (total # for period)
Math – MAP MAP: N/A
Grades/literacy scores Fall 153 Math:
Winter – 175 Spring – 184
IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 Reading – Map Reading
Fall- 155 Spring - 181
Winter - 163
Other:

a) Target goal for use of replacement behavior (i.e. 70% DPR points & no further ODRs):

We would like to see Steven earn 50% of his points at least 80% of the time. No more than 4
office incident referrals.

Follow Up Meeting: Tuesday May 6, 2013 at 2:00 pm

Participants:

Positives: There have been times when Steven has had a couple good days in a row. He is sleeping less
in class. He is on level academically.

Academically: Steven has not taken the spring MAP assessment yet. When Steven is interested in a
subject, he will complete. If he doesn’t want to complete work, he won’t do it. He is on level
academically and is capable of grade level work, but doesn’t always show it in his work because he
rushes through it. Steven has a difficult time, receiving redirection and/or corrections. The afternoons
are a little more difficult.

SAIG: (listening skills, accepting consequences, ignoring distractions) Steven participated in SAIG.
When in a small group (with three other children), he did not like feedback or redirection. He would
sometimes shut down. Mrs. R was also concerned about impulsive control and restlessness.

Medical Updates: Steven had a sleep study completed on April 25th, 2013 to test for sleep apnea. She is
waiting for the results from the sleep study. Mrs. B reports that more recently, Steven has not been
falling asleep during class. Steven’s next therapy appointment is May 28, 2013 at 9:00 am. He has been
seen one other time by the therapist. Steven’s afternoon routine is the same; he goes to Dad’s house after
school and then his mother picks him up after she is done with work. Steven is completing homework
inconsistently.

Home/School Connection: We will continue the behavior chart that was implemented in February. To
try to increase Steven meeting his goal, he will be able to earn Chuckee Cheese tokens at home with his
mother. When he earns between28-41 points he will get 2 token and if he earns 42 points or more he
will earn 4 tokens. That gives him the possibility of earning 100 tokens by the end of the school year for
IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network
 his birthday. At school he earns computer time, time in room 114, time with Mr. D when he meets his
goal.

Data Review 6/10/13

Steven met his specialized CICO goal of 50% of his points 38% of the time. He received two
suspensions during the intervention period.

IL-PBIS Network 2009. Adapted from R. Horner March, 2008, C. Anderson, July 2007 from Todd, Horner, Sugai, & Colvin, 1999, Educational and Community Supports. University of Oregon, Revised 11.09 Buffalo Public Schools
FBA/BIP Template Rev. 09.6.11, Illinois PBIS Network