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Appendix A

Functional Assessment/Behavioral Intervention Checklist

IEP teams can use this checklist to guide them through the process of conducting a functional behavioral assessment and writing and implementing a positive behavioral intervention plan.

Student: _______________________________________ Date: __________________________

Team leader: __________________________________ Grade: __________________________

Behavior(s) of concern: __________________________________________________________

_________________________________________________________________________________

 

Yes

No

 
   
1. Is the student behavior of concern clearly defined?
   
2. Have replacement behaviors that serve the same function (or result in the same outcome) for the student been identified, along with the circumstances under which they should occur (e.g., when threatened by peer in hallway)?
   
3. Are multiple sources of information available that have been collected from various individuals (e.g., teachers, parents, classmates, student)? At least two separate indirect measures and multiple direct measures (e.g., ABC charts, scatterplots) that capture multiple occurrences/non-occurrences of the behavior (and its context) should be in agreement.
   
4. Has the team produced an acceptable convergent database?
   
5. Is the hypothesis statement written according to the three-term contingency (i.e., under x conditions, the student does y, in order to achieve z) so that an intervention plan can easily be produced?
   
6. Is the plan aligned with student needs and assessment results?
   
7. Does the plan address all aspects of the social/environmental contexts in which the behavior of concern has occurred?
   
8. Is there a strategy to verify the accuracy of the hypothesis statement (e.g., analogue assessment)?
   
9. Does the plan address both short-term and long-term aspects of student behavior (and its social/environmental context), including procedures to eliminate reliance on unacceptable behavior?
   
10. Does the plan include practical ways to monitor both its implementation (e.g., checklist, treatment scripts) and its effectiveness as a behavioral intervention plan?
   
11. Does the plan include ways to promote the maintenance and generalization of positive behavior changes in student behavior (e.g., self-monitoring)?
   
12. Is the plan consistent with building-level systems of student behavior change and support?

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