Jamie+Holly+FBA+Form (1)

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Diana Browning Wright, M.S., L.E.P. with contributions from Sioux City Iowa Schools Page 1 of 5 Functional Behavioral Assessment Assignment Jamie Holly EDUU-602 Professor Nicholson February 12, 2023

Diana Browning Wright, M.S., L.E.P. with contributions from Sioux City Iowa Schools Page 2 of 5 F UNCTIONAL B EHAVIOR A SSESSMENT R EPORT An FBA is an analytical process based on observations, review of records, interviews, and data analysis to determine the function the behavior serves for the student, how that function can be met more appropriately, and how the environment can be altered to better support general positive behaviors. Date of Report : 2/5/2023 Date(s) of FBA Data Collection : 1/19/2023, 1/20/2023, 1/25/2023, 1/26/2023, 1/27/2023, 1/30/2023, 1/31/2023, 2/1/2023, 2/2/2023, and 2/3/2023 SECTION 1: Student Information Student Name : Sassy Sarah ☐ Male ☐ Female Last (legal) First (no nicknames) M.I. Birthdate : 5/19/2009 Grade : 7 th Resident District : Holly Unified District School of attendance : Holly Middle School SECTION 2: Parent/Guardian Contact Information ☐ Parent Name : Theresa Silver Home Phone : ( 510) 123-4567 ☐ Foster Parent Address : 1234 G street Work Phone : ( ) - ☐ Guardian City/State : Fremont, California Cell Phone : ( ) - ☐ Surrogate Zip : 94536 E-mail : TheresaSilver@1234.com ☐ Student SECTION 3: Behavior Analysis 1. Behavior(s) of concern When presented with structured academic tasks, Sarah engages in inappropriate language which consists of the use of profanity on the school campus and/or threatening a peer with physical harm. As a result, her behavior creates a safety issue for herself and her peers, causes disturbance in the classroom environment, and takes time away from instructional periods. 2. Frequency, Intensity, and/or Duration of current behavior : During the ten school days between January 19 - February 3, 2023, the student displayed the behavior of interest (delivery of a verbal message that is not suitable or appropriate for school including verbal threats) throughout the entire day during transitions, task demands, low preference activities and denied access to preferred activity or person. Sarah was suspended on January 20, 2023 and was not on campus on January 23 rd and 24 th . When looking at the frequency line graph, and event recording data, it was observed that the student did not go a day without showing behavior of interest. As observed above, the behavior was most apparent during the core enrichment (Math, Science, History, and English Language Arts).

Diana Browning Wright, M.S., L.E.P. with contributions from Sioux City Iowa Schools Page 3 of 5 It has become apparent from reviewing the student ’ s teacher interview that the student’s behavior is not only disrupting the teacher, but also her class environment; therefore, instruction has been hard. Both the student and her peers ’ academics are being affected by this behavior of interest. The two permanent products that were provided data of assertive discipline, discipline, and interventions. Since Sarah has arrived to Hope Middle School on August 11, 2022, she has five assertive disciplines are two fighting, two caused or attempted to cause physical injury and one class disturbance. The five disciplines are two minors- inappropriate language, two minors-disrespect behavior and one minor - property misuse. 3. Analysis of this behavior was based on : ☐ Interviews with Mainstream science teacher Mr. Stafford, Ms. Antsy, and Ms. Melody ☐ Student observation(s) on event recordings on January 19, 2023, January 20, 2023, January 25, 2023, January 26, 2023, January 27, 2023, January 30, 2023, January 31, 2023, February 2, 2023, February 3, 2023, ☐ Review of records, consisting of: ☐ health ☐ discipline ☐ other: ☐ Environmental analysis for supportive and unsupportive variables on ______ Summary of Interview, Observation, Record Review, and Environmental Analysis : 4. Is the behavior impeding the learning of the student or peers? ☐ Yes ☐ No If yes, please describe : Sarah ’ s behavior creates a safety issue for herself and her peers, causes disturbances in the classroom environment, and takes away from instructional periods. 5. Have Tier II Strategies or other Interventions been tried? (e.g., school/home notes, behavior contracts, self- monitoring) ☐ Yes ☐ No Describe previously selected intervention : 6. Result of selected Tier II or other Positive Behavior Interventions and Strategies: 7. Is a behavior intervention plan recommended? ☐ Yes ☐ No Rationale: Sarah struggles to complete work to the best of her ability because she shuts down and does not want to do the work or wants to leave the environment. She also tends to react inappropriately when faced with a problem or a conflict. She will sometimes engage in vocal outbursts or make comments that are inappropriate for the setting. 8. Environmental Factors : ● What are the reported and observed predictors for the current behavior(s)? Transition, Task demand, low preference activity, and denied access to preferred activity or person. ● What supports the student using the current problem behavior(s): a summary based on the environmental assessment portion of this assessment : (e.g., what is in the environment that should be eliminated or reduced? What is not in the environment that should be added?)

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Diana Browning Wright, M.S., L.E.P. with contributions from Sioux City Iowa Schools Page 4 of 5 Sarah receives attention/verbal redirection from adults, avoids/delays non-preferred tasks, accesses preferred items/activities, and gains positive or negative attention from peers. Some environmental changes, structure and supports needed to remove the student ’ s need to use the behavior are antecedent-based interventions, “ First-then ” when presenting non-preferred tasks, daily behavior chart, frequent opportunities for movement and verbal check in ’ s. 9. Functional Factors : ● Hypothesis of function (purpose) of this behavior for this student based on data collected in Section 3. When Sarah is presented with structured academic tasks, Sarah engages in inappropriate language which consists of the use of profanity on the school campus and/or threatening a peer with physical harm because she wants to avoid or escape structured academic tasks. ● Suggested functionally equivalent replacement behavior : Instead of engaging in escape-maintained behaviors (elopement, inappropriate language), Sarah should utilize a communication system (visual or verbal) to appropriately request a break from an aversive task or situation. During instructional periods, breaks can be taken inside or outside of the classroom. Instead of engaging in attention- maintained behaviors (physical aggression and stealing, Sarah should communicate with a trusted adult (counselor, teacher, site safety) about an aversive situation. Instead of engaging in Access maintained behaviors (physical aggression, inappropriate language, stealing) Sarah should utilize her daily behavior chart to self-monitor expected behaviors (with the assistance of an adult) to gain access to preferred items and activities. SECTION 4: Conclusion/Recommendation 1. Conclusions : (Recommendations for IEP, 504, or school team consideration) The recommendations are Behavior Intervention Plan, curriculum accommodations or modifications addressed in IEP, environmental supports/changes necessary, and teaching of new replacement behavior and reinforcement. 2. Estimate of need for behavior intervention : ☐ Extreme ☐ Serious ☐ Moderate ☐ Needs attention, early-stage intervention ☐ Monitor behavior only; no formal behavior intervention plan is recommended at this time 3. If a Behavior Intervention Plan is NOT now recommended: ☐ Behavior goals to be developed by: and contained in: ☐ Consider Tier II interventions, or other interventions, such as ☐ Consider assistance to student’s teacher to enhance environmental/student ☐ Consider other Tier III interventions, such as district provided Cognitive Behavioral Therapy as a Related Service to address emotionally driven behavior ☐ Consider WrapAround or Multiagency teaming Commented [1]: for our purposes you would not mark any of these boxes but if you are doing a "real" FBA you may.

Diana Browning Wright, M.S., L.E.P. with contributions from Sioux City Iowa Schools Page 5 of 5 Rationale for selection of an alternate approach : 4. This team has determined that if a behavior plan is NOT to be developed as a result of this assessment, a functional behavioral assessment will be considered again if: ☐ data demonstrates the problem behavior intensity, duration or frequency escalates or continues at current rate or ☐ data demonstrates non-responsiveness to selected other approaches Describe: 5. This student has : ☐ a current IEP ☐ a current 504 Plan ☐ neither 6. Goals to monitor future behavior will be added to : ☐ a new or amended IEP ☐ a new or amended 504 Plan ☐ a school team’s plan (no IEP or 504 Plan) SECTION 5: Evaluation Personnel Individuals contributing to this evaluation : Name Position Name Position Jamie Holly SDC Teacher Dr. Smiley Psychologist Carmen Super Behavior Support Specialist Katy Johnson Behavior Analyst Contact person for this report : Phone : (123) 456-7890 E-mail : JamieHolly@HollyUnifiedSchool.net

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