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RTI2-B School Team Workbook

Tier III Day 1 TrainingSchool:

District:

Date:

Participants:

Activity #1: How is Tier III Different?Reflect on Tier I and Tier II training. How do you answer the questions differently in each tier? As a team, complete the table in preparation for a group discussion.

Tier I Tier II Tier III

Types of interventions?

Which students?(all, some, few)

Which staff?

How is data used?

What is the impact on problem

behavior?

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Activity #2: Organizing Your NumbersUse your school’s enrollment numbers to determine the number of students who could represent each percentage across the three tiers. Fill in the chart below. Then fill in the blanks in the summary box to reflect your school.

School Name: ________________________________Academic Year: _______________________________

Total Student Enrollment

__________

Our Numbers Our Numbers3% 5%

10% 15%80%

At __________________ school, the student population is _____________. We can expect approximately _________ students will be successful with our school’s Tier I practices. Approximately _________ students may need Tier II supports. Finally, it is possible that ________ students may need Tier III supports over the course of the school year.

*Remember these numbers are a National Average and represent what a school could expect when implementing their RTI2-B plan with at least 80% fidelity across all three tiers.

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Activity #3: What’s the Function?Review the function scenarios. Determine the function of each target behavior/scenario with your team. Circle one choice only in the 2nd column and one choice only in the 3rd column for each scenario.

Scenario

Obtain

Avoid

(Circle One)

Tangible ItemTask or ActivitySocial Attention

Sensory Stimulation

(Circle One)

Whenever Troy is asked to do independent math work, he tears up his paper and puts his

head down.

Obtain

Avoid


Sensory Stimulation

Matthew has a difficult time interacting with others. During free time, he typically goes to the space where there are no other people

Obtain

Avoid


Sensory Stimulation

Norma loves recess. It is raining so there will be no outside recess today. Upon hearing the

news, she screams…and screams…and screams…

Obtain

Avoid


Sensory Stimulation

Gilbert loves to tell jokes. During a large group math lesson, he begins to tell a joke

while the teacher is talking. The other students in the class laugh at Gilbert.

Obtain

Avoid


Sensory Stimulation

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Activity #4: Assign Tier III Team Roles Tier III Team should include a Tier III system coordinator, administrator, an individual with behavioral expertise, an individual with knowledge of students, Tier II member, an individual with knowledge of grade levels and programs, and multi-agency supports. Tier III Team responsibilities include a team lead, recorder, time keeper, communicator. Assign your Tier III Team roles, determine a set day to meet, location, and time.

RTI2-B Tier III Team Composition Chart

Function Name of Person(s) Position of Person(s) If unfilled, Action Steps

Team Lead

Recorder

Time Keeper

Communicator

Day to meet: Time:

Location:

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(Adapted from OSEP Tier II Getting Started Workbook)

Activity #5: Identifying StudentsOnce you have identified students on the data spreadsheet, write down the list of students who your team believes could possibly receive Tier III Interventions These are students who are “High Risk” in one or more categories. This list is an example of what the Data Analyst could bring to a Tier II/Tier III meeting for the team members to discuss. These are students who may not have been previously identified and the Tier II/III team would then determine what interventions may or may not be appropriate.

Continue Tier II Intervention Student meets 2 or more criteria for “At-Risk” behavior Student meets 2 or more criteria “At-Risk” and 1 “High Risk”

Refer Student for Tier III Intervention Student has met 2 or more criteria for “High Risk” behavior Student is in crisis Student is not responding to Tier II after changes have been made

Note: Simply place a check mark in the column that is an area of concern.

StudentName Grade

Area of Concern Tier II/Tier III Team Decision

(Start Tier III intervention or continue to monitor)

SRSS-E SRSS-I ODR Attendance

Totals ___ Continue to monitor___ Start Tier III Intervention

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RTI2-B School Team Workbook: Tier III

Activity #6: Completing Your School’s GridAs a team, review and complete the Cut-Off Score Grid from Tier II Training.

Measure Proficient Score At-Risk High Risk Date(s) to Review

ODR Monthly (list meeting dates);

SRSS-IEExternalizing 0-3 4-8 9+ Fall, Winter, Spring

(list dates)

SRSS-IEInternalizing

Elem 0-1Middle High 0-3

Elem 2-3Middle High 4-5

Elem 4+Middle High 6+

Fall, Winter, Spring(list dates)

Absences Monthly (list meeting dates)

Tardy

Monthly (list meeting dates)10/6/2016, 11/3/2016, 12/1/2016,

1/5/2016, 2/2/2016, 3/2/2016, 4/6/2016, 5/4/2016

ISS


1/5/2016, 2/2/2016, 3/2/2016, 4/6/2016, 5/4/2016

OSS


1/5/2016, 2/2/2016, 3/2/2016, 4/6/2016, 5/4/2016

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Activity #7: Teacher Nomination FormAs a team, review your Tier II Nomination Form. Determine what information needs to be added to make it appropriate for Tier III nominations.Should include a space to document:

Relevant medical history Suspensions/expulsions Previous FBA/BSP

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Notes:


Activity #8: Tier III Team vs. Student Support TeamAs a team, work together to sort the cards that describe roles, responsibilities, members, and features that belong to the Tier III Team and those that belong to the Student Support Team.

Tier III Team Student Support Team

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Activity #9: Defining Problem BehaviorWatch the video clip. Write a tally mark in the box below each time the problem behavior of non-compliance occurs.

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Activity #10: Defining Problem BehaviorSort the slips of paper into examples and non-examples of Faith’s non-compliance in the table below.

Faith’s non-compliance is defined as: verbal or nonverbal refusal to comply with an adult given directive within 5 seconds.

Examples Non-examples

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Activity #11: Defining Problem BehaviorReview the definition of Faith’s non-compliance including the examples and non-examples. As you watch the video clip again, tally when non-compliance occurs.

Non-compliance – verbal or nonverbal refusal to comply with an adult given directive

Examples include: when teacher holds up sight word card with expectation of student responding and Faith does not respond, putting head down on desk, turning away from teacher when prompted, playing with clothing while not responding to teacher, not answering teacher when prompted

Non-examples include: responding but repeating response numerous times (ex: here, here, here when presented with sight word ”here”), movements related to instruction such as hand raising or motor breaks, briefly looking away but looking back (lasting no longer than 3 seconds)

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Activity #12: FACTS Part AListen to the FACTS interview. Follow along and fill in the information on the blank FACTS form below.

Efficient Functional Behavior Assessment: The Functional Assessment Checklist for Teachers and Staff (FACTS): Part A

The FACTS is a brief, semi-structures interview for use in building behavior support plans. The FACTS should be completed with a staff who know the student best and should take about 20 minutes.

Step 1: Demographic DataRecord the student’s name and grade level, who was interviewed, the date the interview was completed, and who administered the interview. Student: FORMTEXT Grade: FORMTEXT Date: Click or tap to enter a date.

Respondent: FORMTEXT Interviewer: FORMTEXT

Step 2: Student Profile Identify at least three strengths of special attributes of the student. This can include activities the student is good at, activities they enjoy, or special qualities. This step helps the team identify strengths and activities that could potentially be used as part of the intervention.

1. FORMTEXT

2. FORMTEXT

3. FORMTEXT

Step 3: Problem BehaviorsMark the problem behavior(s) you are seeing. Circle the one of greatest concern. ☐ Tardy☐ Disruptive☐Withdrawn

☐ Self-Injury☐ Theft☐ Vandalism☐ Non-compliance

☐ Unresponsive☐ Defiance☐ Work not done☐ Verbally inappropriate

☐ Fight/ Physical Aggression☐ Inappropriate Language☐ Verbal Harassment ☐ Other

Describe the Problem Behavior: FORMTEXT

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Step 4: Routine Analysis Identify routines when problem behaviors (identified in Step 3) are most likely to occur:Schedule: Identify the times that define the student’s schedule. Include unstructured times like transitions, lunch, and before/after school.Activity: For each time listed, indicate the type of activity the student is typically engaged in during that time (e.g. small group instruction, math, and transition). Likelihood: (Use the 1 to 6 scale to indicate which times/activities are least and most likely to be associated with the problem behavior. “1” indicates low likelihood and “6” indicates high likelihood. Specific Problem Behavior: For any activity rated 4, 5, or 6, indicate which problem behavior is most likely to occur during that time.

Schedule Activity(large group, small group, independent

work, unstructured time)

Likelihood of Problem Behavior

Specific Problem Behavior

Ex: 11:30 Math Whole group instruction Low High☐1 ☐2 ☐3 ☐4 ☒5 ☐6

Walking out of classroom

FORMTEXT FORMTEXT Low High☐1 ☐2 ☐3 ☐4 ☐5 ☐6 FORMTEXT








Step 5: Target Routine for Behavior SupportSelect between 1 or 2 activities with ratings of 4, 5, or 6 from Step 4. Write the name of the activity and the most common problem behavior occurring during that time. Only combine activities when activities and problem behavior(s) are the same.

Activities Problem Behavior(s)From Step 3

Example Math- whole group instruction DefianceRoutine #1 FORMTEXT FORMTEXT Routine #2 FORMTEXT FORMTEXT

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Activity #13: Conduct FACTS Part A

Efficient Functional Behavior Assessment: The Functional Assessment Checklist for Teachers and Staff (FACTS): Part A

The FACTS is a brief, semi-structures interview for use in building behavior support plans. The FACTS should be completed with a staff who know the student best and should take about 20 minutes.

Step 1: Demographic DataRecord the student’s name and grade level, who was interviewed, the date the interview was completed, and who administered the interview. Student: FORMTEXT Grade: FORMTEXT Date: Click or tap to enter a date.

Respondent: FORMTEXT Interviewer: FORMTEXT

Step 2: Student Profile Identify at least three strengths of special attributes of the student. This can include activities the student is good at, activities they enjoy, or special qualities. This step helps the team identify strengths and activities that could potentially be used as part of the intervention.

4. FORMTEXT

5. FORMTEXT

6. FORMTEXT

Step 3: Problem BehaviorsMark the problem behavior(s) you are seeing. Circle the one of greatest concern. ☐ Tardy☐ Disruptive☐Withdrawn

☐ Self-Injury☐ Theft☐ Vandalism☐ Non-compliance

☐ Unresponsive☐ Defiance☐ Work not done☐ Verbally inappropriate

☐ Fight/ Physical Aggression☐ Inappropriate Language☐ Verbal Harassment ☐ Other

Describe the Problem Behavior: FORMTEXT

Step 4: Routine Analysis

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Identify routines when problem behaviors (identified in Step 3) are most likely to occur:Schedule: Identify the times that define the student’s schedule. Include unstructured times like transitions, lunch, and before/after school.Activity: For each time listed, indicate the type of activity the student is typically engaged in during that time (e.g. small group instruction, math, and transition). Likelihood: (Use the 1 to 6 scale to indicate which times/activities are least and most likely to be associated with the problem behavior. “1” indicates low likelihood and “6” indicates high likelihood. Specific Problem Behavior: For any activity rated 4, 5, or 6, indicate which problem behavior is most likely to occur during that time.

Schedule Activity(large group, small group, independent

work, unstructured time)

Likelihood of Problem Behavior

Specific Problem Behavior

Ex: 11:30 Math Whole group instruction Low High☐1 ☐2 ☐3 ☐4 ☒5 ☐6

Walking out of classroom









Step 5: Target Routine for Behavior SupportSelect between 1 or 2 activities with ratings of 4, 5, or 6 from Step 4. Write the name of the activity and the most common problem behavior occurring during that time. Only combine activities when activities and problem behavior(s) are the same.

Activities Problem Behavior(s)From Step 3

Example Math- whole group instruction DefianceRoutine #1 FORMTEXT FORMTEXT Routine #2 FORMTEXT FORMTEXT

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Activity #13: FACTS Part B Video

The Functional Assessment Checklist for Teachers and Staff: Part BComplete a FACTS-Part B for each activity identified in Step 5 of Part A

Step 6: Target RoutineComplete this part of the interview separately for each targeted activity and problem behavior of the FACTS-Part A. Use multiple Part B forms if more than one activity was targeted.

Activity Problem Behavior(s) FORMTEXT FORMTEXT

Step 7: Problem Behavior DetailsProvide details about problem behavior(s).Describe the problem behavior(s). What does it look like? Provide examples. FORMTEXT How often does the problem behavior(s) occur (one per week or day, hourly)? FORMTEXT How long does this problem behavior(s) last when it does occur (minutes, hours)? FORMTEXT How intense is the problem behavior(s)? Does the behavior cause injury to self? Injury to others? FORMTEXT

Step 8a: AntecedentsIdentify the events that occur prior to the problem behavior(s) by asking the following guiding questions. In this activity, what happens most often just before the problem behavior? FORMTEXT If you put this trigger in place 10 times, how often would it result in problem behavior? FORMTEXT Does the problem behavior ever happen when the trigger is absent? Or when the opposite of trigger occurs? FORMTEXT

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Step 8b: AntecedentsOnce the antecedent has been identified, place a check mark in the relevant trigger box and complete the row

Trigger Features to Describe Describe☐ If tasks (e.g. group work, independent work, small-group instruction)…

Describe the task in detail (e.g., duration, ease of task for student), what features of it likely are aversive to the student and why is it hypothesized?

FORMTEXT

☐ If unstructured time… Describe the setting, activities, and who is around

FORMTEXT

☐ If reprimand… Describe who delivers the reprimand, what is said, and what the purpose of the correction is.

FORMTEXT

☐ If structured, nonacademic activities… Describe the context, who is around, what activities are going on, what behaviors are expected?

FORMTEXT

☐ If transitions… Describe the activity that is ending and the one that is being transitioned to, identify whether any of the activities are highly preferred or non-preferred, which are structured versus non-structured

FORMTEXT

☐ If isolated… Where did the behavior occur? What features of the environment might be relevant?

FORMTEXT

Step 9: Setting EventsSetting events are things that happen before a problem behavior that make it more likely that an antecedent will trigger the behavior (e.g., conflict at home, hunger, lack of sleep, medication, assignments not completed). Ask the following guiding questions to find out if a setting event is involved. Is there something that, when present, makes it more likely that the trigger identified above sets off the behavior? FORMTEXT If yes, is this event present sometimes and absent others? FORMTEXT Does the behavior occur only when the event is present? FORMTEXT

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Step 10: ConsequencesWhat consequences appear most likely to maintain the problem behavior(s)? Ask the following guiding questions to consider what the student may be trying to obtain or escape. Once you have identified the consequence, check the appropriate box. If there seems to be more than one relevant consequence, put the number “1” next to the consequence that you believe is most valued by student and a “2” next to the one that is the next important. Then move to the “consequence” and “features to describe” box. In the activity identified, when the trigger occurs and problem behaviors happen what occurs next? What do you do? FORMTEXT What do other students do? FORMTEXT

What activities happen or stop happening? FORMTEXT

Things that are obtained Things avoided or escaped from☐ adult attention☐ peer attention

☐ activity☐ tangible items

☐ sensory ☐ hard tasks☐ reprimands

☐ peer negatives☐ physical effort

☐ adult attention☐ sensory

Consequence Features to Describe Describe☐ If adult or peer attention is obtained or avoided

Define who provides/avoids attention, what they say/or do, and how long the attention/or lack of attention typically lasts. What does the student do following this attention or lack of attention? Does the problem behavior get worse or escalate?

FORMTEXT

☐ If a task/activity/request is obtained or avoided

Obtained: describe the specific activity including who else is present, what the activity consists of, and how long it lasts.Avoided: Describe what activity is removed, how long it is removed for, and what the student does instead.

FORMTEXT

☐ If tangible items are obtained or avoided

Describe the specific item(s) obtained or avoided, including who else is present and how long the student has access or is restricted from using the item.

FORMTEXT

☐ If sensory stimulation is obtained or avoided

Describe the context, who is around, what activities are going on, what behaviors are expected?

FORMTEXT

Step 11: Summary of Behavior

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Antecedent(s)/ TriggersFrom Part B Step 8b

FORMTEXT

Problem Behavior(s)From Part B Step 6 and 7

FORMTEXT

Consequence(s)/ FunctionFrom Part B Step 10

FORMTEXT

Setting EventsFrom Part B Step 9

FORMTEXT How likely is it that this Summary of Behavior accurately explains the identified behavior occurring?

Not real sure 100% Sure☐1 ☐ 2 ☐3 ☐4 ☐5 ☐ 6

During insert target routine, insert student name is likely to insert problem behavior(s), when s/he insert details of antecedent conditions that trigger behavior, and we believe that s/he does this to insert details of consequence/function. It is more likely to occur when insert details of setting event.

Activity #14: Conduct FACTS Part B: Steps 6 & 7

Step 6: Target RoutineComplete this part of the interview separately for each targeted activity and problem behavior of the FACTS-Part A. Use multiple Part B forms if more than one activity was targeted.

Activity Problem Behavior(s) FORMTEXT FORMTEXT

Step 7: Problem Behavior DetailsProvide details about problem behavior(s).Describe the problem behavior(s). What does it look like? Provide examples. FORMTEXT How often does the problem behavior(s) occur (one per week or day, hourly)? FORMTEXT How long does this problem behavior(s) last when it does occur (minutes, hours)? FORMTEXT How intense is the problem behavior(s)? Does the behavior cause injury to self? Injury to others? FORMTEXT

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Activity #15: Conduct FACTS Part B: Steps 8a – 9

Step 8a: AntecedentsIdentify the events that occur prior to the problem behavior(s) by asking the following guiding questions. In this activity, what happens most often just before the problem behavior? FORMTEXT If you put this trigger in place 10 times, how often would it result in problem behavior? FORMTEXT Does the problem behavior ever happen when the trigger is absent? Or when the opposite of trigger occurs? FORMTEXT

Step 8b: AntecedentsOnce the antecedent has been identified, place a check mark in the relevant trigger box and complete the row

Trigger Features to Describe Describe☐ If tasks (e.g. group work, independent work, small-group instruction)…

Describe the task in detail (e.g., duration, ease of task for student), what features of it likely are aversive to the student and why is it hypothesized?

FORMTEXT

☐ If unstructured time… Describe the setting, activities, and who is around

FORMTEXT

☐ If reprimand… Describe who delivers the reprimand, what is said, and what the purpose of the correction is.

FORMTEXT

☐ If structured, nonacademic activities… Describe the context, who is around, what activities are going on, what behaviors are expected?

FORMTEXT

☐ If transitions… Describe the activity that is ending and the one that is being transitioned to, identify whether any of the activities are highly preferred or non-preferred, which are structured versus non-structured

FORMTEXT

☐ If isolated… Where did the behavior occur? What features of the environment might be relevant?

FORMTEXT

Step 9: Setting EventsSetting events are things that happen before a problem behavior that make it more likely that an antecedent will trigger the behavior (e.g., conflict at home, hunger, lack of sleep, medication, assignments not completed). Ask the following guiding questions to find out if a setting event is involved. Is there something that, when present, makes it more likely that the trigger identified above sets off the behavior? FORMTEXT If yes, is this event present sometimes and absent others? FORMTEXT Does the behavior occur only when the event is present? FORMTEXT

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Activity #16: Conduct FACTS Part B: Step 10

Step 10: ConsequencesWhat consequences appear most likely to maintain the problem behavior(s)? Ask the following guiding questions to consider what the student may be trying to obtain or escape. Once you have identified the consequence, check the appropriate box. If there seems to be more than one relevant consequence, put the number “1” next to the consequence that you believe is most valued by student and a “2” next to the one that is the next important. Then move to the “consequence” and “features to describe” box. In the activity identified, when the trigger occurs and problem behaviors happen what occurs next? What do you do? FORMTEXT What do other students do? FORMTEXT

What activities happen or stop happening? FORMTEXT

Things that are obtained Things avoided or escaped from☐ adult attention☐ peer attention

☐ activity☐ tangible items

☐ sensory ☐ hard tasks☐ reprimands

☐ peer negatives☐ physical effort

☐ adult attention☐ sensory

Consequence Features to Describe Describe☐ If adult or peer attention is obtained or avoided

Define who provides/avoids attention, what they say/or do, and how long the attention/or lack of attention typically lasts. What does the student do following this attention or lack of attention? Does the problem behavior get worse or escalate?

FORMTEXT

☐ If a task/activity/request is obtained or avoided

Occurs: describe the specific activity including who else is present, what the activity consists of, and how long it lasts.Avoided: Describe what activity is removed, how long it is removed for, and what the student does instead.

FORMTEXT

☐ If tangible items are obtained or avoided

Describe the specific item(s) obtained or avoided, including who else is present and how long the student has access or is restricted from using the item.

FORMTEXT

☐ If sensory stimulation is obtained or avoided

Describe the context, who is around, what activities are going on, what behaviors are expected?

FORMTEXT

Activity #17: Conduct FACTS Part B: Step 11

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Step 11: Summary of BehaviorAntecedent(s)/ TriggersFrom Part B Step 8b

FORMTEXT

Problem Behavior(s)From Part B Step 6 and 7

FORMTEXT

Consequence(s)/ FunctionFrom Part B Step 10

FORMTEXT

Setting EventsFrom Part B Step 9

FORMTEXT How likely is it that this Summary of Behavior accurately explains the identified behavior occurring?

Not real sure 100% Sure☐1 ☐ 2 ☐3 ☐4 ☐5 ☐ 6

During insert target routine, insert student name is likely to insert problem behavior(s), when s/he insert details of antecedent conditions that trigger behavior, and we believe that s/he does this to insert details of consequence/function. It is more likely to occur when insert details of setting event.

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Activity #18: Family Interview VideoBasic FBA - Family Interview

Complete the interview below with student’s parent(s)/guardian(s). Item written in bold are the questions to ask parents/guardians. Answers should be written or typed in the white spaces below the questions. The summary statement at the bottom should be completed by the interviewer (not the parent/guardian). Demographic InformationStudent: Shane Grade:8th Date:11/14/17Respondent: Mrs. Stevens (Shane’s mother) Interviewer: Mrs. Barnes

What are your child’s strengths? (Can select more than 1 option)☐Friendly☐Helpful☒Sociable☐Organized☒Natural leader

☐Liked by peers☐Self-starter☐Follows directions☐Honest

☐Easygoing☐Respectful☐Kind☒Funny☐Positive

☐Hard worker☐Good communicator☒Other: Athletic

What are your child’s preferences? (Can list multiple) (Examples: preferred items, activities, food/snacks, peers)List the preferences below: Sports (especially football and basketball), listening to music, technology (loves being on the computer and his cell phone), telling jokes/making people laugh (especially his friends), junk food (chips, candy, Taco Bell)

What does your child like to do during his/her free time? (Please describe)On the football team, plays pickup basketball games in the neighborhood, hangs out in his room listening to music and playing games on his phone or computer

What behavior(s) are you most concerned about at home? (Please describe)He can be very disrespectful – talks back, refuses to do what is asked (particularly chore or math-related). Struggles to get him to do his homework. Very concerned about his grades, particularly in math. Possible Antecedents: When problem behavior happens at home, describe what happens right before that problem behavior

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occurs. (Please describe)If he’s told to do something or gets in trouble.

If parent/guardian has difficulty identifying antecedents, the interviewer can ask the questions in the row below, and check off antecedents that match what the parent says. You do not need to read off every check box, but some check boxes can be read if a parent is struggling to give examples or identify an antecedent.

Does the problem behavior happen if you give your child a task to complete (e.g. group work, independent work, etc.)

Does the problem behavior happen if

your child has unstructured time

at home?

Does the problem behavior happen if you reprimand your child for something? (e.g., tell them “no,”

“stop,” don’t give them something

they want)

Does problem behavior happen if

your child has to transition to or away

from something?

Does problem behavior happen if

your child is not getting any

attention/isolated?

☐Other: FORMTEXT

☒When asked to do a chore or task☒ When it is time to do homework☐ When told to do something non-preferred

☐Tasks that are difficult or confusing☐Not prepared with necessary materials☐Multi-step work or projects☐Given a direction to follow

☐Unstructured situations or settings

☒ When told “no” or “stop” ☐When corrected☐When he/she cannot have something they want☐When given an ultimatum

☐Transitions☐ When there is a change in routine

☐When working or playing independently☐When adult attention is on others

Possible Consequences: thinking about the problem behaviors you are concerned about, please tell how you or others at home typically respond when those problem behaviors occur. (Please describe)If he’s told to do a chore or homework, or told to stop doing something (usually to try and get him to do a chore or his homework), he gets disrespectful and is sent to his room.

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If parent/guardian has difficulty identifying consequences, the interviewer can ask the questions in the row below, and check off consequences that match what the parent says. You do not need to read off every check box, but some check boxes can be read if a parent is struggling to give examples or identify a consequence. When problem behavior

happens, do you give your child attention in some form? (e.g., give “the look,” correct my child, comfort/soothe

my child, etc.)

Obtain attention…

When problem behavior happens, do you give

your child what they’re asking for?

Obtain item/activity…

When problem behavior happens, do you give your child access to

sensory things? (e.g., squeezes, bear hugs,

swing time, etc.)

Obtain other…

When problem behavior happens, does your

child then spend time by themselves? (e.g., sent

to timeout, sent to bedroom)

Avoid attention…

When problem behavior happens, does your

child get anything taken away, or have to stop

doing a task he/she was supposed to be doing?Avoid activity or task…

Avoid other…☐Give a nonverbal cue (e.g., give “the look”)☐Verbally correct or prompt☐Assist my child ☐Speak to my child afterward☐Provide a reminder of what is and isn’t appropriate☐Explain and discuss the issue☐Comfort/ soothe child

☐Let him/her have what they are asking for

☐Other: FORMTEXT

☐Send child to bedroom or quiet area by themselves

☒He/she gets out of or delays doing the task☐Take away an activity or free time☐Take a privilege away☒Send child to bedroom or quiet area by themselves (they don’t have to do what they were supposed to do)

☐Other: FORMTEXT

Summary Statement: Identify the hypothesis that will be used to build a behavior support plan. Mark your confidence in the hypothesis statement.

Antecedent(s) Problem Behavior: Consequences:If asked to do a chore or homework Talks back and/or refuses to follow

directionsAvoids doing a chore or homework

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Not Real Sure 100% Sure ☐1 ☐2 ☐3 ☐4 ☐5 ☒6

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Activity #19: Student Interview Video

Basic FBA- Student InterviewComplete the interview with student. Items written in bold are the questions to ask the student. Answers should be written or typed in the white spaces below the questions. The summary statement at the bottom should be completed by the interviewer (not the student).

Demographic Information: Student: Shane Grade: 8th Interviewer: Mrs. Barnes Date: 11/15/17

What is your favorite class at school?Keyboarding

What do you like about that class?Technology, computers

What are some things you do very well?Sports (football and basketball), technology

When do you have the most difficulty at school? OR What things are really hard for you to do at school?Math is really hard

What is it about (above answer) that you find to be the most difficult? OR Why do you think (above answer) is so hard? Feels like the other students understand it more than he does. Doesn’t like having to work by himself.

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The following is a list of possible rewards for doing good work. Read the options to the student and check any the student is interested in earning.

ACCESSAttention

☐Helper to an adult in the building☐Helper to younger student☐Work with a friend☐Positive note/call home ☐Pick seat for a period☐Use teacher’s chair/desk☐Lunch bunch☐Tell a joke/story to class☐Deliver announcements☐Share work, art, or item with class☐Earn a reward for the whole class☐Change name for the period or day

Activity/ Tangible ☐Drawing time☐Treasure box☐Use preferred writing tool☐Choose video for class to watch or movement break☐Special snack☐Stickers☐Extra technology time☒Listen to music at end of class

Other ☐Use of sensory tools during instruction (e.g., wiggle cushion, ball chair, etc.) (only read this option if available at the school)☐Movement breaks☐Extra time for a sensory activity (e.g., swings, water play, listening to music)☐Class helper for sensory tasks (e.g., erase board, take down chairs, carry books)

AVOIDAttention

☐Exemption from portion of assignment requiring public speaking☐Participation based on written responses rather than oral responses☐Choice of small group or individual work☐Questions posed to class presented to the student before the activity/period☐No speaking pass (get out of answering questions out loud for the period)

Activity/Tangible☐Helper to adult in the building during a non-preferred activity ☐Helper to younger student during a non-preferred activity☐_____ minutes of free choice time☒Go to lunch/recess early☒Listen to music for part of non-preferred activity☒Do only part of an assignment☐No bell-ringer activity for a day☒”No Homework” pass

Other☐Temporary break from non-preferred sensation/activity (e.g., break from swinging, break from noisy cafeteria)☐Exemption from non-preferred sensation/activity (e.g., stay inside during recess, eat lunch in classroom instead of cafeteria)☐Temporary control of volume, intensity, duration of an activity or experience☐Choice of seating, lighting, noise level in classroom☒Break pass

Other tangible or nontangible items the student would like to earn: (List options shared by student)Candy, chips

Summary Statement: (To be completed by the interviewer)

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Identify the hypothesis that will be used to build a behavior support plan. Mark your confidence in the hypothesis statement. Antecedent(s): Problem Behavior: Consequences:

When doing math, especially independent math work

Engages in defiant behavior To avoid doing math work

Not Real Sure 100% Sure ☐1 ☐2 ☐3 ☐4 ☐5 ☒6

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Tier III Glossary of Terms

Term What It Means Examples

FunctionalBehavior

Assessment

An information-gathering process to figure out when and why problem behavior is happening.

Results guide the interventions used to decrease problem behavior and increase appropriate behavior.

What does a student get out of engaging in the problem behavior? Are they trying to GET or AVOID…

Attention from an adult or peer?

Certain items or activities? Certain types of stimulation

or sensory input?

Antecedent

The event(s), action(s), or circumstances that occur immediately before the problem behavior.

Teacher asks student a question

Toy is taken from a child Transition to the cafeteria

ConsequenceThe action(s) or response(s) that immediately follows the problem behavior.

Brief redirection from adult Laughter from peers Preferred item removed

Setting Event

Events that happen in the student’s environment at points before the antecedent occurs that make it more likely for the problem behavior to be triggered

Lack of sleep Conflict at home Hunger Assignments not completed

Function

Refers to the purpose or intent of the student’s actions.

Why the student engages in certain behaviors

To GET or AVOID Attention from an adult or

peer Demands or tasks Stimulation or sensory

See Function Flowchart

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Indirect Assessment

Structured interviews, checklists, rating scales, or questionnaires used to gather information from people who are familiar with the person exhibiting the problem behavior; used to generate an initial hypothesis about when and why problem behavior occurs?

Record Review FACTS – staff member interview Parent Interview Student Interview

Descriptive Assessment

Direct observation of problem behavior and the antecedent and consequent events under naturally occurring conditions.

ABC Observation Data Direct Data Collection and

Analysis

Summary Statement

Summarizes all assessment information into a succinct statement that describes when and why problem behavior occurs, and is the basis for developing intervention strategies.

During <insert target routine>, <insert student name> is likely to <insert problem behavior(s), when he/she <insert details of antecedent conditions that trigger behavior>, and I believe that s/he does this to <insert details of consequence/function>. It is more likely to occur when <insert details of setting events>.

Adapted from: Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc.

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Day 1 Homework Checklist and Action Plan:Action Item: Who? By When? Notes:

Review Teacher Nomination Form and determine if more information is needed

Identify and discuss target behaviorDetermine who will complete FACTS Part A & B with each teacherAssign Student Support Team members to complete the interview with family and student (if appropriate)Complete the FACTS, family, and student interview (if appropriate)

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