functional assessment interview and observation

8/17/2019 Functional Assessment Interview and Observation

1/20

FUNCTIONAL ASSESSMENT INTERVIEW

(adapted from O’Neill, R., Horner, R., Albin, R., Sprague, J. R., Storey, K., and Newton, J. S. 1!."#un$tional A%%e%%ment &nter'iew. &n #un$tional A%%e%%ment and )rogram *e'elopment+ A )ra$ti$al

Handboo, -nd dition. )a$ifi$ /ro'e+ 0roo%2ole )ubli%3ing 2ompany4

Student Name 23ild 0 Age ! Se5 6ale

*ate of &nter'iew -nd No'ember -718 &nter'iewer 9ea$3er

Re%pondent% 9ea$3er

I. Student Behavior

A. List the strengths and o!"etenies o# the student in eah o# the do!ains$

So$ial+

• Able to re%pond to familiar %o$ial a$tion% (eg. Hi:;, %3ae 3and%, a$$epting item%4

• Able to %tay in a %mall group wit3 3i% peer% during group wor %e%%ion%

• Able to demon%trate le'el of awarene%% by taing toy% from 3i% peer% w3en t3ey tae t3em

away from 3im

A$ademi$ 2ogniti'e+

• 6at$3ing ob


2/20

2ommuni$ation+

• 2urrently on )i$ture 5$3ange 2ommuni$ation Sy%tem ()2S4

• Able to $omplete )3a%e & of )2S = %imple 1 to 1 e5$3ange wit3 different reinfor$er%

• 2urrently woring on )3a%e && and &&& of )2S = waling a$ro%% t3e room to $omplete t3e

e5$3ange and di%$riminating between two different )2S $ard%

a% &esri'e the 'ehaviors o# onern$

1.Behaviour &esri"tion Fre(uen) &uration Intensit)

1. #looring 23ild will drop to t3e

ground (%ometime% roll

on t3e floor4 and begin

to purpo%ely mae 3im

feel 3ea'y %o t3at

ot3er% are not able to

$arry 3im.

>3ene'er 3e doe% not

want to do %omet3ing

t3at t3e tea$3er dire$t%

3im to.

?min% = 17 min%

(depending on w3at

t3e tea$3er re@uire%

3im to do4

Hig3 = 23ild

%truggle w3en tea

trie% to $arry 3im

%tand up.

-. 0iting S3irt 23ild will bite 3i% %3irt$on%tantly and t3at

would $au%e many

3ole% on 3i% %3irt%.

>3ene'er 3e get%up%et, angry or o'erly

e5$ited.

O'er ?7 min% w3entea$3er doe% not

prompt 3im to %top

biting 3i% %3irt.

; %e$ond% w3en

tea$3er prompt% 3imto %top biting 3i% %3irt.

ow = 23ild doe%%3ow fru%tration w

3e i% prompted to

biting 3i% %3irt. A

3e doe% not tri

ot3er $3ildren in$la%% wit3

be3a'iour.

?. Ki$ing and

2rying

23ild will lie down on

t3e floorB u%e 3i% 3and%

to $o'er 3i% ear% and

$ry, i$ing w3ate'er

tea$3er, peer or toy%around 3im.

>3ene'er 3e i% put in

a %etting t3at 3e i% not

$omfortable wit3.

O'er 1; min% for

e'ery meltdown.

Hig3 = 23ild

%3out and $au%e%

noi%e% t3at w

di%rupt t3e o

$3ildren in t3e $Some $3ildren wi

triggered and

meltdown% a% due to t3e loud no

8. 93rowing t3ing% 23ild will t3row t3ing%wit3 a lot of for$e

(toy%, food4 onto t3e

floor.

>3ene'er 3e i% %i$ of t3e food or gi'en

toy% t3at 3e doe% not

want.

- %e$ond% for t3rowing, at mo%t 1

min of t3rowing all

t3e t3ing% on t3e

table.

Hig3 = t3rowt3ing% may 3it o

$3ildren and

$au%e a lot of tea$

to $lean up after 3

-. >3i$3 of t3e be3a'ior% de%$ribed abo'e are liely to o$$ur toget3er in %ome wayC

93rowing t3ing% and biting %3irt

#looring, i$ing and $rying

?. >3at do you now about t3e 3i%tory of t3e unde%irable be3a'ior%, t3e program% t3at 3a'e been attempted

de$rea%e or eliminate t3em, and t3e effe$t% of t3o%e program%C

Behaviour *o+ ,ong has this 'een a

"ro',e!-

rogra!s E##ets


3/20

1. #looring 23ild 3a% alway% been

flooring but 3a% %tarted

be$oming be3a'iour %in$e !

mont3% ago.

23ild will be gi'en %na$%

(eg. oreo4 to pa$ify 3im and

moti'ate 3im to wal.

)rogram 3a% been effe$ti'e to a

$ertain e5tend a% $3ild will get up

from t3e floor mo%t of t3e time.

-. 0iting S3irt 23ild 3a% been biting 3i%

%3irt %in$e 3e wa% ; year%

old.

23ild will be gi'en fruit%

%u$3 a% orange% (for t3e

%our ta%te4 and apple% (for

t3e $run$34 for 3i% %en%ory

diet.

)rogram 3a% been effe$ti'e in

beginning w3en 3e 3ad


4/20

?. *e%$ribe %leep pattern% and po%%ible relation%3ip to be3a'ior+

23ild %leep% regular 3our% and doe% not 3a'e any po%%ible relation to 3i% be3a'iour

8. *e%$ribe eating routine% and diet and po%%ible relation%3ip to be3a'ior+

23ild eat% ba%i$ t3ree meal% a day but al%o %na$% alot t3roug3out t3e day. #ood i% u%ed a% a

%trategy to pa$ify 3im w3en 3e mi%be3a'e%.

;. Student’% daily %$3edule (&ndi$ate w3et3er t3ey are a$ti'itie% 3e%3e en


5/20

:00

!:00

#urt3er detail%+ Inable to fill up t3e %$3edule for $3ild 0 before 3e attend% $la%% due to t3e parent% di%$retion

. How many other 'ersons are typi$ally around t3e %tudentC *oe% t3e %tudent typi$ally %eem bot3ered in

%ituation% t3at are more $rowded and noi%yC

S$3ool Home

9ea$3er Helper

9ea$3er Aide )arent%

9ea$3er Aide Sibling%

23ild %eem% to be more bot3ered in $rowded and noi%y %ituation% lie in %$3ool w3en t3ere are more %tudent%

around 3im.

!. >3at i% t3e pattern of %taffing %upport t3e %tudent re$ei'e%C *o you belie'e t3at t3e n(mber of %taff, t3etraining of %taff, or t3eir social interactions with the st(dent affe$t t3e de%irable or target be3a'iorC

S$3ool Home9ea$3er Helper : 3a% been wit3 $3ild e'er %in$e 3e

wa% born

9ea$3er Aide : trained in 3andling $3ildren

wit3 %e'ere AS*, proa$ti'e in $la%%room

%etting%

)arent%

9ea$3er Aide : trained in 3andling $3ildren

wit3 %e'ere AS*, proa$ti'e in $la%% %etting%

and trained in toileting

Sibling%

)attern or %taff and training of %taff are %uffi$ient for t3e $la%% $3ild 0 i% in. Student% are all diagno%ed wit3 AS

%imilar to $3ild 0.

. >3at agen$ie% are in'ol'ed wit3 t3e %tudentC

5f there is any social agency in&ol&ement 'lease see %gency 5n&ol&ement (estionnaire 3 %ttachment ".

C. &e#ine s"ei#i i!!ediate anteedent events that "redit +hen the 'ehaviors are likely and not

likely to our.

1. 9ime% of *ay+ When are t3e be3a'ior% mo%t and lea%t liely to 3appenC

4esirable 2arget ,ost i-ely >3en $3ild i% a%ed to mo'e from one

%etting to anot3er

>3en $3ild doe% not get w3at 3e want%

>3en $3ild i% a%ed to parti$ipate in

anyt3ing t3at i% tea$3er dire$ted

east i-ely >3en $3ild i% able to %ele$t 3i% $3oi$e of

a$ti'ity


6/20

-. Setting%+ Where are t3e be3a'ior% mo%t and lea%t liely to 3appenC

4esirable 2arget ,ost i-ely *uring $ir$le time %etting

*uring group a$ti'ity %etting

east i-ely

?. )eople+ With whom are t3e be3a'ior% mo%t and lea%t liely to 3appenC

4esirable 2arget

,ost i-ely

east i-ely

8. A$ti'ity+ What acti&ities are mo%t and lea%t liely to produ$e t3e be3a'iorC

4esirable 2arget ,ost i-ely

east i-ely

;. Are t3ere parti$ular or idio%yn$rati$ %ituation% or e'ent% not li%ted abo'e t3at %ometime% %eem to

"%et off t3e be3a'ior%, %u$3 a% parti$ular demand%, noi%e%, lig3t%, $lot3ingC

. >3at one thing $ould you do t3at would mo%t liely mae t3e be3a'ior% o$$urC

4esirable 2arget

!. 0riefly de%$ribe 3ow t3e target be3a'ior would be affe$ted if. . .

a4 ou a%ed 3im or 3er to perform a diffi$ult ta%+

23ild 0 will floor and %truggle w3en being p3y%i$ally broug3t to perform a ta%.

b4 ou interrupted an en


7/20

23ild will floor and %truggle, not wanting to mo'e from one area to anot3er if t3e routine i%

di%rupted. Inle%% it i% to bring 3im to an a$ti'ity t3at 3e prefer% (eg. water play4, $3ild will

parti$iapte and will not %3ow be3a'iour

d4 93e %tudent wanted %omet3ing but wa% unable to get it+

23ild will pu%3 tea$3er% out of t3e way in order to get %omet3ing t3at 3e prefer%

e4 ou didn’t pay attention to t3e %tudent or left t3e %tudent alone for aw3ile (e.g., 1; minute%4.

&f $3ild i% engaged in 3i% preferred a$ti'ity (eg. playing wit3 3i% preferred toy%4, $3ild will not

%3ow any be3a'iour. Howe'er, after aw3ile, 3e will %tart to run around t3e $la%%room and

t3row t3ing% on t3e floor.

&. Identi#) the onse(uenes or outo!es o# the "ro',e! 'ehaviors that !a) 'e !aintaining the!

/i.e.0 the #untions the) serve #or the student in "artiu,ar situations%. 93in of t3e be3a'ior% li%ted in Se$tion 0,

and identify t3e %pe$ifi$ $on%e@uen$e% or out$ome% t3e per%on get% w3en t3e be3a'ior% o$$ur in different %ituation%.

0e3a'ior )arti$ular Situation% >3at e5a$tly doe% t3e

%tudent getC

>3at doe% t3e %tudent a'

a4

b4

$4

d4

e4

E. Consider the overa,, efficiency o# the "ro',e! 'ehaviors. E##iien) i# the o!'ined resu,t o# /A% ho+

!uh "h)sia, e##ort is re(uired0 /B% ho+ o#ten the 'ehavior is "er#or!ed 'e#ore it is re+arded0 and /C%

ho+ ,ong the student !ust +ait to get the re+ard.

0e3a'ior

ow

ffi$ien$y

Hig3

ffi$ien$y

1 - ? 8 ;

1 - ? 8 ;

1 - ? 8 ;

1 - ? 8 ;

1 - ? 8 ;

F. What functional alternative 'ehaviors does the student a,read) 1no+ ho+ to do- />3at %o$ially appropri

be3a'ior% or %ill% $an t3e per%on already perform t3at may generate t3e %ame out$ome% or reinfor$e% produ$e

t3e problem be3a'ior%C4 2See Setion A #or strengths and o!"etenies.

3. What are the "ri!ar) +a)s the student o!!uniates +ith other "eo",e-

1. >3at are t3e general e5pre%%i'e $ommuni$ation %trategie% u%ed by or a'ailable to t3e %tudentC 93e%e mig3t

in$lude 'o$al %pee$3, %ign%ge%ture%, $ommuni$ation board%boo%, or ele$troni$ de'i$e%.


8/20

-. How $on%i%tently are t3e %trategie% u%edC

?. On t3e following $3art, indi$ate t3e be3a'ior% t3e per%on u%e% to a$3ie'e t3e $ommuni$ati'e out$ome% li%te

Communication

Functions

C o ! " , e 4 s " e e h

/ s e n t e n e s % M

u , t i " , e 2 + o r d " h r a s e s

O n e 2 + o r d u t t e r a n e s

E h o , a , i a

O t h e r v o a , i 5 i n g

C o ! " , e 4 s i g n i n g

S i n g , e s i g n s

. o i n t i n g

L e a d i n g

S h a 1 e s h e a d

3 r a ' s 6 r e a h

e s

3 i v e s o ' 7 e

t s

I n r e a s e d ! o v e ! e n t

M o v e s , o s e t o ) o u

M o v e s a + a ) o r , e a v e s

F i 4 e d g a 5 e

F a i a , e 4 " r e s s i o

n

A g g r e s s i o n

S e , # 2 i n 7 u r )

O t h e r

Re(uest attention

Re(uest he,"

Re(uest "re#erred

#ood2o'7ets ativities

Re(uest 'rea1

Sho+ )ou so!ething

or so!e ",ae

Indiate "h)sia, "ain

/headahe0 i,,ness%

Indiate on#usion

or unha""iness

rotest or re7et a

situation or ativit)

8. >it3 regard to t3e %tudent’% re$epti'e $ommuni$ation, or ability to under%tand ot3er per%on%. (#or ea$3

item, li%t if only a few4.

a4 *oe% t3e %tudent follow %poen re@ue%t or in%tru$tion%C &f %o, appro5imately 3ow manyC

b4 *oe% t3e %tudent re%pond to %igned or ge%tural re@ue%t% or in%tru$tion%C &f %o, appro5imately 3ow manyC

$4 &% t3e %tudent able to imitate if you pro'ide p3y%i$al model% for 'ariou% ta%% or a$ti'itie%C

d4

How doe% t3e %tudent typi$ally indi$ate yes or no w3en a%ed if 3e or %3e want% %omet3ing, want% to go

%omew3ere, and %o onC

I. What are the things )ou shou,d do and things )ou shou,d avoid in +or1ing +ith and su""orting this

"erson-

1. >3at t3ing% $an you do to impro'e t3e lieli3ood t3at a tea$3ing %e%%ion or ot3er a$ti'ity will go well


9/20

wit3 t3i% %tudentC

-. >3at t3ing% %3ould you a'oid t3at mig3t interfere wit3 or di%rupt a tea$3ing %e%%ion or a$ti'ity wit3

t3i% %tudentC

8. What are things the student ,i1es and are rein#oring #or hi! or her-

1. A$ti'itie% in %$3ool+

-. A$ti'itie% at 3ome+

?. A$ti'itie% in $ommunity+

8. Ob


10/20

Attah!ent 9

:uestions to as1 i# a student is in #oster are$

1. >3o 3a% $u%tody of t3e $3ildC &% t3i% a parentfo%ter parent relati'e friendC 2omment%Note%

a.

b.

-. &f t3e $3ild i% in publi$ $u%tody, w3o i% t3e $3ild’% $a%e worerC

a. 93e $a%e worer a$t% a% $u%todian.

b. 93ere i% a %pe$ifi$ group of $3ildren w3o are being %er'ed by a 23ildren’%

Home. 93e%e $3ildren are all eligible for adoption, and awaiting familie%. &n

t3e%e $a%e%, t3e %taff per%on from 23ildren’% Home a$t% a% t3e $u%todian.

?. &n w3at type of fo%ter 3ome i% t3e $3ild pla$edC

8. >3o i% t3e $3ild’% /uardian Ad item 2ourt Appointed Spe$ial Ad'o$ateC

a. 93e /uardian Ad item (/A4 i% a per%on appointed by a magi%trate in

3at %er'i$e% i% t3e $3ild re$ei'ingC

a.

b.

. *oe% t3e $3ild 3a'e an a$ti'e $a%e wit3 a mental 3ealt3 agen$y or pro'iderC

a. A $3ild in'ol'ed wit3 mental 3ealt3 %er'i$e% will 3a'e an 5ndi&id(ali8ed

1er&ice Plan) 51P/ t3at delineate% t3e goal% t3e $3ild i% woring on in t3erapy.

&S)% and &)% %3ould be $oordinated. b. Some t3erapi%t% $an be a'ailable to attend %$3ool meeting%.


11/20

Attah!ent ;

Funtiona, Assess!ent O'servation For!

Name+

Starting *ate+ nding *ate+

)er$ei'ed #un$tion% A$tual

2on%[email protected]'ior% )redi$tor% %$apeA'oid /etObtain Sen%ory

9ime

# l o o r i n g

0 i t i n g S 3 i r t

K i $ , i n g

a n d 2 r y i n g

9 3 r o

w i n g t 3 i n g %

* e m a n d 1 R e @ u e % t

*

i f f i $ u l t 9 a % ,

9 r a n % i t i o n %

& n t e r r u p t i o n

A l o n e ( n

o a t t e n t i o n 4

* o e % n o t w a

n t t o b e i n a

9 $ 3 r . * e m a n d 1 R e @ u e % t

A $ t i ' i t y L 9

a % , ( / r o u p 4

) e r

% o n :

O t 3 e r :

9 e a $ 3

e r A t t e n t i o n

) e

e r A t t e n t i o n

# o o d

A $ $ e % % a t a % , :

A $ $ e % %

t o + d e % i r e d

i ' i t y

O t 3 e r 1

*

o n ’ % K n o w

/ r a t i f i $ a t i o n

5 $ i t e m e n t

(if not3ing

3appened in

period, write

initial%4

2omment%

?pm1

!

1

!1

1

!

1

!!

1

!! 1

?.?7pm 8 8 8 8 8 8

8pm - -

-

;

-

;

-

;

;

-

;

-

-

;

-

;

8.?7pm

;pm

?

?

?

?

?

?

?

?

;.?7pm

pm

9otal%

'ent%+ 1 - ? 8 ; ! 17 11 1- 1? 18 1; 1 1! 1 1 -7 -1 -- -? -8 -;

*ate+


12/20

Student < &ireted Funtiona, Assess!ent Intervie+

Student Name+ &nter'iewer+

Referring 9ea$3er+ *ate+

I. O"ening. 9We are meeting today to find ways to change school so that yo( li-e it more. 2his inter&iew will ta-e abo(t $0 min(tes. 5 can hel' yo( best if yo( answer

honestly. o( will not be as-ed anything that might get yo( in tro(ble.;

Positi&e


13/20

Mou will u%e t3e number% to t3e left a% $ode% for t3e identified be3a'ior% a% you $omplete t3e re%t of t3e inter'iew.

Su!!ar) State!ent For!

A$ti'ity or 'ent >3at Happen% 0efore 0e3a'ior(%4 >3at Happen% After

; 9 >

2omplete t3e diagram following t3e numbered %e@uen$e (0e3a'ior(%4 fir%t, t3en )redi$tor%, et$.4. 2on%ider t3e item% below a% po%%ible element% for in$lu%ion in t3e

diagram. 2omplete a different diagram for ea$3 new $on%e@uen$e.

>3at important e'ent% or a$ti'itie%

tend to %et up t3e be3a'iorC >3at appear% to %et off problem be3a'iorC >3at do t3e problem be3a'ior% loo lieC

>3at do you gain from t3e

problem be3a'ior%Ca$ of %leep 2la%% demand% t3at are+ ate to $la%% %$ape or A'oid

&llne%% 9oo 3ard 9al out in $la%% 9ea$3er demand%

)3y%i$al pain 0oring *i%ruption% 9ea$3er reprimand% $orre$tion

Hunger In$lear &nappropriate language )eer %o$ial $onta$t (tea%ing4

9rouble at 3ome ong *i%re%pe$ti'e be3a'ior 9a%% (3ard, long4

#ig3t$onfli$t wit3 peer% 9ea$3er reprimand% )roperty de%tru$tion /et Attention

Noi%edi%tra$tion% )eer tea%ing 2arrying weapon% #rom peer%

A$ti'ity$la%% )eer en$ouragement #idget #rom tea$3eradult

(%eating arrangement%4 Ot3er Not $ompleting wor /et A$ti'ity or &tem

(tea$3er error $orre$tion4 Steal A$$e%% to game93reaten A$$e%% to toy

Fandali%m A$$e%% to food

Ot3er A$$e%% to money

(looing around and waling4 A$$e%% to ta%

Sen%ory

)3y%i$al gratifi$ation

5$itementarou%al

Student < &ireted Funtiona, Assess!ent Intervie+0 ".>

Student &ai,) Shedu,e


14/20

)lea%e pla$e an "E in ea$3 $olumn to %3ow t3e time% and $la%%e% w3ere you 3a'e diffi$ulty wit3 t3e be3a'ior% we taled about. &f you 3a'e a lot of diffi$ulty during a

period, pla$e an "E on or near t3e . &f you 3a'e a little diffi$ulty during t3e $la%% or 3all time, pla$e t3e "E on or near t3e 1. >e $an pra$ti$e on a $ouple toget3er

before we %tart.

Be#ore

Shoo,

9st

eriod

*a,, ;nd

eriod

*a,, >rd

eriod

*a,, ?th

eriod

Lunh @th

eriod

*a,, th

eriod

*a,, th

eriod

*a,, th

eriod

A#ter

Shoo,

Su'7et0

Teaher None None None None None None None None None

Most

&i##iu,t

@

?

>

;

Least

&i##iu,t

9

Ta',e 9

*)"othesis Su!!ar) State!ent Wor1sheet


15/20

Setting andor Hi%tory 'ent or A$ti'ity

)redi$tor or 9rigger (Ante$edent4

9arget 0e3a'ior

6aintaining 2on%e@uen$e(/oal of t3e 0e3a'ior4



9arget 0e3a'ior




9arget 0e3a'ior



16/20

Ta',e ;

Su!!ar) State!ent o# Re",ae!ent Behavior Strategies Wor1sheet

Setting andor Hi%tory

'ent or A$ti'ity

)redi$tor or 9rigger

(Ante$edent4

Repla$ement 0e3a'ior

(tae% t3e pla$e of t3eunde%ired be3a'ior4

*e%ired 0e3a'ior Re%ult

6aintaining $on%e@uen$e

Setting andor Hi%tory'ent or A$ti'ity


Repla$ement 0e3a'ior (tae% t3e pla$e of t3eunde%ired be3a'ior4



Setting andor Hi%tory'ent or A$ti'ity


Repla$ement 0e3a'ior (tae% t3e pla$e of t3eunde%ired be3a'ior4




17/20

List Strategies that Ma1e the ro',e! Behavior Irre,evant0 Ine##etive0 D Ine##iient

Setting Event

Strategies

reditor

Strategies

Teahing

Strategies

Conse(uene

Strategies


18/20

Bui,ding a Su""ort ,an

*e%ired 0e3a'ior 2on%e@uen$e%

Setting 'ent% )redi$tor% )roblem 0e3a'ior

Repla$ement 0e3a'ior 6aintaining 2on%e@uen$e%

)re'ention )re'ention &nter'ention>3at are way% to $3ange t3e

$onte5t to mae t3e problem

be3a'ior unne$e%%aryC

>3at are way% to pre'ent t3e problem

be3a'iorC

>3at $an be done to in$rea%e

e5pe$ted be3a'ior% or to tea$3 a

repla$ement be3a'iorC

>3at %3ould 3appen w3en

de%ired or repla$ement

be3a'ior o$$ur%C

>3at %3ould 3appen w3en a problem be3a'ior

o$$ur%C (>3at %trategie% from t3e pre'iou%

page would you u%e w3en t3e be3a'ior o$$ur%2larify rule% and e5pe$ted Reminder% about be3a'ior )ra$ti$e e5pe$ted be3a'ior in $la%% Reward programC

be3a'ior for w3ole $la%% w3en problem be3a'ior i% liely Self:management program )rai%e from tea$3er

>ritten $ontra$t wit3 t3e Student% )ro'ide e5tra a%%i%tan$e Ot3er gi&e 'rom'ts for eA'ected beha&ior/ Ot3er

Student %elf:manipulator %3eet 6odify a%%ignment% to mat$3 %tudent %il l%

23ange %eating arrangement%

23ange %$3edule

2oun%eling

Ot3er e.g.B more slee' at home/ Ot3er e.g.B shorter assignments) more time/


19/20

Behavior Su""ort ,an

Student Name+

*O0+

*ate of )lan+

9ea$3er(%4+

)arti$ipant(%4+

9. Target Behavior/s% /state the "ro',e! 'ehavior in o'serva',e and !easura',e ter!s%$

;. Media, *istor)6Mediation6Menta, *ea,th &iagnosis$

>. *)"othesis/es% /re#er to Ta',e 9%$

?. Current Leve, o# Funtioning /state the #re(uen)0 intensit)0 and duration o# the 'ehavior 'ased

@. 3oa,s D O'7etives /in,ude state!ent o# Re",ae!ent Behaviors and &esired Behavior Resu,ts%$

. &ata Co,,etion Method$

. revention Ativities /re#er to Bui,ding a Su""ort ,an%$

. Intervention Ativities /re#er to Bui,ding a Su""ort ,an%$

. Crisis Manage!ent roedures$

9. Res"onsi'i,ities$93e following %taff will be managing t3e o'erall implementation of t3e plan+

>3o notifie% ot3er %taff of t3eir re%pon%ibilitie%C

i%t pre'ention and inter'ention %tep% and t3o%e indi'idual% re%pon%ible for ea$3+

)re'ention Step Re%pon%ible )er%on &nter'ention Step Re%pon%ible )er%on


20/20

99. Re(uired !ateria,s0 training0 and sta## to i!",e!ent ",an$

a. 6aterial%+

b. 9raining+

$. Staff+

9;. Fo,,o+2u" ,ans$

>3o will meet again and w3en+

our %ignature indi$ate% you are aware of and are in agreement wit3 t3e implementation of t3i% plan.

)arent /uardianSurrogate 9ea$3er

Student 9ea$3er

S$3ool )%y$3ologi%t )rin$ipal

Agen$y Repre%entati'e Agen$y Repre%entati'e

Ot3er :9itle Ot3er :9itle

functional assessment interview and observation

Documents