JSD 9/5/2007

Instructions for Using the FUBA and BIP Templates

10/07

1. The gray spaces on the template indicate areas that can be filled in; just click on the area and begin typing.
2. Do not type below the bottom line of the box: It will not print out.
3. You can type more than one line where there is space: It will move down to the next line. Just do not go below
the bottom line of the box you are in.
4. Page breaks are set and can not be altered so the document will always print out as it appears on the screen.
5. The data collection page (including review section) should be printed and data collected by hand on a
daily/weekly basis.
6. To print your finished document, click the print icon in the right hand corner on the light gray tool bar strip just
above the document. If you print from the File/Print menu, you will get the whole website screen or other
gobblygook.
7. Remember to save your new document under a new name so that you keep your template clean.
JSD 9/5/2007

FUNCTIONAL BEHAVIORAL ASSESSMENT (FUBA)

1) Student: N/A DOB: 05/06/10 Date: 05/24/19 Grade: 3rd School: Park Lane Elementary
Classification: Specific Learning Disability Date of Current IEP: 9/25/19
Date of Current Academic/Behavioral Assessment:      
Participants: Parents, SPED teacher, GenEd teacher,

2) List all behaviors of concern for this student: does not follow adult directions; does not complete work;      ;      ;      ;      ;      ;      .
Identify one TARGET BEHAVIOR: listening to adult directions
(State as an observable and measurable behavior from behaviors of concern list)

Baseline data on the TARGET BEHAVIOR indicates: (Frequency, intensity, duration, etc.) ACTUAL: 16 days between 4/29/19-5/21/19 he displayed an average
of 3 prompts per period per day. The average number of prompts per period per day ranged from 1 to 5+. MY DATA: 3 days (each for one period of the day)
average of 1.3 prompts range from 1 to 2 prompts.

3) ANTECEDENTS/TRIGGERS: What usually happens before the behavior?

EVENTS: What event/action usually occurs before PLACES/TIME: Where and when does the PEOPLE: Who is usually involved in and around
the behavior? (Check any that apply) behavior usually occur? (Check any that apply) the behavior? (Check any that apply)

An academic request Location: Across multiple settings Peer(s):      

A behavioral request to do or to stop Time of day: Most in the morning (subject      
Teased/aggression by another student related) Teacher(s): SPED and Gen Ed
Structure/location of classroom changed Academic subject: Math Whole Group, ELA Administrator:      
(transition, group time, recess) Resource Aide(s):      
Consequence imposed Person(s): Staff/Adults Other:      
Teacher occupied/unavailable Day of the week:       Other:      
Other:       Activity or Event: Staff input, Math & ELA
Other:      
Other:      

4) CONSEQUENCES/PAYOFF: What usually happens after the behavior? Payoff refers to how the student benefits from performing the behavior.
(Check any that apply)

Gains teacher attention Ignored by teacher

Gains peer attention/class disrupted Ignored by peers
Gains desired activity/item Avoids task/request/undesired activity
Gains control over situation Self-stimulation
Other:       Other:      
JSD 9/5/2007

FUNCTIONAL BEHAVIORAL ASSESSMENT (FUBA)

5) FUNCTIONAL ASSESSMENT: Looking over the data recorded on the previous page, what does the pattern of behavior indicate is the function of the
TARGET BEHAVIOR across all settings or class subjects? Why does this student keep doing this behavior? What does s/he get out of the behavior?

Escape: get out of an activity or away from a person or group Access to material, activities, control or power: something tangible the
Academic evaluation indicated that this student: student wants
does does not have an academic skill defcit
Sensory Stimulation: a self-reinforcing behavior such as thumb sucking,
Attention: peer attention, adult attention hand flapping, head banging

Determine the most common ANTECEDENT that occurs prior to the TARGET BEHAVIOR and Examples
determine what the “PAYOFF” is for the student. • When entering the room this student swears
When an undesired or difficult task is given by staff and calls other students names in order to gain
(ANTECEDANTS) attention and disrupt the class.
this student does not follow directions given by staff (complains, sits passively, makes excuses, argues,) • When it is independent work time this student
(State observable and measurable TARGET BEHAVIOR) puts his head down on his desk in order to avoid
doing work.
in order to avoid task preceived as difficult and gain control of situation
(PAYOFF) • When given a direction this student argues in
order to avoid the request or assignment.

6) REPLACEMENT BEHAVIOR: • Rather than swearing and calling people names,

I want this student to come in and sit quietly in
Identify a REPLACEMENT BEHAVIOR that the student can perform in place of the TARGET his seat in order to earn “free chat” time with his
BEHAVIOR when the ANTECEDENT occurs, in order to obtain the same PAYOFF. In other words, what peers when his work is complete.
do you want the student to do, instead of the TARGET BEHAVIOR, that will still earn him the same • Rather than putting his head down on his desk, I
PAYOFF? want this student to write his name on his paper
and independently start the first problem in
order to receive a point for starting his work that
Rather than not following directions given by staff(complaing, passively sitting, making excuses, arguing) will lead to earning a “Get out of an Assignment
(TARGET BEHAVIOR)
Free” ticket.
I want this student to Ask for a break • Rather than arguing with a direction, I want this
(State the REPLACEMENT BEHAVIOR)
student to look at me and say “OK” in order to
in order to gain control of the situation and take time away from the task earn a reduced assignment.
(PAYOFF)
JSD 9/5/2007

BEHAVIOR INTERVENTION PLAN (BIP)

7) PREVENTATIVE STRATEGIES:
List strategies or teaching techniques that can be used or environmental changes that can be made to prevent the TARGET BEHAVIOR from occurring. Review
the FUNCTIONAL ASSESSMENT for people, places, times, locations, and events that are ANTECEDENTS for the behavior.

Classroom token economy      

Panther Paws      
100's chart      
Resource token economy      

8) INSTRUCTIONAL STRATEGIES:
List the skills the student will need to learn/practice in order to perform the REPLACEMENT BEHAVIOR when needed. Identify who will teach the skills, when
they will be taught, and how rehearsal/practice will occur.

SKILLS TO BE TAUGHT: WHO TEACHES THE SKILLS: WHEN/WHERE SKILLS TAUGHT:

1. Ask to take a break 1. school psychologist 1. In psychologist's office
2.       2. resource teacher 2. In resource class
3.       3. gen ed teacher 3. In gen ed class
4.       4.       4.      

PRACTICE PROCEDURES: Briefly describe how skills will be taught, practiced, reinforced, and corrected.
Verbally praised for choosing to take a break
When he gets 3 prompts or less and finishes 50-100% of his work (per period od the day rewarded once before lunch and once at the end of the day) he will choose a reward from
his reward menu on his contract. He carries his contract with him to each classroom so that prompts and work task completion are properly tracked.
     
     
9) POSITIVE INCENTIVES:
List incentives the student can earn for increasing use of the REPLACEMENT BEHAVIOR. Consider primary reinforcers, preferred activities, privileges, social
activities and other personalized incentives. Review the FUNCTIONAL ASSESSMENT to make sure that the student is receiving the same PAYOFF that s/he
was getting from the TARGET BEHAVIOR.

earning rewards/privileges when 3 or less prompts are given and      

50-100% of work is completed      
           
           
JSD 9/5/2007

BEHAVIOR INTERVENTION PLAN (BIP)

10) CORRECTION PROCEDURES:
Create a hierarchy of consequences to be used when the student engages in the TARGET BEHAVIOR. The hierarchy should start with teacher procedures used
in the classroom and increase in severity of loss/restriction for the student. It is recommended that the initial consequence be the loss of a positive incentive that
could have been earned had the student engaged in the REPLACEMENT BEHAVIOR. The hierarchy should increase in small increments of severity. The
administrative procedures should also be listed as a hierarchy of consequences that build in small increments of severity.

CLASSROOM PROCEDURES: ADMINISTRATIVE PROCEDURES:

1. Classroom rules are followed and implemented 1. School rules are followed and implemented
2. What if chart 2. Think Time
3. Think time 3.      
4.       4.      
5.       5.      

11) LEAST RESTRICTIVE BEHAVIORAL INTEVENTIONS (LRBI):

Check any of the following Level III and IV Interventions that will be used in implementing this BIP. These interventions should be used according to the guidelines
specified in the USOE Special Education Least Restrictive Behavior Interventions (LRBI) Guidelines. The potential side-effects of each intervention are presented
in the LRBI Guidelines and should be discussed with parents. The LRBI Guidelines outline the use of Level III and IV interventions on a limited basis in the event of
an emergency situation. Interventions specified on the BIP, as well as other interventions in the LRBI Guidelines, can be used in an emergency situation.

Not Applicable
Forceful Physical Guidance:
Student is physically guided through the proper motions despite his/her resistance.
Seclusionary Time-Out:
Student is placed in a supervised setting for a specific period of time.
Manual Restraint:
The minimum amount of force necessary is used to hold/restrain a student only as long as the student is a danger to him/herself, others, or property.
Other:      
Possible Side Effects:      

DATA COLLECTION METHOD:

Not Applicable Other: Google sheets
Time-out Room Logs and Graphs Other:      
Manual Restraint Logs and Graphs Other:      
JSD 9/5/2007

DATA COLLECTION
12) DATA COLLECTION PROCEDURES: 13) INITIAL GOAL:
Who will manage the BIP? school psych, resource teacher,me (when there) Baseline data indicated that the student exhibited the TARGET BEHAVIOR 4
Who will evaluate and review daily progress with the student? times a period.
School psychologist, resource teacher, me (when there) Baseline data indicated that the student exhibited the REPLACEMENT
The REPLACEMENT BEHAVIOR to be counted is: BEHAVIOR 0 times a day.
Taking a break and asking for help
The TARGET BEHAVIOR to be counted is: Starting on (date)      , the goal will be for the student to demonstrate the
REPLACEMENT BEHAVIOR       times a       in order to earn a
prompts given/ times complained and work task completion
reinforcer.
How often, throughout the day, will the behaviors be counted and recorded?
Per period of his day
Who will count the behaviors for each time period?
The teacher at the time

14) CRITERIA FOR CHANGE:

1. If the plan is implemented accurately and there is no increase in the REPLACEMENT BEHAVIOR or no reduction in the TARGET BEHAVIOR in      
days, the plan will be reviewed and adjusted. (Recommendation: no more than 3 days)
2. If the student meets the daily/weekly goal for this behavior for       days/weeks, the plan will be reviewed and adjusted for higher rates of improvement.
(Recommendation: at least 3 days initially and increasing number of days with success)
3. When the student is performing the REPLACEMENT BEHAVIOR at       level and if s/he maintains that level for       days, the plan will be reviewed and
adjusted to include fading the BIP.
4. When the student is performing the REPLACEMENT BEHAVIOR at       level and if s/he maintains that level for       weeks, the plan will be reviewed for
possible termination.

15) REVIEW DATE:

The team will meet again on (date)       to review the data that has been collected and discuss the success of the BIP. At that time the BIP and data collection
procedures can be reviewed and adjusted as needed. Also at that time, the Review Update (at the bottom of the data collection graph will be completed. The
review procedure should continue until the BIP has been faded and is discontinued.
JSD 9/5/2007

PUTTING IT ALL TOGETHER

16) Briefly describe how the BEHAVIOR INTERVENTION PLAN works including antecedent strategies, reinforcement, and correction procedures:
     

17) AGREEMENT: Date:      

Signing below indicates that you understand the BIP and agree to implement your part of the plan, including collecting data and using it to make informed data-
based decisions on how to proceed.

Parent(s):       Classroom Teacher:      

      Special Educator:      

Student (if appropriate):       Guidance Specialist:      

Administrator:       Other:      

JSD 9/5/2007

DATA COLLECTION
It is recommended that this blank page be copied multiple times for continuous data collection and review updates.

DAILY DATA
Units of Measurement     
Dates

REVIEW UPDATE: Date:      

Participants Present:      
Analysis of Data: Desired decrease in TARGET BEHAVIOR Desired increase in REPLACEMENT BEHAVIOR
Undesired increase in TARGET BEHAVIOR Undesired decrease in REPLACEMENT BEHAVIOR
Action Needed: Continue plan Modify plan Plan for generalization
Discontinue plan due to:      
Notes: