Harlingen Consolidated Independent School District
R.E.A.C.H. Recognizing Essential Abilities all Children Have
Functional Behavior Analysis Chart
Student Name: __________________________
Case Manager: ____________________________________________
Behavior being monitored:______________________________________________________________________________
Total number of days data was gathered: ____ Total number of incidents during data collection: ______
Average number of incidents daily: _________________ (Total number of incidents divided by the number of days data was collected)
Tally the number of incidents as they occur. Week of ____________________________ Monday Time of day/ Number of Incidents Tuesday Time of day/ Number of Incidents Wednesday Time of day/ Number of Incidents Thursday Time of day/ Number of Incidents Friday Time of day/ Number of Incidents
7:30 – 7:45 ___ 7:45 – 8:00 ___ 8:00 – 8:15 ___ 8: 15 – 8:45 ___ 8:45 – 9:00 ___ 9:00 – 9:15 ___ 9:15 – 9:45 ___ 9:45 – 10:00 ___ 10:00 – 10:15 ___ 10:15 – 10:30 ___ 10:30 – 10:45 ___ 10:45 – 11:00 ___ 11:00 – 11:15 ___ 11:45 – 12:00 ___ 12:00 – 12:15 ___ 12:15 – 12:30 ___ 12:30 – 12:45 ___ 12:45 – 1:00 ___ 1:00 – 1:15 ___ 1:15 – 1:30 ___ 1:30 – 1:45 ___ 1:45 - 2:00 ___ 2:00 – 2:15 ___ 2:15 – 2:30 ___ 2:30 – 2:45 ___ 2:45 – 3:00 ___ 3:00 – 3:15 ___ 3:15 – 3:30 ___ 3:30 – 3:45 ___ 3:45 – 4:00 ___ 4:00 – 4:15 ___ 4:15 – 4:30 ___ 4:30 – 5:00 ___
7:30 – 7:45 ___ 7:45 – 8:00 ___ 8:00 – 8:15 ___ 8: 15 – 8:45 ___ 8:45 – 9:00 ___ 9:00 – 9:15 ___ 9:15 – 9:45 ___ 9:45 – 10:00 ___ 10:00 – 10:15 ___ 10:15 – 10:30 ___ 10:30 – 10:45 ___ 10:45 – 11:00 ___ 11:00 – 11:15 ___ 11:45 – 12:00 ___ 12:00 – 12:15 ___ 12:15 – 12:30 ___ 12:30 – 12:45 ___ 12:45 – 1:00 ___ 1:00 – 1:15 ___ 1:15 – 1:30 ___ 1:30 – 1:45 ___ 1:45 - 2:00 ___ 2:00 – 2:15 ___ 2:15 – 2:30 ___ 2:30 – 2:45 ___ 2:45 – 3:00 ___ 3:00 – 3:15 ___ 3:15 – 3:30 ___ 3:30 – 3:45 ___ 3:45 – 4:00 ___ 4:00 – 4:15 ___ 4:15 – 4:30 ___ 4:30 – 5:00 ___
7:30 – 7:45 ___ 7:45 – 8:00 ___ 8:00 – 8:15 ___ 8: 15 – 8:45 ___ 8:45 – 9:00 ___ 9:00 – 9:15 ___ 9:15 – 9:45 ___ 9:45 – 10:00 ___ 10:00 – 10:15 ___ 10:15 – 10:30 ___ 10:30 – 10:45 ___ 10:45 – 11:00 ___ 11:00 – 11:15 ___ 11:45 – 12:00 ___ 12:00 – 12:15 ___ 12:15 – 12:30 ___ 12:30 – 12:45 ___ 12:45 – 1:00 ___ 1:00 – 1:15 ___ 1:15 – 1:30 ___ 1:30 – 1:45 ___ 1:45 - 2:00 ___ 2:00 – 2:15 ___ 2:15 – 2:30 ___ 2:30 – 2:45 ___ 2:45 – 3:00 ___ 3:00 – 3:15 ___ 3:15 – 3:30 ___ 3:30 – 3:45 ___ 3:45 – 4:00 ___ 4:00 – 4:15 ___ 4:15 – 4:30 ___ 4:30 – 5:00 ___
7:30 – 7:45 ___ 7:45 – 8:00 ___ 8:00 – 8:15 ___ 8: 15 – 8:45 ___ 8:45 – 9:00 ___ 9:00 – 9:15 ___ 9:15 – 9:45 ___ 9:45 – 10:00 ___ 10:00 – 10:15 ___ 10:15 – 10:30 ___ 10:30 – 10:45 ___ 10:45 – 11:00 ___ 11:00 – 11:15 ___ 11:45 – 12:00 ___ 12:00 – 12:15 ___ 12:15 – 12:30 ___ 12:30 – 12:45 ___ 12:45 – 1:00 ___ 1:00 – 1:15 ___ 1:15 – 1:30 ___ 1:30 – 1:45 ___ 1:45 - 2:00 ___ 2:00 – 2:15 ___ 2:15 – 2:30 ___ 2:30 – 2:45 ___ 2:45 – 3:00 ___ 3:00 – 3:15 ___ 3:15 – 3:30 ___ 3:30 – 3:45 ___ 3:45 – 4:00 ___ 4:00 – 4:15 ___ 4:15 – 4:30 ___ 4:30 – 5:00 ___
7:30 – 7:45 ___ 7:45 – 8:00 ___ 8:00 – 8:15 ___ 8: 15 – 8:45 ___ 8:45 – 9:00 ___ 9:00 – 9:15 ___ 9:15 – 9:45 ___ 9:45 – 10:00 ___ 10:00 – 10:15 ___ 10:15 – 10:30 ___ 10:30 – 10:45 ___ 10:45 – 11:00 ___ 11:00 – 11:15 ___ 11:45 – 12:00 ___ 12:00 – 12:15 ___ 12:15 – 12:30 ___ 12:30 – 12:45 ___ 12:45 – 1:00 ___ 1:00 – 1:15 ___ 1:15 – 1:30 ___ 1:30 – 1:45 ___ 1:45 - 2:00 ___ 2:00 – 2:15 ___ 2:15 – 2:30 ___ 2:30 – 2:45 ___ 2:45 – 3:00 ___ 3:00 – 3:15 ___ 3:15 – 3:30 ___ 3:30 – 3:45 ___ 3:45 – 4:00 ___ 4:00 – 4:15 ___ 4:15 – 4:30 ___ 4:30 – 5:00 ___
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Harlingen Consolidated Independent School District
R.E.A.C.H. Recognizing Essential Abilities all Children Have
Functional Behavior Analysis Hypothesis
Student Name: __________________________ Case Manager: ____________________________________________
Behavior being monitored:______________________________________________________________________________
Determine if there is a pattern in location: (Circle applicable contexts where behavior occurs) Assemblies Academics Art Bathroom Break Bus Area Center Work Computer Lab Gym/P.E. Large group work Small group work Whole group work Independent work Hallway Home Leisure Activities Library Lunchroom/Cafeteria Music Outside/Playground Snack time Speech room Story time Other: __________________
Determine if there is a pattern in previous circumstances: (Circle applicable antecedents prior to behavior occurring) Transition Denied Access Instruction New Task Teacher attention to others Given a directive Waiting Corrective Feedback Routine Task Choice Given Physical Prompt Redirection Attempt to communicate Down time Close physical proximity Non participation When challenged Other: __________________
Determine if certain behaviors are paired with certain consequences/outcomes: (Circle applicable consequence of behavior) Choice given Redirection Discussion of behavior Personal space given Change/delayed/stopped activity Ignored Peer attention Verbal reprimand Physical prompt Removal of materials Sent home Office referral Time-out Physical Restraint Other: __________________
Determine if certain consequences stop the behavior effectively: (Circle applicable reaction to consequence) Behavior stopped Behavior continued Behavior intensified Slept Apologized Cried Left room Self-stimulation Other: _____________________
Hypothesis: Based on an analysis of the student’s target behavior, _______________________________ appears to demonstrate ____________________________ during (name of student) (problem behavior) ______________________________ . The behavior appears to occur during _______________________________________, prior to (time that behavior appears to occur) (context) _________________________________ . Consequences include ___________________________________________________and are/are not effective. (antecedent) (consequences) (circle one) Student Intervention Plan: An intervention plan is recommended at this time. (See attached) An intervention plan is not recommended at this time.
For Intervention Plan: Target Goal:____________________________________________________________________________________________________________________ Intensity: Location: Whole class General Education Large Group (7 or more) Pull out Small group (6 -4) Both General Ed and Pull Out Very small group (3-2) Individual
Other: __________________________
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Harlingen Consolidated Independent School District
R.E.A.C.H. Recognizing Essential Abilities all Children Have
Student Intervention Plan (Behavior)
Date Student Name Student ID School Date of Birth Grade Start Date: ________________________________ End Date: ___________________ Target Goal: ______________________________________________________________________________________________________________________
Objective #1: Review Dates Intervention: Evaluation Code MP MP MP MP MP MP Review Dates Intervention: SP SP SP SP SP SP AP AP AP AP AP AP M M M M M M Progress Monitoring Comments Progress Monitoring Comments
Objective #2: Evaluation Code MP MP MP MP MP MP
MP- Minimal Progress
SP SP SP SP SP SP
AP AP AP AP AP AP
M M M M M M
AP – Adequate Progress M – Mastered
Evaluation Codes:
SP – Some Progress
After the review of the student’s progress, the following is recommended: Objective #1 Objective # 2 Continue Continue Revise Revise Discontinue Discontinue
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