Forms and Links from Functional Behavioral Assessment: A Three Tiered Prevention Model
Filter, K. J., & Alvarez, M. E. (2012). Functional behavioral assessment: A three-tiered prevention model.
New York, NY: Oxford University Press.
| Forms | Brief Description | MS Word Document | PDF Document |
| Brief FBA interview | This form is used in Tier 2 of the FBA process for interviewing adults about student behavior | Brief FBA interview | Brief FBA interview |
| Developing interventions for FBA-BIP | This form is used in Tier 3 of the FBA process after the data collection is complete and the team is developing interventions for the FBA-BIP. | Developing interventions for FBA-BIP | Developing interventions for FBA-BIP |
| Developing Tier 1 FBA precision hypothesis statements | This form brings together the findings from the office discipline referrals from Tier 1 and is used to write a precision hypothesis statement. | Developing Tier 1 FBA precision hypothesis statements | Developing Tier 1 FBA precision hypothesis statements |
| Direct Observation Progress Monitoring System (DOPMS) | This is a time-sampling direct observation system that can be used to monitor student behavior progress during baseline and intervention. | DOPMS | DOPMS |
| Evaluating Tier 2 interventions in school | Teams use this form to review the Tier 2 interventions available in the school using criteria for quality. | Evaluating Tier 2 interventions in school | Evaluating Tier 2 interventions in school |
| FBA Teacher observation form | This is a simple form that can be used by teachers to record the antecedents, behaviors, and consequence for teach students behavior incident. | FBA Teacher observation form | FBA Teacher observation form |
| FBA-Behavior Intervention Plan (FBA-BIP) | After teams use the Developing interventions for FBA-BIP from, this 5-page document can be used for writing a comprehensive Tier 3 behavior intervention plan that matches the results of the FBA. The FBA-BIP also includes behavior goals and processes for monitoring behavior outcomes and fidelity of implementation. | FBA-BIP | FBA-BIP |
| FBA-Observation and Summary Form (FBA-OSF) | The FBA-OSF is a direct observation form that can be used during Tier 3 FBAs to record antecedents, behaviors, and consequence. | FBA-OSF | FBA-OSF |
| Student records review for Tier 2 | When reviewing records for Tier 2 FBAs, this form simplifies that recording process for summarizing the major findings. | Student records review for Tier 2 | Student records review for Tier 2 |
| Tier 1 FBA-based action planning | After teams have developed a precision hypothesis statement in Tier 1, this form is used to develop an intervention plan and includes information about behavior goals, persons responsible, and decisions made after reviewing outcome data. | Tier 1 FBA-based action planning | Tier 1 FBA-based action planning |
| Tier 2 FBA tracking and process form | This is a case management document for monitoring each student involved in the Tier 2 FBA process through the assessment and intervention phases. | Tier 2 FBA tracking and process form |
Links to other resources described in the book
| Resource | Brief Description | Link |
| Example Office Discipline Referral (ODR) forms | The ODR examples on this page are appropriate for FBA-based data collection in schools and include information about antecedents, behaviors, and consequences | https://www.pbisapps.org/search?query=resources |
| School-Wide Information System (SWIS) | An on-line database for entering and summarizing ODR forms for FBA-based decision-making | http://www.swis.org |
| Functional Assessment Checklist for Teachers and Staff (FACTS) | The FACTS is a structured interview for Tier 3 FBAs | https://www.pbis.org/tools/all-tools |
| Direct Behavior Ratings (BBRs) | DBRs are an alternative to direct observation for efficient progress monitoring | https://intensiveintervention.org/resource/direct-behavior-rating-overview |
