Fba Sample
Student __Thomas Jones__________________________ Age ___13_____ Sex ___M____Teacher(s) __Ms. Gilbow / Team B______________________ Grade ____6th___________Case Manager _Mrs. Brantley____________________________ Date(s) ___4/17/00_____
Reason for intervention plan:
Tom’s behavior often disrupts class. Yesterday he threw a dictionary across the room, knocked over his desk, kicked it, and began yelling obscenities at the teacher and the other students in the class (LD resource room). The teacher had to call for help from his ED resource room teacher to calm him down and safely remove him from the classroom.
Participants (specify names): (x) student __Tom________________________(x) family member_Mrs. Jones______________(x) special educator Ms. Gilbow_____________( ) general educator_______________________( ) peer(s)_______________________________ | ( ) special education administrator_____________(x) general education administrator_Mr. Scott____( ) school psychologist ______________________( ) other agency personnel _________________________________________________________ | ( ) other (specify) ___________________________________________________________________________________________________________________________________________________ | Fact Finding General learning environment: Describe the student’s school class schedule, including any special programs or services.
Tom receives special education to provide support for his emotional difficulties and learning disability in two resource rooms. These classes provide instruction in math, language arts, reading, social skills, and social studies. He is in the regular classroom for specials, lunch, and science. He rides a special bus with a paraprofessional to school. Problem behavior: Define the problem behavior(s) in observable, measurable, and countable terms (i.e., topography, event, duration, seriousness, and/or intensity). Include several examples of the behavior.
Thomas has
Reason for intervention plan:
Tom’s behavior often disrupts class. Yesterday he threw a dictionary across the room, knocked over his desk, kicked it, and began yelling obscenities at the teacher and the other students in the class (LD resource room). The teacher had to call for help from his ED resource room teacher to calm him down and safely remove him from the classroom.
Participants (specify names): (x) student __Tom________________________(x) family member_Mrs. Jones______________(x) special educator Ms. Gilbow_____________( ) general educator_______________________( ) peer(s)_______________________________ | ( ) special education administrator_____________(x) general education administrator_Mr. Scott____( ) school psychologist ______________________( ) other agency personnel _________________________________________________________ | ( ) other (specify) ___________________________________________________________________________________________________________________________________________________ | Fact Finding General learning environment: Describe the student’s school class schedule, including any special programs or services.
Tom receives special education to provide support for his emotional difficulties and learning disability in two resource rooms. These classes provide instruction in math, language arts, reading, social skills, and social studies. He is in the regular classroom for specials, lunch, and science. He rides a special bus with a paraprofessional to school. Problem behavior: Define the problem behavior(s) in observable, measurable, and countable terms (i.e., topography, event, duration, seriousness, and/or intensity). Include several examples of the behavior.
Thomas has