Step 1: Individualized Behavior Rating Scale Tool (IBRST) Student: School: Teacher(s): Target Behavior Date 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 KEY: Problem Behavior : Definition Time/Routine: All day Specific Time/Routine: 5 = Terrible day 4 = Typical bad day 3 = So-so day 2 = Good day 1 = Fantastic day Replacement/Alternate Desired Behavior; Definition Time/Routine: All day Specific Time/Routine: 5 = Fantastic day 4 = Good day 3 = So-so day 2 = Typical bad day 1 = Terrible day
___ Recognizing need for help ___ Asking for help ___ Using visual supports to work independently ___ Ignoring peers ___ Graphic organizers ___ Note-taking strategies ___ Assignment management ___ Working with a peer ___ Move ahead to easier items then go back to difficult items ___ Staying engaged ___ Working independently ___ Making an outline ___ Self-management ___ Making choices from several appropriate options Others: __________________________________________________________________________ 9. What communication skill(s) could the student learn in order to reduce the likelihood of the problem behavior occurring in the future? ___ Asking for a break ___ Expressing emotions (frustration, anger, hurt) ___ Requesting information ___ Raising hand for attention ___ Requesting wants ___ Rejecting ___ Active listening ___ Asking for help ___ Commenting ___ Responding to others Others: ___________________________________________________________________________ Additional comments not addressed above in the Teach Component. PTR Functional Behavior Assessment: Reinforce Component
___ Recognizing need for help ___ Asking for help ___ Using environmental supports to work independently ___ Ignoring peers ___ Graphic organizers ___ Note-taking strategies ___ Assignment management ___ Working with a peer ___ Moving ahead to easier items then going back to difficult items ___ Staying engaged ___ Working independently ___ Making an outline ___ Self-management ___ Making choices from several appropriate options Others: __________________________________________________________________________ 9. What communication skill(s) could the student learn in order to reduce the likelihood of the problem behavior occurring in the future? ___ Asking for a break ___ Expressing emotions (frustration, anger, hurt) ___ Requesting information ___ Raising hand for attention ___ Requesting wants ___ Rejecting appropriately ___ Active listening ___ Asking for help ___ Commenting ___ Responding to others Others: ___________________________________________________________________________ Additional comments not addressed above in the Teach Component. PTR Functional Behavior Assessment: Reinforce Component 1. What consequence(s)/responses of others usually follow the student’s problem behavior?
PTR Functional Behavior Assessment Summary Table: Cheat Sheet Student: ____________________________ School: ___________________________________ Date: _____________________ Behavior Antecedent/Prevent Data Function/Teach Data Consequences/Reinforce Data Problem behavior Name of problem behavior Include information from the Prevent component of the PTR assessment (items #1a, 2a, 3a, 4, 5, 6) Include information from the Teach component of the PTR assessment (items #1 through #6) Include information from the Reinforce component of the PTR assessment (items #1 & 4) Appropriate behavior Name of pro-social or replacement behavior Include information from the Prevent component of the PTR assessment (items #1b, 2b, 3b) Include information from the IBRST (behaviors to increase) and information related to instruction of replacement behaviors (e.g., skill vs. performance deficit) Include information from the Reinforce component of the PTR assessment (items #2, 3, & 5) Possible Hypotheses When…. He/she will….. As a result, he/she …… Problem Behavior Include the relevant data from the problem behavior prevent data above Behavior being evaluated Function (from problem behavior teach data) Replacement Behavior Copy what you have in the row above (problem behavior when) Write in the new behavior/skill or, replacement behavior Copy what you have in the row above (problem behavior function). PTR Form 4b
Interventions PREVENT Implemented Impact Y / N / NA 1 2 3 4 5 TEACH Replacement behavior Y / N / NA 1 2 3 4 5 REINFORCE Reinforce replacement behavior Y / N / NA 1 2 3 4 5 Behavior Plan Assessment: Y/Y + N total