Prevent-Teach-Reinforce Fidelity Checklist for Individualized (FBA) Implementation Process Instructions: Indicate whether or not the following activities occurred in the development of intervention strategies to address your student’s problem behaviors. Was a team (defined as at least one other person other than the teacher) formed to discuss the behavior and develop plans for intervention? YES NO Did the team include the student or was student input considered at each step of the process? YES NO Did the team identify and define a minimum of one problem behavior to be decreased? YES NO Did the team identify and define a minimum of one appropriate/alternative behavior to be increased? YES NO Did the team come to consensus on the behaviors identified, the definitions, and the progress-monitoring method? YES NO Was a daily progress-monitoring data system established to measure occurrence of problem and appropriate behaviors identified for decrease and increase? YES NO Did the data measure have a minimum of 3 days of baseline data? YES NO Did the teacher and the student provide input on the functional behavior assessment? YES NO Did the functional behavior assessment result in a hypothesis statement or summary that included the target behavior and the triggers (antecedents) and the function based on consequences that follow problem behavior? YES NO Did the team come to consensus on the hypothesis statement? YES NO
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
Step 2: PTR Functional Behavior Assessment Summary Table: “Cheat Sheet” Student: ____________________________ School: ___________________________________ Date: _____________________ Behavior Prevent (Antecedent) 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 or other sources that provide the replacement behaviors; (if student PTR used, items #7, 8, 9). 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).
Provided verbal praise Provided reinforcement for surpassing goal Reinforce asking to be excused Provide 1 minute break each time Isaiah asks to be excused Discontinue reinforcement of problem behavior Got Isaiah’s attention and used agreed upon signal when Isaiah stops Waited for Isaiah’s attending response Tapped activity on teacher copy of checklist to remind Isaiah to be engaged Sidebar in hallway if Isaiah stops again Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA Y / N / NA 1 2 3 4 5 1 2 3 4 5 Behavior Plan Assessment Implementation: Total # of Y/Y + N total