___ Yes List the specific non-preferred tasks or activities__________________________________ ___ No 6. Does the seem to be exhibited in order to a non-preferred classmate or get away from (problem behavior) adult? ___ Yes List the specific peers or adults________________________________________________ ___ No 7. What behaviors could the student be taught to do that would help meet academic goals? Select 3-5 behaviors that would academically enable the student to participate and meet academic goals. Study skills Homework completion Work productively (complete and Socially engage (e.g., working Organizational strategies turn in assignments) cooperatively with peers, Attend class Time management cooperate) Self-regulation (controls temper, Arrive to class on time Participate, persist, and be obeys rules, copes with stress) engaged Additional comments not addressed above in the Teach Component. PTR Functional Behavior Assessment Secondary: Reinforce Component 1. What typically happen immediately after the consequence(s)/responses of others (problem student’s Select the top 3-5 that adults and/or peers almost always do immediately after the problem behavior)? behavior. ___ Sent to time-out ___ De-escalation (e.g., LSCI or other) ___ Verbally reprimanded ___ Sent to crisis room ___ Sent to behavior specialist/counselor ___ Verbally redirected ___ Asked to put head ___ Assistance given ___ Stated rules down ___ Allowed to delay activity ___ Physically prompted ___ Sent to office/ODR ___ Changed the activity ___ Peers react (laugh, make ___ ISS ___ Ended the activity comments) ___ OSS ___ Calmed/soothed ___ Physically restrained ___ Ignored ___ Removed reinforcers ___ Natural consequences (Specify)
___ Yes List the specific non-preferred tasks or activities__________________________________ ___ No 6. Does the (problem behavior) seem to be exhibited in order to get away from a non-preferred classmate or adult? ___ Yes List the specific peers or adults________________________________________________ ___ No 7. What behaviors could the student be taught to do that would help meet academic goals? Select 3-5 behaviors that would academically enable the student to participate and meet academic goals. Study skills Socially engage (e.g., working cooperatively with peers, cooperate) Participate, persist, and be engaged Homework completion Organizational strategies Attend class Self-regulation (controls temper, obeys rules, copes with stress) Work productively (complete and turn in assignments) Time management Arrive to class on time Additional comments not addressed above in the Teach Component. PTR Functional Behavior Assessment Secondary: Reinforce Component 1. What consequence(s)/responses of others typically happen immediately after the student’s (problem behavior)? Select the top 3-5 that adults and/or peers almost always do immediately after the problem behavior. ___ Sent to time-out ___ Sent to crisis room ___ Asked to put head down ___ Sent to office/ODR ___ ISS ___ OSS ___ Ignored ___ De-escalation (e.g., LSCI or other) ___ Sent to behavior specialist/counselor ___ Assistance given ___ Allowed to delay activity ___ Changed the activity ___ Ended the activity ___ Calmed/soothed ___ Verbally reprimanded ___ Verbally redirected ___ Stated rules ___ Physically prompted ___ Peers react (laugh, make comments) ___ Physically restrained ___ Removed reinforcers ___ Natural consequences (Specify)