Step 2: PTR Functional Behavior Assessment Summary Table: “Cheat Sheet” Student: ____________________________ School: ___________________________________ Date: _____________________ Behavior Prevent (Antecedent) Data Function (Teach) Data Consequences (Reinforce) Data Include information from the Include information from the Include information from the Prevent component of the PTR Teach component of the PTR Reinforce component of the PTR assessment (items #1a, 2a, 3a, 4, 5, assessment (items #1 through #6) assessment (items #1 & 4) problem 6) behavior of Name Problem behavior Include information from the Include information from the Include information from the Prevent component of the PTR IBRST or other sources that Reinforce component of the PTR assessment (items #1b, 2b, 3b) provide the replacement behaviors; assessment (items #2, 3, & 5) (if student PTR used, items #7, 8, pro-social replacement of 9). Appropriate Name behavior or behavior Possible Hypotheses As a When…. He/she will….. result, he/she …… Include the relevant data from the problem Behavior being evaluated Function (from problem behavior behavior prevent data above teach data) Problem Behavior Copy what you have in the row above (problem Write in the new behavior/skill or, Copy what you have in the row behavior when) replacement behavior above (problem behavior function). Behavior Replacement
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).
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