Functional Behavioral Assessment (FBA) Report

Client/Student Name: [Client/Student Name]

Date of Birth: [DOB]   Age: [Age]

ID Number: [MRN or Student ID]

Grade: [Grade / N/A]

Assessment Location(s): [Location(s)]

Assessment Dates: [Start Date] – [End Date]

Report Date: [Report Date]

Primary Assessor: [Name, Credentials, Role]

Contributing Team Members: [Names and Roles]

Consent: [Consent source, date, or policy basis for proceeding]

Reason for Referral: [1–3 sentence description of why FBA was initiated] (Use neutral, observable language.)

Referral Context and Background

Clinical/Referral Questions:
[Question 1]
[Question 2]
[Question 3] (Phrase as answerable questions.)

Strengths and Protective Factors: [Preferred activities, known reinforcers, successful routines, social strengths]

Relevant History: [Developmental considerations, communication profile, sensory profile, recent transitions, current stressors] (Include only if plausibly related to behavioral function or safety. If unavailable, document what was attempted.)

Medical/Biological Variables: [Current medications, recent changes, pain/illness indicators, sleep, GI concerns] (If not relevant or unknown, state as such.)

Prior Interventions and Response: [What was tried, setting/context, implementation fidelity if known, observed effects] (If unknown, document who was asked.)

Target Behavior(s)

(Repeat for each target behavior. Use objective, bias-free, observable language.)

Behavior Name/Label: [Behavior Name]

Operational Definition – Topography: [What the behavior looks and sounds like in observable terms]

Boundaries (Start/Stop Criteria): [What counts as an occurrence; onset and offset rules]

Intensity Anchors: [Mild / Moderate / Severe with objective anchors] (Include only if relevant to measurement or safety.)

Exclusions: [Similar behaviors explicitly not included]

Measurement Approach: [Primary metric: frequency / rate / duration / latency / interval / ABC narrative], [Observation windows], [Settings]

Replacement Behavior: [Defined replacement behavior] (If not yet identified, state that it will be determined following hypothesis confirmation.)

Assessment Methods and Data Sources

Assessment Window and Coverage: [Dates, settings observed, any meaningful gaps in coverage]

Indirect Data:

• [Interviews: who, date, format]
• [Rating scales/checklists: name, version, respondent]
• [Anecdotal reports: source and noted limitations]

Direct Data:

• [ABC observations: where, when, number of sessions observed]
• [Scatterplots/time sampling: interval length, number of days, contexts]
• [Event recording/duration/latency measures: metric, total observation time]

(If direct observation was not feasible, state explicitly and note that hypotheses are preliminary.)

Record Review: [Attendance, discipline records, prior evaluations, health records] (Summarize without reproducing content.)

Functional Analysis: [Conditions tested, procedures used, brief results] (Clearly distinguish from descriptive FBA. If not conducted, briefly state why.)

Data Quality and Reliability: [Interobserver agreement approach and results] (If IOA not collected, note as a limitation.)

Findings

(Summarize decision-ready patterns. Use separate subsections per behavior.)

Behavior: [Behavior Name]

Baseline Summary: [Typical frequency or rate], [Variability], [Duration/latency if measured], [Peak times/settings]

Occurrence Conditions: [Contexts, tasks, settings, times when behavior occurs]

Non-Occurrence/Protective Conditions: [Contexts where behavior does not occur or occurs less]

Antecedent Patterns: [Immediate triggers: task demands, transitions, denied access, peer interactions, sensory input] [Setting events: sleep deprivation, illness, schedule changes] (Include only when supported by data.)

Consequence Patterns: [Typical responses following behavior] (Distinguish correlation from confirmed maintaining variables.)

Skill Deficits/Competing Pathways: [Evidence of missing skills contributing to behavior: functional communication, tolerance, task persistence, coping]

Hypothesis Statement(s)

(Provide a separate hypothesis for each target behavior. Label all functions as hypothesized unless experimentally demonstrated.)

Behavior: [Behavior Name]

Hypothesis Statement: When [setting event, if applicable] and when [antecedent/trigger], the client [operationally defined behavior], which results in [typical consequence], and the behavior is hypothesized to function to [obtain / escape] [specific reinforcer].

Function Category: [obtain attention / obtain tangibles-activities / escape-avoid demands or situations / automatic-sensory]

Competing Hypotheses: [Alternate function(s) ranked with rationale] (Include only if multiple functions are plausible.)

Confidence Rating: [high / moderate / low] – [Brief justification based on data convergence]

Alternative Explanations: [Skill deficit vs. refusal, medical contributors, sensory sensitivity, trauma-related factors] (Note what evidence would confirm or refute each.)

Recommendations

(Organize by target behavior or by hypothesized function.)

Safety and Crisis Considerations: [De-escalation strategies, environmental modifications, supervision levels] (If restrictive procedures may be required, document rationale, least-restrictive considerations, training requirements, and monitoring plan.)

Antecedent/Prevention Strategies: [Strategy], [Trigger targeted], [Implementation steps], [Expected mechanism linked to hypothesized function]

Teaching and Skill Development: [Replacement behavior(s) to teach], [Teaching format], [Mastery criteria], [Generalization plan]

Consequence Strategies: [Reinforcement plan aligned with function] (If extinction or response cost is proposed, specify conditions, safeguards, and monitoring.)

Response During Escalation: [Early warning signs], [Stepwise staff actions], [What to avoid given maintaining function]

Data Collection and Progress Monitoring: [Ongoing metrics], [Collection schedule], [Who collects], [Decision rules for plan modification]

(These recommendations are intended to inform a Behavior Support Plan or Behavior Intervention Plan.)

Limitations

• Limitation: [Constraint or deviation] | Likely Impact: [Impact on conclusions] | Mitigation: [Next step]
• Limitation: [Constraint or deviation] | Likely Impact: [Impact on conclusions] | Mitigation: [Next step]

Follow-Up Plan

(Include when hypothesis confidence is low or moderate, or when additional assessment is indicated.)

Additional Observations Needed: [Next observation targets and settings]

Functional Analysis: [Recommended / Not recommended] (If recommended, specify safeguards and conditions to test.)

Timeline for Review: [Date or interval for data review]

Criteria for Hypothesis Confirmation: [Decision rules sufficient to proceed with intervention]

Signatures

Assessor Signature: [Name and signature]

Credentials: [Credentials]

Date Signed: [Date]

Time Documentation: [Face-to-face assessment time], [Non-face-to-face time] (Include per setting requirements.)