Functional Assessment Checklist for Teachers and Staff (FACTS-Part A)
Problem in Picture Form (Pro-form)
Step1
Step 2
Step 3
Student/Grade: Eddie “Shane” McDowell
Date: Nov 3, 2005
Interviewer: Ms. Jones, Mr. Stanly, Principal Johnson Respondent(s):
Mr. Willson
Student Profile: Please identify at least three strengths or contributions the student brings to school.
Eddie can be a very pleasant child, he does well in his art class
and he is good at sports
Problem Behavior(s): Identify problem behaviors
__Tardy
 Fight/Physical Aggression
__Unresponsive _Inappropriate Language
__Withdrawn
__Verbal Harassment
__Verbally Inappropriate
 Disruptive
__Insubordination
__Work not done
__Self-injury
__Theft
__Vandalism
__Other_________________
Describe problem behavior: ___________________________________________________________
Step 4
Identifying Routines: Where, When and With Whom Problem Behaviors are Most
Likely.
Schedule
Activity
Likelihood of Problem
Specific Problem
(Times)
Behavior
Behavior
8:30 –9:15
Language
Low
1
9:15-9:21
Transition
Reading
10:05-10:11
Transition
Low
10:11-11:03
Math/Science
Low
1
1
Lunch
Art
Transition
3
4
5
2
3
4
5
Threat s swear
6
High
Harassment
6
High
Threat, Harassment
6
High
2
3
4
5
6
High
2
3
4
5
6
2
3
4
5
6
2
3
4
5
2
3
4
5
High
Swear, aggression
Threat s swear
High
Low
1
Step 5
2
Low
1
12:30-12:36
5
Low
1
11:44-12:30
4
Low
1
11:03-11:44
3
Low
1
9:21-10:05
High
2
6
High
6
Select 3-1 Routines for further assessment: Select routines based on (a) similarity of
activities (conditions) with ratings of 4,5 or 6 and (b) similarity of problem behavior(s).
Complete the FACTS-Part B for each routine identified.
March, Horner, Lewis-Palmer, Brown , Crone, Todd & Carr (2000)
Functional Assessment Checklist for Teachers & Staff (FACTS-Part B)
Student/Grade: _Eddie McDowell. _________
Date:______Nov 3, 2005______
Interviewer: Ms. Jones Respondent(s): Mr. Willson, Mr. Stanly, Principal Johnson
Routine / Activities / Context: Which routine (only one) from the FACTS-Part A is assessed?
Step 1
Step2
Routine/Activities/Context
Problem Behavior(s)
Academic times
Threat, swear, aggression
Provide more detail about the problem behavior(s):
Step 3
What does the problem behavior(s) look like? Threat/Swear = name calling,
sexually Inappropriate comments, loud voice, intimidating gestures
How often does the problem behavior(s) occur? Everyday
How long does the problem behavior(s) last when it does occur? Arguing/threats
continues 3-5 And can lead to fight
What is the intensity/level of danger of the problem behavior(s)? teasing- low intensity
What are the events that predict when the problem behavior(s) will occur? (Predictors)
Related Issues (setting events)
Environmental Features
__illness
Other:____________
__reprimand/correction  structured activity
__drug Use
________________
__physical demands
__unstructured time
negative social ________________
__socially isolated
 tasks too boring
__conflict at home ________________
 with peers
 activities too long
_academic failure ________________
__Other
_______________________
Step 4
What consequences appear most likely to maintain the problem behavior(s)?
Things that are Obtained
Things Avoided or Escaped From
__adult attention
Other:_______________
 hard tasks
Other:_____________
 peer attention
_____________________ __reprimands
__________________
__preferred activity _____________________
__peer
negatives
__________________
__money/things
_____________________
Step 5
__physical effort __________________
__adult attention __________________
SUMMARY OF BEHAVIOR
Step
Identify the summary that will be used to build a plan of behavior support.
Setting Events & Predictors
Problem Behavior(s) Maintaining Consequence(s)
6
Given structured
academic (math)
situations
Step
7
Step 8
Threat
Swear
Aggression
Escape hard tasks
How confident are you that the Summary of Behavior is accurate?
Not very confident
1
2
3
4
5
Very confident
6
What current efforts have been used to control the problem behavior?
Strategies for preventing problem behavior(s)
Strategies for responding to problem behavior
__Schedual Change
__Seating Change
__Curriculum Change
Other:Precorrect
tell him to work
& talk nicely
__Reprimand
Other: send to office
__Office Referral
_______________________
 Detention
________________________
March, Horner, Lewis-Palmer, Brown , Crone, Todd & Carr (2000)