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Section I: Description
Data sources: Observation
Date: October 7, 2015
Grade: 1st
Assessed by: Sarah Emmott
Gain attention
Hypothesis:
When unstructured/free time occurs in the context of the classroom or recess the student
exhibits kicking in order to gain attention form the teacher. This behavior is more likely to occur when
the teacher is in low proximity.
Replacement or competing behavior that could still serve the same function for the student:
Prompting Damien to ask for high fives when he is with his peers to show what an
appropriate interaction looks like.
Is the replacement behavior in the students repertoire, or will it need to be taught directly?
Giving high fives is in Damiens repertoire. However, getting him to ask other peers for a
high five and teaching him how to play with them appropriately needs to be taught directly.
Grade: 1st
Age: 7
computer time
earned privileges
free time
positive visit to administrator
send to office
level drop/loss of points (token economy)
detention
escort to another area
out-of-school suspension
School administrator
Related service
provider (e.g., school
psychologist)
Parent
Additional Information:
n/a
Persons involved in developing/approving
plan:
Title
Date
continue interventions
discontinue
interventions
Signature
Review date:
achieved
outcome
Possible
Points
Points
Earned
10
POINT TOTAL
Note: Half a point will be deducted from any one part of the form that is not completed. If you
complete each section, you will earn full credit (5 points) for each of the assignments.