Functional Assessment Checklist for Teachers and Staff (FACTS-Part A)
Student/ Grade: ______________________________ Date: ____________________________
Interviewer: _________________________________ Respondent(s): ____________________
Student Profile: Please identify at least three strengths or contributions the student brings to school.
___________________________________________________________________________________
___________________________________________________________________________________
Problem Behavior(s): Identify problem behaviors
___ Tardy ___ Fight/physical Aggression ___ Disruptive ___ Theft
___ Unresponsive ___ Inappropriate Language ___ Insubordination ___ Vandalism
___ Withdrawn ___ Verbal Harassment ___ Work not done ___ Other ________________
___ Verbally Inappropriate ___ Self-injury
Describe problem behavior: ____________________________________________________________
Identifying Routines: Where, When and With Whom Problem Behaviors are Most Likely.
Schedule
(Times)
Activity Likelihood of Problem Behavior Specific Problem Behavior
Low High
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
Select 1-3 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) 4/24/00
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Functional Assessment Checklist for Teachers & Staff (FACTS-Part B)
Student/ Grade: ______________________________ Date: ____________________________
Interviewer: _________________________________ Respondent(s): ____________________
Routine/Activities/Context: Which routine(only one) from the FACTS-Part A is assessed?
Routine/Activities/Context Problem Behavior(s)
Provide more detail about the problem behavior(s):
What does the problem behavior(s) look like?
How often does the problem behavior(s) occur?
How long does the problem behavior(s) last when it does occur?
What is the intensity/level of danger of the problem behavior(s)?
What are the events that predict when the problem behavior(s) will occur? (Predictors)
Related Issues (setting events) Environmental Features
___ illness Other:_________________
___ drug use ______________________
___ negative social ______________________
___ conflict at home ______________________
___ academic failure ______________________
___ reprimand/correction ___ structured activity
___ physical demands ___ unstructured time
___ socially isolated ___ tasks too boring
___ with peers ___ activity too long
___ Other ___ tasks too difficult
__________________
What consequences appear most likely to maintain the problem behavior(s)?
Things that are Obtained Things Avoided or Escaped From
___ adult attention Other: ________________
___ peer attention ______________________
___ preferred activity ______________________
___ money/things ______________________
___ hard tasks Other: ___________________
___ reprimands ________________________
___ peer negatives ________________________
___ physical effort ________________________
___ adult attention ________________________
SUMMARY OF BEHAVIOR
Identify the summary that will be used to build a plan of behavior support.
Setting Events & Predictors Problem Behavior(s) Maintaining Consequence(s)
How confident are you that the Summary of Behavior is accurate?
Not very confident Very Confident
1 2 3 4 5 6
What current efforts have been used to control the problem behavior?
Strategies for preventing problem behavior Strategies for responding to problem behavior
___ schedule change Other: ________________
___ seating change ______________________
___ curriculum change ______________________
___ reprimand Other: ___________________
___ office referral _________________________
___ detention _________________________
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The Functional Assessment Checklist for Teachers and Staff (FACTS):
Instructions
The FACTS is a two-page interview used by school personnel who are building
behavior support plans. The FACTS is intended to be an efficient strategy for initial
functional behavioral assessment. The FACTS is completed by people (teachers, family,
clinicians) who know the student best, and used to either build behavior support plans, or
guide more complete functional assessment efforts. The FACTS can be completed in a
short period of time (5-15 min). Efficiency and effectiveness in completing the forms
increases with practice.
How to Complete the FACTS-Part A
Step #1: Complete Demographic Information:
Indicate the name and grade of the student, the date the assessment data were
collected, the name of the person completing the form (the interviewer), and the name(s)
of the people providing information (respondents).
Step #2: Complete Student Profile
Begin each assessment with a review of the positive, and contributing
characteristics the student brings to school. Identify at least three strengths or
contributions the student offers.
Step #3: Identify Problem Behaviors
Identify the specific student behaviors that are barriers to effective education,
disrupt the education of others, interfere with social development or compromise safety at
school. Provide a brief description of exactly how the student engages in these behaviors.
What makes his/her way of doing these behaviors unique? Identify the most problematic
behaviors, but also identify any problem behaviors that occur regularly.
Step #4: Identify Where, When and With Whom the Problem Behaviors are Most
Likely
A: List the times that define the student’s daily schedule. Include times between
classes, lunch, before school and adapt for complex schedule features (e.g. odd/even
days) if appropriate.
B: For each time listed indicate the activity typically engaged in during that time
(e.g., small group instruction, math, independent art, transition).
C: Use the 1 to 6 scale to indicate (in general) which times/activities are most and
least likely to be associated with problem behaviors. A “1” indicates low likelihood of
problems, and a “6” indicates high likelihood of problem behaviors.
D: Indicate which problem behavior is most likely in any time/activity that is
given a rating of 4, 5 or 6.
Step #5: Select Routines for Further Assessment
Examine each time/activity listed as 4, 5 or 6 in the Table from Step #4. If
activities are similar (e.g., activities that are unstructured; activities that involve high
academic demands; activities with teacher reprimands; activities with peer taunting) and
have similar problem behaviors treat them as “routines for future analysis”.
Select between 1 and 3 routines for further analysis. Write the name of the
routine, and the most common problem behavior(s). Within each routine identify the
problem behavior(s) that are most likely or most problematic.
For each routine identify in Step #5 complete a FACTS-Part B
How to Complete the FACTS-Part B
Step #1: Complete Demographic Information:
Identify the name and grade of the student, the date that the FACTS-Part B was
completed, who completed the form, and who provided information for completing the
form.
Step #2: Identify the Target Routine
List the targeted routine and problem behavior from the bottom of the FACTSPart
A. The FACTS-Part B provides information about ONE routine. Use multiple Part
B forms if multiple routines are identified.
Step #3: Provide Specifics about the Problem Behavior(s)
Provide more detail about the features of the problem behavior(s). Focus
specifically on the unique and distinguishing features, and the way the behavior(s) is
disruptive or dangerous.
Step #4: Identify Events that Predict Occurrence of the Problem Behavior(s)
Within each routine what (a) setting events, and (b) immediate preceding events
predict when the problem behavior(s) will occur. What would you do to make the
problem behaviors happen in this routine?
Step #5: Identify the Consequences that May Maintain the Problem Behavior
What consequences appear to reward the problem behavior? Consider that the
student may get/obtain something they want, or that they may escape/avoid something
they find unpleasant.
Identify the most powerful maintaining consequence with a “1”, and other
possible consequences with a “2” or “3.” Do not check more than three options. The
focus here, is on the consequence that has the greatest impact.
When problems involve minor events that escalate into very difficult events,
separate the consequences that maintain the minor problem behavior from the events that
may maintain problem behavior later in the escalation.
Step #6: Build a Summary Statement
The summary statement indicates the setting events, immediate predictors,
problem behaviors, and maintaining consequences. The summary statement is the
foundation for building an effective behavior support plan. Build the summary statement
from the information in the FACTS-A and FACTS-B (Especially the information in Steps
#3, #4, and #5 of the FACTS-B). If you are confident that the summary statement is
accurate enough to design a plan move into plan development. If you are less confident,
then continue the functional assessment by conducting direct observation. Procedures for
completing the functional assessment, and for designing behavioral support are described
in the following references.
Step #7: Determine “Level of Confidence”
Use the 1-6 scale to define the extent to which you, the interviewer or the team
are “confident” that the summary statement is accurate. Confidence may be affected by
factors such as (a) how often the problem behavior occurs, (b) how long you have known
the focus person, (c) how consistent the problem behaviors are, (d) if multiple functions
are identified, and (e) if multiple behaviors occur together
Step #8: Define what has been done to date to prevent/control the problem behavior
In most cases, school personnel will have tried some strategies already. List
events that have been tried, and organize these by (a) those things that have been done to
prevent the problem from getting started, (b) those things that were delivered as
consequences to control or punish the problem behavior (or reward alternative behavior).