Kevin Jackson Day 1 Activity Packet 1 Kevin Jackson

Kevin is a 7th grade student at 6th – 8th middle school. Kevin has a long history of academic difficulty and poor relationships with school staff. Kevin is described by school staff as being too disruptive for general education classes and because of fighting poses a safety risk. Kevin has a documented history of behavior problems at school and has been receiving special education services since the 3rd grade. He has a learning disability in reading and math and has been diagnoses with ADHD. Kevin is prescribed Ritalin (5 mg 3x daily). The ADHD may make it difficult for Kevin to pay attention for lengths of time and to follow multi- step directions. It is not know if the medicine wears off at a later time of the day. Kevin was abused by a neighbor as a young child. He demonstrates mistrust and skepticism toward most adults. Kevin lives with his mother, father, and younger brother. His father is a truck driver and typically away during the week but returns on the weekend. His mother works as a bus driver for the district and is very responsive to calls from the school.

Using the activity packet: 1. Page numbers are located at the top right hand corner of each page 2. On the bottom left hand corner of each page is a footer that tells you a brief name for the page you are looking at (e.g., ABC Recording Form – Math). 3. The packet contains the following: a. Functional Behavioral Assessment Report Worksheet for Kevin…………….pages 2-12 b. Functional Assessment Interview Tool ………………………………………...activity directions page 13 i. FAIT Summary Tool ………………………………………………………pages 14-17 ii. Parent FAIT ………………………………………………………………...pages 18-20 iii. Student FAIT ……………………………………………………………….pages 21-24 iv. Staff FAIT – Computers …………………………………………………..pages 25-27 v. Staff FAIT – LA/Math ……………………………………………………...pages 28-30 vi. Staff FAIT – PE……………………………………………………………..pages 31-33 vii. Staff FAIT – Science ………………………………………………………pages 34-36 viii. Staff FAIT – Social Studies ……………………………………………….pages 37-39 c. Office Discipline Referrals ………………………………………………………...directions page 40, ODRs pages 41-51 d. ABC Frequency Recording Forms ……………………………………………….directions page 51, completed tools pages 52-56 e. Interval Recording Forms …………………………………………………………directions page 56, completed tools . pages 57-61 Kevin Jackson Day 1 Activity Packet 2 FUNCTIONAL BEHAVIORAL ASSESSMENT WORKSHEET

Student: Kevin Jackson

Functional Assessment Completion Date: March 13 2006

Team Meeting Date: February 17 2006

People Present at Initial Team Meeting:

Name Role Name Role Mrs. Jackson Mother Mr. Kinney Social Studies Teacher Mrs. Patrick Science Teacher Mrs. Rodriguez Social Worker Mrs. McCarthy AP Special Education Mrs. Thompson School Psychologist Ms. Pierro Special Education Teacher

Functional Assessment Report Worksheet

1 Indicate all of the strengths, preferences, and learning style conditions suggested by team members

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions Kevin Jackson Day 1 Activity Packet 3

Friendly  Art Lessons/activities that: Helpful  Sports: basketball, football, Sociable skateboarding Encourage reflective thinking Organized  Comic books Use analytical skills Natural leader  Video games Involve building/constructing Liked by peers  Being the center of attention Involve applying concepts or Has lots of friends  Computers and electronics formulas Self starter Involve experiments or testing  Science Socially aware Use creative writing  Interacting with people – Follows directions Utilize the computer opportunities to socialize Honest Allow for artistic expression of Easygoing  Hanging out with friends concepts Attentive to instruction  Watching movies Kind to adults  Family dog Other: when he can do or learn Kind to other students  Listening to music something of interest to him Good sense of humor Other: when you use a highly Has a positive preferred incentive attitude/outlook Other: activities allowing for Good communication creative thinking skills Other: small group activities Hard worker Other: working with him 1:1 Other: athletic Other: does better when tasks are Other: asking good questions given to him one step at a time or Other: computer and electronics are organized for him Other: Other: when he doesn’t have a lot of stuff to keep track of

Functional Assessment Report Worksheet

Operational Definition of Problem Behavior 2

Behavior Definition Provide the group of Priority Level for Kevin Jackson Day 1 Activity Packet 4

List specific behaviors that comprise this behavior group behaviors a label for easy Intervention reference later Planning

1) Unprepared for class, not following directions, making noises, talking Classroom Disruption High to other students, debates over assignment or activity choices with teacher, not initiating work, getting out of his seat engaging in activities Medium other than what he should be doing, yelling out, making fun of other students, hitting, pushing, kicking, or bumping into students with or Low without objects (e.g., a notebook)

2) Pushing, shoving, throwing closed fist punches repeatedly that is Fighting/Physical Aggression High usually accompanied by yelling, cursing, and verbal threats Medium

Low

High

Medium

Low

Functional Assessment Report Worksheet Define the Behavior Escalation Sequence 3 Directions: For each of the behavior groups identified as a priority, define in sequence what the student/behavior looks like at each stage of the escalation cycle. Kevin Jackson Day 1 Activity Packet 5

Behavior Group 1: Behavior Group 2: Sequence of Escalation Classroom Disruption Fighting

Attending to teacher or work Quiet Calm and On Task Engaging in task Making comments or asking questions Same appropriate to task/situation Appears relaxed – minimal fidgeting, facial expression relaxed Friendly, polite, follows directions Fails to follow direction Increases in fidgeting Precursor Makes noises Comments become inappropriate or irrelevant Behaviors that signal a Inattentive to the situation problem is about to happen Talks to other students Makes fun of other students Not initiating work Getting out of his seat Uses a nasty tone with an increased volume Engaging in activities other than what he toward adults Agitated or Peak State should be doing Verbal threats (Problem Behavior) Yells out or talking very loudly Red faced and sweaty Debating with teacher Argues – has to have the last word Engages other students physically (e.g., Cursing bumping into them, kicking, hitting with a Making nasty or disrespectful comments notebook) Talking back to the teacher Physical altercation (pushing/hitting peer) Quiets down Red leaves face Sits down Stops arguing Calming Down Quiets down Sits down Summarize Frequency FBA Data Functional Assessment Report Worksheet 4 If you have more than one behavior group you will need to copy pages 5A – 5D, and 6 Kevin Jackson Day 1 Activity Packet 6

Directions: For each class, routine, or setting observed report the sum of how many times each antecedent, behavior, and consequence occurred during the observation time. Antecedents Consequences

k s s p g n g t e e g n d l k l r s c c u n o r n n Behavior Group o n a i i i i u i i o i a f t t n t o o a l k c r f k r i c c c a r W f

Classes, a e Being Observed: t C m

W f O e a t e o i G i

t s T r r r

r r i i a i

c o n D e i e p W

Routines, or e s t d e t D t

e m t v s e

t t

i e n m n d r i f t o o A n

Settings Classroom Disruption R e R n e E o a

N l e

e N r d l

e h / s a n S e a a

Observed: c p t e b o c p b a e o r r r o e A d L u o e e t o n T V N I c V C e L Math

Science

Social Studies

Language Arts

Summary across observations Average occurrence across observations

Comments: ______

Functional Assessment Report Worksheet 5A Kevin Jackson Day 1 Activity Packet 7 Additional Supportive Data that Describes Behavior Group 1

Duration Data _____ Duration data was collected for this FBA __X__ Duration data was not collected for this FBA (Complete summary below) (Go to next page)

Directions: List the classes, routines, or settings observed in the first column. Then list the amount of time each incident lasted. For multiple incidents, separate the minutes by a comma. In the last column, sum across incidents for each routine. Finally, calculate an average duration across observations

Classes, Sum the total time behavior Routines, or List the amount of time each incident of behavior occurred during this occurred during this Settings observation. Separate occurrences with a comma observation session across Observed: individual incidents of behavior

Average occurrence across observations

Comments: ______

5B Functional Assessment Report Worksheet Kevin Jackson Day 1 Activity Packet 8 Additional Supportive Data that Describes Behavior Group 1

Interval Data __X__ Interval data was collected for this FBA _____ Interval data was not collected for this FBA (Complete summary below) (Go to next page)

Directions: For each observation count the total number of intervals that behavior was present. Next count the total number of intervals for that observation period. Third, calculate the percentage of intervals behavior was present during the observation. Sum across the observations and then calculate the average percentage.

Report the number of intervals and percentage of time the behavior was present during Summary Average each class, routine, or setting observed across Occurrence observations Math Social Studies Science Language Arts N/A Across observations, the # of intervals / # of intervals / # of intervals / # of intervals / # of intervals / total # of total possible total possible total possible total possible total possible intervals / total intervals intervals intervals intervals intervals possible intervals / 60 / 60 / 60 / 60 / / 240

Comments: ______

5C

Functional Assessment Report Worksheet Kevin Jackson Day 1 Activity Packet 9 Additional Supportive Data that Describes Behavior Group 1

Latency Data _____ Latency data was collected for this FBA __X___ Latency data was not collected for this FBA (Complete summary below) (Go to next page)

Directions: For each type of request assessed, record the lapse of time for each opportunity and then calculate the average across opportunities.

Type of Response time Response time Response time Response time Response time Average Request for opportunity 1 for opportunity 2 for opportunity 3 for opportunity 4 for opportunity 5 Response Time

Comments: ______

Functional Assessment Report Worksheet 5D Kevin Jackson Day 1 Activity Packet 10 Additional Supportive Data that Describes Behavior Group 1

Anecdotal Data _X___ Anecdotal data was collected for this FBA _____ Anecdotal data was not collected for this FBA (Complete summary below) (Go to next page)

Date Location Time/Period Antecedent Behavior/Offense Consequence

5E Functional Assessment Report WorksheetHypothesis Statement for Behavior Group 1 Kevin Jackson Day 1 Activity Packet 11

Setting Events Antecedent Triggers What does the In Order to In Order to student do? Escape? OR Gain Access? (Behavior) The student wants to The student wants access escape because: to:

the work/expectation is attention and validation too hard of peers the learning material is attention and non preferred or validation of adults perceived as irrelevant control over the he/she wants to avoid situation being embarrassed predictability to know he/she wants to “save when preferred face” in front of friends items/events will be he/she is not sure of available what to do or what is predictability to know expected what comes next the environment is too stimulation or stimulating excitement wants to leave the classroom

Provide any addition Provide any addition explanation or information explanation or information that will help to understand that will help to understand the function: the function:

6A Functional Assessment Report WorksheetHypothesis Statement for Behavior Group 2 Kevin Jackson Day 1 Activity Packet 12

Setting Events Antecedent Triggers What does the In Order to In Order to student do? Escape? OR Gain Access? (Behavior) The student wants to The student wants access escape because: to:

the work/expectation attention and validation is too hard of peers the learning material attention and is non preferred or validation of adults perceived as irrelevant control over the he/she wants to avoid situation being embarrassed predictability to know he/she wants to “save when preferred face” in front of friends items/events will be he/she are not sure of available what to do or what is predictability to know expected what comes next the environment is too stimulation or Stimulation excitement wants to leave the classroom

Provide any addition Provide any addition explanation or information explanation or information that will help to understand that will help to understand the function: the function:

Functional Assessment Report Worksheet FAITs for Kevin 6B Kevin Jackson Day 1 Activity Packet 13

Staff FAIT for computers, PE, math/language arts, science, and social studies Parent FAIT Student FAIT Activity Directions:

Part 1

1. Review each of the completed FAITs for Kevin 2. Using the FAIT summary form (next page) fill in the information obtained on the FAITs for each person by: a. Listing out and grouping behaviors reported b. Summing the total responses across people for each item (write that number in the space in front of the item)

Stop and put this handout aside. We will come back to this activity later.

Part 2

1. What questions would you have for the team about their description of problem behaviors? Stop here. 2. What questions would you have for the team about their description of setting events and antecedents? Stop here. 3. What questions would you have for the team about how they respond to occurrences of behavior and motivation for behavior?

Functional Assessment Interview Tool: Summary Version

Student: ______Date Completed: ______

Problem Behavior and Definition Check off the level of Kevin Jackson Day 1 Activity Packet 14 List all of the behaviors team members reported. To the greatest extent possible try to group intensity team behaviors by common topography (e.g., hitting, punching, pushing are all examples of physical members reported aggression) the behaviors occur

Redirectable Repeated Unmanageable

Redirectable Repeated Unmanageable

Redirectable Repeated Unmanageable

Redirectable Repeated Unmanageable

Redirectable Repeated Unmanageable

Functional Assessment Interview What Works Well for the Student? Tool Summary Check off all the positives and successful learning conditions reported by team members. Write in reported preferences.

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions Kevin Jackson Day 1 Activity Packet 15

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable Encourage reflective thinking Organized Use analytical skills Natural leader Involve building/constructing Liked by peers Involve applying concepts or Has lots of friends formulas Self starter Involve experiments or testing Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: Kind to other students Good sense of humor Other: Has a positive attitude/outlook Other: Good communication skills Other: Hard worker Other: Other: Other: Other:

Functional Assessment Interview What Contributes to Occurrences of Problem Behavior? Tool Summary

Summary of antecedent triggers Kevin Jackson Day 1 Activity Packet 16 Number of Antecedents Number of Antecedents Responses Responses ______When asked to do a chore or helping task ______Transition at the beginning of a class/routine/activity ______When it is time to do academic work ______Unstructured situations or settings ______When told to do something non preferred ______When given a direction to follow ______When held to a time limit (e.g., curfew or time for class ______When corrected ______Tasks that are difficult or confuse the student ______When he/she can not have something they want ______When working/playing/entertaining independently ______Preferred peer group present ______When working in group activities ______When given an ultimatum ______Not prepared with materials ______When he or she is told “no” or stop ______Multi-step work or projects ______When there is a change in routine ______Lecture: with note taking OR without note taking ______When adult attention is on others ______Public response required (e.g., read aloud) ______When there are visitors to the setting ______Being teased or being joked around with ______Other:

Summary of consequences/responses/strategies tried

Number of Consequences/Responses Number of Consequences/Responses Responses Responses ______Give a non verbal cue (e.g., look at student) ______Deduct points from an assignment ______Verbally correct the student privately ______Send the student to an administrator ______Verbally correct the student publicly ______Other students laugh or “egg” the student on ______Help the student to get on task ______Give the student a pass to guidance or CST ______Speak to the student after class ______Have the student take a break ______Call the student’s parents ______Teacher assigned detention ______Take away recess or other free time ______Student gets out of or delays doing work ______Moved seat ______Provide a reminder of what is and isn’t appropriate in ______Student – teacher conference class ______Take a privilege away ______Try to explain and discuss the issue ______Let the student have what they are asking for ______Other:

Functional Assessment Interview ToolSummary Summary of reasons why people think behavior is occurring

Number of Reasons Why Behavior Occurs Number of Reasons Why Behavior Occurs Responses Responses Kevin Jackson Day 1 Activity Packet 17 ______Get out of situations/work that is too hard ______Get out of the situation because they are not sure of ______Get out of situations/work that is perceived as boring what to do or what is expected Get out of work/class to avoid being embarrassed ______Student shows off to win the validation of peers ______because he/she is behind peers ______To get control over the situation “Save face” in front of friends ______To get the teacher to pay attention to him/her (even if ______To be left alone this is negative attention) ______To get something he/she wants ______To get peers to pay attention to him/her Student wants more of OR less ______Have predictability to know what comes next stimulation/excitement

Comments:______

Functional Assessment InterviewFunctional Assessment Interview Tool: Parent/Guardian Version Tool Summary Student: Kevin Jackson Date Completed: March 2006

Parent/Guardian: Mrs. Jackson Kevin Jackson Day 1 Activity Packet 18

What Behaviors are a Concern for You?

List any behaviors that occur at home or school that you are concerned about:

 Getting into fights  Disrupting class  Not following parent directions  Breaking curfew  Arguing with adults (parents and teachers)  Not doing school work

Kevin likes to be the center of attention, he likes when he does things that make other people shocked and creates a ruckus

Functional Assessment Interview Tool Parent Version What Works Well for Your Child? What have you observed are your strengths or preferences?

Positive Things About my Child My Child’s Preferences or Interests Learning Conditions that Work Well Kevin Jackson Day 1 Activity Packet 19 for My Child

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable Encourage reflective thinking Organized Loves sports, video games, comics, Use analytical skills Natural leader hanging out with friends, watching Involve building/constructing Liked by peers movies, family dog, likes to be the Involve applying concepts or Has lots of friends center of attention, likes to listen to formulas Self starter music Involve experiments or testing Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: likes to work with other Kind to other students kids Good sense of humor Has a positive Other: does better when tasks are attitude/outlook given to him one step at a time or Good communication are organized for him skills Hard worker Other: when he doesn’t have a Other: good with electronics, lot of stuff to keep track of computers, etc. Other: Other: Other: Other:

FunctionalFunctional Assessment Assessment Interview Interview What Contributes to Occurrences of Problem Behavior? ToolTool Parent Parent Version Version Thinking about the problem behaviors you are concerned about, when do behaviors typically occur: When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow Kevin Jackson Day 1 Activity Packet 20 When held to a time limit (e.g., curfew or going to bed) When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present When working in group activities When given an ultimatum Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Lecture: with note taking OR without note taking When adult attention is on others (e.g., siblings or a phone Public response required (e.g., read aloud) call) Being teased or being joked around with When there are visitors to the setting Other: When he has a lot of time and nothing to do Other: When it is time to go to school

When problem behavior occurs, how do you (or other family members) typically respond? Give a non verbal cue (e.g., look at your child) Send to him/her to his/her room Verbally correct the child privately Take a privilege away Verbally correct the child publicly Let the child have what they are asking for Give an ultimatum (if you don’….then you’ll go to your Argue or debate over the issue room) Try to explain and discuss the issue Help your child to get on task/ start the request Other: Take away a planned activity Child gets out of or delays doing the task/request

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to do Get out of situations/work that is perceived as boring or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Student wants more of OR less stimulation/excitement Have predictability to know what comes next Functional Assessment Interview Tool Parent Version Functional Assessment Interview Tool – Student Version Response Form

Student: Kevin Jackson Date Completed: March 2006 Interviewer: Mrs. Patrick Kevin Jackson Day 1 Activity Packet 21

How would you describe yourself?

“A lot of trouble” “Funny” “outgoing” “Don’t take anybody’s crap” “Stand up for myself”

What are some of you interests or favorite things?

Skateboarding, video games, music, science, sports (especially football), pizza, comics, hanging out at the mall

FunctionalI’m going Assessment to show/read Interview you a list of typical school activities. Which ones best answer the question: “I like school Toolwhen…”? Student Version

I can work by myself X I understand and can do the work I can think creatively I get to write List any other things you like about X I get involved in an activity X I get to see and talk with friends your school day: X I can work with other kids Kevin Jackson Day 1 Activity Packet 22 X I am interested in what I am  Lunch learning  When teachers are unfairly picking on X There are activities or games me  When I get to hang out with my friends  Going to gym class

Now we are going to talk about times when you get in trouble. What are some things you do that typically gets you in trouble with school staff?

“Get into fights”

“Cause trouble in class” when asked for examples:  Arguing with the teacher  Talking with friends  Getting out of my seat  Not doing my work

I would like to talk about each of the behaviors you listed. For each one, I am going to ask you some questions. There is no right or wrong answers. I want to know your opinion about what is happening. Functional Assessment Interview ToolBehavior Student :Version Fighting

What was happening before Student’s Thoughts and The student’s perceptions The student’s thoughts and the behavior Feelings While Engaging in about staff and other student feelings about how people the Behavior responses to the behavior responded to the behavior Kevin Jackson Day 1 Activity Packet 23

Somebody makes me mad, like “He did on purpose” “The other kids know not to “It was T.K.s fault, I don’t think when T.K. knocked into me in “He was trying to make me mess with me because I’ll take I should be suspended for the hallway – he did that on look stupid” care of myself” defending myself” purpose to make me look “Mad as hell” stupid in front of everybody “Not going to let him make me look like a chump”

Behavior: “Arguing with the teacher”

What was happening before Student’s Thoughts and The student’s perceptions The student’s thoughts and the behavior Feelings While Engaging in about staff and other student feelings about how people the Behavior responses to the behavior responded to the behavior

“She always targets me. “She just wants me out of her “I don’t know. Lots of kids “I have to get my point out Everyday, she goes after me. class. She doesn’t know what were talking, not just me” there. Because she doesn’t She does it with some of the to do with me so she sends me listen to me.” other students too. I hate going to the office.” to that class. I know she is going to give me a hard time.”

“Kids like that I argue with her. They want to but they’re too scared.”

Functional Assessment Interview Tool Student Version Behavior: “Not doing my work” “Getting out of my seat”

What was happening before Student’s Thoughts and The student’s perceptions The student’s thoughts and the behavior Feelings While Engaging in about staff and other student feelings about how people the Behavior responses to the behavior responded to the behavior Kevin Jackson Day 1 Activity Packet 24 “I’m suppose to be doing some “I don’t like that class, it’s “Other kids think the class is “She is so unfair, she is always stupid work” stupid. I don’t need to learn stupid. They don’t want to do yelling at me and she never that stuff. A lot of the time I’m the work either.” helps me. She just wants me just bored cause I don’t even out of there” know what she is talking “She gets really mad at me. I about.” think I get on her nerves.”

Functional Assessment Interview Tool Student Version Functional Assessment Interview Tool: Staff Version

Student: Kevin Jackson Date Completed: March 2006

Staff Person: Mr. Bachman (Computers) Kevin Jackson Day 1 Activity Packet 25

What Behaviors are a Concern for You?

In the blank space provided, please list behaviors that are a concern for you in your classroom or area. Please be specific and provide examples of behaviors you have observed. Please check whether the student behavior in your class is: redirectable (i.e., occurs once or twice and then not again after redirections), repeated (i.e., occurs on and off throughout class, typically stops after a redirection but then occurs again a short time later), or unmanageable (i.e., the behavior is too disruptive for the student to remain in class). Finally, list any strategies you have tried to deal with this behavior.

Problem Behavior and Definition How would you describe this behavior Physically and verbally aggressive with peers Redirectable Talks back to teacher and argues about assignments Repeated Unmanageable

Unprepared to class, doesn’t complete assignments Redirectable Repeated Unmanageable

Gets off task easily, talks to peers and gets out of seat when he should be doing work Redirectable Repeated Unmanageable

Functional Assessment Interview Tool Staff Version - Computers What Works Well for the Student?

What have you observed are the student’s strengths or preferences?

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions

Kevin Jackson Day 1 Activity Packet 26 Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable  Enjoys playing sports Encourage reflective thinking Organized  Likes and is good with Use analytical skills Natural leader computers Involve building/constructing Liked by peers  Video games Involve applying concepts or Has lots of friends formulas Self starter Involve experiments or testing Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: working with peers Kind to other students Good sense of humor Other: working one-on-one Has a positive with Kevin attitude/outlook Good communication Other: skills Hard worker Other: Other: Athletic Other: Other: Other:

Functional Assessment Interview What Contributes to Occurrences of Problem Behavior? ToolThinking Staff Version about -the Computers problem behaviors you identified that occurred in your classroom, please review the following list and check off any conditions that serve as triggers for the student’s problem behavior (i.e. set the student off): When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow When held to a time limit (e.g., curfew or time for class When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present Kevin Jackson Day 1 Activity Packet 27 When working in group activities When given an ultimatum Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Lecture: with note taking OR without note taking When adult attention is on others Public response required (e.g., read aloud) When there are visitors to the setting Being teased or being joked around with Other:

When problem behavior occurs, how do you (or students in the class) typically respond? Give a non verbal cue (look at student) Let the student have what they are asking for Verbally correct the student privately Deduct points from an assignment Verbally correct the student publicly Send the student to an administrator Help the student to get on task Other students laugh or “egg” the student on Speak to the student after class Give the student a pass to guidance or CST Call the student’s parents Have the student take a break (e.g., go to the bathroom) Take away recess or other free time Teacher assigned detention Moved seat Student gets out of or delays doing work Student – teacher conference Provide a reminder of what is and isn’t appropriate in class Take a privilege away Try to explain and discuss the issue

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to Get out of situations/work that is perceived as boring do or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Student wants more of OR less stimulation/excitement Have predictability to know what comes next Functional Assessment InterviewFunctional Assessment Interview Tool: Staff Version Tool Staff Version - Computers Student: Kevin Jackson Date Completed: March 2006

Staff Person: Mrs. Pierro (Language Arts and Math Resource)

What Behaviors are a Concern for You? Kevin Jackson Day 1 Activity Packet 28 In the blank space provided, please list behaviors that are a concern for you in your classroom or area. Please be specific and provide examples of behaviors you have observed. Please check whether the student behavior in your class is: redirectable (i.e., occurs once or twice and then not again after redirections), repeated (i.e., occurs on and off throughout class, typically stops after a redirection but then occurs again a short time later), or unmanageable (i.e., the behavior is too disruptive for the student to remain in class). Finally, list any strategies you have tried to deal with this behavior.

How would you Problem Behavior and Definition describe this behavior

Classroom disruption – During teacher led instruction Kevin will talk to peers, hum loudly, or fall out of Redirectable his seat. He is very disruptive in class. Repeated Unmanageable

Pushing peers – when Kevin was upset he physically pushed a peer Redirectable Repeated Unmanageable

Functional Assessment Interview Tool Staff Version – LA and Math What Works Well for the Student?

What have you observed are the student’s strengths or preferences?

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable - Art Encourage reflective thinking Kevin Jackson Day 1 Activity Packet 29 Organized - Basketball and football Use analytical skills Natural leader - Comic books Involve building/constructing Liked by peers - Video games Involve applying concepts or Has lots of friends formulas Self starter Involve experiments or testing Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: when he can do or learn Kind to other students something of interest to him Good sense of humor Has a positive Other: when you use a highly attitude/outlook preferred incentive Good communication skills Hard worker Other: Other: Other: Other:

Functional Assessment InterviewWhat Contributes to Occurrences of Problem Behavior? ToolThinking Staff Version about the – LAproblem and Math behaviors you identified that occurred in your classroom, please review the following list and check off any conditions that serve as triggers for the student’s problem behavior (i.e. set the student off): When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow When held to a time limit (e.g., curfew or time for class When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present When working in group activities When given an ultimatum Kevin Jackson Day 1 Activity Packet 30 Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Lecture: with note taking OR without note taking When adult attention is on others Public response required (e.g., read aloud) When there are visitors to the setting Being teased or being joked around with Other:

When problem behavior occurs, how do you (or students in the class) typically respond? Give a non verbal cue (look at student) Let the student have what they are asking for Verbally correct the student privately Deduct points from an assignment Verbally correct the student publicly Send the student to an administrator Help the student to get on task Other students laugh or “egg” the student on Speak to the student after class Give the student a pass to guidance or CST Call the student’s parents Have the student take a break (e.g., go to the bathroom) Take away recess or other free time Teacher assigned detention Moved seat Student gets out of or delays doing work Student – teacher conference Provide a reminder of what is and isn’t appropriate in class Take a privilege away Try to explain and discuss the issue

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to do Get out of situations/work that is perceived as boring or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Functional Assessment Interview Tool: Staff Version Functional Assessment Interview ToolStudent: Staff Version – LAKevin and JacksonMath Date Completed: March 2006

Staff Person: Ms. Snyder (PE)

What Behaviors are a Concern for You?

In the blank space provided, please list behaviors that are a concern for you in your classroom or area. Please be specific and provide examples of behaviors you have observed. Please check whether the student behavior in your class is: redirectable (i.e., occurs once or twice and then not again after redirections), repeated (i.e., occurs on and off throughout class, typically stops after a redirection but then Kevin Jackson Day 1 Activity Packet 31 occurs again a short time later), or unmanageable (i.e., the behavior is too disruptive for the student to remain in class). Finally, list any strategies you have tried to deal with this behavior.

How would you Problem Behavior and Definition describe this behavior

Kevin will disrupt the class by using sports equipment inappropriately (e.g., throwing a basketball hard Redirectable against a wall, kicking a soccer ball into the bleachers on purpose). Repeated Unmanageable

Kevin will argue and debate with me when he doesn’t like the activity or wants to do something he Redirectable wants. On some occasions this arguing/debating will continue all class. Repeated Unmanageable

Functional Assessment Interview Tool Staff Version – PE What Works Well for the Student?

What have you observed are the student’s strengths or preferences?

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable  Kevin seems to enjoy sports, Encourage reflective thinking Organized especially basketball. Use analytical skills Natural leader Involve building/constructing Kevin Jackson Day 1 Activity Packet 32 Liked by peers Involve applying concepts or Has lots of friends formulas Self starter Involve experiments or testing Socially aware Use creative writing Follows directions (usually) Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: Hands on activities Kind to other students Good sense of humor Other: Has a positive attitude/outlook Other: Good communication skills Other: Hard worker Other: Other: Other: Other:

Functional Assessment Interview Tool Staff Version – PE What Contributes to Occurrences of Problem Behavior? Thinking about the problem behaviors you identified that occurred in your classroom, please review the following list and check off any conditions that serve as triggers for the student’s problem behavior (i.e. set the student off): When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow When held to a time limit (e.g., curfew or time for class When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present When working in group activities When given an ultimatum Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Kevin Jackson Day 1 Activity Packet 33 Lecture: with note taking OR without note taking When adult attention is on others Public response required (e.g., read aloud) When there are visitors to the setting Being teased or being joked around with Other:

When problem behavior occurs, how do you (or students in the class) typically respond? Give a non verbal cue (look at student) Let the student have what they are asking for Verbally correct the student privately Deduct points from an assignment Verbally correct the student publicly Send the student to an administrator Help the student to get on task Other students laugh or “egg” the student on Speak to the student after class Give the student a pass to guidance or CST Call the student’s parents Have the student take a break (e.g., go to the bathroom) Take away recess or other free time Teacher assigned detention Moved seat Student gets out of or delays doing work Student – teacher conference Provide a reminder of what is and isn’t appropriate in class Take a privilege away Try to explain and discuss the issue

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to do Get out of situations/work that is perceived as boring or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Student wants more of OR less stimulation/excitement Have predictability to know what comes next Functional Assessment Interview Tool: Staff Version Functional Assessment Interview ToolStudent: Staff Version – PEKevin Jackson Date Completed: March 2006

Staff Person: Mrs. Patrick (Science)

What Behaviors are a Concern for You?

In the blank space provided, please list behaviors that are a concern for you in your classroom or area. Please be specific and provide examples of behaviors you have observed. Please check whether the student behavior in your class is: redirectable (i.e., occurs once or twice and then not again after redirections), repeated (i.e., occurs on and off throughout class, typically stops after a redirection but then occurs again a short time later), or unmanageable (i.e., the behavior is too disruptive for the student to remain in class). Finally, list any strategies you have tried to deal with this behavior. Kevin Jackson Day 1 Activity Packet 34

How would you Problem Behavior and Definition describe this behavior

Disrespectful to teacher Redirectable Repeated Unmanageable

Disruptive during class (e.g., makes noises, talks to other students, getting out of his seat engaging Redirectable in activities other than what he should be doing, yelling out). Repeated Unmanageable

Unprepared for class and he doesn’t initiate work Redirectable Repeated Unmanageable

What Works Well for the Student? Functional Assessment Interview ToolWhat Staff have Version you observed – Science are the student’s strengths or preferences?

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable  Science topics Encourage reflective thinking Organized  Being the center of attention Use analytical skills Natural leader  Likes to interact with people Involve building/constructing Liked by peers  Sports Involve applying concepts or Has lots of friends  Skateboarding formulas Kevin Jackson Day 1 Activity Packet 35 Self starter Involve experiments or testing Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: activities allowing for Kind to other students creative thinking Good sense of humor Has a positive Other: small group activities attitude/outlook Good communication Other: skills Hard worker Other: Other: Asks good questions Other: Athletic Other: Other:

What Contributes to Occurrences of Problem Behavior? FunctionalThinking Assessment about the problem Interview behaviors you identified that occurred in your classroom, please review the following list and check off Toolany Staff conditions Version –that Science serve as triggers for the student’s problem behavior (i.e. set the student off): When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow When held to a time limit (e.g., curfew or time for class When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present When working in group activities When given an ultimatum Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Lecture: with note taking OR without note taking When adult attention is on others Public response required (e.g., read aloud) When there are visitors to the setting Kevin Jackson Day 1 Activity Packet 36 Being teased or being joked around with Other:

When problem behavior occurs, how do you (or students in the class) typically respond? Give a non verbal cue (look at student) Let the student have what they are asking for Verbally correct the student privately Deduct points from an assignment Verbally correct the student publicly Send the student to an administrator Help the student to get on task Other students laugh or “egg” the student on Speak to the student after class Give the student a pass to guidance or CST Call the student’s parents Have the student take a break (e.g., go to the bathroom) Take away recess or other free time Teacher assigned detention Moved seat Student gets out of or delays doing work Student – teacher conference Provide a reminder of what is and isn’t appropriate in class Take a privilege away Try to explain and discuss the issue

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to Get out of situations/work that is perceived as boring do or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Student wants more of OR less stimulation/excitement Have predictability to know what comes next Functional Assessment Interview Tool: Staff Version Functional Assessment Interview ToolStudent: Staff Version – ScienceKevin Jackson Date Completed: March 2006

Staff Person: Mrs. Kinney (Social Studies)

What Behaviors are a Concern for You?

In the blank space provided, please list behaviors that are a concern for you in your classroom or area. Please be specific and provide examples of behaviors you have observed. Please check whether the student behavior in your class is: redirectable (i.e., occurs once or twice and then not again after redirections), repeated (i.e., occurs on and off throughout class, typically stops after a redirection but then occurs again a short time later), or unmanageable (i.e., the behavior is too disruptive for the student to remain in class). Finally, list any strategies you have tried to deal with this behavior. Kevin Jackson Day 1 Activity Packet 37

How would you Problem Behavior and Definition describe this behavior

Redirectable Kevin is very argumentative in class. He is constantly disrupting class and refusing to do what he is Repeated asked to do. He distracts other students by making noises, getting out of his seat, and talking. Unmanageable

Redirectable Kevin does not pay attention in class and is rarely prepared. Repeated Unmanageable

Functional Assessment Interview Tool Staff Version – Social Studies

What Works Well for the Student?

What have you observed are the student’s strengths or preferences?

Positive Things About the Student Student’s Preferences or Interests Successful Learning Conditions

Friendly List known or suspected preferences: Lessons/activities that: Helpful Sociable  Being the center of attention Encourage reflective thinking Organized Use analytical skills Natural leader Involve building/constructing Liked by peers Involve applying concepts or Has lots of friends formulas Self starter Involve experiments or testing Kevin Jackson Day 1 Activity Packet 38 Socially aware Use creative writing Follows directions Utilize the computer Honest Allow for artistic expression of Easygoing concepts Attentive to instruction Kind to adults Other: Kind to other students Good sense of humor Other: Has a positive attitude/outlook Other: Good communication skills Other: Hard worker Other: Other: Other: Other:

Functional Assessment InterviewWhat Contributes to Occurrences of Problem Behavior? ThinkingTool Staff about Version the – problem Social Studies behaviors you identified that occurred in your classroom, please review the following list and check off any conditions that serve as triggers for the student’s problem behavior (i.e. set the student off): When asked to do a chore or helping task Transition at the beginning of a class/routine/activity When it is time to do academic work Unstructured situations or settings When told to do something non preferred When given a direction to follow When held to a time limit (e.g., curfew or time for class When corrected Tasks that are difficult or confuse the student When he/she can not have something they want When working/playing/entertaining independently Preferred peer group present When working in group activities When given an ultimatum Not prepared with materials When he or she is told “no” or stop Multi-step work or projects When there is a change in routine Lecture: with note taking OR without note taking When adult attention is on others Public response required (e.g., read aloud) When there are visitors to the setting Being teased or being joked around with Other: Kevin Jackson Day 1 Activity Packet 39 When problem behavior occurs, how do you (or students in the class) typically respond? Give a non verbal cue (look at student) Let the student have what they are asking for Verbally correct the student privately Deduct points from an assignment Verbally correct the student publicly Send the student to an administrator Help the student to get on task Other students laugh or “egg” the student on Speak to the student after class Give the student a pass to guidance or CST Call the student’s parents Have the student take a break (e.g., go to the bathroom) Take away recess or other free time Teacher assigned detention Moved seat Student gets out of or delays doing work Student – teacher conference Provide a reminder of what is and isn’t appropriate in class Take a privilege away Try to explain and discuss the issue

What is your best guess as to why the problem behavior is occurring? Get out of situations/work that it is too hard Get out of the situation because they are not sure of what to do Get out of situations/work that is perceived as boring or what is expected Get out work/class to avoid being embarrassed because he/she Student shows off to win the validation of peers behind peers To get control over the situation Save face in front of friends To get adults to pay attention to him/her (even if this is To be left alone negative attention) To get something he/she wants To get peers to pay attention to him/her Student wants more of OR less stimulation/excitement Have predictability to know what comes next Functional Assessment Interview Tool Staff Version – SocialOffice Studies Discipline Referrals for the following dates: 10/11; 10/26; 11/16; 11/22; 12/13; 1/12; 1/21; 2/11; 2/16; 2/21; 2/25

Activity Directions:

Part 1

3. Review each of the office discipline referrals for Kevin. 4. Use page 5E of the FBA Report Worksheet, fill in the information for each of the office referrals

Stop there and wait to come back together as a group for additional directions. Kevin Jackson Day 1 Activity Packet 40 Part 2

1. Using the data reported on page 5E of the worksheet, develop a summary statement for the FBA report.

Stop there and wait to come back together as a group.

OFFICE DISCIPLINE REFERRAL

Student Name: Kevin Jackson Referring Staff Mrs. Patrick Location Date 10/17/2004 Period: Going from 2nd to 3rd __ Classroom __ Bus __ Offices ______Previous # of Suspensions ___ ISS ___OSS __ Cafeteria __ Gym__ Locker room X Hallway B Wing __ Library __ School grounds

Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor A. Requires For Major Infractions Problem Behaviors B. Administrative Action Kevin Jackson Day 1 Activity Packet 41 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 10/17 Date ______Resolved by Department Chair X Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected ___ Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher X Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact 2 days 10/18-10/19 disrespect disrespect disrespect ______Date ___ Harassment ___ Referral to Drop-In/SAC ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Police contact disruption disruption disruption ______Date ___ Property damage/vandalism ___ Legal hearing request ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Guidance counselor contact ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Board hearing detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Other ___Dress code ___Dress code ___Dress code ___ Phone ______Date(s) ___ Bomb threat/false alarm violation violation violation ___ Note ______Date ___ Use/possession of weapons Further Administrative Action ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date Taken: ___Tardy ___Tardy ___Tardy ___ Teacher-student discipline ___Misuse of ___Misuse of ___Misuse of ___ Detention ______Date Others Involved: ___SRO contact pass pass pass ___ Guidance counselor contact ___None ___Case manager contact ___Other: ___Other: ___Other: ___ Change of clothes for dress code ___Staff ___Friday detention violation ___ Substitute ___Saturday detention Others Involved: Others Involved: Others Involved: ___ Other ___ Peers X Parent conference 10/20 ___ None ___ None ___ None ___ Teacher ___Expulsion ___ Staff ___ Staff ___ Staff ___ Other ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: While going to the nextOFFICE class, Kevin DISCIPLINE pushed Jimmy causing REFERRAL him to fall down the stairs. When asked why he did, Kevin responded “He’s lucky I didn’t punch him in the face after what he said about my mother.” These two students have a history of altercations.

OfficeStudent Referral Name 10/17: Kevin Jackson Referring Staff Mrs. Snyder Location Date 10/26/2005 Period: 7th Health X Classroom __ Bus __ Offices ______Cafeteria __ Gym__ Locker room Previous # of Suspensions ___ ISS 2 OSS __ Hallway ______Library __ School grounds

Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor C. Requires For Major Infractions Problem Behaviors D. Administrative Action Kevin Jackson Day 1 Activity Packet 42 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 2/16 Date ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment (______hours/days) ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Referral to Drop-In/SAC disruption disruption disruption ______Date X Property damage/vandalism ___ Police contact ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Legal hearing request ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Guidance counselor contact detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Board hearing ___Dress code ___Dress code ___Dress code ___ Phone ______Date(s) ___ Bomb threat/false alarm ___ Other violation violation violation ___ Note ______Date ___ Use/possession of weapons ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date Further Administrative Action ___Tardy ___Tardy ___Tardy ___ Teacher-student discipline Taken: ___Misuse of ___Misuse of ___Misuse of ___ Detention ______Date Others Involved: pass pass pass ___ Guidance counselor contact ___None ___SRO contact ___Other: ___Other: ___Other: ___ Change of clothes for dress code ___Staff ___Case manager contact violation ___ Substitute ___Friday detention Others Involved: Others Involved: Others Involved: ___ Other ___ Peers X Saturday detention 10/29 ___ None ___ None ___ None ___ Teacher ___ Parent conference ___ Staff ___ Staff ___ Staff ___ Other ___Expulsion ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: Kevin was in class and would not do any of his assigned work. He was touching other students and being very disruptive to the entire atmosphere. Kevin was also defacing school property. The class could not continue with him present.

Office Referral 10/26 OFFICE DISCIPLINE REFERRAL

Student Name: Kevin Jackson Referring Staff Mrs. Location Harrison X Classroom __ Bus __ Offices ______Date 11/16/2004 Time: 5th __ Cafeteria __ Gym__ Locker room __ Hallway ______Library __ School grounds Previous # of Suspensions ____ ISS 2 OSS Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor E. Requires For Major Infractions Kevin Jackson Day 1 Activity Packet 43 Problem Behaviors F. Administrative Action

1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials X Abusive/Inappropriate X Parent contact 11/16 ______Resolved by Department Chair Language ___ In-school suspension ___ Student verbally corrected ___ Fighting/Physical Aggression ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat X Insubordination (______hours/days) language language language ___ Student’s IEP reviewed ___ Property Misuse ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Physical assault on a teacher disrespect disrespect disrespect ______Date ___ Inappropriate sexual contact (______hours/days) ___Mild Disruption ___Mild Disruption ___Mild Disruption ___ Dept Chair–student conference ___ Harassment ___ Referral to Drop-In/SAC ___Horseplay ___Horseplay ___Horseplay ______Date ___ Disruption ___ Police contact ___Missed ___Missed ___Missed ___Case manager-student ___ Property damage/vandalism ___ Legal hearing request detention detention detention conference ___ Forgery/theft ___ Guidance counselor contact ___Dress code ___Dress code ___Dress code ___ Referral to Drop-In ___ Use/possession of tobacco ___ Board hearing violation violation violation ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Other ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Phone ______Date(s) ___ Bomb threat/false alarm ___Tardy ___Tardy ___Tardy ___ Note ______Date ___ Use/possession of weapons Further Administrative Action ___Misuse of ___Misuse of ___Misuse of ___ Meeting ______Date Taken: pass pass pass ___ Teacher-student discipline ___Other: ___Other: ___Other: ___ Detention ______Date Others Involved: ___SRO contact ___ Guidance counselor contact ___None ___Case manager contact Others Involved: Others Involved: Others Involved: Code violation ___Staff ___Friday detention ___ None ___ None ___ None ___ Other ___ Substitute X Saturday detention 11/18 ___ Staff ___ Staff ___ Staff ___ Peers ___ Parent conference ___ Substitute ___ Substitute ___ Substitute ___ Teacher ___Expulsion ___Peers ___Peers ___Peers ___ Other ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: Unprepared for class ( folder and pencil). Talking out making noises, pushing the table into another student, refused to listen to directions, cursing, said the “F” word several times. He could not be redirected to task to or settle down. OFFICE DISCIPLINE REFERRAL Office Referral 11/16 Student Name: Kevin Jackson Referring Staff Mrs. Snyder Location Date 11/22/2004 Period: 7 X Classroom __ Bus __ Offices ______Cafeteria __ Gym __ Locker room Previous # of Suspensions ___ ISS 2 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 44 Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor G. Requires For Major Infractions Problem Behaviors H. Administrative Action 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 11/23 ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment (______hours/days) ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Referral to Drop-In/SAC disruption disruption disruption ______Date ___ Property damage/vandalism ___ Police contact ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Legal hearing request ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Guidance counselor contact detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Board hearing ___Dress code ___Dress code ___Dress code ___ Phone ______Date(s) ___ Bomb threat/false alarm ___ Other violation violation violation ___ Note ______Date ___ Use/possession of weapons ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date X Other – extremely disruptive Further Administrative Action ___Tardy ___Tardy ___Tardy ___ Teacher-student discipline Taken: ___Misuse of ___Misuse of ___Misuse of ___ Detention ______Date pass pass pass ___ Guidance counselor contact Others Involved: ___SRO contact ___Other: ___Other: ___Other: ___ Change of clothes for dress code ___None ___Case manager contact violation ___Staff X Friday detention 11/25 Others Involved: Others Involved: Others Involved: ___ Other ___ Substitute ___ Saturday detention ___ None ___ None ___ None ___ Peers ___Parent conference ___ Staff ___ Staff ___ Staff ___ Teacher ___Expulsion ___ Substitute ___ Substitute ___ Substitute ___ Other ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: Came without gym clothes. Argued with me repeatedly over the choice of activity. Was yelling and cursing at other students. Failed repeatedly to comply with directions. OFFICE DISCIPLINE REFERRAL

OfficeStudent Referral Name 11/22: Kevin Jackson Referring Staff Vice Principal Location Date 12/13/2005 Time: Arrival __ Classroom __ Bus __ Offices ______Previous # of Suspensions ___ ISS 2 OSS __ Cafeteria __ Gym__ Locker room __ Hallway ______Library X School grounds Kevin Jackson Day 1 Activity Packet 45 Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor I. Requires For Major Infractions Problem Behaviors Administrative Action 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 12/13 ______Resolved by Department Chair ___ In-school suspension ___ Student verbally corrected X ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat (______hours/days) language language language ___ Student’s IEP reviewed Fighting/Physical X Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference 2 days 12/14-12/15 disrespect disrespect disrespect ______Date Aggression ___ Referral to Drop-In/SAC ___Mild disruption ___Mild disruption ___Mild disruption ___ Dept Chair–student conference ___ Insubordination ___ Police contact ___Horseplay ___Horseplay ___Horseplay ______Date ___ Property Misuse ___ Legal hearing request ___Missed ___Missed ___Missed ___Case manager-student ___ Physical assault on a teacher ___ Guidance counselor contact detention detention detention conference ___ Inappropriate sexual contact ___ Board hearing ___Dress code ___Dress code ___Dress code ___ Referral to Drop-In ___ Harassment ___ Other violation violation violation ___ Teacher-parent contact ___ Disruption ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Phone ______Date(s) ___ Property damage/vandalism Further Administrative Action ___Tardy ___Tardy ___Tardy ___ Note ______Date ___ Forgery/theft Taken: ___Misuse of ___Misuse of ___Misuse of ___ Meeting ______Date ___ Use/possession of tobacco pass pass pass ___ Teacher-student discipline ___ Use/possession of drugs/ alcohol ___SRO contact ___Other: ___Other: ___Other: ___ Detention ______Date ___ Bomb threat/false alarm ___Case manager contact ___ Guidance counselor contact ___ Use/possession of weapons ___Friday detention Others Involved: Others Involved: Others Involved: ___ Change of clothes for dress ___ Other ___Saturday detention ___ None ___ None ___ None code X Parent conference 12/15 ___ Staff ___ Staff ___ Staff violation ___Expulsion ___ Substitute ___ Substitute ___ Substitute ___ Other Others Involved: ___Peers ___Peers ___Peers ___None ___Teacher ___Teacher ___Teacher ___Staff ___Other ___Other ___Other ___ Substitute ___ Peers ___ Teacher ___ Other Brief Description of Incident: While walking out to the bus, Kevin punched another student in the back. He said that the student had been bugging him all day and was asking for it when he (the other student) tried to make Kevin look like a fool. OFFICE DISCIPLINE REFERRAL Office Referral 12/13 Student Name: Kevin Jackson Referring Staff Mr. Kinney Location Date 1/12/06 Time: 2nd X Classroom __ Bus __ Offices ______Cafeteria __ Gym __ Locker room Previous # of Suspensions ___ ISS 4 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 46 __X__ Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor J. Requires For Major Infractions Problem Behaviors K. Administrative Action 1st Offense 2nd Offense 3rd Offense Date:1/8 Date: 1/9 Date: 1/12 Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 1/12 ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension X Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment ___ Referral to Drop-In/SAC ___Mild ___Mild X Mild ___ Dept Chair–student conference ___ Disruption ___ Police contact Disruption Disruption Disruption ______Date ___ Property damage/vandalism ___ Legal hearing request ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Guidance counselor contact ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Board hearing detention detention detention X Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Other ___Dress code ___Dress code ___Dress code X Phone 1/8; 1/11 Date(s) ___ Bomb threat/false alarm violation violation violation ___ Note ______Date ___ Use/possession of weapons Further Administrative Action ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date Taken: ___Tardy ___Tardy ___Tardy X Teacher-student discipline ___Misuse of ___Misuse of ___Misuse of X Detention 1/8 Others Involved: ___SRO contact pass pass pass ___ Guidance counselor contact ___None ___Case manager contact X Other: X Other: X Other: ___ Change of clothes for dress code ___Staff X Friday detention 1/14 unprepared unprepared unprepared violation ___ Substitute ___Saturday detention ___ Other ___ Peers X Parent conference 1/18 Others Involved: Others Involved: Others Involved: ___ Teacher ___Expulsion ___ None ___ None ___ None ___ Other ___ Staff ___ Staff ___ Staff ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher

Brief Description of Incident: Kevin has not had his homework done any day this week nor has he brought his book to class. He said he hasn’t done it because he doesn’t want to and his mother is aware that he OFFICEhasn’t done it. DISCIPLINE REFERRAL Office Referral 1/12 Student Name: Kevin Jackson Referring Staff Ms. Pierro Location Date 1/21/06 Period: 1st X Classroom __ Bus __ Offices ______Cafeteria __ Gym__ Locker room Previous # of Suspensions ___ ISS 4 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 47 Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor L. Requires For Major Infractions Problem Behaviors M. Administrative Action 1st Offense 2nd Offense 3rd Offense Date: Date: Date: Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 1/22 ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment ___ Referral to Drop-In/SAC ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Police contact Disruption Disruption Disruption ______Date ___ Property damage/vandalism ___ Legal hearing request ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Guidance counselor contact ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Board hearing detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Other ___Dress code ___Dress code ___Dress code ___Phone ______Date(s) ___ Bomb threat/false alarm violation violation violation ___ Note ______Date ___ Use/possession of weapons Further Administrative Action ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date Taken: ___Tardy ___Tardy ___Tardy ___Teacher-student discipline ___Misuse of ___Misuse of ___Misuse of ___ Detention Others Involved: ___SRO contact pass pass pass ___ Guidance counselor contact ___None ___Case manager contact ___Other: ___ Other: ___Other: ___ Change of clothes for dress code ___Staff X Friday detention 1/26 violation ___ Substitute ___ Saturday detention Others Involved: Others Involved: Others Involved: ___ Other ___ Peers ___ Parent conference ___ None ___ None ___ None ___ Teacher ___ Expulsion ___ Staff ___ Staff ___ Staff ___ Other ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher

Brief Description of Incident: Came unprepared for class. Defiant, refused to be quiet and do assigned work. Refused to comply with directions OFFICE DISCIPLINE REFERRAL Office Referral 1/21 Student Name: Kevin Jackson Referring Staff Mrs. Harrison Location Date 2/11/06 Time: 5th __ Classroom __ Bus __ Offices ______Cafeteria __ Gym__ Locker room Previous # of Suspensions ___ ISS 4 OSS X Hallway B Wing __ Library __ School grounds

Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor N. Requires For Major Infractions Kevin Jackson Day 1 Activity Packet 48 Problem Behaviors O. Administrative Action

1st Offense 2nd Offense 3rd Offense Date: Date: Date: Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 2/11 ______Resolved by Department Chair X Fighting/Physical Aggression X In-school suspension ___ Student verbally corrected ___ Insubordination 3 days 2/12-2/14 ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse ___ Out of school suspension language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact ___ Referral to Drop-In/SAC disrespect disrespect disrespect ______Date ___ Harassment ___ Police contact ___Mild disruption ___Mild disruption ___Mild disruption ___ Dept Chair–student conference ___ Disruption ___ Legal hearing request ___Horseplay ___Horseplay ___Horseplay ______Date ___ Property damage/vandalism ___ Guidance counselor contact ___Missed ___Missed ___Missed ___Case manager-student ___ Forgery/theft ___ Board hearing detention detention detention conference ___ Use/possession of tobacco ___ Other ___Dress code ___Dress code ___Dress code ___ Referral to Drop-In ___ Use/possession of drugs/ alcohol violation violation violation ___ Teacher-parent contact ___ Bomb threat/false alarm Further Administrative Action ___Lying/cheating ___Lying/cheating ___Lying/cheating ___Phone ______Date(s) ___ Use/possession of weapons Taken: ___Tardy ___Tardy ___Tardy ___ Note ______Date ___Misuse of ___Misuse of ___Misuse of ___ Meeting ______Date ___SRO contact pass pass pass ___Teacher-student discipline Others Involved: ___Case manager contact ___Other: ___ Other: ___Other: ___ Detention ___None ___Friday detention unprepared unprepared unprepared ___ Guidance counselor contact ___Staff ___Saturday detention ___ Change of clothes for dress ___ Substitute X Parent conference 2/15 Others Involved: Others Involved: Others Involved: code ___ Peers ___Expulsion ___ None ___ None ___ None violation ___ Teacher ___ Staff ___ Staff ___ Staff ___ Other ___ Other ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher

Brief Description of Incident: Students were returning to class from an assembly and sitting down. As Kevin walked toward his seat he kicked another student in the left shin and then hit a girl next to him with his agenda book while she had her head down on her desk.

Office Referral 2/11 OFFICE DISCIPLINE REFERRAL Student Name: Kevin Jackson Referring Staff Ms. Johnson Location Date 2/16/2006 Period: 4th __ Classroom __ Bus __ Offices ______X Cafeteria __ Gym__ Locker room Previous # of Suspensions ___ ISS 7 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 49 Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor P. Requires For Major Infractions Problem Behaviors Q. Administrative Action 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials ___ Student Initials ___ Student Initials ______Abusive/Inappropriate Language X Parent contact 2/16 ___ Resolved by Department Chair X Fighting/Physical Aggression X In-school suspension ___Inappropriate ___Inappropriate ___Inappropriate ___ Student verbally corrected ___ Insubordination 1 day 2/17 language language language ___ Student assigned different seat ___ Property Misuse ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Student’s IEP reviewed ___ Physical assault on a teacher disrespect disrespect disrespect ___ Teacher-student conference ___ Inappropriate sexual contact ___ Referral to Drop-In/SAC ___Mild disruption ___Mild disruption ___Mild disruption ______Date ___ Harassment ___ Police contact ___Horseplay ___Horseplay ___Horseplay ___ Dept Chair–student conference ___ Disruption ___ Legal hearing request ___Missed ___Missed ___Missed ______Date ___ Property damage/vandalism ___ Guidance counselor contact detention detention detention ___Case manager-student ___ Forgery/theft ___ Board hearing ___Dress code ___Dress code ___Dress code conference ___ Use/possession of tobacco ___ Other violation violation violation ___ Referral to Drop-In ___ Use/possession of drugs/ alcohol ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Teacher-parent contact ___ Bomb threat/false alarm Further Administrative Action ___Tardy ___Tardy ___Tardy ___ Phone ______Date(s) ___ Use/possession of weapons Taken: ___Misuse of ___Misuse of ___Misuse of ___ Note ______Date pass pass pass ___ Meeting ______Date ___SRO contact ___Other: ___Other: ___Other: ___ Teacher-student discipline Others Involved: ___Case manager contact ___ Detention ______Date ___None ___Friday detention Others Involved: Others Involved: Others Involved: ___ Guidance counselor contact ___Staff ___Saturday detention ___ None ___ None ___ None ___ Change of clothes for dress ___ Substitute X Parent conference 2/17 ___ Staff ___ Staff ___ Staff code X Peers ___Expulsion ___ Substitute ___ Substitute ___ Substitute violation ___ Teacher ___Peers ___Peers ___Peers ___ Other ___ Other ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: I heard a loud slapping sound and students “ohhh.” When I looked up from my desk J.M. was holding the back of his head and said “Kevin just knocked me on the back of my head.” Other students also said they saw the incident happen. J.M. was sent to the nurse and had a small lump on the back of his head OFFICE DISCIPLINE REFERRAL Student Name: Kevin Jackson Referring Staff Ms. Pierro Location Date 2/21/2005 Time: 1st X Classroom __ Bus __ Offices ______Cafeteria __ Gym __ Locker room Previous # of Suspensions 1 ISS 7 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 50 Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor R. Requires For Major Infractions Problem Behaviors S. Administrative Action 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 2/21 ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment (______hours/days) ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Referral to Drop-In/SAC disruption disruption disruption ______Date ___ Property damage/vandalism ___ Police contact ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Legal hearing request ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Guidance counselor contact detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Board hearing ___Dress code ___Dress code ___Dress code ___ Phone ______Date(s) ___ Bomb threat/false alarm X Other sat in office until violation violation violation ___ Note ______Date ___ Use/possession of weapons next period ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date ___Tardy ___Tardy ___Tardy ___ Teacher-student discipline Further Administrative Action ___Misuse of ___Misuse of ___Misuse of ___ Detention ______Date Others Involved: Taken: pass pass pass ___ Guidance counselor contact ___None ___Other: ___Other: ___Other: ___ Change of clothes for dress code ___Staff ___SRO contact violation ___ Substitute ___Case manager contact Others Involved: Others Involved: Others Involved: ___ Other ___ Peers ___Friday detention ___ None ___ None ___ None ___ Teacher ___Saturday detention ___ Staff ___ Staff ___ Staff ___ Other ___ Parent conference ___ Substitute ___ Substitute ___ Substitute ___Expulsion ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: Students were told to get out agenda books and write down HW. Kevin continued talking to another student. When I said “let’s go Kevin” he yelled back “I don’t have mine.” This was the third time this period he talked back to me in a hostile tone.

Office Referral 2/21 OFFICE DISCIPLINE REFERRAL

Student Name: Kevin Jackson Referring Staff Mrs. Patrick Location Date 2/25/2006 Period: 3rd X Classroom __ Bus __ Offices ______Cafeteria __ Gym__ Locker room Previous # of Suspensions 1 ISS 7 OSS __ Hallway ______Library __ School grounds Kevin Jackson Day 1 Activity Packet 51

Minor Problem Behavior Current or Previous Action __X__ Major Infractions Disciplinarian Decision Situation is Remedied by Staff Taken by Staff for Minor T. Requires For Major Infractions Problem Behaviors U. Administrative Action 1st Offense 2nd Offense 3rd Offense Date: ______Date: ______Date: ______Check all that apply ___ Cutting Class/Study/Homeroom ___ Conference with student Student Initials Student Initials Student Initials ___ Abusive/Inappropriate Language X Parent contact 2/26 ______Resolved by Department Chair ___ Fighting/Physical Aggression ___ In-school suspension ___ Student verbally corrected X Insubordination ___Inappropriate ___Inappropriate ___Inappropriate ___ Student assigned different seat ___ Property Misuse (______hours/days) language language language ___ Student’s IEP reviewed ___ Physical assault on a teacher ___ Out of school suspension ___Defiance/ ___Defiance/ ___Defiance/ ___ Teacher-student conference ___ Inappropriate sexual contact disrespect disrespect disrespect ______Date ___ Harassment (______hours/days) ___Mild ___Mild ___Mild ___ Dept Chair–student conference ___ Disruption ___ Referral to Drop-In/SAC disruption disruption disruption ______Date ___ Property damage/vandalism ___ Police contact ___Horseplay ___Horseplay ___Horseplay ___Case manager-student conference ___ Forgery/theft ___ Legal hearing request ___Missed ___Missed ___Missed ___ Referral to Drop-In ___ Use/possession of tobacco ___ Guidance counselor contact detention detention detention ___ Teacher-parent contact ___ Use/possession of drugs/ alcohol ___ Board hearing ___Dress code ___Dress code ___Dress code ___ Phone ______Date(s) ___ Bomb threat/false alarm ___ Other violation violation violation ___ Note ______Date ___ Use/possession of weapons ___Lying/cheating ___Lying/cheating ___Lying/cheating ___ Meeting ______Date Further Administrative Action ___Tardy ___Tardy ___Tardy ___ Teacher-student discipline Taken: ___Misuse of ___Misuse of ___Misuse of ___ Detention ______Date Others Involved: pass pass pass ___ Guidance counselor contact ___None ___SRO contact ___Other: ___Other: ___Other: ___ Change of clothes for dress code ___Staff ___Case manager contact violation ___ Substitute X Friday detention 3/1 Others Involved: Others Involved: Others Involved: ___ Other ___ Peers ___Saturday detention ___ None ___ None ___ None ___ Teacher ___Parent conference ____ Date ___ Staff ___ Staff ___ Staff ___ Other ___Expulsion ___ Substitute ___ Substitute ___ Substitute ___Peers ___Peers ___Peers ___Teacher ___Teacher ___Teacher ___Other ___Other ___Other

Brief Description of Incident: Throughout class Kevin was refusing to follow directions and was very disruptive. When he was told to get out his books and begin his assignment, Kevin turned to another student and said “I’m so sick of doing this stupid crap.” When told to come up to my desk Kevin made a spectacle of himself huffing and puffing, knocking into another student’s desk causing books to fall over and deliberately meandered to my desk. Kevin Jackson Case Example Office Referral 2/25 ABC Frequency Data for Math, Social Studies, Language Arts, and Science

Activity Directions: Kevin Jackson Day 1 Activity Packet 52

Part 1

5. Review the data for each of the classes observed 6. Tally each column for each data sheet 7. When finished tallying each data sheet, record the tally on page 5A of the FBA report worksheet.

Stop there and wait to come back together as a group for additional directions.

Part 2

2. Using the data reported on page 5A of the worksheet, develop a summary statement for the FBA report.

Stop there and wait to come back together as a group.

Antecedent-Behavior-Consequence Frequency Count Date: 3/23 Observer(s): Period: Math Mrs. Thompson Activity: Teacher Instruction, Independent Practice Antecedents Consequences And Comments Responses Kevin Jackson Day 1 Activity Packet 53 s p e k g n d n d d d d k g s r i c s u n e e e o n n n a i i o t Target v i i a o l z a d a f t t k r a i e i c k f

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ABC Frequency Form - MathAntecedent-Behavior-Consequence Frequency Count Kevin Jackson Day 1 Activity Packet 54 Date: 3/24 Observer(s): Period: Social Studies Mrs. Thompson Activity: Teacher Instruction, Independent Practice Antecedents

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s o V o s A i N d X X- yelling across X X the room X X X – making X X derogatory comments X X X – not following X X X directions X X X? X – out of his seat X X X

ABC Frequency Form – Social Studies Kevin Jackson Day 1 Activity Packet 55 Antecedent-Behavior-Consequence Frequency Count Date: 3/28 Observer(s): Period: Language Arts Mrs. Thompson Activity: Teacher Instruction, Independent Practice Antecedents

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s o V o s A i N d X X – bumped into X another student X X X? X- said he was X X X not “into working” today X X X? X- “huffing and X X X puffing” at his seat, very noisy with objects X X X? X – calling out, X X talking with peers Kevin Jackson Day 1 Activity Packet 56 ABC Frequency Form – Language Arts Antecedent-Behavior-Consequence Frequency Count Date: 3/29 Observer(s): Period: Science Mrs. Thompson Activity: Teacher Instruction, Independent Practice Antecedents

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Kevin Jackson Case Example

Interval Data for Math, Social Studies, Language Arts, and Science

Activity Directions:

Part 1

8. Review the data for each of the classes observed 9. For each class observed, tally each column, sum the columns, and calculate the percentage 10.Record the data for each class on page 5C of the FBA Report Worksheet

Stop there and wait to come back together as a group for additional directions.

Part 2

3. Using the data reported on page 5C of the worksheet, develop a summary statement for the FBA report.

Stop there and wait to come back together as a group. Kevin Jackson Day 1 Activity Packet 58 Interval Recording Form Name Date Class Target Behavior Observer

Kevin Jackson March 28 Language Arts Classroom Disruption Mrs. Rodriguez

Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? Minut Behavior Present? e 1:00 - 24:00 - 47:00 - 70:00 2:00 + 25:00 + 48:00 + 71:00 3:00 + 26:00 - 49:00 + 72:00 4:00 - 27:00 - 50:00 - 73:00 5:00 - 28:00 - 51:00 + 74:00 6:00 + 29:00 - 52:00 + 75:00 7:00 - 30:00 + 53:00 - 76:00 8:00 + 31:00 - 54:00 - 77:00 9:00 - 32:00 - 55:00 - 78:00 10:00 - 33:00 - 56:00 - 79:00 11:00 + 34:00 - 57:00 - 80:00 12:00 + 35:00 - 58:00 - 81:00 13:00 + 36:00 + 59:00 - 82:00 14:00 - 37:00 + 60:00 - 83:00 15:00 - 38:00 - 61:00 84:00 16:00 + 39:00 - 62:00 85:00 17:00 - 40:00 - 63:00 86:00 18:00 - 41:00 - 64:00 87:00 19:00 + 42:00 + 65:00 88:00 20:00 - 43:00 - 66:00 89:00 21:00 - 44:00 - 67:00 90:00 22:00 - 45:00 - 68:00 23:00 - 46:00 + 69:00 Column Total: Column Total: Column Total: Column Total:

Total number of intervals behavior was present: Kevin Jackson Day 1 Activity Packet 59

Interval Recording Form – Language Arts Interval Recording Form

Name Date Class Target Behavior Observer

Kevin Jackson March 23 Math Classroom Disruption Mrs. Thompson

Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? 1:00 + 24:00 - 47:00 + 70:00 2:00 + 25:00 - 48:00 + 71:00 3:00 - 26:00 - 49:00 - 72:00 4:00 + 27:00 - 50:00 - 73:00 5:00 - 28:00 - 51:00 + 74:00 6:00 + 29:00 + 52:00 - 75:00 7:00 + 30:00 - 53:00 + 76:00 8:00 - 31:00 - 54:00 + 77:00 9:00 + 32:00 - 55:00 - 78:00 10:00 + 33:00 - 56:00 + 79:00 11:00 - 34:00 - 57:00 - 80:00 12:00 - 35:00 - 58:00 - 81:00 13:00 - 36:00 + 59:00 - 82:00 14:00 + 37:00 - 60:00 - 83:00 15:00 - 38:00 - 61:00 84:00 16:00 - 39:00 - 62:00 85:00 17:00 + 40:00 + 63:00 86:00 18:00 - 41:00 + 64:00 87:00 19:00 - 42:00 - 65:00 88:00 20:00 + 43:00 - 66:00 89:00 21:00 + 44:00 + 67:00 90:00 22:00 - 45:00 - 68:00 23:00 - 46:00 + 69:00 Column Total: Column Total: Column Total: Column Total: Kevin Jackson Day 1 Activity Packet 60 Total number of intervals behavior was present:

Interval Recording Form Interval Recording Form – Math Name Date Class Target Behavior Observer

Kevin Jackson March 29 Science Classroom Disruption Mrs. Rodriguez

Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? 1:00 - 24:00 - 47:00 - 70:00 2:00 - 25:00 - 48:00 + 71:00 3:00 - 26:00 - 49:00 - 72:00 4:00 - 27:00 - 50:00 + 73:00 5:00 + 28:00 - 51:00 + 74:00 6:00 - 29:00 - 52:00 - 75:00 7:00 - 30:00 - 53:00 - 76:00 8:00 - 31:00 - 54:00 - 77:00 9:00 + 32:00 - 55:00 + 78:00 10:00 - 33:00 - 56:00 - 79:00 11:00 - 34:00 + 57:00 - 80:00 12:00 - 35:00 - 58:00 - 81:00 13:00 + 36:00 - 59:00 - 82:00 14:00 - 37:00 - 60:00 - 83:00 15:00 - 38:00 - 61:00 84:00 16:00 - 39:00 + 62:00 85:00 17:00 + 40:00 - 63:00 86:00 18:00 - 41:00 - 64:00 87:00 19:00 - 42:00 - 65:00 88:00 20:00 - 43:00 - 66:00 89:00 21:00 - 44:00 - 67:00 90:00 22:00 - 45:00 - 68:00 23:00 - 46:00 - 69:00 Column Total: Column Total: Column Total: Column Total: Kevin Jackson Day 1 Activity Packet 61 Total number of intervals behavior was present:

Interval Recording Form Interval Recording – Science Name Date Class Target Behavior Observer

Kevin Jackson March 24 Social Studies Classroom Disruption Ms. McCarthy

Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? Minute Behavior Present? 1:00 + 24:00 - 47:00 + 70:00 2:00 + 25:00 + 48:00 + 71:00 3:00 + 26:00 - 49:00 + 72:00 4:00 - 27:00 - 50:00 - 73:00 5:00 - 28:00 - 51:00 + 74:00 6:00 + 29:00 + 52:00 + 75:00 7:00 + 30:00 - 53:00 + 76:00 8:00 - 31:00 - 54:00 + 77:00 9:00 - 32:00 - 55:00 + 78:00 10:00 + 33:00 - 56:00 + 79:00 11:00 + 34:00 - 57:00 - 80:00 12:00 + 35:00 - 58:00 - 81:00 13:00 - 36:00 - 59:00 + 82:00 14:00 + 37:00 - 60:00 - 83:00 15:00 + 38:00 - 61:00 84:00 16:00 - 39:00 + 62:00 85:00 17:00 + 40:00 + 63:00 86:00 18:00 + 41:00 - 64:00 87:00 19:00 + 42:00 - 65:00 88:00 20:00 + 43:00 - 66:00 89:00 21:00 + 44:00 - 67:00 90:00 22:00 - 45:00 - 68:00 23:00 - 46:00 + 69:00 Column Total: Column Total: Column Total: Column Total: Kevin Jackson Day 1 Activity Packet 62 Total number of intervals behavior was present:

Interval Recording – Social Studies