Rating Behavior Scale

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List up to five behaviors you want to see changed(put a brief description of the behavior you will rate. Ex: hits, runs away, yells)

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FREQUENCY SCORE

How often does this happen?	0 - 1 (Up to once a week)	2 - 4 (Up to 4 times a week)	5 - 7 (Up to once a day)	8 - 28 (Up to 4 times a day)	29 - 49 (Up to 7 times a day)	50 - 70 (Up to 10 times a day)	71 - 112 (Up to once an hour)	113 - 224 (Up to twice an hour)	225 - 448 (Up to 4 times an hour)	>449 (More than 4 times an hour)
Frequency Score->	1	2	3	4	5	6	7	8	9	10

PROBLEM SEVERITY

Describe the first behavior	Frequency Score Severity: 0 1 2 3 4 5 6 7 8 9 10
Describe the second behavior	Frequency Score Severity: 0 1 2 3 4 5 6 7 8 9 10
Describe the third behavior	Frequency Score Severity: 0 1 2 3 4 5 6 7 8 9 10
Describe the fourth behavior	Frequency Score Severity: 0 1 2 3 4 5 6 7 8 9 10
Describe the fifth behavior	Frequency Score Severity: 0 1 2 3 4 5 6 7 8 9 10

	OVERALL SEVERITY SCORE
Behavior 1
Behavior 2
Behavior 3
Behavior 4
Behavior 5
Total Severity Score

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Questions? Send them to Laburd@medicine.nodak.edu.