Behavioral Chain Analysis Worksheet

WORKSHEET

Major Problem Behavior Start Date______Time______Place______

Precipitating Event in the Environment Start Date______

Vulnerability Factors (Context of self and environment) Start Date______

Consequence in the Environment and Yourself

Different Solutions

Prevention Strategies for the Future

Plan for Repair

Chain of Behavior (thought/expectation/belief: feeling/emotion; action) and Events

Actual Events

/

Options

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

Thoughts/beliefs

/

T/F/A:

Feelings

Actions

/

Skill:

1