STUDENT: ______DOB: ______

TODAY’S DATE: ______

FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)

INTERVIEW QUESTIONS – TEACHER/PARAPROFESSIONAL /STAFF

What strengths does the student have?

In what environment or under what circumstances have you seen these strengths occur?

What behavior(s) gets in the way of you teaching/working with the child? Pick only one or two.

What behavior(s) get in the way of student learning?

How do you feel when the student exhibits problem behaviors (your gut reactions)?

What do you think reinforces the behavior for the student?

When does the problem behavior occur?

-In which class?

-Around which activity?

Always in front of others or when the student is alone?

What could you do right now to make the behavior occur?

Is there a time when the behavior does NOT occur?

STUDENT: ______DOB: ______TODAY’S DATE: ______

FUNCTIONAL BEHAVIORAL ASSESSMENT

INTERVIEW QUESTIONS - STUDENT

What strengths do you have?

When do you see these strengths occur?

List things the teacher does and things you do that most gets in the way of your teacher working with you or teaching you? Pick only one or two.

What do you do that interferes with your learning?

How do you feel when this situation occurs?

What makes you want to show this behavior again?

When does this behavior occur?

-In which class?

-Around which activity?

-Always in front of others or by yourself?

What could motivate you right now to do this particular behavior?

Is there a time when you do not choose to use this behavior?

Revised th: 08-09

STUDENT: ______DOB: ______

TODAY”S DATE: ______

TEACHER’S NAME:______

FUNCTIONAL BEHVIORAL ASSESSMENT (FBA)

INTERVIEW QUESTIONS – PARENT

What strengths does your child have?

When do you see these strengths occur?

What behavior do you see that gets in the way or prevents your child from doing what is asked of him at home? Pick only one or two.

What behavior most gets in the way of your child’s relationships with friends?

What behavior most gets in the way of your child’s interactions with adults?

How do you feel when your child exhibits/uses this behavior?

What do you think reinforces the behavior for your child?

When does the problem behavior occur?

-Around which activity?

-Always in front of others – or when he is alone?

What could you do right now to cause the behavior to occur?

Is there a time when the behavior does NOT occur?

Revised th: 08/09