Functional Behavior Assessment
TEACHER INTERVIEW SUMMARY OF TARGET BEHAVIORS
Student: ______Respondent(s): ______
School: ______Age: ______Sex: MFDate: ______
1. What specific behaviors (maximum of 3) occur in school that interferes most with this student’s learning and/or social relationships? (List in order of greatest concern).
*Describe exactly what the student is doing in very specific, observable terms. For instance, instead of “aggressive”, you would state “hits other students”
Problem Behavior 1: ______
Problem Behavior 2: ______
Problem Behavior 3: ______
2. How frequent and intense is the most serious of the behaviors above and how long does it usually last? ______
______
3. Rate how manageable the behavior is:
a. Problem Behavior 112345
Unmanageable Manageable
b. Problem Behavior 212345
Unmanageable Manageable
c. Problem Behavior 312345
UnmanageableManageable
4.Rate how disruptive the behavior is:
a. Problem Behavior 112345
MildlyVery
b. Problem Behavior 212345
MildlyVery
c. Problem Behavior 312345
MildlyVery
5.How often does the behavior occur per day (please circle)?
a. Problem Behavior 1<1-34-67-910-12>13
b. Problem Behavior 2<1-34-67-910-12>13
c. Problem Behavior 3<1-34-67-910-12>13
6.How many months has the behavior been present?
a. Problem Behavior 1<1 2 3 4 entire school year
b. Problem Behavior 2<1 2 3 4 entire school year
c. Problem Behavior 3<1 2 3 4 entire school year
The following questions should focus only on the most serious of the behaviors listed above. The remaining behaviors, if any, can be addressed after the most serious behavior has been resolved.
1. When is the problem behavior most likely to occur?
___Morning___Afternoon ___Before School ___After School ___Lunch
___Recess Other: ______
2. Where is the problem behavior most likely to occur?
____ Classroom ____ Library _____ Hallways ____ Bus
____ Cafeteria ____Gym _____ Recess ___ Bathroom Other: ______
3. During which Subject is the problem behavior most likely to occur?
Subject Area(s): ______
4. During which setting is the problem behavior most likely to occur? Check all that apply.
___ Independent Seatwork ____ Small Group Activities _____ Recess
___ Whole Class Lessons ____ One-to-One Interaction _____ Cafeteria
___ Unstructured Activities ____ Transitions _____Bathroom
___ Other: ______
5. Who is usually present when the problem behavior occurs?
____ Teacher _____ Classmates _____ Other Peers _____ Other Staff
Specific Person(s): ______
6. Are there other events or conditions that take place right before the problem behavior occurs?
___ A demand or request ____ Unexpected changes in schedule or routine
___ Consequences imposed for behaviors
___ Comments/teased from other students
7. When doesn’t the problem behavior occur? When is the student most successful? ______
ANTECEDENTS: Problem Behavior #_____:______YesNo
1.Does the behavior occur more often during a certain type of task?______
2.Does the behavior occur more often during easy tasks?______
3.Does the behavior occur more often during difficult tasks?______
4.Does the behavior occur more often during certain subject areas?______
5.Does the behavior occur more often during new subject material?______
6.Does the behavior occur more often when a request is made to
stop an activity?______
7.Does the behavior occur more often when a request is made to
begin a new activity?______
8.Does the behavior occur more often during transition periods?______
9.Does the behavior occur more often when a disruptionoccurs
in the student's normal routine?______
10.Does the behavior occur more often when the student's request
has been denied?______
11.Does the behavior occur more often when a specific person
is in the room?______
12.Does the behavior occur more often when a specific person
is absent from the room?______
13.Are there any other behaviors that usually precede the problem
behavior?______
14.Is there anything you could do that would ensure the occurrence
of the behavior?______
15.Are there any events occurring in the child's home that seem to
precede occurrence of the behavior at school?______
CONSEQUENCES: Problem Behavior #_____:______
1.Please indicate whether the following consequences occur after the behavior is exhibited.
ConsequenceYesNo
Access to Preferred Activity______
Termination of Task______
Rewards______
Peer Attention______
Teacher Attention______
Praise______
Ignore______
Re-direction______
Interrupt______
Reprimand______
ANTECEDENTS: Problem Behavior #_____:______YesNo
1.Does the behavior occur more often during a certain type of task?______
2.Does the behavior occur more often during easy tasks?______
3.Does the behavior occur more often during difficult tasks?______
4.Does the behavior occur more often during certain subject areas?______
5.Does the behavior occur more often during new subject material?______
6.Does the behavior occur more often when a request is made to
stop an activity?______
7.Does the behavior occur more often when a request is made to
begin a new activity?______
8.Does the behavior occur more often during transition periods?______
9.Does the behavior occur more often when a disruptionoccurs
in the student's normal routine?______
10.Does the behavior occur more often when the student's request
has been denied?______
11.Does the behavior occur more often when a specific person
is in the room?______
12.Does the behavior occur more often when a specific person
is absent from the room?______
13.Are there any other behaviors that usually precede the problem
behavior?______
14.Is there anything you could do that would ensure the occurrence
of the behavior?______
15.Are there any events occurring in the child's home that seem to
precede occurrence of the behavior at school?______
CONSEQUENCES: Problem Behavior #_____:______
1.Please indicate whether the following consequences occur after the behavior is exhibited.
ConsequenceYesNo
Access to Preferred Activity______
Termination of Task______
Rewards______
Peer Attention______
Teacher Attention______
Praise______
Ignore______
Re-direction______
Interrupt______
Reprimand______
FUNCTION OF THE BEHAVIOR:
1. What does the student get when he/she does the problem behavior?
____ Teacher/adult attention ____ Peer Attention _____ Removal from Class
____ Desired item/activity ____ Self-stimulation_____ Parent’s Attention
____ Control over others or situation Other: ______
2. What does the student avoid or escape when he/she does the problem behavior?
____ Teacher/adult attention ____ Peer attention _____ Class Work
____ Non-preferred activity, task, or setting_____ Certain teacher/peer
____ A difficult task or frustration situation Other: ______
What have you tried already to change the problem behavior (e.g., interventions, consequences, positive reinforcers, communication with the parent)? Which showed some degree of success?
______
Do you believe the student does not know how to achieve his/her needs using appropriate behavior (can’t do) or does the student know how to behave appropriately but just chooses not to (won’t do)?
______
In your opinion, what would be an acceptable substitution for the problem behavior but still enable the student to meet his/her need(s)?
______
What are the student’s favorite things to do (possible reinforcers)?
______
Student’s strengths: (social and academic)
______
Student’s weaknesses: (social and academic)
______
St. Landry Parish FBA Teacher Interview (Jan 2013)Page 1