Functional Assessment Interview Tool: Staff Version

Functional Assessment Interview Tool: Parent/Guardian Version (FAIT)

Student: Kevin Jackson Date Completed: March 2006

Parent/Guardian: Mrs. Jackson

Recently, your child has been having behavior difficulties at school. To better understand how we can support Kevin at school, we are conducting a functional behavioral assessment. Your opinion is one important part of this assessment. The functional behavioral assessment involves getting information from staff, the parent/guardian, and the student. Additionally, observations of your child in classroom and non classroom settings are conducted.

The purpose of this tool is to get information from you about four key things: 1) What are your child’s strengths/preferences, 2) What behaviors you are concerned about, 3) Situations where you have observed the behavior and 4) How you and other family members respond when the behavior occurs. Any information you can provide will be extremely helpful in this process. We know you are extremely busy and appreciate the time you are taking to complete this assessment tool.

Please return this tool to: Mrs. Rodriguez by: March 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 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 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: What Contributes to Occurrences of Problem Behavior?

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 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