Functional Behavioral Assessment Staff/parent Interview
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1
2South Bend Community School Corporation
Special Education Department
Functional Behavioral Assessment Staff/Parent Interview
Student:
School:
Grade:
Interviewer:
Person Interviewed/Position
Date Completed:
To be used to gather information from parents, school staff or administrators
Strengths: Identify at least three (3) student strengths
o self-disciplined
o trustworthy
o
exhibits leadership
o positive about school
o motivated
respectful
o
o works
i ndependently
o focused on goals
o
humorous
o efficient
o
athletically talented
o handles conflicts well
o artistically/musically talented
o verbally expressive
o
academically talented
o other ___________________
What is the specific primary behavior of concern?
Never
Sometimes
Frequently
Always
1. Does the problem behavior occur when you tell him/her to perform
a task?
2. When the problem behavior occurs, do you redirect him/her back to
the task?
3. Is the problem behavior more likely to occur when told he/she
cannot do something that he/she wants?
4. During a conflict with peers/siblings, does it involve verbal or
physical aggression?
5. When the problem behavior occurs, do others argue or laugh at the
him/her?
6. Is the problem behavior more likely to occur following a conflict with
someone?
7. Does the problem behavior occur to get your attention?
8. Does the problem behavior only occur at specific times or places?
9. Is the problem behavior more likely to continue to occur throughout
the day following an earlier episode?
10. Does he/she engage in the problem behavior if told he/she cannot
have a preferred activity or item?
11. Does the problem behavior stop if others stop interacting with
him/her?
12.Does he/she fall asleep or withdraw after the problem behavior?
8/6/10
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