Functional Analysis Screening Tool: To The Interviewer: The FAST Identifies Factors That May Influence
Functional Analysis Screening Tool: To The Interviewer: The FAST Identifies Factors That May Influence
Informant-Client Relationship 9. Does the problem behavior occur even when no Yes No N/A
1. Indicate your relationship to the person: ___Parent ___Instructor one is nearby or watching?
___Therapist/Residential Staff ______________________(Other) 10. Does the person engage in the problem behavior Yes No N/A
2. How long have you known the person? ____Years ____Months even when leisure activities are available?
3. Do you interact with the person daily? ____Yes ____No
4. In what situations do you usually interact with the person? 11. Does the problem behavior appear to be a form Yes No N/A
___ Meals ___ Academic training of self-stimulation?
___ Leisure ___ Work or vocational training
___ Self-care ___________________________________(Other) 12. Is the problem behavior less likely to occur Yes No N/A
when sensory stimulating activities are
Problem Behavior Information presented?
1. Problem behavior (check and describe): 13. Is the problem behavior cyclical, occurring for Yes No N/A
__ Aggression ________________________________________ several days and then stopping?
__ Self-Injury _________________________________________
14. Does the person have recurring painful Yes No N/A
__ Stereotypy _________________________________________
__ Property destruction __________________________________ conditions such as ear infections or allergies?
__ Other _____________________________________________ If so, list:_____________________________
2. Frequency: __Hourly __Daily __Weekly __Less often 15. Is the problem behavior more likely to occur Yes No N/A
3. Severity: __Mild: Disruptive but little risk to property or health when the person is ill?
__Moderate: Property damage or minor injury
__Severe: Significant threat to health or safety 16. If the person is experiencing physical problems, Yes No N/A
4. Situations in which the problem behavior is most likely to occur: and these are treated, does the problem behavior
Days/Times____________________________________________ usually go away?
Settings/Activities ______________________________________
Persons present ________________________________________
5. Situations in which the problem behavior is least likely to occur: Scoring Summary
Days/Times____________________________________________
Settings/Activities ______________________________________ Circle the number of each question that was answered Yes and
Persons present ________________________________________ enter the number of items that were circled in the Total column.
6. What is usually happening to the person right before the problem
behavior occurs?________________________________________ Items Circled Yes Total Potential Source of Reinforcement
______________________________________________________
______________________________________________________ 1 2 3 4 ____ Social (attention/preferred items)
7. What usually happens to the person right after the problem
behavior occurs?________________________________________ 5 6 7 8 ____ Social (escape from tasks/activities)
______________________________________________________
______________________________________________________
8. Current treatments_______________________________________ 9 10 11 12 ____ Automatic (sensory stimulation)
______________________________________________________
______________________________________________________ 13 14 15 16 ____ Automatic (pain attenuation)
______________________________________________________
______________________________________________________ 2005 The Florida Center on Self-Injury