Functional Behavioral Assessment

Teacher Interview Form

Interviewer(s)_____________________________________________ Date(s)_________________________________

Student(s)_________________________________________________________________________________________

Respondent(s)_____________________________________________ Title___________________________________

1. Describe the behavior of

concern.___________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

2. How often does the behavior occur?________________________________________________________________

__________________________________________________________________________________________________
__________________________________________________________________________________________________
How long does it last?____________________________________________________________________________
__________________________________________________________________________________________________
How intense is the behavior?______________________________________________________________________
__________________________________________________________________________________________________

3. What is happening when the behavior occurs?_______________________________________________________

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

4. When/where is the behavior most/least likely to occur?________________________________________________

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

5. With whom is the behavior most/least likely to occur?________________________________________________

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

6. What conditions are most likely to precipitate (“set off ”) the behavior?_________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

7. How can you tell the behavior is about to start?______________________________________________________

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
 Functional Behavioral Assessment
Teacher Interview Form

8. What usually happens after the behavior? Describe what happens according to adult(s), peers, and student
responses._____________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

9. What is the likely function (intent) of the behavior; that is, why do you think the student behaves this way?
What does the student get or avoid? ______________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

10. What behavior(s) might serve the same function (see question 9) for the student that is appropriate within the
social/environmental context? ____________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

11. What other information might contribute to creating an effective behavioral intervention plan (e.g., under
what conditions does the behavior not occur?) ______________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

12. Who should be involved in the planning and implementation of the behavioral intervention plan? ___________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Source: Gable, Quinn, Rutherford, & Howell (1998)

 Functional Behavioral Assessment
Teacher Interview Form
Functional interviews should be structured so that they give the IEP team information regarding the behavior of concern
and its social, affective, and/or environmental content. Here is an example of an intervention conducted with Trish’s
science teacher.

Interviewer(s)__________________Ms. Day_____________________ Date(s)______________4/01/01_____________

Student(s)______________________________Trish_______________________________________________________

Respondent(s)________________Mr. Smith__________________________ Title_Science Teacher_____________

1. Describe the behavior of concern.

“Trish makes what she thinks are funny comments during my instruction, they cause disruption and really interfere with
her learning and the learning of her classmates.”

2. How often does the behavior occur?

“It occurs on average three times per week.”
How long does it last?
“The behavior only last about 3 minutes.”
How intense is the behavior?
“It varies, most of the time it is not too intense.”

3. What is happening when the behavior occurs?

“Group discussions, usually when discussing what students learned from the previous nights reading assignment.”

4. When/where is the behavior most/least likely to occur?

“Trish does not behave this way when she is working alone or on small cooperative group projects.”

5. With whom is the behavior most/least likely to occur?

“There does not seem to be an individual or group, Trish usually acts up when she thinks the work is too hard.”

6. What conditions are most likely to precipitate (“set off ”) the behavior?
“When the class is asked to take out their notes on the reading assignment from the previous night.”

7. How can you tell the behavior is about to start?

“Yes, I can predict pretty accurately what will cause Trish to act up.”

8. What usually happens after the behavior? Describe what happens according to adult(s), peers, and student
responses.
“The class looks at Trish and smiles; actually there are times I can’t help laughing myself; she is funny. But, it takes us a
long time to get back on track and often a significant amount of valuable instructional time is lost.”
 Functional Behavioral Assessment
Teacher Interview Form

9. What is the likely function (intent) of the behavior; that is, why do you think the student behaves this way?
What does the student get or avoid?
“I think she really enjoys the attention. But, there are other more appropriate ways for her to get attention.”

10. What behavior(s) might serve the same function (see question 9) for the student that is appropriate within the
social/environmental context?
“Maybe if she contributed to the discussion instead of getting us all off track.”

11. What other information might contribute to creating an effective behavioral intervention plan (e.g., under
what conditions does the behavior not occur?)
“Trish is quite likeable and sometimes has important information to offer, but we don’t get to see that side often.”

12. Who should be involved in the planning and implementation of the behavioral intervention plan?
“I would certainly think all of her teachers, her parents, school and division officials, and I think Trish would provide
valuable insight to the plan.”

Source: Gable, Quinn, Rutherford, & Howell (1998)

 Functional Behavioral Assessment

Student Assisted Interview Form

Interviewer_________________________________________ Date_______________________________

Respondent_______________________________________________________________________________

1. Tell me about things you like/dislike in school; home; and other places.

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

2. Tell me about the things that seem to be going well/not so well at school; home; and other places.

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

3. Tell me about the subject/class you like most/least; why?

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

4. Tell me about when you seem to have the most/least problems (where are you; what time of day; who else is
around you?).

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

5. Tell me what happens when you (Target Behavior). What does the teacher say/do; what do the other students
say/do?

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

6. Do you remember what were you thinking right before you (Target Behavior)?

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
 Functional Behavioral Assessment

Student Assisted Interview Form

In addition to interviews conducted with adults, interviews with students may be useful in identifying how they perceive the situation and what causes them to
act (or react) in the way that they do. What follows is an example of a functional interview conducted with Trish:

Interviewer________Ms. Day__________________________ Date______________4/01/01___________

Respondent__________________________________________________________________________

1. Tell me about things you like/dislike in school; home; and other places.

“I don’t know….I like Art and Music. Lunch time with my friends is fun. I like hanging out with them at school and at
home. I don’t like Social Studies or Science, there is too much work! And to top it all off we got a new foster kid at
home, what a pain.”

2. Tell me about the things that seem to be going well/not so well at school; home; and other places.

“I am in the Art Club, but they won’t let me go because my grades have not been very good. I want to be in the club, but I
can’t get good enough grades, that makes me mad. Everything else is ok…..oh yeah, except homework, especially
science the book is real hard to read, I don’t understand it.”

3. Tell me about the subject/class you like most/least; why?

“I really like Art and Music, Computer Lab is ok. I am good at Art and I love to sing. I hate Language Arts and Math, I
really hate Science and Social Studies. The books are hard to read and we have homework every night, I don’t do my
homework, because most of the time I don’t know how.”

4. Tell me about when you seem to have the most/least problems (where are you; what time of day; who else is
around you?).

“I don’t have too many problems, except when we discuss the homework. I have asked for help but everyone says it is
my responsibility to get it done. This happens most of the time in Science and Social Studies. I do really well in my
other classes….most of the time.”

5. Tell me what happens when you make funny comments. What does the teacher say/do; what do the other
students say/do?

“Everyone laughs and looks at me. Sometimes Mr. Smith even cracks up. I do it so the other kids will notice me, because
other kids get all kinds of attention for being smart or finishing their work.”

6. Do you remember what were you thinking right before you make funny comments?

“I don’t know…..I guess I was thinking that this is boring and I don’t have my homework anyway so what difference does
it make if I act stupid, I mean silly. Sometimes in class, I wish I could just get up and leave.”
 Daily Student Schedule
Problem/Context Form

Student Trish Interviewer Date 4/7/00

First place an “x” in each column to show the times and places where you have problems with your behavior(s). Next, if you have a lot of problems
during a period, activity, or hall time, I need you to place a “” on or near the six (6). But, if you have only a few problems during a period, activity, or
hall time, you should place a “” on or near the one (1).

Before 1st Hall 2nd Hall 3rd Hall 4th Lunch 5th Hall 6th Hall 7th Hall 8th After
School Period Period Period Period Period Period Period Period School

Subject LA Math Art PE SocSt Sci Music Comp

x x x x x x x

Teacher Smith Jones Brown Reed Smith Jones Black Olson

Most
Problems
6   

5 

4   

3 

2     

1
Fewest
Problems
   

Comments_________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________

Source: Adapted from Reed, Thomas, Sprague, & Horner (1997)

 Daily Student Schedule
Problem/Context Form

Student________________________________________________ Interviewer____________________________ Date______________________

First place an “x” in each column to show the times and places where you have problems with your behavior(s). Next, if you have a lot of problems
during a period, activity, or hall time, I need you to place a “” on or near the six (6). But, if you have only a few problems during a period, activity, or
hall time, you should place a “” on or near the one (1).

Before 1st Hall 2nd Hall 3rd Hall 4th Lunch 5th Hall 6th Hall 7th Hall 8th After
School Period Period Period Period Period Period Period Period School

Subject

Teacher

Most
Problems
6

1
Fewest
Problems

Comments_________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________

Source: Adapted from Reed, Thomas, Sprague, & Horner (1997)