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FunctionalBehavioralAssessment-1

The document outlines a Functional Behavior Assessment (FBA) process for evaluating a child's emotional and behavioral difficulties (EBD). It includes questions regarding the reasons for referral, situational triggers, frequency and intensity of behaviors, awareness and motivation of the child, and previous interventions. The assessment aims to identify the function of the problem behavior and the desired outcomes from the parent's perspective.

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allisonj
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3 views

FunctionalBehavioralAssessment-1

The document outlines a Functional Behavior Assessment (FBA) process for evaluating a child's emotional and behavioral difficulties (EBD). It includes questions regarding the reasons for referral, situational triggers, frequency and intensity of behaviors, awareness and motivation of the child, and previous interventions. The assessment aims to identify the function of the problem behavior and the desired outcomes from the parent's perspective.

Uploaded by

allisonj
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Functional Behavior Assessment

1. What is the reason for the EBD referral and description of the problem:

2. Are there situations that seem to set off the problem behavior?

3. Where do the problems tend to occur? (please list all)

4. When do the problems tend to occur?


Times of Day:
Days of week:

5. How often do the problems occur? How long does the behavior last?
How intense is the problem?

6. Is your child psychologically and neurologically capable of controlling his


or her behavior? Is there evidence of control by your child?

7. Is your child aware of the problems?


8. Does yours child seem motivated to improve the behavior?

9. What is the function of the problem behavior? What seems to be


maintaining or reinforcing your child’s misbehavior?
__ Ability __ Awareness __ Adult Attention

__Power or Control __ Escape or avoidance __Peer Attention

__ Competing Reinforces __ Skill deficit (doesn’t understand what is expected)

___ Frustration from Skill deficit (academic)

___ Bullying Behavior

10. Strengths of your child (please list three).

11. The parent’s goal or desired outcome:


How would you like to see your child change?

What can’t you “live with” any longer?

12. What interventions have been tried and their results:

13. Any additional notes, please add to back of this page.

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