1

UBC-Functional Assessment Interview (UBC-FAI)

Focus Person (Child/Adolescent/Adult):_______BD__________ Date Completed: October 01, 2011 Informant(s): __S.S/J.E. (Group home staff)Interviewer:_Amanda Schulkowsky The purpose of this tool is to get information that will help to inform our understanding of why the focus persons behaviour is occurring, in order to design and implement interventions to support him or her. Part A: The Person Under what situations does this person do WELL? In other words, when does this person have NO or FEW problem behaviours? Check all that apply.

When tasks/activities are structured in a stepWhen he/she is engaged in reflective thinking When he/she receives frequent positive by-step way When he/she knows what is expected attention or support When he/she is already familiar with a concept When he/she works alone or task When he/she works with others When tasks or activities are repetitive (i.e., When he/she is allowed to set the rules or involve doing the same thing over and over again) make choices When he/she engages in artistic expression When he/she gets what he/she wants (drawing, painting, music, etc.) When he/she has 1:1 adult supervision and/or When he/she engages in a hands on activity assistance or an activity that allows for movement When he/she gets to interact with When he/she can use a computer or other peers/classmates/siblings technology to complete a task or activity Not sure When adaptations are put in place to make the Other (describe): work accessible ________________________________________ When he/she is able to use analytical skills When BD is involved in physical activity

Other than the above, what can you do to improve the likelihood that no problem behaviour will occur??

Reward appropriate behaviour with seeing mom/dad, talking about mom/dad, phone calls to mom/dad

Pat Mirenda and Joe Lucyshyn, 2011; adapted from Lohrmann, S., Martin, S., & Patil, S. (2007). Functional Assessment Interview Tool, Teacher and Parent Versions. New Brunswick, NJ: The Elizabeth M. Boggs Center on Developmental Disabilities, UMDNJ-Robert Wood Johnson Medical School; McAtee, M., Carr, E. G., Schulte, M., & Dunlap, G. (2004). A Contextual Assessment Inventory for problem behavior: Initial development. Journal of Positive Behavior Interventions, 5, 148-165; and ONeill, R., Horner, R., Albin, R., Sprague, J., Storey, K., & Newton, S. (1997). Functional assessment and program development for problem behavior: A practical handbook. Pacific Grove, CA: Brooks/Cole.

2 What specific items, activities, or social interactions does this person especially enjoy, that might be reinforcing for him or her? Be as specific as possible. 1. Food and/or drink items: Hot Chocolate, French Toast,

2. Objects (e.g., toys, favourite items): strings of fabric twisted together and twirled in the air, Videos

3. Activities at home, at school, or in the community (e.g., watching a specific TV show, going to music class, going to the park): Hiking, watching Disney shows, Puzzles

4. Social interactions (e.g., tickles, high fives, roughhousing, etc.): Being with mom and dad, deep pressure, massage, having hair brushed, talking with someone,

5. Other: Part B: Problem Behaviours of Concern For each of the problem behaviours of concern, describe the topography (how it is performed/what it looks like), frequency (how often it occurs per day, week, or month), duration (how long it lasts when it occurs), and intensity [how damaging, destructive, or disruptive the behaviours are when they occur, on a scale of 1 (minor problem) to 5 (major problem)]. Behaviour a. Shredding/ripping her property and other peoples property Topography Ripping/shredding fabric items such as mattress, bedding, clothing, towels, and carpet Single hit to staffs arms/legs with a closed fist Stands and stomps feet on the floor Frequency More than ten times a day Duration Intensity

Until item is destroyed

5 4 3 5

b. Hitting staff

Twice a day

Approximately 5 seconds.

c.

Stomping

Five times a day 30 seconds to 1 minute

d. Property damage

Breaks/rips apart structural items to building (E.g. smashing windows, ripping out light fixtures, ripping moulding off walls, pulling drywall off walls)

Twice a day

Until targeted item is destroyed or staff has intervened

3 e. Screaming Vocalizations that begin quietly and increase in pitch and volume Picks at nail beds on both hands and feet Approximately twenty times a day Once a day 30 seconds to 5 minutes at a time

3 5

f.

Nail Picking

Until nail gone and nail beds are bleeding

Which of the behaviours described above are likely to occur together in some way? Do they occur about the same time? In response to the same type of situation?

Stomping and Screaming often occur together in response to the denial of a request; this often progresses to Hitting staff and finishes with Property Damage. Can you identify an escalating sequence that begins with low intensity behaviours and escalates to moderate and/or high intensity behaviours? If yes, fill in the boxes below. Vocalizations: low to high pitch, screaming and stomping feet Low intensity Hitting staff Shredding/Ripping items and Property damage

Moderate intensity Part C: Setting Events

High intensity

BEFORE PROBLEM BEHAVIOUR OCCURS: Are there any behaviours that suggest that this person is going to have a difficult/bad day with an unusual number of problem behaviours? These behaviours may indicate the presence one or more setting events. Check all behaviours that apply.

I do not notice any behaviours that signal a bad day Negative facial expression Negative tone of voice Negative body language Decreased cooperation Withdrawn or solemn disposition Tense or edgy disposition

Other; specify:_______________________ Loud Vocalizations Repeated requests to see mom/dad _____________________________________ _____________________________________

4 Part C: Setting Events (Continued) Listed below and on the next page are a number of setting events that may be related to problem behaviour. Setting events occur either prior to or simultaneous with problem behaviours and increase the likelihood that they will occur, but do not predict/trigger problem behavior directly. CHECK the boxes next to descriptors that you believe act as setting events for this persons problem behaviour. When slash marks are present, underline or circle the appropriate option (e,g., too hot/too cold). Behavioural Histories Recent encounter with an upset peer adult (group home staff) Recent disagreement with peer adult (group home staff) Recently bullied or teased by peer adult Recently reprimanded or disciplined by peer adult Recently physically restrained by peer adult Recent corrective feedback from a peer adult Too little recent attention from a peer adult Recently rushed or hurried Recently completed holiday or special event Request/preference recently denied/not met Recent experience of a late event (appointment, activity, etc.) Recent cancellation of planned activity/event (visit with mom/dad) Recent failure to earn a reinforcer or reward (phone call with mom/dad) Recent absence of a preferred peer/adult Recently broken/lost personal item Recent change in routine/usual route (different routine in new group home than from last group home) Recent major change in living or school situation (has lived in this group home for three months) Upcoming holiday or special event Presence of unfamiliar/non-preferred peer adult Few friends/no social network Bad mood for unknown reason Other; specify: ______________________________________________________________________ Biological/Physiological Conditions Hunger Thirst Tiredness Poor overall diet; poor nutrition Effects of special diet; specify: ___________________________________________________ Too much/too little caffeine/sugar Allergy symptoms (rash, sinusitis, etc.) Acute or impending illness (cold, flu, etc.) Symptoms of chronic illness (e.g., low blood sugar from diabetes; manic phase of bipolar disorder) Chronic pain (headache, toothache, etc.) (Pre)menstrual symptoms Long period without cigarettes or another drug Medication changed or missed Medication side effects; specify: PRN Zyprexa Zydis(Olanzapine quick dissolve oral tablet) 5 mg tablets can be given up to a maximum dosage of 20 mg in a 24 hour period Recent seizure Other; specify: ______________________________________________________________________

5 Ecological /Task Conditions Unpleasant weather (rain, heat, etc.) Change of season; specify:_________________ Noisy environment Visually stimulating environment (too bright, fluorescent lights, etc.) Crowded environment Busy environment (too much activity) Environment too hot/too cold Uncomfortable seating Too many/too few choices Group activity/cooperative work Rigid/inflexible schedule Unstructured/unpredictable setting or activity Other; specify:_______________________________________________________________________ Underlying Skill Deficits Poor hand writing skills Poor motor skills Poor social skills Poor reading skills Poor math skills No/inadequate communication skills/system (non-verbal points/gestures and uses single word hand signs Other; specify:_

6 Part D: Antecedents Listed below and on the next page are a number of antecedents that may be related to problem behaviour. Antecedents occur prior to problem behaviour and act as triggers that predict their occurrence, at least some of the time. CHECK the boxes next to descriptors that you believe act as antecedents for this persons problem behaviour. When slash marks are present, underline or circle the appropriate option (e,g., too hot/too cold).

Left alone (no attention) Peer Adult nearby but not attending (e.g., parent on telephone, teacher talking to other students) Upset peer/adult nearby peer adult (staff) Disagreement with a Reprimanded or disciplined by peer adult Bullied or teased by a peer adult Physical restraint by peer adult peer adult Corrective feedback from a Sudden display of emotion (crying, screaming, laughing, etc.) by peer adult (staff ) Unpleasant tone of voice (stern, crying, etc.) by peer adult (staff reprimands) Non-preferred or unfamiliar peer/adult approaches/initiates interaction Rushed or hurried Request/preference denied/not met (van ride request, request to visit mom/dad) Being late (for an appointment, preferred activity, etc.) Being informed that a planned activity/visit is cancelled (visit with mom/dad) Failure to earn a reinforcer or reward (phone call to mom/dad) Given a non-preferred food/drink Preferred activity changed Preferred activity ends Preferred peer adult absent Broken/lost personal item Sudden, loud noise Other people too close by Request to transition between activities/settings Change in routine/usual route Warned/reminded that a scheduled activity will take place Told/asked to do a non-preferred task/activity Told/asked to wait (in line, for an activity, etc.) Boring task; specify: Watching TV, sitting with staff Repetitive task; specify: ______________________________________________________________ Difficult task; specify: _______________________________________________________________ New or unfamiliar task Multi-step task or project Makes an error or mistake in a task or activity Activity too long/too short; specify:_____________________________________________________ Instructional pace too fast/too slow Unclear directions Acute pain Other; specify: _____________________________________________________________________

7 Are there particular or idiosyncratic situations or events not listed previously that sometimes seem to 'set off' or trigger the problem behaviours?

When BD is left alone without scheduled activity What things should you avoid that might interfere with or disrupt a teaching session or activity with this person?

Mentioning Mom or Dad, having no choices of activities, and staff making demands What one thing could you do that would most likely make the problem behaviour occur?

Ignore BD Part E: Schedule Briefly list the person's typical daily schedule of activities and the approximate time at which each activity occurs. Check the boxes by those activities/routines in which problem behaviours are unlikely to occur (No PBs) and those in which they are likely to occur (PBs).

No Formalized Schedule in place at this time

No PBs PBs Time 7-8 8-9 9-12 12-1 1-2 2-4 4-5 5-7 7-9 Activity/Routine Breakfast Morning Hygiene Free Time Lunch Movie/TV Outside, walk/yard Dinner Routine Free time Bedtime Routine (bath, brush teeth, wash hair, etc) 9-7 Sleep Time in Bedroom No PBs PBs Time Activity/Routine

Settings: Where are problem behaviours most and least likely to happen? Most likely: In the Group Home, living room, bedroom, hallway, bathroom, co-clients rooms Least likely: Dining Room, out in the community

People: With whom are problem behaviours most and least likely to happen? Most likely: Staff and Parents

8 Least likely: The behaviours happen the least with a particular staff member, Deb. Part F: Consequences In this section, identify the adult-implemented consequences that typically follow problem behaviours when they occur.

Ignore the person

Take way points or other tokens that the person has earned Take away an activity, free time, or privilege Give the person help or assistance with a task Remove a demand or non-preferred activity Reduce the amount or length of a nonpreferred activity Let the person take a break

Ignore the behavior but continue with the task or activity Nonverbal cue (e.g., eye gaze, facial expression, etc.) Verbal correction, prompt, or redirection

Verbal reprimand

Verbal threat, criticism

Remind the person what is and isnt appropriate

Send the person home

Speak to the person afterwards about the problem and possible solutions Attention from peers (may be positive or negative)

Send the person to an administrator (principal, etc.) or counsellor Give a time-out (in the hallway, to a bedroom, etc.) Deduct points from an assignment

Give affection (hug, cuddle, kiss, etc.)

Give/let the person have what he or she wants/asked for Call the persons parent or guardian

Move or re-assign classroom seat

Assign an in-school detention

Administer a slap, spank, or other physical consequence (holding BD arms) Other:___________________________

Assign an after-school detention

Other: PRN Zyprexa Zydis 5mg tablets

9 How do peers (classmates, brothers and sisters) react when problem behaviours occur?

No reaction (ignore the person and the behaviour) Laugh or encourage the person to continue the behavior Verbal correction (reprimand, yell, etc.)

Offer assistance, encouragement or support

Tattle/get an adults attention to intervene

Other; specify:___________________ Flee in Fear

Part G: Linking the Antecedents that Occasion Problem Behaviour with the Consequences that Maintain Problem Behaviour Given the information you have gathered so far, the next step is to link the behaviours identified in Part B with the antecedent triggers identified in Part D and the consequences identified in Part F. The key is to link each problem behaviour (or group of behaviours) with one or more antecedent triggers and the subsequent consequence(s) that likely serve to reinforce the behaviour [i.e., the maintaining consequence(s)]. If a problem behaviour has more than one antecedent trigger, list the behaviour more than once and link it each time to each of the relevant antecedent (e.g., verbal aggression may be triggered by demands to do tasks, corrections, and criticism). Be sure to identify the maintaining consequence only that is, the consequence that most likely acts as a reinforcer for the problem behaviour. Problem Behaviour Shredding/Ripping Shredding/Ripping Antecedent (i.e., Trigger) Left Alone Request Denied Maintaining Consequence Verbal reprimand Attention from staff Take away activity, verbal reprimand, time-out in bedroom Verbal reprimand, remind person what is/isnt appropriate, take away activity, remove demand, PRN, physical intervention Ignore the person Verbal reprimand, reduce length of activity Verbal reprimand Ignore the person Reduce the length of activity Ignore the person

Hitting

Adult not attending

Stomping Stomping Screaming Screaming Screaming Screaming

Disagreement with staff Request Denied Request Denied Preferred activity ends Told to do non-preferred task/activity Told to wait

Property Damage Property Damage Nail Picking Nail Picking

Left Alone Being informed visit is cancelled Left Alone Boring task

10 Verbal reprimand, take away activity, time out, PRN Verbal reprimand, take away activity, time out, PRN Remind what is/isnt appropriate, verbal reprimand Remind what is/isnt appropriate, verbal reprimand

11 Part H: Function(s) Based on Part G, what is your hypothesis as to the function of the problem behavior(s)? The person gets access to: The person escapes or avoids:

Something tangible (food, drink, activity, item) that he/she wants Attention from classmates, siblings, etc. (even if it is negative) Adult attention (even if it is negative)

Activities/work that are/is too hard, boring, long, etc. An unpleasant/negative social interaction

Criticism or a reprimand

Time alone

A situation in which he or she is not sure what to do or what is expected A situation that is too stimulating; specify:______________________________ A situation in which there is not enough to do/not enough stimulation; specify: Being alone in bedroom when not sleepy, sitting in a chair in TV room with staff Other; specify:___________________

Predictability

Preferred sensory input; specify:___________ | ____________________________________

Other; specify:____________________

Are there any additional issues that you believe are related to or affect the problem behavior? If so, what are they? Obsessive Compulsive Disorder and High Anxiety Confusion and upset regarding change in living situation Not knowing when the next time she will be able to see mom/dad

12 Develop separate Summary Statements for each relevant routine, unless the same antecedents and maintaining variables remain constant across more than one routine. If this is the case, combine across relevant routines.

Routine

Setting Event(s) Boring Task/ Unstructured Setting

Antecedent Trigger(s)

Problem Behaviour(s)

Maintaining Consequences

Function
Automatic

Sleep Time in Bedroom

Left Alone in Bedroom

Nail Picking Shredding/Ripping Property Damage Verbal reprimand, Reminded of appropriate behaviour, PRN Verbal Reprimand, Take an activity away, PRN

Postive R+ Gives BD something to do Adult Attention

Free Time Across the day

Tired/Unstructure d setting/inadequate communication/T oo little attention from staff/request recently denied

Denial of a Request/Cancella tion of visit with mom/dad

Screaming/Stomping

Hitting Staff Property Damage