1

UBC-Functional Assessment Interview (UBC-FAI)

Focus Person (Child/Adolescent/Adult)

Jacob

Date Completed: October

23, 2011

Informant(s): Anne (French teacher), A (Classroom teacher)

Interviewers: Dana

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 make involve doing the same thing over and over choices When he/she gets what he/she wants again) When he/she engages in artistic expression When he/she has 1:1 adult supervision and/or (drawing, painting, music, etc.) assistance (note: sometimes resistant to help) When he/she engages in a hands on activity When he/she gets to interact with or an activity that allows for movement peers/classmates/siblings When he/she can use a computer or other Not sure technology to complete a task or activity Other (describe):________________________ When adaptations are put in place to make the ________________________________________ work accessible When he/she is able to use analytical skills

Other than the above, what can you do to improve the likelihood that no problem behaviour will occur?? Not putting any demands on him (e.g. allowing Jacob to roll around on the carpet)

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: His parents reward him with gum at the end of a good day

2. Objects (e.g., toys, favourite items): Bey blades (no longer permitted at school), stuffie

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): Choosing time, in particular creating, cars & trucks, and fire station 4. Social interactions (e.g., tickles, high fives, roughhousing, etc.): He likes hugs, physical touch and high-5s 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. Topography Frequency Often Duration 3-5 minutes Intensity 5

Distracting others Making silly faces, sticking out tongue in circle time Leaving lesson without permission, ignoring demand to return

b. Leaving instructional area without permission c. Touching others (friendly)

Sometimes

3-5 minutes

Giving someone a shoulder hug

Sometimes (during carpet time more frequent) 4 5 day

1 3 seconds

varies

d. Hitting

Open hand slap on arm or torso, punch, poke, step, karate chop Disengaging from task and leaving seat

1 minute

e.

Not completing work

Sometimes

1 minute

Behaviour f. Disrupting lesson

Topography Calling out; trying to engage another peer or adult in conversation during lesson Not performing classroom routine when asked (e.g. clean up) Playing so rough with toys they are broken (e.g. Dropping them)

Frequency Often

Duration 2 -3 minutes

Intensity 5

g.

Non-compliance

Often

1 5 minutes

h. Damaging property

Sometimes

30 seconds

i.

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?

Distracting others, leaving instructional area, disrupting lesson. They tend to happen during carpet time instruction. 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. None apparent.

Part C: Setting Events 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: tense or stiff posture

_____________________________________ _____________________________________

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 Recent disagreement with peer adult 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 Recent failure to earn a reinforcer or reward Recent absence of a preferred peer/adult Recently broken/lost personal item Recent change in routine/usual route Recent major change in living or school situation Upcoming holiday or special event peer adult Presence of unfamiliar/non-preferred Few friends/no social network Bad mood for unknown reason Other; specify: attachment disorder 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:______________________________________________________ Recent seizure Other; specify: his body being held in a rigid and tense way is a signal that he is anxious

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 Other; specify: Jacob does not understand his own feelings, nor have empathy for feelings of others

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 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 Unpleasant tone of voice (stern, crying, etc.) by peer adult Non-preferred or unfamiliar peer/adult approaches/initiates interaction Rushed or hurried Request/preference denied/not met Being late (for an appointment, preferred activity, etc.) Being informed that a planned activity/visit is cancelled Failure to earn a reinforcer or reward 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:_________________________________________________________________ Repetitive task; specify: ______________________________________________________________ Difficult task; specify: listening task (e.g. circle time, French activity) 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: _____________________________________________________________________

Are there particular or idiosyncratic situations or events not listed previously that sometimes seem to 'set off' or trigger the problem behaviours? No.

What things should you avoid that might interfere with or disrupt a teaching session or activity with this person? Making a demand or request without an optional out for the student.

What one thing could you do that would most likely make the problem behaviour occur? Ignoring him. 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 PBs PBs Time 8:40 9:00 9:50 10:17 10:30 11:05 11:40 12:05 12:25 1:30 1:45 1:55 2:20 Activity/Routine Opening Choosing time French snack Seat work Outside play Lunch Quiet time Seat work Recess Snack Music Story Gym No PBs PBs Time Activity/Routine

Settings: Where are problem behaviours most and least likely to happen? Most likely: Least likely:
In the classroom during instructional time

during meal/snack time

People: With whom are problem behaviours most and least likely to happen? Most likely: Least likely: With peers or adults nearby not giving him attention When an adult is giving him 1 to 1 attention

8 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 Other:___________________________

Assign an after-school detention

Other:_____________________________

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:___________________

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 Making faces, distracting others Leaving instructional area Touching other students (friendly) Hitting Antecedent (i.e., Trigger) Difficult or boring task (e.g. oral lesson) Difficult or boring task (e.g. oral lesson) Difficult or boring task (e.g. oral lesson) Preferred activity changed, not getting what he wants Difficult or boring task Difficult or boring task (e.g. oral lesson) Preferred activity ends or changes Peers nearby but not attending Maintaining Consequence Lesson stops temporarily/ Peers laughing, joining in Lesson stops temporarily , movement, stimulation Peer attention, physical affection Expression of his anger/ Attention from adults and peers Attention from adults Lesson stops temporarily, stimulation Gets to spend longer doing preferred activity Peer and adult attention

Not completing work Disrupting, calling out Non compliance Damaging property

10 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: a difficult
or boring task (e.g. oral lesson )

Predictability

Preferred sensory input; specify:___________ | ____________________________________ Other; specify:____________________

Other; specify:___________________

Are there any additional issues that you believe are related to or affect the problem behavior? If so, what are they?
See Systems Profile for details of Jacobs attachment disorder, emanating from difficult family circumstances when he was very young.

11 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
- Circle time/French

Setting Event(s)
- hunger, thirst tiredness - environment too hot

Antecedent Trigger(s)
- Difficult or boring task (e.g. oral lesson)

Problem Behaviour(s)
- Making faces, distracting others - Disrupting, calling out - Leaving instructional area - Not completing work

Maintaining Consequences
- Lesson stops temporarily

Function
- escape

- Circle Time/French

- hunger, thirst, tiredness - environment too hot - poor social skills - noisy, crowded environment - environment too hot - recently rushed or hurried - unstructured activity - hunger or thirst - noisy, crowded environment - environment too hot - recently rushed or hurried

- Difficult or boring task (e.g. oral lesson)

- Gets support for task - Adult attention

- escape

- Choosing time

- Preferred activity changes or ends

- Hitting

- Expression of his anger - Adult and/or peer attention

- attention

- tangible - Preferred activity changes or ends - Non-compliance - Time with preferred activity extended

- Choosing time

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- Choosing time - noisy, crowded environment - poor social skills - attachment disorder - unstructured activity - Hunger, thirst, tiredness - environment too hot - rushed or hurried Peers nearby but not attending Dropping or damaging toys Peer and adult attention - attention

Seat work

difficult or boring task (e.g. kindergarten desk activity)

Not completing work

attention from adults

- attention

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Competing Behaviour Pathways Diagram:

Circle Time Routine
Remains at circle time until the end of the lesson Teacher/EA praise Gets access to preferred activity (i.e. whole or part of symbolic icon) Maintaining Consequence Does not have to participate in lesson, or lesson stops (i.e. escapes from lesson)

Desired Behaviour Feeling hungry, thirsty, tired or too hot Having just done a sitting/listeni ng activity A sitting/listening activity (i.e. a difficult or boring task) Leaves the instructiona l area without permission Disrupts the lesson (e.g,. making faces at other students) Problem Behaviour Jacob can ask for a break using a break card Alternative Replacement Behaviour

Setting Event(s)

Antecedent Trigger(s)

Maintaining Consequence

14 Positive Behaviour Support Plan

Strategies that Make Problem Behaviours Irrelevant, Ineffective, and Inefficient Setting Event Strategies Inquire whether Jacob feels hungry or thirsty, and if yes, offer him a snack. If Jacob appears flushed or the environment is too hot, suggest Jacob remove sweater, etc. If Jacob is tired, omit the activity entirely and provide a break in another location. Give Jacob an activity break between two consecutive sitting/listening activities (e.g., EA can take him outside for some play time). Preventative Strategies Teaching Strategies Teach Jacob to use a break card and set parameters for acceptable alternative activities. Introduce a contingency map showing 1) Jacob using his break card and getting icon (or part of one) he can exchange for access to preferred activity vs. 2) leaving the area and then being made to come back to the carpet, or being moved into another spot in the circle. Consequence Strategies Give praise contingent on Jacob remaining in instructional area and participating in the lesson. For desired behaviour, Jacob earns whole or part of picture icon he can later exchange for access to preferred activity. Allow Jacob noncontingent access to a break card upon request. If Jacob leaves the instructional area, the EA immediately brings him back to the lesson. If Jacob disrupts the lesson by engaging with a classmate, the EA moves him away from that student to a different position on the carpet. Minor problem behaviours: teacher ignores and does not pause or discontinue the lesson; EA provides verbal corrective feedback and prompts Jacob to use break card.

Provide a visual schedule of the showing times of preferred activities. Pre-correct appropriate circletime behaviour. EA prompts Jacob to use his break card if he is shows any indication he is about to cause a disruption or leave the instructional area. Teacher starts listening tasks with active, movementoriented activities.

15

Competing Behaviour Pathways Diagram:

Choosing Time (Clean-up) Routine

Complies with teacher request to clean up and/or finish preferred activity

Teacher/EA praise Gets access to preferred activity

Desired Behaviour Feels hungry, thirsty, tired or too hot Recently rushed or hurried Poor selfregulation skills Setting Event(s) Preferred activity ends Non compliant Is violent toward adults and/or other students

Maintaining Consequence Tangible (he gets additional time in preferred activity)

Antecedent Trigger(s)

Problem Behaviour

Maintaining Consequence

Jacob can ask for 5 more minutes of Choices time

Alternative Replacement Behaviour

16 Positive Behaviour Support Plan

Strategies that Make Problem Behaviours Irrelevant, Ineffective, and Inefficient Setting Event Strategies Inquire whether Jacob feels hungry or thirsty, and if yes, offer him a snack. If Jacob appears flushed or the environment is too hot, suggest Jacob remove sweater, etc. If Jacob appears tired, provide maximum support through the clean-up routine. If Jacob is feeling rushed or hurried, refer to visual schedule and show him schedule of other preferred activities that day or the next. Preventative Strategies Teaching Strategies Teach Jacob to refer to the visual timer to see how much time is left before clean-up. Teach Jacob how to appropriately request 5 more minutes of Choices time. Introduce a contingency map showing 1) Jacob asking for and getting 5 more minutes of Choices time and access to highly preferred activity vs. 2) Jacob demonstrating problem behaviour and having to clean up. Teach Jacob to regulate frustration or disappointment with a relaxation routine. Consequence Strategies Jacob gets praise from the Teacher and EA if he cleans up appropriately when Choices is over. Jacob gets five more minutes of Choices time contingent upon request. For desired behaviour, Jacob earns whole or part of picture icon he can later exchange for access to preferred activity. Minimize reinforcement for problem behaviours by continuing to prompt Jacob to clean up when asked by tapping him on the shoulder (EA may also provide direct assistance cleaning up.)

Provide Jacob with a visual timer to show time remaining before clean up. Pre-correct with a contingency map showing how to earn access to highly preferred activity. Pre-correct to ask for 5 more minutes. If EA sees signs that Jacob is becoming frustrated, prompt him to do his relaxation routine.