Consultant's Name:
Consultant's Name: ____________________________
Observer's Name: ______________________________
Date: _______________________
Subject ID __________________
PROBLEM IDENTIFICATION INTERVIEW
OBJECTIVES CHECKLIST
Listen to the audiotaped PII provided. Place a checkmark on the line to the left of each item that you believe the consultant addressed. If information is obtained from the parent, place a check in the “home” column. If information is obtained from the teacher, place a check in the “school” column. In some cases, the information will be provided by the consultee without the consultant asking for it. In these cases, the consultant should summarize or repeat the information to the consultee. Use the definitions provided in Kratochwill, Elliott, and Rotto (1990) to ensure consistency and objectivity in your ratings.
Home School
_____ _____ 1. Opening salutation
_____ _____ 2. General statement to open discussion
Behavior specification
_____ _____ 3. Specify examples
_____ _____ 4. Specify priorities
_____ _____ 5. Target behavior definition
_____ _____ 6. Summarize target behavior
Behavior setting
_____ _____ 7. Specify examples
_____ _____ 8. Specify priorities
Preliminary conditional/functional analysis
_____ _____ 9. Identify antecedent conditions/setting events
_____ _____ 10. Identify consequent conditions
_____ _____ 11. Identify environmental/sequential conditions
_____12.Summarize and validate conditions and functions
_____ _____ 13. Behavior strength
_____ _____ 14. Summarize and validate behavior and strength
_____ _____ 15. Existing procedures
_____ _____ 16. Strengths/Assets
_____ _____ 17. Possible reinforcers
_____ _____ 18. Summarize and validate behavior, strength, goal
_____ _____ 19. Rationale for data collection
Data collection procedures
_____ _____ 20. What?
_____ _____ 21. Where?
_____ _____ 22. How?
_____ _____ 23. When?
_____ _____ 24. Summarize and validate data recording procedures
____25. Next appointment
_____ _____ 26. Closing salutation
_____ Total _____ Total
home school (divide each by 26)
PERCENT OF OBJECTIVES MET:
_____ % Home _____ % School
Consultant's Name: ____________________________
Observer's Name: ______________________________
Date: _______________________
Subject ID __________________
PROBLEM ANALYSIS INTERVIEW
OBJECTIVES CHECKLIST
Listen to the audiotaped PAI provided. Place a checkmark on the line to the left of each item that you believe the consultant addressed. If information is obtained from the parent, place a check in the “home” column. If information is obtained from the teacher, place a check in the “school” column. In some cases, the information will be provided by the consultee without the consultant asking for it. In these cases, the consultant should summarize or repeat the information to the consultee. Use the definitions provided in Kratochwill, Elliott, and Rotto (1990) to ensure consistency and objectivity in your ratings.
Home School
_____ _____ 1. Opening salutation
_____ _____ 2. General statement regarding: data and problem
_____ _____ 3. Behavior strength across settings
_____ _____ 4. Goal of consultation
Conditions/Functional analysis
_____ _____ 5. Antecedent conditions
_____ _____ 6. Consequent conditions
_____ _____ 7. Sequential conditions
_____ _____ 8. Summarize and validate behavior, strength, conditions
_____ _____ 9. Interpretation of behavior
_____ _____ 10. Cross-setting plan development
_____ _____ 11. Summarize and validate plan
_____ _____ 12. Data recording procedures
_____ _____ 13. Next appointment
_____ _____ 14. Closing salutation
_____ Total _____ Total
home school (divide each by 14)
PERCENT OF OBJECTIVES MET:
_____ % Home _____ % School
Consultant's Name: ____________________________
Observer's Name: ______________________________
Date: _______________________
Subject ID __________________
TREATMENT EVALUATION INTERVIEW
OBJECTIVES CHECKLIST
Listen to the audiotaped TEI provided. Place a checkmark on the line to the left of each item that you believe the consultant addressed. If information is obtained from the parent, place a check in the “home” column. If information is obtained from the teacher, place a check in the “school” column. In some cases, the information will be provided by the consultee without the consultant asking for it. In these cases, the consultant should summarize or repeat the information to the consultee. Use the definitions provided in Kratochwill, Elliott, and Rotto (1990) to ensure consistency and objectivity in your ratings.
Home School
_____ _____ 1. Opening salutation
_____ _____ 2. Questions regarding procedures and outcome
_____ _____ 3. Questions about goal attainment
If goal has not been attained:
_____ _____ 4. Plan modifications
_____ _____ 5. Next appointment
If goal has been attained:
_____ _____ 4. Plan effectiveness
_____ _____ 5. External validity
_____ _____ 6. Post-implementation planning
_____ _____ 7. Procedures for generalization/maintenance
_____ _____ 8. Follow-up assessment procedures
_____ _____ 9. Need for future interviews
_____ _____ 10. Termination of consultation
_____ _____ 6/11. Closing salutation
____ Total _____ Total
home school (divide each by 6 or 11)
PERCENT OF OBJECTIVES MET:
_____ % Home _____ % School
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