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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download