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Functional Behavior Observation Form

Clinical Field Experience A:
Functional Behavior Observation Form

Topic

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Description
Note whether this topic was observed or discussed or both.
Observation Models
FBA tool used by mentor to observe and gather information about student behavior. Is there a specific process and/or form used?
Data Collection Methods Methods used by mentor to gather data about student behavior and effect on learning.
Setting
Classroom, faculty office, front office, playground, etc. Describe settings of student observations in detail.
Student Behaviors
What observations of student behaviors did you notice? If no observable misbehavior or disruptive behavior was present, what positive behavior did you notice from students? [NOTE: Preserve student confidentiality and do not use real names when describing students.]

Interventions
Used to affect behavior by making changes to antecedents (triggers), environment, consequences, etc.
Ethical and Professional Principles
How did/do staff and faculty interact with students and/or families in a compassionate manner and remain cognizant of confidentiality?

Reflection:
In 250-500 words, summarize and reflect on the shadowing experience. How will you use what you observed and discussed about functional behavior assessments in your future professional practice?

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