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ABAI Presentation Resources · Tool 06

Family Context & Cultural Questionnaire

Type your notes below each prompt, or print the worksheet to write by hand. Fields expand as you type. Use Print / save as PDF to keep your completed notes. Notes are not saved when you leave or reload this page; nothing you type is submitted.

A permission-based conversation about the family’s routines and preferences.

Presentation companion • Newly written educational practice aid informed by the sources identified below. This is not a validated assessment or a diagnostic instrument. Adapt collaboratively within your training, role, and consented services.

  1. Who would you like involved in planning and decision-making?
  2. Which languages and communication formats work best?
  3. Which traditions, beliefs, or routines should our recommendations respect?
  4. What demands compete with practice time?
  5. What supports are available, and which would you like help locating?
  6. What have I not asked that would help me understand your family?

Conceptual sources: (Behavior Analyst Certification Board [BACB], 2020; Taylor et al., 2019). The specific prompts and examples are newly written teaching suggestions, rather than tested protocols from these sources.

Reflection & next step

What did the caregiver identify as most important?

What will we change, who will do it, and when will we review it?

How will we ask whether the change was helpful?

Material credit: Newly written instructional synthesis prepared for PBHC’s presentation resource hub. The wording, prompts, illustrative dialogue, and worksheet layout are presentation materials, not reproduced author or publisher instruments. The cited authors are credited for the underlying concepts. These tools have not been validated; citation does not imply author endorsement.

References

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2019). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654–666. https://doi.org/10.1007/s40617-018-00289-3

Additional reading

Related background selected from the presentation reference list; these publications do not validate this worksheet.

Beaulieu, L., & Jimenez-Gomez, C. (2022). Cultural responsiveness in applied behavior analysis: Self-assessment. Journal of Applied Behavior Analysis, 55(2), 337–356. https://doi.org/10.1002/jaba.907

Didiana (Didi) De La Osa, BCBA-D · ABAI presentation resource page