Not there yet. Let’s take another look.

Despite a careful assessment and quality treatment plan implemented with integrity, the client’s severe SIB is still well above acceptable levels. The BA creates a behavior graph with phase change lines for each medication adjustment over the last two years and asks the caregivers to make an appointment with the psychiatrist to see about getting the medication adjusted.

The behavior analyst discovers that the behavior plan is not being implemented in the job placement setting due to a counter-recommendation made by the vocational therapist. The BA’s initial reaction is to send a carefully worded email and cc some other stakeholders. She then reconsiders and picks up the phone and talks directly to the vocational therapist. The BA asks if she can come to observe the next time the therapist plans to be at the job site so she can better understand the vocational therapist’s interests and offer some adaptations that are aligned with the plan.

After studying the behavior graph, the BA decides to make another graph with the staff and days of the week labeled. This graph provides some very useful data trends from which she can make recommendations.

The inappropriate sexual behavior at school has escalated and the client is at risk of being referred to a more restrictive placement. The BA has only been with the client for a few months and needs some additional perspective. He asks the caregivers if he can talk to the BA from the prior agency and invite her to the next team meeting at the school.

Each year, the client goes away to spend three weeks with his parents in Florida. It is often the case he is aggressive toward his housemates upon his return and is no longer using his alternative responses or self-calming techniques. This year, the BA asks the parents if they would be willing to have a 30-min video session prior to the visit and each week the client is with them.

When the data are showing a new trend, the BA brings it to the attention of the client’s caregivers with two options for how to proceed.

Despite the chaos the client’s crisis behavior has created, the BA is trying his best to make careful decisions regarding next steps, consultations, and referrals. He takes the time to document his decisions as he makes them.

Three weeks into the program, the BA is not seeing the expected change. She begins to wonder whether the attention-maintained behavior is nuanced in a way that was not detected by her assessment. It feels awkward to implement more assessments at this time, but she thinks it will be in the client’s best interest and wants to be accountable for creating an effective plan.