| Was this response problematic with regard to ethics, professionalism, or the client’s treatment program? | When/how might feedback be delivered by the supervisor? | What types of additional training might improve this supervisee's performance? |
|---|---|---|
This is a form of restraint and is not legal in many schools and clinical practices. | As unobtrusively as possible during the session to prevent the use of illegal behavior management strategies, after the session, in writing after the session, and then again before the next session. | Restraint and seclusion law, antecedent interventions (like taking a break when she starts to demonstrate signs of agitation) |
There might not be enough background information to determine if Sylvia has the repertoire to communicate her needs by any means (e.g., vocal communication, ASL, AAC device, etc.). Assuming that she can coherently use complete sentences, she should be prompted to communicate her need for a break from the desk. Instead of offering her chances to speak first, Sylvia was response blocked; a form of (positive) punishment. Therefore, it may have been unprofessional to use punishment FIRST before reinforcement. It is ethically a problem because behaviorists are to use the least restrictive methods possible first, especially for individuals with a lack of history of any crisis behaviors. We cannot fault Sylvia for her hitting attempts at the RBT due to feelings/fear of being trapped. | "We are to use reinforcement FIRST before we utilize punishment procedures. This is due to punishment having many side effects. We cannot ensure that Sylvia will always be responsive to the same punishment procedure, EVEN IF it WAS effective, as an example of a side effect" If Sylvia is prompted and follows through on an instruction such as "Say, 'I want to take a break, please'", she is much more likely to use this skill in the future. It's easy to understand the request, likely to be reinforced in many general environments, promoting a socially valid & acceptable behavior when Sylvia is having a tough day and no longer wants to be doing a task." | Prompting procedures (e.g., least-to-most), Premack Principle, Alpha Commands, etc. |
Yes, the RBT's actions were problematic across multiple dimensions. | Immediately after the incident with a private debrief. | Behavior management and crisis prevention, ethics and scope of practice, supervision and role-playing |
Yes, the RBT's actions were problematic across multiple dimensions. | Immediately after the incident with a private debrief. | Behavior management and crisis prevention, ethics and scope of practice, supervision and role-playing |
yes there are ethical concerns with this response. | if there in person, I would redirect the RBT with direct instruction of a more ethical response to client behaviors | functional communication training |
yes | as soon as the supervisor was aware of the environmental adjustments | antecedent procedures |
Yes, client should not be pinned in | Supervisor would implement immediate feedback and provide a detailed summary in an email for staff to refer to later | Staff should use natural consequences such as having client pick up tossed items. Staff should also promote use of functional communication skills such as having the client request a break and provide immediate reinforcement for independent trials |
This response was problematic. Instead of trying to de-escalate the situation, this response in turn escalated the client response. Undo harm occurred and unless escape extinction was part of the treatment program, should not have been used . | Supervisior would give feedback at the debrief from the incident and in the moment would model the corrected response. | Additional training on DRA, FCR, and de-escalation based on the client. |
No | As soon as the Supervisor is aware of the situation and after modeling the correct response for the supervisee | Skills training |
I'd ask more information about the student's treatment program - is there reinforcement for presence of alternative or absence of target behavior? How is the target behavior operationally defined, and if the protocol includes extinction, how is the client safeguarded against undue harm, such as the behaviors that might arise due to an extinction burst. | Immediate feedback might be delivered via email with follow-up items in further discussion discussed at the next supervision meeting. | The supervisee might benefit from additional training around escape extinction and differential reinforcement alternatives to behavior change. |
Yes, this scenario violates a clients rights and autonomy, the clinician is not obtaining client assent and providing an aversive/punitive response which is prohibited from an ethical and moral standpoint. | The supervisor should immediately intervene in a scenario like this to model appropriate responses to keep the child safe and not utilize punitive measures, the supervisor will provide feedback as soon as it is safe and appropriate to (e.g., immediately following, once client is safe and relaxed/engaged). | Enhancing staff use of any proactive strategies to set the client up for success prior to the situation, prompting FCT, utilizing DRA and positive reinforcement based interventions. |
yes | in-person or written feedback | Review other possible responses |
What the RBT did was forced compliance, restricting the client to desk; thus, preventing the client from being able to get up and walk away. So, yes, it involves ethics, professionalism, and the treatment program. Would it not be wiser to use functional communication training to teach client to appropriately ask for a break? | Immediatey, the supervisor could point out that re-arranging the environment is an ABA technique; however, restricting the client without any means of escape is an ethical concern, it being forced complicance. | Help RBT by modeling examples of functional communication training and positive reinforcement of desired behaviors. |
This response has ethical problems because it removes the client's autonomy and is very restrictive, which then led to the aggressive behavior. A restrictive response of this level should only be used if it is documented in a plan and has been consented to by caregivers, but even then, only in the case of more extreme behavior. If this wasn't written in a plan, this was also unprofessional of the RBT to implement. | Feedback should be delivered as soon as the supervisor hears/see. In the moment feedback could be coaching if the supervisor is present. The supervisor could review ethical guidelines and work through the problem solving process with the RBT to determine more appropriate solutions and consider writing an updated protocol if the desk flipping behavior persisted. | problem solving, training on physical boundaries/restrictive interventions |
Yes it was problematic.The supervisee should have followed the clients treatment plan and should not have implemented an escape intervention without the supervisor present. | Feedback should be provided immediately and should involve role playing the situation | Training in functional communication as well as treatment fidelity |
It might have violated the written protocol of the treatment plan. What antecedent strategies are in place like FCT, DRA, Choice Giving, etc. | Modeling alternative procedures could be delivered at the time the supervisor sees the escalation. Then during supervision at a later time, retraining could occur with the RBT. | FTC Training, Choice Giving, antecedent strategies, |
When pinning the individual it can be seen as a restraint. It further agitated the individual feeling trapped. Functional communication would be a better option asking for a break and returning to the task after a specified time or using coping strategies such as counting or deep breathes to work through the frustration and continue the work. | Feedback should acknowledge that there could be an ethical concern of regarding the treatment of the individual due to the restraining type solution. It also is not televisable and would not be something that the RBT would appreciate having done to them. They must be treated with dignity and respect. Other opportunities are available such as function communication, asking for assistance, implementing coping strategies, etc. | Modeling from the supervisor could be helpful in these scenarios as well as training on functional communication, visual displays, etc. |
yes | If the supervisor was not present at that moment in time, it should be addressed the next time the supervisor sees the RBT | modeling by the supervisor |
yes | if BCBA is present feedback needs to be provided immediately and the correct supervisee response modeled for the supervisee | review of treatment protocol for escape maintained behaviors |
In this situation, the RBT went straight to a punishment procedure instead of evaluating the use of reinforcement. Putting the desk against the wall is a good idea (altering the environment), but preventing Sylvia from standing up presents an ethical and treatment issue. | Training should be provided to assist the RBT in thinking about using reinforcement in her interventions. | The supervisor should also explain why reinforcement should be considered in ABA therapy. This would provide the RBT an overall/wholeistic perspective. |
Yes | Clear feedback, explain and role play | Rehearsal with additional clients |
Yes, this response was problematic due to ethics because the individual was not able to stand and the behaviors escalated toward more intense self-injurious behavior. | I would deliver feedback ASAP and talk directly with the supervisee. I would go through different problem solving options and role play the scenario. | The supervisee could use some more problem solving training. |
Possibly all three. The strategy identified only addressed one component - escape bx, but did not take into account potential additional factors contributing to the increase in the behavior. Also did not plan for potential unwanted effects or escalation caused by the intervention. Also this appeared to possibly be an overly restrictive approach. If a client is engaging in | If the supervisor is present, immediately providing feedback and modeling to support client de-escalation and then once the situation has calmed to review and collaborate on a more appropriate approach and check for understanding and confirmation. | BST and roleplaying. Written protocol. |
This response was problematic in regards to ethics. This is because the supervisee's response was restrictive to the learner and reactive. It wasn't based on evidence based practice or the client's treatment program, caused more harm, and escalated the learner's response. | Feedback needs to be delivered by the supervisor immediately about appropriate protocol that aligns with treatment goals for the learner's escape maintained behavior. | Additional training using behavioral skills training for responding to related scenarios of escape-maintained behavior may improve the supervisee's performance. |
Yes. | After the client has been de-escalated. Ideally as immediately as possible | Ethics training, verbal de-escalation/nonrestraint based training. Re-training the BSP |
| Was this response problematic with regard to ethics, professionalism, or the client’s treatment program? | When/how might feedback be delivered by the supervisor? | What types of additional training might improve this supervisee's performance? |
