| 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? |
|---|---|---|
Yes, the RBT should have realized it was not an opportunity for coping skills but rather an opportunity to self- advocating. Teaching an FCT response of "i need a break" would have potentially avoided self injurious behaviors and protected all involved. | immediately, the supervisor should stress the importance of using conceptual skills to make better in the moment treatment decisions. | Modeling, rehearsing, feedback. It is also helpful to answer any questiosn the RBT may have. |
Yes, since the scenario should not have been using for a coping opportunity in the client's treatment program, and did not maintain the client's dignity in the store. | Right away, to go over what to do in these scenarios and going over the client's current repertoire and how they may respond to those situations. | Training on behavior management and escalation, client dignity and thinking on their feet in novel situations. |
This situation could be considered an ethical concern, but we are not sure if it aligns with the treatment plan or not since every client's treatment plan varies. | Supervisor could suggest that since the client does elicit extreme challenging behaviors, teaching opportunities such as this in the community should only be implemented when either the BCBA or parent is also present to ensure safety and fidelity of behavior plan. | Supervisor could emphasize the importance of antecedent strategies prior to the behavior. Teaching the technician to remove the client from the situation if possible to avoid behaviors when it is only them during the session. |
Yes. Ethics and treatment program. Great intentions but not set up for success. | Once everyone is safe feedback should be delivered in a private meeting. | Review how and when to work on those new skills and how we can set up a client for success while in the community. |
Ethics, professionalism and treatment program | After the event and immediately because it leads to file a reportable event | Ethics code, client’s treatment program such as differential reinforcement, environmental modification |
yes | more de-escalation tech need to be used | additional training |
Yes, it was because the trainee’s decision to keep the client in a clearly escalating environment, despite known triggers or lack of appropriate preparation, failed to prioritize the client’s welfare and safety. It also failed to properly manage risk | The feedback should be immediate. It should be met with action plans to prepare for a better response in the future. | Crisis management and de-escalation strategies, including decision-making during community outings. Risk assessment training for public environments, especially for clients with a history of severe behaviors. Ethical decision-making and application of the BACB Code through case studies and role-playing scenarios. |
Yes. If there is a chance of SIB, the RBT shouldn't have attempted unless other staff were there to support | Immediately, if SIB was involved | crisis management |
While the intention to work on the coping skills may have been good, it may have been better to prompt a functional response to leave the environment / get away from the child. | As soon as possible, at the next meeting or maybe could be in an e-mail. | Review of functional communication training and when a good time to practice coping strategies would be. |
Yes this was problematic on multiple levels. Ethically, you should never put your client in a situation that is considered aversive and could potentially escalate to a safety concern. Professionally, you are putting multiple people at risk and unless otherwise noted in the clients treatment program under natural environment training (NET), this is not following protocol. The risk out weigh the benefits and should be only considered if there are additional staff members to ensure the safety of everyone involved and maintain dignity for your client. | Feedback should be delivered in person and before the next outing into the community. The opportunity to ask questions and gain further insight into why this choice was made is necessary. | Utilizing BST is a must in this situation with the requirement that the supervisor also attend the next outing to ensure competency of implementation to appropriate responses. |
Yes. The supervises changed the clients treatment program without authorization. | At the next supervisor meeting, the treatment plan and ethics code violations should be reviewed. | Limits of changing programs, how to respond to crises and ethics code violations may be reviewed. |
Yes. This supervisee should never practice their skills on a client that they don't work with. They had to neglect their own client to do so. This caused the client to have unsafe behaviors. | Immediately. | How to practice within the scope of one's training. |
just like our clients, others in the community engaging in tantrums deserve the dignity of not being watched. if this coping skill was not practiced explicitly within a controlled setting, I wouldn't try and generalize it out in the community | immediately | review decision making |
Yes, it appears that the RBT may not have been following a behavior plan which would most likely call for two people to be present in a community based situation. | Immediately following the incident, review what would have been a better way to manage the trip to the store and retrain on the behavior plan. | Additional training on the behavior plan and on reactive strategies as it seems that they attempted a control hold by themselves in the store |
Yes. The response was problematic due to the environment. | At the supervision meeting, referencing the code of ethics, professionalism, and the client's treatment program, as the client should have had opportunities to practice in contrived situations. | s |
If it was not part of the treatment plan to keep the client in the setting when antecedents to problem behaviors were occurring, it is an ethical violation because the trainee did not implement the plan as written and instead made their own decision about how to provide services. | The supervisor should review the plan in full with the trainee and review procedures and expectations for maintaining treatment fidelity. | How to implement behavior plans with consistency / treatment fidelity |
I do not think this was problematic for ethical, professional, or counterintuitive reasons regarding a client's treatment program. There were no restraints, reprimands, or anything that might violate ethics. The trainee opted for coping methods to flex the client's repertoire when challenged with aversive stimuli within the natural environment, promoting a likely scenario that a parent might encounter. When the client's situation escalated and entered a state of crisis, they understood that they could not control the situation themselves and opted for assistance, showing professionalism. | "I think you did everything I would have done in that situation. I applaud that you took steps to have the client use their coping strategies before taking more intrusive interventions. I like that you took the client from onlookers to maintain their dignity. When it became too much to handle by yourself, you had a moment of honesty. You asked for assistance whilst keeping the client away from other harmful stimuli and keeping them in a corner to become more emotionally stable." | Crisis behaviors, a deeper analysis, and understanding of precursors to SIB, and brainstorming more ways to have the client work on their coping skills in a place that might not be as overwhelming as a grocery store (e.g., a candy store). |
yes | immediately | how to deescalate bxs |
issue with clients treatment program | there should be a safety procedure defined and put into place to accommodate community settings | review of the safety procedure and BST role play with feedback |
Yes | meeting after the session | Identifying precursors |
Yes, SIB behaviors should not purposely be provoke in an uncontrolled environment | Supervisor would provide immediate feedback of practicing coping skills in a controlled environment before moving to an unpredictable one | |
No. | give positive praise for following the treatment program. | Additional training on the crisis plan |
Yes | Immediately | Safety |
Yes. Ethically, this is a trainee who doesn't have support to safely de-escalate with the client in the community. If the coping skills are not mastered and generalized to another setting and exposure to a stressor in the community is not programmed for, it should be navigated to prevent unsafety as best as possible. Additionally, the client's behavior involves self-injury and there was extended self-harm as a result of staying in the situation, which also was in public (considerations of privacy and safety). | The supervisor should provide immediate feedback, possibly via phone call if in-person is not available. Review of the target behavior and safety protocols. | BST with modeling/role play/specific feedback in how to reinforce or support the client in that situation, with the focus on future prevention. |
Yes, I would say this is problematic due to them staying up on the presence of a known antecedent to escalated behaviours. The staff should have begun to proceed to exits to ensure safety, should the client demonstrate success and be able to/wanting to stay, then they could always do that. But as precaution should be working toward exiting while using strateiges. | At the next possible opportunity to discuss response strategies and safe management or a situation. | Responding to escalations, crisis management in the moment - utilizing safe management techniques, padded items for self-injury etc., along with reading cues and responding in the moment. |
| 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? |
