| 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? |
|---|---|---|
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. |
no | Review treatment | Review other possbile scenerios |
Yes, it is problematic, and leads to an escalation of behaviors. | Immediately, at the first opportunity the supervisor should discuss/suggest alternatives to forcing the client to stay in an environment that is clearly unpleasant for that client. | Review the particular client's crisis management plan. Also teach and model alternatives to restricting client to unpleasant setting. Possible also implementing functional communication training to teach client to appropriately request to leave an area. |
It depends- if this client has a history of using coping skills, then it may have been appropriate to practice. However, if coping skills are new, this is an ethical concern because the client began showing SIB as well as the professional concern because the trainee was out of his area of competence and unable to escort the client, leading to greater escalation and possible loss of dignity. | Once everyone is safe and calm/session is over. Supervisor should use problem solving to talk through scenario with trainee and determine other possible options. | review crisis plan |
3.01 RBTs only practice under the close, ongoing supervision of a qualified supervisor and 3.02 RBTs must be competent in the areas in which they provide behavior technician services. What was the protocol in the behavior treatment plan surrounding loud sounds and tantrum behavior in the community setting? Was this something that was practiced before going out into the community? It also appears that this RBT did not have the proper training and oversight to protect this client or themselves in this situation. | The feedback should be delivered immediately, and they should step into the situation. | Antecedent behavioral strategies, such as choice giving and crisis intervention training. |
Problematic in regards to the clients treatment program | The supervisor would give examples of the ethics code violation , the rbt task list, and role play the situation | Task list adherence, ethics code, appropriate client actions/programming changes |
Yes. The trainee attempts to practice skills that have not been generalized in any way to the community, and may not have been mastered in a learning environment. | Feedback can be delivered immediately to help calm the client if feasible, but if not, during the next supervision session, retraining can take place. | Generalization techniques, dealing with difficult situations, dealing with escalating behavior |
Professionalism and ethics. The individual should not have been forced to remain in a situation that could knowingly escalate or cause behaviors. The individual has now had a public behavior and outburst of his own. There are other opportunities to practice coping skills without public exposure. | The supervisor should communicate to the RBT that public outings are not appropriate locations to teach potential high risk behavior coping skills. Scenarios could have escalated worse causing harm to the client or others. | Training on skills base training, HIPPA, self-injurious behavior. |
If working on coping skills was part of the clients treatment plan then it is not problematic. If that was not part of the plan then yes | At the next supervision meeting the supervisor can address how to handle this in a public setting and the conditions of the environment | modeling or direction with the supervisor present |
yes | as soon as possible, immediately if BCBA is present | training on who supervisee is authorized to work with and liability issues |
Yes, because the trainee used a training opportunity not in the behavior plan. | Training should include practicing different scenarios the trainee might face during community outings. | Additional training should include discussing the importance of staying within the interventions. |
Yes | Recognizing the potential for dangerous escalatory responses | Reminders |
Yes - professionalism and treatment outcome. If going into outings, we should plan for potential events that may occur and have strategies in place of how best to respond. | When the next opportunity to review the situation occurs. Preferably as soon as the situation is de-escalated and the client and staff members are safe. | Reviewing client treatment plan, roleplaying scenarios |
The response was problematic with regards to ethics. There are extraneous variables in the community setting and the trainee should only practice coping skills in that unfamiliar environment if they received proper training related to that environment. | Feedback should be delivered by the supervisor immediately. | Additional training related using unfamiliar interventions and/or familiar interventions in an unfamiliar environment should be addressed. Mitigating risk of harm to the client in an unfamiliar environment should also be addressed. |
yes. the client escalated in a community setting and dignity was not protected | before the next session during a supervision meeting | reviewing the treatment plan, adaptive protocols |
Yes the trainee uses force to move the client | promptly and immediately | BST using a dra to allow the client to mand for their needs |
I do not believe so; as long as coping skills are a target that are being worked on. If they took it upon themselves to try this then yes. | Afterwards | When is the best time and place to practice these skills and do you have reinforcement/back up ready to go |
| 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? |
