Module 8 (Part 1): Scope of Practice Videos
F-1 Describe the BACBs RBT supervision requirements and the role of RBTs in the service-delivery system
What’s a Registered Behavior Technician® (RBT®)? Part 1
https://www.youtube.com/watch?v=06fgpGmL2_k
Part 2
https://www.youtube.com/watch?v=qOiPjuEngaM
Part 3
https://www.youtube.com/watch?v=BoJemWBRhJw&t=360s
Day in the life of an ABA Interventionist
https://www.youtube.com/watch?v=P_F9uoxKUDE
Module 8 (Part 2): Professionalism Considerations
Behavior Analyst Certification Board Registered Behavior Technician™ (RBT®) Task List 2nd ed.
D-6 Implement crisis/emergency procedures according to protocol.
E-1 Effectively communicate with a supervisor in an ongoing manner.
E-2 Actively seek clinical direction from supervisor in a timely manner.
E-3 Report other variables that might affect the client in a timely manner.
E-4 Generate objective session notes for service verification by describing what occurred during the sessions, in accordance with applicable legal, regulatory, and workplace requirements.
E-5 Comply with applicable legal, regulatory, and workplace data collection, storage, transportation, and documentation requirements.
F-2 Respond appropriately to feedback and maintain or improve performance accordingly.
F-3 Communicate with stakeholders (e.g., family, caregivers, other professionals) as authorized.
F-4 Maintain professional boundaries (e.g., avoid dual relationships, conflicts of interest, social media contacts).
F-5 Maintain client dignity.
As a direct service provider, paraprofessionals are on the front line of ABA services. In addition to client interactions, they are in contact with parents and other professionals on a regular basis. Therefore, various ethical and professional skills are needed to perform their job responsibilities effectively. This module will tie professional skills into the ethics content already covered in Module 7.
Documentation Considerations
It is a paraprofessionals responsibility to demonstrate integrity by maintaining a responsibility to all parties effected by their services, commitment to evidence-based treatments and doing no harm (Bailey & Burch, 2010). A paraprofessionals integrity needs to be demonstrated through their daily interactions with clients, parents, and other professionals. For instance, throughout the course of daily interactions, a paraprofessional will have conversations about and collect data regarding private information pertaining to clients. Paraprofessionals are ethically and legally bound to take reasonable precautions to uphold their client’s confidentiality (Bailey & Burch, 2010). As discussed in previous modules, paraprofessionals are tasked with the responsibility of collecting data for behavior reduction and skill acquisition programs. These data are important to gage a client’s progress and indicate whether program modifications are necessary. In addition, paraprofessionals may also have to generate objective session notes for service verification by describing what occurred during the sessions including progress towards goals, in accordance with applicable legal, regulatory, and workplace requirements. These notes must be written in a professional manner as they are part of the client’s record. In addition, if a client or their family inform you of a significant change in their medication or a major life event it will be important to communicate these changes to your BCBA supervisor so that they can follow-up and be aware of events that may affect the clients progress. If a novel behavior occurs or an existing behavior occurs at a novel intensity or frequency or topography noting it in the session notes and contacting your supervisor as soon as possible will be warranted. In addition, if a client or their family inform you of a significant change in their medication or a major life event it will be important to note these changes as well as communicate them to your BCBA supervisor as soon as possible so that they can follow-up and be aware of events that may affect the clients progress. Each organization will have a template and specific training on specific components of a session note, however if a paraprofessional is every concerned about what to write on a session note they should always reach out to their supervisor for advice
Interpersonal Considerations
Just as paraprofessionals are in contact with confidential information, there interactions are likely heavily entwined with that of the client and their family. In most cases, the clients and their families are grateful for these services and may become very friendly with a paraprofessional or what to show appreciation in tangible ways, however, in line with the RBT ethics code, the paraprofessional should be friendly but set professional boundaries (e.g., not excepting gifts, not attending a family party outside of work hours or babysitting for a current client, interacting over social media accounts) not enter into a dual relationship with the family (Bailey & Burch, 2010). Dual relationships cloud professional judgment and should be avoided, however social situations with families and clients can be difficult to manage at times, especially in a world that has various modes of social interaction including social media. One of the simplest ways to politely decline from entering a dual relationship is to make the client or parent aware of your ethical code. For instance, if a parent sends you a Facebook friend request, you can simply say “ Thanks for the request, but unfortunately, social media contacts with clients and their families aren’t allowed within the parameters of my ethical guidelines as a practicing RBT.” If you feel that you need assistance managing professional boundaries you should reach out to your supervising BCBA. Your BCBA knows how difficult these situations can be as they themselves are held to the same standards and likely have more experience navigating such professional issues. They can offer strategies and coach you through this situation among many others. Always remember to use your BCBA as a resource to strengthen your professional behavior.
Your BCBA supervisor has a responsibility to support your professional development. One of the most important ways to support you is by providing feedback. Feedback is how our professional behavior is shaped. One of the key ingredients to a successful career is to welcome and accept feedback in order to learn and grow. Training and coaching form your supervisor may include corrective feedback to help you understand areas for improvement and offer general reminders and further clarification. Feedback will also include encouragement for skills that you are doing well with and your supervisor would like to see you continue to maintain. Some people are very comfortable receiving feedback and integrating feedback into their work performance, whereas others may find this is a skill that they must work on. Nonetheless, it is imperative that an RBT be able to appropriately and respectfully respond to feedback and maintain or improve performance accordingly.
Implementing crisis/emergency procedures
Recall that a Behavior Reduction Plan (BRP) is an individualized plan written by a BCBA, outlining the challenging behaviors targeted for decrease, the replacement behaviors targeted for increase, and how to run the interventions necessary to execute the interventions. These types of plans may also be referred to as a Behavior Intervention Plan, Behavior Plan, Behavior Management Guidelines, Behavior guidelines, or other similar names. In this Module, this document will be referred to as a Behavior Reduction Plan (BRP).
In addition, a client who engages in severe challenging behavior (e.g., self-injury or aggression that poses a serious risk of imminent harm to self or others) may also have an Emergency Safety Plan (ESP). An ESP outlines behavior that has historically led to an imminent risk of serious harm. It serves as a safety plan and a quick reference of least intrusive strategies to maintain safety in emergency situations. In the event of an emergency for reasons other than those outlined in an ESP, approved protective measures may be necessary for the safety of clients or staff members. Support and communication with other parties are often necessary to implement such procedures.
An ESP should indicate the least restrictive procedures that are likely to be effective to maintain safety as well as any client-specific prohibited procedures for medical reasons or procedures that have been found ineffective etc.) An ESP may include but is not limited to medical considerations, protective equipment for the client and/or staff members, historically effective protective measures, safety checks and/or weapon checks, and 911 protocols. It may also include the staffing ratios necessary to maintain safety and debriefing, contact, and data collection procedures related to the emergency incident. However, it is important to note that all organizations paraprofessional is employed by will have their own templates and guidelines related to the policies and regulations they abide by.
Physical protective measures (e.g., protective holds – often referred to as restraint, escorts/transports) should only be used when necessary for safety, and only with the utmost respect and care for the safety and wellbeing of the client. All clients deserve to be treated in a humane and professional manner and to have their human rights supported by their caretakers. It is a paraprofessionals responsibility to foster a supportive environment and protect their client’s dignity at all times, including during a behavioral emergency.
It is much better to prevent serious behavioral incidents than to have to physically manage them, however behavioral incidents that present an imminent risk of serious harm may occur during the teaching process. The information in this module is only an introduction to the management of severe behavioral incidents the paraprofessionals organization will provide much more intensive training and decision-making support. Therefore, most organizations that a paraprofessional is employed by will train their staff members to safely manage such emergency situations. The protective measures that a company may need to implement to keep a client and others safe will be unique to population the company serves. There are many safety training curricula that a company may use to train their staff on the implementation of protective measures. The training provided for physical management/protective measures should be done in compliance with any relevant laws and regulations.
It is imperative that paraprofessionals implement the behavior plan, skill acquisition programs, and ESP as trained and written. However, in some cases, situations may occur that the ESP does not cover or are outside of the realm of historical challenges the client has engaged in. This is a prime example of how communication between the paraprofessional and the BCBA is integral for safety. For instance, in some cases, if it is safe to do so (via phone or walkie talkie) immediate contact with the supervisor to problem solve or support a behavioral incident may be necessary for guidance. Sometimes the paraprofessional may have to have another person make this contact for them so they can continue to safely manage the client. In other cases, seeking emergency assistance (i.e., calling 911) before contacting a supervisor may be warranted. An ESP should outline this for paraprofessionals, however there are occasions when the paraprofessional will need to make judgment calls. These judgment calls should always be under the influence of the “Do no harm” ethical clause. Overall, a paraprofessional should implement procedures as trained, however, if they are unable to do so due to unique circumstances, they must make decisions that can be justified by the benefits outweighing the risks to the client and others. For instance, a paraprofessional may be trained in how to lift and transport a client if they flop in a parking lot, however, if that client is flopped in a parking lot, the lift is not effective and a car is coming, that paraprofessional would likely be able to justify picking the client up and putting them over their shoulder to move them from the situation because if they didn’t act in a different manner than they had been trained, the child would be in more harm by the approaching vehicle. Nonetheless, to maintain the safety of the clients and staff members, paraprofessionals should ask for clarification and feedback throughout training and after the training of protective measures. If an ESP is difficult to implement or hard to understand, the paraprofessional should seek immediate assistance from a supervisor for clarification to ensure everyone’s safety. In addition, if more support or resources are needed to safely manage a client, a paraprofessional should respectfully bring these concerns to their BCBA so that the need can be addressed.
Furthermore, debriefing after implementing protective measures is part of appropriate communication between a paraprofessional their supervisor and other team members. The parties involved should meet to discuss and review all relevant information about the incident. During this time the BCBA may have feedback regarding what went well and what may need to be done differently in the future. It is important that the paraprofessional be open to this feedback to foster the safety and cusses of their client. This process will assist with problem-solving and planning accordingly for any future behavioral challenges.
In addition, being that the use of protective measures is considered an emergency procedure they should be documented via an incident report designed by the organization to meet the regulations set forth for the setting in which the client receives services.
https://www.surveymonkey.com/r/Module8Quiz
References
Bailey, J. S., & Burch, M. R. (2010). 25 essential skills & strategies for the professional behavior analyst: expert tips for maximizing consulting effectiveness. Taylor & Francis.