The success of Applied Behavioral Analysis (ABA) has been well researched and validated among children diagnosed with Autism Spectrum Disorder (ASD) for many years. As a practitioner, I have a plethora of evidence-based studies with children to refer to when designing treatment plans. To ensure the consistent delivery of services, many ABA providers have also adopted the service delivery model that utilizes Registered Behavior Technicians (RBT’s). Visit www.bacb.com for more information.
A RBT is a skilled technician responsible for implementing the specific elements of a treatment plan. The majority of research, training materials and tests are designed to develop skills when working with children. For example, many of the training videos and examples demonstrate an ABA therapist working with a child at a table performing a discrete trial. Supporting the individual needs of adults and children with the principles of ABA differ greatly.
The complexity of behavior management increases with age for a large variety of reasons. Obviously, the vast amount of variables in our lives increase as we age that need to be accounted for when creating an adult behavior plan. Our brains become more elasticized (hardened), that makes it increasingly difficult to learn new tasks over time. Thus, early childhood education and intervention is so important. Let’s work together to provide more treatment to more students and shorten the waiting lists for services! Technology is bridging the gap.
Dilemma: What happens when students are not diagnosed, do not receive appropriate treatment, and grow up into adulthood with challenges?
Fortunately, many adult providers are adopting the BACB© RBT Certification Program due to the documented success with children. Sadly, there are few related articles or documented research studies that provide information on the success of RBTs working with the adult population. The lack of resources for RBT’s working with adults is the reason I am passionate about sharing this information and writing this blog entry.
In 2017, I was the first BCBA in the State of California to supervise RBTs working under a new model using ABA in residential environments with adults. Though I have worked with a variety of children and adults in different settings, this treatment model provided a unique set of challenges. The “typical” prescription of ABA services just went from 10 hours-per-week to 84! If there are 4 residents, that is 336 hours per week! To provide behavioral support 24/7, the amount of staff training is much greater and the type of data collection is often different.
In summary, my experience with RBTs supporting adult clients is that the ABA structure provides a positive and statistically significant impact when implemented correctly. Through extensive data analysis and supervision, I have witnessed the rate of behaviors for adult (crisis) clients decrease from -5% to -95% with the RBT certification program. To ensure this level of success in a residential environment 24/7, it is critical to consider the large variety of variables that impact the client declination, or progress. Certainly there is more research and training that needs to be developed for staff members supporting adults with ASD/ID/DD. The following tips and considerations are important when supervising RBT’s that support the adult population:
Considerations
- Identify BCBAs able to provide supervision on all shifts (24/7)
- Determine amount of time spent on behavior-analytic services (time studies, surveys, observation)
- Depending, each RBT may spend 10-30 hours a week providing behavioral analytics services
- A facility that has 12 employees (RBTs) may require up to 40+ hours of monthly RBT supervision
- Notably, most facilities would likely not have all staff members RBT certified concurrently
- Budget for training and supervision of non-RBT staff (competency assessments, treatment fidelity)
- Identify process of communication and data collection betwixt all shifts (Behavior Agent)
- Identify a Lead or Supervisor for every shift who is RBT certified
Tips
- Provide consistent delivery of services (when, who, how)
- Gain as much input from the client as possible to establish written goals and objectives
- Always consider client rights when designing treatment plans, verbiage, and staff training
- Establish clear explanations and expectations for new staff that are unfamiliar with the RBT process.
- Provide “reinforcement” upon passing the certification test (announcements, bonus, pay raise)
- Develop strong and clearly-written Individualized Behavior Support Plan (IBSP)
- Provide documented training for general and specific IBSP Training
- Remain client-focused, have monthly staff meetings, and create teamwork among shifts
- Utilize treatment-fidelity checks for all support staff (RBT and non-RBT)