Competency, Caseload, and a Two-Person Hold
A BCBA supervises four RBTs in a home program. One RBT, certified six months ago and new to this case, is assigned 15 hours per week with a 12-year-old whose plan includes a two-person physical hold for aggression. The BCBA has observed the RBT twice in the past month; the RBT has never been checked out on the hold. The RBT texts that she "feels fine" and asks to run sessions alone starting next week. The BCBA is carrying an additional caseload and has just accepted two new clients.
1. What are the supervisor's obligations with respect to this RBT and this client?
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The supervisor owns both the client's welfare and the RBT's competence.
- RBTs must be trained to competence on each procedure with each client before implementing independently. A physical hold is a high-risk procedure and requires in-vivo competency-based training: instruction, modeling, rehearsal in role play, then performance with the client while coached, with a signed competency checklist.
- Supervision of RBTs requires at least 5% of their behavior-analytic hours per month and at least two observation-based contacts per month, at least one of which is individual. Two observations in a month can satisfy the letter of the requirement while failing its purpose for a client with a restraint protocol - observation must cover the high-risk procedures, not just convenient sessions.
- Self-report of readiness ('I feel fine') is not evidence of competency and cannot substitute for direct observation.
2. The BCBA wants to grant the request because the RBT is reliable and the family needs coverage. What is the correct decision and how is it implemented?
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No - the request is denied until competency is documented, regardless of staffing pressure or the RBT's reliability.
Implementation:
- Schedule an in-vivo session this week. Conduct BST on the hold with a second staff member present, then observe the RBT implement and record a signed checklist.
- Until that is done, pair the RBT with a trained staff member for any session in which the hold might be needed.
- If coverage cannot be arranged, the session configuration changes - the family receives a trained staff member, or the session is rescheduled. The standard is not lowered to meet the schedule.
- Tell the RBT plainly what is missing and why, so the denial reads as a training plan rather than a judgment about her.
A preventable injury during an untrained hold is the outcome that ends the case and the certification.
3. What does accepting two new clients while supervision is already thin imply ethically, and what are the supervisor's options?
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The supervisor may not accept a case if doing so makes it impossible to meet supervision and service obligations on existing cases. Taking on work that dilutes supervision of a client with a restrictive procedure is a foreseeable risk, not an unlucky coincidence.
Options, in order of preference:
- Decline or delay the new referrals until the current caseload can be supervised to standard.
- Reduce the RBT's hours on this case and redistribute to a staff member already checked out on the hold.
- Delegate a specific, well-defined supervision task to another qualified BCBA - delegation is limited to tasks the delegatee is competent to perform, and the supervising BCBA retains responsibility for the case.
- Transition a client with a documented plan, notice, and a warm handoff, rather than quietly reducing contact.
Whichever is chosen, document the decision and the date. 'I was busy' is not a defense for inadequate supervision of a client with a restraint protocol.