Aggression in a Group Home: Choosing a Functional Assessment Under Safety Constraints
Marcus is a 34-year-old man with moderate intellectual disability and limited vocal communication who lives in a six-bed group home. In the past 30 days, staff recorded 14 aggression episodes (hitting, scratching, biting), lasting 3–10 minutes; two required first aid and one led to an emergency department visit. A review of 42 ABC entries shows 67% occurred during morning routine and shower transitions, 19% when staff removed his tablet, and 14% had no clear antecedent. Staff say he aggresses “to get out of work,” but three episodes occurred while a staff member was on a personal phone call and two occurred when another resident was receiving praise. A physician ruled out acute medical causes; sleep is variable. The agency will not approve a standard functional analysis because of injury risk and staffing, but the BCBA has 20 hours over four weeks and two RBTs. The team wants a behavior plan immediately.
1. What can and cannot be concluded from the ABC data, and what assessment decision would you make next? Defend the choice given the safety constraints.
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ABC data are correlational. The 67% demand cluster is a strong hypothesis, but attention is confounded: the phone-call and praise episodes show that diverted attention may set the occasion for aggression, and staff may inadvertently reinforce with reprimands, delay, or task removal. The 14% unclassified events mean the hypothesis is incomplete. A standard functional analysis is not automatically required, but some manipulation is needed to distinguish escape from attention. Given injury risk, I would propose a brief trial-based functional analysis embedded in routines: 2-minute trials, conditions for escape (demand present; break contingent on aggression), attention (attention diverted; reprimand/attention contingent), and play/control; 4–6 trials per condition across two weeks; protective equipment, two staff, physician clearance, and stopping rules (any skin break or escalation beyond 3 minutes). If the team rejects that, I would use a structured descriptive assessment plus brief demand probes, label conclusions as hypotheses, and avoid a plan that assumes escape only. Agency refusal does not remove the ethical duty to assess and monitor risk.
2. Design the measurement and data-collection plan for the assessment and for early treatment evaluation, including IOA and procedural integrity.
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Operationalize aggression as forceful contact (hit, bite, scratch, kick) toward another person; measure frequency and duration per episode, plus latency from demand to aggression. During assessment, collect trial-by-trial condition, response, and staff response; have a second observer for 30% of sessions, with exact-count IOA for frequency and duration IOA within 10%. Use a 10-second partial-interval measure for tantrum only if duration is hard to time. Use a procedural-integrity checklist per trial: demand delivered, consequence delivered as specified, no unplanned attention; aim for 90%, and retrain if below 80%. For treatment evaluation, graph daily aggression, mands, and task completion; include baseline, FCT, and follow-up. Add social validity from staff and client preference. Decision rules: if aggression does not decrease by 30% over five sessions with integrity ≥90%, revisit the hypothesis. If integrity falls below 80%, fix training before interpreting data.
3. If the agency refuses even a brief functional assessment, what ethical and clinical steps would you take?
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I would document the refusal, the safety risks, and the limits of the current data. I would consult with the clinical director and, if needed, an outside BCBA, and I would explain to the team that a plan based only on ABC data is a hypothesis, not a confirmed function. I would propose the least restrictive feasible option: structured descriptive assessment, brief demand probes, and close monitoring with stopping rules. I would obtain informed consent for assessment and treatment, clarify who is responsible for restraint or crisis procedures, and avoid endorsing restrictive procedures without evidence and competence. If the agency’s refusal creates unacceptable risk, I would escalate through formal channels and consider whether I can continue as supervisor. The ethical obligations are to benefit, do no harm, and practice within competence; administrative convenience does not override them.