Two Teams, One Student
Amara is a 9-year-old receiving clinic-based services for escape-maintained disruption during writing tasks. Her school team uses a 'quiet corner' and sends her home after two incidents in a day; your clinic uses behavior momentum, a token economy, and a break card. The school counselor emails your personal account asking for raw session videos and complete data sheets, writing that the mother 'already said it was fine' over the phone to her. There is no signed release on file. The mother separately reports three 'seizure-like' episodes in the past two weeks during tantrums - stiffening and brief unresponsiveness - that were never documented before.
1. How do you handle the reported episodes?
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Do not name them. 'Seizure-like' is a description, not a diagnosis, and diagnosing is outside your scope. Your job is to describe, document, refer, and protect.
Document each episode as reported: what preceded it, exactly what was observed (stiffening, unresponsiveness, duration, eye position, incontinence, post-episode confusion or fatigue), how it ended, and how long recovery took. Ask the mother to keep the same log at home. If staff have witnessed one, get their independent description the same day.
Refer, with written parent consent, to Amara's pediatrician and, on their judgment, a neurologist. Three episodes in two weeks in a child with no prior history is a reason for prompt medical evaluation, and the referral should say that plainly. Send the log with the referral.
Protect in the moment. Train staff on what to do - cushion the head, do not restrain the limbs, do not put anything in the mouth, time the episode, position for breathing, call emergency services if it exceeds the setting's threshold. Brief the school on the same steps.
Reopen the behavioral formulation. If a medical event is occurring, some of what looks like escape-maintained disruption may be a response to a physical event, and the plan may need to change. Document that you have flagged this and that the plan is under review pending medical input.
2. How do you respond to the counselor's request for videos and data sheets?
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Do not send anything to a personal email address, and do not treat a phone call as authorization.
- Consent must be documented. Ask the mother for a signed release of information naming the specific records, the recipient and setting, the purpose, an expiration date, and her right to revoke. A verbal 'it's fine' relayed secondhand is not that, and it is not verifiable by you.
- Transmission must be secure. Even with a signed release, personal email is not an appropriate channel for video or records. Use the agency's encrypted portal, secure file transfer, or a hand-delivered copy.
- Share the minimum necessary. The counselor's stated need is to coordinate programming, which is usually met by a written summary, operational definitions, and graphed data. Raw video of a minor is the most sensitive and least necessary item on the list; release it only if there is a specific, documented reason.
- Remember the school's side. FERPA governs the school's records; a reciprocal release is what lets you receive their incident data.
Say yes to the intent and no to the mechanism. Tell the counselor you want the coordination and will turn the request around as soon as the paperwork is signed, then call the mother yourself to explain what she is being asked to sign and why. Document the request, the delay, and the resolution - a refused-then-resolved request looks very different from an ignored one.
3. Design the coordination plan. What has to be aligned, and what do you do about the send-home contingency?
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Name the conflict first: the school's send-home rule is very likely functioning as escape. Amara's disruption is escape-maintained. Being sent home after two incidents removes the writing task and the school day. If that is happening even occasionally, the school is intermittently reinforcing the exact contingency the clinic plan is trying to extinguish, and no amount of clinic-side fidelity will overcome it.
Bring it to a joint meeting with the mother, the counselor, the classroom teacher, and the BCBA, and align four things:
- Definitions and measurement. One operational definition of disruption, one measurement system (e.g., frequency per writing block), and a shared data sheet so the two teams can compare numbers.
- Antecedents. Behavior momentum into writing in both settings; the break card available and honored in both; task difficulty and length matched.
- Consequences. Agree that a break is available for appropriate requesting and that the send-home is reserved for genuine safety events, with a graded in-school alternative (e.g., a supervised reset room for a fixed short interval) replacing it.
- Roles and review. Identify a school-based implementer, train that person with BST, provide a one-page protocol, schedule an IOA check and a review in four weeks.
Be realistic about constraints. Send-home may be district policy, or the principal may own it. If so, negotiate the smallest change available - a higher threshold, a required parent contact first, a return later in the day - and document the constraint so the clinic plan's limited effects are not attributed to poor implementation. Follow up in writing after every meeting; verbal agreements between two teams dissolve.