The Blank Data Sheet and the Babysitting Text
An in-home RBT finishes a three-hour Saturday session and realizes she never opened the data app. She remembers 'about 80%' on the discrete-trial targets, 'four or five' instances of aggression, and that the client fell off a trampoline in the backyard and cried for a few minutes. She is due at her second job in 20 minutes. The mother texts: 'Can you babysit Friday night? $20/hour, don't tell the company, they'll charge more.' Earlier that week the mother also asked whether the client 'is autistic or has ADHD.'
1. What goes in the session note, and what must not?
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The numbers do not get invented. Writing '80%' or '4 aggressions' when no data were taken is falsification, even if the estimate happens to be close. The note should say plainly that data were not recorded during the session, and describe what was observed in its place. If the agency permits estimated data, label it as an estimate and say why - and that is a question to ask the supervisor, not to decide at 4:40 p.m.
The fall must be documented properly: approximate time, what happened, what body part was involved, what was observed (bruising, limp, none), what first aid was given, when the mother was informed, and that an incident report was filed per policy. Avoid 'he was fine' - describe what you saw.
Leave out: diagnoses, speculation ('he fell because he was seeking attention'), blame of the parent, and vague reassurance.
Timeliness: the second job does not change the deadline. Write the note before leaving the driveway or within the agency's window; do not let it slide to Monday. Late notes invite reconstruction, and reconstruction is where accuracy dies.
2. How should the RBT respond to the babysitting request?
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Decline - warmly, briefly, and without a lecture.
- It is a dual relationship. The RBT is the client's technician and would become the family's paid childcare provider. That blurs roles, complicates the therapeutic relationship, and makes it hard to enforce boundaries later.
- The 'don't tell the company' clause is the tell. A request that requires concealment from the employer is not one that can be accepted, and a private rate offered to undercut the agency puts the RBT in a position where the family is paying her directly for access to her.
- The power differential matters. The family may feel they can't say no to someone who works with their child, and the RBT may feel pressure to keep the relationship smooth.
A usable script: 'I really appreciate you thinking of me, but I'm not able to take outside work with families I serve - it's a boundary the company sets for everyone. I'm glad to help you find a respite provider if that's useful.'
Then tell the supervisor, per agency policy. Not reporting it, and having it surface later from the mother, is worse for everyone.
3. The mother's question about autism and ADHD - what does the RBT say, and why does the answer matter beyond that moment?
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She does not answer it. RBTs do not diagnose, and they do not offer diagnostic impressions, rankings of likelihood, or 'well, between you and me.'
A usable response: 'That's really a question for the BCBA and the diagnostic team - I'm not qualified to answer it, and I don't want to give you a guess that turns out wrong. I can tell you what I see him do and what we're working on, and I can ask the BCBA to set up a time with you.'
Why it matters beyond politeness:
- Scope of competence. Offering a diagnostic opinion is outside the RBT's training and certification; if the family repeats it to a pediatrician as 'the therapist said,' it can shape real decisions.
- It's a request the RBT will get again. Parents ask because she is the person they see most. Having a prepared, non-rejecting line is the difference between a boundary and an awkward silence.
- Document it. A brief, factual note that the parent asked about diagnosis and was referred to the BCBA protects the RBT and gets the family a real answer.
- It's a supervision issue, not a secret - tell the BCBA so the conversation happens with someone qualified to have it.