I was pretty fresh out of RBT training and certification when I was placed on a client I’ll call Steven. One of Steven’s behaviors we were working to reduce–ideally, to the point it didn’t happen anymore–was spitting, often onto other people. His BCBA decided on a DRO procedure.

Now, a DRO (Differential Reinforcement of Other behaviors) procedure is where, if a specific behavior does not occur at all during a set time interval, like 2 minutes, the learner earns a reward. Typically, engaging in the behavior does not act as the trigger for this time interval. But, in Steven’s case, as soon as he spit on someone, we started a 2-minutes timer. We gave him a Skittle if he didn’t spit in that two minutes.

You know what Steven did?

He spat again as soon as the Skittle was in his mouth.

This would continue until we had gone through 1 or even 2 whole packs of Skittles, at which time Steven was tired of Skittles and we probably wouldn’t see spitting the rest of the session…or at least until he wanted more. He’d often giggle as he chewed his Skittle, eyeing the remaining candies. “Spit on Britt,” he’d mumble with a grin, the cause-and-effect of “spit = Skittle” clearly mapped out in his mind.

Your first instinct might be that I had the procedure wrong, but after repeated insistence from the BCBA that this was THE intervention to get rid of spitting, we only start the timer once he’s already spitting, and we couldn’t make any changes to it. All I knew was that this didn’t quite sound like the DRO I had learned about in training, this BCBA knew more than I did, and…I was spat on more than ever with no actual positive change in sight.

“You have to have a healthy relationship with your RBT. We know these kids better than you do. We see them the most. You might come in and observe or look at their programs and stuff, but…I was with this kid 8 months and saw the BCBA once.”

Behavior technicians (BTs) are overseen most often by a master’s level clinician, a Board Certified Behavior Analyst (BCBA). There are some other qualifications and differences I could dive into, but that’s not the focus of this post. What is the focus is on the supervisory relationship: the experiences of BTs as they are supervised, coached, trained, and otherwise managed by BCBAs.

As I tried to get to the root of what influenced BTs to stay with or leave the field, including what made some companies and settings more pleasant than others, the supervisory experience stood out. As the BTs I interviewed seemed to agree, supervision from BCBAs was “hit or miss.” In fact, sometimes in a more literal way, as in it may not really occur at all.

One former RBT said that, in eight months on a client, she recalls seeing her BCBA only once. For a bit of perspective, supervision is usually 5% to about 25% of a learner’s total direct therapy hours, and a lot factors into exactly how much supervision is needed, as that time is not only for providing coaching to the BTs, but also making changes to what the learner is working on and how. More typically, it seems, supervision is between 10% and 20% of therapy hours, delivered on a weekly basis. Or, at least, that’s what is requested from insurance. The reality is, some BCBAs fall way under that percentage. And, regardless of how many hours of therapy that client was receiving, seeing a BCBA only once in all that time is certainly not meeting even minimal expectations.

Another former RBT described that the BCBAs she worked under did come in frequently but would “sit and watch” without much guidance. As mentioned in a previous part of this series, a former RBT early in her career experienced “a lot of pressure” from the supervising BCBA, including intense criticism, yelling, being told she wasn’t good at or cut out for the job, and repeatedly called out for her struggles on a particularly challenging case. In that post, I describe very similar experience I too had as a new RBT and the stark differences in support under two different supervising BCBAs. As that former RBT pointed out (an insight I was highly impressed with) the BCBA was teaching the child learner how to self-advocate while punishing the RBT’s attempts to advocate for her own needed supports.

“A few BCBAs at my past clinic…made me hate my job [due to] their lack of support and honesty.”

As my former and current BTs who have worked in ABA centers describe, and I remember well from my own time as a center RBT and student, if your learner is out for the day and another learner’s staff are also out, you may be placed with another learner, sometimes at the last possible second. In fact, one former RBT noted that she and the other highly competent RBTs may be moved from their typical kid to another challenging learner. This impacted everyone’s schedules and, potentially, progress. For BTs who were already scheduled to work with two or three learners each day in recurring blocks of time (like Client A in the mornings and Client B in the afternoons), this change added even more programs, reinforcement schedules, responses to potentially dangerous behaviors, and even learner preferences, triggers, approved pick-ups, emergency procedures, and other need-to-know details to become familiar with.

My interviewees reflected on not having enough time to get familiar with protocols or the impact of the behaviors themselves, like furniture being thrown, severe head-banging against concrete and tile, ripping out staff hair, biting other kids, running toward the road. “Figure it out” is what one remembers hearing from a BCBA.

Management–BCBAs, office managers, clinical directors, etc.–seemed to dismiss staff concerns about which learner they may be assigned to as “just complaining” and gave blanket statements that all RBTs needed to be able to “just work with any [learner].” I myself remember parroting something that had similarly been drilled into my brain, as ashamed as I am to admit it now. Staff, said my interviewees, were just not adequately trained for the really severe cases, resulting to injuries to them, the kids they were working with, and sometimes nearby adults and kids.

“[I have trauma] from leadership definitely. They seemed like they were always trying to catch you failing and were being super punitive instead of giving guidance.”

Inconsistent and punishment-based supervision aren’t the only challenges BTs can experience. There can also be poor treatment judgment and unchecked egos.

Sometimes, the BCBA assigned to a learner can change; a BCBA may leave the company, the learner may have unique needs that another BCBA is better equipped to respond to, schedules change and remove availability, or other reasons. For one former RBT, she experienced a BCBA change on one of her cases. As soon as the new BCBA took over, she made major changes to protocols. No real rationale was given. The RBT saw immediate and lasting negative consequences for the learner.

Across several interviewees, there was a common struggle with BCBAs over plans of care and interventions, or how skill were taught and behaviors were managed, which became more noticeable as their own knowledge and experience in ABA grew. A former RBT remarked that it’s at least somewhat easy to accept what you’re being told to do, even when it seems “off,” in the beginning because you accept that your supervisor knows more and has the best intentions. But once you gain more clarity into ethical concerns, potential harm toward clients, and the science behind ABA (ironically, from the good supervisors’ teachings!), it becomes harder and harder to blindly accept bad supervision and treatment planning.

I was told numerous stories well represented by the following two anecdotes:

“I worked with a kid where his programs were not appropriate [for] him. I asked for an updated evaluation so we could get more programs for him…I was ignored. She told me I didn’t know what I was talking about [because I was just an RBT] and she wasn’t going to be changing anything. [And when I needed her,] I couldn’t get ahold of her.”

“I don’t feel the programs we were running were appropriate to [their] age and skills…I felt like we were making [them] more upset than teaching anything at that point, and that was hard to deal with.”

One such story was about a male learner who had had the same goals with no changes to teaching procedures, added goals, removed goals, or other changes for around 6 months. He had long since shown he could do these 100% of the time, far exceeding the mastery criteria and time for new things to learn. Another story was about a 14-year-old female learner still working on the same picture matching goals she had had about two or three years earlier, when she first entered ABA, with no changes in sight and no real progress. She was now to the point of becoming visibly frustrated and engaging in self-injury, throwing items, and hitting when the task was brought up.

In both scenarios, the RBTs working with these clients knew their learners could do so much more…but were stuck with the lackluster programming given to them.

“Supervision was both the best and the worst part of my experience as an RBT.”

One of my interviewees volunteered this advice to BCBAs and other supervisors:

“Ask your RBTs what they want to see and actually implement what they are telling you…If we all could have sat down together to talk, it had the potential to be something great.”

And she has a point. I have known many BCBAs to almost instinctively counter, “But we can’t always implement whatever you want to be working on!” And that’s completely right. I have had BTs recommend some programs, responses to behaviors, and other things that didn’t align with ABA principles, weren’t ethical, did not mesh with family values or priorities, or had other barriers. But our role isn’t to ignore these suggestions. Our role as mentors is to acknowledge the idea, identify why it isn’t appropriate to that learner or situation, and collaborate with the BT on any modifications that could be feasible or other things that could be implemented instead. In my experience in the field, others are almost always receptive when they feel heard, the rationale is identified and they can understand it, and the case lead makes everyone’s contributions on the case feel welcome, not shut out or deemed “less than.”

That former RBT added that, when a company scales quickly or doesn’t plan for the resulting impact, support tends to be cut across everyone, everywhere. She empathized that BCBAs are likely also stretched thin and finding it hard or even impossible to provide exceptional supervision across their caseloads.

This further supports that companies have to be responsive to BCBAs nearly shouting from the rooftops that they are overloaded and overwhelmed. They also must plan for the effects of growing, including more new staff with little experience, middle management also trying to keep up with supervisor oversight, and more limited physical resources. When growth is reckless, technician turnover is bound to increase, throwing supervisors back into trying to keep inexperienced staff afloat on top of reassessing, updating protocols, meeting with families and other stakeholders, and more.

There is hope yet. As promised earlier in the series, we didn’t focus only on the negatives in these interviews. Next time, we’ll talk about these before wrapping up with more advice from BTs to their supervisors, company owners, and others in the ABA space.

by Britt Bolton, BCBA