Staffing a Severe Behavior Program

Individuals who will provide case management, operational direction, and direct patient care require specialized training and expertise. Below is a list of these individuals. You can find a list of suggested education and training for each position here.

Clinical Director

The clinical director is responsible for overseeing all aspects of the program including but not limited to the budget, hiring and training, developing policies, and coordinating and directing patient care. The clinical director also serves as billing provider for the severe behavior program and evaluates and treats patients.

BCBA-Ds

The BCBA-Ds are responsible for assisting the clinical and assistant director as needed and providing direct oversight and supervision of BCBAs. The BCBA-Ds are responsible for primary direction of assessment and treatment procedures and patient intake and discharge activities. The BCBA-Ds also serve as billing providers for the severe behavior program and evaluate and treat patients.

BCBAs

The BCBAs are responsible for assisting the BCBA-Ds as needed and providing direct supervision to and scheduling direct care staff. The BCBAs are responsible for assisting with direct patient care as needed and ensuring integrity with assessment and treatment protocols. The BCBAs serve as billing providers for step-down or follow-up program patients.

RBTs

Registered behavior technicians are responsible for direct patient care including but not limited to conducting assessment and treatment procedures, completing patient intake and discharge activities, and collecting and graphing patient data.

Insurance and Authorizations Specialist

The insurance and authorizations specialist is responsible for securing insurance authorization for patients, communicating with caregivers and providers who refer patients, scheduling evaluation and treatment of patients, and working with supervisors, case managers, and directors to coordinate all aspects of patient services.

Patient Team

Each patient should have a team that includes three RBTs, one BCBA, and one BCBA-D during their admission. The BCBA-D oversees and directs the assessment and treatment procedures. The BCBA provides front-line oversight and feedback. The RBTs conduct assessment and treatment sessions. Figure 2 recommends three RBTs for each patient with severe destructive behavior, whereas the billing codes discussed above require a minimum of two RBTs for each patient.

Monitoring and managing staff injuries and potential liabilities

Professionals and technicians who work in a severe behavior program are unique. They regularly put themselves in situations in which they are at considerable risk of being hit, kicked, bit, or worse. Given the potential risks to staff, caregivers, and patients when assessing and treating destructive behavior, it is critically important for a severe behavior program to accurately monitor and effectively manage staff, caregiver, and patient injuries. It is recommended to track all staff, caregiver, and patient injuries and examining the data regularly (e.g., monthly) to identify patterns that may illuminate strategies that may be employed to prevent or mitigate future injuries.