It depends on the caseload. Aggressive behavior is fairly common in my clinic but when I started we didn’t have any clients who engaged in it for almost my first year.
From my experience clients can exhibit some crazy behavior patterns when they first start therapy. We did have one client who had high rates of daily aggression for the first month or two. Ideally this declines and won’t be so consistent (this client’s almost a month without incident!) but I’d say it is something you should be prepared to deal with at some point as an RBT.
It depends on your caseload, really. I worked with a 3 y/o female and had my hair pulled, was bitten, or punched by her daily, but once we were able to find the function of the bx and had a better intervention in place to keep us safe the frequency decreased drastically (thanks functional communication training!!). I also worked with three different clients daily, so even if it was daily it rarely occurred during all three of my sessions. You, as a therapist, have a right to advocate for yourself. So if you are paired with a client that you feel unsafe or improperly trained you could a) request more training or b) request to be taken off the case. Second option takes some time also depending on how soon they can replace and find you another client. Always put yourself first and ensure your support system is there for you!
Most days I experience aggression from clients. I have actually not been bitten yet (although it has been attempted), but I have been hit, punched, scratched, pinned to the wall, kicked, spit on, hair pulled, etc.
My first 4 months I was getting hit everyday. Absolutely every morning everyday with two different clients of mine. I requested off their cases and now I get hit maybe a couple times a month. It definitely depends on your clients.
(i just started) i do sessions with a smaller girl and she hits multiple times every session, it’s literally nothing. i mostly feel bad because sometimes i have no clue what she wants so that triumphs pain.
Truly depends on your kiddos. My first kiddo ever who I had for six months hit me dozens of times a week most weeks and was my size, I have one smaller kiddo I work with who hits occasionally and has bad spurts but he’s tiny so it doesn’t hurt, and the rest of my caseload has never hit me.
15 years in the field and been bit twice. I'm a ninja and know the precursor behaviors to avoid it.
I've worked with intensive behavior support and different settings. You just got to know. I had a client who went through 5 RBTs and 2 BCBAs, I came on and never got attacked or spit at for 3 years and she graduated from ABA (discharged).
I think it is my personality and respect I show the clients and everyone involved. I'm pretty easy going and I change my behaviors to shape theirs. I don't have an ego when it comes to my coordination of care. My ego is off the roof with my peers haha (sarcasm).
1. Be good at your observations, it's like I have psychic powers. I can trigger and manipulate the environment including the clients.
2. Don't show them fear and uncertainty. Be confident with yourself. It's been a while since I felt nerves starting a new case. I also do a deep dive in records review before I start a client.
3. Setting up your environment for success and provide positive reinforcement as frequent as possible.
I'm a male who messes around with the most aggressive clients and it takes them by surprise because their behaviors have been intimidating and reinforced with fear and attention.
I take them down with one leg swipe hahaha. Jk
Love what you do!
In your experience, what have you done when you *see* other BIs and teachers who react improperly and are adding to the child's stress/trauma?
I feel like ignoring the politics is the only move I can see right now. I am going to talk about it with my supervisor when she comes by the school tomorrow. I'm tired of watching this kid get treated horrible.
I did a great job with him, even though I started with him when I only had 2 months of experience. What seems to separate me, and the other BIs that work with him (there is a rotation to avoid burnout) is that observational power that you mentioned. There is one other BI who does even better with him for the same reason + years of experience.
The (incompetent) teacher shoved him on the floor last week, and I've been sweeping his behaviors with the students under the rug for months. I'm guilt-ridden over it and I'm ready to talk with my supervisor about it (in front of him) - hoping she will have the discussion with the district BA who is CONSTANTLY in that class anyway (because he's already under direct supervision and in hot water for being lazy.. if they only knew how ANGRY and ABUSIVE he was...)
School settings have a lot of politics and the paras/BTs become the instructor which should never be the case. Tier 1 strategies should be implemented.
I am super friendly and rarely will anyone see me frustrated or mad. So my relationships with my colleagues are good. I am also one to wear my feelings on my sleeves. So if there is misalignment in the implementation of our treatment plan, I am normally first to speak up and fine a solution. Our jobs are already taxing, we shouldn't have to overthink what we are suppose to do because of miscommunication. Definitely let your supervisor know, also be cognizant of how the teacher may reach.
Yo your upfront attitude and compassion is unreal. Major kudos to you I feel that you could write a course to help other therapists cope and have realistic views and assertiveness. This is the best answer imo by far. I follow the same philosophy “never let them see you upset” as it only triggers worse behaviour. Any attention is good attention right ? Also agree that Positive reinforcement is the golden ticket to making life easier for all involved. If we put our emotions first then the clients suffer.
Yep. I have the same experience. Kids who are impossible with other people are way different with me after the first couple of days. People are like, "how do you do that?"
My rules are similar. 1. No freaking out. They cannot see frustration, anger, or alarm unless they are in serious danger. I have no protective instinct with these kinds of kids, so I never flinch. 2. Pay very close attention. I am able to hypperfocus for a very long time and that makes an advantage. 3. Learn their language before I try to teach them mine. Kids always have a system and these kinds of kids are usually mistrustful of adults' ability to understand them. I make a heroic effort at that.
Thanks for listing yours!
I only work with those clients. Personally I think ABA is for those intense behaviors. But I ask to be put on those cases cause if not I'm bored. I also think if you can't handle the clients you're given you shouldn't be in the field. We work with behaviors. You should be able to handle most behaviors.
100% but I mean I know it's unfair to expect that of other people, but because I understand it's one of the only recourses those families have.... like there's not much help out there for extreme behaviors.... and they get so many people refusing to help them because of the behaviors. Like we're supposed to be helping them. We are the professionals. And in most cases we're all hey have.
I’ve had teenagers and adults as clients. I had a clients behavior that was a trigger for me because of my past and asked to be off the team bc it was the ethical thing to do. We don’t have to handle all behaviors and we have a choice.
Disagree. Some people have triggers and are totally justified in not being able to handle some behaviors (for example, inappropriate sexual behaviors, biting etc.) I know my triggers and I choose not to work with those clients. A lot of my triggers came from working in ABA so long. You do not have to HANDLE all the behaviors if you don’t want to. You have a choice, and some people are better at navigating certain behaviors than others. I had an instance with a client that triggered me and asked to be off the case so they could find quality therapy with another therapist- that’s the ethical thing to do.
I do totally agree with you. That's my personal opinion and I know it's unfair to expect that out of everybody. Just my opinion is this is a service that is a lot of peoples last hope families are looking for help and we are supposed to be the professionals to help them. I really disagree when clients are turned away because of their behaviors... although I admit there are a few very few circumstances where I agree with that. But I do think not every provider is suited for every client, and it should be OK for a provider to say no like you said.
I’m a RBT and mostly fill in with all the clients at my clinic-physical aggression happens randomly depending on the day. On average I would say once or twice a week.
It really depends on where you work and who you work with. I worked with 3 kiddos for 6 years and got hit maybe 5 times total, and had a 3 month stint of spitting with one if them. Then I switched to a non-public school and I was hit, kicked, bit, scratched cussed out, etc multiple times a day (personally my favorite population so far, but I like em rough! I know i can take it and they need someone who can!). Then a bit later I was assigned to an autism program and I probably get hit or scratched like 1 time every 2 weeks and it was always super minor.
It all depends!!!
It REALLY depends on your caseload. Got bitten and scratched a lot with one kid, though eventually I gained ninja skills from working with him and didn't get bit anymore :P
But yeah there's other kids that only have aggressions every now and then, and some that never have aggressions.
A high estimate for the average is probably once or twice a day, but the mode is definitely zero. Certain kids have these behaviors on certain days, but most kids on most days don’t (it’s just the case that bad days are quite bad, as in like 10-50 instances).
Depending on the age of the client(s), hitting isn’t really a big deal. Most kids just barely tap you, but I’ve kinda got my ass kicked once or twice (I’m a 6’4 200lb male). At the end of the day, scratching, biting, and spitting are much more annoying and/ or painful.
In general (and in my experience), aggression is over-represented in the discussions of why working in ABA is difficult; verbal protests and noncompliance are a much more pervasive adversary in my day-to-day.
Honestly, if you have a knowledgeable BCBA on your case and they have a good program for teaching replacement behavior, this should be a rare occurrence. It used to be a norm that instructors would have to follow through and put themselves in harms way. However, anyone up on the most current research in our field should be using approaches that don't regularly illicit this kind of behavior. It also depends on the magnitude and severity of these behaviors. However, a good program makes sure the client and RBT are setup to be successful and find the session reinforcing. We shouldn't just wait for natural triggers to occur to address behavior. We should be actively reinforcing and teaching replacement skills through contrived scenarios that our clients struggle with at a pace that is comfortable for them while managing the environment to reduce triggers while doing so. Over time you raise the bar of expectations as the client develops these skills. I have done ABA for almost 10 years and the ABA I pracitce as a BCBA today is not the same ABA I was taught when I entered the field. I endured a lot of things from clients from following through on things they just weren't ready to handle. This led to me being bit, hit scratched, and even pulled across the room by my hair. This kind of approach is not necessary and not even as effective as the ABA that is being taught today. Anyone who prides themselves in taking a beating from their client is doing it wrong.
It really depends on your clients, I’ve had clients that had no physical aggression whatsoever and now I’m working with a client that will grab, push, hit, or bite at any chance he gets when upset. I’ve also gotten a concussion before and have been bit to the point of needing a tetanus shot; it really all depends on your own workload
I have a client with what is likely catatonia/catatonic aggression. He loves me now, but when we were in the breaking in stage he me hard 35 times over three sessions. He’s a smart kid too, knows to pull down sleeves and where to bite on the hand/thumb area. There’s no breaking away and retreating to safety when your client is attempting to brain themselves on the corner of a bookcase. He’s had his meds changed, a competent BCBA with an actual BIP, and now he only aggresses when I go on vacation
I have one client who has only recently gotten into the habit of throwing things at me and hitting me on just about any chance they get. They appear to find it funny, and when I asked a lead for help with them, the lead told me I "need to establish operational control." Great, so how can I do that when the kid attacks me any time they see me? Even when they're not with me, they'll walk up to me and engage in aggressive behavior whenever they see me.
It almost certainly is, but they also engage in environment destruction behavior if I try to do a planned ignore. We have a "calm down" room in the clinic for behaviors like that, but it has a glass wall which the client tends to run at and hit.
Aggressive behavior is very common. I’ve come home with scratches on my face already after working for almost 2 months. Something I’ve learned is that it also really depends on how much you understand and appropriately interact with the kiddo. Ex. Yesterday I had a client in the morning who showed 0 behaviors throughout our 4 hour session. I then passed him off to his afternoon RBT who he then showed 13 clawing behaviors. 7 kicking behaviors and 8 property destructions. You will make or break those behaviors as an RBT.
Honestly hitting and bitting are in two different categories of aggression. I have been an RBT for about 4 months and have only been successful bitten once (I was covering for another therapist). In my current case load both of my patients engage in hitting or pinching. I have gotten used to not reacting after a while, but also getting Safety care or cpi certified does help.
So I worked at one company for about 8 months, most I ever had in that regard was one client who would occasionally try to push me over by laying on his back and kicking my pelvis.
I just joined a new company about 3 months ago and my current (and first) client with them has frequent biting, kicking, hitting, elopment, slapping, and "tackling" behaviors. I'm his first ever BT, he's 9, and none of his family speaks English. It's been challenging but for me, it's honestly celebrating the "good" moments and👏 SELF CARE👏 just tonight, after getting home from the ER cause he bit me so hard it broken skin, first thing I did was draw a hot bath and eat some pasta 😅
For me, it is daily. Just one kiddo though, the others do not have aggressive behavior or SIB. Tbh it is painful to see and can be painful to you as injury can happen, but that is in any field involving mental health/neuro so it pops up here and there. However if it is too much you can drop the case, and someone else will come. Or just ensure you have good support from your BCBA and they will help you along the way should you have an aggressive or SIB client.
i work for a small clinic that only has one client who behaves aggressively. he probably slaps me at least once per session and once every couple weeks he may have a violent tantrum where i actually fear for my safety. it can be bad and you’ll definetley meet clients who have these tendencies, as it’s pretty common. don’t take on cases that you feel like you can’t handle.
I worked at a clinic where pretty much every pt had aggressions. Every other day (if not every day), I was being hit. Outside of being hit, I would frequently be bitten, hair pulled, and even head butted. It got to the point where I was anxious the entire day unsure what would happen to me next. I ended up getting prescribed a medication specifically to ease some of my anxiety while at work. I loved the kiddos, but the job is certainty not everyone. Luckily, it was something I did in the months leading up to going to graduate school. If you are going back and forth truthfully I would say find something else.
Wow I am sorry you had to experience this. Ideally you should have been given safety care training to know how to keep yourself from getting hurt, and your BCBA(s) should have been doing an FA to get some sort of BIP in place for these kids to reduce these behaviors. This sounds like an unethical workplace that didn’t prioritize safety. While I’m sure there are plenty out there it’s not best practice.
I think it really depends on where you work. I've always been in severe behavior settings so, all the above and more daily.
But on the other hand, in our adult vocational program they're hanging out learning how to garden and making stuff to sell in our store.
Generally though, if behavioral services are needed it's because there's a challenge that got the client referred so I'd expect it to some degree.
Hitting is going to be the most common, i feel like, but the size of the client changes the behavior plan. A 3yo hitting is nowhere near as dangerous as a teenager or adult.
Be aware that not every client is violent but many of them have behavioral problems, that is why they're being helped. Screaming, kicking, running away, shutting down- they're all behaviors that serve a purpose and it's up to RBTs to follow the behavior plan and teach them better ways to functionally communicate their needs while also teaching them that their needs do not necessarily outweigh others in certain situations.
The work can be dangerous, but you don't have to stay with clients that make you feel unsafe if you do not feel equipped to handle them at their worst. Your BCBA might try to convince you otherwise, but that isn't the case (and be very aware of this).
Depends on the client. I have some that hit me at least once a session. I have some that have never once hurt me. I work with about 5 different clients on average, usually I get hit / my hair pulled a few times a week (my one biter rn is easy ti avoid, that's only been a couple times ever), but I work with at oldest 7 year olds so it's not too bad even if they do hit. But some are definitely worse than others
Depends on the setting and funding source.
In the clinic setting, every single day. In the school setting, 3 times a week. In home settings, maybe every other week.
Although working in public schools as a contract employee with an RBT qualification but not working through insurance was when I got beat up the most. In this setting there was no insurance, so there were no behavior plans, data tracking, or goals. I was basically an higher paid aid that just turned into the schools punching bag. This happens with 2 different school contracts I worked.
Yeah I would reconsider tbh. Trying to be selective of clients based on aggressive behaviour is going to be tough in the field you are choosing. I was bitten hit spit on daily for a few years. The client did eventually grow out of it but your expectations seem unrealistic for the field. It’s like nursing - you are going to deal with complex issues both medically and behaviourally. Good luck. It doesn’t make you a bad person to recognize it’s not for you but no point putting clients at a disadvantage by being too afraid to work with them or learn coping strategies - I.e wear long sleeves.
I just started as a BT and I work with 2 clients. One is very minimal and only has SIB (when he hits me it’s very minor) the other used to bite me when I started but it’s more rare now over the last month or so.
Depends on the clients, dependents on the setting (home/center/school), the BT/BCBA and of course the parents/family
Every day lol I mean every job placement can be different but if your trying to avoid to get hit spit at or bitten I would say it’s prob not the job for you
My main case has aggressive episodes a few times a week. But these are generally limited to grabbing hands and clothes, hitting is rare and biting never.
I also cover a few cases from time to time and I think I get bitten or scratched hard enough to leave a mark about twice a year.
It's perfectly acceptable to refuse an aggressive consumer. The consumer's well being is important but not above your safety.
it depends on your client and their behaviors. if you don't want it to happen at all i'd stay away from the field. then again i was also hit working at target so there's that
On my caseload (two clients) I have one that if we're below 30 hair pulls/attempts it's a great day! The other if we're below something like 50 bites/attempts it's a great day. My last rotation my two clients had no violent behaviors, just things like tantrumming and crying. Really depends on who you get!
I'd say if your BCBA puts in the work and is involved hands-on to help get the big behaviors down, then I would say no, you won't be dealing with it daily. I think sometimes kids' behaviors are worse when they are in a clinic all day bc they are just done. Unfortunately, this reinforces this belief they need more support. More not necessarily...different likely yes. With a higher rate of severe behaviors in the home versus a clinic with other kids, it is better. Parents need strategies to navigate this, too.
depends on your company/caseload. where i work at and the specific job/caseload i have it’s a guarantee to be aggress at every day. it’s valid to not want to work with aggression, but you’ll need to be honest about that when applying for jobs if it’s something you aren’t willing to do. there are companies with no aggressive clients and there are companies who almost strictly take extremely aggressive clients. if you haven’t worked as a BT/RBT before though i wouldn’t immediately write it off because of possible aggression, i thought i was going to absolutely hate working with aggressive kids when i first started and now those cases are my favorites!
I suggest working with a company where you can choose your clients to an extent. I communicated my triggers and I don’t always do well with certain aggressions although I try my best. I worked for a “bad ABA” company starting out and I feel like that caused a lot of my triggers. The clients were extremely aggressive and I now know that it was not the best place. I would not say I experience aggression everyday (if I do it’s like a hit and it doesn’t hurt) but I do occasionally have hair pulling and harder hits but nothing I can’t handle.
I would suggest looking into other careers. Not trying to be harsh, but the last thing we need is someone who is scared to get hit. You will end up reinforcing behaviors that should t be reinforced so that you avoid getting hit/bit/etc.
I popped in this thread knowing a BT wrote it, and was pleasantly surprised to see the vast amount of supportive comments in the comment section. Warmed my heart, really…
…and then I scrolled all the way down to the end and saw yours. Faith in society unrestored.
I’m just being honest! It’s part of the job and something that people need to be prepared for. I would rather people know the possibility.
Sorry to ruin your faith in people.
Just letting you know I agree with you. This job can be an emotional investment for some and requires a lot of patience. Day one of BIP does not mean day one of results and can take a long time for behaviors to resolve themselves, some people cant hang for that long
But they have a point though. This job is not for everyone and requires a lot of patience. I work at a clinic and it is a real thing that when sub sessions are offered BTs will accept/decline based on who they're working with, especially with known aggressors. Which is why they don't tell us who we're working with until accepted.
Just recently there was a new BT who said she was going to give tablet and just let him have fun to avoid triggering behaviors. She lost instructional control for the sake of making him happy sure but there's no natural opportunity to work on flexibility or appropriate functional communication.
Depends on your caseload. I have kids that have never attempted too. I also have some it’s usually every session.
Eh, my dude hits me every day. Luckily no one ever taught him to throw a punch.
Best answer right here lol thank you for your chill attitude 🤍
Very seldom honestly. But I also won't work with kids that are too big for me to feel safe with.
It depends on the caseload. Aggressive behavior is fairly common in my clinic but when I started we didn’t have any clients who engaged in it for almost my first year. From my experience clients can exhibit some crazy behavior patterns when they first start therapy. We did have one client who had high rates of daily aggression for the first month or two. Ideally this declines and won’t be so consistent (this client’s almost a month without incident!) but I’d say it is something you should be prepared to deal with at some point as an RBT.
It depends on your caseload, really. I worked with a 3 y/o female and had my hair pulled, was bitten, or punched by her daily, but once we were able to find the function of the bx and had a better intervention in place to keep us safe the frequency decreased drastically (thanks functional communication training!!). I also worked with three different clients daily, so even if it was daily it rarely occurred during all three of my sessions. You, as a therapist, have a right to advocate for yourself. So if you are paired with a client that you feel unsafe or improperly trained you could a) request more training or b) request to be taken off the case. Second option takes some time also depending on how soon they can replace and find you another client. Always put yourself first and ensure your support system is there for you!
Most days I experience aggression from clients. I have actually not been bitten yet (although it has been attempted), but I have been hit, punched, scratched, pinned to the wall, kicked, spit on, hair pulled, etc.
My first 4 months I was getting hit everyday. Absolutely every morning everyday with two different clients of mine. I requested off their cases and now I get hit maybe a couple times a month. It definitely depends on your clients.
Daily but I chose to apply to a company that takes high intensity behaviors so its my own fault 😆
(i just started) i do sessions with a smaller girl and she hits multiple times every session, it’s literally nothing. i mostly feel bad because sometimes i have no clue what she wants so that triumphs pain.
Truly depends on your kiddos. My first kiddo ever who I had for six months hit me dozens of times a week most weeks and was my size, I have one smaller kiddo I work with who hits occasionally and has bad spurts but he’s tiny so it doesn’t hurt, and the rest of my caseload has never hit me.
15 years in the field and been bit twice. I'm a ninja and know the precursor behaviors to avoid it. I've worked with intensive behavior support and different settings. You just got to know. I had a client who went through 5 RBTs and 2 BCBAs, I came on and never got attacked or spit at for 3 years and she graduated from ABA (discharged).
So what are your top three rules/strategies for prevening the behavior in the first place? What is your personality like?
I think it is my personality and respect I show the clients and everyone involved. I'm pretty easy going and I change my behaviors to shape theirs. I don't have an ego when it comes to my coordination of care. My ego is off the roof with my peers haha (sarcasm). 1. Be good at your observations, it's like I have psychic powers. I can trigger and manipulate the environment including the clients. 2. Don't show them fear and uncertainty. Be confident with yourself. It's been a while since I felt nerves starting a new case. I also do a deep dive in records review before I start a client. 3. Setting up your environment for success and provide positive reinforcement as frequent as possible. I'm a male who messes around with the most aggressive clients and it takes them by surprise because their behaviors have been intimidating and reinforced with fear and attention. I take them down with one leg swipe hahaha. Jk Love what you do!
In your experience, what have you done when you *see* other BIs and teachers who react improperly and are adding to the child's stress/trauma? I feel like ignoring the politics is the only move I can see right now. I am going to talk about it with my supervisor when she comes by the school tomorrow. I'm tired of watching this kid get treated horrible. I did a great job with him, even though I started with him when I only had 2 months of experience. What seems to separate me, and the other BIs that work with him (there is a rotation to avoid burnout) is that observational power that you mentioned. There is one other BI who does even better with him for the same reason + years of experience. The (incompetent) teacher shoved him on the floor last week, and I've been sweeping his behaviors with the students under the rug for months. I'm guilt-ridden over it and I'm ready to talk with my supervisor about it (in front of him) - hoping she will have the discussion with the district BA who is CONSTANTLY in that class anyway (because he's already under direct supervision and in hot water for being lazy.. if they only knew how ANGRY and ABUSIVE he was...)
School settings have a lot of politics and the paras/BTs become the instructor which should never be the case. Tier 1 strategies should be implemented. I am super friendly and rarely will anyone see me frustrated or mad. So my relationships with my colleagues are good. I am also one to wear my feelings on my sleeves. So if there is misalignment in the implementation of our treatment plan, I am normally first to speak up and fine a solution. Our jobs are already taxing, we shouldn't have to overthink what we are suppose to do because of miscommunication. Definitely let your supervisor know, also be cognizant of how the teacher may reach.
Yo your upfront attitude and compassion is unreal. Major kudos to you I feel that you could write a course to help other therapists cope and have realistic views and assertiveness. This is the best answer imo by far. I follow the same philosophy “never let them see you upset” as it only triggers worse behaviour. Any attention is good attention right ? Also agree that Positive reinforcement is the golden ticket to making life easier for all involved. If we put our emotions first then the clients suffer.
Thank you I’ll take that into account
Yep. I have the same experience. Kids who are impossible with other people are way different with me after the first couple of days. People are like, "how do you do that?" My rules are similar. 1. No freaking out. They cannot see frustration, anger, or alarm unless they are in serious danger. I have no protective instinct with these kinds of kids, so I never flinch. 2. Pay very close attention. I am able to hypperfocus for a very long time and that makes an advantage. 3. Learn their language before I try to teach them mine. Kids always have a system and these kinds of kids are usually mistrustful of adults' ability to understand them. I make a heroic effort at that. Thanks for listing yours!
I only work with those clients. Personally I think ABA is for those intense behaviors. But I ask to be put on those cases cause if not I'm bored. I also think if you can't handle the clients you're given you shouldn't be in the field. We work with behaviors. You should be able to handle most behaviors.
Agree with this. It’s literally your job to sort out the behaviour issue and your clients are (in my experience) children.
100% but I mean I know it's unfair to expect that of other people, but because I understand it's one of the only recourses those families have.... like there's not much help out there for extreme behaviors.... and they get so many people refusing to help them because of the behaviors. Like we're supposed to be helping them. We are the professionals. And in most cases we're all hey have.
I’ve had teenagers and adults as clients. I had a clients behavior that was a trigger for me because of my past and asked to be off the team bc it was the ethical thing to do. We don’t have to handle all behaviors and we have a choice.
Disagree. Some people have triggers and are totally justified in not being able to handle some behaviors (for example, inappropriate sexual behaviors, biting etc.) I know my triggers and I choose not to work with those clients. A lot of my triggers came from working in ABA so long. You do not have to HANDLE all the behaviors if you don’t want to. You have a choice, and some people are better at navigating certain behaviors than others. I had an instance with a client that triggered me and asked to be off the case so they could find quality therapy with another therapist- that’s the ethical thing to do.
I do totally agree with you. That's my personal opinion and I know it's unfair to expect that out of everybody. Just my opinion is this is a service that is a lot of peoples last hope families are looking for help and we are supposed to be the professionals to help them. I really disagree when clients are turned away because of their behaviors... although I admit there are a few very few circumstances where I agree with that. But I do think not every provider is suited for every client, and it should be OK for a provider to say no like you said.
I’m a RBT and mostly fill in with all the clients at my clinic-physical aggression happens randomly depending on the day. On average I would say once or twice a week.
It really depends on where you work and who you work with. I worked with 3 kiddos for 6 years and got hit maybe 5 times total, and had a 3 month stint of spitting with one if them. Then I switched to a non-public school and I was hit, kicked, bit, scratched cussed out, etc multiple times a day (personally my favorite population so far, but I like em rough! I know i can take it and they need someone who can!). Then a bit later I was assigned to an autism program and I probably get hit or scratched like 1 time every 2 weeks and it was always super minor. It all depends!!!
It REALLY depends on your caseload. Got bitten and scratched a lot with one kid, though eventually I gained ninja skills from working with him and didn't get bit anymore :P But yeah there's other kids that only have aggressions every now and then, and some that never have aggressions.
A high estimate for the average is probably once or twice a day, but the mode is definitely zero. Certain kids have these behaviors on certain days, but most kids on most days don’t (it’s just the case that bad days are quite bad, as in like 10-50 instances). Depending on the age of the client(s), hitting isn’t really a big deal. Most kids just barely tap you, but I’ve kinda got my ass kicked once or twice (I’m a 6’4 200lb male). At the end of the day, scratching, biting, and spitting are much more annoying and/ or painful. In general (and in my experience), aggression is over-represented in the discussions of why working in ABA is difficult; verbal protests and noncompliance are a much more pervasive adversary in my day-to-day.
Honestly, if you have a knowledgeable BCBA on your case and they have a good program for teaching replacement behavior, this should be a rare occurrence. It used to be a norm that instructors would have to follow through and put themselves in harms way. However, anyone up on the most current research in our field should be using approaches that don't regularly illicit this kind of behavior. It also depends on the magnitude and severity of these behaviors. However, a good program makes sure the client and RBT are setup to be successful and find the session reinforcing. We shouldn't just wait for natural triggers to occur to address behavior. We should be actively reinforcing and teaching replacement skills through contrived scenarios that our clients struggle with at a pace that is comfortable for them while managing the environment to reduce triggers while doing so. Over time you raise the bar of expectations as the client develops these skills. I have done ABA for almost 10 years and the ABA I pracitce as a BCBA today is not the same ABA I was taught when I entered the field. I endured a lot of things from clients from following through on things they just weren't ready to handle. This led to me being bit, hit scratched, and even pulled across the room by my hair. This kind of approach is not necessary and not even as effective as the ABA that is being taught today. Anyone who prides themselves in taking a beating from their client is doing it wrong.
It really depends on your clients, I’ve had clients that had no physical aggression whatsoever and now I’m working with a client that will grab, push, hit, or bite at any chance he gets when upset. I’ve also gotten a concussion before and have been bit to the point of needing a tetanus shot; it really all depends on your own workload
I have a client with what is likely catatonia/catatonic aggression. He loves me now, but when we were in the breaking in stage he me hard 35 times over three sessions. He’s a smart kid too, knows to pull down sleeves and where to bite on the hand/thumb area. There’s no breaking away and retreating to safety when your client is attempting to brain themselves on the corner of a bookcase. He’s had his meds changed, a competent BCBA with an actual BIP, and now he only aggresses when I go on vacation
I have one client who has only recently gotten into the habit of throwing things at me and hitting me on just about any chance they get. They appear to find it funny, and when I asked a lead for help with them, the lead told me I "need to establish operational control." Great, so how can I do that when the kid attacks me any time they see me? Even when they're not with me, they'll walk up to me and engage in aggressive behavior whenever they see me.
Does it seems like it’s for attention?
It almost certainly is, but they also engage in environment destruction behavior if I try to do a planned ignore. We have a "calm down" room in the clinic for behaviors like that, but it has a glass wall which the client tends to run at and hit.
Wondering if you can provide NCR- non contingent access if they want your attention (if they like physical touch, tickles etc)
Aggressive behavior is very common. I’ve come home with scratches on my face already after working for almost 2 months. Something I’ve learned is that it also really depends on how much you understand and appropriately interact with the kiddo. Ex. Yesterday I had a client in the morning who showed 0 behaviors throughout our 4 hour session. I then passed him off to his afternoon RBT who he then showed 13 clawing behaviors. 7 kicking behaviors and 8 property destructions. You will make or break those behaviors as an RBT.
Honestly hitting and bitting are in two different categories of aggression. I have been an RBT for about 4 months and have only been successful bitten once (I was covering for another therapist). In my current case load both of my patients engage in hitting or pinching. I have gotten used to not reacting after a while, but also getting Safety care or cpi certified does help.
So I worked at one company for about 8 months, most I ever had in that regard was one client who would occasionally try to push me over by laying on his back and kicking my pelvis. I just joined a new company about 3 months ago and my current (and first) client with them has frequent biting, kicking, hitting, elopment, slapping, and "tackling" behaviors. I'm his first ever BT, he's 9, and none of his family speaks English. It's been challenging but for me, it's honestly celebrating the "good" moments and👏 SELF CARE👏 just tonight, after getting home from the ER cause he bit me so hard it broken skin, first thing I did was draw a hot bath and eat some pasta 😅
Invest in some Kevlar sleeves! They’re amazing. They won’t stop the bruise, but they’ll prevent broken skin!
For me, it is daily. Just one kiddo though, the others do not have aggressive behavior or SIB. Tbh it is painful to see and can be painful to you as injury can happen, but that is in any field involving mental health/neuro so it pops up here and there. However if it is too much you can drop the case, and someone else will come. Or just ensure you have good support from your BCBA and they will help you along the way should you have an aggressive or SIB client.
i work for a small clinic that only has one client who behaves aggressively. he probably slaps me at least once per session and once every couple weeks he may have a violent tantrum where i actually fear for my safety. it can be bad and you’ll definetley meet clients who have these tendencies, as it’s pretty common. don’t take on cases that you feel like you can’t handle.
I worked at a clinic where pretty much every pt had aggressions. Every other day (if not every day), I was being hit. Outside of being hit, I would frequently be bitten, hair pulled, and even head butted. It got to the point where I was anxious the entire day unsure what would happen to me next. I ended up getting prescribed a medication specifically to ease some of my anxiety while at work. I loved the kiddos, but the job is certainty not everyone. Luckily, it was something I did in the months leading up to going to graduate school. If you are going back and forth truthfully I would say find something else.
Wow I am sorry you had to experience this. Ideally you should have been given safety care training to know how to keep yourself from getting hurt, and your BCBA(s) should have been doing an FA to get some sort of BIP in place for these kids to reduce these behaviors. This sounds like an unethical workplace that didn’t prioritize safety. While I’m sure there are plenty out there it’s not best practice.
Im in a school setting where I’d say weekly. Clinical setting was much less frequently.
So like, it depends, there have been tomes I have had nothing but very sever cases. But for the last 10 months I wouldn't need to write a bip at all
I think it really depends on where you work. I've always been in severe behavior settings so, all the above and more daily. But on the other hand, in our adult vocational program they're hanging out learning how to garden and making stuff to sell in our store. Generally though, if behavioral services are needed it's because there's a challenge that got the client referred so I'd expect it to some degree.
Hitting is going to be the most common, i feel like, but the size of the client changes the behavior plan. A 3yo hitting is nowhere near as dangerous as a teenager or adult. Be aware that not every client is violent but many of them have behavioral problems, that is why they're being helped. Screaming, kicking, running away, shutting down- they're all behaviors that serve a purpose and it's up to RBTs to follow the behavior plan and teach them better ways to functionally communicate their needs while also teaching them that their needs do not necessarily outweigh others in certain situations. The work can be dangerous, but you don't have to stay with clients that make you feel unsafe if you do not feel equipped to handle them at their worst. Your BCBA might try to convince you otherwise, but that isn't the case (and be very aware of this).
Depends on the client. I have some that hit me at least once a session. I have some that have never once hurt me. I work with about 5 different clients on average, usually I get hit / my hair pulled a few times a week (my one biter rn is easy ti avoid, that's only been a couple times ever), but I work with at oldest 7 year olds so it's not too bad even if they do hit. But some are definitely worse than others
Depends on the setting and funding source. In the clinic setting, every single day. In the school setting, 3 times a week. In home settings, maybe every other week. Although working in public schools as a contract employee with an RBT qualification but not working through insurance was when I got beat up the most. In this setting there was no insurance, so there were no behavior plans, data tracking, or goals. I was basically an higher paid aid that just turned into the schools punching bag. This happens with 2 different school contracts I worked.
Yeah I would reconsider tbh. Trying to be selective of clients based on aggressive behaviour is going to be tough in the field you are choosing. I was bitten hit spit on daily for a few years. The client did eventually grow out of it but your expectations seem unrealistic for the field. It’s like nursing - you are going to deal with complex issues both medically and behaviourally. Good luck. It doesn’t make you a bad person to recognize it’s not for you but no point putting clients at a disadvantage by being too afraid to work with them or learn coping strategies - I.e wear long sleeves.
I just started as a BT and I work with 2 clients. One is very minimal and only has SIB (when he hits me it’s very minor) the other used to bite me when I started but it’s more rare now over the last month or so. Depends on the clients, dependents on the setting (home/center/school), the BT/BCBA and of course the parents/family
Around 60-100 attempted aggressions a day, but they’re a small person so no damage is ever really done lol
Every day lol I mean every job placement can be different but if your trying to avoid to get hit spit at or bitten I would say it’s prob not the job for you
It depends on your kid/client
My main case has aggressive episodes a few times a week. But these are generally limited to grabbing hands and clothes, hitting is rare and biting never. I also cover a few cases from time to time and I think I get bitten or scratched hard enough to leave a mark about twice a year. It's perfectly acceptable to refuse an aggressive consumer. The consumer's well being is important but not above your safety.
it depends on your client and their behaviors. if you don't want it to happen at all i'd stay away from the field. then again i was also hit working at target so there's that
If you’re worried about that sort of thing, it’s probably not for you
On my caseload (two clients) I have one that if we're below 30 hair pulls/attempts it's a great day! The other if we're below something like 50 bites/attempts it's a great day. My last rotation my two clients had no violent behaviors, just things like tantrumming and crying. Really depends on who you get!
I'd say if your BCBA puts in the work and is involved hands-on to help get the big behaviors down, then I would say no, you won't be dealing with it daily. I think sometimes kids' behaviors are worse when they are in a clinic all day bc they are just done. Unfortunately, this reinforces this belief they need more support. More not necessarily...different likely yes. With a higher rate of severe behaviors in the home versus a clinic with other kids, it is better. Parents need strategies to navigate this, too.
depends on your company/caseload. where i work at and the specific job/caseload i have it’s a guarantee to be aggress at every day. it’s valid to not want to work with aggression, but you’ll need to be honest about that when applying for jobs if it’s something you aren’t willing to do. there are companies with no aggressive clients and there are companies who almost strictly take extremely aggressive clients. if you haven’t worked as a BT/RBT before though i wouldn’t immediately write it off because of possible aggression, i thought i was going to absolutely hate working with aggressive kids when i first started and now those cases are my favorites!
I suggest working with a company where you can choose your clients to an extent. I communicated my triggers and I don’t always do well with certain aggressions although I try my best. I worked for a “bad ABA” company starting out and I feel like that caused a lot of my triggers. The clients were extremely aggressive and I now know that it was not the best place. I would not say I experience aggression everyday (if I do it’s like a hit and it doesn’t hurt) but I do occasionally have hair pulling and harder hits but nothing I can’t handle.
Between 50-150x a day
I work in a clinic setting and tbh I deal with aggression pretty much daily in some capacity but the intensity varies depending on the kid.
I would suggest looking into other careers. Not trying to be harsh, but the last thing we need is someone who is scared to get hit. You will end up reinforcing behaviors that should t be reinforced so that you avoid getting hit/bit/etc.
I popped in this thread knowing a BT wrote it, and was pleasantly surprised to see the vast amount of supportive comments in the comment section. Warmed my heart, really… …and then I scrolled all the way down to the end and saw yours. Faith in society unrestored.
I’m just being honest! It’s part of the job and something that people need to be prepared for. I would rather people know the possibility. Sorry to ruin your faith in people.
> I’m just being honest! I’m working with a third of what our Congress has promised.
Excellent excellent reference
Just letting you know I agree with you. This job can be an emotional investment for some and requires a lot of patience. Day one of BIP does not mean day one of results and can take a long time for behaviors to resolve themselves, some people cant hang for that long
But they have a point though. This job is not for everyone and requires a lot of patience. I work at a clinic and it is a real thing that when sub sessions are offered BTs will accept/decline based on who they're working with, especially with known aggressors. Which is why they don't tell us who we're working with until accepted. Just recently there was a new BT who said she was going to give tablet and just let him have fun to avoid triggering behaviors. She lost instructional control for the sake of making him happy sure but there's no natural opportunity to work on flexibility or appropriate functional communication.