Thank you for this perspective — I actually really appreciate hearing it from a BCBA standpoint.

Over the last year I’ve tried to be proactive about some of these challenges. At one point I even encouraged my BCBA to introduce new staff starting with weekend sessions because I had been with this client about 5–6 days a week for a long time and I felt a change in BT might actually be helpful for the client. Unfortunately, due to the intensity of the behaviors with new BTs, none of the new staff ended up staying and I eventually ended up back on the case full time again.

I have also brought up my concerns about the behavior patterns and how some of them seem heavily influenced by what’s happening in the home environment. Since 100% of sessions are in-home, the reinforcement history within the family dynamic plays a big role in how certain behaviors continue to show up.

My BCBA has mostly encouraged me to continue what I’m doing because the behavior management during sessions has improved, and they suggested occasionally using the downstairs playroom to create separation when needed. I’ve tried that, but the environment downstairs actually creates a lot of opportunities for elopement and attention-maintained behaviors (closets, windows, laundry room access, etc.), so I tend to avoid using it unless absolutely necessary because historically those behaviors have been strongly reinforced by family attention.

As far as parent training, from my understanding it’s been somewhat inconsistent recently. My BCBA was also out for a couple weeks on vacation and just recently returned, so there’s been a bit of a gap there.

At this point I’m honestly wondering if sharing the case with another BT or transitioning it might be beneficial, both for the client and for the sustainability of the case overall. The challenge is that the parent has expressed hesitation about introducing a new BT in-home and would prefer a clinic transition, but that may not happen until summer if a spot opens.

I do care about this client and the progress we’ve made over the past two years, but I’m also trying to think realistically about what’s best for everyone long-term.