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RBT Decision Flowcharts: Protocol Selection Guides

These decision-making flowcharts provide step-by-step guidance for common clinical decisions you’ll face as an RBT. Each flowchart includes decision points, rationales, and example scenarios to help you understand the decision-making process for selecting appropriate procedures and responding to various clinical situations.

Effective decision-making is a critical skill for RBTs, requiring a systematic approach to applying ABA principles in real-world settings. These flowcharts help bridge the gap between theoretical knowledge and practical application, guiding you through the reasoning process for selecting appropriate procedures based on assessment data and client needs.

How to Use These Flowcharts?

  1. Start at the top question and follow the path based on your specific situation
  2. Consider each decision point carefully, referencing the explanatory notes if needed
  3. Reach your conclusion at the end of the path
  4. Consult with your supervising BCBA if you’re unsure at any point

Remember that these flowcharts are guidance tools, not replacements for clinical judgment or supervisor consultation. All intervention decisions must ultimately be approved by your supervising BCBA.

Assessment Selection Flowchart

This flowchart helps you determine which type of preference assessment might be most appropriate based on client characteristics and assessment goals.

Preference Assessment Selection

Start: Need to identify potential reinforcers
↓
Does client have prerequisite discrimination skills?
→ No → Consider single-stimulus presentation
→ Yes ↓
Does client have difficulty choosing between multiple options?
→ Yes → Consider paired-choice format
→ No ↓
Is creating a complete preference hierarchy important?
→ No → Consider multiple-stimulus with replacement (MSW)
→ Yes ↓
Time constraints?
→ Significant time constraints → Consider brief MSWO
→ Adequate time available → Conduct full MSWO assessment

Decision Point Explanations

Prerequisite Discrimination Skills

This decision point asks whether the client can differentiate between items and make selections when presented with choices.

When to Select “No”:

  • Client does not consistently reach for preferred items
  • Client shows no clear preference between highly preferred and non-preferred items
  • Client has severe visual impairments
  • Client has significant motor limitations affecting selection responses

When to Select “Yes”:

  • Client consistently reaches for or indicates preferred items
  • Client shows differential responding to preferred vs. non-preferred items
  • Client can physically make selections between options

Example Scenario: A 4-year-old client with limited language skills but good motor abilities consistently reaches for colorful toys when presented individually, indicating basic discrimination skills are present. You would follow the “Yes” path in the flowchart.

Intervention Selection Flowchart

This flowchart helps you select appropriate function-based interventions based on assessment results.

Function-Based Intervention Selection

Start: Identified Function of Behavior
↓
What is the function?
→ Attention → Attention-Maintained Branch
→ Escape → Escape-Maintained Branch
→ Sensory → Sensory-Maintained Branch
→ Tangible → Tangible-Maintained Branch

Attention-Maintained Branch:
↓
Is appropriate attention-seeking behavior in repertoire?
→ Yes → Differential Reinforcement of Alternative Behavior
→ No → Teach Functional Communication

Escape-Maintained Branch:
↓
Is task too difficult?
→ Yes → Task Modification or Additional Prompting
→ No → Increase Reinforcement for Task Completion

Sensory-Maintained Branch:
↓
Is behavior harmful?
→ Yes → Redirection and Response Blocking
→ No → Sensory Substitution or Scheduled Access

Tangible-Maintained Branch:
↓
Is delay tolerance established?
→ Yes → Token Economy with Delayed Reinforcement
→ No → Teach Waiting and Requesting

Decision Point Explanations

Attention-Maintained Behavior

Key Question: Is appropriate attention-seeking behavior in repertoire?

This decision point asks whether the client already has appropriate ways to request attention in their behavioral repertoire. If yes, you’ll focus on reinforcing those appropriate behaviors while placing the inappropriate behavior on extinction. If no, you’ll need to teach new functional communication responses first.

When to Select “Yes”:

  • Client can use appropriate language or gestures to request attention
  • Client has demonstrated appropriate attention-seeking in some contexts
  • Client has verbal ability to request help or interaction

When to Select “No”:

  • Client lacks communication skills to appropriately request attention
  • Client has never demonstrated appropriate attention-seeking
  • Client’s only method for gaining attention is through problem behavior

Example Scenario: A 6-year-old student frequently calls out during class without raising his hand. Functional assessment indicates this is maintained by teacher attention. The student knows how to raise his hand and has demonstrated this in other contexts, showing that appropriate attention-seeking is in his repertoire. The appropriate intervention would be differential reinforcement of hand-raising (alternative behavior) while minimizing attention for calling out.

Ethical Decision-Making Flowchart

This flowchart guides you through the process of evaluating potential ethical dilemmas and determining appropriate responses.

Ethical Decision-Making Process

Start: Potential Ethical Issue Identified
↓
Is there immediate risk of harm to client or others?
→ Yes → Intervene immediately to ensure safety → Report to supervisor ASAP
→ No ↓
Is the issue within your scope of practice as an RBT?
→ No → Refer to supervisor or qualified professional
→ Yes ↓
Does the issue involve potential violation of the RBT Ethics Code?
→ Yes → Consult Ethics Code for guidance → Discuss with supervisor
→ No ↓
Are you unsure about how to proceed?
→ Yes → Pause and consult supervisor before acting
→ No ↓
Document decision-making process and actions taken

Decision Point Explanations

Immediate Risk of Harm

Key Question: Is there immediate risk of harm to client or others?

This decision point asks you to evaluate whether the situation presents an immediate safety concern that requires prompt action to prevent injury or harm.

When to Select “Yes”:

  • Client is engaging in self-injury or aggression
  • Client is at risk of elopement into an unsafe area
  • There is a medical emergency
  • There is suspected abuse or neglect requiring mandatory reporting
  • Environmental hazards present immediate danger

When to Select “No”:

  • The ethical concern involves non-emergency issues
  • The situation involves professional disagreements
  • The concern relates to best practices but not immediate safety
  • The issue involves long-term planning or programming decisions

Example Scenario: You observe a colleague using an unauthorized restraint procedure with a client. While this represents a significant ethical concern, if the client is not currently at risk of injury, you would follow the “No” path—document your observations and report to your supervisor promptly rather than interrupting the session. However, if the unauthorized restraint were causing distress or potential injury, you would follow the “Yes” path and intervene immediately.

Data Collection Method Selection Flowchart

This flowchart helps you select the most appropriate measurement system based on the behavior’s characteristics.

Measurement System Selection

Start: Need to measure behavior
↓
Is behavior discrete with clear beginning/end?
→ Yes → Can you capture every instance?
   → Yes → Are exact counts important?
      → Yes → Frequency/Event Recording
      → No → Rate Measurement
   → No → Is behavior high frequency?
      → Yes → Interval Recording/Time Sampling
      → No → Frequency/Event Recording
→ No ↓
Does duration of behavior matter?
→ Yes → Duration Recording
→ No ↓
Is speed of response important?
→ Yes → Latency Recording
→ No ↓
Is behavior continuous or a behavioral state?
→ Yes → Time Sampling/Momentary Time Sampling
→ No → Reconsider behavior definition

Decision Point Explanations

Discrete Behavior with Clear Beginning/End

Key Question: Is behavior discrete with clear beginning/end?

This decision point asks whether the target behavior has distinct start and stop points that can be clearly observed, or if it’s more of a continuous state.

When to Select “Yes”:

  • The behavior has clear, observable starting and stopping points
  • Each occurrence is separate and countable
  • You can clearly tell when one instance ends and another begins
  • Examples: hand-raising, vocalizations, hitting, requesting

When to Select “No”:

  • The behavior is ongoing without clear starts and stops
  • The behavior represents a state rather than an event
  • It’s difficult to determine when one instance ends and another begins
  • Examples: on-task behavior, engagement, attention, appropriate positioning

Example Scenario: You need to measure a student’s hand-raising during class. Since hand-raising has a clear beginning (hand starts moving up) and end (hand returns to desk), and each instance is distinct and countable, you would select “Yes” and continue down the flowchart toward frequency or rate measurement, depending on subsequent decisions.

Crisis Response Flowchart

This flowchart guides you through appropriate responses to escalating client behavior.

Crisis Response Protocol

Start: Client showing signs of distress
↓
Is behavior dangerous to self or others?
→ Yes → Is crisis plan in place?
   → Yes → Implement crisis plan → Monitor effectiveness
   → No → Implement safety procedures → Alert supervisor immediately
→ No ↓
Can antecedents be modified to prevent escalation?
→ Yes → Remove triggers → Provide calming environment
→ No ↓
Is client responsive to redirection?
→ Yes → Redirect to alternative activity
→ No ↓
Is behavior escalating despite interventions?
→ Yes → Move to safer environment → Get assistance
→ No → Continue current approach → Monitor closely

Decision Point Explanations

Dangerous Behavior

Key Question: Is behavior dangerous to self or others?

This decision point asks you to evaluate whether the current behavior presents an immediate safety risk that requires crisis intervention.

When to Select “Yes”:

  • Client is engaging in self-injury with risk of tissue damage
  • Client is exhibiting aggression that could harm others
  • Client is attempting elopement into unsafe areas
  • Client is engaging in property destruction that could create safety hazards
  • Client is showing signs of medical distress

When to Select “No”:

  • Behavior is disruptive but not physically dangerous
  • Client is exhibiting precursor behaviors but not crisis behaviors
  • Behavior is escalating but remains at a manageable level
  • Client is showing signs of distress but responding to interventions

Example Scenario: A client begins throwing small classroom items when frustrated by a difficult task. While disruptive, the items are soft and lightweight, posing no significant danger to the client or others. You would select “No” and proceed to assessing whether antecedents can be modified (perhaps by adjusting the task difficulty or providing additional prompting).

Prompt Fading Decision Flowchart

This flowchart helps you determine when and how to fade prompts during skill acquisition.

Prompt Fading Protocol

Start: Client learning new skill with prompts
↓
Has client demonstrated consistent success with current prompt level?
→ No → Continue at current prompt level → Reassess after more practice
→ Yes ↓
Is client showing any independent responses?
→ Yes → Begin systematic prompt fading → Least-to-most or most-to-least
→ No ↓
Is client becoming prompt dependent?
→ Yes → Introduce prompt fading → Transfer stimulus control
→ No ↓
Has current prompt level been used for extended period without progress?
→ Yes → Consult supervisor about modifying approach
→ No → Continue current approach → Reassess regularly

Decision Point Explanations

Consistent Success with Current Prompt Level

Key Question: Has client demonstrated consistent success with current prompt level?

This decision point asks whether the client has shown mastery with the current level of assistance before attempting to reduce that assistance.

When to Select “Yes”:

  • Client responds correctly with current prompt level at least 80-90% of opportunities
  • Success has been maintained across multiple sessions
  • Client responds correctly with current prompt level across different settings or with different materials
  • Performance has been stable for at least 3-5 consecutive sessions

When to Select “No”:

  • Client’s performance is variable with current prompt level
  • Client has shown initial success but not consistent mastery
  • Success rate falls below 80% with current prompt level
  • Client has just begun learning with this prompt level

Example Scenario: You’ve been teaching a client to wash hands using a full physical prompt. Over the past five sessions, the client has correctly completed the hand-washing sequence with physical prompting at 90% accuracy. This consistent success indicates it’s time to begin fading to a less intrusive prompt level, so you would select “Yes” and move to the next decision point about independent responses.

Documentation Decision Flowchart

This flowchart guides you through decisions about what information needs to be documented in session notes.

Session Documentation Protocol

Start: Session completed, documentation needed
↓
Were there any safety concerns or incidents?
→ Yes → Document incident details, actions taken, supervisor notification
→ No ↓
Were there any changes to protocols/procedures?
→ Yes → Document changes, rationale, and supervisor approval
→ No ↓
Was data collected on target behaviors?
→ Yes → Summarize data, note trends, compare to previous sessions
→ No → Document reason for missing data
↓
Were there any new behaviors observed?
→ Yes → Document new behavior, context, and frequency
→ No ↓
Were there any changes in client status or environment?
→ Yes → Document relevant changes and potential impacts
→ No ↓
Complete standard session documentation with:
- Programs implemented
- Client response to intervention
- Materials/reinforcers used
- Plans for next session

Decision Point Explanations

Safety Concerns or Incidents

Key Question: Were there any safety concerns or incidents?

This decision point asks whether any events occurred during the session that involved client safety, injuries, near-injuries, or other reportable incidents.

When to Select “Yes”:

  • Client engaged in dangerous behavior (self-injury, aggression, elopement)
  • Client or staff sustained any injury, regardless of severity
  • Safety procedures or crisis plans were implemented
  • Reportable incidents occurred (falls, accidents, seizures)
  • Medication errors or reactions occurred
  • Client became ill during session

When to Select “No”:

  • Session proceeded without safety concerns
  • Challenging behaviors occurred but did not pose safety risks
  • Minor behavior escalation occurred but was successfully de-escalated
  • No unusual health or safety events transpired

Example Scenario: During a session, a client had a brief emotional outburst, crying and refusing to participate in activities for 5 minutes before calming down with redirection. Since this did not involve any safety risks or require crisis procedures, you would select “No” and move to the next decision point about protocol changes.

Related Resources

Remember, these flowcharts are decision-making aids, not substitutes for clinical judgment or supervisor guidance. Always consult with your supervising BCBA when facing complex clinical decisions or situations not clearly addressed by these flowcharts.