RBT Task List – Documentation and Reporting – (E-03)

We’re systematically building out Section E: Documentation and Reporting. After establishing the importance of RBTs engaging in general effective communication with their supervisors (E-01) and recognizing their professional responsibility to actively seek clinical direction when needed (E-02).
We now focus on a specific and critical category of information that RBTs must be vigilant in observing and reporting.

Let’s do a comprehensive exploration of:

E-03: Report Other Variables That Might Affect the Client (e.g., illness, relocation, medication)

This task highlights the RBT’s essential role as a key observer and communicator of factors outside the direct therapy session programming that can significantly influence a client’s behavior, learning, motivation, and overall well-being.

Promptly and accurately reporting these variables allows the supervising BCBA/BCaBA to make informed clinical decisions, interpret data correctly, and ensure the client’s program remains effective and responsive.

What Are These “Other Variables”?

Beyond the direct data collected on target behaviors and skill acquisition during a session, RBTs are uniquely positioned to observe and gather information about a wide range of “other variables.”

These are factors that can significantly impact a client’s presentation and performance. These variables are often external to the immediate teaching interaction but can act as:

• Setting Events: These are stimulus events or contexts that occur at one point in time but can affect the likelihood of behavior occurring at a later point in time.
  • They often do this by altering the value of reinforcers or the salience (noticeability) of discriminative stimuli (Sᴰs). For example, a poor night’s sleep can be a setting event for increased irritability and decreased cooperation the next day.
• Motivating Operations (MOs): As discussed in D-03 (Antecedent Interventions), MOs alter the current effectiveness of certain reinforcers and can also alter the current frequency of all behavior that has been reinforced by those reinforcers.
  • Many “other variables” function as MOs. For instance, if a client hasn’t eaten for a while (deprivation), food becomes a more powerful reinforcer (an establishing operation).

This task item (E-03) emphasizes the RBT’s responsibility to identify these influential variables and report them to their supervising BCBA/BCaBA in a timely and objective manner.

The examples given in the RBT Task List (“illness, relocation, medication”) are common but by no means exhaustive.

RBTs need to be consistently observant and use good professional judgment in determining what information might be relevant and impactful.

Why is Reporting These Variables So Critical?

• Provides Contextual Understanding of Behavior: Client behavior doesn’t occur in a vacuum. These “other variables” provide crucial context.
  • A sudden increase in problem behavior or a decrease in skill performance might be perfectly understandable if the RBT reports that the client has a high fever or didn’t sleep the night before.
• Ensures Accurate Data Interpretation: Without knowing about these influential variables, a supervisor might misinterpret the data collected during sessions.
  • For example, a significant dip in performance on learning targets might be incorrectly attributed to an ineffective teaching plan when it’s actually due to the client being sleep-deprived or feeling unwell.
• Allows for Proactive and Responsive Program Adjustments: Knowing about medication changes, for instance, allows the supervisor to monitor for potential side effects or changes in motivating operations and adjust program demands or reinforcement strategies accordingly.
  If a child is ill, demands might be temporarily reduced.
• Prioritizes Client Safety and Health: Reporting signs of illness, injury, or significant distress is a fundamental aspect of client care and ethical responsibility.
• Upholds Ethical Responsibility: Withholding information that could significantly impact the client’s well-being or the effectiveness of their treatment would be an ethical lapse.
• Facilitates Collaboration with Caregivers and the Wider Team: Information shared by parents (e.g., about a stressful event at home) that the RBT then relays to the supervisor can inform a more holistic and effective approach to the client’s care.

Common Categories of “Other Variables” RBTs Should Report

RBTs should be attentive to information gathered through various means: direct observation during sessions, communication with caregivers (parents, teachers, other providers), or sometimes from the client themselves (if appropriate for their communication level and reliability).

1. Physiological / Medical Factors:
   • Illness: Any signs like fever, cold symptoms (cough, runny nose), flu-like symptoms, ear infection indicators (tugging at ear, crying), stomach ache, allergies (seasonal, food-related flare-ups), rash, or any observable signs of pain or discomfort (e.g., wincing, limping, holding a body part).
     • Example: “Leo’s mom mentioned at drop-off this morning that he had a slight fever last night and might be coming down with something. He seemed more lethargic than usual during our session today and required more prompting to engage.”
   • Medication Changes (Information from Caregivers):
     • If a new medication has been started.
     • If there have been dosage changes (increase or decrease) for an existing medication.
     • If the time of administration for a medication has changed.
     • If any doses of regular medication were missed.
     • Any observed side effects that caregivers report or that you observe coinciding with medication changes (e.g., drowsiness, hyperactivity, nausea, dizziness RBTs report observations, not diagnose the cause).
     • Example: “Parent reported that Anya started a new ADHD medication this morning. During our session, I observed that she was less active than usual and yawned frequently during DTT, which is a change from her typical presentation.”
   • Sleep Patterns: Reports of significant changes in sleep (e.g., very little sleep the night before, difficulty falling asleep, waking frequently during the night, nightmares).
     • Example: “Sam’s dad informed me that Sam was up most of the night due to a thunderstorm. During today’s session, Sam had noticeable difficulty focusing and engaged in significantly more off-task behavior than usual.”
   • Dietary Changes / Issues: Reports of significant changes in diet, skipped meals (especially if it impacts energy or motivation), known food allergies or sensitivities if a reaction is suspected or reported, issues like constipation or diarrhea that might cause discomfort.
     • Example: “Mia’s teacher noted in the communication log that Mia barely touched her lunch today. During our afternoon session, she manded for snacks much more frequently than is typical for her.”
   • Pain or Injury: Any observed or reported pain, new bruises, cuts, scrapes, etc. (This also has mandated reporting implications if abuse or neglect is suspected see F-07).
2. Environmental Factors:
   • Changes in Routine/Schedule: Major deviations from the typical daily or weekly schedule (e.g., school holidays, no school due to weather, a different RBT conducting the session if the regular one is out, a significant change in session time or location).
     • Example: “Today’s session was held at 3 PM instead of our usual 10 AM slot due to a doctor’s appointment for the client. Alex seemed more agitated during this later time and was less responsive to instructions compared to his morning sessions.”
   • Significant Changes in the Physical Environment:
     • Relocation: Client has moved to a new home, a new classroom, or even if there’s been a significant furniture rearrangement in the usual therapy or home setting.
     • Example: “The family completed their move into their new apartment over the weekend. The designated therapy room is still being set up, and many familiar items are in boxes. Leo seemed a bit disoriented and clingier today.”
     • Sensory Changes: Unusual or intense noise levels (e.g., construction nearby, fire alarms, loud arguments in another room), significant lighting changes, extreme temperatures (too hot/cold), strong or unusual smells.
     • Example: “There was a scheduled fire drill at the clinic during our session today. Even after it ended and we returned to the room, Ben continued to cover his ears periodically and refused to engage in demanding tasks for about 15 minutes.”
     • Presence/Absence of Specific People: New people in the environment (e.g., visitors in the home, new staff at school or clinic) or the absence of familiar and important people (e.g., a parent traveling for work, a regular teacher being out sick).
     • Example: “Grandma is visiting from out of town this week, and she observed part of the session today. Ava was very excited by her presence and showed higher rates of on-task behavior and verbal initiations when Grandma was actively praising her.”
3. Social / Emotional / Behavioral Factors (Observed or Reported by Reliable Sources):
   • Significant Life Events: Major family stressors (e.g., financial difficulties, parental illness), parental separation or divorce, the birth of a new sibling, death in the family or of a beloved pet, starting a new school, or other major life transitions.
     • Example: “Parent shared at the beginning of the session that they had a difficult family argument last night. Client C seemed more withdrawn than usual and was less vocal during our activities today.”
   • Changes in Social Dynamics: Reports of conflicts with peers at school, bullying incidents (either as victim or aggressor), new friendships forming, or loss of friendships.
   • Unusual Emotional States: If the client appears unusually sad, anxious, irritable, hyperactive, or excessively silly, especially if it’s a marked change from their typical demeanor and significantly impacts their engagement in the session.
     RBTs should report the observable behaviors associated with these states.
     • Example: “During free play today, Maya was observed crying intermittently for no immediately apparent environmental reason and kept saying ‘I miss Mommy.’ This is unusual for her during our sessions.”
   • Exposure to Stressful or Traumatic Events (If disclosed by caregiver or if directly observed impacting the client during or before session).
   • Changes in Reinforcer Potency/Motivation: Items or activities that were previously highly preferred are now being consistently rejected, or new, very strong interests emerge suddenly.
     • Example: “Alex usually works very hard for iPad time as a reinforcer, but for the past two sessions, he has refused it and has only been asking for the blue race car. This is a new and very strong preference.”

How and When to Report These Variables to Your Supervisor

• Timeliness is Key:
  • Immediate Reporting (e.g., Phone Call, Secure Text, In-Person to Supervisor): This is for variables with immediate safety or health implications. Examples include:
    • Sudden onset of significant illness symptoms or observed injury during a session.
    • Caregiver disclosure of suspected abuse or neglect (follow agency and legal mandated reporting protocols, which always include informing your supervisor).
    • Report of a serious medication error by a caregiver that could have an immediate impact.
    • Client expressing extreme distress or agitation clearly linked to an external event.
  • Routine Reporting (e.g., In Session Notes, Secure Email, Discussion during Next Supervision Meeting): This is for less urgent variables that still provide important context for the supervisor. Examples include:
    • Client was a bit tired or seemed to have a mild cold.
    • Minor change in daily routine reported by parent.
    • Parent mentioned a busy or exciting weekend.
• Objectivity in Reporting:
  • Report facts and observable behaviors. Focus on what you saw, heard, or what was directly reported to you.
  • Avoid personal interpretations, diagnoses, or assumptions. Instead of saying, “Leo was clearly sad because he misses his old house,” report “Leo was observed crying at two separate times during the session and stated, ‘I want to go to my old house.’ His mother mentioned they moved last week.”
  • If reporting information from a caregiver, clearly attribute it: “Mom reported that…” or “The teacher mentioned that…”
• Clarity and Conciseness: Be clear about what was observed or reported and its potential relevance to the client’s behavior or performance in session. Be as brief as possible while still conveying the necessary information.
• Documentation is Essential:
  • Many of these variables should be included in the objective section of your daily session notes (see E-04).
  • For significant events or ongoing issues, a separate email or direct communication to the supervisor might be necessary, in addition to session note documentation.
• Maintain Confidentiality: Always maintain client confidentiality when reporting, using secure communication channels as per agency policy and HIPAA regulations.

The RBT’s Role: To REPORT, Not to Analyze, Interpret, or Intervene Independently Based on These Variables

• The RBT’s primary job in this context is to gather and accurately report this information to their supervisor.
• The BCBA supervisor will then analyze how these reported variables might be functioning as MOs or setting events. They will use this information, along with session data, to decide if any changes to the client’s program are needed (e.g., temporary adjustments to demands, changes in reinforcement strategies, consultation with parents or other professionals).
• RBTs should not independently change procedures or make assumptions about causation based on these variables.
  • For example, an RBT wouldn’t decide to cancel all demands for a session because a client reports being tired; they would report the observation of tiredness and the client’s statement, and the supervisor would then advise if any program modifications are needed for that session or moving forward.

Key Vocabulary Related to Reporting Other Variables

• Variable: Any factor, condition, or event that can change or vary and potentially influence behavior.
• Setting Event: A stimulus event, condition, or context that occurs at one point in time (often temporally distant from the behavior) that affects the likelihood of a specific behavior occurring at a later point in time.
  • Setting events often work by altering the value of reinforcers or the evocative strength of discriminative stimuli. (e.g., a poor night’s sleep is a setting event that can increase the likelihood of irritability and problem behavior the next day).
• Motivating Operation (MO): (As defined in D-03) An environmental variable that (a) alters the reinforcing effectiveness of some stimulus, object, or event (value-altering effect); and (b) alters the current frequency of all behavior that has been reinforced by that stimulus, object, or event (behavior-altering effect).
  • Many “other variables” function as MOs (e.g., food deprivation is an MO that makes food more reinforcing and increases food-seeking behaviors).
• Contextual Variables: Factors surrounding the client and their environment that can influence behavior; this is a broad term that encompasses many of these “other variables.”
• Objectivity: Reporting based on directly observable and measurable facts, free from personal opinions or interpretations.
• Subjectivity: Reporting based on personal opinions, feelings, or interpretations (to be minimized in professional reporting; if an impression is shared, it should be clearly labeled as such).
• Mandated Reporter: A legal obligation for certain professionals (often including RBTs) to report any suspected child abuse or neglect to the appropriate authorities.
  • Information related to this falls under “other variables” that MUST be reported through specific, defined channels, including to your supervisor.

Common Mistakes & Misunderstandings in Reporting Other Variables

• Under-Reporting: Not recognizing the potential significance of a variable and therefore failing to report it (e.g., thinking a “minor” cold isn’t worth mentioning, but it could be the reason for a client’s decreased responding or increased irritability). When in doubt, it’s usually better to report.
• Over-Reporting Irrelevant Details: Reporting excessive information that has no clear or likely bearing on the client’s behavior or program (e.g., detailing what the parent had for breakfast, unless it’s directly tied to a client’s specific dietary issue that day).
  • Finding the right balance comes with experience and ongoing guidance from your supervisor.
• Reporting Subjectively or with Personal Bias: Using judgmental language or inserting personal opinions instead of sticking to objective facts.
  • For example, “I think Mom is too lenient with him at home, and that’s why he’s acting out today.” Instead, an objective report might be: “Mom reported that when Leo engages in tantrum behavior at home, she usually gives him his iPad to help him calm down.”
• Delaying Reports of Significant Variables: Waiting until the end of the week to report that a client started a new medication on Monday, or that they seemed significantly unwell during a session.
• Diagnosing or Making Medical/Psychological Interpretations: For example, saying “I think Mia has ADHD because she was really hyper today.” Instead, an objective report would be: “Mia was observed to be frequently out of her seat, talking rapidly, and had difficulty attending for more than 30 seconds to tasks today.
  This level of activity was an increase from her typical behavior observed in previous sessions.”
• Failing to Document Reported Variables in Session Notes: Mentioning something important verbally to the supervisor but then not including it in the written session notes, which form part of the client’s permanent record.
• Not Knowing What’s “Normal” vs. “Reportable” for a Specific Client: This understanding develops over time with experience with the client and through good initial information gathering and ongoing communication with the supervisor.
  • If unsure, it’s generally better to report the observation and let the supervisor determine its clinical significance.
• Breaching Confidentiality While Reporting: Discussing these sensitive client variables in non-secure ways (e.g., in public areas, via unencrypted personal email) or with unauthorized individuals.

Being a keen observer and a diligent, objective reporter of these “other variables” is a vital contribution an RBT makes to the entire clinical team and to the quality of care for the client.

This information provides crucial context that allows the supervising BCBA to see the bigger picture, accurately interpret data, and ensure the client’s treatment plan is responsive, effective, and compassionate.

When in doubt about whether a piece of information is relevant enough to report, it is almost always better to err on the side of communicating it to your supervisor.

This provides a very thorough overview of E-03: Report Other Variables That Might Affect the Client. We’ve detailed the types of variables, why reporting them is crucial, how RBTs should go about reporting them, and common pitfalls to avoid.

Next in Section E of the RBT Task List is typically E-04: Generate objective session notes by describing what occurred during sessions. This is where the RBT formally documents the session events, data, and observations.