# Training Gaps in Behavior Analysis: Understanding RBT Experiences with Severe Problem Behavior
Behavior analysis professionals understand the importance of ethical, effective services—especially when working with individuals who engage in severe problem behavior. Registered Behavior Technicians (RBTs) are the frontline providers in Applied Behavior Analysis (ABA), yet their training does not always prepare them for the intense needs of these clients. A 2023 study by Aneesa Warren Ralston and Kristopher Brown, published in Behavior Analysis in Practice, offers the first formal look into the training experiences of RBTs in these high-stakes situations.
This blog breaks down their findings and explains what BCBAs, clinical directors, and agency leaders should know to improve training, reduce burnout, and keep both clients and staff safe.
## What Is Severe Problem Behavior?
Severe problem behavior refers to high-risk actions that pose serious safety threats, such as:
- Aggression toward others (e.g., hitting, kicking)
- Self-injury (e.g., head-banging, skin-picking)
- Property destruction
- Elopement (attempts to run away)
These behaviors are particularly common among individuals with Autism Spectrum Disorder (ASD) or intellectual and developmental disabilities (IDD). They can result in:
- Injuries to staff or the individual
- Barriers to accessing community services
- Increased risk of burnout and job turnover
## Why RBTs Play a Vital Role
Although BCBAs design treatment plans, it’s RBTs who implement them daily. They are often the first responders to crisis situations, making their training and support essential. When RBTs are underprepared, consequences can include ineffective intervention, increased injuries, and poor job satisfaction.
## What Did the Study Examine?
Ralston and Brown (2023) surveyed 142 RBTs, with 114 completing the full 28-item questionnaire. Recruitment was done via ABA-related social media platforms. The survey covered:
- RBT demographics
- Initial training experiences
- Support and supervision
- Case outcomes, including injuries and burnout
## Demographics and Job Experience
Some key stats:
- 83% had worked with clients who engaged in severe problem behavior.
- Most worked in clinic settings.
- The majority had 2 years or less of RBT experience.
- Most common client ages: 4 to 11 years.
## Forms of Severe Behavior Encountered
RBTs reported being exposed to a wide variety of behaviors, with the most common being:
1. Hitting (90%)
2. Biting (78%)
3. Throwing objects (75%)
4. Hair pulling
5. Kicking
6. Scratching
7. Self-hitting or banging
8. Excessive screaming
9. Pinching
10. Elopement
These behaviors occurred frequently, often multiple times per session.
## Gaps in Initial Training
Alarmingly, 13% of RBTs received no specific training before working with severe behavior.
Other key points:
- 22% were never asked about their comfort level before assignment.
- Only 40% received crisis training before working the case.
- 23% never received formal crisis training at all.
Training methods were often informal and inconsistent, including:
- Shadowing peers (with or without experience)
- Brief supervisor meetings
- Self-directed learning with little guidance
## Behavior Plans and Implementation
A formal Behavior Intervention Plan (BIP) was provided in 86% of cases. But the way it was rolled out varied:
- Only 25% were always trained before using the plan.
- 36% received occasional BIP-related training.
- 16% rarely or never received BIP training.
- Just 17% reported frequent treatment integrity monitoring.
This raises concerns for both treatment effectiveness and staff safety.
## Ongoing Support Models
RBTs reported the following supervision and support practices:
- Most common: 3–5 hours/month of supervision
- Feedback types:
- 42% verbal-only
- 49% mixed (verbal, written, or data-based)
- 30% said they had no formal ongoing training
Support formats included:
- 1-on-1 office meetings
- Group team meetings
- Field overlaps
- Graph reviews and written feedback
- Peer discussion groups
## Burnout and Safety Concerns
The emotional toll of working high-intensity cases is clear:
- Only 33% reported their supervisors ever discussed burnout.
- Of those, 68% said changes were made once it was brought up.
- However, 67% reported that burnout was never addressed.
In terms of safety:
- 75% of RBTs had sustained an on-the-job injury.
- 12% required hospitalization.
- Almost 9% missed a week or more of work.
- 37% reported client injuries during sessions.
These numbers highlight an urgent need for change in staff training and supervision.
## What Should BCBAs Do Differently?
This study offers a clear message: Standard practices aren't enough. The authors recommend several strategies:
1. Ask RBTs about their comfort level before assigning cases.
2. Provide hands-on training before case start.
3. Use structured shadowing with experienced staff.
4. Apply the Behavioral Skills Training (BST) model.
5. Monitor BIP fidelity on a regular schedule.
6. Make crisis management training mandatory.
7. Use multiple forms of feedback—verbal, written, and data-driven.
8. Proactively check in about emotional fatigue and burnout.
9. Adjust staff caseloads when burnout is detected.
10. Use remote tools for supervision to increase accessibility.
## Study Limitations
While this research was pioneering, it’s not without limits:
- Only 0.11% of all RBTs participated
- Data came from Reddit and Facebook groups
- Geographic diversity was unclear
Future research should explore resources available (or lacking) on the BCBA side, and whether increased supervision correlates with better case outcomes.
## Final Thoughts
This study lays the groundwork for rethinking how the field supports its entry-level practitioners. Better training means safer environments, more consistent services, and higher RBT job satisfaction. As the demand for ABA services grows, preparation must match the complexity of the work.
Improving how we train and support RBTs isn’t an optional improvement—it’s a professional obligation.
## References
Ralston, A. W., & Brown, K. (2023). Registered behavior technicians’ training experiences for severe problem behavior: A survey. Behavior Analysis in Practice, 16, 1175–1190. https://doi.org/10.1007/s40617-023-00809-w
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📣 Are you a supervisor or clinical director? Now is a perfect time to audit your current training and support model. Align your supervision practices with this research to better protect your team—and your clients.
📌 Stay tuned for our next post: We'll share practical RBT supervision templates and fidelity checklists inspired by this study.
