u/zipurlipslike

I’ve been doing mostly school hours with a client since January. Since then, my client has arrived to school smelling of cat pee/wearing clothes, shoes, backpack that have been recently peed on and unwashed. The school is very accommodating regarding the client and their dignity for this issue (she’s been given two or three new backpacks from the school, the teachers wash her clothes in the home economics classroom while she wears borrowed clothes purchased by her teachers and shoes from the gym, and her new backpacks end up being washed weekly by paras because even though the smell is somewhat always there, sometimes you can tell it has been freshly peed on), but I personally feel like this should have warranted at least a call home by now. I deferred to the school regarding this and they told me they would discuss with the parent in a meeting, then told me it “never came up.” That was two and a half months ago. My issue here is that cat urine is not just something harmless and smelly; this is a health and hygiene concern for this child. The client has developed a persistent cough for the last month, which could be entirely unrelated, but is most definitely exacerbated by this, right?

I’ve made a report previously for repeated comments the client made about violence in her home, and alongside that report I expressed dental concerns and child services was able to connect the family to a clinician/dental program. Are there any programs that could help with this? At what point is this neglect? I’ve never seen the client’s mother in unwashed clothes or smelling of cat pee. Client’s mother has quoted to me that the cat “uses [client]’s room as the litter box.”

I’m a BHT and am primarily school-based with the goal of teaching my client and their school staff the skills to manage behaviors. Recently, one of the teachers complained to my BC that I was “chirping” my client, so my BC and I agreed that I would take a step back and allow the school staff to take over the majority of the prompting and reinforcement and see where we’re at after that.

Well, we saw a major regression, but the school doesn’t seem to see it, because they’re shaping the environment to prevent behaviors in a way that is setting the client up for failure in the long-term (removing all demands to avoid behaviors, and calling it a win when there are no crises).

To avoid meltdowns and tantrums, my client will spend 45 minute school periods doing coloring pages or watching YouTube instead of doing the work their teacher originally intends for the period, then they’re asked which candy they want as “reinforcement” (not sure what they’re reinforcing if they’re not placing any demands on the client). Once, my client came off a 3 minute break and sat down at their seat to return to working, and ended up sitting at their seat staring at a wall and intermittently watching the iPad of a peer across the room while the para who was supposed to be working one-to-one with them gossiped about local real estate with other staff for 20 minutes, then gave the client gum as a reward for “waiting.”

On another occasion, my client was engaging in an aggressive behavior during a work interval (poking para’s face w/ pencil), and after being poked 3 times, the para’s response was, “Do you want an M&M?” Then, the para gave the client an M&M. Client complains that it wasn’t enough and gets another. The edible wasn’t used to reinforce, it’s being used to placate. This is not the first, second, or even twentieth time that I’ve seen edible reinforcement used improperly with this client, and I’m at my wits end.

Today, my BC informed me that this para came in and decided to count my “chirps” (prompts) during the first 40 minutes they were present during the school day, and reported to the teacher that I prompted the client 36 times in 40 minutes. Maybe I’m crazy, but I don’t think 36 prompts in 40 minutes is excessive if I’m prompting, on average, every 6-8 seconds until the directive is followed, especially if no other staff are sitting with the student to prompt them while they work.

The school staff are also frustrated with me at the moment as I informed them I will not be attending a field trip with the client due to them not having an elopement or aggression intervention plan in place for the trip (I will not be taking that liability on my shoulders, my program director/BCBA are fully supportive on this), and because I put my foot down (per my program director) and told them I will not take the client into other classes without a member of school support staff (i.e. a para) present due to a recent crisis putting myself and other students in an incredibly unsafe situation and resulting in myself being injured (client became frustrated and attacked me in a full gen-ed classroom; myself and the substitute teacher had no way to call for immediate assistance).

I’ve talked to my BC and the program director and we plan to schedule a meeting to get everyone on the same page due to this being an ongoing issue, but has anyone here had a similar experience or have suggestions? I’m becoming incredibly burnt out on this case due to the lack of follow through and commitment from the staff. A state ABA program has even come in to train the school staff and explained to them many of the things I’ve said, and they’re more willing to hear it from the state, but even so they just don’t seem to be willing to implement with fidelity and I’m so worn down.

EDIT FOR CLARIFICATION:

I worded the 36 “chirps” improperly. Where I said 36 prompts in 40 minutes, I should have clarified that I meant 36 prompts AND SDs combined, with a total of no less than 20 tasks. I realize this context and clarification is important.