BCBA Fieldwork in Diverse Settings: Clinic, School, Home, & Community

When obtaining supervised fieldwork hours for the Behavior Analyst Certification Board (BACB), trainees have the opportunity to work in various settings throughout their experience. Ideally, trainees should try to obtain hours in several different settings with a variety of clients to have exposure to different situations and to help them incorporate their experience into considerations for their clients receiving behavior analytic services.

As a board certified behavior analyst (BCBA) supervisor for 7 years, I have had the opportunity to work in clinics, schools, homes, and in the community. The aim of this article is to reflect on my experiences and explore the pros and cons of working in these diverse settings, along with tips on adapting your approach to each environment. Different settings offer unique experiences for both the trainee and client. Also, challenges can arise in each of the environments. It is my hope that this article will help prepare trainees for those difficulties, so that they can have a plan to navigate the stressors in each setting type.

In Clinic

Pros:

I have been able to work in-clinic in several different states as a BCBA supervisor. A great thing about clinic-based services for applied behavior analysis (ABA) therapy is that it is a controlled environment. It can be structured with visual aids to assist your client, and there are other providers working nearby to be able to help with maladaptive behaviors or collecting data. Having several sets of data can ensure that interobserver agreement is established and increase treatment fidelity. Working in-clinic also means that your clients have access to a wider variety of materials, toys, games, and potential reinforcers. Another great thing about clinic services for BCBAs and their employees is they don’t have to drive from one client to the next. This decreases wear and tear on vehicles, saves employees on gas, and since there is no driving time employees can have more flexible options when scheduling clients. Finally, as a trainee working in a clinic, you might have the chance to be more closely monitored by your supervising BCBA which means that you will have ample opportunities to ask questions, receive feedback, and observe others implementing techniques.

Cons:

There are some downsides to providing ABA in a clinic. These include generalization issues as sometimes skills learned in a clinic are not always transferred to other settings because the clinic is such a controlled environment. In the real-world there are different factors that can play into behavior, and those are not always addressed in-clinic. Next, clients may face challenges reaching the clinic due to location or transportation or scheduling issues. In my experience, the children that I worked with receiving ABA also had to drive to and schedule speech, occupational and physical therapies along with regular appointments and sometimes school or daycare settings. Also, in-clinic settings might not always have age appropriate clients available for social skills practice and interaction. And finally, and in my experience, one of the biggest downfalls of providing services in-clinic is practitioners don’t get to interact with parents, siblings, and caregivers as much in-clinic as they do during in-home therapy. In homes parents can be active participants in their child’s therapy and learn how to work on goals. In-clinic, even if the parents get a daily update and parent training, they do not get to see interventions modeled as much since they aren’t viewing the entire session. 

School

Pros:

Working in schools can be an extremely valuable setting for BCBA trainees, offering a wealth of opportunities to develop essential skills. BCBA trainees in schools will learn how to collaborate with others and can gain experience implementing group contingencies. Working with teachers and support staff in schools allows for a team-based, collaborative way to help support students. Also, working in schools also allows for the opportunity to train staff and get feedback on interventions.Schools serve as naturalistic settings, allowing BCBAs to observe and understand the real-life factors influencing a client’s behavior on a daily basis. This environment is rich with opportunities for social interactions, enabling trainees to support and enhance students' social skill development through structured programs and interventions. Overall, the school setting offers a comprehensive and dynamic training ground for aspiring BCBAs, preparing them to address diverse behavioral challenges effectively.

Cons:

There are some difficulties that BCBA trainees will encounter when working in a school setting. There are unpredictable disruptions which means that interventions may not always be able to be implemented consistently. For example, school breaks, fire-drills, state testing, and school activities mean that providers are not always able to work around school demands to target skill acquisition programs. Another con is there is limited control in school as BCBAs and their trainees and staff are not able to manage other students, schedules, and external variables. Finally, in schools there are some major resource constraints. Schools may lack materials, staff, or just the time needed to implement behavior analytic interventions correctly. In my experience, teachers sometimes see BCBAs as aversive because they increase the teacher’s workload by asking them to take data or implement interventions. It’s important to remember that teachers are stretched thin as it is- we need to plan interventions that help clients without overworking the teachers we collaborate with.   

Home

Pros:

The home is obviously the client’s most natural environment. Working in-home with clients truly promotes the generalization of skills to the client’s day-to-day life, which arguably makes the greatest impact on a client. In-home services allow for significant family engagement, as parents and caregivers can work closely with therapy staff who are implementing programs. Furthermore, clients’ homes are the most familiar settings for them. They can feel more comfortable and perform better in a familiar environment surrounded by people they know and trust. This comfort can lead to more accurate assessments and goal writing. Additionally, working in-home helps BCBAs and their trainees identify preferred reinforcers that clients might want to work for because they can observe the client in their natural environment. This setting also allows for the customization of interventions to fit the unique dynamics and routines of each household, leading to more sustainable and impactful outcomes. Overall, in-home can provide a holistic approach that is deeply personalized for the client. 

Cons:

In-Home is also a very variable environment. Distractions such as pets, siblings, family dynamics, and activities going on in-home can create distractions for clients working on ABA goals. In-home there may also be limited resources as far as specialized materials, reinforcers, and novel items that are available in-clinic. If a BCBA or their staff don’t bring a particular item to a client’s home, they might not be able to run specific programming, so in-home takes more prior planning and organization. Additionally, the home environment can present safety challenges, as clients may have access to dangerous items such as kitchen utensils and sports equipment. This variability can make managing maladaptive behavior safely a challenge. Furthermore, in-home sessions often require providers to navigate complex family dynamics and routines, which can complicate the implementation of interventions and how you are perceived in a family’s home. Finally, for providers, in-home services can mean a lot of driving between clients, especially if their organization supports a large service area. This extensive travel can impact employee schedules, pay, and overall job satisfaction, potentially leading to burnout. 

Community

Pros:

Some of my favorite memories as a BCBA have been made in the community working with clients. Working on interactions like purchasing an item from the store, riding a city bus, or participating in a group sport are invaluable skills, and practicing them in community settings promotes better generalization. The diverse interactions with various people and scenarios enhance adaptive and social skills. In my experience, it helps a client feel better about themselves and gain independence when they work on skills and participate in their community. Moreover, community-based interventions provide real-world contexts that challenge clients to apply their skills in unpredictable situations. The sense of accomplishment clients feel when successfully navigating these settings is amazing. These experiences are not only beneficial for the clients but also deeply rewarding for the practitioners who witness their growth and progress in real-life environments.

Cons:

Community outings do have some difficulties. Firstly, in my experience, most insurances will not pay for community outings. So, if you are providing services by working with private insurance, this might not be something that you can incorporate into a treatment plan for services. The community setting is unpredictable; even if we teach a client how to handle a situation with multiple examples, we will probably not cover every external factor. There are also some safety concerns that arise if you are working with a client who has a history of elopement or aggressive behavior. Public spaces are challenging settings to de-escalate maladaptive behaviors, which can add stressors to the providers and clients. Additionally, some community locations may be difficult for clients to access due to transportation or mobility issues. Insurances have strict policies about transporting clients, as do most organizations that I have worked for. Therefore, it is crucial to plan for the best way to meet a client in the community that is ethical and safe for all parties involved. This often requires careful coordination with families and caregivers to ensure that transportation is arranged, and that the location is accessible. Moreover, the variability and unpredictability of community settings demand that providers be highly adaptable and prepared for a wide range of scenarios, which can be both challenging and resource intensive. 

Conclusion

Working in different settings as a BCBA trainee offers invaluable experiences that contribute to professional growth and improved client outcomes. Each environment presents unique challenges and benefits that require adaptation and strategic planning. By understanding the pros and cons of working in clinics, schools, homes, and the community, trainees can better prepare for diverse situations and develop comprehensive, effective behavior analytic services. Embracing these varied experiences will ultimately lead to more well-rounded and competent behavior analysts, capable of making a positive impact in the lives of their clients.