The document discusses the use of RBTs within a tiered service delivery model to improve clinical processes and outcomes. Data is presented showing that after introducing RBTs, there was an increase in the frequency and duration of interventions, more efficient data entry, and reductions in challenging behaviors and increases in skill acquisition for two individuals. The inclusion of RBTs allowed for more clinical presence in programs and improved clinical workflow. Overall, initial results indicate a favorable return on investment from using RBTs within the tiered model.

1. Do RBTs™ Improve Quality?
Improving clinical process and
outcomes via expansions of the
behavior analytic tiered service-
delivery model
Jonathan Worcester, Ph.D., NCSP, BCBA-D
Trisha O’Connell, M.A., LMHC, BCBA
Corina Lugo, B.S., RBT
Joseph N. Ricciardi, Psy.D., ABPP, BCBA-D, CBIS

2.  Rationale: Behavior analysts are routinely asked to provide presented
with the challenge of providing comprehensive treatment to
individuals and families with increasing clinical complexity and acuity.
 The BACB’s newest credential—the Registered Behavior Technician™-
-offers an opportunity for behavior analysts to improve clinical
processes and outcomes, potentially while delivering services more
efficiently and at greater volume.
 The bottom line: What is the return on investment of the RBT
credential? What value do RBT-credentialed providers offer relative
to processes? Outcomes?
Rationale

3. Our Vertical Team Structure
 We use a tiered service-delivery
model to ensure that all aspects of
clinical service delivery are properly
directed, supervised, and supported.
 Pairs level of professional
competence with level of care
(medical necessity).
 Consistent with BACB’s vision of
behavior analytic service delivery
(BACB, 2014).
 Cost effective, built for growth and
sustainability.
BCBA-D
BCBA
BCaBA
RBT
BCBA
RBT RBT

4. The RBT™ Credential
BACB Requirements
 18 years of age
 High school or equivalency
 Criminal background/abuse
registry check
 40 –hour RBT training
 RBT competency assessment
 RBT examination (New; 12/14/15)
Additional SHF Requirements
 Associates or bachelors degree
(prefer psychology or special
education)
 Prior direct care experience
 Safety-Care™ Behavioral Safety
Training certified trainer
 Career aspirations in behavior
analysis
www.bacb.com

5.  A. Measurement
 B. Assessment
 C. Skill Acquisition
 D. Behavior Reduction
 E. Documentation and Reporting
 Professional Conduct and Scope of Practice
The RBT™ Task List
www.bacb.com

6. Measurement
Processes
 Frequency of Visits
 Duration of Visits
 Minutes of Behavior Data Entry (A-05)
 Minutes of Challenging Behavior Data
Graphing (A-05)
 Minutes of Skill Acquisition Data Entry (A-05)
 Minutes of Graphing Skill Acquisition (A-05)
 Frequency of Staff Reinforcement(C-03)
 Minutes of Incidental Teaching (C-05)
 Minutes of Antecedent Intervention (D-03)
 Minutes of DR (D-04)
 Minutes of De-Escalation (D-05)
 Minutes of Crisis Management (D-06)
Outcomes
 Target behavior reduction
 Skill acquisition
 Qualitative data from BCBA
 Qualitative data from RBT

7. 0
2
4
6
8
10
12
14
16
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Hours
Monthly Cumulative
Duration of BCBA and RBT
Visits
Program A (BCBA) Program A (RBT)
0
2
4
6
8
10
12
14
16
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Frequency
Monthly Frequency of BCBA
and RBT Visits
Program A (BCBA) Program A (RBT)

8. 0
2
4
6
8
10
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Frequency
Monthly Frequency of BCBA
and RBT Visits
Program B (BCBA) Program B (RBT)
0
2
4
6
8
10
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Hours
Monthly Cumulative
Duration of BCBA and RBT
Visits
Program B (BCBA) Program B (RBT)

9. 0
20
40
60
80
100
Program A
Baseline
Program A
Intervention
Program B
Baseline
Program B
Intervention
Miinutes
Duration of Time Engaged
in A-5 By BACB Credential
BCBA RBT
0
20
40
60
80
100
Program A
Baseline
Program A
Intervention
Program B
Baseline
Program B
Intervention
Minutes
Duration of Time Engaged in
C-3, C-5, D-3, D-4 By BACB
Credential
BCBA RBT

10. 0
5
10
15
20
25
30
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Frequency
Individual A: Mean Monthly Challenging Behavior Frequency
Verbal Outburst SIB Minor SIB Major Aggressive Outburst
1/12/15, 1/29/15, 3/18/15: Medication changes
Consistent presence
of RBT started May
2015

11. 0%
20%
40%
60%
80%
100%
Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
PercentAccuracy
Individual A: Monthly Mean FCT Data
Requesting Preferred Requesting Attention Requesting Escape
Goal Line
Consistent presence of
RBT started May 2015

12. 0
10
20
30
40
50
60
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Frequency
Individual B: Mean Monthly Challenging Behavior Frequency
Verbal Outburst Aggressive Outburst Self-injury
Consistent presence of
RBT started May 2015

13. 0%
20%
40%
60%
80%
100%
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
PercentAccuracy
Individual B: Monthly Mean FCT Data
Requesting Preferred Requesting Attention Requesting Break Task Completion
Consistent presence of
RBT started May 2015
Goal Line

14. Conclusions
 The inclusion of the RBT™
within the SHF vertical team
structure yielded initial positive
outcomes relative to clinical
processes and outcomes.
 The representative data
depicted here illustrate a
favorable clinical return on
investment that outweighs
prerequisite demands on the
vertical team (e.g., supervision,
technical assessment, payroll).
 Processes:
 Increased frequency and
duration of interventions
implemented within programs.
 Improved data entry/graphing
efficiency
 Outcomes:
 Contributed to stable behavior
change over time (reduction,
acquisition).

15. Collateral Outcomes
(Quality Improvements)
Increased Clinical Presence in Programs
 Multiple visits per week to programs.
 Increased opportunities for modeling, coaching,
and discrete trial training procedures.
 More opportunities for objective assessments of
environmental triggers, challenging behaviors,
teaching and reinforcement opportunities, and
preferences.
 Implementation appears to have improved as a
result of the increase in clinical presence (relative
to overall implementation and for materials-
dependent interventions such as FCT).
Improved Clinical Workflow
 Material s development and job aides
 Frees up BCBA to perform higher level
duties and responsibilities (e.g., behavior
support plan development, staff training,
data analysis and decision making).
 Efficient staff training (position required
prior direct care experience).
 Improves contextual fit (Albin et al., 1996)
relative to staff training, data sheets, and
intervention planning.

16.  Treatment integrity data
 Duration of time study
 Expansion to additional RBT™ task list items
 Expansion to additional individuals and programs
Limitations & Next Steps

17.  Albin, R. W., Luchysyn, J. M., Horner, R. H., & Flannery, K. B. (1996). Contextual fit
for behavioral support plans. In L. K. Koegel, R. L. Koegel, & G. Dunlap (Eds.).
Positive Behavioral Support: Including people with difficult behavior in the community
(pp. 81-98), Baltimore, MD: Paul H. Brookes Publishing Co.
 Behavior Analyst Certification Board. (2014). Applied behavior analysis treatment of
autism spectrum disorder: Practice guidelines for healthcare funders and managers
(2nd ed.). Littleton, CO: Author. Retrieved from http://bacb.com/wp-
content/uploads/2015/07/ABA_Guidelines_for_ASD.pdf.
 Registered Behavior Technician™ Overview. Retrieved from www.bacb.com/rbt.
 Behavior Analyst Certification Board. (2013). Registered Behavior Technician™
(RBT™)Task List. Littleton, CO: Author. Retrieved from http://bacb.com/wp-
content/uploads/2015/05/RBT_Task_List.pdf.
References