Professionalism While Working in the Home

Our profession often places many of us in our clients’ homes. This can be amazing, as it can open new doors for generalization, and personally I think there is nothing better than working with a client in their natural environment where they are most comfortable. However, working in the home and so close with families can present with many challenges, especially maintaining our professionalism. Trust me, I’ve been there and experienced some doozies. 

Some of the most common issues we face revolve around siblings, parents, behaviors, and boundaries. Some siblings LOVE to be involved in session, which can be good in some ways! Parallel play, sharing, social skills, and generalization are a few examples of the benefits of incorporating siblings. However, sometimes the siblings can be a bit too intrusive and bossy when it comes to what to do during session. I know it can be frustrating.

Some of the experiences I have with helpful, though intrusive family members included: Stakeholders who insist the therapist run specific programs, family members who repeat the SD, and helpful siblings who deliver reinforcer prior to the client manding. Working in the home can also be ethically challenging, especially when you are striving to uphold our ethics code. Some of these experiences include family members unloading their relationship problems, work drama, financial troubles, and more on you. Family members really do mean well, but it does sometimes interfere with our job. Luckily, our friends Bailey and Burch have outlined methods of approaching these sticky ethical moments to help us maintain professionalism. 

In addition to the resources found in Cooper and Bailey and Burch, here are some tips to maintain professionalism during these difficult situations:

• Planned ignoring- We do it with our clients when we need to, and we can do it with siblings as well. After asking nicely or trying to verbally prompt them to give you some space, some good old planned ignoring may be the necessary thing to do. Of course, we cannot ensure that our client will ignore their sibling, but in my experience when siblings intrude on session it’s because they want your attention.
• Model the behavior you want your client to do- If there are tense situations in the environment (parents arguing, sibling having a tantrum, etc.) it can affect your client immensely. Be sure to model the behavior you would like to see, such as remaining calm and not drawing attention to the event. These times may warrant non-contingent attention and reinforcement for your client in order to keep them calm and engaged.
• “I’ll mention it to my supervisor and leave it up to her/him”- When parents have suggestions on specific ways to do something, this quote can remind them that clinical decisions are made by the supervisor/BCBA, and you need to run programs and plans as written and prescribed until you are told otherwise.
• Smile and nod- Many times the parents we interact with in the homes may be stay-at-home parents and do not get to interact with many other people during the day. When they unload on you it is probably because they are just so relieved to have some adult time. While it can be frustrating, remember that when we choose to work in homes, we choose to build rapport with parents and meet them where they’re at. If that means showing compassion and letting mom vent to you for 5 minutes, then so be it.
• Lean on your supervisor- If you are faced with a difficult situation, boundaries are crossed, or you just don’t know what to do, reach out to your supervisor. They are there to support you. Supervisors can be the ones to have the conversation with parents about boundaries in a tasteful, compassionate way without putting you in a more challenging position.
• When the going gets tough, remember why you are there!– This is not an easy job, and it is not always fun, but damn it’s rewarding. If you have chosen this field then you have compassion, patience, and an appreciation for the science. While we may strive for perfection and perfect professionalism, not every session can be fabulous and flawless. Sometimes at the end of the day, the most important thing is that neither you nor the client got hurt. If that’s all that was accomplished, it can still be a successful session. Don’t be so hard on yourself, you’re doing a difficult job!

I swear I could write a book on the difficult and awkward situations I’ve been in, such as having a client bolt into the bathroom and rip open the shower curtain, exposing his father in the shower when I was right there. Dad didn’t make eye contact with me for a few weeks, but we both laugh about it now! While it isn’t always easy, at the end of the day I find working in the home to be very rewarding. I wouldn’t change my profession for the world, and hopefully these tips can help you maintain your professionalism with a client.

About the Author:

Brittany is in her third and final year of grad school, working to get her Master’s degree in ABA to become a BCBA. She is a huge fan of true crime, craft beer, and Big Brother (she even created a Facebook group called “The ABA of Big Brother 22”- check it out!). Follow Brittany’s ABA journey on Instagram @your_behavior_neighbor