D.7 Crisis and emergency procedures
A crisis is a situation in which behavior or an emergency puts the client or others at risk of harm; emergencies also include medical events, fires, severe weather and missing clients. The RBT's first priority is safety, and their actions follow the client's crisis plan and the organization's emergency procedures, which the RBT has been trained in. Afterward, the RBT documents objectively and notifies the supervisor promptly.
What the outline says
Task D.7 in content area D, Behavior Reduction (14 of the 75 scored questions): "Implement crisis/emergency procedures."
Crisis plans and emergency procedures
A behavior intervention plan aims to reduce problem behavior and build skills over time. A crisis plan answers a different question: what to do in the moment when behavior becomes dangerous. The supervisor designs it with input from caregivers and the team. It usually lists early warning signs (precursors), steps to take as behavior escalates, when to clear the area and call for help, any physical procedures the RBT is trained in, and how to document and report.
The organization's emergency procedures cover events that are not behavioral: fire and evacuation, severe weather, medical emergencies and missing persons. Individual clients may also have protocols, such as a seizure protocol or an allergy action plan. Implementing crisis/emergency procedures "according to protocol" is also one of the tasks on the RBT Initial Competency Assessment.
Being ready before anything happens
There is no time to learn a plan during a crisis. Before working with a client or at a new site, the RBT should:
- read the client's crisis plan and any medical protocols, and ask the supervisor about unclear steps;
- get training in any procedure they will use, through instruction, modeling, rehearsal and feedback, until the supervisor verifies competence;
- know the exits, the first-aid kit, emergency contacts and the site's procedures;
- before outings with a client who elopes, carry emergency information and know the elopement steps.
During a crisis
Safety of the client, the RBT and others comes first, before finishing a trial, collecting data or calling the supervisor. Typical steps from crisis plans include:
- Act early. When the plan's precursors appear, such as pacing and clenched fists, use the early strategies right away, for example offering a break card and reducing demands.
- De-escalate: speak calmly with few words, give the client space, and avoid raised voices, long explanations and crowding.
- Protect others: move other people away and call for the second staff member if the plan says so.
- Keep the client in sight, for example during elopement, and get help.
Crisis procedures take priority over the behavior plan when crisis conditions are met. If a client on escape extinction escalates to dangerous aggression that meets the crisis plan's criteria, the RBT switches to the crisis steps. During a fire alarm, the RBT evacuates with the client even if the plan normally keeps demands in place. Planned ignoring never means letting a client walk into traffic.
If the plan's steps are not keeping people safe and there is immediate danger, the RBT follows policy, which typically means calling emergency services, and reports to the supervisor as soon as possible. The RBT never invents a new procedure or uses a hold from another client's plan or a previous job.
Restrictive procedures
Physical holds and other restrictive procedures carry a real risk of injury and distress for clients and staff, so they are a last resort. Under the RBT Ethics Code (2.05), an RBT uses them only when they are in the client's documented plan and the supervisor has verified the RBT's competence; laws and organization policies may add further limits. During any hold, the RBT watches the client's breathing and physical condition at all times and releases the hold as soon as the plan's release criterion is met. A restrictive procedure is never used to punish, to force compliance or for convenience. If a coworker or caregiver asks the RBT to use a hold they are not trained in or to lock a client in a room, the RBT declines, follows the plan and tells the supervisor.
Medical and environmental emergencies
- Unresponsive client: call emergency services and give first aid within your training.
- Seizure: move hazards away, protect the head, time the seizure and follow the protocol. Do not hold the person down or put anything in their mouth. If a step such as rescue medication is limited to trained staff, do every step you are trained for, call 911 as the protocol says, and get trained help.
- Severe allergic reaction: follow the action plan without delay, for example using the auto-injector and calling 911 if trained to do so.
- Swallowed medicine or chemicals: call emergency services or poison control right away; do not make the person vomit.
- Head injury: if a client hits their head and then vomits, seems confused or is unusually sleepy, call emergency services and follow policy.
- Fire alarm or tornado warning: follow the evacuation or shelter procedure with the client.
- Missing client: after a quick search of the immediate area, follow the missing-person procedure, which typically includes calling emergency services and the supervisor.
After the crisis
Once everyone is safe, the RBT gives first aid as trained (including for their own injuries), then writes an objective incident report: the time, antecedents, what the client did, the procedures used with start and end times, any injuries and who was notified. "At 2:14 p.m. the client hit the RBT's arm 4 times with an open hand" is objective; "the client had a meltdown" is not. The supervisor is notified as soon as the situation is safe, and caregivers as policy requires. In public, the RBT shares no information about the client with onlookers.
The supervisor may hold a review to understand what led up to the crisis and whether the plan should change. Patterns the RBT notices, such as crises right after the tablet is removed at transitions, are shared promptly so the supervisor can plan prevention.
Examples and non-examples
| Example | Non-example |
|---|---|
| A client starts pacing with clenched fists. Following the plan, the RBT offers the break card and reduces demands before aggression starts. | The RBT waits until the client hits before doing anything, although the plan lists pacing as an early sign. |
| A hold in the plan ends as soon as the client has stopped trying to hit for 10 seconds, the plan's release criterion. | The RBT keeps holding until the client apologizes. Holds are for safety, not lessons. |
Common mistakes
- Calling the supervisor or finishing data before making the situation safe.
- Using a hold that is not in the client's plan or that the RBT has not been trained in, even when a coworker or caregiver asks.
- Letting the behavior plan (for example, extinction) override an emergency evacuation or a crisis plan.
- Writing incident reports with labels and guesses instead of observable facts.
- Waiting until the next supervision meeting to report a crisis.
How it's tested
Questions describe a dangerous moment and ask what the RBT should do first, or what is or is not allowed. The right answer protects safety, follows the written crisis plan or emergency procedure, stays within the RBT's training, and ends with prompt, objective documentation and notification. Options in which the RBT improvises a procedure, uses an untrained or unplanned hold, delays emergency help, or holds longer than the release criterion are wrong.
Practice questions for task D.7
10 of our 41 questions on this task. The rest are in the Behavior Reduction practice sets and the mock exams.
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Question 1A client's behavior suddenly becomes dangerous during a session. What is the RBT's first priority?
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C: Keeping the client and others safe. In any crisis or emergency, the first priority is the safety of the client, the RBT and anyone nearby. The RBT follows the crisis plan and emergency procedures, then reports and documents.
- A: Teaching stops mattering when someone may be hurt; safety comes first.
- B: Immediate safety steps come first; the supervisor is contacted as soon as it is safe or as the plan directs.
- D: Data and documentation are completed once everyone is safe.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.01
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Question 2What should guide an RBT's actions during a crisis with a client?
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B: The client's crisis plan and the organization's emergency procedures. Crisis and emergency procedures are planned ahead by the supervisor and the organization. The RBT follows them as trained, not on-the-spot ideas.
- A: Speed alone is not a guide; unplanned actions can harm the client.
- C: Procedures from other clients' plans may not be safe or approved for this client.
- D: The RBT follows the written plan and policy and reports any conflict to the supervisor.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.02
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Question 3An RBT is about to start working with a new client who has a history of aggression. What should the RBT do before the first session?
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B: Read the crisis plan and ask the supervisor about unclear steps. RBTs prepare for service by reviewing the client's plan, including crisis procedures, and getting clarification and training from the supervisor before they need to use it.
- A: Each client's plan is individual; methods from past clients may not apply.
- C: There is no time to learn a plan during a crisis; it must be known in advance.
- D: Caregiver input is useful, but the RBT follows the supervisor's plan.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.04
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Question 4Under the RBT Ethics Code, when may an RBT use a restrictive procedure such as a physical hold?
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C: When it is in a documented plan and the RBT's competence is verified. The RBT Ethics Code allows restrictive or punishment-based procedures only when they are part of a documented behavior-change plan and after the supervisor has verified the RBT's competence. Laws and organization policies may add further limits.
- A: Refusal alone does not justify a restrictive procedure.
- B: Caregiver requests do not meet the code's requirements.
- D: Use with other clients does not put it in this client's plan.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.05
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Question 5Which use of a physical hold is never acceptable?
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B: Using it to punish a client for refusing a task. Restrictive procedures in crisis plans exist to prevent serious harm. They are never used as punishment, for convenience or to force compliance.
- A: This matches how restrictive procedures are meant to be used.
- C: Releasing promptly is part of using a hold correctly.
- D: Documenting the hold is required, not forbidden.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.01 · RBT Ethics Code 2.05
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Question 6A crisis has ended and everyone is safe. What should the RBT do next?
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C: Write an objective incident report and notify the supervisor. After a crisis, the RBT documents what happened in objective terms and notifies the supervisor (and others, such as caregivers) as the organization's policy requires, in a timely manner.
- A: Crises need timely reporting, not a wait until a routine meeting.
- B: Guesses about feelings and causes are not objective documentation.
- D: Organization policy requires written documentation, not only a verbal mention.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.02
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Question 7Which incident description is the most objective?
Show answer
A: At 2:14 p.m. the client hit the RBT's arm 4 times with an open hand. Objective documentation states observable facts: time, what the client did, how often and what staff did. It avoids labels and guesses about inner states.
- B: "Meltdown" is vague, and the cause is a guess about feelings.
- C: "Violent" and "out of control" are labels, not observable facts.
- D: "Bad mood" and "lashed out" are interpretations, not observations.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.02
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Question 8A client has a seizure during a session. The client's seizure protocol says to time it and call 911 if it lasts longer than 5 minutes. What should the RBT do?
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D: Time the seizure, keep the client safe and follow the protocol. During a seizure, the RBT moves hazards away, protects the head, times the seizure and follows the client's seizure protocol, including when to call 911.
- A: Restraining a person during a seizure can cause injury and does not stop the seizure.
- B: Objects in the mouth can cause choking or injury.
- C: Moving a person during a seizure can cause injury; hazards are moved away from them instead.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.01
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Question 9A fire alarm sounds during a session. The client drops to the floor and refuses to move, and the plan uses escape extinction for refusal. What should the RBT do?
Show answer
A: Evacuate with the client using the emergency procedure. In an emergency, safety procedures replace the behavior plan. The RBT follows the evacuation procedure, getting help if needed, and reports what happened afterward.
- B: Behavior plan procedures never take priority over an emergency evacuation.
- C: Leaving a client behind during a fire alarm puts them at serious risk.
- D: Alarms are treated as real; the evacuation procedure starts right away.
Task D.7 · 40-hour curriculum section E · RBT Ethics Code 2.01
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Question 10A client's plan lists early signs that aggression may follow (pacing and clenched fists) and says to offer a break card and reduce demands when they appear. The RBT sees the client pacing with clenched fists. What should the RBT do?
Show answer
D: Use the plan's early-step strategies right away. Many crisis plans include steps for precursor behaviors, the early signs that a crisis may follow. Acting early, as written, can prevent escalation.
- A: The plan calls for acting at the early signs, before aggression.
- B: The plan names these signs and gives specific steps to take.
- C: Holds are not for early signs, and this plan calls for a break card and reduced demands.
Task D.7 · 40-hour curriculum section E
Answer every question to see your score.
Key terms
| Crisis intervention | The planned, safety-focused steps taken when behavior creates an immediate risk of serious harm to the client or others, carried out according to the crisis or emergency plan. |
|---|---|
| Behavior intervention plan (BIP) | A written plan, developed by the supervisor from assessment results, that describes how to prevent, respond to and replace a client's problem behavior. |
| Restrictive procedures | Interventions that limit a person's movement, freedom or access to reinforcers, or that involve aversive stimuli, such as physical restraint, seclusion or exclusionary time-out. |
| Client dignity | Treating each client as a person of worth, with respect for their privacy, preferences, choices and age, in all interactions and procedures. |
| Session note | The written record of a service session describing objectively what occurred, including services delivered, client responses, relevant events and any required details for legal, payer and workplace requirements. |
| Operational definition | An operational definition describes a target behavior in observable, measurable terms so that different observers can agree on when it does and does not occur. |
| Escape extinction | An extinction procedure for escape-maintained behavior in which problem behavior no longer ends, delays or avoids the demand or situation. |
| Confidentiality | The obligation to protect information about clients and others from being shared except with authorized people, for valid reasons, as allowed by law, the BACB and the employer. |
| Behavioral skills training (BST) | A training method made up of instructions, modeling, rehearsal and feedback, repeated until the learner performs the skill correctly. |