Scenario

A BCBA is working with a medically fragile teenager, significantly impacted in several domains (communication – very little functional language, daily living, social skills etc.). The client suffers from a rare heart condition requiring an AED (on her person – in backpack) at all times. The family recently learned of the only potential surgery that could save her life (implant of internal defib). However, the setting on the implant cannot be set for her specific needs so it will “fire” a shock, at random times, to ensure appropriate electrical functioning. The medical provider requested the BCBA implement a protocol to prevent and treat trauma associated with the unpredictability of the electrical shock. The BCBA has experience with PTSD clients but is unsure of all the components involved in this scenario. The medical provider shared that there is no way to measure the intensity of the shock, as that is relative to the patient (this client does not have enough functional language to share such information). Parents are unsettled regarding the procedure but feel it is the only way to ensure her safety, long-term. Parents are requesting a coordinated plan of care prior to surgery. What are the next steps for this BCBA?

Response

• Ensure experience and competency with PTSD and trauma, if not, seek out additional resources and supports

• Reviewing what is in our scope of practice; risk benefit analysis for getting the surgery vs. keeping defib on her person at all times

• Discuss with doctor as well as previous patients if available to talk about the effects and intensity of the shock

• Refer to counselor or psychologist for family care and ongoing needs that the client would need to build a collaborative team

• BCBA, continuing to build communication, Likert scale for communicating pain etc.

• Taking a supportive approach to parent training after the surgery and keeping in mind the fragile state of the family to slowly integrate protocol training into sessions