Safety Measures for Behavioral Service Agencies and Schools Open during the COVID-19 Pandemic

I provide online Supervision, clinical support/'telebehavior' and BCBA test prep services (www.drlousandler.com) and have students/clients who work for service agencies from the West to New York City which has now become America's epicenter for COVID spread. I am worried about my students, to especially include several in particular, who are rather ill right now. I am in touch with my students and, in doing so, have learned of some selected service agency practices which I consider distressing.

There apparently are at least some agencies who continue to minimize the need to follow even basic CDC/WHO, health department and professional guidelines for not wanting families or staff to think anything was wrong or that there is a crisis which might then could upset them.

Well, the reality is that something is VERY wrong since we are in the middle of a global and national pandemic and still rapidly growing national public health crisis for which this nation was not and remains unprepared. In fact, and as many of us have also been warning would happen next, the WHO just identified that the U.S. could likely become the 'next epicenter of the global coronavirus crisis.'

Think about that....and decide if we need to better prepare state to state; region to region and, provider to provider and, even, family to family. And we need to do it together since we are all in this together.

These measures also apply to schools remaining open for even partial student services.

A number of my clients, from school teachers to BCBAs and RBTs have been ill with a few already testing positive with others being more likely positive but STILL unable to get testing done. This even as other nations, to notably include South Korea, have tested thousands; tens of thousands of persons a day while getting a strong handle on the spread of COVID.

As of March 14, in fact, South Korea had tested over a quarter of a million of it's citizens documenting a mortality rate of only .9% This compares to Hubei, with initial warnings suppressed as they have/had been here in the US, where mortality currently stands at 4.5%. We may not currently have a 'cure' for the coronavirus but how we respond does make a clear and data based difference.

The U.S., in comparison to South Korea, has been hard to verify figures though one survey as of 9 March only documented around 4500 citizens nationally who've been tested. I believe those numbers have since gone up as I've elsewhere seen numbers of around 11,000 tested though, even if true, it still pales in comparison to South Korea and other nations. And in the U.S., a notable percentage of those tested have yet to have their tests evaluated for lack of resources and the needed reagent in the states. This means we likely have a number of citizens who are positive for COVID but still unaware and still moving about.

As Behavior Analysts, we are uniquely prepared and trained need to read, understand and apply that data far more efficiently. So, yes...a key point here is that something very definitely is wrong and pretending otherwise or trying to minimize is not only dishonest but dangerous as we've already seen at the national level.

But based on what we already know about the spread of COVID also means that if we are smart; if we are purposeful, if we are deliberate and if we follow CDC/WHO, local health department and professional guidelines, we can positively impact and reduce the risk, the rate of spread and the intensity of the illness if contracted even though we still remain unable to 'cure' COVID.

Agencies who are not FULLY supporting their staff, clients and families need to start by re-reading the BACBs ethics code to especially include more recently released COVID specific guidelines and updates.

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Taken from.... BACB COVID Updates

Health and Safety

• To minimize risk, service providers should consider developing a COVID-19 pandemic risk mitigation plan and implementation policies. The risk mitigation plan may include some of the following elements: regular communication with staff and clients about how to stay safe, telecommuting/telehealth, limits on air travel, attestations about symptoms and exposure, encouraging social distancing, considerations for determining whether to continue/augment/suspend client services, and cancelling services/sessions if clients or service providers are symptomatic or if deemed necessary to comply with social distancing recommendations.

Continuity of Care

• Assuming there are no mandates to the contrary, the service provider must determine if the risk of suspending services (e.g., substantial risk of injury to the client) is greater than the risk of continuing to provide services.
• If continuing services is deemed appropriate, the certificant must then determine if services can be delivered in a manner that does not unduly increase the risk of exposure to COVID-19 (e.g., enhanced disinfecting protocols, minimizing numbers and points of contact, using protective gear).

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Our first and foremost obligation is to the safety and health of children, families and staff. In fact, I'd offer that following these guidelines are not only required but would very likely help families and staff to be more comfortable in the knowledge that their employer; that the agency is making every effort to do what they can. That, in turn, may help more families continue to use services for as long as possible and to keep staff more at ease and better prepared to report to work. 

For the record, I am not unconditionally opposed to agencies remaining open so long as they adhere to local and state government mandates and use proper precautions and procedures which prioritize the health of children and staff. I am on record of not supporting unconditional and indefinite school closures and would like to see schools reopening before the end of the current school year - but differently.

Schools Must Re-Open...After Additional and Specific Planning (Revised: 23 March 2020)

But it is NOT ok for agencies or schools agencies who overlook or minimize recommendations which are explicitly designed for the safety and well being all during the current crisis. Based on CDC/WHO; BACB and related guidelines, EVERY open Agency and school should:

• Take, and document, the temperature of ALL staff and children upon arrival and just before leaving. Retake temps during the day should anybody even think they are feeling unwell or that a specific child appears to have become unwell.
• Incorporate active and consistent use of disinfectant protocols as identified by the CDC/WHO.
• Maintain OPEN COMMUNICATION at all times with everybody. Address questions and concerns openly and directly Problem solve...
• Do health checks to identify primary symptoms of COVID towards what the BACB calls an 'attestation of symptoms and exposure.' Agencies/schools could create a short checklist for children and staff to document daily upon arrival and just prior to departure for the day which prioritizes if exposure has occurred and the key symptoms of COVID to include sudden increase in temperature and degree of exhaustion along with a persistent dry cough. And encourage in-contact primary family members/caregivers to participate whenever possible

CDC COVID DIsease Symptoms

• Practice Universal Precautions AT ALL TIMES. Wear disposable gloves which are correctly removed and disposed of, changed and hands washed between all contacts, if soiled with bodily fluids and if handling food. Use masks if available to include knowing how to properly remove and dispose of them, too. Create objectives to help our clients tolerate use of masks, again, if available.
• Be sure to check in with and maintain open and active communication parents and caregivers. Asking parents/caregivers how they feel is also important. (I realize I've mentioned this above...but it is important enough to repeat!)
• Reduce physical contact to the degree possible. In behavioral service agencies, we spend a lot of time with little guys and help with personal care and meals as well as the use of instructional prompting is inevitable. And this can certainly be the case in schools who are even offering more limited contacts and services.. For service agencies, this is also an excellent opportunity to practice greatly reducing more intrusive and ongoing instructional physical contacts to include persistent hand-over-hand and physical prompting. Actively practice the use of most to least; prompt fade techniques. Not only does this reduce risk but it's also represents much better instructional technique.
• In the absence of full protective gear, staff should bring at least one - maybe a second - change of outer clothes should they become contaminated by child body fluid. Wearing a 'smock;' an over-sized shirt or the like over your clothes which can be taken off and changed as needed is another alternative. Staff who may have extras of such items should bring them in for the use of all. At least two full changes of under and outer clothing for all children should be provided by parents/caregivers
• Staff should more frequently do their own laundry and, specifically, of their work clothes.
• Minimally - if at all - hug....and stop tickling children
• While children and staff can't be expected to stay 1:1 and separated from all others all the time, keep better distance overall looking to stay at least a couple of arm's lengths from each other and/or other groups when in common areas; engaging in common activities
• Minimize staff physical contact to include no hugging or hand shaking. Do elbow bumps as one appropriate alternative behavior. Do not engage physical contact with parents/caregivers. This is as important as it will and can be difficult.
• Have a much lower tolerance for flu/cold symptoms. If children OR staff are showing any signs, they should either stay home or be sent home, be required to see an MD to include getting the MD's written clearance before returning to work or their program. Common expectations for at least two episodes of diarrhea before calling parents/caregivers, having more than a very low grade fever and/or 24 hours without symptoms as attested to by caregivers, for instance, must be changed for the foreseeable future.

And, above all, follow available guidelines, take care of yourself and one another..