A Structured Approach to Selecting Therapist-Worn Protective Equipment

Staff injuries remain a persistent challenge in ABA settings, particularly during functional analysis and early treatment phases. When therapists feel unsafe, the consequences ripple outward—affecting attendance, retention, and ultimately the continuity of client care. This article examines recent research on how clinics can make smarter decisions about protective equipment, moving beyond habit and assumption toward a more systematic approach.

What is the research question being asked and why does it matter?

The main question: how can clinics select therapist-worn protective equipment (PE) in a way that keeps staff safer and makes PE easier to use?

This matters because many ABA staff get hurt when working with clients who hit, bite, scratch, or throw items. When staff feel unsafe, they may avoid certain teaching steps, call out sick, or leave the job. That disrupts services and forces new staff to be trained repeatedly.

A second question: why do staff sometimes skip PE, even when it’s available?

Without understanding the real reasons, clinics might default to reminders or write-ups—approaches that often miss the mark. The study examined common barriers like discomfort, restricted movement, and worry that PE could change the client’s behavior. These concerns come up frequently during functional analysis and early treatment, when high-risk behavior is most likely.

What did the researchers do to answer that question?

They conducted two small studies in one outpatient clinic for severe behavior.

First, they surveyed clinic employees—therapists and supervisors—about when they wear PE, whether rules are clear, and why they might avoid it. Open-ended questions let people describe their own reasons. This gave the clinic a quick picture of staff views, not just policy.

Second, they tested a “prescription” method for choosing PE. They modified an existing decision tool to focus on behavior that could contact staff and on the PE the clinic actually had available. Then they ran FA-type sessions comparing three conditions: therapist-chosen PE, tool-prescribed PE, or no PE. They measured how often the client’s behavior contacted protected versus unprotected body areas and tracked staff-reported injuries after each session.

Only two therapist-client pairs completed this PE test. Two other cases were stopped because the tool indicated PE wasn’t needed—showing appropriate caution about risk. The clinic also gathered acceptability feedback from team members, which adds useful context but remains opinion data rather than direct measures of comfort or performance.

How you can use this in your day-to-day clinical practice

Start by understanding what staff actually experience. If your team is inconsistent with PE, don’t assume noncompliance. In the survey, the top reasons for skipping PE were discomfort, restricted movement, or feeling it wasn’t needed. Some staff also worried it could increase behavior, become a target, or look stigmatizing.

A practical first step: ask your staff these same types of questions before changing policy. Skip this step, and you may select PE that looks good on paper but gets avoided in sessions.

Use a structured method to match PE to the client’s behavior. In the small test, prescribed PE covered more of the body areas that actually got contacted than therapist-chosen PE. The tool helped select gear that better matched where contact occurred.

For day-to-day work, this means reviewing a few recent sessions or incident notes, listing the topographies and contact sites, then choosing PE that protects those sites with the least extra gear needed.

Don’t position PE as a behavior-reduction tool. In this study, rates of challenging behavior didn’t consistently decrease when PE was worn. For one therapist, behavior was actually higher with prescribed PE than without any. The clinical takeaway: PE is primarily a safety support, not a treatment. Your behavior plan should still focus on teaching skills and adjusting reinforcement.

Watch for contact shifting, but don’t assume it will happen. A common fear is that protecting the arms will lead clients to start hitting the face or other unprotected areas. In this study, major shifts toward unprotected areas didn’t appear when PE was worn.

That said, this was only two cases in a padded clinic room with short sessions. In practice, track contact sites briefly after any PE change. If new targeting of unprotected areas emerges, treat it as a signal to reassess both safety supports and teaching strategies.

Make dignity and choice part of the plan. Staff mentioned stigma as a real concern, especially in community settings. If PE is needed, reduce stigma by choosing the least noticeable option that still protects—a compression shirt under regular clothing instead of bulky gear, for example. Use neutral language when explaining the purpose. Avoid “gearing up” in ways that might alarm the learner.

Also consider whether PE changes how staff position themselves, how they prompt, or how they appear during sessions. These shifts can affect rapport.

Build PE decisions into your risk review process. Create a short PE decision note for each client with injury risk: topographies, likely contact sites, recommended PE, and rationale. Revisit it after new data, medication changes, or major setting changes. This keeps supervisors and therapists aligned—important because they didn’t always report the same reasons for using or avoiding PE.

Don’t overgeneralize these results. The PE test was small, conducted in one specialty clinic with many PE options. Injuries were rare in the sessions measured, and injury data were self-reported, which can miss minor injuries or delayed effects.

You shouldn’t conclude that a decision tool will prevent injuries in all settings. What you can reasonably take from this study: a structured approach may help select PE that better matches contact patterns, and this matching may reduce some staff concerns when the gear is well-chosen.

Keep PE as one part of a broader safety plan. If staff still avoid PE after you improve selection, the problem may be environmental or systemic—storage, time to put it on, unclear rules, fear of judgment, or mixed messages from leadership.

This study supports working at both levels: a better method for matching PE to client needs, and an organizational plan that makes safe use realistic during busy clinical work.

Works Cited

Sullivan, E. K., Zarcone, J. R., & Zangrillo, A. N. (2025). A preliminary evaluation of prescribing therapist-worn protective equipment. Journal of Organizational Behavior Management. https://doi.org/10.1080/01608061.2025.2504947