Therapist-Worn Protective Equipment in Severe Behavior Work

Staff injuries are common in settings where clients engage in hitting, biting, scratching, or throwing. Protective equipment can help—but only if teams actually use it and choose the right gear for the situation. This article breaks down recent research on why staff do or don’t wear protective equipment, whether a structured decision tool leads to better protection, and how clinicians can apply these findings in everyday practice.

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

This paper asked two practical questions about therapist-worn protective equipment (PE) when working with clients who may hit, bite, scratch, or throw items. First, why do staff wear or avoid PE in a severe behavior clinic? Second, does using a simple decision tool to prescribe PE provide better protection than letting the therapist choose—or wearing nothing at all?

These questions matter because staff injuries are common in severe behavior work, especially during functional analysis sessions that intentionally evoke problem behavior. Injuries can interrupt services, lead staff to avoid necessary procedures, and contribute to burnout. At the same time, PE can feel uncomfortable, limit movement, and seem stigmatizing. Teams need a way to choose PE that is both safe and workable.

A key clinical concern is “behavior shifting”—the client starts aiming for unprotected body parts. Another worry is that PE could make behavior worse. This paper examined both safety outcomes (injury rates and contact locations) and behavior outcomes (rates of challenging behavior) in a small, controlled way.

What did the researchers do to answer that question?

In Study 1, researchers surveyed 27 clinic employees about PE use and opinions. Most agreed PE prevents injury and said they usually wear it correctly when required. But many reported barriers—especially discomfort and reduced mobility. Some staff also said PE might be stigmatizing, might get “targeted” by the client, might increase escalation, or might interfere with session performance.

In Study 2, researchers tested a modified PE decision tool (based on the IBA-PEDK) during FA-style sessions. Only two therapist–client pairs completed the full comparison; two other cases were stopped when the tool indicated PE was unnecessary. For the completed cases, researchers compared three conditions: therapist-chosen PE, prescribed PE (selected by the tool after observing behavior), and no PE.

They measured rate of challenging behavior, where contact landed on the therapist’s body (protected vs. unprotected areas), and therapist-reported injuries. They also asked the clinical team whether the prescribed PE seemed acceptable and workable.

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

If your team struggles with inconsistent PE use, treat it as a matching problem—not a compliance problem. In the survey, staff often avoided PE because it felt uncomfortable, limited movement, or seemed unnecessary. A generic rule like “wear arm guards with this client” may not be enough. A better first step is defining exactly what you’re protecting against (bite to forearm, scratch to neck, punch to upper arm) and what the job demands (fast blocking, running, sitting at a table). Spend more time matching PE to the real risk, not just the label “aggression.”

Use a short, repeatable decision process to select PE, even if you don’t use this exact tool. In Study 2, prescribed PE covered more of the areas actually getting contacted than the therapist’s own choice did. For one therapist, “therapist choice” meant no PE—and that’s where injuries occurred. The takeaway isn’t “always prescribe PE,” but “make the decision based on observed topographies, contact sites, and injury risk.” In practice, this can be a quick review after baseline or assessment sessions: What happened? Where did contact land? How bad was it? What would reduce harm without blocking needed movement?

Plan for comfort and mobility from the start—those are the main reasons staff stop wearing PE. The study’s social validity ratings suggested prescribed PE didn’t seem uncomfortable or limit movement for most team members, which differed from what staff reported in the survey. One practical change: stop offering only a “default” option (like bulky sleeves) and instead build a small menu that includes lighter options—compression-style layers, lower-arm guards versus full-arm guards. When you prescribe PE, include a comfort check: “If you can’t do safe blocking or you’re overheating, pause and problem-solve with the supervisor.” This keeps safety and dignity in the plan without blaming staff.

Watch for behavior changes, but don’t assume they’ll happen. In this study, contact did not shift to unprotected areas when PE was worn. That’s useful because many teams fear PE will just move the problem to the face, neck, or hands. Still, this study was small, and other research has sometimes found shifting. So measure it. Track contact sites briefly when PE changes—even a simple tally (upper arm, lower arm, torso, neck). If you see new targeting of unprotected areas, treat it as data that your current PE match is incomplete, not as proof that PE “doesn’t work.”

Don’t use this study to argue that PE will reduce problem behavior. In one case, challenging behavior rates were higher when prescribed PE was worn than when no PE was worn. That doesn’t prove PE caused the increase, but it’s a clear warning not to sell PE as a behavior-reduction strategy. PE is a risk-reduction tool. Your treatment plan still needs function-based reinforcement, skill building, and environmental changes. PE may help staff stay calm and consistent during that work, but it shouldn’t replace it.

Use “no PE” comparisons carefully and ethically. One therapist reported feeling uncomfortable during the no-PE condition when behavior was high. In real clinics and schools, asking staff to run “no PE” sessions just to test a point may not be reasonable. A safer approach is comparing “current PE” versus “better-matched PE,” rather than “PE versus none,” unless risk is very low and staff fully agree. The goal is learning what level of protection is needed with the least burden—not proving toughness.

Be honest about the limits before changing policy. Study 2 had only two completed cases, few injuries, and a setting with many PE options and padded rooms. Don’t assume the same results in home sessions, public schools, or programs with limited equipment. What you can take from this is the process: observe, rate risk in a structured way, prescribe the least restrictive PE that covers the real contact sites, then re-check comfort, movement, and contact patterns.

Finally, build shared language between supervisors and therapists. Supervisors in the survey mostly talked about “safety” and “preventing injury,” while therapists also mentioned confidence, requirements, mobility, and session integrity. Schedule a short, concrete conversation when PE is prescribed: what risk you’re protecting against, what staff can expect to feel, what movements must stay possible, and how staff can request adjustments without fear of judgment. This supports staff well-being and client dignity while keeping clinical work moving.

Works Cited

Lee, J., Choi, E., & Li, A. (2025). Effects of correct versus incorrect response feedback on work performance. Journal of Organizational Behavior Management. https://doi.org/10.1080/01608061.2025.2578475