Quality Care Begins With Staff Safety
- Shelby Quigley, MA, BCBA
- 18 hours ago
- 6 min read
Shelby Quigley, MA, BCBA
Guest Writer Bio
Amigo Care ABA: https://amigocareaba.com/
Shelby Quigley, MA, BCBA, is a Board Certified Behavior Analyst and Organizational Behavior Management practitioner whose work examines staff safety, performance systems, and organizational variables affecting service delivery in human-service settings. She serves as Director of Operations & Clinical Supervisor at Amigo Care ABA and previously contributed to applied research on injury prevention, staff performance, and reinforcement-based treatment models at the Kennedy Krieger Institute’s Neurobehavioral Unit. Shelby has presented her research at ABAI and MABA, centered on behavior-based safety, data-driven organizational assessment, and the development of systematic approaches to reducing staff injury risk in ABA environments.
Rethinking Injury Prevention in ABA
In Applied Behavior Analysis, much of our conversations center on client progress, treatment outcomes, supervision strategies, and data-based decision making. Yet one critical variable still receives far less attention than it deserves: the safety and well-being of the people delivering the services.
Across ABA settings, staff injuries are common, so common that many professionals begin to view them as “part of the job” (myself included). I remember one of my first weeks on the Neurobehavioral Unit at Kennedy Krieger Institute: a staff member shrugged off a bite mark on her arm and said, “It happens.” At the time, I nodded, because everyone else did.
However, years later, through my work maintaining injury-monitoring systems (Hardesty et al., 2025), one truth became impossible to ignore: We cannot deliver high-quality ABA in an environment where staff are not safe.
Staff well-being and client well-being are inseparable. When staff are injured, overwhelmed, or worried about getting hurt again, the quality of care suffers. This is not because clinicians lack competence, but because they are human.
An environment where injuries are expected or ignored cannot support ethical, high-quality ABA. Staff safety isn’t an operational detail, it is a clinical necessity.
Why We Needed a Better System
When I began working on injury monitoring systems, it quickly became clear that the issue wasn’t a lack of concern. Staff members cared about safety. The problem was the system.
Injury documentation was vague, inconsistent, or incomplete. Staff often didn’t know what counted as reportable.
Many felt there wasn’t enough time to complete an incident report after a difficult shift. And some believed “small injuries” weren’t worth mentioning.
In reality, these minor events signaled broader patterns. Patterns that could have helped prevent more serious injuries if the right data were available.
So we reframed the narrative: Underreporting was not a staff problem, it was a systems problem. Lucky for us, systems can be redesigned.
Building a Behavior-Analytic Framework for Injury Monitoring
The first step was ensuring that every injury report collected meaningful, consistent, actionable information. That meant eliminating ambiguous free-text entries and introducing structured, behaviorally defined data fields.
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Every injury, no matter how small, was documented with:
Type of injury (e.g., bite, scratch, contusion, strain, body fluid exposure)
Body location
The specific context (e.g., ADLs, transitions, sessions, play, blocking)
Use of PPE and/or protective equipment
Who was involved and when
A standardized severity rating scale
The severity scale (1–4), adapted from Hardesty (2020), was especially important. A scratch that didn’t break skin is NOT equivalent to a direct blow to the head, but without severity scoring, organizations often treat these incidents the same way or they go underreported.
Severity scoring allowed us to prioritize risk, implement rapid interventions, and assign appropriate follow-up procedures.
This framework solved multiple problems at once. Reporting became faster, clearer, and more objective. Staff no longer had to guess. While leadership finally had access to detailed, reliable injury data.
What Happened When the Data Became Clear
Once data were accurate and complete, patterns emerged that had previously gone unnoticed: