How do you keep the same BIs with each child?

Give each child a small, steady team: one primary BI (behavior interventionist) who runs most of the sessions, one or two trained backups who know the child and the plan, and one supervisor who sees all of them. The primary gives the child and family a familiar face week to week. The backups mean a sick day or a resignation doesn't hand the child to a stranger. Idaho's CHIS rules don't require this set-up, and the research on staff continuity is thinner than you might expect. The evidence we could find still points the same way.

What the evidence says, and what it doesn't

We looked for public research on whether keeping the same BI with a child improves outcomes in habilitative or behavioral intervention. We didn't find a study that tests this directly. We did find three related lines of work.

• Turnover is recognised as harmful, and it can be predicted. A 2015 survey of 96 behavior technicians (the study's name for staff in a BI's role) at 19 agencies in Southern California (Kazemi, Shapiro and Kavner, Research in Autism Spectrum Disorders) opens by noting that turnover hurts service quality and the therapeutic relationship. The study didn't measure child outcomes. It asked what predicts a staff member's intention to leave. The answer was satisfaction with training, supervision, pay and the job itself. Actual pay didn't track with intent to leave.
• Consistent caregivers are a widely endorsed practice in early childhood, but the outcome data is mixed. A 2018 study of infant-toddler classrooms (Horm and colleagues, Early Childhood Research Quarterly) found that continuity of care was linked to higher teacher ratings of self-control, initiative and attachment, and fewer behavior concerns, while children were in those rooms. It found no consistent link once children moved on to preschool. The authors say their results don't give clear support for the practice and call for more research. Child care classrooms are not CHIS sessions, so treat this as related evidence only.
• One person alone may not be enough either. A classic review in the Journal of Applied Behavior Analysis (Stokes and Baer, 1977) describes a study where a greeting skill taught by one adult usually didn't carry over to other adults. It carried over to more than 20 staff once a second adult trained it alongside the first. A skill that only shows up with one person is fragile.

Put together, nobody has proven that one BI per child produces better outcomes. There are good reasons to keep the team small and steady, and good reasons not to make it a team of one. A primary BI with trained backups fits both.

What the Idaho rules say (and don't)

Idaho's CHIS rules are in IDAPA 16.03.26, Sections 180 to 186, effective July 1, 2026. We read them in September 2026, along with the CHIS chapter of the Idaho Medicaid Provider Handbook (dated August 17, 2026). Neither one requires a child to keep the same BI.

The DDA rules do require training on each child before a BI works with them. Every CHIS DDA is certified under IDAPA 16.03.21, and Section 302.03, Participant Specific Training, says direct service staff "must be trained on the specific needs of the participant" before delivering services. The rules don't say how you deliver participant specific training (PST), only that it comes first.

Several parts of the CHIS rules also bear on continuity:

• Implementation plans. A qualified provider completes and signs an implementation plan describing how the intervention will be carried out (Section 183.02). Anyone who works with the child needs to know that plan.
• Fidelity. The rules define fidelity as "the consistent and accurate implementation" of services under the chosen model or protocol (Section 180.06). Every new person on a child's team is a new chance for the plan to drift.
• Supervision. BIs at the intervention technician level must be supervised by a specialist or professional who observes and reviews their services, and supervision must occur monthly (Section 184.02). The handbook explains the purpose:

Supervision must occur monthly to ensure staff demonstrate the necessary skills to provide the services correctly.

• Annual training. Everyone who delivers CHIS must complete at least 12 hours of training each calendar year, including one hour of ethics and six hours of behavior methodology or evidence-based intervention (Section 184.09). This is general training. PST is the part tied to one child.
• Who provides the hours. Ongoing prior authorization requests list the CHIS hours requested and the qualifications of the people who will provide them (Section 183.01.c). If a staffing change alters who is delivering a child's hours, check the current handbook for what that means for an open authorization.

So the rules set a floor: a written plan, PST before a first session, monthly supervision and annual training, with fidelity defined as consistent, accurate implementation. A steady team is how many agencies meet that floor with the fewest surprises, and it stays a practice choice.

Building a primary and backup team for each child

At our fictional agency, Sagebrush Behavioral Services, a small team for one child might look like this.

Role	Who	What they do for J.M.
Primary BI	Ava	Most weekly sessions. Knows the plan best. First contact for session-level questions from the family.
Backup BI	Marcus	One regular session a week, plus cover when Ava is out.
Second backup (optional)	Priya	Has had PST for J.M. and is scheduled now and then so she stays familiar.
Supervisor	Rachel	Monthly observation of each BI on the team. Owns the implementation plan.

A few habits make this work:

1. Give the backup a regular session. A backup who only appears in an emergency is a stranger with a file. One standing session a week, or every other week, keeps the child used to them and keeps them current on the plan.
2. Cap the team size. We'd suggest two or three BIs per child. More than that and "familiar" stops meaning much. Fewer than two and every absence is a cancellation.
3. Match hours to what each BI can carry. A primary scheduled right at their limit will burn out. In the Kazemi study, satisfaction with the job predicted whether staff meant to stay, and every BI who leaves takes a child's familiar face with them.
4. Keep the pairings visible. Whoever builds the schedule should be able to see, for each child, who the primary and backups are. If that only lives in someone's head, it leaves when they do.
5. Write it down. Note each child's team in your records so a new scheduler or supervisor can pick it up.

Bringing a new BI in before they work alone

PST has to come before a BI's first session with a child, and the rules leave the method to you. Before a new BI runs a session alone with a child, a good sequence is:

1. Read the implementation plan and the child's current goals, with the supervisor available for questions.
2. Shadow the primary for one or more sessions, watching how the plan is carried out with this child.
3. Run part of a session while the primary or supervisor watches and gives feedback.
4. Get a supervisor's sign-off that they can run the plan as written, and record the PST date.
5. Meet the family, so the first solo visit isn't also the first hello.

Your supervisor decides how many shadow sessions are enough, based on the child and the plan. Whether overlap time is reimbursable is a separate question. Check the current handbook and your authorization before you assume it is.

The hard part is remembering. When a gap needs filling at short notice, it's easy to assign whoever is free without asking whether they've had PST for the child. A check at the moment of assignment helps.

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Handling turnover without starting over

BIs will leave. Plan so that a departure costs the child one familiar face and leaves the rest of the team in place.

• Promote the backup. If the backup already has a standing session, they can step up to primary with little disruption. This is the main payoff of the primary-and-backup model.
• Use the notice period. If the departing BI gives notice, use those weeks for overlap sessions with whoever is taking over.
• Re-check the whole schedule. A BI leaving usually affects several children. Look at every child they served and every week they were booked, so no session is left without a BI.
• Refill the backup slot. Once the backup becomes primary, the child has no backup. Get someone new through PST for that child before the next absence finds the gap for you.
• Look at why people leave. The research points at training, supervision and the job itself. Exit conversations and regular check-ins about supervision quality cost less than constant rehiring.

What to tell families

Families notice changes in who comes to the door, and a surprise can shake their trust faster than the change itself. Some things that help:

• Explain the team at intake. Tell families their child will have a main BI and one or two others who know the plan. Say why: so sessions go ahead when someone is sick, and so skills carry over to more than one person.
• Introduce backups early, ideally during a shadow session, well before the day they're needed.
• Tell families about planned changes before they happen. Who is leaving, who is taking over, when, and what the handover looks like.
• Be honest about why, within reason. "Ava is moving on, and Marcus, who has been seeing J.M. on Thursdays, will take over" is enough. Families don't need staff details, and your own privacy and HR policies still apply.
• Let them see the week. When families can see who is scheduled, a change is something they can check instead of something they hear about at the door.

The rules also require that a copy of the child's implementation plan be offered to the parent or legal guardian (Section 183.02). A change of BI is a natural time to remind families that the plan stays the same when the person running it changes.

Where Pairing fits

Pairing is a scheduling and team-messaging app for Idaho CHIS DDAs. When you cover a session, Pairing suggests BIs in a ranked list. The first time a BI is paired with a child, it asks whether they've completed PST for that child: trained, scheduled but not held yet, or not trained. The answer goes in a PST log. With the parent portal turned on, a parent sees their own child's sessions for the week and the name of the BI coming to each one, and can message the agency. The portal is included, optional, and costs nothing extra. Pairing works in any web browser, and the iPhone app is in testing. If keeping BIs with the same children is hard at your agency, get in touch.

How this page was made

We read IDAPA 16.03.26, IDAPA 16.03.21 and the Idaho Medicaid CHIS handbook chapter directly, along with the research sources listed below, in September 2026. Where the evidence is thin or doesn't come from CHIS settings, we've said so. Drafted with AI assistance and reviewed by the Pairing team.