The paper briefly discusses 12 critical issues that significantly affect program success in reducing severe self-injurious behavior (SIB) in group homes. The paper emphasizes the necessity of: (1) a process approach to the development and monitoring of treatment; (2) demythologizing the self-injurious client; (3) discussing and clarifying legal liability issues early and often in treatment; (4) attending to staff stress tolerance levels; (5) attending to other clients' stress tolerance levels; (6) facilitating and developing staff support systems and lines of communication; (7) recognizing and addressing the staff's emotional response to the treatment; (8) minimizing or eliminating pressure from non-team members who question the program; (9) maximizing staff self-direction and decision-making ability in a crisis situation; (10) developing the staff's understanding of the probable course of treatment; (11) anticipating the effects on other clients' programs; and (12) accepting that there may be differential program effects. The paper concludes that the success of a program to reduce self-injurious behavior has less to do with behavior technology available than with the confluence of staff, client, and communication/support issues. (LH)