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BCBA’s Performing Diagnostics

Scenario

“There has been an uptick in ABA agencies posting that they will diagnose children with Autism if the child does not already have a diagnosis. I’m concerned about the field confusing competence within a scope with receiving some continuing education in another area. There are only a few levels of physicians that can diagnose (normal pediatricians do not have this ability), so for a BCBA to go through a minimal training course and feel they are equipped to perform a diagnostic evaluation without a supervising (diagnosing) physician overseeing the entire process is unethical and does a great disservice to clients. I’ve seen reports from these agencies go out to non-contracted diagnosing physicians hoping for a stamp of approval, but without the diagnostician seeing the actual child, that would be unethical at best and a license revocation at worst. I think these agencies state their purpose as an aid to help alleviate the diagnosis delay, but by using BCBAs to do this, it’s doing nothing more than adding additional charges to clients on top of the diagnostician they will have to go to to get an actual diagnosis. Normal BCBA training does not cover child development, counseling families on receiving diagnoses or any training on diagnostic evaluations.”

Committee Input (e.g., considerations for pathways forward, potential barriers, potential solutions):

In accordance with Ethics Code 2.04, the committee recommends that the author reach out to the BCBA(s) sending out confidential test results to advocate for appropriate adherence to HIPAA and protection of clients.

In accordance with Ethics Codes 1.01, 1.05, 1.10, 2.06, 2.12, and 3.01, the committee recommends that the author reach out to the BCBA(s) testing for Autism to advocate for clients to receive only testing directly relevant to providing behavior analytic services that do not require medical and clinical training to perform.  The committee would encourage the author to explore the following steps as options; this should not be considered legal advice:

  1. Write a formal letter to the testing BCBA, educating them on and outlining our ethical codes of conduct surrounding client confidentiality, Behavior Analysts’ scope of competency, treatment biases, etc.  Consider providing suggestions to them on ways in which they can support clients getting appropriate diagnoses in the surrounding area to meet best practice standards.
    1. Documentation of concerns can provide a clear statement for follow-up.
  2. If meaningful change is not made to satisfy the ethical code of conduct, the BCBA could send their letter along to the Arizona Board of Psychologist Examiners for both Psychologists and BCBAs, the BACB and to state funders for auditing purposes.
    1. If the administration leaders are not behavior analysts, the correction process can still be sent to state licensing boards to ensure that only approved practitioners are providing diagnostic testing to clients.

Ethics Codes (specific standards that could apply to support/oppose):

  • 1.01 Being Truthful
  • 1.05 Practicing within Scope of Competence
  • 1.10 Awareness of Personal Biases and Challenges
  • 2.04 Disclosing Confidential Information
  • 2.06 Accuracy in Service Billing and Reporting
  • 2.12 Considering Medical Needs
  • 3.01 Responsibility to Clients
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