Scenario

“The company I work for assigns caseloads of 12-14 patients per BCBA. 14 would be for BCBAs that have a masters level student working under them in a mentorship program. My ethical dilemma is that I do not feel I am able to give my patients the full service that I have prescribed, and they require to make meaningful changes in their behavior reduction and skill acquisition. I am not able to see them for the full authorization of consultation hours nor am I able to keep up with updating their behavior plans as often as I see necessary. On top of that I am required to mentor a student- the company thinks having a student should help but this student is just starting to collect unrestricted hours and requires me to shadow her and provide feedback more frequently than a student who has collected most of their hours. I feel I am not meeting her needs as a up and coming BCBA and not doing a just service to my patients. Also, I have over 20 supervisees under my name under the board. I cannot effectively supervise that many RBTs during the month and maintain my patients programming.

Myself and colleagues have brought this to the attention of our supervisors both clinical and management and feel our concerns have been dismissed as other BCBAs in the organization are managing a caseload this large so we are expected to as well. I hate that my next solution is to leave and find a company that doesn’t push billable hours so hard and allows room to spend in unbillable supervision meetings and have a smaller caseload so I can provide meaningful supervision to my RBTs.”

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

In accordance with Ethics Codes 2.01, 2.09b, 5.02, and 5.04 the committee recommends that the author continue to advocate for a client and supervisory caseload that is commensurate for the time required to perform the duties of behavior analysts successfully and ethically. The committee would encourage the author to explore the following steps as option, noting this should not be considered legal employment advice.

1. Write a formal letter to your supervisor and to the executive administration, including HR, educating them on and outlining our ethical codes of conduct surrounding supervision, caseload size, etc. Provide suggestions to them on ways in which they can support BCBAs in your agency that are more conducive to best practices in supervision and quality care for clients. 
   1. Documentation of concerns can provide protection against wrongful termination and provides 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 to the ethics committee at the BACB for further feedback.
   1. If administration/leadership are not behavior analysts, the correction process can be more difficult because they are not held to our standard. For this reason, we recommend seeking out leadership with a BCBA credential to minimize this challenge in the previous step. 

If resolution cannot be achieved, the author may need to explore ethical and values-aligned employment opportunities.

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

• 1.02 Boundaries of Competence 
• 2.01 Accepting Clients 
• 2.15 Interrupting or Discontinuing Services (subpart d) 
• 2.15 Interrupting or Discontinuing Services (subpart e) 
• 3.01 Behavior-Analytic Assessment