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Clinic Owner Requesting Services

07 Aug 2023 6:06 PM | Anonymous


“I work for an ABA agency in town, and have been told that I will be switching to a new case in the next few weeks. However, when I found out that the child I was going to be working with was the child of the owner of the company I got very nervous. I tried to remember more about what was discussed in my ethics course, but I am not too sure. I am not sure what I should do. I feel like there is a conflict of interest and I am worried about what would happen to me if I don’t do a good job or if I make a mistake. I have worked for another company in the past, who allowed staff to have their children treated at the company (and that seemed a little unethical too), but never the owner. What should I do?”

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

The ethics committee recognizes the uncomfortable nature of a request to provide services to a family member of a supervisor and will outline specific areas of approach.

  • The Ethics committee acknowledges that the owner of said company may not be a Behavior Analyst, in which, the State Licensing Board and Behavior Analyst Certification Board do not have jurisdiction over. In the case that there is an Ethics violation, the board would hold the Licensed Behavior Analyst overseeing the case as the person responsible to answer to the board(s). 
  • It is unknown how rural of an area the complainant is in, but with the advent of telehealth being reimbursed, it would be difficult to justify that the owner of the company has no other options than utilizing their own staff. Outside of potential HR breaches, there are a few ethical considerations that may at best make technicians and BCBAs uncomfortable providing services to a supervisor’s child.  The people involved do have a duty as credentialed clinicians to offer alternatives and provide a risk/benefit analysis for provided services to this child.  The potential ethical considerations are outlined below. 
  • If this complainant is an RBT, an area to be mindful in the RBT Ethics 2.0 code is area 1.10: “RBTs avoid multiple relationships with clients, coworkers, and supervisors. Multiple relationships occur when there is a mixing of two or more relationships (e.g., friend, family member, employee/employer) that may result in conflicts of interest and risk of harm to the client. If RBTs find that a multiple relationship has developed, they immediately inform their supervisor, work to resolve it, and document these actions. If the multiple relationship involves their supervisor, RBTs should report it to their supervisor’s manager or other appropriate entity (e.g., human resources, BACB) and document this communication.” 

Regardless of the owner’s certification or lack thereof, there is a power dynamic at play between the owner and the RBT providing services to their child.  It would be difficult to move forward with terminations, promotions or any other career delineation once this RBT has spent time with the owner’s child without any HR repercussions, at the very least.  This may be viewed as discrimination, favoritism, or exploitation.  This could also be said if the complainant is a BCBA.

If the owner is a BCBA, this may be a violation of Ethics Codes 1.11 Multiple Relationships and 1.13 Coercive and Exploitative Relationships.

If the complainant is an RBT and the case supervisor is a BCBA, that BCBA may still be accountable for these Code areas toward both the RBT and the BCBA.

If the complainant is a BCBA, it would behoove them to speak to the owner about alternative options for service to avoid any potential ethics violations. The BCBA may want to speak to an HR representative or employment attorney in the event that the owner retaliates the case refusal.  The BCBA also needs to be aware of providing a safe environment for the staff they supervise and eliminate concerns from RBTs about providing services if this is the only option.  BCBAs should be aware of Ethical Code area 4.04 Accountability in Supervision.

Considerations for exploration:

  • If telehealth is the appropriate service modality for a client’s level of need, and the funder allows for billing telehealth, consider requesting case consultation from an out of area provider. 
  • At minimum, a discussion of options needs to be had between the owner, BCBA, HR and potential technicians and informed consent should be drawn from parties employed. 
  • The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. 

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

  • RBT: 1.10 
  • BCBA: 1.10, 1.12, 1.13, 1.14

Arizona Association for Behavior Analysis
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