Scenario

On XXX, the XXX BCBA at XXX instructed the director, the managers, behavior specialists, and paraprofessionals to line up by age; the oldest on the left side of the room and the youngest on the right side of the room. We were then told to talk amongst ourselves to determine who was the oldest/youngest and to line up accordingly. The oldest employee would be positioned in the front of the line and the youngest employee would be at the end of the line. There were between 30-35 employees that were asked to do this. The end result of this Friday-morning exercise was not only humiliating to the oldest employee, but to the youngest one as well. What was the point of this? Our BCBA wanted us to see how diverse we are in age and how our age may be an indication of how we conduct our behavior support to the students.

Relevant background: The BCBA started in October and replaced previously terminated BCBA 

Possible solutions: I would like to approach this with HR, but the XXX HR has not been supportive in the past.

Credentialing: Reporter self- identified as RBT, Supervisor is an LBA 

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

In accordance with the Core Principles of the Ethics Codes under “2. Treat Others with Compassion, Dignity, and Respect”, BCBAs are required to treat others with equality regarding personal identifiers.

The committee recommends that the reportee review Ethics Codes 1.07 and 1.08, detailing the requirements for certified professionals as it relates to non-discrimination and maintaining an environment that supports diversity. In this situation, it seems that there is a concern with the icebreaker/group activity inappropriately highlighting aspects of the employees’ identities.

Behavior analysts have a responsibility to do their best to foster a culture of non-discrimination and adequately address concerns when there may be areas to improve upon in the workplace.

It is recommended that the reportee do the following:

• Bring their concerns about the activity directly to the facilitator of the event, and discuss what would be helpful in the future for avoiding these types of concerns. It may be helpful to understand that while an activity or situation may appear discriminatory or ill-intentioned by one person, this may not be the perception of all involved. Discussing this with the facilitator would likely be helpful in avoiding this in the future. 
• If the facilitator is a BCBA, they have an obligation (Codes 1.07 and 1.08) to attempt to foster a non-discriminatory environment and avoid future activities in which activities could be perceived in this light to the fullest extent possible. 
• If this level of clear communication with the facilitator does not result in a ceasing of this type of activity, it is less so an issue that pertains to the Ethics Code and more so an issue of personal preference/comfort level. Attempting to bring this up with HR may be helpful if a mediator between parties is necessary to maintain a supportive employee/employer relationship (if that is what the relationship is in this situation). 
• If this is a non-required activity that is not breaking ethical codes but is uncomfortable to this person, it may be best for the reportee to simply opt out of participation in the activity and alert the facilitator the purpose if necessary. 

Considerations for exploration:

This may or may not have been intended to highlight age as a defining factor in a staff member’s ability to conduct their job responsibilities. While it may have come off as a “distasteful” activity to some, it does not seem to overtly contradict an ethics code requirement. Further inquiry is recommended on the part of the reportee to address the concerns with the person in charge of developing/facilitating the activity.

Applicable Ethics Codes and ARS (identified by the committee):

• 1.07 Cultural Responsiveness and Diversity
• 1.08 Nondiscrimination

Scenario

Is person studying for and writing their BCBA exam multiple times still held to the ethical codes during this time?

Relevant background: This person frequently billed, solicited clients and therapists, and provided services while unsupervised.

Possible solutions: Submitted complaint to AZ psych board but they didn’t have jurisdiction.

Credentialing: Person is not a credentialed behavior analyst

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

The Ethics committee acknowledges that a supervisee in question is not a BCBA, and thus the State Licensing Board and Behavior Analyst Certification Board do not have jurisdiction. In the case that there is an Ethics violation, the board would hold the Licensed Behavior Analyst overseeing the supervisee as the person responsible to answer to the board(s).  As for all behavior analytic services provided in the state of Arizona, supervisees are required to practice under a licensed, Board Certified Behavior Analyst.  This BCBA has the responsibility to ensure the supervisee is providing ethical and competent services.

In accordance with BACB guidance regarding possible complaints, it is recommended that the author of this complaint reach out to the supervisee to discuss potential violations as well as reaching out to the BACB overseeing the supervisee.  If the overseeing BCBA is not readily known, it is advised that the author reach out to the highest BCBA in leadership to determine who should be involved in remedying the complaint areas.

• Regarding the billing aspect of this complaint, it is advised to reach out to the supervising BCBA to determine if a billing violation occurred. Depending on the funder and service contract, some codes are allowed to be billed without the presence of an overseeing LBA. 
• Regarding soliciting clients, more information would be needed to determine if this is a potential violation. Solicitation itself would not be a violation unless testimonials are being requested from clients or personal information is being disclosed (HIPAA violation). Solicitation of clients and therapists from other companies may be considered “bad practice” but are not considered ethical violations. 
• Regarding providing services while not under the supervision of an LBA, this may be allowable depending on the funder. The supervisee should be following guidance for ongoing supervision per Board standards and should not be prescribing treatment without direct/indirect supervision. 
• • This may be a complaint for the supervising BCBA under 4.01 Compliance with Supervision Requirements, 4.04 Accountability in Supervision and 4.06 Providing Supervision and Training and A.R.S. 32-2091 12(e), and 32-2091 12(y). 

Considerations for exploration:

The committee would encourage the author to explore the following steps as options; this should not be considered legal employment advice:

1. Formally address your concerns with the supervising BCBA and supervisee to ensure they are aware of the ethical requirements on supervision.  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 author should consider sending their letter to the Arizona Board of Psychologist Examiners and Behavior Analyst Certification Board regarding the supervising BCBA.
   1. Establish if fraudulent billing occurred based on funder requirements; self-disclose errors with funders if necessary.

Applicable Ethics Codes and ARS (identified by the committee)

• 2.06 Accuracy in Service Billing and Reporting 
• 4.01 Compliance with Supervision Requirements 
• 4.04 Accountability in Supervision 
• 4.06 Providing Supervision and Training 
• 5.07 Soliciting Testimonials from Current Clients for Advertising 
• A.R.S. 32-2091 12(e), and 32-2091 12(y)

Scenario

“Last October, I had two individuals resign with less than 24 hours’ notice, who were collecting BACB supervision hours towards their BCBA application with me as their primary supervisor. After resigning, they left their monthly verification forms with me to sign. Since their last day, I have not signed their hours and have been thinking over if they would competently and ethically work in the field. I cannot in good conscious sign off on their hours with the thought they might leave other clients overnight without a transition plan. Previously, the supervisees were in breach of the supervision contract because they were not sending in their verification hours on time.  Prior to leaving, their supervision hours log had multiple errors, as they failed to maintain feedback for their logs; but 3 weeks after resigning they sent me their most updated logs which matched with the hours on their monthly forms dropped off day after resignation.” 

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

The codes in question listed by the submitter were: 3.01 Responsibility to Clients and 3.16 Appropriately Transitioning Services.  These code violations appear to be concerns only after the supervision was terminated, so may not apply to the question of signing off on monthly verification forms.

Per BACB Fieldwork Requirements, all monthly fieldwork verification forms are required to be signed by the end of the following calendar month (linked below).  Any hours accrued by the supervisees in question that have not been signed off will be considered forfeited.

• If there are breaches in contract, or inappropriate behavior exhibited during the supervisory period, the BACB requires the supervisor to provide feedback as well as documentation of training and/or re-training during the supervision period. 
• There does not seem to be an instance in which the BACB approves withholding signatures from monthly verification forms for breaches in administrative duties (turning paperwork in late). 
• If some forms were signed (even when turned in late) prior to resignation, this failure to sign verification forms gathered after resignation may be seen as retaliatory in nature. 
• If the supervisee(s) engaged in dangerous behavior during the supervision period that required mandated reporting (abuse, neglect, etc), a police report and/or report to the BACB for misconduct is required and refusal to sign monthly verification forms may be considered appropriate. 

As far as lack of timeliness transitioning case(s), the BACB does not consider RBTs or supervisees to be independent practitioners that are responsible for their own caseloads. Therefore, although this may be an employment contract violation, it is not considered to be an ethics violation of client abandonment.  Without knowledge of what the exact role of the supervisees were in, they may or may not be in a position to be in violation of the ethics code. 

If there is concern, the committee encourages the submitter to look through the BACB’s guidance on considerations for filing a complaint (linked below). If there is a concern about the overall performance of the supervisee(s) after documented training and feedback occurred OR if violations are found after the supervisee(s) left the facility, the BCBA can also follow guidance to contest the Final Verification Form outlined in the August 2019 newsletter (linked below).

Considerations for exploration:

• If the BCBA did not respond to requests to sign off on verification forms in a timely manner, they may be in violation of Ethics Code 1.15 Responding to Requests, 4.01 Compliance with Supervision Requirements, 4.04 Accountability in Supervision, and 05 Maintaining Supervision Documentation.
• The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board against themselves under the guidance of 1.16 Self-Reporting Critical Information. 
• If the supervisees did commit a violation of the Ethics code, it is suggested that the BCBA first reaches out to the party responsible before filing a complaint with the Behavior Analyst Certification Board. 
  

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

• 1.15 
• 1.16 
• 3.15 
• 3.16 
• 4.01 
• 4.04 
• 4.05 
• 4.08 
• A.R.S. 32-2091 12(e)/12(q)/12(v) 

Additional Resources:

• https://www.bacb.com/wp-content/uploads/2022/01/BCBAHandbook_230118-a.pdf 
• https://www.bacb.com/ethics-information/reporting-to-ethics-department/reporting-alleged-violations-by-rbts/ 
• https://www.bacb.com/wp-content/uploads/2020/08/Considerations-for-Reporting-a-Notice-of-AllegedViolation_BCaBA_BCBA_200811.pdf 
• https://www.bacb.com/wp-content/uploads/2020/12/BACB_August2019_Newsletter-200826.pdf

Scenario

“Clinical director wants BCBA to take on cases that are fully Spanish speaking with the help of an interpreter. The child speaks no English and programming would need to be done in Spanish – this is out of the scope of the BCBA who speaks English only.”

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

Although the Arizona community includes many families that are non-English speaking, there is not an equal amount of access to services that are offered and implemented in the family’s native language.  If there is not a provider in your organization who speaks the client’s native language (Spanish), it is recommended that the BCBA accept the client with the following accommodations/consideration for exploration:

• Specific funders require that access to interpreters is provided to non-native English-speaking families and some funders do not specifically require this. 
• Depending on the funding source, there may be a limited number of providers who have ABA services available, and even fewer that have immediate openings and also providers who speak the client’s native language. 
• The Ethics Committee recommends, in alignment with BACB standards, that if there are no available providers at the agency who accept a family’s funding and speak the client’s native language, that an interpreter be requested to attend all client sessions. Not only is it important that the family understands what the BCBA is saying, but they should also be able to communicate with the client’s technician. Additionally, providing documentation in the native language (i.e., Spanish) is a best practice standard to ensure that families understand the services and treatment being offered. 
• Along with the necessity of communicating through the language barrier, it is also important to recognize differences in cultural practices. A funder-assigned or agency-contracted interpreter may help with this, or the family may have a community member who is willing to attend sessions to translate and assist in navigating circumstances that are too nuanced to translate vocally alone. 

Additional Considerations:

• If the agency accepts this client, there should be no cost associated with the interpretation service. 
• If an interpreter is utilized, they should be certified to provide medical translation services to outline ABA treatment procedures and medical necessity criteria. 
• If an interpreter is utilized, they should sign nondisclosure agreements to ensure the privacy of client information. 

In summary, failure to (1) provide culturally competent care or (2) to demonstrate clear communication for the consent/assent of treatment due to a language barrier, are potentially reportable offences to the BACB. More information would be needed in the above submission to provide more explicit pathways for exploration.  We would encourage the person who submitted this concern to flush out the context and provide additional details if additional guidance is needed. 

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

• 2.01 Providing Effective Treatment 
• 2.04 Disclosing Confidential Information 
• 2.08 Communicating About Services 
• 2.19 Addressing Conditions Interfering with Service Delivery 
• 3.03 Accepting Clients 
• 3.06 Consulting with Other Providers
• 3.09 Communicating with Stakeholders About Third-Party Contracted Services 
• 3.12 Advocating for Appropriate Services 
• 4.01 Compliance with Supervision Requirements 
• 4.02 Supervisory Competence 
• 4.04 Accountability in Supervision 
• 4.06 Providing Supervision and Training 
• 4.09 Delegation of Tasks 
• 4.10 Evaluating Effects of Supervision and Training 
• A.R.S. 23-2091 12(c)/12(g)
  

Scenario

“The client’s programs have not been updated, the [BCBA] also has too many clients under [her] and she has not supervised her clients.”

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

In accordance with Ethics Codes 2.01, 3.01, 3.03, 4.01, and 4.06, as well as Arizona Revised Statutes 32-2091 12, the committee recommends that the author continue to advocate for a client 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.

• 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. 
• • It should be noted that the writer noted that administration had been notified, but the BCBA is an executive of the company. Additional written feedback is suggested as documentation of concerns can provide protection against wrongful termination and provides a clear statement for follow-up. 
• 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.
• • The BACB advises first discussing a potential complaint with the potential offender and providing this letter in writing to the clinician and administration would serve as appropriate documentation for the complaint as well as documentation that may protect from retaliation. 
• In the event that a BCBA has neglected to supervise a case over the course of many months, we advise the submitter to report this to the Arizona Board of Psychologist Examiner’s and/or Behavior Analyst Certification Board immediately.  As requested, the process for the submitter is to gather as much information as possible to go with the formal complaint.  Once a complaint has been filed, the board will complete a full investigation of the licensed BCBA and their work as indicated in said complaint.  Depending on the findings of the committee, consequent actions could vary between mandated education, censure, or in rarer cases revocation of license. 

Considerations for exploration:

• The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board, against the party in the organization who is inappropriately supervising a client, if mediation using other, more informal methods does not yield an improved result. 
• • Information on the complaint process can be found here: https://psychboard.az.gov/investigations
• If resolution cannot be achieved, the author may need to explore ethical and values-aligned employment opportunities. 
• While the BCBA has a responsibility to provide adequate supervision for a client, they are also responsible for providing adequate supervision for the RBTs they oversee. If this BCBA is overseeing RBTs, it is advised that the RBT ensure appropriate documentation of supervision is available to them.

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

• 2.01 Providing Effective Treatment 
• 2.18 Continual Evaluation of the Behavior-Change Intervention 
• 3.01 Responsibility to Clients 
• 3.03 Accepting Clients 
• 4.01 Compliance with Supervision Requirements 
• 4.04 Accountability in Supervision 
• 4.06 Providing Supervision and Training 
• 4.10 Evaluating Effects of Supervision and Training A.R.S. 32-2091 12(a)/12(e)/12(o)/12(v)

Scenario

“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

Scenario

“If a BCBA didn’t supervise me with a certain client for 8 months and goals didn’t change due to this, what would happen to this BCBA?  Goals for this client had met mastery for over 4 months of services without setting the next phase change.”

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

In the event that a BCBA has neglected to supervise a case over the course of many months, we advise the submitter to report this to the Arizona Board of Psychologist Examiner’s and/or Behavior Analyst Certification Board immediately.  As requested, the process for the submitter is to gather as much information as possible to go with the formal complaint.  Once a complaint has been filed, the board will complete a full  investigation of the licensed BCBA and their work as indicated in said complaint.  Depending on the findings of the committee, consequent actions could vary between mandated education, censure, or in rarer cases revocation of license.

We also recommend, if possible, to immediately reach out for another BCBA within the organization to provide emergent supervision for a client who has not received supervision, but this does not remove burden from the original supervising BCBA.  The committee advises that this information be brought to the leadership of the agency for support with facilitation for the current client.  While the BACB does not provide a direct percentage of supervision that must be done with each client, it is suggested that clients receive between 10-20% supervision on a monthly basis depending on the level of need.  Supervision may include updating goals and assessments, analyzing data, collaborating and training stakeholders, and should also include face to face (or telehealth) supervision of the client with their technicians.  While circumstances may warrant structural changes to supervision, technicians and stakeholders should be notified of any changes and if a case is being transferred, that contact information should be provided to all parties.

Additional considerations:

• While the original BCBA should be contacted to address any concerns of negligence, the previous months of non-treatment constitute a complaint to the Arizona Board of Psychologist Examiners. The BCBA should make every attempt to change their supervision practices moving forward, but the past 8 months need to be accounted for. 
• If the BCBA is currently billing for supervision and not supervising, that would be a violation of state and funder contracts and constitute billing fraud. This is covered under A.R.S. 32-2091 12 (a), obtaining a fee by fraud or misrepresentation and Ethics Code 2.06 Accuracy in Service Billing and Reporting. 
• If the client is engaging in dangerous behavior and/or staff has not had in-person training with a supervisor, in addition to an Ethics Code violation, this could be considered gross negligence in the practice of a behavior analyst [A.R.S. 32-2091 12(e)] 
• The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board, against the party in the organization who is inappropriately supervising a client, if mediation using other, more informal methods does not yield an improved result. 
• Information on the complaint process can be found here: https://psychboard.az.gov/investigations

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

• 1.04, 2.01, 2.13, 2.14, 2.15, 2.17, 2.18, 3.01, 3.03, 4.01, 4.04, 4.06
• A.R.S. 23-2091 12(a)/12(e)/12(o)/12(v)

Scenario

“When maintaining your RBT certificate, is it against ethic code for an RBT to become a “LEAD” RBT within a company that they work for? Job duties would include: The role of the Lead RBT is to assist in the planning, development, implementation, and monitoring of behavioral supports to meet the needs of students diagnosed with Autism Spectrum Disorders (ASD) and/or other behavior, social, and/or communication challenges. Provide Support to fellow RBT’s while still under the direct supervision of a BCBA. To assist in New RBT’s with the 40/hour course, as well as working with a BCBA to complete direct treatment plans? Any insight on this topic would be truly helpful.”

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

More information would be needed in the above submission to provide more explicit pathways for exploration.  We would encourage the person who submitted this concern to flush out the context and provide additional details if additional guidance is needed.

Many agencies may determine that a “Lead RBT” is an appropriate use of an RBT who shows high quality performance and leadership skills.  This role may be used to mentor new staff, assist with assessments and guide fellow technicians on selecting appropriate stimuli for targets.  It should be noted that no client guidance should be done without the explicit training and supervision of the BCBA assigned to the case.

To address the RBT’s concerns, some areas to orient toward in the RBT 2.0 Ethics Code are:

• 1.03 RBTs only provide services under their RBT certification within a clearly defined role under close, ongoing supervision. 
• 1.05 RBTs do not knowingly make false, misleading, or exaggerated statements about their qualifications or behavior technician services. They provide a current and accurate set of relevant credentials to employers and supervisors upon request. 
• 1.06 RBTs provide behavior-technician services only after their supervisor confirms that they have demonstrated competence. They work with their supervisor to continually evaluate their competence. If an RBT identifies that they are being asked to do something that goes beyond the scope of their certification and/or competence, they immediately inform their supervisor or other appropriate individuals at their place of employment and document this communication. 
• 2.02 RBTs follow the direction of their supervisors, accurately implement behavior-technician services, and accurately complete all required documentation (e.g., client data, billing records). 
• 2.04 RBTs do not use unfamiliar interventions or provide services to unfamiliar client populations unless they have received proper training

To consider the BCBA’s role, they should consider the following Ethics Code areas for Behavior Analyst’s when determining how to utilize staff for support:

• 2.01 Providing Effective Treatment 
• 2.13 Selecting, Designing, and Implementing Assessments 
• 2.14 Selecting, Designing, and Implementing Behavior-Change Interventions 
• 2.15 Minimizing Risk of Behavior-Change Interventions 
• 2.16 Describing Behavior-Change Interventions Before Implementation 
• 3.01 Responsibility to Clients 
• 3.11 Documenting Professional Activity 
• 4.04 Accountability in Supervision

Considerations for exploration:

• If an RBT has been asked to be a Lead Technician without explicit training in each area that involves a client, the RBT should reach out to the BCBA to discuss their role. All treatment plans fall under the BCBA’s license and require informed consent from caregivers. 
• If an RBT is asked to progress the goals from the treatment plan, the BCBA should be reviewing and approving changes or updates and providing a training on the next steps of implementation to the Lead and then checking during in-person supervision to ensure everyone on the team is correctly implementing. If the RBT is asked to add new goals or do trainings without explicit oversight, they should refrain to ensure they are not violating the RBT Ethics Code 2.0. 
• Arizona Revised Statutes dictates who can call themselves a Behavior Analyst and what is required of service provision. 

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

• RBT 2.0: 1.03, 1.05, 1.06, 2.02, 2.04 
• BCBA 2020: 2.01, 2.13, 2.14, 2.15, 2.16, 3.01, 3.11, 4.04 
• ARS 32-2091.3, 32-2091.4, 32-2091.5, 32-2091.12(p), 32-2091.12(q)

Scenario

“What are the current AZ State Statutes regarding providing behavior analytic services through Telehealth? As long as the practicing Behavior Analyst holds an Arizona license, is it legal to provide all supervision through telehealth?”

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

More information would be needed in the above submission to provide more explicit pathways for exploration.  That said, various support options are outlined below.  We would encourage the person who submitted this concern to flush out the context and provide additional details if additional guidance is needed.

If the submitter is asking if telehealth is an appropriate method for client supervision, the LBA providing the service must consider the magnitude of any problem behavior, the level of hands-on training provided to the behavior technician, and the initial service requested of the funder.

• If the funder did not specify telehealth as an option for reimbursement, consider A.R.S. 32-2091 12 (a), obtaining a fee by fraud or misrepresentation. The LBA would need to contact the funder to request a change in place of service and may not be in compliance with the Ethics Code 2.06 Accuracy in Service Billing and Reporting, and 3.12 Advocating for Appropriate Services. 
• If the client is engaging in dangerous behavior and/or staff has not had in-person training with a supervisor, this could be a violation of A.R.S. 32-2091 12(e), gross negligence in the practice of a behavior analyst. 
• In addition, they may also consider Ethics Code 2.01 Providing Effective Treatment, 2.19 Addressing Conditions Interfering with Service Delivery, 3.01 Responsibility to Clients, 3.03 Accepting Clients and 3.12 Advocating for Appropriate Services, 4.04 Accountability in Supervision, and 4.06 Providing Supervision and Training. 

In the event that the submitter is asking about funder requirements:

• The LBA will need to refer to their specific contracts about the ability to perform telehealth as a billable service. Billing for a service that is not allowable in the service contract could be a violation of A.R.S. 32-2091 12 (a), obtaining a fee by fraud or misrepresentation and the LBA may be required to reimburse the funder for payment. 

Considerations for exploration:

• If telehealth is the appropriate service modality for a client’s level of need, and the funder allows for billing telehealth, no changes are necessary. 
• If telehealth is the most convenient service modality but does not meet the needs of the client or technician, consider referring to a provider who has the availability to meet the client’s needs within funder requirements. 
• If this is a concern about a BCBA not meeting the needs of the client, first seek out additional information from that BCBA about clinical recommendations for the client. If a needs assessment was not provided for the client and the needs of the client are not being met, it would be appropriate to discuss concerns with the supervising BCBA. 
• The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board, against the party in the organization who is inappropriately supervising a client, if mediation using other, more informal methods does not yield an improved result. 
• Always review your contract for billing allowances and be aware that individual plans may differ within the specific funder.

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

• 2.06, 3.12 
• 2.01, 2.19, 3.03, 3.12, 4.04, 4.06 
• A.R.S. 23-2091 12(a)/12(e)

Scenario

“I am having a disagreement with management at my company and would like some guidance. I believe that stakeholders are entitled to their child’s treatment plan in order to know the goals that are working on and current progress. When I meet with them we discuss the goals and progress together, they sign a copy and keep a copy. My company is telling me that they need a release of information to gain access to their child’s treatment plan and even then I can only give them a summary.”

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

The committee recommends that the reportee review, in accordance with Ethics Code 2.04, Disclosing Confidential Information. The Ethics Code statute states, Behavior Analysts may share confidential information when informed consent is obtained – confidential information may be released about the client and stakeholders, among others.  In this example, the ‘client’ represents The direct recipient of the behavior analyst’s services, while ‘stakeholder’ would represent the legal guardian of the client.

If the stakeholder in question is the client’s legal guardian, they are entitled to a thorough description of the entire scope of treatment including but not limited to client assessment procedures, therapeutic interventions, ongoing data collected, results from progress monitoring and ongoing, detailed documentation of services provided (Codes 2.08, 2.09, 2.14, 3.11).  Failure to provide information in an accessible manner could be considered a breach of these ethical codes on the part of the practitioner as well as a direct violation of Arizona Revised Statute 32-2091 under 12s of unprofessional conduct wherein client records are required to be made available promptly when requested.

Considerations for exploration, 

• the stakeholder is not the client’s legal guardian –  it may be required to obtain additional consents for sharing the information. 
• The same is true if the client is their own legal guardian and has not consented to the sharing of their private medical information. 

Further, the committee acknowledges that any breach in the BACB Ethics Code is also reportable to the Arizona State Licensure Board.  The Committee would encourage the reportee to explore filing a complaint with the licensure board, against the party in the organization who is implementing the policy, if mediation using other more informal methods does not yield an improved result.

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

• 2.04, 2.08, 2.09, 2.14, 3.11 
• A.R.S. 32-2091 (12) S