Scenario

Client that is being billed through insurance by the Agency that I work for is being accepted into college courses. He would like a letter of recommendation from his supervisor for some scholarship opportunities. Is it ethically appropriate to provide a letter for his college? What would be precautious steps to take in the event that we can provide a letter? Would this be better to provide during billable or non-billable therapy/supervision? What are some possible HIPPA considerations? Ethical issue: Dual relationship, Monetary concerns (if client receives scholarship for college), Billable/non-billable/spare time concerns.

Response

• Committee Input: 
• • Potential dual relationship issue 
  • Can the client give their own consent to be able to release of PHI? 
• Exploration: 
• • Avoid the multiple relationship. “Our ethical code states that” 
  • Coaching the client through asking other teachers/professional people 
• Codes: 
• • 1.06B; 1.07A

Scenario

A school district posted a job opening for a BCBA, and said they would take someone non-certified, as long as the person pays for their own supervision. Would another district BCBA still be responsible for providing supervision, especially during the time between supervision ending (1500 hours completed) and time of certification? 

Response

• Committee Input: 
• • What would the BCBA doing within their job? 
  • What is the job description? If candidate is a supervisee, supervision is required 
• Exploration: 
• • Ensure that you are not mis-representing the credential. 
  • Be careful of dual relationship with the supervisor. 
  • Behavior Analysts in the school typically have large caseloads, would they have the support to take on additional supervisees? 
  • Make sure your contract is clearly written about support of supervision/payment 
  • Plan how you are going ensure support 
• Codes: 
• • 10.7; 6.0; 5.05; 8.03

Scenario

I am a founder and executive director for a school for children with ASD. We have a female HS student who has an iPhone with access to her own social media accounts. She is very socially motivated. She comes from a single parent, low SES home. Her mother can be challenging to work with. We have found recently on her phone inappropriate content. Solicitations for attention from men that we don’t think she knows…your basic nightmare. Obviously the first step would be making her mother aware of this, but I highly suspect that won’t go anywhere.  I will still do that as a first measure.  Is this a CPS call? What social services might be available to ensure this student is safe? She is obviously an extremely vulnerable young adult.

Response

• Committee Input: First step includes meeting with parent, disclosing content that was found on phone and the nature of how the content was discovered. Invest in sex ed curriculum (evidence based)/programming available to remediate maladaptive behavior and increase skills. Provide recommendations to parent for monitoring/parental controls (ie. Disney Circle). Establish open communication between parent/school site to support ongoing check-ins on status. 
• Exploration: Policies and procedures related to reasonable permission to review social media account of students. Parental consent to access student phones/accounts. Consider including policies and procedures around access to technology/consent at onset of services? Consider level of permission. Collaborate/reach out to attorney to determine what is within limits of law etc. Reach out to third parties for staff/parent inservices/training(s) related to online safety and sex ed – PR, Specialists (therapists, online safety specialists) and PD. 
• Codes: 2.05, 4.02

Scenario

Using testimonials on website, no disclaimers

Response

• Committee Input: Reach out to organization’s leaders (BCBAs) as soon as possible to resolve (lead with education). Provide guidance on code and potential action items. Follow up on website/with BCBA after initial conversation. Document actions taken (include dates) 
• Exploration: If parents wrote the testimonial, consent is implied to use names; Are owners BCBAs (yes). Who is managing the solicitation/posting of testimonials (owners should provide education regarding the PECC)? 
• Codes: 8.05; 2.06;

Scenario

I got in a car accident today in front of a client’s house. The client’s mom came outside after she heard the accident and saw the position of the cars. I had to move my car because I was blocking the street. Would it be appropriate if I ask her if she could be a witness? Or would that be an ethical violation? I have to go to court in February. When the police officer asked if I knew the client’s mom I told him I couldn’t answer that because of HIPAA.

Response

• Committee Input: Protection of the consumer (PHI) as intention; as a “witness” there is no obligation to disclose nature of professional relationship.
• Exploration: What aspects of HIPAA are related to incident (where is the breach)? What is the nature of the professional relationship/context/environmental factors? Impact on harmful effects of multiple relationships – is this applicable in the specific situation? How does that relationship impact whether or not to request support? Check organization’s internal policies and procedures; reach out to internal HR or HIPAA Officer for guidance (incident report??). 
• Codes: 1.06

Scenario

Our school has been bit by RPM…HELP.  One parent went to a conference on RPM and has come back convinced that she has been undervaluing her son’s intelligence. She’s making somewhat extraordinary claims about what he is communicating with his RPM instructor, and sort of implying that we should be instructing him differently at school.  We’ve been clear that we cannot change his goals unless we see him displaying those skills at school.  In one week, we now have another family saying that they heard about it and are starting RPM as well and are “expecting a miracle.” I’m thinking about the Bridget Taylor Compassion article, and I want to ensure I don’t get on my BCBA high horse and refuse to listen. At the same time, these families want us to watch several hours of video of the student in RPM sessions and attend a conference too. Obviously, we aren’t willing to invest our time into learning about something we are opposed to.  I am trying to find the words to lovingly and respectfully help these parents to understand that there is no evidence to support this treatment and it may even be harmful.  I imagine thinking you are “hearing” your child’s voice for the first time is incredibly reinforcing, and they aren’t likely to walk away from that.  Any tips on how we can help this family, and what to say to the other families that may reach out to us about it? It seems to be spreading :/

Response

• Codes to Consider: 1.01; 1.02; 2.09 
• Committee Input: 
• • Approaching the topic in an un-biased way by finding the literature of the topic to share with families. 
  • • Ask questions: Address how to fade the prompts in a systematic way. Is there specific procedure or protocol available? How will this be functional? 
    • Discuss generalization and functionality of this mode of communication. 
  • ASHA sent out statement not supporting RPM (discuss with speech therapist, family, team members etc.). 
• Exploration: 
• • First watch the videos that the parents are wanting to show, then have the conversation of effective treatment and evidence-based treatment. 
  • Consider conversation about prompt fading 
  • Pull in the other professionals (speech, OT etc.) to be a united front/share information from varying perspectives 
  • Addressing the community as a whole about communication, provide educational opportunities for families?. 
  • Data collection on the student using it with different people or in different environment. There may be other data already collected on problem behaviors to show that this intervention is not benefitting the student. 
  • Using the individual that has the most rapport with the family to be able to have this conversation.

Scenario

There are currently 3 BCBAs on the staff at my current site. 2 of the BCBAs are licensed and one of us is working on getting licensed, we are all certified. The 2 BCBAs that are licensed are relatively new to this site and have not mastered the work that we do. We have a few supervisees that require supervision. Per the BACB, a supervisee is expected to have 2 client observations supervised as well as individual supervision meetings. Is it ethical to have the unlicensed but certified BCBA who is an expert in session run client observation audits while the other 2 BCBAs provide independent and group supervision on the task list that they are experts in? Currently we are having only the licensed BCBAs provide supervision. However, this is leading to staff burn out and may not be appropriate according to 5.01 and 5.04 ethical compliance codes.

Response

• Codes to Consider: 5.01, 5.02, 5.03, 5.04, 5.05 
• Steps to Explore: The credentialing LBA vs BCBA doesn’t appear to be an ethics concern as long as the nature of the supervision and consequences of such are disclosed to the supervisee; it would fall under a barrier to licensure. The hours by the unlicensed person would not count pursuant of licensure in AZ. Those hours would have to be accrued under an LBA when acquiring licensure. However, delegation of tasks in relation to supervisor scope of practice and scope of competency should be taken into consideration. Unlicensed BCBA can still support supervisees in areas of expertise (outside of formal supervision). Assess appropriate supervisee volume/capacity- provision of effective supervision.

Scenario

A BCBA needs to approach a colleague about questionable clinical practices and/or professional ethical practices (e.g., outdated intervention procedures or not following the PECC to resolve conflicts). Instead of interacting with the BCBA, the colleague in question uses an attorney to send out a cease and desist for alleged slander before direct attempts to connect with colleague to clear up confusion. How should this be handled?

Response

• Codes to Consider: 7.02, 1.01, 1.02, 1.03
• Steps to Explore: Consult with an attorney due to cease and desist letter. That may not be a safe place to stop if there is clinical concern. Staff with leadership team. Reach out to the BACB or AzBoPE

Scenario

I am on a new team with a very involved young child with ASD and several other diagnoses. When meeting with the team, it was determined that PECS would be a great starting point for the child for functional communication. The speech therapist stated that she will just recommend a communication device because she hates doing PECS, implementing it and keeping up on the pictures. The family expressed concern about the child using a device as he doesn’t point and will just slap or pat on electronic devices. Upon further discussion, the speech therapist said if we do PECS then she will not participate or work on it with him and would prefer to be taken off the team. As the BCBA how do you ensure that the team is providing socially significant programming when it is now potentially causing a team member to leave? 

Response

• The entire team should hopefully presenting information on PECS with grace to the SLP. 
• Prerequisite skills are not in place to use a device 
• Clinical relationship with the entire team including the family may be in jeopardy 
• 3.01- Relying on assessment; this could support PECS vs Device

Scenario

I am looking for resources for IRB approval for independent researchers. I’m partnered with a university and have approval for a project but I have other projects unrelated to that project that I would like to get approval for. Any suggestions?

• The university s/he is partnering with may have its own IRB (I know ASU does), otherwise whoever their university contact is should have resources? I’m in the early stages of this process as well but I’m just going through ASU’s 
• You can pay for an independent IRB contractor (online) to approve your work as well