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

Scenario

I am working with young child with ASD. The family has sought out numerous treatments for their son. They feel that the hyperbaric chamber, oxygen therapy, gluten free diet and supplements have been the most beneficial treatments for their son. The team feels that the evidence-based practice of ABA is making a great impact on the child with the therapist. He is able to perform a wide variety of skills in different areas of development for the provider. The family feels that we should not be allowed to share details of programming, outside treatments or concerns with the funding source without their specific permission. The funding source is requiring the Qualified Professional to provide information related to supplemental therapies/outside activities that relate to treatment etc.  Are there specifics or limitations to what a BCBA or Qualified Professional is allowed to share with the funding source?

Response

• FB response: Parents can withdraw consent at any time, but insurance companies can withdraw service for not providing all the information. 
• More information is needed. 
• The family may see that these other interventions are not evidenced based and are nervous that the funding source will not approve services moving forward. 
• Possibly the educating the family the consequences that can occur from doing this. 
• Dual Relationship by making a secret with the family.

A team is looking for insight on how to handle parents offering dinner and other token items during check out/transition out of service session (especially how a BCBA would coach a RBT to handle this in the moment)?

Response

• Explanation of appreciation but limitations that exist to accept 
• Make sure message is firm but respectful; establish mutual trust, prime the situation 
• Many of these families feel eternally indebted to us, we need to acknowledge their thankfulness and redirect this – illustrate your own values “the best gift for me is for you to be here and be present and participate on this journey with me” etc.

Scenario

How does a BCBA terminate services when parent behavior is impeding patient services?

Response

• Review expectations at onset of service 
• Revisit tx plan goals and alignment with family values 
• Reach out to supporting BCBAs for guidance 
• Set discharge criteria in initial tx plan 
• Refer to counseling for additional services if exp. avoidance is hypothesized

Scenario

A BCBA is subpoenaed, court ordered and approached by one guardian(parent) lawyer for issues involving family court. What are the next steps for the BCBA?

Response

• Outline at the onset of services (conditions of participation in such situations, must be judge-ordered etc. 
• Annually revisit conditions for participation in court 
• Address familial stressors at intake

Scenario

You are a new BCBA to an established case and go to meet your client and his family for the first time.  The client is a 12- year-old male evaluated using the VB-MAPP and has been a client of the company for 5 years.  You see the client run in and out of the meeting wearing only his underwear and holding up an iPad to his ear.   While meeting with the family, you learn that the previous BCBA has only been out to observe the client 1 time per quarter since starting and none of the programs have hit mastery.  The family is very happy with progress and hope that they can work on building a conversation with the client by the end of the year.  After the meeting, you look at the data with the current technicians and they say they have been working on tacting for 6 months and want him to tact 50 items before moving on to manding.  Other goals the technicians are working on are cutting, coloring and sorting shapes. As a new BCBA, how do you move to change the direction of treatment when the parent is happy with the way things are going and the amount of supervision the previous BCBA had accomplished. 

Response

• Determine if previous BCBA is still with company (it not, acquire ROI to connect) 
• Approach BCBA regarding clinical practice (investigate context) 
• Discuss dosage of supervision 
• Build rapport with family – change is difficult (explain the why, connect to values etc.) 
• Take this as an opportunity to re-assess, evaluate tx plan, set new criteria (supervision etc.) 
• Review funding source expectations 
• Loop in BCBA’s supervisor 
• Follow up and determine if elevated action should occur 
• Document actions