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

Scenario

Dilemma: Supervisee slaps a child in the school setting.

Response

• Mandatory reporters- DCS
• Reach out to the BACB 
• Reach out to the state psych board 
• Look at supervision contract and what the criteria to terminate it is 
• Learning point- make sure you are writing your contracts accordingly to cover certain situations that require immediate action 
• How would we know if someone has a previous incident against them? – probably not known until it’s been substantiated by the BACB 
• Need support of other BCBA’s

Scenario

You receive an ABA referral from a pediatrician for a 3-year-old client; you call the parent listed and gather insurance details and enough background information to see if the client’s behaviors are within the scope of the practice. The client is severely impacted and engaging in high rates of SIB; your colleague that specializes in SIB has an opening on his caseload. When the team proceeds to obtain prior authorization from the client’s primary insurance, pre-auth is denied as there is no IQ score listed on the developmental pediatrician’s evaluation. Additionally, there is not a standard assessment included on the developmental pediatrician’s evaluation; an additional reason for the denial. The ABA team for the insurance company acknowledges the autism diagnosis on the report but state they cannot process the pre-authorization with the missing components. You explain the situation to the parent; he attempts to schedule another appointment with the pediatrician, but the next available appointment is in 9 weeks. The parent is extremely worried that the child might cause serious selfharm in the interim and is desperate for help. Does our code guide us in how to approach this situation? What are the ethical considerations? 

Response

• 2.01 accepting clients- business decision pro-bono work
• Disseminating information to diagnosing physicians 
• Setting up contract to provide consultation in the interim

Scenario

You have been working with a family for 18 months. The father is consistent with parent training attendance, actively engages in sessions and follows through with protocol implementation. The client recently experienced an increase in aggression; the team has developed a modified protocol and you are prepared to share it at the next parent training session. At the parent training session, Dad mentions that he is trying CBD oil (with THC) with the child in hopes to reduce aggression – he read about this on an online forum. When you ask if this is under medical orders or supervision, he mentions that the child’s pediatrician was indifferent to the decision but did not medically endorse the use of CBD & THC for the young child. When you ask how the parent is obtaining the substance, he makes a general statement regarding one of the locations that you may purchase such items with his medical card. You are concerned but not sure how to navigate the situation. How might you handle this?

Response

• Behavior analyst required to follow the law 
• Mandated reporter 
• 1.01 Reliance on Scientific knowledge 
• 2.09 Treatment/Intervention Efficacy 
• 4.01 Conceptual Consistency 
• 6.01 Affirming Principles 
• Need a script for child under 18 
• Difference between CBD and THC; CBD not illegal 
• Asking for clarification on prescribing Physician for any and all medications 
• Direct to medical provider for spike in behavior if team is controlling other environmental variables

Scenario

You keep in touch with a good friend from High School and you know that their young child is showing signs and symptoms of Autism. They end up getting a diagnosis and reach out to you asking for some tips. You give them some tips on increasing communication, following through with demands, and capturing motivation. The information is well received, but they’re now asking you more questions, about behaviors, and school support, and whether you think their child will ever be able to have a conversation with them. You want to help, but also know they need more intensive support and are starting to feel uncomfortable. From an ethics perspective, what next steps are there?

Response

• 1.05(a) define the relationship/role 
• 1.06 multiple relationships 
• Create and distribute list of referrals of agencies 
• In a specific/unique situation, contact the BACB for guidance on how to proceed

Scenario

You are starting to build your online presence, and network with other professionals via Facebook and Instagram. You are judicious in checking your security settings, and only add people that you know are in the field. That being said, you do not have a personal connection with all of your online “friends.” One day, on Instagram, you see an online friend post a picture, with a “friend” (online only) holding a bottle of alcohol and stating that it was a gift from a client. Do you seek clarification because it appears to be a violation of multiple relationships? Should you ask if it is an ABA client, or otherwise? Should you just mind your own business?

Response

• Confirmation that it is a behavior analyst and seek for clarification on if the gift was from an ABA client 
• Send message for clarification sooner than later and take a screen shot of the initial post for evidence to support the claim 
• Message should state how the photo was interpreted and that it may be interpreted by other professionals in the same way 
• 7.02- reporting guidelines; 1.06 not receiving gifts; 10.02 timely responding 30 days of the date 
• Second component- is this a reportable offense, first approach the person, then employer/supervisor, then BACB (and AzBoPE is appropriate) if the matter meets reporting requirements