Scenario

I am a BCBA working in a school setting. My boss has created a hostile work environment (i.e. threatening job security, public humiliation, gaslighting, intentional sabotaging and retaliation). Due to stress, I have found that my quality of work is decreasing and impacting my ability to provide effective services to my students (ethical code 2.09). However, if I leave my job, my students will lose their BCBA (the school will not hire another) and they will not receive the behavioral services they need. I want to act in the best interest of my students (ethical code 2.15) and not leave them without a BCBA. However, working in a hostile work environment has impacted my ability to be an effective BCBA. I filed a complaint with HR regarding my boss’s behavior. An attorney was brought in and began an investigation. The results of the investigation stated that my boss had not done anything illegal and there would be no action taken against him.

Response

• Our responsibility is to transition clients following ethical guidelines, but it is not up to the employee to stay in order for the school to staff/fill the position 
• Send letter of recommendation to school administration for student’s receiving services to providing supporting documentation showing the need for continued service/dosage 
• Due diligence to have conversations with boss etc. first then moving to HR to attempt to resolve conflict 
• Meet with families during IEP possibly bring up outside services the family could pursue and provide a referral list or resources for additional support if they choose

Scenario

is a mid-level therapist, currently in supervision with an agency in which utilizes ABA for children with Autism. Frank has been working with a family for the last 12 months, with two children recommended 40 hours a week of early intervention. There has been little to no data, hampering adherence to service requirements. The parents have a difficult time with transitions, developing relationships and managing the schedule of two child on the spectrum with higher level(s) of medical attention. Frank has had numerous conversations with the parent and the supervising BCBA regarding the concern of not being able to work the program with fidelity due to parent inconsistencies.  The input Frank has received from the BCBA is that unless the parent is wanting to terminate or transition services, it is unlikely to occur prior to end of contract due to funding source regulations. Without a collaborative change, the barrier remains between the client and provision of intended services. Parents are reluctant to make a change, risking loss of the one person who is consistent in their schedule, Frank. The agency and Frank remain in contract with the family at this point. What should Frank consider ethically in his next steps with the family?

Response

• 4.07 environmental conditions that interfere with implementation 
• Ethical obligations to make decisions based on data 
• Establish re-evaluation of medical necessity, clinical team continues responsibility and funding source is required to provide the service if the team deems the treatment medically necessary 
• Work with funding source as soon as there is a pattern noticed that may inhibit effective treatment 
• Termination criteria/discharge criteria- outline parent participation etc. 
• Establish effective parent training and response effort for parent participation 
• Initiation of services ensure informed consent and outlining discharge criteria for services, what does the service look like to ensure all team members understand expectations 3.05

Scenario

I have been working with a child that is diagnosed with ASD. She engages in severe self-injurious behavior (head banging). She has been hospitalized 2 times for cuts to her forehead and concussions. Behaviors have decreased at school after staff training from our team but stay consistent in the home. The family is struggling with staying in close proximity to her, being proactive and implementing strategies when staff is not around. Their insurance company is suggesting a helmet to keep her safe, but the parents don’t want their child to walk around with a helmet on all the time even if it means keeping her safe when staff is not around. I am not sure what approach to take with this family since behaviors are still very high and dangerous when staff is not around. To keep the child safe, a helmet is the next best choice…thoughts? 

Response

• Review record of parent training and approach to parent training 
• Increased frequency of parent training, assess where the function lies with the parent not implementing with procedural fidelity 
• Reassess to ensure proper function is identified in the home setting 
• Ethical obligation to communicate with family that adaptive equipment could increase behaviors and should be handled carefully with risk/benefit assessment and appropriate protocols in place 
• 2.09 right to effective treatment

Scenario

I am a BCBA and therefore, a mandated reporter. After a report I made recently (details protected to maintain confidentiality), the guardian is retaliating (harassment, threats, etc.). Is there any protection in the state of AZ against retaliatory actions towards a mandated reporter? I do not feel personally intimidated specific to making/not making future reports; however, it is clear that such actions towards a mandated reporter may have a punishing effect on new(er) professionals with less confidence or support. Any suggestions from the ethics committee on how this should be handled? Any resources available?

Response

• First step would be severing the relationship if the BCBA is still providing services 
• Potentially contact attorneys or professional liability 
• Review mandated reporter requirements with teams frequently 
• Possibly using the report as a teaching moment for the team/family and being transparent at times with certain reportable situations to work as a team with the family

Scenario

Hi guys I’m looking for advice on 8.05 in the Ethics code, soliciting testimonials. Our organization is celebrating our 10- year anniversary, and we would like to put together a short video montage of the parents of our students and clients saying a few words of appreciation to the staff. This would be used for internal purposes only…purely as a means of appreciating our staff, and not for promotional purposes whatsoever. Thoughts?

Response

• Ensure no personal information is included in the video if it’s being shared with the company
• Potentially have a disclaimer at the end of the video that these statements are voluntary 
• No ethical concerns with using the video with the intention of not using for publication

Scenario

I am a parent of a teenager receiving ABA services. We have been in the system (in many different capacities) for 13 years. My son has been receiving ABA interventions for about 6 months. I have already noticed positive changes in my son. However, I have concerns regarding the parent training I am receiving. The BCBA is extremely knowledgeable and teaches me through a behavior skills model – this is great because she shows me what to do and really walks me through the stages. As far as programs, I understand what to do and I am able to implement these techniques with my son. I just feel like the parent training is rigid and very much in a silo. I feel like it’s almost robotic at times and we don’t get to discuss the tougher things that surface (i.e. long-term planning, how this has affected the family – especially siblings etc.). How should I approach this with the BCBA? Ethically, is the BCBA just required to teach me the individual programming? 

Response

• Did the family have the ability to provide input ahead of time? 
• Suggest the BCBA research a less restrictive procedure that the family may be able to implement at this time 4.09- least restrictive procedures 
• Parents are not generally motivated by research, BCBA should take a step back and do more values-based intervention talk and discussion that lead to the “why” behind the implementation of the procedure 
• BCBA is still responsible for providing transition of services if they feel they are not able to provide services: code 2.15 
• BCBA should reach out to supervisor for additional support and/or strategies

Scenario

I am a parent of a teenager receiving ABA services. We have been in the system (in many different capacities) for 13 years. My son has been receiving ABA interventions for about 6 months. I have already noticed positive changes in my son. However, I have concerns regarding the parent training I am receiving. The BCBA is extremely knowledgeable and teaches me through a behavior skills model – this is great because she shows me what to do and really walks me through the stages. As far as programs, I understand what to do and I am able to implement these techniques with my son. I just feel like the parent training is rigid and very much in a silo. I feel like it’s almost robotic at times and we don’t get to discuss the tougher things that surface (i.e. long-term planning, how this has affected the family – especially siblings etc.). How should I approach this with the BCBA? Ethically, is the BCBA just required to teach me the individual programming?

Response

• Encourage the family to talk to the BCBA about things that they want to cover in parent training 
• Encourage the family to write out an email ahead of time to make sure the content is covered and it fosters accountability on both ends to ensure 
• Missing values-based intervention on the BCBA’s side, while likely not intentional, there’s an ethical obligation under 4.01/4.06/4.07 for implementing behavior analytic principles and meeting the mark of hitting the family’s priorities to increase buy in and build rapport 
• Request more integration of programming with siblings to meet the family’s needs as services impact the whole family unit 
• Encourage family to advocate for themselves during training sessions to speak up if they are unsure/uncomfortable/or feeling off track

Scenario

I work under a BCBA who is providing services to a family whom she has multiple relationships with. The parents of the client are long-time friends of hers which she openly shared with me. I have expressed concerns about the family being very aggressive and hostile towards my client and will interrupt my sessions to tell me that I’m doing my job incorrectly and have tried to get me to physically force my client to hang from a monkey bar and hold her hands so she cannot move when she engages in stunning. I refused to do it, but the parents still make her do it. I shared this with my BcBA as well as an experience where the father was trying to use intimidation and threats to get the child to stop laughing and I felt unsafe. I told my BCBA that I did not want to work in such a hostile environment and she said that I could leave the case but I had to sit down with the family and tell them why I was unhappy and why I was leaving. She said that she thought it was better if she was not present for this meeting. I feel incredibly uncomfortable with this situation and I don’t know what to do. I believe she is violating ethics code 1.06 and I feel like she is not fulfilling her duties as my supervisor but I’m not sure if there are any other ethical violations happening? 

Response

• 1.06- violation of multiple relationships 
• 4.01- program implementation violations for least restrictive program implementation and behavior change consistent with behavior analytic principles 
• BCBA is violating 5.06 and 5.03 regarding supervisory obligations 
• Next steps- have a more extensive conversation with supervisor and then loop in the BCBA’s supervisor if met with continued resistance. If these steps do not resolve the concerns, it would warrant a complaint with the BACB & AzBOPE

Scenario

Dear Ethics Committee: I am an ABA student preparing for the BCBA exam. I have a question about pro bono limitations. I read in the code 2.13 about fees and financial arrangements. But in many references to this code, people will say that the relationship must be “remunerative.” Does this mean that pro bono work is discouraged? Many other professionals (i.e. some medical doctors I know) regularly provide a portion of their time to people on a pro bono basis. May a BCBA do this, provided that the relationship is spelled out clearly, and the other standards of the profession are withheld? That is, if we treat the client and others with the same high standards and in the same manner as paying customers, may we also do some pro bono work? I don’t see this addressed in high profile ABA contexts.

Response

• I found that the bacb defines a behavior analyst as some one who does work for pay too, but it doesn’t specifically state not to do pro bono. I also found a presentation that states that the word remuneration needs to be taken out. I have, as most of us have, done presentations and talks, as a BCBA, for free. I don’t think the bacb wrote that part of the code to avoid pro bono, and it was just not thought about. 
• I wonder if they mean 2.12? In either case, I don’t see anywhere that suggests that one must avoid pro-bono work. My position is that so long as the pro bono work is clearly outlined and provided through a clearly defined contract the same as a remunerative relationship (with all of the same provisions and protections in place) a BCBA should be in good shape. I’ve done and continue to do pro bono work. 
• Define the relationship just as you would any other, and execute the BCBA part of the job just as you would with any other- the only difference being that the payment is $0. 
• I am not sure in which references to the code this was stated, but I have never interpreted any part of the code to mean pro bono would not be acceptable. I agree that how the relationship is defined is the key. 
• I had a couple of thoughts on this…The first is that, unless you’re an independent contractor, it implies that the pro bono work is beyond the workload and scope within your organization. Code 2.01 states that a behavior analyst should only accept clients that are commensurate with organizational policies. So, if you’ve signed a non-compete agreement, I can see a potential ethical issue, strictly based on that. My second thought is that the code doesn’t actually state “remuneration.” It says that the behavior analyst defines: the scope of their service, the roles of all parties and, specific compensation and billing arrangements. I would assume that if you wrote the details of the pro bono arrangement in that section, it would satisfy that guideline.

Scenario

I have recently been diagnosed with a spine problem, which is causing me great pain, but has not kept me from doing my high quality work as a Behavior Analyst. I am fearful of continuing on my pain medications due to a family history of addiction. Therefore, I have done some research on the use of Medical Marijuana as a more natural way for me to treat the pain from this injury. My question is this, since Medical Marijuana is legal in Arizona, but still recognized as illegal from a Federal law standpoint, what are the BACB/Arizona Psych Board ethical considerations I need to think about before utilizing this form of pain management?

Response

• https://www.goodhire.com/blog/marijuana-laws-drug-testing-policy-changes
• Could be interesting to look at Ethical code …1.4 Integrity section here as well...d) Behavior analysts’ behavior conforms to the legal and ethical codes of the social and professional community of which they are members. The definition of “community” is at question here. If our “community” (Arizona) supports, accepts, votes in the use of medical marijuana is it fair to say that one may be conforming to the legal and ethical codes of our community? 
• “In October 2003, applicant submitted a Certified Master Social Worker (“CMSW”) application which was approved in December 2003. On that application, applicant reported that she did not use any illegal substances. In July of 2004, that certification was converted to a Licensed Master Social Worker (“LMSW”) license which was subsequently renewed in 2005, 2007, and 2009. On each renewal request, applicant again denied any use of illegal substances. In July of 2002, applicant began working at an agency (“Agency 1”). While at Agency 1, she was counseled for policy violations, work quality problems, inappropriate conduct, and insubordination. She was involuntarily terminated in April of 2008. On her 2009 LMSW renewal, she listed her reason for separation from Agency 1 as “administrative closure”. Applicant was arrested in May of 2010 for an offense that required reporting to the Board within ten days, but applicant failed to do so. Applicant allowed her LMSW license to expire on 11/30/11. In April of 2012, she was involuntarily terminated from her position with another agency (“Agency 2”). In January of 2013, applicant submitted a LMSW application to the Board. At that point she disclosed her 05/10 arrest and her 04/08 termination (but still listed the reason as “administrative closure”), but she failed to disclose her 04/12 involuntary termination, instead listing the reason as “conflict of care”. Through Board investigation, treatment records showed (and applicant admitted to) continual marijuana use since 1999. With the exception of a period from August 2011 – August 2012 (when she was issued a medical marijuana card), the substance use was illegal. She also acknowledged that she should have reported this on her 2003 CMSW application and subsequent renewals in 2005, 2007, and 2009, and her 2013 LMSW application.” 
• Her app was denied based on unprofessional conduct pointing out a precedent of a board’s exclusion of medical marijuana from the category of “illegal substance” 
• While I think this is helpful in the categorization of the legality of medical use in AZ (from a professional board perspective), it doesn’t get to the issue of impairment. Generally (I’ve not experienced AZ’s board), licensure boards look at the complaint and determine if the behavior deviates sufficiently from standards of care to warrant impairment. This seems like it would need more than simply a test for remnants in the system (as Joe mentioned earlier, it’s likely a parallel to Opioid use). The remnant test would be important if the board deemed it illegal and was looking for evidence of any use.
• To answer the question of opioid use, yes I would argue based on my experience with the board that the opportunity for deliberation would be present regardless of the legality of the substance if the complaint presented to the board indicates potential impairment while practicing, or the potential for a substance abuse issue that may impact the mental stability and/or competence of the practitioner. I think it’s important to understand that deliberation is purely a discussion of whether or not further action is necessary. The statutes are written in a way that allow for subjectivity in deliberation (I.e they say ‘the board at its own accord’ or ‘regardless of if conviction occurs’). I’ve seen actions related to DUI self-reporting range from minor deliberation with a motion to dismiss to more formal action like a request for mental evaluation and subsequent practice monitoring. In those cases; clients were not involved they were all just self-reports of DUI charges. I’ve even seen similar deliberation regarding an animal neglect charge (that resulted in no conviction but led to a 4-3 vote to dismiss). I would agree that in the event the complaint involves a direct question related to specific standards of care, the deliberation would include whether or not the behavior deviated sufficiently from standard of care. But I have personally observed cases in which deliberations included the indirect impact of medications/alcohol/specific medical conditions have been questioned by the board. Again, my disclaimer is that this is not my stance on the situation, just purely comments based on my observations from attending board meetings over the last seven years. Unfortunately they are unable to provide us guidance on the matter as they will review it on a case by case matter. By the end of this year we will have two behavior analysts on the board and a BA subcommittee– this will help guidance on standards of care as the last 7 years it’s been all guided by psychology/psychologist with the exception of a few times we have been afforded advisement opportunities. I have a neighbor that is a DUI enforcement specialist and his new grant funding includes research to determine the how various metabolite stages impacts impairment with hopes of developing guidelines (and I’m sure subsequent state statutes) similar to BAC specifications that are written into legislation