Scenario

I understand that your organization is the Arizona chapter of the Association for Behavioral Analysis International. I also understand that there are no laws or regulations for ABA in Arizona. However, there are professional and ethical standards from your organization and ABAI, and as a parent of an autistic child, I have some questions that deal with professional and ethical standards. My daughter attends an establishment that offers speech and occupational therapy. I have come to learn that this establishment is utilizing ABA practices (compliance training) on clients. The speech and occupational therapists are using these practices on children, even though they do not identify as ABA therapists or have the training to consider themselves ABA therapists. A couple of questions: What is your stance on using ABA practices by people not fully trained in ABA? Should people using ABA methods (like compliance training) be under the supervision of a BCBA? Are there any professional or ethical standards with regard to informed consent and ABA? I.e. should people using ABA practices inform parents they are using these practices and gain consent from parents before these methods are used? If you have answers to any or all of these questions (from the standpoint of professional or ethical standards), I’d appreciate it.

Response

• OT and speech are not bound by our compliance code 
• Related service providers working closely with BCBAs may use similar strategies however they are bound by their own codes 
• Not enough information provided to give appropriate recommendation 
• • Is there dissatisfaction with the services? 
  • Did the provider say they use ABA? 
  • What procedures are being used? 
• In no way can we speak on behavior of a non-behavior analytic provider, could provide some codes to answer the questions however needs to be handled very delicately 
• Go to the designated licensing board or supervisor of the provider; recommend ABA services with BCBA if the mom is not satisfied with what the provider is doing and is interested in ABA services

Scenario

A BCBA is working with a medically fragile teenager, significantly impacted in several domains (communication – very little functional language, daily living, social skills etc.). The client suffers from a rare heart condition requiring an AED (on her person – in backpack) at all times. The family recently learned of the only potential surgery that could save her life (implant of internal defib). However, the setting on the implant cannot be set for her specific needs so it will “fire” a shock, at random times, to ensure appropriate electrical functioning. The medical provider requested the BCBA implement a protocol to prevent and treat trauma associated with the unpredictability of the electrical shock. The BCBA has experience with PTSD clients but is unsure of all the components involved in this scenario. The medical provider shared that there is no way to measure the intensity of the shock, as that is relative to the patient (this client does not have enough functional language to share such information). Parents are unsettled regarding the procedure but feel it is the only way to ensure her safety, longterm. Parents are requesting a coordinated plan of care prior to surgery. What are the next steps for this BCBA?

Response

• Ensure experience and competency with PTSD and trauma, if not, seek out additional resources and supports 
• Reviewing what is in our scope of practice; risk benefit analysis for getting the surgery vs. keeping defib on her person at all times 
• Discuss with doctor as well as previous patients if available to talk about the effects and intensity of the shock 
• Refer to counselor or psychologist for family care and ongoing needs that the client would need to build a collaborative team 
• BCBA, continuing to build communication, Likert scale for communicating pain etc. 
• Taking a supportive approach to parent training after the surgery and keeping in mind the fragile state of the family to slowly integrate protocol training into sessions

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