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 

Scenario

I moved to Arizona seven years ago, but I started my career here providing habilitation services to adults. However, for the past six years, I have been working with only children. Two weeks ago, I saw one of my previous adult clients working at my neighborhood grocery store. I am aware we’re not allowed to approach families of children we work with, because someone could guess we provide services to them based on knowing what our career is. However, this is an adult I haven’t worked with for seven years. If my main focus has been working with children for six years, is there an issue with approaching my former adult client if he is alone?

Response

• I see no ethical problem with being a nice person and saying hello! You can decide where to go from there based on his response to seeing you. 
• To be a devil’s advocate, the BACB compliance code has no expiration date for maintaining client confidentiality. A client may not want to acknowledge a connection publicly even years later. However, just saying hello is of course friendly, and not likely to cause harm especially when the client relationship is long over. Perhaps you could even say hello without saying the client’s name; then if they recognize you and want to talk, great! If not, explaining how you know them publicly may not be appropriate.