Scenario

Frank 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