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BACB Guideline 3.02 Explaining Assessment Results

Recently, a client planned to attend an upcoming IEP meeting for their child who received school services in a private school and Applied Behavior Analysis (ABA) Therapy from a private provider. The client did not want the ABA provider to attend the IEP meeting. Instead, they asked the ABA provider to submit a report that would be reviewed in the meeting.

The ABA provider informed the client that he was unable to submit a report for a meeting that he could not intend. He cited the BACB Guidelines for Responsible Conduct. The client became very upset and even said “Other BCBAs have done this, why can’t you?”

As a BCBA, we must follow the Guidelines established by the Behavior Analysis Certification Board (BACB). As Augustine of Hippo states, “Right is right, even if no one is doing it.”

The BACB Guideline 3.02 specifies what is expected of BCBAs with regards to their assessments. Specifically:

3.03 Explaining Assessment Results.

Unless the nature of the relationship is clearly explained to the person being assessed in advance and precludes provision of an explanation of results (such as in some organizational consultation, some screenings, and forensic evaluations), behavior analysts ensure that an explanation of the results is provided using language that is reasonably understandable to the person assessed or to another legally authorized person on behalf of the client. Regardless of whether the interpretation is done by the behavior analyst, by assistants, or others, behavior analysts take reasonable steps to ensure that appropriate explanations of results are given.

If a BCBA cannot attend a meeting where his report is reviewed, how can he ensure that the report is interpreted appropriately as the Guidelines state? The BCBA has several options:

  1. Have another appropriately trained BCBA go in his place
  2. Have an appropriately trained BCaBA attend his place
  3. Offer to call in to explain the results
  4. Meet separately from the meeting to review the results

Practicing BCBAs have many job responsibilities and obligations. We are often faced with difficult decisions as a result of those responsibilities. It is imperative that we know our Guidelines for Responsible Conduct and that we follow them to the best of our ability.

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graphHi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question was posted on a list serve for parents and family members of individuals with autism. The mom wrote,

“As far as data collection, I hear about the BCBA doing it but I have never seen it nor heard specific results. I requested the data and the BCBA told me that as an outside consultant she is not allowed to provide it.

Having taught a course on Ethics and Professional Issues for behavior analysts, and in addition to offering on-going coursework related to ethical issues for Board Certified Behavior Analysts, hearing things like this really upsets me.

Guideline 2.0 Responsibility to Client

The Behavior Analyst Certifying Board (BACB) has developed a set of Guidelines that BCBAs and BCaBAs must follow. These guidelines are called the Guidelines for Responsible Conduct and they may be viewed here. One of the guidelines states that “the behavior analyst has the responsibility to operate in the best interest of the client“. When the client is a minor or incapacitated (i.e., unable to make decisions for him/her self), the client’s parents or guardians become the client.

In the case above, the BCBA is claiming that her responsibility lies with the school district who is paying her salary. Unfortunately, the school district is a third-party payer. While the BCBA has responsibilities to her employer, those responsibilities cannot override her primary responsibility to the client. In fact, the guidelines address this issues.

Guideline 2.05 Third Party Requests for Services

This guideline has two parts. First the guideline states that “When a behavior analyst agrees to provide services to a person or entity at the request of a third-party, the behavior analyst clarifies to the extent feasible, at the outset of the service, the nature of the relationship with each party. This clarification includes the role of the behavior analyst (such as therapist, organizational consultant, or expert witness), the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.

The guidelines go on to state that “If there is a foreseeable risk of the behavior analyst being called upon to perform conflicting roles because of the involvement of a third party, the behavior analyst clarifies the nature and direction of his or her responsibilities, keeps all parties appropriately informed as matters develop, and resolves the situation in accordance with these Guidelines.

So, while the district is paying for the services, the client is the child and his/her guardian. When he client requests their data, the behavior analyst must make those data available.

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New Year ResolutionAs behavior analysts, we are faced with many responsibilities. Before we even think about seeing clients, we must first acknowledge the need to uphold our ethical obligations. We have a number of rules and principles to keep in mind. These include, but are not limited to the following:

  • Core ethical principles for psychologists
  • BACB Guidelines for Responsible Conduct
  • State Laws
  • Federal Laws

As we embark on the new year, I have a few resolutions for me and my fellow behavior analysts to consider.

  1. I will strive to keep reinforcement a top priority by conducting preference assessments and reinforcer inventories frequently (relates to BACB Guideline 4.05)
  2. I will strive to keep my client’s rights ahead of my own interests and conveniences (relates to BACB Guideline 2.0)
  3. I will strive to engage in professional behaviors at all times so that others view our profession with high regard (relates to BACB Guideline 7.01)
  4. I will strive to remain current in the research related to my area of practice (relates to BACB Guideline 1.03)
  5. I will strive to be the best behavior analyst that I can be (relates to Guideline 1.0)

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One of the things that behavior analysts in training are trying to learn is how to keep personal life separate from professional life. This means that being Facebook friends with families whom we serve is not a good idea. Keep in mind that many employers will “Google” you if you are applying for jobs. Make sure that social media doesn’t come back to haunt you. Thanks to The Joy of Tech and Nitrozac & Snaggy for this awesome cartoon!

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The field of behavior analysis is growing. This is due in part to:

  1. International Board Certification in Behavior Analysis (www.bacb.com)
  2. Increased insurance legislation mandating coverage of Applied Behavior Analysis (ABA) (http://www.autismspeaks.org/advocacy/states)
  3. Increased behavioral needs of all children

Demand

Because of these, and other reasons (e.g., CT has a law requiring BCBA {or similar} supervision of some school programs), BCBAs are hot commodities. Check out Craig’s List in your area and count how many companies are hiring behavior therapists and/or behavior analysts. Agencies will pay top dollar for a highly qualified and experienced BCBA. In fact, a recent email went out to certain BCBAs advertising up to $125,000 annually for a BCBA on the east coast.

Overworked?

Recently the Behavior Analysis Certification Board, produced two important documents. You can read more about them here and here. Essentially, the Board described expectations for supervisors regarding case loads and professional duties. Supervising the provision of ABA services requires on-going and regular contact with the client and therapists on the team. To do this well, BCBAs should maintain a small case load. If the BCBA has a BCaBA to assist with some duties then additional clients may be served. The bottom line is that clients need regular contact and supervision of the program.

In some instances, an agency may hire a BCBA and expect the BCBA to provide all the services for the clients or students within the agencies. For example, numerous school districts hire one BCBA to cover the entire caseload of special education students. The end result is poorly supervised ABA programs and a BCBA who is unable to fulfill his/her job duties effectively.

Important Personal Duties

In addition to all the professional duties required, BCBAs must also tend to multiple personal duties. These include:

  • maintaining certification
  • completing continuing education credits
  • registering for and attending conferences
  • reading and keeping up with the professional literature

During the course of the continuing education webinars provided by Applied Behavioral Strategies, LLC (an approved BACB provider), BCBAs seem to be so busy that they:

  • don’t have time to check their email
  • forget to include important documentation such as BACB certification number
  • forget to come to the webinar

Yes, BCBAs are so busy that they forget to come to a webinar that they have paid for and one that they need in order to maintain their certification.

So, slow down, organize yourself, make priorities, and do not overextend yourself. You owe it to your clients and you owe it to yourself.

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is a follow-up to a previous post on Supervision where Karen had asked “what are the rules on ABA supervision?

Recently, the Behavior Analysis Certification Board (BACB) issued a document related to practice guidelines. While the practice guidelines are specifically related to the provision of ABA services for individuals with autism, readers are provided with clarity regarding the supervision expectations for clients.

The BACB has this to say about on-going supervision of ABA services:

“Although the amount of supervision for each case must be responsive to individual client needs, 1-2 hours for every 10 hours of direct treatment is the general standard of care. When direct treatment is 10 hours per week or less, a minimum of 2 hours per week of clinical management and case supervision is generally required. Clinical management and case supervision may need to be temporarily increased to meet the needs of individual clients at specific time periods in treatment (e.g., intake, assessment, significant change in response to treatment).

A number of factors increase or decrease clinical management and case supervision needs on a shorter- or longer-term basis. These include:
• treatment dosage/intensity
• client behavior problems (especially if dangerous or destructive)
• the sophistication or complexity of treatment protocols
• the ecology of the family or community environment
• lack of progress or increased rate of progress
• changes in treatment protocols
• transitions with implications for continuity of care

Within the same document, the BACB discusses case loads for BCBAs. Specifically, they suggest:

  • The average caseload for one (1) Behavior Analyst supervising comprehensive treatment without support by a BCaBA is 6 – 12.
  • The average caseload for one (1) Behavior Analyst supervising comprehensive treatment with support by one (1) BCaBA is 12 – 16. Additional BCaBAs permit modest increases in caseloads.
  • The average caseload for one (1) Behavior Analyst supervising focused treatment without support of a BCaBA is 10 – 15.
  • The average caseload for one (1) Behavior Analyst supervising focused treatment with support of one (1) BCaBA is 16 – 24.
  • As stated earlier, even if there is a BCaBA assigned to a case, the Behavior Analyst is ultimately responsible for all aspects of case management and clinical direction. In addition, it is expected that the Behavior Analyst will provide direct supervision 2-4 times per month.

Keep in mind that these recommendations are related to comprehensive programs for children with autism.

We hope this helps to clarify our previous suggestions about supervision of ABA programs. We applaud the BACB for providing these guidelines that will prove helpful to behavior analysts, parents, and school district staff alike.

 

 

 

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent who is a regular reader (and poster) on our blog. Thanks Karen for your loyalty. Karen asks:

“What are general rules regarding supervision of the individual that provides ABA services?

How much oversight is required?

Is Supervision provided through data collection or intermittent on site visits?

How many students can the BCBA supervise ?

How is supervision validated?”

Thanks for stopping by our blog again! We love having repeat visitors.

BCBA  Supervision Rules

We have different rules for supervision depending on who we are supervising.

Supervising a BCBA in Training

If we are supervising someone who is training to become a BCBA the board requires us to supervise them a minimum of 2 hours every other week. This process is very long and can take up to 2 years. In addition to the on-going supervision we provide to those in training, we have to complete a form each time we supervise the person. Additional information on this type of supervision may be found here.

Supervising a BCaBA in Training

We have strict rules for providing supervision to a student who is trying to become a BCaBA. This process is also lengthy and requires written feedback. Rules for this type of supervision may be found here.

Supervising a certified BCaBA (on-going)

If we are supervising a practicing BCaBA, we have different rules.The board requires only one hour per month of this type of supervision. However, annually, “at least two of these monthly supervision sessions shall be conducted in-person, to include direct observation of actual service provision with individuals”. Additional information may be found here.

Supervision of Non-Certified Implementers

Finally, our organization lacks specific requirements for supervising staff who implement our programs. We have an ethical duty to make sure that programs are being implemented appropriately. Depending on how much ABA a client is receiving, supervision needs would vary. For example, if a child is receiving 40 hours per week of ABA therapy, more supervision would be needed (2-4 hours per week) but if someone is only receiving 10 hours of therapy per week, they may receive only 1-2 hours per week of supervision. For a detailed list of our guidelines for responsible conduct including supervision recommendations click here.

How is Supervision Provided?

Supervision may be provided a number of ways. Obviously, face to face supervision, where the supervisor is watching the implementation, is ideal. However, this is not always possible. Thus, other types of supervision may be provided. Supervisors may watch live video feed, they may watch previously recorded video, they may have sessions over Skype or other similar technology (we use WebEx for privacy purposes).

How Many People Can a BCBA Supervise?

As supervisors, we have to carefully build our caseload so that all of our clients receive appropriate services. Again, there is no minimum number to follow. We have our guidelines for responsible conduct that we should follow. There are only so many hours in the day. While many people burn the candle at both ends, it is difficult to provide supervision while clients are sleeping. Thus, case loads should be reasonable. When I worked for a large provider, it was common for individuals to have 14-15 clients on their caseload.

How is Supervision Validated?

Supervision is validated in a number of ways. We prefer to use the feedback form during formal supervision. However, if the implementers are not seeking certification, it is not uncommon to provide supervision without written documentation. For example, yesterday, I provided supervision to staff for about 30 minutes regarding a client at his school. We did not document the session because neither implementers is seeking certification.

Additional Resources

Supervision is a tricky issue. Your questions are completely appropriate. Please feel free to visit other sources of support.

  1. The Behavior Analysis Certification Board http://www.bacb.com
  2. The Association for Professional Behavior Analysts  http://www.apbahome.net
  3. The Association for Behavior Analysts International http://www.abainternational.org

Concerned?

If you have concerns about the supervision your child receives, be sure to address it with the BCBA who is responsible for your child’s case. In some instances, the supervision may be limited to funding. If you want more supervision than is funded, consider paying for additional supervision. Perhaps additional staff should be brought on to help (e.g., I’m seeking a BCBA to assist me with cases). Finally, if you cannot get the issue resolved, consider asking for a new BCBA or report the individual to the BACB. You will need extensive documentation but it may result in more appropriate supervision for your child.

We hope that helps.  And of course, come back and visit us often!

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled, “Replicating Milgrim”. The author, Jerry Burger, published the study in the journal, American Psychologist.

Study Purpose

The purpose of Dr. Burger’s study was to replicate the work of Milgram whose study series is known to many. (In case you are thinking–”who the H-E-Double Hockey Sticks” is Milgram, think back to the study where the supervisor told the participants to shock the “client” and the study participants did! Repeatedly!!). Psychologists now refer to those studies as the Obedience Studies.

Burger wondered, if after all these years of education, training, human compassion, and so forth, if, in fact, people today would engage in the same behavior. Burger took several steps to ensure the safety of participants in the study (yes, the ones who would be giving shock to the “learner”)

Study Methods

Participants included 29 men and 41 women with a mean age of 42 years. Participants were promised $50 for their time (two 45-minute sessions). Participants learned that they earned the money even if they withdrew from the study. Participants who were familiar with the experiment or who had extensive psychology training were excluded from the study. Experimenters then screened the remaining participants for any possible mental health condition or a reasons that may have resulted in a negative or harmful reaction from participating in the study. Researchers told participants they could quit at any time and that they could be videotaped at any time. Researchers assigned participants to one of two conditions.

The base condition consisted of the participant meeting the experimenter and the confederate (inside experimenter with knowledge of the study). The experimenter explained to the participant and the confederate that they would be in a study. He then paid both of them to give the impression that the study was randomized. Then he had them “draw” to determine who would be the teacher and who would be the learner. The “drawing” was rigged so that the participant always served as the teacher.

 

The experimenter then strapped the confederate in to the chair and attached the electrodes all the while explaining to the participant why he completed his step (e.g., to keep from burning him). Next, the experimenter told the confederate to learn the pairs of words. The experimenter told the confederate that the participant would be testing him and if he missed any answers, he would be administered a shock.

Next the experimenter taught the participant how to administer a shock. He provided a small one to the participant if he/she wanted one. The experimenter told the participant to administer a shock following each incorrect answer. He also instructed the participant to increase the intensity of the shock following each incorrect answer. Finally, the experimenter told the participant the importance of following study procedures .

The modeled refusal condition consisted of the participant meeting the experiment and 2 confederates. One confederate served as a teacher alongside the participant and the other confederate served as the learner. In this condition, the participant observed another “teacher” following the protocol. In this condition, the “teacher” (who happened to be the same gender as the participant) acted scared of the study after the first shock and then after the second shock decided that he/she would quit. The experimenter then allowed the participant to take over and continue as in the base condition.

In both conditions, the researchers enforced strict rules for ending the experiment and keeping the participant safe.

Results

In the base condition 12 out of 18 men and 16 out of 22 women (70% total) continued to administer shock treatments, despite the cries and yelps from the confederate. Meanwhile in the modeled refusal condition, 6 out of 11 men and 13 out of 19 women continued to administer shock treatments.

The researchers completed several personality assessments on the participants and used those results in additional analyses. Statistical analysis did not find any difference between scores on empathy. However statistical analysis revealed differences among participants with a strong desire for control in that they were more likely to stop the study.

Sadly, participants today responded very similarly to those participants in the 1960s.

Take Home Points

As behavior analysts, behavior analysts in training, teachers, and parents, use caution when you are instructed to implement a procedure that you may disagree with. As demonstrated in this study, humans are more likely to follow orders rather than stand up and refuse or question the treatment. When our children are being shocked (as those in Judge Rotenberg Center), restrained, and secluded, perhaps we should seek a 2nd opinion. Isn’t that what we do in medicine when we question a recommendation?

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I (Missy) have started teaching a course for the University of Saint Joseph in their approved BCBA coursework. I am super excited the opportunity. However, instead of teaching

Ethics for Behavior Analysts: 2nd Expanded Edition

instructional methodology like I usually do, I’m teaching the course on Ethical and Professional issues. This topic is not new to me because Rebecca and I have been conducting a number of workshops and webinars on Ethical Issues. But, prepping for and teaching a semester-long course on Ethical Issues is new to me.

I hope to use case studies to expose these professionals in training to many situations. What I would like from my readers is some assistance with case studies. I plan on using the Association for Professional Behavior Analysts and of course I have the best book by Bailey and Burch. But I would love add more case studies. So, take a few minutes and post about an ethical or professional issue regarding behavior analysis. This could be from a BCBA who has been placed in a difficult situation, this could be from a teacher or building principal who has seen a behavior analyst make an unethical decision, this could be from a parent who was placed in a difficult situation by a behavior analyst.

I want to thank you in advance for any assistance you can provide!

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about their child’s behavior. Today’s question comes from a participant in our workshop on Saturday. After reviewing Special Education Law and the associated ethical issues for practicing behavior analysts, the following question came up:

“How do we attend IEP meetings and participate without taking sides? We cannot be on the school’s side and we cannot be on the parents’ side.”

We have no choice but to turn to our “Ethics Bible” to help us answer this question. We use the Bailey and Burch (2011) “Ethics for Behavior Analysts“. We feel strongly that every behavior analyst should have this book and they should keep it out where they can easily access it (paperback is much cheaper). The book reviews the Guidelines for Responsible Conduct that were developed by the Behavior Analysis Certification Board (and to which all behavior analysts agree to follow). The book also provides illustrative case examples to help behavior analysts avoid finding themselves in sticky situations.

Responsibility to Client

In this book, you will see that Guideline 2.0 states, “The behavior analyst has a responsibility to operate in the best interest of the client.” Thus, when you attend IEP, IFSP, and other relevant meetings, your first concern belongs to the client you serve. While you may be paid by one party, any contract you sign at the outset of services, should clearly state that you have a responsibility to the client, even if it means that your professional recommendations do not align with  the party who pays your salary.

Responsibility to Other Parties

If you go on to read, you will see that Guideline 2.03 states, “The behavior analyst’s responsibility is to all parties affected by behavioral services.” Now you will see that you also have a responsibility to the parents as they are directly affected by your behavioral services. However, if you serve your client in the school setting, now you have a responsibility to the school as well. If you find yourself caught in the middle of the parents and the school, your number one priority is your client so act on his/her behalf.

Client Rights Under the Law

Finally, Guideline 2.06 states, “the behavior analyst supports individual rights under the law.” As a behavior analyst who works in schools, you have the responsibility to become educated on the laws that affect your client. You have a duty to ensure that you follow those laws and that you support your clients rights under those laws. If you do not know special education law and want to learn more, consider enrolling in one of our workshops on this topic. We will be conducting a day-long workshop at the ABA International Conference in Seattle and we will offer our webinar again in the fall.

In summary, if you find yourself stuck in the middle between parents and the school, remember, your first responsibility is to the client and then you have equal responsibility to the parents and the school team.

How many of our fellow behavior analysts have been in this position? I have to also ask, how many fellow teachers have been put in this position? Teachers, too, have responsibilities to their students. They often find it difficult to advocate for the child when they know how expensive services can be. Readers, how have you handled these predicaments?

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