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Archive for the ‘Ethical Issues’ Category

Applied Behavior Analysis (ABA ) services by a Board Certified Behavior Analyst (BCBA) are becoming increasingly common. If you are new to our blog, you may read more about ABA services here and you may read more about a BCBA here.

Today’s post is really for BCBAs and BCaBAs. However, we always welcome parent and teacher readers because everyone can learn from one another.

Are You Doing Due Diligence?

What is “due diligence”? While there are several definitions, the most appropriate definition here is: “acting with a certain standard of care” (Wikipedia).

Standard of Care

What is the standard of care within ABA? The best resource available, in my opinion, is the practice guidelines produced by the Behavior Analysis Certification Board (BACB). The BACB created a beautiful and comprehensive manual describing the standard of care in behavior analysis. The manual is called, “Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers”. You may download the manual here. The manual doesn’t talk about caseload for BCBAs who consult with teachers, classrooms, and schools. Rather, the manual discusses ABA services for individual children.

Tiered Services

One important feature regarding ABA services is the tiered model of service delivery. Just like in medical care, the licensed vocational nurse (LVN) provides direct care, he is overseen by the registered nurse (RN), who follows a treatment plan developed by a physician. In ABA, a technician provides direct care to clients. The technician is overseen by a BCaBA or a BCBA. The BCBA develops the treatment plan and oversees the individuals providing direct care.small group training

If you are a BCaBA, you must work under the guidance and supervision of a BCBA. BCBAs are independent practitioners. However, I know very few BCBAs who want to be on their own. Most of the individuals I have met, want to work alongside a team of professionals in order to solve the most complex cases. Behavior therapists are not independent practitioners either and they, too, must work under the guidance and supervision of a BCBA or BCaBA.

Caseload

How many students are on your caseload?

How many should be on your caseload? This manual has great recommendations regarding the appropriate caseload for BCBAs. The recommendation is based on the type of case. For example, a comprehensive case would require more intense supervision while a case focusing on one are of learning (e.g., toileting), may need less supervision.

Case Oversight

assesment

All ABA cases, including the technician, will need supervision. Case supervision may come in the form of indirect services (e.g., graphing, analyzing data, writing reports) or direct supervision (e.g., modeling program implementation, collecting interobserver agreement, or completing fidelity checks). While case supervision will vary from child to child, the BACB recommends 2 hours of case supervision for each 10 hours of service.

Take a moment and reflect on your cases. Are you doing due diligence?

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Documents

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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