Ethical Guidelines for Therapists Implementing ABA Treatment

Objectives

  • Define Ethics
  • Discuss 9 Ethical Principles
  • Review BACB Guidelines for Ethical Conduct
  • Discuss examples and non-examples of guidelines

Ethics

Wikipedia defines Ethics (also known as moral philosophy) as: is a law philosophy that addresses questions about morality–that is, concepts such as good and evil, right and wrong, justice, virtue, etc.

Nine Ethical Principles (Koocher & Keith-Spiegel, 1998)

  1. Do No Harm
    • Make sure that the services that we are providing to clients will maintain their safety and that we are not knowingly engaging in practices that will cause them harm. Not knowingly practicing outside one’s area of expertise. Additionally, willfully remaining ignorant of something, could lead to harm to the client. It is incumbent upon the RBT to ask questions, to continue training in order to best support the learner and keep the learner safe.
  2. Respecting Autonomy
    • Autonomy is the promotion of independence and self-sufficiency. We are working within a population that often has limited abilities across a wide range of areas and requires support in a range of categories and subsequently that puts this population at greater risk for becoming overly dependent on others for daily living needs. RBTs should understand that just because we want to keep the learner under control, it may not be justification for intervening. Even if this doesn’t make anything easier for ourselves, parents or other caregivers. We need to do everything we can to promote our learner’s independence because that is the goal of ABA therapy–to help our learners lead independent lives.
  3. Benefitting Others
    • The primary role of the RBT, BCBA and other Professionals is to benefit others in whatever setting/situation that they may work in. The work is not about us. Our ego. It is about the learner. Always the learner. And their family. It can also be the parent or the teacher, the “client” shifts depending on who the focus of the training or interaction is with.
  4. Being Just
    • The “Golden Rule”. Do unto others as you would have done unto you. Treat others as you yourself wish to be treated. This includes the learner or the “client”, other professionals and colleagues. Remember… “If I was in their shoes… I would want ____”
  5. Being Truthful
    • Well respected professionals attain their reputation based on the trust placed in them by others.
  6. According Dignity
    • Each and every client is treated with dignity and respect, and what this means is that every person deserves to be treated with ethical consideration, respect and valued as a person. It is critically important for the most vulnerable members of our population.
  7. Treating Others with Care and Compassion
    • If you are following the ethical principles of 2, 3 & 6 this principle will automatically be ensured. This extends to parents and siblings of the client as well.
  8. Pursuit of Excellence
    • Stay current with new developments as well as updated rules and regulations. Be a lifelong learner. New research is exciting, dig in! Subscribe to journals! Attend conferences, workshops, seminars!
  9. Accepting Responsibility
    • You are responsible for making sure that the proposed treatment is proper, justified and worthy of consideration. (BCBA is/RBT is responsible for implementing). Red flags however, and knowledge of client allow RBT some leverage in communicating real concerns. Further education allows for deeper questions/considerations. When a treatment fails you must take responsibility, accept blame, and make corrections to satisfy the client and other related parties –for the therapist, direct staff, RBT this means getting the BCBA involved to make change(s).

What Makes Behavior Analysis Unique?

Behavior analysis is the only human services approach to require that treatment use methods based on science. We must have evidential proof that what we are actually implementing with a learner is effective. There must be a scientific basis for the treatment itself. So we rely on research. Scientific research. And this research guides the decisions that we make in creating behavior plans and making adjustments and modifications to those plans as the learner progresses through their program.

  • Treatments are carried out by others, often paraprofessionals under the supervision of a BCBA.
  • A vast majority of behavior analytic work is done in the setting where the behavior problem actually occurs
  • Patient, clients or students are often referred to behavior analysts for treatment by someone else and if the behavior is severe enough that the person must be under supervision
    • Potential ethical considerations:
      • Referred to by others: respect the right of client
      • Treatment settings: may stigmatize the client
  • Behavior analysts are often called to work on severe behavior problems and sometimes the presenting problems are very complex
    • The BCBA must examine all possibilities and determine which are most salient in arriving at a treatment approach
    • Consequences are important, but must use least restrictive (not aversive) and positive reinforcement procedures must be balanced with the client’s right to effective treatment.

BACB Guidelines for Responsible Conduct

  1. Responsible Conduct of an Behavior Analyst (RBT):
    • Addresses concern for the overall responsible conduct of an RBT/analyst.
    • Conduct self in a way that reflects positively on the field of Behavior Analysis
    • Emphasizes our roots in science (Skinner)
    • Reminds to tie decisions to science
    • Expectations:
      • To read published research and keep in touch with scientific knowledge
    • Proficiency in professional practice:
      • keep training, studying, lifelong learning
    • Recommendations to those entering the field:
      • Monitor your own behavior
      • Ensure your conduct is within the law
      • Strive to be recognized as an exemplary citizen
      • Shed biases and learn to work with people of different race, ethnicity, gender, sexual orientation, ability, etc.
    • 1.00-Responsible Conduct of a Behavior Analyst: 
      • The behavior analyst maintains the high standards of professional behavior of the professional organization *When working as a professional you must uphold the standards of the profession, including: honesty, integrity, reliability, confidentiality, and trustworthiness
    • 1.01-Reliance on Scientific Knowledge:
      • Behavior analysts rely on scientific knowledge and professionally derived knowledge when making scientific or professional judgements in human service provision, or when engaging in scholarly or professional endeavors
        • Assessment based on observation of behavior and use of functional assessments
        • Use interviews, but rely on objective data to make treatment decisions
        • Recommendations based on research
        • Avoid using unproven therapies in treatment
    • 1.02-Competence
      • Behavior analysts provide services, teach, and conduct research only within the boundaries of their competence,  based on their education, training, supervised experience, or appropriate professional experience
    • 1.03 Professional Development
      • Behavior analysts who engage in assessment, therapy, teaching, research, organizational consulting, or other professional activities maintain a reasonable level of awareness of current scientific and professional information in their fields of activity and undertake ongoing efforts to maintain competence in the skills they use
        • Seek out additional education, maximize ongoing training, attend conferences, etc.
    • 1.04 Integrity
      • (A) Behavior Analysts are truthful and honest
        • Refrain from making commitments that cannot be kept/no false promises
        • Show up to therapy sessions on time
      • (B) Behavior analyst’s behavior conforms to the legal and moral codes
        • Beware of legal issues pertaining to the delivery of service
        • Moral and social values of the community
      • (C) The activity of a behavior analyst falls under these guidelines only if the activity is part of his or her work-related functions or the activity is behavior analytic in nature
      • (D) If behavior analyst’s ethical responsibilities conflict with law, behavior analysts make known their commitment to these guidelines and take steps to resolve the conflict in a responsible manner in accordance with the law
    • 1.05 Professional & Scientific Relationships
      • (A) Services only provided in a defined professional role
      • (B) Behavior analysts provide information prior to service about the nature of their services and the expected results
        • And this is done without jargon in a language that the client/caregivers can understand
      • (C) Seek training and support when working with unfamiliar religions, orientations, disability, ethnic, socioeconomic groups, etc
        • When working with individuals that are different from your usual client populations, seek guidance from another professional
      • (D) Behavior analysts do not discriminate
        • It is unethical to discriminate. Period.
      • (E) Behavior analysts do not harass
        • Do not demean others, engage in sexual advances, tease, etc.
      • (F) Behavior analysts refrain from providing services when personal circumstances may compromise delivering services to the best of their abilities
        • Monitor your behavior and realize your stressors
        • Make arrangements to take time off
    • 1.06 Dual Relationships & Conflicts of Interest
      • (A) In many communities and situations, it may not be always feasible or reasonable to avoid social situations or other nonprofessional contact with clients.
        • Be aware of potential conflicts and attempt to avoid social and casual contacts with clients
      • (B) A behavior analyst refrains from entering a relationship other than therapeutic if it will reasonably impair objectivity or otherwise interfere with the behavior analyst’s ability to effectively perform their functions.
      • (C) If due to unforeseen factors a potentially harmful multiple relationship has arisen the behavior analyst will attempt to resolve in accordance with the guidelines.
        • Resolve dual relationships in best interest of client
      • 1.07 Exploitative Relationships
        • (A) Behavior analysts do not exploit persons over whom they have supervisory, evaluative, or other authority such as students, supervisees, employees, research participants, and clients.
          • Do not take advantage of…. regardless
        • (B) Do not engage in sexual relationships with clients, students, or supervisees in training over whom the behavior analyst has evaluative or direct authority, because such relationships easily impair judgement or become exploitative
        • (C) Behavior analysts are cautioned against bartering with clients because it is:
          • 1) clinically contraindicated, and
          • 2) prone to formation of an exploitative relationship
            • Bartering can start off well and then go sour quickly
  2. The Behavior Analyst’s Responsibilities to Client’s (RBT):
    • 2.00 The Behavior Analyst’s Responsibility to Clients
      • Responsibility to operate in the best interest of clients
    • 2.01 Definition of Client
      • Whomever the behavior analyst provides professional services to (e.g. individual, parent, agency, institution, etc.)
    • 2.03 Responsibility
      • The behavior analyst’s responsibility is to all parties affected by behavioral services
    • 2.06 Rights & Perogatives of Clients
      • (a) Support individual rights of clients under the law
        • constitutional rights of the client
      • (b) Must provide client credentials upon request
      • (c) Permission must given by client to record session
        • Consent for different uses must be given
      • (d) Client have the right to complain about services
      • (e) Must comply with requirements for criminal background checks
    • 2.07 Maintaining Confidentiality
      • (a) Must take precautions to respect confidentiality of those with whom you work or consult, recognizing that confidentiality may be established by law, institutional rules or professional or scientific relationships
      • (b) Clients have a right to confidentiality
        • Should be explained at the onset of a relationship
      • (c) Use only information germane to the situation
      • (d) Only discuss confidential information with people clearly involved in the matter
        • Confidential information-ficticious information should replace identifying information
    • 2.08 Maintaining Records
      • Maintain appropriate confidentiality in creating, storing, accessing, transferring, and disposing of records
        • In compliance with applicable federal or state law or regulations, and a manner that permits compliance with the requirements of the Guidelines
    • 2.09 Disclosure
      • May disclose information with consent
      • Disclosure of confidential information without consent can only occur to:
        • Provide needed professional services to the individual or organizational client
        • Obtain appropriate professional consultations
        • Protect the client or other from harm
    • 2.11 Documenting Professional & Scientific Work
      • (a) Appropriately document professional and scientific work to facilitate provision of services later by them or by other professionals, to ensure accountability, and to meet other requirements of institutions or the law
      • (b) Create and maintain documentation in the kind of detail and quality that would be consistent with the reasonable scrutiny in an adjudicative form
      • (c) Obtain and keep appropriate consent (e.g Institutional Review Board (IRB) when data gathered during their professional services will be submitted to professional conferences and peer reviewed journals.
  3. Assessing Behavior: This guidelines does not specifically apply to the RBT
  4. The Behavior Analyst and the Individual Behavior Change Program (RBT):
    • 4.06 Avoiding Harmful Reinforcers
      • Minimize the use of items as potential reinforcers that may be harmful to long-term health of the client or participant (e.g., cigarettes, sugar or fat laden food), or that may require undesirably marked deprivation procedures as motivation operations.
    • 4.07 On-Going Data Collection
      • The behavior analyst collects data, or asks the client, client-surrogate, or designated others to collect data needed to assess progress within the program
  5. The Behavior Analyst as the Teacher or Supervisor: This guidelines does not specifically apply to the RBT
  6. The Behavior Analyst and the Workplace (RBT):
    • 6.00 The Behavior Analyst and the Workplace
      • Adhere to job commitments, assesses employee interactions before interventions, work within their scope of training, develop interventions that benefit employees, and resolve conflicts within these Guidelines.
    • 6.01 Job Commitments
      • The behavior analyst adheres to job commitments made to the employing organization
    • 6.06 Conflicts with the Organization
      • If the demands of an organization with which behavior analysts are affiliated conflict with these Guidelines, behavior analysts clarify the nature of the conflict, make known their commitment to these Guidelines, and to the extent feasible, seek to resolve the conflict in a way that permits to the fullest adherence to these Guidelines
  7. The Behavior Analyst’s Ethical Responsibilities to the Field of Behavior Analysis (RBT):
    • While growing it is still a relatively small field. Bad conduct of a few ABA professionals’s seems greater than if within a larger field of study. We MUST set a high standard of ethical and moral conduct.
    • Protect and enhance the field that we work in — this is good ethical behavior
      • Everyone should support the values of the field
    • Strive to Employ the Core 9 Ethical Principles:
      • Do No Harm
      • Be Honest
      • Respecting Autonomy
      • Benefiting Others
      • Being Just
      • According Dignity
      • Treating Others with Caring and Compassion
      • Pursuit of Excellence
      • Accepting Responsibility
    • 7.00 The Behavior Analyst’s Ethical Responsibility to the Field of Behavior Analysis
      • The behavior analyst has a responsibility to support the values of the field, to disseminate knowledge to the public, to be familiar with these guidelines, and to discourage misrepresentation by non-certified individuals
    • 7.01 Affirming Principles
      • Uphold and advance the values, ethics, principles, and mission of the field of behavior analysis; participation in both state and national behavior analysis organizations is strongly encouraged
    • 7.03 Being Familiar with these Guidelines
      • Be familiar with these Guidelines, other applicable ethics codes, and their applications to behavior analysts’s work
        • Lack of awareness of misunderstanding of a conduct standard is not itself a defense to a charge of unethical conduct
    • 7.04 Discouraging Misrepresentation by Non-Certified Individuals
      • Behavior analysts discourage non-certified practitioners from misrepresenting that they are certified
  8. The Behavior Analyst’s Ethical Responsibilities to Colleagues: This guidelines does not specifically apply to the RBT
  9. The Behavior Analyst’s Ethical Responsibilities to Society:
    • 9.00 The Behavior Analyst’s Ethical Responsibilities to Society
      • The behavior analyst promotes the general welfare of society through the application of the principles of behavior
    • 9.01 Promotion in Society
      • The behavior analyst should promote the application of behavior in society by presenting a behavioral alternative to other procedures or methods
    • 9.04 Statements by Others
      • (a) Engage others to create or place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements
      • (b) Make reasonable efforts to prevent others whom they do not control from making deceptive statements concerning behavior analysts practices or professional or scientific activities
    • 9.05 Avoiding False or Deceptive Statements
      • Do not make public statements that are false, deceptive, misleading, or fraudulent
        • Could be what is directly stated, conveyed, suggested or what information is omitted
          • Related to one’s research, practice, work activities, or organization with which they are affiliated
    • 9.07 Testimonials
      • Do not solicit testimonials from current clients or patients or other persons who because of the particular circumstances are vulnerable to undue influence
    • 9.08 In-Person Solicitation
      • Do not engage, directly or through agents, in uninvited in person solicitation of business from actual or potential users of services who because of their particular circumstances are vulnerable to undue influence.
  10. The Behavior Analyst and Research: This guidelines does not specifically apply to the RBT

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