Ethics in Every Day Practice ABAI Conference 2014

Transcription

1 Ethical Issues in Every Day Practice Melissa L. Olive, Ph.D., BCBA-D LLC Social Media Follow our blog: Follow me on Like us on Facebook: Join our Mailing List: Sources Bailey, J.S. & Burch, M. R. (2005). Ethics for behavior analysts: A practical guide for responsible conduct. Lawrence Erlbaum Associates: Mahwah, NJ. Revised version (2 nd edition) 2011 Bailey, J.S. & Burch, M. R. (2010). 25 Essential Skills and Strategies for the Professional Behavior Analyst: Expert Tips for Maximizing Consulting Effectiveness. Lawrence Erlbaum Associates. Mahwah, NJ. BACB Guidelines for Responsible Conduct and BACB Professional and Disciplinary Standards 5 [email protected] 1

2 Core Principles for Psychologists (Koocher & Keith-Spiegel, 1998) Do No Harm Respecting Autonomy (promoting independence) Benefitting Others Being Just (Ethic Reciprocity or Do Unto Others) Being Truthful According Dignity Treating Others with Care and Compassion Pursuit of Excellence (remain aware of latest research) Accepting Responsibility (especially if treatment fails) 6 To Be Ethical in Our Practice, What Must We Know? All things BACB (stay updated) BACB Guidelines for Responsible Conduct BACB Disciplinary and Ethical Standards Federal Laws (e.g., SPED, HHS, DD) State Laws (e.g., SPED, HHS, DD issues) Other (e.g., psychology, counseling, speech, etc depending on your other certifications) 7 Remain Current with BACB BACB Newsletters (only 33% of certificants open these!) Did you know about recent changes? Changes to task list University passing rates are posted Changes to supervision requirements The supervision module Identification card for BCBAs 8 [email protected] 2

3 BACB Guidelines for Responsible Conduct 1. Responsible Conduct of a 2. The BA s responsibility to 3. Behavior 4. The BA and the Behavior Program 5. The BA as a or 6. The BA and the workplace 9 BACB Guidelines cont. 7. The BA s responsibility to the 8. The BA s responsibility to 9. The BA s responsibility to 10. The BA and 10 Professional Disciplinary & Ethical Standards 6. Gross or repeated negligence, incompetence, misconduct, or malpractice in professional work, including, but not limited to: a. any physical or mental condition that currently impairs competent professional performance or poses a substantial risk to the client/consumer of behavior analysis services; b. Professional conduct that constitutes an extreme and unjustified deviation from the customary standard of practice accepted in the applied behavior analytic community and that creates a serious risk of harm to or deception of consumers; c. Abandonment of a consumer resulting in the termination of imminently needed care of a consumer without adequate notice or provision for transition; 11 [email protected] 3

4 Professional Disciplinary & Ethical Standards d. Professional record keeping and/or data collection that constitutes an extreme and unjustified deviation from the customary standard of practice for the field, and/or deceptively altering consumer records or data; e. Engaging in blatant fraud, deception, misrepresentation, false promise or pretense or intimidation in the practice of applied behavior analysis or in solicitation of consumers; and 12 Professional Disciplinary & Ethical Standards, cont 9. Failure to adequately supervise or be supervised in accordance with the BACB Standards for Supervision. 13 Ethical Issues in Schools 14 4

5 Administrative Issues Private schools versus public schools Does administration support ABA Does administration support children with disabilities/behavior challenges Does administration support your mission Frequency of observations Frequency of team meetings Involving parents at all times Third-Party Requests for Services (a) 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 Third-Party Requests for Services (b) 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. 17 [email protected] 5

6 2.07 Maintaining Confidentiality 18 (d) Behavior analysts discuss confidential information obtained in clinical or consulting relationships, or evaluative data concerning patients, individual or organizational clients, students, research participants, supervisees, and employees, only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters Fees, Financial Arrangements and Terms of Consultation. (c) Prior to the implementation of services the behavior analyst will provide in writing the terms of consultation with regard to specific requirements for providing services and the responsibilities of all parties (a contract or Declaration of Professional Services) Preparing for Consultation The behavior analyst implements or consults on behavior management programs for which the behavior analyst has been adequately prepared. 20 6

7 Collaborative Issues General Education Teachers Special Education Teachers Para-educators Behavior Techs Related Service Providers 21 Collaborative Issues Asking you to help on non-clients Staff reliance on you and your team Do they understand your BIP Do they appreciate the data you collect Do they mind the presence of you and your staff Dual relationships HIPAA, FERPA, and IDEIA violations Professional and Scientific Relationships (a) Behavior analysts provide behavioral diagnostic, therapeutic, teaching, research, supervisory, consultative, or other behavior analytic services only in the context of a defined, remunerated professional or scientific relationship or role. 23 [email protected] 7

8 1.06 Dual Relationships and Conflicts of Interest Treatment Efficacy (a) The behavior analyst always has the responsibility to recommend scientifically supported most effective treatment procedures. Effective treatment procedures have been validated as having both long-term and short-term benefits to clients and society. (b) Clients have a right to effective treatment (i.e., based on the research literature and adapted to the individual client) Dual Relationships and Conflicts of Interest (b) A behavior analyst refrains from entering into or promising a personal, scientific, professional, financial, or other relationship with any such person if it appears likely that such a relationship reasonably might impair the behavior analyst s objectivity or otherwise interfere with the behavior analyst s ability to effectively perform his or her functions as a behavior analyst, or might harm or exploit the other party. 26 [email protected] 8

9 Supervisee Issues Being asked by staff to perform tasks that only a BCBA should do Being asked by staff to perform non-behavior analysis tasks Dual relationships Time sheet fraud The Behavior Analyst As Teacher and/or Supervisor 5.02 Limitations on training. Behavior analysts do not teach the use of techniques or procedures that require specialized training, licensure, or expertise in other disciplines to individuals who lack the prerequisite training, legal scope of practice, or expertise, except as these techniques may be used in behavioral evaluation of the effects of various treatments, interventions, therapies, or educational methods Feedback to Student/Supervisees The behavior analyst provides feedback to the student/supervisee in a way that increases the probability that the student/supervisee will benefit from the feedback. 29 [email protected] 9

10 5.10 Requirements of Supervisees 30 The behavior analyst s behavioral requirements of a supervisee must be in the behavioral repertoire of the supervisee. If the behavior required is not in the supervisee s repertoire, the behavior analyst attempts to provide the conditions for the acquisition of the required behavior, and refers the supervisee for remedial skill development services, or provides them with such services, permitting them to meet at least minimal behavioral performance requirements Training, Supervision, and Safety Behavior analysts provide proper training, supervision, and safety precautions to their employees or supervisees and take reasonable steps to see that such persons perform services responsibly, competently, and ethically. If institutional policies, procedures, or practices prevent fulfillment of this obligation, behavior analysts attempt to modify their role or to correct the situation to the extent feasible. 31 Client Issues Confidentiality Effective treatment Dignity Record keeping 32 [email protected] 10

11 2.07 Maintaining Confidentiality (a) Behavior analysts have a primary obligation and take reasonable precautions to respect the confidentiality of those with whom they work or consult, recognizing that confidentiality may be established by law, institutional rules, or professional or scientific relationships. 33 Maintaining confidentiality cont. (c) In order to minimize intrusions on privacy, behavior analysts include only information germane to the purpose for which the communication is made in written and oral reports, consultations, and the like Case Study Ronnie was a 10-year-old with autism. He had a history of swearing and other outbursts. The private school requires him to be with a behavior tech at all times. If he calls out more than 3 times, he must leave the class for the rest of the period. If he swears, he is sent home for the day. If he threatens with violence, he is sent home for the day. He is high functioning and worries about what his friends think of him. [email protected] 11

12 37 Parent Issues Are they present for services Do they support ABA Medication and other unplanned changes Do they follow the treatment plan Pitting behavior techs against each other and/or the supervisor Two houses if divorced (and other divorce issues) Social media Dual relationships Other Family Members Grandparents Babysitters Girlfriends Boyfriends Siblings Siblings friends The Behavior Analyst and the Individual Behavior Change Program 4.01 Describing Conditions for Program Success Environmental Conditions that Preclude Implementation Environmental Conditions that Hamper Implementation

13 40 Behavior Techs Lack of interaction other than client and family on their own Materials and supplies Keeping the book orderly Who does the book belong to? Injuries Parental presence (or lack thereof) Cell phones, sleeping, etc. on the job Social media & dual relationships 5.11 Training, Supervision, and Safety Behavior analysts provide proper training, supervision, and safety precautions to their employees or supervisees and take reasonable steps to see that such persons perform services responsibly, competently, and ethically. If institutional policies, procedures, or practices prevent fulfillment of this obligation, behavior analysts attempt to modify their role or to correct the situation to the extent feasible Employee Health and Well Being The behavior analyst develops interventions that enhance the health and well being of the employees

14 Client Issues Loss of service If parent interrupts If behavior tech is on phone or sleeping Generalization issues Extinction issues Case Study Natalia was a therapist assigned to Nikki who was 8 and had autism. Nikki s parents were divorced and lived in 2 different houses with a schedule not even the therapists could learn. One day Natalia arrived for therapy. The mom let her in but went back to bed. As Natalia began implementing the programs, she realized that a man was also in the home. Nikki could also hear the adults and insisted on going up to her mom s room. Natalia had a difficult time getting Nikki interested in therapy. Finally, it was time for lunch so Natalia got Nikki to the table. Just as she was about to start the new foods program, the mom came down the stairs. Nikki immediately threw her food on the floor and Applied mom Behavioral sent Strategies the boyfriend out to get McDonald s. Training Adults Parent Training Teacher Training Behavior Tech Training University programs Continuing Education for BCBAs Supervision of BCaBAs Supervision of those pursuing certification 46 [email protected] 14

15 Parent & Teacher Training Is enough time allocated to ensure they master the material? Are they motivated to learn? Are you available to provide the supervision that is needed for performance feedback? Designing Competent Training Programs and Supervised Work Experiences Behavior analysts who are responsible for education and training programs and supervisory activities seek to ensure that the programs and supervisory activities: are competently designed provide the proper experiences and meet the requirements for licensure, certification, or other goals for which claims are made by the program or supervisor. 48 Behavior Tech Training Going rate is $300 PER PERSON! Does this have to be 1:1? Does it all have to be didactic? What about hands on? BACB Guidelines for training BACB Guidelines for Responsible Conduct (for RBT) Faced with multiple issues each day 49 15

16 50 University Programs Who is teaching this required coursework? Is this in their scope of practice? Is a brand new BCBA with no experience really ready to teach? Are universities shirking their duties and passing them on to supervisors? Academic Integrity Issues Does the university look the other way? Students need model teachers! 51 ACE Providers Who can be an ACE provider? What are the prerequisites? Is there any oversight? What are the RULES? Tardy Content Syllabus Evaluations Online rules Supervision Where do we start? Supervision training curriculum Supervision requirements 8-hour training Module 3 hours of continuing education thereafter 53 [email protected] 16

17 Business Ethics Dr. Bailey s talk Dr. Bailey s new guidelines Billing issues Medical necessity issues Training staff Scope of practice to run a business Using ABA within the business HIPAA 56 Business Ethics Insurance Gas & Travel money Business Attorney Contracts Secure mail, fax, and file storage 57 Case Study: Ethics Class Assignment 58 I ask the students in the Ethics Class to interview a BCBA about how they learned about ethics, how they deal with ethics, and how they train others about ethics. 1. BCBAs won t participate or they don t want me to know their name 2. BCBAs who report that they don t see any ethical issues. Ever. 3. BCBAs who don t even know they are violating ethical guidelines. [email protected] 17