OUR BLOG

Effective Treatment

June 17, 2019

 

Review of The Right to Effective Treatment by Houten et.al

 

As a behavior analyst I think it is important to teach parents, caregivers, and clients how to advocate for themselves. Obtaining a diagnosis and beginning ABA therapy can be a challenging time for any family. I wanted to share this article that I think may be helpful because it discusses the right to effective behavioral treatment. This article was written back in 1988 by some of the most well-known names in behavior analysis. 


The authors first discuss how behavior analysts have an obligation to provide the most effective treatment that is available. In an earlier post I outlined the professional and ethical code for behavior analysts that expands on this point. Behavior analysts should be seeking continuing education opportunities and constantly reviewing the success of the programs they have in place. A BCBA should never continue an ineffective treatment. 


The first right of a client described in this article is the right to a therapeutic environment. This means that the environment should not only be safe but it should be conducive to learning in that it provides enjoyable activities. These activities should be age-appropriate as well as reinforce appropriate behaviors and skill-building. Everyone who interacts with the client in their therapeutic environment should be competent and caring. A therapeutic environment should impose as few restrictions as possible while ensuring safety. Clients should have as much access to items and activities that they enjoy and the freedom to access them in any placement. 


Clients also have the right to services whose overriding goal is personal welfare. The immediate and long-term welfare of the client should be considered in all aspects of behavior intervention. In the event that an intervention may pose a risk to the client it is imperative that the BCBA seek a peer or human rights review committee to help ensure that the treatment is delivered with respect to the client’s dignity, privacy, and humane care. 


Another right that should be considered when choosing services is that the client has the right to treatment by a competent behavior analyst. Clinical competence is often acquired through experience and there may be instances where the BCBA that is working with a client cannot provide the best care for them. Clients have a right to seek the direct involvement of a doctoral-level behavior analyst who can assess the current treatment and provide recommendations.

 

Clients have the right to programs that teach functional skills. This is such an important consideration for families and behavior analysts and is something that requires collaboration by both parties. The ultimate goal of ABA therapy is to increase functional skills and reduce barriers to learning. The skills that are taught in ABA should be relevant to the client and help them to function more effectively in their environment and in the community. 


Throughout a client’s course of therapy they have the right to ongoing assessment and evaluation. Assessment and evaluation is how behavior analysts determine the success of a treatment and informs decisions about treatment plan modifications. Behavior analysts should be analyzing program and behavior data frequently and not only when an insurance company or other funding source requests an updated treatment plan. 


Finally, an individual has the right to the most effective treatment available. Effective treatment involves many variables such as effectiveness as well as the side effects of reinforcement. Behavior analysts are obligated to use interventions that have been proven to be effective. A behavior analyst should be continuously researching treatments and obtaining continuing education credits to stay updated on the newest technologies in ABA. 


In conclusion, as a behavior analyst I want recipients of ABA and their caregivers to be well-informed. Knowing your rights as a client will hopefully help you to make a more informed decision about the

treatment that you or your loved one is receiving. 


For a copy of this article in its entirety please refer to the Journal of Applied Behavior Analysis 1988, 21, 381-384.

Behavior Analysts Certification Board

June 22, 2019

Professional and Ethical Compliance Codes for Behavior Analysts 


Board Certified Behavior Analysts (BCBAs) are bound by 10 professional and ethical compliance codes. This information is valuable to clients and their caregivers. Please consult the Behavior Analyst Certification Board at https://www.bacb.com/ for further information. 


Responsible conduct is the first code and states that BCBAs will rely on scientific knowledge from professional sources such as the Journal of Applied Behavior Analysis. BCBAs are required to seek empirical evidence for research and interventions. This code also states that BCBAs will work within the boundaries of their competence and seek continued education and supervision for cases that are out of their scope of expertise. In addition, BCBAs must display integrity in their professional and scientific relationships. BCBAs must not discriminate, harass, or demean those with whom they have entered into a professional relationship. Multiple relationships are also prohibited, meaning that a BCBA cannot enter into a professional relationship with a friend or relative. In addition, behavior analysts must maintain professional relationships by not becoming personal friends with clients and their families. A BCBA must not exploit a professional relationship such as by requiring a supervisee or employee to do work that is outside the scope of behavior analysis. 


First and foremost, a BCBA has a responsibility to their clients. BCBAs should only take on a client if they feel confident that they can help them. Consultation is an important aspect of behavior analysis and BCBAs must schedule appropriate consultation times. As a guideline, a client should receive consultation time that is equal to 10% of their ABA therapy hours. Many clients who seek ABA Therapy are receiving additional services such as Occupational Therapy or Speech and Language. A BCBA should cooperate with other disciplines in order to deliver the best care to clients. If a conflict should arise, the BCBA should do their best to resolve conflicts in a way that is beneficial to the client. The client may request access to the credentials and background check of the BCBA at any time. Maintaining confidentiality is imperative when creating, accessing, and storing client information. Behavior analysts are responsible for maintaining client confidentiality and taking precautions against divulging identifiable information about the client. If at any time the BCBA does have to disclose client information, it should only be in those instances where not doing so would mean the risk of imminent harm to the client. For example, if a BCBA had knowledge of neglect or abuse they would be required to alert authorities as a mandated reporter. Clients have the right to appropriate and effective treatment and BCBAs must advocate for the appropriate amount of intervention needed. BCBAs also have a responsibility to use best practices as defined by the law for documenting professional work and must keep client records for 7 years. In addition, all contracts, fees, and financial arrangements must be defined by the BCBA and must be agreed upon with the consumer before services begin. When the BCBA bills for services rendered they must submit accurate billing details. In addition, a BCBA is not allowed to give or accept money or gifts in return for referrals. If a behavior analyst must interrupt or discontinue services it is the responsibility of the BCBA to act in the best interest of the client to avoid the disruption of services as BCBAs do not abandon clients and/or supervisees. 


One of the fundamental duties of a behavior analyst is to assess behavior and relay this information to caretakers and insurance companies in a responsible way. Before a BCBA can make a recommendation for treatment intervention they must first assess the target behavior using various methods including interviews, observations, and standardized measures. If a BCBA suspects that a target behavior may be due to a medical condition, they must recommend a medical consultation before continuing with a behavioral intervention. Behavior analysts must obtain consent before conducting an assessment and must explain the results of the assessment. Finally, behavior analysts must obtain consent before disclosing records to insurance companies. 


Behavior analysts spend much of their time preparing behavior change protocols for their clients. According to the professional and ethical compliance code, these behavior change protocols must be conceptually consistent with behavior analytic principles. Behavior analysts create individualized behavior change programs designed for the client and involve the client in the planning of such programs. The BCBA must obtain the approval and consent of the client before the implementation. The BCBA must also describe the objectives of the behavior change program as well as the conditions under which the goals of the behavior change program will be met. If there are environmental conditions that hinder the success of a behavior change program the behavior analyst must seek to eliminate any barriers to the success of the program. While behavior analysts use reinforcement procedures whenever possible, there are instances where it may be more beneficial to implement a punishment procedure. Under these conditions, the behavior analyst is obligated to provide more training and supervision to those who are implementing the procedure as well as create a plan to discontinue aversive procedures as soon as possible. In addition, BCBAs are obligated to use the least restrictive procedures and avoid harmful reinforcers. Behavior analysts must also describe criteria for the discontinuation of services once goals have been met and it is appropriate for the client to transition out of ABA therapy. 


Behavior analysts often supervise students who are training to become behavior analysts as well as the Registered Behavior Technicians (RBTs) who work one-on-one with clients. It is important that the BCBA only take on the number of supervisees that they feel confident to oversee. In addition, the BCBA should only delegate tasks to supervisees that are behavior-analytic in nature and within their scope of training. The behavior analyst should also design effective supervision and training and provide systematic feedback throughout training. 


Behavior analysts have an ethical responsibility to the profession of behavior analysis as well as to their clients and supervisees. It is imperative that behavior analysts uphold the values, ethics, and principles of behavior analysis. Behavior analysts must also make their research information available in order to contribute to the scientific community.

Behavior analysts also have an ethical responsibility to their colleagues and must promote an ethical culture in their professional endeavors. BCBAs are mandatory reporters and must work to protect clients. In the event that a behavior analyst learns of an ethical violation perpetrated by another BCBA they must make a formal complaint with the Behavior Analyst Certification Board (BACB). 


Behavior analysts are obligated to maintain professional and ethical standards by avoiding false or deceptive statements. Behavior analysts should not use non-ABA methods. When a BCBA uses the intellectual property of another they must give credit to that person. They must also identify paid advertisements and refrain from uninvited soliciting. If a BCBA addresses the media they must not give false information or violate the confidentiality of their clients.

 

Behavior analysts must adhere to the ethical code when conducting research. A BCBA may conduct research for a variety of uses. Research must be conducted in a responsible manner and conform to laws and regulations. Behavior analysts must obtain informed consent, protect the identity of clients involved, and debrief all involved parties at the conclusion of the experiment. In addition, they must acknowledge contributions and confirm the accuracy of their data. 


Finally, behavior analysts have an ethical responsibility to the Behavior Analyst Certification Board. This code states that the BCBA must provide truthful and accurate information to the BACB and update their information in a timely manner. A behavior analyst must also stay in compliance with the BACB supervision code and review it regularly to maintain familiarity. Behavior analysts must also discourage misrepresentation by non-certified individuals.


In-Home vs. Center-Based Therapy

July 14, 2019

Is in-home or center based therapy the right placement for your child? In the Michiana area it is more common to find ABA services in a center, however, this may not be the preferred option for your child. It is important to start ABA services soon after receiving a diagnosis as the sooner a child begins ABA the more likely they are to get the maximum benefits. Whenever possible, it is most beneficial to clients to have their parents and caretakers involved in their therapy. Spectrum Behavioral Services realizes the parent is the child's first and most effective teacher. When a client receives services in-home the behavior analyst and behavior technicians are able to teach the methods we use to direct behavior change. In-home therapy is also a more convenient option as there is no need to make an appointment to visit the clinic. Parent trainings are also provided in-home by the behavior analyst who can teach the principles of ABA in the child's natural environment. Therapy can also be conducted in the community such as play groups, the grocery store, and church to promote generalization of skills.