Protecting The Future Of Our Field
Originally posted at www.bsci21.org/protecting-the-future-of-our-field/ on July 26th, 2017.
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When a company hires a BCBA that has passed their exam and met all other requirements from the BACB, they expect to be hiring a quality therapist that will provide ethical and effective therapy. When a family, new to Applied Behavior Analysis (ABA), is introduced to their BCBA, they assume that person has the education and experience to do what’s best for their child. When a direct treatment staff is assigned a program supervisor, they assume they will be trained and supervised appropriately to do their job correctly. All of these assumptions are not guaranteed, and can lead to negative generalizations about our whole field instead of the single BCBA.
The blog post “Why I left ABA” is a prime example of this generalization and leads to inaccurate judgements about ABA. However, the issues brought up in this article and others like it, are not issues with our field, but with the BCBA’s or BCaBA’s supervising the programs. The above post, written by an ABA therapist, shows evidence of using extinction procedures without providing functionally appropriate replacement behaviors, using unnecessary physical restraints, and a lack of training on the programs they were asked to run. Each of these are valid concerns and would require immediate investigation by the company this author worked for, but the person responsible for these issues is the BCBA, not the whole field of ABA. Whether it is due to insufficient education, inadequate experience and training during supervision, or a disinclination to the hard work needed to do our job well, the BCBAs that are inspiring this trend of associating ABA with harmful practices are damaging the future of our field and our ability to be taken seriously as scientists and practitioners.
What are the responsibilities of a BCBA?
When you’re hired at a new company, you are undoubtedly handed a slip of paper describing your job responsibilities. While this lists out your responsibilities to your company, you are also required by the Behavior Analyst Certification Board (BACB) to uphold certain standards, such as the following:
Supervision of behavior therapists: Supervision of our direct treatment staff is one of the most important aspects of our job as they are the ones implementing our programs and collecting the data. Registered Behavior Technicians (RBTs), need to be supervised for 5% of their direct therapy hours each month, which includes live meetings, and in-person or video chat (“Maintaining the RBT Credential, BACB”). The supervision needs to improve and develop their skills as an RBT. While review of materials counts towards supervision, sitting in an office reviewing their material while hardly ever seeing the RBT in person is not “effective behavior-analytic supervision”. And providing in-person supervision while sitting on your computer not interacting with the behavior tech is not “effective behavior-analytic supervision” (“Responsible Certificants, BACB”). We need to provide structured and regular feedback, model implementation of programs and behavior plans, and expand their knowledge and understanding of ABA. (Ethical Codes 4.09, 5.04, 5.06, 5.07)
Direct Caseload Supervision: While there is not an official ethical code or guideline to say how many hours of supervision we should provide for our clients, the BACB has offered a resource tool, “Practice Guidelines for Autism Spectrum Disorder”, which address this, and other concerns. The guidelines recommend two hours of supervision for every ten hours for direct therapy, with at least 50% of the supervision being direct. Direct supervision includes observing implementation of programs, checking treatment integrity, and teaching staff and caregivers how to implement programs. If we are not present in our client’s sessions, so many opportunities for training and improvement are being lost.
Data and Graphs (aka Indirect Caseload Supervision): In my first ABA course at Florida Institute of Technology, Jose Martinez-Diaz told us, via pre-recorded video, that if we’re not collecting and graphing data on a regular basis, then we are not doing ABA. That really stuck with me and when I see graphs that haven’t been updated for several months or only cumulative targets graphed instead of individual programs, his voice comes back into my head. The BACB also has something to say about this topic in the “Practice Guidelines for ASD” and the Ethical Code. Indirect supervision should include summarizing and analyzing data at least weekly. Section 3.01b states that BCBAs need to collect and graphically display data that allows for decisions and recommendations to be made. If you are working with month-old data or graphs that do not show individual programs or targets, you cannot make these decisions.
Individualized Programs: One of the main obligations that distinguishes the BCBA’s position from the direct treatment staff is the qualification and education to assess and create programs/goals for our clients. Our therapy must meet the criteria set forth by Baer, Wolf, and Risley, in their 1968 article, “Some Current Dimensions of Applied Behavior Analysis”. This includes being applied (relevant to the client and their family), conceptual (based on the science of behavior), and effective (proven to make socially significant results). We must write unique and individualized programs for each client to help them improve their ability to function independently and participate in the world at a level appropriate to them. This does not mean transforming each section of the VB MAPP into a goal and copying across all of your clients. Sometimes we will need to focus on sections of an assessment, but the goal of a BCBA should be to improve the life of our client, and not improve their test taking abilities. Both the ethical code and practice guidelines require that our programs are individualized for each client. (Ethical Codes 4.01, 4.03)
Effective Programs: We need to make sure our programs are effective. We won’t know if they are unless we are graphing and analyzing data on a regular basis. Analyzing the data is more than just looking at a line on a graph. We need to look at the trend of our data, include information about outside variables, and make changes if our data is remaining stable or decreasing in progress. Most of the time this means seeing the program being implemented to understand why it’s not working and making changes to increase the effectiveness of your therapy. This is important for programs that are struggling, but also for tracking mastered goals. If a goal has been mastered two months ago and we are still working on it as a regular program because the data sheets weren’t updated, two months of valuable, and often expensive, time has been wasted. (Ethical Codes 2.09, 4.01, 4.03)
What to do if a BCBA is not following Ethical Guidelines
So what should we do if someone we work with is not performing according to the rules and recommendations from the BACB? That depends on what your position is…
RBT Perspective: First and foremost, know what you should expect from your supervision by reviewing the RBT supervision requirements and the ethical code. If you are unclear about why you are working on something, ask questions, and if needed request additional support or training. Be sure to document all of your questions and requests for support. If your attempts to get assistance are left unanswered, take your questions and documentation of requests to someone higher up. What if you are being asked to do something that is clearly against the Ethical Guidelines? Communicate the situation to the Clinical Director, to the HR staff, and if the situation is not dealt with appropriately, to the BACB.
Co-Worker Perspective: Section 7.0 of the Ethical Guidelines deals entirely with the issue of working with colleagues that may not be meeting their ethical obligations. We should always be promoting an ethical workplace by offering assistance and modeling appropriate behavior to hopefully decrease the incidents of unethical behavior. If BCBAs are found to be in violation of our ethics and are not causing harm or legal violations, you should try to informally resolve the issue by bringing it to their attention, then reporting them to their supervisor or employer if it is not resolved. If someone is causing or has the potential to cause harm or is doing something illegal, they need to be reported to the appropriate authorities and the BACB.
Company Perspective: The first step as a clinical director or manager is to determine if there are any ethical violations occurring. Become familiar with the “Practice Guidelines for ASD” and the Ethical Code, get feedback from behavior therapists and parents that work directly with BCBA, and observe what their sessions look like. Identifying high and low performing supervisors through observations or surveys may help to identify what is working and what is not. Setting up a mentorship program between those groups could provide the support needed to improve their ethical practices. Performance feedback should be given regularly and it should be about the quality of supervision, not just the billable hours. Be clear and honest about their work and let them know what the expectations are from the company as well as the BACB.
Offender Perspective: What if you are the one that is not following our ethics or best practices guidelines? Seek out and be receptive to feedback from others. It’s easy to get defensive when you’re told something you’ve been doing for years is wrong, but be open to what others are telling you and educate yourself in the areas you’re having trouble with. It is important that we don’t accept clients that require experience or knowledge that we lack. If you have made a serious violation that has impacted others, it is best to self-report the incident to the BACB within 30 days. (Ethical Codes 1.02, 1.03, 2.01, 10.02).
Regardless of the ethical dilemma you face, you can analyze it and come to a decision using Bailey & Burch’s (2016) seven-step model for evaluating ethics situations in their book “Ethics for Behavior Analysts”.
Is the incident covered by the ethics code? Be sure to review the sections relating to integrity professional conduct. Even if an issue isn’t direct listed in the ethical guidelines, it may be covered by a more general code.
Identify the players. Identify all the people that are involved in this issue, including the client, parents or family, supervisor, agency, and insurance company or other organizations.
Have contingency plans in place. Your first attempt to deal with the issue may not be successful, so you need to plan ahead and have multiple plans in place if your initial attempt does not work.
Have the skills and clout to handle the dilemma. You need to have the assertiveness, communication, and leadership skills to effectively deal with people that may be higher up than you and the ability to handle the situation if they become difficult or defensive.
Evaluate the risks. Dealing with the ethical issue may carry risks to some of the players. You may risk losing your job or you could be risking the client’s access to treatment. Make sure you are ready for the risks of the plans you have decided on.
Prepare for implementation. Consider the plans you’ve made and the risks associated with each. Determine the best one to start with and the best time and place to present your concerns to the relevant player.
Evaluate the outcome. Take notes on what happened and continue to monitor the situation. Your notes will help you in future ethical issues you encounter and if you are ever called into a legal dispute regarding the case.
In 1982, Skinner posed the question “Why are we not acting to save the world?” with behavior analysis (Skinner, 1982). In the 30+ years since then, our field has come a long way, but as career opportunities for behavior analysts grow, we need to make sure we are growing with quality, not just quantity. Behavior analysts have the ability to improve the lives of so many people, even beyond those with autism, but if we continue to produce behavior analysts with uncertain expertise, our expansion is going to limited by our lower performing colleagues.
Thank you to Jeremiah Anzualda, B.A. and BCBA student at the Chicago School of Professional Psychology for his ideas and contribution to the “What to do if a BCBA is not following Ethical Guidelines” section.
References
Baer, D.M., Montrose M.W., and Risley, T.R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91-97
Bailey, Jon S., Burch, Mary R. Ethics for Behavior Analysts 3rd Edition. New York; London: Routledge, Taylor, and Francis, 2016.
Instructions for Responsible Certificants. Behavior Analyst Certification Board. Retrieved July 8, 2017 from https://bacb.com/responsible-certificants/
Maintaining the RBT Credential. Behavior Analyst Certification Board. Retrieved July 8, 2017 from https://bacb.com/maintaining-rbt/
Practice Guidelines for Autism Spectrum Disorder 2nd ed. Behavior Analyst Certification Board. Retrieved July 8, 2017 from https://bacb.com/asd-practice-guidelines/
Professional and Ethical Compliance Code for Behavior Analysts. Ver. March 21, 2016. Behavior Analyst Certification Board. Retrieved July 8, 2017 from https://bacb.com/ethics-code/
Skinner B. F. Why we are not acting to save the world. (1982, August). Paper presented at the 90th annual convention of the American Psychological Association, Washington, DC.
Steph (May 22, 2015). Why I Left ABA. Socially Anxious Advocate. Retrieved July 1, 2017 from https://sociallyanxiousadvocate.wordpress.com/author/anxiousadvocate/
Verified Course Sequences (2016). Behavior Analyst Certification Board. Retrieved July 8, 2017 from https://bacb.com/verified-course-sequences/
