Scenario

Work space sharing is becoming an efficient way to share resources among hospitals and other business models. Do we have any ethical guidelines regarding shared work spaces among two companies that provide similar ABA services in a private property? We can address the confidentiality issues but we wanted to make sure we did our due diligence in preparation for a possible space sharing situation.

Response

• Committee Input (e.g., considerations for pathways forward, potential barriers, potential solutions): 
• • The committee input is provided based on the assumption that the shared workspace being referred to, is an outpatient treatment facility. 
  • • Additional privacy measures such as computer privacy screens, using abbreviations during phone calls and keeping files securely, considering schedule rotations/shifts to minimize client overlap 
    • Additional consents to consumers 
    • Posted disclosures to consumers 
    • Ongoing environmental audits to ensure compliance with privacy/confidentiality measures 
• Ethics Codes (specific standards that could apply to support/oppose): 
• • 06 maintaining confidentiality. 
  • 07 maintaining records- ensuring files are locked etc.

Scenario

You obtained your Board Certified Assistant Behavior Analyst (BCaBA) certification 3-months ago. You went from working as a Registered Behavior Technician (RBT), as you accumulated your required supervised fieldwork hours, to a position as a BCaBA with the same company. Suddenly, you had more authority to make decisions regarding your clients’ treatment programs, as well as an increased case load.

Shortly after you took on your new role as a BCaBA, you met with the Board Certified Behavior Analyst (BCBA) who is supervising you to discuss expectations regarding your new position. During the meeting, your supervisor said that the company manager has a requirement that you request 10-hours per week of one-on-one therapy for each new client the company serves when submitting your requests for hours to your clients’ insurance providers. Your supervisor also told you that you will be training RBTs to implement the behavior intervention plans (BIPs) so that you can oversee as many clients as possible. From your experience working with your current clients, you realized that not every client requires 10-hours of applied behavior analysis (ABA) therapy per week and you asked, “What if each new client does not require that many therapy hours?” Your supervisor responded that it is an unwritten company policy. Suddenly, you were faced with an ethical dilemma and you had to decide how best to handle the situation. 

Response

• Committee Input: 
• • Dosage should be directly related to medical necessity (there are no set minimum/maximums of treatment) 
  • • Recommendations include bringing proposed tx plan/assessment with dosage to review specific details (why your recommendation is less than 10 hours etc.) with Supervisor and BCBA. You can address this without acknowledging the unwritten rule – simply explain your treatment plan objectively with supporting evidence to defend your recommendation (think of it as doing a live or clinical review with the Supervisor). 
  • If this is unsuccessful, you should follow the ethical decision process outlined by the BACB to help guide you in next steps/reporting requirements. 
• Exploration: 
• • Access and review definition of medical necessity from the funding source (you could also use this as supporting documentation when meeting with Supervisor) 
  • Is there another program available? For example, does the company separate out types of services (consultative, comprehensive, focused?). It this is the case, maybe the 10 hours is the cut off for the focused model but this consumer could be supported in another capacity (like a consultative model) rather than a prescriptive dosage for consumers? 
• Relevant Codes: 
• • 2.09, 3.01, 4.03, 5.03, 7.01

Scenario

I work for an ABA company that offers in home ABA services. I have three plus families that live within a couple mile radius of each other. Multiple parents have asked me if I know of any other children or families around that are similar age skill set etc. The parents are wanting to have a play date / create a friendship with another child with autism. I have not disclosed any information about other families due to HIPPA to the families that are asking. 

How can I assist these families that have expressed wanting to connect with each other without violating HIPPA? If i give phone numbers or names I am violating their privacy even though they have asked me to do this?

Is it covered in an roi? Can there be a special roi? How can I make sure I am protecting privacy but also assisting me families create a supportive community with each other? What do others do to connect families? 

Response

• Committee Input: 
• • Parents can sign ROI so that emails can be exchanged and then they can coordinate it 
  • Suggest Facebook groups 
  • Create a social group; collect the ROI prior 
  • You would want to be careful connecting those clients (future implications/relationship doesn’t go well, how does this impact rapport etc.) 
• Exploration: 
• • Have the parents check Facebook groups, NextDoor app, peanut app or direct them to your agency’s Facebook page to post for playdates. 
• Codes: 
• • 2.06; 2.08

Scenario

Client that is being billed through insurance by the Agency that I work for is being accepted into college courses. He would like a letter of recommendation from his supervisor for some scholarship opportunities. Is it ethically appropriate to provide a letter for his college? What would be precautious steps to take in the event that we can provide a letter? Would this be better to provide during billable or non-billable therapy/supervision? What are some possible HIPPA considerations? Ethical issue: Dual relationship, Monetary concerns (if client receives scholarship for college), Billable/non-billable/spare time concerns.

Response

• Committee Input: 
• • Potential dual relationship issue 
  • Can the client give their own consent to be able to release of PHI? 
• Exploration: 
• • Avoid the multiple relationship. “Our ethical code states that” 
  • Coaching the client through asking other teachers/professional people 
• Codes: 
• • 1.06B; 1.07A

Scenario

A school district posted a job opening for a BCBA, and said they would take someone non-certified, as long as the person pays for their own supervision. Would another district BCBA still be responsible for providing supervision, especially during the time between supervision ending (1500 hours completed) and time of certification? 

Response

• Committee Input: 
• • What would the BCBA doing within their job? 
  • What is the job description? If candidate is a supervisee, supervision is required 
• Exploration: 
• • Ensure that you are not mis-representing the credential. 
  • Be careful of dual relationship with the supervisor. 
  • Behavior Analysts in the school typically have large caseloads, would they have the support to take on additional supervisees? 
  • Make sure your contract is clearly written about support of supervision/payment 
  • Plan how you are going ensure support 
• Codes: 
• • 10.7; 6.0; 5.05; 8.03

Scenario

I am a founder and executive director for a school for children with ASD. We have a female HS student who has an iPhone with access to her own social media accounts. She is very socially motivated. She comes from a single parent, low SES home. Her mother can be challenging to work with. We have found recently on her phone inappropriate content. Solicitations for attention from men that we don’t think she knows…your basic nightmare. Obviously the first step would be making her mother aware of this, but I highly suspect that won’t go anywhere.  I will still do that as a first measure.  Is this a CPS call? What social services might be available to ensure this student is safe? She is obviously an extremely vulnerable young adult.

Response

• Committee Input: First step includes meeting with parent, disclosing content that was found on phone and the nature of how the content was discovered. Invest in sex ed curriculum (evidence based)/programming available to remediate maladaptive behavior and increase skills. Provide recommendations to parent for monitoring/parental controls (ie. Disney Circle). Establish open communication between parent/school site to support ongoing check-ins on status. 
• Exploration: Policies and procedures related to reasonable permission to review social media account of students. Parental consent to access student phones/accounts. Consider including policies and procedures around access to technology/consent at onset of services? Consider level of permission. Collaborate/reach out to attorney to determine what is within limits of law etc. Reach out to third parties for staff/parent inservices/training(s) related to online safety and sex ed – PR, Specialists (therapists, online safety specialists) and PD. 
• Codes: 2.05, 4.02

Scenario

Using testimonials on website, no disclaimers

Response

• Committee Input: Reach out to organization’s leaders (BCBAs) as soon as possible to resolve (lead with education). Provide guidance on code and potential action items. Follow up on website/with BCBA after initial conversation. Document actions taken (include dates) 
• Exploration: If parents wrote the testimonial, consent is implied to use names; Are owners BCBAs (yes). Who is managing the solicitation/posting of testimonials (owners should provide education regarding the PECC)? 
• Codes: 8.05; 2.06;

Scenario

I got in a car accident today in front of a client’s house. The client’s mom came outside after she heard the accident and saw the position of the cars. I had to move my car because I was blocking the street. Would it be appropriate if I ask her if she could be a witness? Or would that be an ethical violation? I have to go to court in February. When the police officer asked if I knew the client’s mom I told him I couldn’t answer that because of HIPAA.

Response

• Committee Input: Protection of the consumer (PHI) as intention; as a “witness” there is no obligation to disclose nature of professional relationship.
• Exploration: What aspects of HIPAA are related to incident (where is the breach)? What is the nature of the professional relationship/context/environmental factors? Impact on harmful effects of multiple relationships – is this applicable in the specific situation? How does that relationship impact whether or not to request support? Check organization’s internal policies and procedures; reach out to internal HR or HIPAA Officer for guidance (incident report??). 
• Codes: 1.06

Scenario

Our school has been bit by RPM…HELP.  One parent went to a conference on RPM and has come back convinced that she has been undervaluing her son’s intelligence. She’s making somewhat extraordinary claims about what he is communicating with his RPM instructor, and sort of implying that we should be instructing him differently at school.  We’ve been clear that we cannot change his goals unless we see him displaying those skills at school.  In one week, we now have another family saying that they heard about it and are starting RPM as well and are “expecting a miracle.” I’m thinking about the Bridget Taylor Compassion article, and I want to ensure I don’t get on my BCBA high horse and refuse to listen. At the same time, these families want us to watch several hours of video of the student in RPM sessions and attend a conference too. Obviously, we aren’t willing to invest our time into learning about something we are opposed to.  I am trying to find the words to lovingly and respectfully help these parents to understand that there is no evidence to support this treatment and it may even be harmful.  I imagine thinking you are “hearing” your child’s voice for the first time is incredibly reinforcing, and they aren’t likely to walk away from that.  Any tips on how we can help this family, and what to say to the other families that may reach out to us about it? It seems to be spreading :/

Response

• Codes to Consider: 1.01; 1.02; 2.09 
• Committee Input: 
• • Approaching the topic in an un-biased way by finding the literature of the topic to share with families. 
  • • Ask questions: Address how to fade the prompts in a systematic way. Is there specific procedure or protocol available? How will this be functional? 
    • Discuss generalization and functionality of this mode of communication. 
  • ASHA sent out statement not supporting RPM (discuss with speech therapist, family, team members etc.). 
• Exploration: 
• • First watch the videos that the parents are wanting to show, then have the conversation of effective treatment and evidence-based treatment. 
  • Consider conversation about prompt fading 
  • Pull in the other professionals (speech, OT etc.) to be a united front/share information from varying perspectives 
  • Addressing the community as a whole about communication, provide educational opportunities for families?. 
  • Data collection on the student using it with different people or in different environment. There may be other data already collected on problem behaviors to show that this intervention is not benefitting the student. 
  • Using the individual that has the most rapport with the family to be able to have this conversation.

Scenario

There are currently 3 BCBAs on the staff at my current site. 2 of the BCBAs are licensed and one of us is working on getting licensed, we are all certified. The 2 BCBAs that are licensed are relatively new to this site and have not mastered the work that we do. We have a few supervisees that require supervision. Per the BACB, a supervisee is expected to have 2 client observations supervised as well as individual supervision meetings. Is it ethical to have the unlicensed but certified BCBA who is an expert in session run client observation audits while the other 2 BCBAs provide independent and group supervision on the task list that they are experts in? Currently we are having only the licensed BCBAs provide supervision. However, this is leading to staff burn out and may not be appropriate according to 5.01 and 5.04 ethical compliance codes.

Response

• Codes to Consider: 5.01, 5.02, 5.03, 5.04, 5.05 
• Steps to Explore: The credentialing LBA vs BCBA doesn’t appear to be an ethics concern as long as the nature of the supervision and consequences of such are disclosed to the supervisee; it would fall under a barrier to licensure. The hours by the unlicensed person would not count pursuant of licensure in AZ. Those hours would have to be accrued under an LBA when acquiring licensure. However, delegation of tasks in relation to supervisor scope of practice and scope of competency should be taken into consideration. Unlicensed BCBA can still support supervisees in areas of expertise (outside of formal supervision). Assess appropriate supervisee volume/capacity- provision of effective supervision.