1 Schedule Lecture: Today and Thursday – Certification and licensing of behavior analysts – Professional ethics Exam & Assignment: Tuesday, 4/15 –15 points:

1

Schedule

• Lecture: Today and Thursday– Certification and licensing of behavior

analysts– Professional ethics

• Exam & Assignment: Tuesday, 4/15– 15 points: completion of the on-line

training program – 20 points: exam over certification and

licensing, and professional ethics

2

Schedule

• Thursday, 4/17– Return of E8– Special grade sheet for ME2, can you benefit from

taking ME2, and if so how many pts do you need?– ME2 study objectives handed out– No lecture– Good day to do course evaluations during class time

3

Schedule

• Make-up Exam 2 (Units 5 - 8)– Monday, 4/21– 12:30-2:30 PM: Be here at 12:30!

• I will not permit anyone to start the exam after a student has finished or left the room with the answers

• You will receive a zero on the exam if you come late and ask to start taking it after a student has left the room with the answers

4

Unit 8: Online Ethics Training Program• Online Training Program: citiprogram.org

– You must hand in a computer print out that you have completed the online training on the day of U8 exam (no electronic copies via email)

– For the computer print out – MODULES COMPLETED, which lists the score you received on the quiz for each module

• If you have already completed this training, you only need to print off a copy of the page that indicates that you have completed it. You don’t need to do it again.

– Completion criterion: average of 80% across all quizzes.Important:Quizzes can be retaken at the end of the module, but you cannot go back and retake quizzes after you have told the program you have finished the quiz/module and have moved onto the next module. Thus, you must monitor your quiz scores as you move through the program to make sure you don’t come up short of an average of 80%.

(cont. on next slide)

5

Unit 8: Online Ethics Training Program

– If you do not hand this in on (or before) the day of E8 - no credit. I will not accept late assignments.

– See study objectives for grading criteria– See study objectives for instructions on logging onto the training

program

6

Certification vs. Licensing

• Certification is voluntary, licensing is legally required• The Behavior Analysis Certification Board is the organization that

certifies behavior analysts (it is independent from ABAI)• Individual states pass license laws, in contrast

– Because of this, just like the license laws for clinical psychologists, those laws vary from state to state

– Compliance is overseen by licensing boards established by the state

– There are legal penalties for violating these laws• National certification began in 1998• Licensing has begun only recently, but

– 10 states now have licensing laws– 9 additional states have laws pending/in process– A MI law is currently being drafted by the state legislature

(encountering some controversy and confusion over the licensing laws because they are so different fromstate to state, and we are just beginning to see some of the problems/ramifications, more on that later)

7

Certification

• Certification was developed to meet the needs of behavior analysts, state governments, and consumers: who is qualified to do and call themselves a behavior analyst?– Sets “minimum” standards for behavior analysts

• Certification is voluntary, not legally required– That is, you do not have to be certified to call yourself a behavior

analyst or practice behavior analysis• Primarily relevant for those who work in human services (work with

children diagnosed with autism or children and adults with developmental disabilities)– Thus, behavior analysts who work in other fields, such as

organizational behavior management and applied animal training, often do not seek certification

8

Certification

• While not required, almost all human service organizations that provide behavioral services to at-risk individuals require employees with an MA or Ph.D. to be certified in order to be hired– If you are planning on working in human services, you should

plan on becoming certified– At this point, direct care staff and technicians do not have be

certified, but the BACB is initiating a new credential: Registered Behavioral Technician

9

Certification

• Two levels of certification– Board Certified Assistant Behavior Analyst (BCaBA)– Board Certified Behavior Analyst (BCBA)

• Added a BCBA-D to signify doctoral level with a minimum of 10 years of experience post-Ph.D.

10

SO1: Requirements for Board Certified Assistant Behavior Analyst

A. BA degree in a related field:Does not have to be in behavior analysis or psychology

B. 180 hours of specific coursework in behavior analysis (following details not required for the exam)

1) Ethics (hence this unit): 15 hours2) Concepts and principles: 45 hours3) Research methods: 15 hours4) Applied behavior analysis: 90 hours5) Discretionary: 15 hours

(Requirements fall into five categories; hours are not credit hours but contact hours)

11

SO1: Requirements for Board Certified Assistant Behavior Analyst

C. Experience requirementNFE: This ranges from 500 to 1000 hours of supervised experience depending upon the nature of the experience and intensiveness of supervision. Supervisor must be a BCBA.

D. Pass the certification exam administered by the BACB

12

SO2: Before applying for the exam which of the requirements must be met?

• All of the other three– BA degree*– 180 hours of coursework in behavior analysis– Experience requirement

*Don’t forget this one if I ask this on the exam

13

SO3: When you graduate from WMU with a BS in the behavioral science major, which requirements are met?

• Only the bachelors degree requirement• Not for exam:

– The BACB has approved a sequence of our graduate courses, however, we have not, to date, sought approval for our undergraduate courses

– Most of our students get certified only after obtaining their MA degree and often skip BCaBA certification and go straight to BCBA certification

– It is hard to acquire the experience requirements necessary to become certified at either level while in school

• Time and effort it takes the students• We do not have sufficient faculty to supervise all of the students who might

like to fulfill this requirement

– Some MA programs, such as UNT, do require students to fulfill the experience requirement as part of the MA, but that increases the number of credit hours required to complete the degree; 45-48 credit hours, compared to 36

14

SOs 4 and 5

4A. How long does the original certification last?• 2 years

4B. What must be done to maintain certification?• Renew certification each year by application• Apply for recertification after 2nd year

SO5. What are the recertification requirements?• Complete 20 hours of continuing education every two

years (4 must be in ethics)or• Retake and pass the certification examination

15

SO6: Requirements for certification as a Board Certified Behavior Analyst (BCBA)

A. MA degree in (a) behavior analysis, psychology, or education or (b) a degree program that has a couse sequence approved by the BACB

B. 270 hours in specific course work at the graduate level in behavior analysis (a sequence of our graduate level courses have been pre-approved to meet this requirement)

C. Experience requirements (750 - 1500 hours of supervised experience)

D. Pass the certification exam

16

SO7: Not for ExamRenewal and Recertification: Similar to BCaBA*

A. How long does the original certification last?A. 2 years

B. What must be done to maintain certification?A. Renew certification each year by applicationB. Apply for recertification after 2nd year

C. What must be done to obtain recertification after 2nd year?A. Complete 32 classroom hours of continuing education in

behavior analysis (4 must be in ethics) orB. Retake and pass the certification examination

*The only difference between BCaBA and BCBA, number ofCEUs required. If a BCBA is supervising individuals pursuing certification, he/she mustalso complete 3 credit hours of supervision as part of the CEU hours.

Licensing

• Historically, the purpose of licensing has been to protect the public from incompetent professionals (charlatans)

• Within psychology and human services, the laws are primarily designed to protect at-risk individuals– Clinical psychologists have to be licensed– School psychologists have to be licensed– Typically, I/O psychologists do not

17

SO8: Two main reasons for BA license laws

• To protect at-risk individuals and integrity of the field of behavior analysis in general– Push for licensing came from behavior analysts who

work in human services or with other at-risk individuals

• States began to pass autism insurance laws to cover ABA services– Needed a way to determine who was competent to

provide those services and thus (b) who could receive reimbursement

18(these laws do not pertain to the experimental analysis of behavior; directed at applied services)

SO9: Two main types of license laws

• Broad title and/or practice laws– You cannot call yourself a behavior analyst and/or

practice behavior analysis unless you are licensed• Six states have passed this type of law

– Arizona, Kentucky, Massachusetts, Missouri, Virginia, Wisconsin

• Restrictive laws– Only behavior analysts who provide services to autistic

children and/or individuals with pervasive behavioral disabilities need to be licensed

• Four states have passed this type of law– Nevada, North Dakota, Pennsylvania, and Rhode Island

19(the wording of the laws do differ, and others might object to my categories, but I am attempting to just give you a broad overview – things are complicated right now. First type are controversial)

NFE: “Oddities” and other regulations

• Title license law: Wisconsin– You can practice behavior analysis without a license but

you cannot call yourself a behavior analyst

• No law: Certification is sufficient: W.VA. (6/12)• Regulations specifically tied to autism insurance

laws (some are written into the insurance laws)– Autism service providers that provide ABA do not have

to be licensed but must be board certified in order to be reimbursed

– 16 states have these type of regulations

20

NFE: How will these laws affect you?

• In most cases, the licensing process is the same as the certification process– Some laws require certification to be licensed – Some laws permit licensing of individuals with equivalent training and

experience– Regardless, if you are certified, in most states you will immediately

qualify for licensing

• If you plan to work in human services, you should become certified– You will meet the legal requirements for licensing in states that have

license laws – You will meet the regulatory requirements in states that don’t have

license laws and have many more job opportunities

21

(basically, the states have determined that the certification process is already a good process, no sense creatingsomething new, cont. on next slide)


If you plan to work in applied areas other than with at-risk individuals, keep tuned, but my best guess is that you will not need to be licensed (or certified). But I could be wrong.– The BACB created a model license law to help states

develop appropriate wording– The first model law was a broad title and practice law,

thus that is what many states passed– Based on concerns expressed by some behavior

analysts the model license law was revised in 10/12• One of the revisions was potential exemption for behavior

analysts who practice with “nonpatients” for states who wish to adopt that language

22


The exemption language for states that wish to adopt it:

A behavior analyst who practices with nonhuman or nonpatient clients and consumers, including, but not limited to applied animal behaviorists, and practitioners of organizational behavior management.

Thus, if states adopt this language, the laws would fall into the category of “restrictive laws” – laws that only cover applied behavior analysts who work in clinical settings.

23

(moving forward, I expect most states will adopt this language; hard to know what will happen in thosestates that have already passed broad title and practice laws without such an exemption)

24

SO10: Professional Ethics

• Materials in the course pack– All of the 12 ethical task statements for behavior analysts and the

certification exam – not for the 4600 exam, just FYI– Dickinson article

• Task statements (6 of the 12) for the 4600 exam• Explanations of the ethical guidelines for behavior analysts

relevant to each task • Case study examples

– Declaration of Professional Practices and Procedures for Behavior Analysts (to give clients before working with them – not for exam just FYI)

• Basically a contract with the client defining the responsibilities of each party – both the behavior analyst and the client

25

Exam Questions (also indicated in S10)

• I will give you a copy of the six task statements– You do not have to memorize them!

• I will ask two types of questions about these or similar case studies (give you options, e.g., answer any 5 out of 8)– Did the behavior analyst act ethically? Why or why not?– Which task statement or statements are relevant to this

case study and why? • A particular case study often involves more than one task

statement.

– Short open-ended questions such as:• What should the person in the case study do?• Is it OK for the person in the case study to start the

intervention or research, or is there something else the person must do before starting?

Ethics for Behavior Analysts, 2005, 2011

26

Mary Burch Jon Bailey

27

Task Statement 1-1

• Solicit or otherwise influence clients only through the use of truthful and accurate representations of intervention efficacy (effectiveness) and one’s personal competence (within his/her area of specialization) in applied behavior analysis.– The second part means “don’t exaggerate your

credentials/experience within your area of specialization (autism, OBM, applied animal training, etc.)

(truth in advertising; I am emphasizing this because task 2 deals with restricting activities to your own areaof expertise within behavior analysis; difference is a bit confusing)

28

Case Study 1A

Dr. B, a BCBA-D, was consulting at a residential facility for clients diagnosed with developmental disabilities that were severe enough to prevent them from living at home or in the community. This was a new client for Dr. B. and he wanted to demonstrate how behavior analysis could help the clients. One day, as soon as Dr. B. arrived, the administrator approached him and began congratulating him on successfully treating one of the most difficult clients in the facility. Dr. B. then discussed the case with the student who was helping him. The student told him that, in fact, baseline was still underway and the treatment plan had not yet been executed.

1. What should Dr. B. do?

2. Why is this relevant to task statement 1-1?

29

Case Study 1A

1. What should Dr. B. do?He should meet with the administrator and explain that no credit was due. That, in fact, baseline was still underway and the treatment plan had not been implemented.

2. Why is this relevant to task statement 1-1?Solicit or otherwise influence clients only through the use of truthful and accurate representations of intervention efficacy

30

Case Study 1BDr. G. was a school psychologist working with a private tutoring service to help children who were having trouble in school. Some of the children were diagnosed with ADHD, some with dyslexia. Dr. G. conducted a controlled study with 2 of the ADHD clients and 2 of the dyslexia clients. She found her behavioral teaching methods were much more effective for teaching these children how to read and do math than the methods being used. Dr. G. was excited as was the director of the tutoring service. The director sent press releases to several magazines and newspapers. Dr. G. found out that the director had written the following headline: “Dramatic New Advances in Education: Teaching Methods at ABC Tutoring Cure ADHD and Dyslexia.”

1. What should Dr. G. do?2. Why is this relevant to task statement 1-1?

31

Case Study 1B1. What should Dr. G. do?

She should immediately contact the director and explain that the headline was not appropriate. She should rewrite the headline and immediately contact all of the magazines and newspapers and tell them not to print the article. If it is too late to stop publication, Dr. G. should request that a follow-up piece be published correcting the misconception that it cured ADHD and dyslexia and talk about the limitations of the study (only dealt with 2 ADHD students and 2 dyslexia students, no evidence that ADHD or dyslexia were “cured.”).

2. Why is this relevant to task statement 1-1?Behavior analysts should be truthful about the effectiveness of an intervention and should not exaggerate their effectiveness.

32

Case Study 1CJake was a student in a Ph.D. program in Organizational Behavior Management. He wanted to supplement his income by consulting with local companies. Jake had an MA degree in OBM and had worked with a number of companies doing projects in classes arranged by his professors where he was supervised by both a person in the organization and the professor. He had also completed two practicum courses in organizations under the supervision of his advisor. When he developed his resume, under “experience” he listed the companies he had worked with and the projects he had completed for each.

1. Is there anything else Jake should include on his resume?2. Why is this relevant to task statement 1-1?

33

Case Study 1C1. Is there anything else Jake should include on his resume?

Yes. He should indicate that the projects were completed as part of a course, listing both the professor and on-site individual as supervisors.

2. Why is this relevant to task statement 1-1?The behavior analyst must give the client an accurate and truthful representation of his/her credentials when soliciting clients. He is exaggerating his personal competence within his area of specialization, which is OBM. Solicitation and public statements include personal resumes and curriculum vita. Without the information above, it appears as though Jake was an independent consultant for the organizations. That is misleading.

3. How does this situation apply/generalize to students applying for jobs or to graduate school?

34

Task Statement 1-2

Practice within one’s limits of professional competence in applied behavior analysis and obtain consultation, supervision, training, or make referrals as necessary.

• Unlike Task 1, this task deals with competence in other areas of behavior analysis and other professional areas– An OBM person accepting/giving advice about a child

diagnosed with autism– A person trained in autism accepting a client or giving advice

about a client who has a brain-injury– A behavior analyst making a “diagnosis” of autism – A behavior analyst making suggestions about diet and

nutrition as a way to “cure” autism– A student trained in behavior analysis doing sensory

integration, etc.

Remember: Task1 deals with one’s competence within one’s own area of specialization

35

Task Statement 1-2

• Some discriminations are easy to make, such as indicated earlier - an OBM specialist should not accept an autistic child as a client or give advice about how to deal with an autistic child (or vice versa)

• Some discriminations are harder to make• A student who is/has taken general behavior analysis courses: If

that individual is also an athlete, I see no problem whatsoever with that individual working with a local coach of an athletic team, a health club, or a senior citizen’s home that has an exercise room for its residents and encourages them to develop exercise programs (however, recognizing the need for medical approval first)

36

Case Study 2A

Martin, a BCBA, moved to a new city to work at a large long-term care facility for adults with head injuries. Martin’s past experience was limited to clients who were developmentally disabled. Some of his clients did engage in aggressive behaviors. At the new facility, Martin was assigned to work with Dan, a 23-year old who had a severe head injury. Due to the head injury, Dan engaged in violent and dangerous outbursts of aggression. Dan’s outbursts had resulted in medical treatment for a few staff members. Martin was eager to help Dan and began reading everything he could about how to treat this type of aggression that was directly due to Martin’s head injury.

1. Is there anything else Martin should be doing?2. Why is this relevant to task statement 2?

37

Case Study 2A

1. Is there anything else Martin should be doing?Even though Martin has worked with aggressive clients before, because he has not worked with clients with head injuries, he needs to consult with a BCBA who is an expert in the treatment of head injury and aggression. If there is no such person at the facility, he needs to find someone in the area to supervise him. He should do this because of the ethical issues involved; there could be liability issues as well if he does not.(ethics and law are sometimes the same; sometimes not)

2. Why is this relevant to task statement 2?Must practice within one’s area of competence and obtain consultation and supervision, if necessary.

(many of us consult with one another – recently consulted with two Ph.D. level behavior analysts inhuman service settings: one had run into a union problem with the staff that enabled the staff toimplement procedures not good for the clients; incentive system for clinical staff.

38

Case Study 2B

Melinda, a BCaBA, is working with a child in an after-school clinic affiliated with a university. The child is beginning to engage in self-injurious behavior and the parents are concerned that the behaviors may escalate into more severe types of behaviors. Melinda has implemented a behavioral program to reduce/eliminate the self-injurious behaviors. One of the parents asks Melinda, “Does my child’s self-injurious behavior indicate that he may have attention deficit disorder?”– 1. How should Melinda respond?– 2. Why is this relevant to Task Statement 1-2?

39

Case Study 2B1. How should Melinda respond?

That diagnosis is outside my area of expertise. Your child’s doctor would be better able to help you determine that.

2. Why is this relevant to Task Statement 1-2?Practice within one’s limits of professional training and education and make referrals when appropriate.

Other potential questions that may come up with a parent:Should I put my child on a special diet? Refer to pediatrician

or nutritionist and perhaps relevant literatureWhat should I say to convince the judge in my child custody

case that I am the best parent to promote this ABA program for my child? I can’t give you advice on that - I suggest you talk to your lawyer.

One of the problems here is that you may not have much time to think about your reply.

40

Task Statement 1-4: (I am not covering 1-3 from the guidelines)

Obtain informed consent within applicable legal and ethical standards.

– Provide a written description of all procedures and obtain consent from all clients before research, assessment, intervention, and changes in intervention.

– When working with clients, describe procedures in language they can understand and obtain assent if “consent” cannot be given.

(identical to informed consent for research ps)

41

Case Study 4A

Susan is a thirty-eight-year-old woman with developmental disabilities. She lives at home with her mother who is her legal guardian and she attends a vocational training program. Susan receives behavioral programming as needed. Angie is a BCBA who works with clients at the vocational program. Angie has been asked to provide behavioral services for Susan. It seems as though Susan has been spending most of her money on junk food.

Then, so that she has money, she has been asking staff to give her loans or pay her for small favors. This behavior has escalated to the point that at times, Susan has no money for bus transportation and she is making everyone uncomfortable with her begging. Because begging is not an appropriate behavior, and will interfere with Susan’s being promoted to do more complex work which could lead to a “real” job outside of the vocational training center, Angie feels that it would be okay to instruct the staff to immediately begin treating begging with social disapproval.

1. Can Angie implement this program immediately?

2. Why or why not?

3. Why is this relevant to Task Statement 1-4?

42

Case Study 4A

1. No.2. She must get consent from Susan’s mother before

implementing any program.Angie needs to outline the objectives of the behavior plan in writing for Susan’s mother and have her sign the consent form. If Mom doesn’t consent, she cannot implement the program, even if it is in the best interest of Susan to do that.

3. Why is this relevant to Task Statement 1-4?Give procedures in writing and obtain informed consent (in in writing) before implementing any research or behavior change procedure.

43

Case Study 4B

Sarah is working in a special education classroom. Students spend part of the school day in the classroom and they are mainstreamed the remainder of the day. Jessie is a tall, lanky twelve-year-old who swears and becomes disruptive in class. She is on a behavior program that worked well until recently. Knowing her clients very well, Sarah quickly figured out that Jessie was bored with the reinforcers. Sarah planned some changes in the intervention, including changing the reinforcers, reinforcement schedule, and adding consequences for misbehavior.

1. Because the behavior plan was already in effect, the goals of the program were clear, and the changes were only slight changes , Sarah was certain that all of the permission forms that were previously signed would cover the changes. Was she correct in assuming this?


44

Case Study 4B

1. No. 2. Why is this relevant to Task Statement 1-4?

When a behavior program is modified, the behavior analyst needs to explain the modifications and obtain consent again. In this case, consent would come from the parents. The changes should also be explained to Jessie.

(no BCaBA, or BCBA: that is OK; it is not unethical for a person who is not certifiedto do BA with at-risk individuals; however, it would be both unethical and illegalif the state had a license law and Sarah was not licensed.)

45

Case Study 4C

Shakira was working on her master’s degree in behavior analysis. Although not her thesis, she wanted to do some pilot research in a high school that was in a low-income neighborhood. She began volunteering at the school and she established an excellent working relationship with the principal and some of the teachers. She met with the school and got approval to conduct her research. Because this was not an official psychology department assignment and because this was a pilot study, she told the school officials that she was going to be “flexible, implementing procedures that would become apparent as the baseline data became available.” The school (the teachers and principal) said they understood the need for this flexibility and looked forward to seeing what Shakira would do.

1. Was Shakira ready to begin his pilot research after obtaining approvals from the school principal and the teachers involved in the study?

–

46

Case Study 4C

1. No. Shakira needed an approval of the HSIRB before starting any research in the schools. She would also need to obtain consent from the parents. Finally, the procedures must be planned and written. The approval from school personnel was not sufficient.

Two-step consent process: first for baseline, then for the intervention after she decided what type of program would be appropriate

2. Why is this related to task statement 1-4?

Must obtain the written consent of the participant or guardian before beginning research and also must conduct research with humans and nonhumans in accordance with the local human research board (if there is one) and the HSIRB for the academic institution with which the student is affiliated.

47

Task Statement 1-7

Identify and reconcile contingencies that compromise the practitioner-client covenant, including relationships among the practitioner, the client and other parties.• Again, sometimes this is an easy discrimination to

make, sometimes it is more difficult• Is it OK to use behavioral principles to help out a

grandparent or an ill aunt or uncle, even though you are not trained in gerontology or behavioral medicine?– What are the limits?– When would it be OK, when wouldn’t it be OK?

48

Case Study 7A

A BCBA who specializes in behavioral gerontology was asked by her sister to develop an ABA program for her their elderly mother. The sister lives about 60 miles away and the mother has a separate apartment in the sister’s house. The mother had lung surgery about three months ago. The physician and surgeon have given the mother a “clean bill of health” - that is she has no lingering medical problems. However, the mother has stopped engaging in many activities she used to enjoy, and is beginning to just sit around the house complaining – usually about the sister. The sisters have a very close relationship. The BCBA is very concerned about her mother and also wants to help her sister. She is very grateful that her sister has taken on the role of primary care-taker for the mother.

1. What is the BCBA’s most appropriate course of action?

2. Why?

49

Case Study 7A

1. The BCBA should locate another BCBA in the area and refer the sister to that individual. There is too much potential for conflict within the family - either between the mother and the BCBA or between the BCBA and her sister. This would require a long-term intervention.What if there wasn’t another BCBA in the area? What should the BCBA do then?

2. Why is this relevant to task statement 1-7?Conflicts of interest here. The behavior analyst must always be sensitive to potential harmful effects of personal and social relationships on their work and on those persons with whom they deal. Behavior analysts provide behavioral services only in the context of a defined, professional or scientific relationship role.

50

Case Study 7B

Bill was a twenty-seven-year-old, single BCBA who worked with clients and conducted research in a large state institution. Bill had a good working relationship with the local university’s psychology and special education programs. One semester, Bill found himself attracted to Kristi, one of the college students he was supervising. The attraction seemed mutual because Kristi “flirted” with Bill and made it a point to let Bill know she was single and available for dating.

1. Because the feelings seemed to be mutual, was there any problem with Bill asking Kristi for a date?


51

Case Study 7B1. Yes, of course.


Behavior analysts do not engage in dating or sexual relationships with clients, students, or supervisees; such a relationship could impair their judgment and constitute a form of exploitation as well. If Bill wants to date Kristi, he should wait until her internship is over. Also, depending on the nature of the interactions, it might be appropriate to have someone else supervise Kristi.

3. How is this relevant to student-faculty relationships? Are there any circumstances when a student-faculty relationship is OK?

4. How is this relevant to student TAs and student supervisors in practicum settings?

5. Is it OK for faculty to hire students as babysitters, handymen, and house sitters?

(changing standards -)

52

Case Study 7C

John was working with developmentally disabled clients in a day training center in a small town. He was an excellent behavior analyst and his clients not only made good progress, but liked him a lot. He met many of the parents of his clients at the training center and also in the community. John decided to apply to a Ph.D. program in behavior analysis. When he told some of the parents about his plans, they offered to write him a letter of recommendation.

1. Would there a problem if he accepted their offers?2. Why is this relevant to Task Statement 1-7?

53

Case Study 7C

1. Is there a problem if he accepted their offers?

No, he can ethically accept the offers because the parents volunteered to write the letters.


He could not ask or prompt the parents to write letters – that would be unethical. Why?

Behavior analysts do not solicit testimonials from current clients or patients or other persons who because of their particular circumstances are vulnerable to undue influence.

That is, if the parents said no, it might influence the care John gives the DD client or the parents might think if they said no, it would influence the care John gives to their children. Thus, that would create a conflict of interest.

John should get the letter from the person who supervises him at the day training center (or the director of the center).

54

Task Statement 1-8

Use the most effective assessment and behavior change procedures within applicable ethical standards taking into consideration the guideline of minimal intrusiveness of the procedure to the client.

55

Case Study 8A

Kevin is 7 years old and has mild autism. He does go to school. Several times during the day, he hits the sides of his head with the palms of his hands for 5-10 minutes at a time, but not hard enough to hurt himself. He also has trouble attending to any task for any length of time. Alicia, a BCBA has recently been assigned to Kevin’s classroom as a member of a treatment team that consists of an OT, speech therapist, and the teacher who has a certificate in special education and autism. Before Alicia joined the team, the team developed a treatment plan that consists of Kevin wearing a weighted vest. Weighted vests are very popular. It is a sensory integration procedure designed to eliminate a inattentiveness and stereotypic behavior that rare conceptually due to over or under sensitivity to sensory input. The vests are believed to provide deep pressure stimulation that has a calming and organizing effect on the central nervous system.

(cont. on next slide)

56

Case Study 8A

Alicia knows that the research literature does not support this type of intervention and that the only studies that have supported the effects of weighted vests have serious methodological problems from an experimental perspective.

However, the other members of the treatment team firmly believe that weighted vests have very positive effects. Alicia knows that weighted vests do not hurt the child (and many children seem to enjoy wearing them), but is concerned it will not benefit Kevin. The other members of the team believe that the vest is helping Kevin.

1. Given that Alicia is new to this treatment team and must work well with the team members so that she can help other children as well, what should she do given that she is clearly out numbered and her team mates are so convinced of the effectiveness of weighted vests?

2. Why/how is this related to Task 1-8?

57

Case Study 8A

1. Alicia should first politely, but firmly, explain that she has reservations about the effectiveness of weighted vests given her knowledge of the literature. She should ask the team if they would be willing to bring in data-based research articles they feel support the effectiveness of the vests, and that she will bring in articles that have formed her opinion, and they could discuss them. If they agree to this, she should then critique the articles re their experimental methodology.She should also suggest that the team evaluate the effects of the vest on Kevin’s behavior and develop a study to do that.She could also suggest that she believes the behaviors may be caused by different variables or perhaps at least partially controlled by different variables and suggest doing a functional analysis.Alicia could suggest implementing a behavioral treatment plan in addition to the vest, but what is the problem with that?

2. Uses the most effective assessment and behavior change procedures based on research, conducts functional assessments to get data necessary to develop an effective treatment, collects data to assess the program

(Dr. Peterson Dr. Frieder’s evaluation of weighted vests in schools)

58

Case Study 8B

Juan, a BCBA, has just started working in a privately-owned school for children with autism. He has been asked to work with Carl, a child who has been shrieking and slapping himself in the face. Juan was hired to replace a BCBA who had resigned. The previous BCBA had completed an excellent functional analysis indicating that Carl’s face slapping is being maintained by self-reinforcement. Juan decides, with due and reasonable consideration, that that Carl’s face slapping is serious enough to warrant a punishment procedure as an intervention so that Carl does not hurt himself. When Carl slaps his face, Juan wants Carl’s hands to be firmly pulled away from his face, and for the therapist to say “No!” in a very loud voice. Juan does plan to submit this program to Carl’s parents for approval.

1. Is punishment an OK procedure given the situation?

2. Is there anything else Juan should do before submitting his plan to the parents for approval?

3. How is this related to Task 1-8?

59

Case Study 8B1. It is OK to accept the functional analysis done by the previous BCBA.

It is OK to use a punishment when warranted.You must consider the alternative. We know that punishment is an effective treatment for self-injurious behavior and that it typically suppresses behavior immediately. A DRO reinforcement procedure typically takes much longer, as does extinction. If the functional assessment indicates that punishment is appropriate and the client may suffer injuries if the behavior continues, then punishment is OK.

“A procedure’s overall restrictiveness is a combined function of (a) its absolute

level of restrictiveness, (b) the amount of time required to produce aclinically acceptable outcome, and (c) the consequences associated withdelayed intervention.

Furthermore, selection of a specific treatment is not based on personal conviction. Techniques are not considered “good” or “bad” according to whether they involve the use of reinforcement rather than punishment. For example, positive reinforcement can produce a number of indirect effects, some of which are undesirable.”

Right to effective treatment (1988): Van Houten, Axelrod, Bailey, Favell,Fox, Iwata, & Lovaas

60

Case Study 8B

2. However, behavior analysts should recommend reinforcement along with punishment (given that punishment is necessary); thus, Carl’s program should have some reinforcement procedures for alternative behaviors, such as holding and playing with a toy, raising his hand to get his teacher’s attention, and/or using a musical instrument or art materials.

3. Why is this related to task statement 1-8?Take into consideration minimal intrusiveness of the procedure - punishment is considered to be an intrusive intervention procedure in the field.Also if extinction is used for an inappropriate behavior, use the same reinforcer (if possible) that was maintaining the inappropriate behavior to reinforce some incompatible appropriate behavior - woman whose head was falling off (U2).

NFE: Interesting study!Hanley, Piazza, Fisher, & Maglieri (2005)

•Participants: 2 children with severe behavior disorders•Conditions

–Functional communication training (reinforcement) with extinction for self-injurious and aggressive behaviors

–Functional communication training (reinforcement) with punishment for self-injurious and aggressive behaviors

•Results–FCT with punishment was more effective in reducing problem

behavior–When given the option, both children showed a clear

preference for the FCT with punishment condition •Proposed reason for the preference

–Punishment suppressed the problem behavior more quickly and more effectively than extinction, thus

–Children received a much more reinforcement because they emitted a much higher rate of appropriate behaviors

61(don’t make assumptions about punishment; punishment –therapist held hands down at the side ofthe child, and for one also visual screening, put on hand over the eyes of the child)

62

Case Study 8C

Shelly, a BCaBA, has been asked by parents to provide behavioral services to their child, who is 6 years old, severely autistic, and has no language at all. She wets her pants and has tantrums. She throws food if she does not like it. She screams and cries at night when her parents try to put her to bed. The insurance company is willing to pay for only 2 hours of behavioral services each week and Shelly feels that this is not at all sufficient. The parents are at the point where they are literally crying and saying they are desperate for any level of service. Shelly is considering working with child even though she does not believe she can do much, if any good, because she really wants to support the parents, who believe something is better than nothing.

1. What should Shelly do?

2. Why is this relevant to task 1-8?

63

Case Study 8C

1. She should refuse the position, explaining that level of services is not going to help their child. She should also try to find alternatives for the parents, if there are any (moving to a school district or state that provides more services and funding, or provides “scholarships” for children who need intensive (temporary) residential treatment.

What are some of the problems if she accepted the position?

2. Why is this related to task statement 1-8?

Use the most effective assessment and treatment procedures

3. What other task statement is relevant?

Task 1-1: do not exaggerate the benefits of ABA.

(child would not get better, ABA doesn’t work, insurance fraud. Always say no if the parents, school district,group home, residential treatment center does not have the resources or are unwilling to have the behavior analyst devote sufficient time due to mixing and matching of therapies . )

64

Task Statement 1-9

• Protect confidentiality.• Note that this is strongly related to task

statement 1-4: Obtain consent

65

Case Study 9A

Dr. C. was a BCBA who worked with a number of children in her small community. Dr. C. most often provided treatment in the children’s home after school hours. Two of Dr. C.’s clients, Jason and Jennifer, were a brother and sister. Their alcoholic father was in and out of the home and the father had abused the mother in the past. Dr. C. attended a church where several of the members of the congregation knew the family. They cared very much about the children and would ask how they were doing. They would often tell Dr. C. what they knew about the family and they would ask how the children were getting along at school and at home. The women from the church had donated clothing and food to the family in the past and they always had the children on the list to receive Christmas gifts from the church.

1. How much information should Dr. C. give these caring church members? If you were Dr. C., what should/would you say?

66

Case Study 9A

1. How much information should Dr. C. give these caring church members? If you were Dr. C., what should/would you say?Behavior analysts have an obligation to respect the confidentiality of those with whom they work. When asked about the children, Dr. C. should politely tell anyone who asks that she cannot discuss her work with her clients. She should then politely change the conversation.

2. Why is this relevant to task statement 1-9?Confidentiality

67

Case Study 9B

Dr. W., a BCBA, has been working on Tom’s behavioral issues for two years. Tom lives in a supported living apartment in the community and he works at a job with supervision from Vocational Rehabilitation. Dr. W’s data show that Tom frequently arrives at work late, sometimes falls asleep at work, and sometimes does not come to work at all. Tom would rather stay at home and sleep, and a variety of behavioral incentive programs have not been effective. Dr. W. is wondering whether Tom might have a sleeping disorder and might benefit from a sleep evaluation. Dr. W. has a friend who is a physician who specializes in sleep disorders. Dr. W’s plan is to invite his friend to lunch and tell him about Tom.

1. Can Dr. W. ethically talk to another professional about Tom to determine if (a) the person feels a referral might be appropriate, and (b) if the person would consider taking Tom as a patient/client?

68

Case Study 9B

1. Can Dr. W. ethically talk to another professional about Tom to determine if (a) the person feels a referral might be appropriate, and (b) if the person would consider taking Tom as a patient/client?If he talked about issues in a general way and did not divulge any information from which Tom could be identified, it would be OK. However, the best course of action, to insure that he would not violate the confidentiality of Tom, would be to obtain the written consent of Tom (or his guardian) before talking to another professional. Certainly, disclosing Tom’s records or giving information such as his name or behavioral specifics to another professional would be unethical, regardless of the purpose.

69

Case Study 9CSandy, a BCaBA was taking behavioral data for clients in a school setting using her lap top computer that had a special program designed for that. The data are saved on the computer (as opposed to being entered on a secured web site).

What are some of the precautions that Sandy should take to protect the confidentiality of her data?

What are some of the important laws/guidelines that Sandy must follow?

70

Case Study 9CElectronic and digital gadgets have introduced many complications and problems with respect to confidentiality.

1.No identifying information can be on the electronic data form or file2.Sandy should have an encrypted section on her hard drive to which she saves the data3.Her lap top should be password protected4.She should never leave her lap top unattended (in her car, for example), in an unlocked office (even for a few minutes while going to the bathroom), or at a table at a café while getting coffee

Laws/ethical violations she needs to know about:1.Electronic transmission of confidential records across any unsecured medium (email, faxes in public areas) is both illegal and unethical.

Question: what’s secured, particularly now with wireless and clouds? What about your email? Do you mention names or other identifying information in emails to your practicum supervisor?

71

NFE: Task Statement 1-11

• Ensure that the dignity, health, and safety of one’s clients are fully protected at all times.– Behavior analysts do not engage in discrimination

against individuals or groups of individuals based on age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status.

– They do not engage in behavior that is harassing or demeaning to persons with whom they interact in their work based on the above factors.

– They operate in the best interests of the client.– They take reasonable steps to avoid harming their

clients, research participants, students and others with whom they work and to minimize harm where it is foreseeable and unavoidable.

72

Case Study 11A

Ahmed took a specialized undergraduate track in his bachelor’s degree program that permitted him to take the BCABA certification exam, which he passed. In school, he earned very good grades and excelled at doing functional assessments in his practicum. When he got his first job, he discovered that one of his student clients in an elementary school was a Sunni Muslim. Ahmed mentioned this to his parents who were irate and insisted that he refuse to associate in any way with this student of a rival religious sect.

1. Ahmed is in a very sensitive situation. How should he handle this?

73

Case Study 11A

1. Ahmed is in a very sensitive situation. How should he handle this?Refusing to provide treatment to a person based on religion, ethnicity, or national origin is a form of discrimination and is not condoned. It is illegal as well. This means that Ahmad cannot refuse treatment to this child to satisfy his parents. If he cannot be totally unbiased, he must make a referral to another BCBA, and rethink his commitment to being a behavior analyst.

74

Case Study 11B

Jason, a ten-year-old with learning disabilities and social acting out, was mainstreamed into an elementary school physical education class at the beginning of the new school year. The school was in Florida. Jason would frequently disrupt the whole class with his antics during softball, which was played outside. He would squeal loudly if he missed the ball and he would make every attempt to run in a humorous manner so that other students would laugh. The physical education teacher was frustrated and ready to implement his own behavioral intervention that was to have Jason run around the track that surrounded the softball field each time he misbehaved. The school principal sent Dr. K., a BCBA, to meet with the phys ed teacher and discuss alternatives. Dr. K. suggested that the first intervention simply be that when Jason acted out, he would be sent to the bench to sit and watch. Dr. K. explained to the phys ed teacher that this was a procedure that was research-based and was usually effective.

1. Why was sit and watch preferable to running around the track?

75

Case Study 11B

1. Why was sit and watch preferable to running around the track?

Sit and watch which is a brief time-out procedure is a better starting point than the physically grueling, and potentially dangerous, task of running around the track in the hot sun (remember it was FL).

2. Why is it relevant to Task 1-8 as well?

Because this is the first attempt at a behavior plan for Jason, the behavior analyst needs to start with the least restrictive, intrusive procedures.

76

Case Study 11C: Excellent example of Task 1-11

Terrence lived in a group home and hated to get up in the morning to go to work. He would fight with staff members, throw shoes at them, and pull the bed covers up over his head. Maria was asked to develop an intervention program for him. Before taking baseline data, she met with all of the direct care staff who worked with Terrance. One staff member who reported no such reaction when she was on duty described her method of getting Terrence up. “Basically I try to treat him like my dad who lives with us. He’s on medication just like Terrence, and I know that it makes him groggy in the morning. So, I have to show some patience with Terrence. What I do is I go in his room and say in my sweetest voice, ‘Terrence honey, it’s almost time to get up,’ and I open the curtains about halfway and then I leave his room. Then I come back about 15 minutes later and open them the rest of the way and go to Terrence and gently rub his arm and say, ‘ How yah doin’ Terrence? It’s almost time to get up. We’ve got some fresh coffee brewing and I’ve set out your work clothes. I’ll be back to get you in a few minutes.’ Then about 15-minutes after that I come back and if he’s not up I turn on his clock radio and say, ‘Terrence sweetheart, it’s time to get up now. Here let me help you get dressed.’ I know this takes extra effort but this is the way I would like to be treated and it’s the way I treat my dad so I don’t mind. And it works. By the time I turn on the radio he’s swinging out of bed and has that little half-grin on his face that says ‘Thank you for being so understanding.’”

77

NFE, but more interesting cases: Time permitting

Jose, a BCABA, was working with an autistic child in the child’s home. The child’s parents were originally from Jordan. In Jordan, as in many middle-eastern countries, the offer of food and drink is an extremely important cultural practice related to hospitality. It is considered extremely rude not to offer a guest something to eat and drink. Knowing this, Jose accepts the offers when he is working in the home. One day, the mom, Aida, not only serves him food, but gives him several large containers of food to take home. She made the food for him specifically. Jose graciously accepts. This has become a regular pattern. Every two weeks Aida makes meals for him to take home.

1. Was there a problem with this?2. Why is this relevant to Task Statement 1-7?

78

Case Study

1. Was there a problem with this?

Interestingly, two years ago, a similar case was hotly debated at by a panel of ethics experts at BAAM. It came to be known as “Ambushed by the casserole!”

One panel member was adamant that this was completely unethical and in fact Jose never should have accepted the food and drink when he was in the home. This same panel member ended up saying that, similarly, teachers should never accept even an apple from a student. He was making the “slippery slope” point.

Other panel members said it was OK – that Jose had to be sensitive to the cultural background of his clients and it would have insulted the parents if he had refused and thus could have jeopardized his work with the child.

Yet another panel member said it was OK for Jose to accept the food and drink when he was in the home, but it went over the line when he accepted the food to take home.


Jose could become too friendly with the parents and that could affect how he interacts with the child and with them.

The apple? The teacher might come to like that student more; other students may not have enough money to give gifts to the teacher and feel bad even if the teacher did not show any bias toward the student who gave him/her an apple, etc.

More Interesting Cases, Time Permitting

• Behavior analyst in school room – teacher and she become friends, both new to the area. First, a cup of coffee, then drinks at a bar. Then….

slippery slope or not? (task 7)• Behavior analyst is working in the home with a child.

The mom tells the behavior analyst that she needs to run to the store – and that she won’t be gone long.

OK or not OK?

79

80

THE END

• Don’t forget to bring your computer verification of completion of the on-line training for research ethics!

There is no second chance!• Instructional assistance hours:

– Monday, 4/14, 6:00-7:30 PM– It’s Michael’s turn

Documents

1 Schedule Lecture: Today and Thursday – Certification and licensing of behavior analysts – Professional ethics Exam & Assignment: Tuesday, 4/15 –15 points: