We Need Better Ethical Decision Making | Autism & ABA Ethics
Dr. Mary Barbera
I recently presented on an ABA ethics panel at the ABAI conference in San Diego, so today I’m going to get on a soapbox regarding ethical decision making and one of the most common ethical issues I’ve seen in the past two decades in the autism world.
If you are a Board Certified Behavior Analyst, you probably are aware that you need to follow the BACB code of compliance, and you need 4 hours of Type II BACB ethics CEUs every two years, to recertify as a BCBA with ethical compliance. I don’t know about you, but I’ve been to some pretty dull ethics for behavior analysts workshops since 2003, when I was first certified, so I recently put together a four-part ethics interview series, with four Type II BACB Ethics CEUs, but before I tell you more about this series, I want to tell you about one of the most common ethical issues I see, which you’re probably not aware of and probably never considered as an ethical issue before.
One of many ethical scenarios...
Let me tell you about a 200-pound teen I’ll call Billy, and this is just one of many ethical scenarios that I’ve seen. Billy was in a private ABA school, and the district that was funding him to go there wanted an independent educational evaluation and an FBA, a functional behavior assessment, which I agreed to do, because the school was concerned that the private ABA school was asking to increase from two-to-one, two staff on Billy, to three-to-one staff, three staff for just Billy. I think he was about 15 years old, and he was still an early learner, not speaking at all, and his problem behaviors included aggression and property destruction. He also eloped from the home a few times.
I went to the home first, to evaluate Billy, and found a very distraught mother. Billy towered over her, and they also had a younger brother who was not home at the time. But Mom really was frightened of Billy, and to be honest, I was kind of frightened of Billy too, when I was in the home, because without large staff to control Billy’s behavior, it was very unpredictable what he was going to do.
I then went to his school, and what I found there was a very elaborate restraint over-correction protocol that required a two-to-one ratio, but now it was going to require a three-to-one ratio. And worst of all, the data showed that this protocol appeared to be reinforcing, so the problem behaviors were going up instead of down. There was just a general lack of concern for what was happening at home, where it was just Mom trying to control Billy with a younger sibling at home. There was a failure to pair, and mand, and to conduct a verbal behavior assessment, which I would have recommended. And I was particularly concerned that there was no response to the current data, which was clear, that the restraint procedure was actually leading to more problem behaviors. Billy ended up in a residential treatment facility, and I doubt he ever lived at home again.
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And I have, unfortunately, dozens of stories like Billy’s, where well-meaning professionals and BCBAs develop protocols that are either not individualized or not created looking at the whole child in terms of providing programming and treatments that will work in all settings, and there’s a failure to work together with families to ensure optimal treatment.
Ethics for Behavior Analysts
As BCBAs, we’re required to work with families and other team members to thoroughly assess and program for each child and to make data based decisions on the progress or lack of progress for each client. If you’re using one-size-fits-all protocols or have protocols in place that aren’t working to increase or decrease behaviors, I think you should look at this as an ethical situation and evaluate some ways to change your own behavior as a BCBA.
As I talked about a few minutes ago, I’ve recently created a four-part ethical interview series, and up until now, this ethical series has only been available as part of my verbal behavior bundle course membership, which includes all 32 BCBA CEUs. In the ethical series, four BCBAs with ethical expertise give their advice on ethical decision making.
Ethical Decision Making
Dr. Eileen Schwartz created an ethical decision making matrix, and covers this matrix in interview number one of the series. So, let’s talk about the matrix and how it would relate to a child like Billy. Part of Dr. Schwartz’s ethical matrix involves asking myself why Billy’s situation triggers my ethical radar. This is triggered because Billy’s safety, and the safety of his mom, brother, and staff members, are all at risk. It’s also an ethical issue to me because of Billy’s dignity, the impact of escalating problem behaviors on his relationships, and his overall outcome.
One of the most profound things Dr. Schwartz said during her interview was that BCBAs are spending way too much time focusing on the little things, like, “Can I accept a cup of coffee from a client”, or “Is that a gift I must decline?” instead of looking at larger ethical issues, like ensuring that ABA treatment leads to dignity and quality of life for our clients.
The other three individuals I interviewed included Rosemarie Griffin, who’s an SLP and BCBA, and Drs. Megan Miller and Amanda Kelly. For more information about the ethical series, please visit ethics and if you want to learn more about the verbal behavior bundle, which covers assessment and programming for early and intermediate learners, sign up for a free online workshop at marybarbera.com/bundle-ws.
Leave me a comment, give me a thumbs up, and share this video to help me get the word out about ethical decision making, and I will see you next week.
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