Inspect before you respect – Is your Behavior Analyst competent and do they follow their ethical guidelines

This note is written specifically for parents of children who receive interventions based on Applied Behavior Analysis (ABA).A special thanks to my colleagues in the field, Dr. Geetika Agarwal, Ms. Gita Srikanth, Ms. Sheela Rajaram and  Ms. Tasneem Hegde for reviewing the draft and for their valuable feedback. I hope I have been able to do justice to their inputs.

First off : ABA is not a therapy! Rather,  it is science based on which a number of  evidence based interventions have been developed to address socially significant behaviors across the entire human spectrum regardless of age, abilities or challenge.

Would you consent to have yourself treated by a person who has learnt medicine by working in a pharmacy? You should ensure that the person has studied medicine formally, keeps up to date with research in his field and conducts himself according to certain ethical guidelines. Unquestioningly and blindly trusting “experts” and “specialists” is not the way to go and this applies especially to people with whom you trust your children with learning challenges or problem behaviors.

So, when you have decided to give your child the benefit of interventions based on the science of Applied Behavior Analyst (ABA), one of the first considerations is to find out if the therapist who is going to work with your child is guided and supervised closely by a BCBA- D /  BCBA or a BCaBA .  The first two are Board Certified  Behavior Analysts ( Former is Doctoral) and the third is a Assistant Behavior Analyst who in turn needs to be supervised by a BCBA or a BCBA-D. The final responsibility, thus  for your childs programming goals , intervention procedures  and supervision of therapists should be with a BCBA-D or a BCBA.  Once you know the name of the professional, even if they are renowned and famous, see if they are listed in the BACB registry – http://www.bacb.com –> find certificants.

For those in a hurry, let me present some  key questions  to ask  :

1. Is my child in good hands – is a credentialled Behavior Analyst designing and supervising the interventions ?

2. Are the interventions designed to ensure my child/ care giver does not come to harm – are  any risks/ risk mitigation discussed well with me and signed off?

3. Does the Behavior Analyst talk to me in plain english shorn of jargon.  Is he/she able to explain choice of teaching strategies/ interventions to my satisfaction?

4. Does the Behavior Analyst talk to me with data and graphed trends to communicate progress of my child?

5. Does the Behavior analyst respect and  maintain confidentiality  ?

6.  Is the Behavior Analyst a ” good citizen” ? For instance, is he/she  on the right side of the law in his or her dealings?

7. Is the Behavior Analyst on a continuous learning mode – does he/ she attend scientific conferences, present technical papers, disseminate knowledge

For those who would like to dwell a little deeper I’ll aim to elaborate on the above. A Behavior Analyst signs up to high standards of ethical conduct – I will list some of them that have a direct bearing for your child and yourself. You’d need to keep following and watching your behavior analysts behavior and convince yourself that he  or she displays behavior in consonance with these.

1. Do no harm , right to most effective treatment and least intrusive interventions : The primary client for the Behavior Analyst (BA) is the child or the vulnerable person receiving services. Parents / Guardians/ carers /teachers/ relatives  ( called significant others) will be secondary clients.  It is the BA’s responsibility to ensure that risks of any potential harm due to interventions are carefully analyzed, discussed with the client or significant others with risk management plans in place. Interventions covering these should be signed off in writing  with significant others to avoid any misunderstanding.

This also means, for example that in the event of your relocation or transition of services, the Behavior Analyst makes appropriate referrals and communicates status assessments to future provider to ensure the child does not suffer. Similar considerations should be seen if for some personal reason the BA is not able to continue providing services – they need to ensure presentation of suitable referrals where possible, a reasonable notice period , exit reports etc. Any information they share with third parties should be with your written consent.

2. Should maintain high standards of integrity in their personal lives and are seen as upstanding citizens . Even if they are clinically brilliant, they need to be operating on the right side of law. If you have any reasons to suspect this, stay away and consider reporting to the Behavior Analyst Certification Board ( http://www.BACB.com ).

2. Keeps up with scientific knowledge : Does the BA attend conferences/ seminars on behavior analysis, is seen making efforts to use the lastest technological advances in the field?

3. Talks to you in plain english : Behavior analysts have an obligation to explain their intervention, assessments etc. in plain English for clients, consumers and professionals from outside the field.  If there is heavy jargon in their talk thats not intelligible to you , watch out! You could be dealing with style provider than substance.

4. Recommends the most effective evidence based interventions : There are a number of effective evidence based procedures such as Antecedent intervention,Joint attention intervention,Precision teaching, modeling, peer training package, schedules, self management etc.  that are based on Applied Behavior Analysis.   The BA, while discussing interventions for your child, should be able to substantiate their choice referring to scientific evidence base (e.g. number of scientific studies published in peer reviewed journals). If you are proposing a non- behavioral intervention, they could use scientific behavioral methods to evaluate its effectiveness.

5. Assesses, measures and communicates with data : Rather than say that they have been very successful, the BA should be able to discuss progress with data and  graphs of progress pre and post intervention. Do you see the BA constantly assessing progress and making changes on the basis of data ?

6. Takes informed consent :  Knowledge derived from interventions  with your child could be useful in  helping others facing similar challenges and add to the scientific knowledge base. In certain contexts the BA will take your permission in writing with a clause that such permission may be withdrawn by you at a later date.   The typical contexts include consent for use of videos data from interventions with your child in scientific conferences/ training programs/ website,  for including your child as a participant in a scientific study ( even if it benefits your child )  which may be published in a scientific journal and for taking up an intervention that involves reduction in socially inappropriate behavior .  It is  important for you to give the informed consent without any feeling of ‘pressure’  such as a fear that your child’s intervention may be compromised if you withold consent.

7. Confidentiality : The ethical Behavior Analyst will share information about your child only with personnel directly involved in designing and providing interventions .  Information Specifically identifying children are  masked ( unless significant others have consented otherwise) when information needs to be shared with peers or the larger community of Behavior Analysts such as in journal articles, technical paper presentations etc.

8. BA’s responsibility to the field of Behavior Analysis : You may ask, how does this concern me as a parent or recipient of services for my child . However, if the BA is seen disseminating knowledge about the field in various fora, seen fighting mis-representation of the field by non-qualified personnel , is seen attending, presenting posters and papers in national and international conferences you are probably seeing a ethical Behavior Analyst.

9. No Dual relationships or conflicts of interest please :  Behavior Analysts relationships with their clients and their significant others is strictly professional in nature and guided by a written contract. Behavior Analysts becoming best friends, joining you in family holidays, accepting gifts etc., would be in violation of their code of conduct as services to the client could be compromised.

These are but a few important points and some yardsticks lay people can evaluate the Behavior Analyst on.  It may be uncomfortable to do such an evaluation as  blind faith is a lot easier. However, with your child’s interests at stake I’d recommend nothing less than a diligent and ongoing evaluation.

Beofre I close, I must say that there are a number of changes you may have to undergo to make the most of your Behavior Analysts services – yes, it is a two way street.  Behavior Analysts prefer to address matters with data and trends and will need your buy in for the interventions with reasonable modifications . They may nor promise or guarantee miracle results but are likely to share information on interventions that have an evidence base and promise on going monitoring with data to demonstrate improvements. They are more likely to concerned with an improvement from here on rather than on an impractical standard thats out there. A Behavior Analyst may not entertain long discussions involving emotional reasons or hypothetical constructs ( invisible reasons that purport to explain the cause of problem but actually do not – see an early blog of mine on mentalism and circular reasoning) but will in a scientific way be able to draw your attention to the real function of problem behavior ( what does the behavior get as a consequence that makes it relevant) and the socially acceptable interventions that should work. This approach would aim to build trust based on objective evaluation of your child’s progress rather than ‘faith’ and this could be a subject matter for another blog!