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As a BCBA, if you work for a company/agency you may not have much say over which clients you will/will not serve. You get assigned a caseload of very diverse clients, and continue to be assigned cases until the caseload maximum is reached.
However if you choose to offer services independently as a BCBA, then it is very much up to you to decide who to work with. This may not be something most people consider or contemplate as they move closer and closer to certification, but: How will you choose which clients you will serve?
Once someone obtains certification, they are now qualified to work independently (depending on the state). I've briefly talked about working independently on my blog before, but this post is specifically about making the judgment call of when to select, and when to decline, a particular client.
Many ABA professionals don’t have experience working independently. I started out in this field working independently, but that isn’t everyone’s background. Most people start out under a company or agency, and don’t branch out to independent work until post- certification. Thankfully the Board does provide guidelines to help with this:
Accepting clients - The Behavior Analyst accepts as clients only those individuals or entities (agencies, firms, etc.) whose behavior problems or requested service are commensurate with the behavior analyst’s education, training, and experience. In lieu of these conditions, the behavior analyst must function under the supervision of or in consultation with a behavior analyst whose credentials permit working with such behavior problems or services.
Providing consultation - Behavior Analysts arrange for appropriate consultations and referrals based principally on the best interests of their clients, with appropriate consent, and subject to other relevant considerations, including applicable law and contractual obligations.
Who is your client? - The term client as used here is broadly applicable to whomever the Behavior Analyst provides services whether an individual person (service recipient), parent or guardian of a service recipient, an institutional representative, a public or private agency, a firm or corporation.
|Termination with clients- Behavior Analysts make reasonable efforts to plan for facilitating care in the event that behavior analytic services are interrupted by factors such as the behavior analyst’s illness, impending death, unavailability, or relocation or by the client’s relocation or financial limitations. Behavior Analysts do not abandon clients. Behavior Analysts terminate a professional relationship when it becomes reasonably clear that the client no longer needs the service, is not benefiting, or is being harmed by continued service.|
So what’s the takeaway summary here?
There are clear ethical guidelines for how a BCBA can initiate services with a client, how you must present yourself/market your services, how to professionally interact with a client, and how to terminate services with a client.
These ethical guidelines should give even the greenest, brand new BCBA, clear cut boundaries of how to maintain a professional business relationship with clients.
I’d like to add some points and tips to the above guidelines, based on what I have experienced and had to learn the hard way:
- Know thyself- Part of being a professional is being able to truly evaluate your own strengths, weaknesses, and limits. To put it bluntly, don’t bite off more than you can chew. If you work a full time job, plus you are in school, and a client contacts you to inquire about consultation, can you really add that to your already full plate? Your decision making should be governed by what you can do well, not by sympathy or finances. If you know that you could squeeze more onto your plate, but they will go to the bottom of your priority list, the quality of your work will be poor, or they will get what’s left over of your time and concentration, then its unethical to add that client. Is this sometimes hard to explain to people??? Yes….. It sure is :-). I have worked with many great professionals who were very kind and caring people, but unfortunately that can sometimes translate into someone who doesn’t know how to say “No”.
- Honestly state your expertise – This is very similar to the 1st point, but part of being a professional is being able to honestly and clearly state your clinical expertise. Most of my experience in the world of ABA has been with early intervention. If someone contacted me to consult on a case with a 28 year old man, would I be interested? It’s possible, yes. However, based on my expertise and training am I the ideal BCBA to work with this individual? Probably not. It’s important to work within the realm of your expertise, and when necessary seek out additional training or mentorship so you can perform your job with excellence. If you have never worked with a type of client before, then you need to clearly explain that to the potential client so they can make an informed decision about whether to hire you or not.
- Boundaries! – I’m going to say that again: Boundaries! It’s that important that I needed to say it twice. When I first started in this field, I was really, really, bad at maintaining boundaries and speaking up for myself. Over the years, I learned how to be assertive, not aggressive, when clients trampled my boundaries. If you are going to work independently, you have to know how to clearly communicate your boundaries to clients, and then actually enforce them. Sometimes a client will unintentionally step on your toes, and sometimes it will be quite intentional :-). You may tell a family during the initial meeting “I don’t work on weekends”, and then 6 months in you suddenly find yourself meeting with them every Saturday. How did that happen?? It happened because at some point you failed to enforce your own boundaries.
- “Termination” is not a dirty word – Every BCBA and every client will NOT be a good match. Just because a family contacts me to request services and I have availability, that doesn’t mean it’s an automatic green light. I know myself well enough to know I work better with certain kinds of families or clients, and being a certified Behavior Geek, oops, I mean Behavior Analyst, I know a thing or two about reading behavior. If during the initial intake process the parents aren’t completing my forms, they lost the contract, they are a no-show for an assessment appointment (or 2), etc., those are like blinking neon signs that maybe you don’t want to initiate ABA services after all. Of course, there is such a thing as grace and giving people the benefit of the doubt, but only you can decide what you are willing to put up with. I have had to initiate termination of services with private clients before, and it can get a bit…challenging. People may not agree with you that termination is best, or they may feel you just need to be more patient, more understanding, etc. Only you can decide how valuable your time really is. If you are working with a client and having persistent, recurring issues with non-involvement, disrespect, or low commitment to treatment, it may be time to part ways.
Reference: BACB Guidelines for Responsible Conduct (I suggest paying particular attention to section 2.0)