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Ethics can be defined as a standard of practice and conduct. Ethics help to define and establish what is appropriate, what is inappropriate, and also help protect the public/consumers.

If you work in this field in some capacity --even if you just work part time for a small company --you need to be aware of the ethical standards for this field. Why, you ask? Well, you can cause harm to yourself and/or others if you are providing services in an unethical manner.

Like other BCBA's, I have often been in the position of leading the "new staff training".  What I have noticed is these trainings often gloss over, or completely leave out, information about ethics. I don't agree with that at all. Let's face it: this is a young field. It is not uncommon to work with very young staff who may have never had a "real" job before. Or whatever they were doing before ABA was a non-professional position. I have had many situations of having to pull a new staff aside to discuss their work attire, cell phone use, or defensiveness when receiving correction. This is why I started generally going over professionalism with all my new staff, with a crash course in ethical behavior.

Hopefully this information will provide a good jumping off point for creating your own staff resources, or could possibly be integrated into a comprehensive training. This information could also be used to create company policies, or an employee handbook.

I strongly suggest using lots of real examples when teaching about ethics. I vividly remember sitting in a training years ago as a new ABA therapist, and the trainer was explaining that we cannot take food out of the children's lunchboxes (this was a center facility). I remember thinking to myself what a dumb thing to go over in a training, but then the trainer explained a therapist was just fired for repeatedly eating the children's food!
So now when I'm putting together trainings of my own, I always aim to include actual ethics fails that I have seen to make things much more relevant. :-)

Here is a quick overview of the topics I try to cover with my staff. I have found that when problems happen or when families complain, usually it is about one of these issues.

Crash Course Suggestions:

Professional Dress
Most of my direct staff are young females, many of whom have never had a job before where they work in someone’s home. Yoga pants, halter tops, high heels, sports bar/no bra, huge earrings, super tight pants…I’ve seen it all! And NONE of it is appropriate. This is a job where you often work with children, typically kneeling, bending over, squatting, running…. you get the point. Improper clothing is one of the top things parents complain to me about when it comes to direct staff.
Confidentiality & Privacy
This is a big one. If your staff are new to a professional position, this will be completely foreign to them. I used to work at a facility in a very small town, and it was hard to get the staff to understand they could not gossip at the local hangouts about their clients after work. It is imperative to protect client information, which can include data sheets, verbal information, client address, client diagnosis, etc. Especially if the client receives insurance funding, HIPAA compliance is a must!
Professional Boundaries
I started in this field as a direct therapist, so I get it: it is easy to get chummy with the families you serve and start to form friendships. Parents will blur the boundaries when they like you, because hey…you are always at their house! As the professional, it is YOUR job to set clear boundaries and to maintain them. All of the ethical burden falls on you, and it is much easier to maintain a clear boundary than it is to try and establish a boundary after lines have been crossed.
Respecting the Dignity of the Client
This would be things like allowing a 10- year old client to cuddle with you while sitting on your lap, or teaching play skills to an adult client using Barbie dolls. At all times the dignity of the individual you are serving needs to be at the front of your mind. Think about how you would want to be treated if you were the client. Your nonverbal clients won’t be able to tell you if their rights are being violated, so again, all of the ethical burden falls on you.
Boundaries of Competence
It is very important to know the limitations of your competencies, and to seek out appropriate supervision and training. If you are not qualified or knowledgeable to do something, its best to step back. I know this can be hard depending where you work…. some companies pay no attention to staff competency when staffing cases. This also refers to knowing when to be quiet. I have had to correct new staff for giving parents medical advice, recommending supplements, or suggesting changes to the behavior plan. Learn the following phrase and be prepared to say it often: “You need to speak to the BCBA about that” 
The Social Media Minefield
So as technology continues to get fancier, this is a topic I have to address more and more with staff. It’s inappropriate to “friend” clients on social media, OR to discuss/vent about your clients on social media. Even if you don’t name names. Be very careful, I have seen people face legal action over things like this. Just because you don’t say a name, if you describe the client enough that I can figure out who you are talking about then you have violated that client’s privacy, as well as behaved unethically.

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*Note: This post is Part II of a Two Part series.

Disclaimer Time :-)

ABA treatments or interventions are not one size fits all, and should never follow a generic formula across individuals. The specific needs and strengths of the individual receiving services will always guide treatment planning and intervention choices. This post is meant to be a helpful guide, not a guaranteed "recipe" to designing intervention.

End of disclaimer.

We already reviewed the challenges of designing intervention for early learners/individuals who are new to therapy. Now let's talk about the challenges of designing intervention for the advanced learners, or those who are only mildly impacted by their diagnosis.

To make sure we're are all on the same page, what do I mean when I say an advanced learner?

  • Typically older, or if younger this is an individual who is only mildly impacted by their diagnosis (e.g. Asperger's)
  • Typically in a regular education classroom with some supports. If this type of child IS in a self- contained room, it is usually only because of problem behavior
  • Deficits are NOT pervasive; the individual may be on grade level academically, but struggles with self-help skills. Or the individual may have appropriate use of language/be conversational, but has meltdowns on a daily basis
  • Typically this individual has problems with communication only when escalated. The ability to communicate, yet the likelihood to aggress when upset, can be highly frustrating to parents/teachers
  • Interest in peers, age appropriate toys, or social interaction can often be quite typical. Sadly there can be a strong desire/interest to be social but significant social deficits that stigmatize the child from peers
  • Problem behavior rate and severity can range from mild to high. This type of individual may be described as "moody". When they are calm and cooperative, they are a joy to work with/hang out with. However when they escalate, they can escalate quickly and take a long time to de-escalate  
For those of you who will be designing intervention, this type of child is way-y-y past the VB - MAPP, and may have filled up most of the grid on the ABLLS-R. We are way past Matching, Gross Motor Imitation, and Stacking Blocks with this kind of learner.

When I first meet an advanced learner, what usually strikes me is my initial thought of "Wow, why in the world are we working with this kid???". This is the type of client who will greet you, strike up a conversation, excitedly show you their room and their toys, and proudly tell you they just got an A on a science report. But start to notice some things. Like the child is 9, and the parents report he wears Pull Ups at night. Or the child is 13, and her best friend is the 4 year old girl across the street. Or the individual is 22, and won't leave the house without their pink Dora backpack.

 Many of you are nodding in agreement right now, because you have also had that "A-ha" moment where you realize that what appears to be a completely well functioning individual is actually someone in need of intervention and assistance.
Its a bit unfair, but I find that my advanced learner clients tend to irritate their caregivers and teachers the most. There is an expectation of self-management that just is not being lived up to.
 So what's the deal here?? How can you be so high functioning in some areas, yet so low functioning in other areas?

Its really simple, and I find myself explaining this to related professionals quite often. It is critical not to lower your expectations of early learners, or to raise your expectations of advanced learners. Simple.
It frustrates me, but I come across people all the time who don't expect much out of my early learner clients. Or the exact opposite: people who think just because my client with ASD can talk and be sociable, that they have NO other problems. Both are unfair, inaccurate, and completely ignore the unique strengths and deficits of the individual. ASD is a spectrum: expect variety.

I don't get to work with older, or more advanced learners very often, but when I do its so fun :-)
There are so many areas of programming you explore with a higher functioning client (cooking, vocational skills, shopping/making purchases, science projects/arts & crafts, manners/etiquette) and these types of clients will also entertain you during the therapy session. Like one client who noticed I had changed my hair color, and promptly told me I looked like Ariel from Little Mermaid. Or another client who told me she was going to call the police on me if I didn't stop making her do work. Or a 7 year old who asked me if I liked rap music, and when I said "no" he told me "Its okay, you'll like it one day when you get cool".

 Below is a sample of the intervention package for one of my previous advanced learner clients, including typical (see disclaimer) program goals.

Keep in mind that these recommendations are not setting specific. In other words, advanced learners will likely need these structures in place whether intervention takes place at home, at an ABA clinic, in a classroom, or at a work site. Changing the setting does not change what these individuals need to be successful.

Sample Intervention Package 

Teacher to Student Staffing Ratio:
Group Instruction (if aggressive, a 1:1 aide may be necessary)
Teaching Format:
Mostly Natural Environment Teaching,
Incidental Learning, and Community Based Instruction
Recommended Intensity:
8-15 hours per week
Reinforcement Schedule:
Variable or fixed interval schedule, for example 25:1 (one break every 25 minutes)
Types of Reinforcement:
Naturally occurring reinforcement (bake a cake, then eat it) should be provided on a thin schedule, as well as Token Economy systems
 Intervention Goals:
Community Outings, Intraverbal Associations, Socio-Dramatic Play, Hygiene, Sight Words, Reading Comprehension, Math Fluency Drills, Sportsmanship, Accepting Change, Resolving Conflict, Social Stories, Chores, Preparing Meals
Watch Out For These:
Over prompting/promoting rote responding (this is why DTT with this individual is not recommended), client curiosity about therapy progress, "splinter skills" learning profile, teaching should include adult, peer, and self-provided reinforcement, don't forget to teach self-management of behavior/self-evaluation of goals, for older clients physical management training for staff becomes vital,  inappropriate play/leisure interests (avoid social stigma)
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