Ethical Behavior: Informed Consent

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As a provider of ABA services, are you familiar with the concept of Informed Consent? You should be.

 Ethical and professional behavior, as well as best practices, require that the consumers you serve as an ABA professional are well informed about your services. In very basic terms, informed consent means to outline the scope of treatment to the consumer, explain the potential risks and benefits of treatment, and that, armed with this information, the consumer willingly chooses to initiate services.
Unlike other professions (doctors, counselors, etc.), many of us who provide ABA services either work primarily with children, or with individuals unable to give consent (e.g. young children). Technically, in these situations you may still be able to seek client assent to services. However, usually the parent or legal guardian of the client is the one who will be agreeing to or declining treatment decisions.

I recently posted about getting client buy in, and if you have visited my blog before you may have picked up that parent involvement in treatment is a super important issue with me. 
Let me show you how ethical behavior will set you up for success when it comes to parent involvement:

A)      Let’s say you work for a low quality ABA provider where the intake process  is rushed and disorganized, and mainly focuses on matching available staff to the client’s availability. Proper explanation of services is not provided, and the consumer is not given multiple opportunities to ask questions. How will that family know what to expect? Will they be prepared for the demands of ABA therapy? Do they understand that both skill acquisition and behavior reduction can progress slowly? Or are they expecting to see lightning fast results?

B)      Now lets say you work for a high quality ABA provider. The intake process is organized and methodical, and includes gathering information as well as giving information. Policies and expectations are outlined in writing, and the family is encouraged to ask questions and give feedback. The anticipated length of treatment, intensity of treatment, and possible risks of treatment are explained in detail so the family can make an informed decision.

Situation A is ripe for consumer dissatisfaction, complaints, and misunderstandings, when what the family thought they were signing up for does not turn out to be the reality of what they are getting. Dissatisfied consumers terminate services so companies like the one in situation A may have rapid turnover of clients, lots of angry clients, and/or high staff turnover, due to parents regularly venting their frustration on the direct staff.
 See how all this stuff is tied together??

From the initial point of contact with a consumer (typically intake), be intentional about obtaining informed consent. By the way, don’t think you go through the consent process once and then never have to do it again. When the goals of treatment change, significant treatment details are added or omitted, when approaching termination of services, or when adding behavior change strategies (such as Extinction procedures), you need to once again obtain consumer consent, and explain the possible risks and benefits. 
Just think of this as being as transparent as possible. The consumers you serve should be familiar with the “what”, “how”, and “why” of treatment during the length of their service contract.

When done properly, informed consent allows the consumer to say “Yes, this is the treatment I want and I am able/willing to do the work involved” OR “No, this is not the treatment I wanted and I am unable, or unwilling, to do the work involved”.

Here are some possible ideas of what to include when creating consent documents for your workplace, or if you work independently, to use with your own clients. Consent documents will vary depending on the work setting, the consumers served, the specific services provided, etc. So some of this information may be applicable to your needs, and some may not.

  • Possible benefits to participating in treatment
  • Possible risks of participating in treatment
  • The specific treatment goals including the selected strategies to reach those goals
  • Problem behaviors may experience some increase, in duration, frequency, severity, etc.
  • Parental stress
  • Client fatigue
  • May require changes/modifications to client home
  • Increased demands on parents time/energy to learn ABA methodology
  • Intrusiveness of staff and materials in the client home
  • Skills learned may not generalize to other instructional environments (e.g. school)
  • Aversive strategies may be utilized during treatment
  • Reinforcers utilized during therapy sessions may lose their “power” outside of therapy sessions
  • Treatment may begin with a high intensity (e.g. 30 hours/week) which can be difficult on the client and their family
  • Direct staff may have less experience and/or education than the case supervisor
  • Limitations to client confidentiality (e.g. mandated reporting)
  • Persistent non-adherence to treatment plan and company policies can result in termination of services, even if the client still presents with clinical need for services
  • Selected intervention strategies must be empirically supported/evidence based (for some consumers, this will be difficult to understand)
  • Disruptions to the daily life/routine of the household which may cause emotional distress to the whole family

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