The Ethics of Big Business.

 




As an industry, ABA is a billion dollar market with large, multi-state, companies becoming more and more common in the US. 

There are many reasons for this massive boom, such as the increasing visibility of ABA as a career field, which drives more people to pursue credentialing and certification, and ultimately to seek ABA employment. The insurance mandates across states has also led to this boom, with more and more people now able to access ABA treatment through their insurance plans (removing cost as a barrier to treatment). ABA as an industry has become very attractive to investors and equity firms, which means more businesses and clinics being opened, or existing businesses and clinics expanding and multiplying. Lastly, the increase of ABA services outside of the world of Autism has led to an overall increased demand for/awareness of  BCBAs, with clinicians moving into areas such as criminal justice, the business world, education, geriatrics, and policy change. 

Unless you live in a very small town (or outside of the US) you've probably already seen ABA businesses and clinics pop up in your community, with a more aggressive presence than before.  

As a clinician, it can be a dizzying process to look at the  vast array of ABA employment options out there and choose the best place to pour your time, energy, and talent into, day after day after day. 

This specific question of "Where should I work?" is something I've posted about multiple times (see here, here, or here).


We talk about clinician burnout, we discuss the problematic high turnover rates in this field, but where are the resources to help clinicians weigh their employment options to select a reputable, ethical, and professional organization to work for?


Beyond just tips and commiserating by swapping stories of companies from hell, I'd like to offer some actual evidence- based action steps (see sources below), to help when it comes to scrutinizing an employer pre-hire, successfully navigating The Contract, and enjoying where you work!

What in the world was the point of all those college courses, 2am study sessions, supervision hours, and textbook paper cuts, if you're just going to get up every day to "clock in" at a company you loathe? Why work somewhere where all you are viewed as is a means to billable hours? That makes no sense at all.


Before jumping into some red flags of unethical organizations, I want to emphasize the importance of the pre-hire process. From that initial email or phone call, all the way up to the point where you sign your name on the offer letter or contract, you should be evaluating that employer just as much as they are evaluating you. It should be a mutual process, or dance, of "Show me what you got". For example:

Who owns the company? (super important question to ask these days) How many BCBAs are in leadership positions? How long has the company been around? What is the mission statement or company vision? How about the company culture? How reasonable is the clinical workload? How much of the work day is paid time (billable hours vs non-billable time)? Why did the last person in this position leave? What is the staff turnover rate? How is value demonstrated to employees, in tangible and concrete ways that are NOT tied to meeting productivity quotas? How does the company make diversity and inclusion a necessity, not just at the practitioner level, but at the executive level as well? Is work-life balance a buzz word, or actually attainable at this company? 


Also, we live in the Jetsons age. Your entire life is on the internet. If you think that interviewer is not looking you up before the interview, you are delusional. Have you looked the organization up online? Have you read over the company reviews, written both by consumers and by employees? Have you searched for any lawsuits/legal action, or ethical investigations the company was involved in? You should.



Identifying Unethical Organizations


  • Pre-Interview/Interview process - Organization does not or cannot provide clear, logical answers to persistent applicant questions, supervision and training as described is insufficient/does not meet best practice standards, cannot explain/no process of onboarding new hires, poor management of client health records (HIPAA concerns), scope of competence is not a consideration when staffing cases, both a very brief or a drags on and on interview process are not good signs, beware of recruiters who make grandiose promises during pre-hire (get it in writing), vague or shifting caseload expectations, cannot explain efforts/no efforts made to accommodate the diverse cultures of client population

  • Evidence Based Practices- Organization promotes/advertises or clearly offers non-behavior analytic services while claiming to be an ABA agency, unethical practices or non-evidence based procedures are observed or discussed (e.g. BCBA supervisor implements Floortime with clients), executive level staff lacks BCBA's or clinicians, minimal to no understanding of Behavior Analytic Code of Ethics, clinical competency is not considered or critical to caseload assignments (e.g. brand new RBT's are placed on high intensity cases), clinical supervision and training is too minimal for RBT's to refine their skillset

  • High-Quality Service - Workload expectations are unrealistic to an amount that impacts clinical quality (e.g. Supervisors carrying huge caseloads), clinician mentoring and emotional support is replaced by micromanagement (incessant "check-ins" that are only focused on productivity), job description is unrealistic/multiple jobs crammed into one position, treatment hours are mandated regardless of client need (e.g. push for "40 hours a week" for all clients), "cookie-cutter" treatment planning, lack of parent training/caregiver involvement in treatment, no company policy or procedures for gaining parental adherence to participation guidelines, no company policy or procedures for families who frequently cancel/show up late/"no show-no call", unethical and/or unprofessional behavior is being modeled by senior or executive level employees (e.g. BCBA supervisor is dating his RBT supervisee), ethical conduct is not taught, expected, or maintained by the organization, company online presence/website is heavy on outdated, Ableist, or anti-Autistic language such as "cure", "recovery", "suffering with Autism", or "saving" children

  • Non-Certified Supervisors or Owner - While not automatically a red flag, the supervisor/owner must be knowledge of the Code of Ethics, must understand that credentialed and certified employees are required to practice ethically, must demonstrate understanding of appropriate clinical caseloads, clinical supervision, and clinical training, must be committed to clinicians practicing within competency,  and must not attempt to make clinical/treatment decisions due to not being qualified to do so

  • Contract Terms - Offer letter or contract contains terms, restrictions, or information never previously mentioned or explained during pre-hire (e.g. "surprises" in the contract), information that was verbally stated is not put in writing/not in the offer letter or contract, highly restrictive and punitive non-compete or non-solicitation clauses that prohibits the employee from reasonably working in the field during, or post-employment, length of employment conditions that require the employee agree to work at the organization for a specific amount of time ("handcuffing" employees to the organization), requirement to sign any document after accepting the position (e.g. 10 days after signing offer letter, only then is employee asked to also sign a non-compete agreement), huge bonuses/perks/incentives that only kick in after a specific duration of employment (indicates the company has high turnover rates), being offered an independent contractor position if you are a RBT or BCaBA (you cannot work independently)

**References:


BHCOE Position Statement on Non-Compete Agreements


Brodhead, M. T., & Higbee, T. S. (2012). Teaching and maintaining ethical behavior in a professional organization. Behavior analysis in practice5(2), 82–88. 


Brodhead, M. T., Quigley, S. P., & Cox, D. J. (2018). How to Identify Ethical Practices in Organizations Prior to Employment. Behavior analysis in practice11(2), 165–173. 


Brown, K.J., Flora, S.R. & Brown, M.K. Noncompete Clauses in Applied Behavior Analysis: A Prevalence and Practice Impact Survey. Behav Analysis Practice 13, 924–938 (2020). 


Kazemi, E., Shapiro, M., & Kavner, A. (2015). Predictors of intention to turnover in behavior technicians working with individuals with autism spectrum disorder. Research in Autism Spectrum Disorders, 17, 106–115. 


Rubenstein, A. L., Kammeyer-Mueller, J. D., Wang, M., & Thundiyil, T. G. (2018). “Embedded” at hire? Predicting the voluntary and involuntary turnover of new employees. Journal of Organizational Behavior, 40, 342–359. 

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