Issue # 3 - February, 2009
Ethics Challenge #2
by Mary Jane Weiss
A soon to be published study, based on a survey, suggests that a significant number of BCBAs are endorsing and using a variety of non-behavioral treatments, despite their belief that the treatments are difficult to implement, not cost-effective, and not supported by research.
Q: Is it unethical for Board Certified Behavior Analysts to endorse or use procedures not supported by sound research?
A: The dilemma posed generated a great deal of discussion and many excellent, reflective, and thought-provoking responses; thanks to all of you who shared your views. It is not possible to print all of your replies, but we have integrated several excerpts into our discussion below.
Indeed, alternative treatments and unverified treatments
abound, and it is common for behavior analysts to
encounter them in their practice. Often behavior
analysts feel significant discomfort when time and other
resources are being allocated to such procedures.
The Behavior Analyst Certification Board Guidelines for
Responsible Conduct for Behavior Analysts cover this
issue in several ways. First, in section 1. 01 - Reliance
on Scientific Knowledge, the guidelines specify that“behavior analysts rely on scientifically and
professionally derived knowledge when making
scientific or professional judgments in human service
provision, or when engaging in scholarly or professional endeavors.” In this guideline, the
primacy of scientifically derived knowledge in informing recommendations and treatments is
highlighted. Furthermore, in section 2.09 – Treatment Efficacy, more explicit guidelines for
treatment recommendations are given. “The behavior analyst always has the responsibility to
recommend scientifically supported most effective treatment procedures. Effective treatment
procedures have been validated as having both long-term and short-term benefits to clients
and society. Clients have a right to effective treatment (i.e., based on the research literature
and adapted to the individual client). Behavior analysts are responsible for review and
appraisal of likely effects of all alternative treatments, including those provided by other
disciplines and no intervention.” In this section, behavior analysts are reminded that clients
have a right to treatments that are effective, and that behavior analysts have a responsibility
to provide effective treatments and to make recommendations regarding all potential
treatments based on the strength of the scientific evidence.
These guidelines were prominent in the minds of respondents to our dilemma. Lori Warner articulated the different dilemmas posed by under-researched treatments and clearly ineffective ones. “There is a difference between a treatment option that has not been adequately investigated and one that has been well-researched and is found lacking. The former may have clinical merit in some circumstances, but practitioners and clients alike should be fully informed as to the limitations of the approach, and well-supported, evidencebased procedures should always be used as a first choice. In my opinion, it is unethical to knowingly use treatments that do not work.” Virginia Greenblatt echoed this when she wrote,“we endanger ourselves, our clients, and society if we promote treatments that do not have a sound basis in proven data.”
While others clearly agreed with these sentiments universally, a few respondents did point out the difficulties faced in settings with few behavior analysts and colleagues who may not place the same importance on evidence in selecting treatments. Sandra Barker said, “As a compromise, I encourage staff members to collect data on the behaviors that the intervention is intended to change to assess their effectiveness.” Similar sentiments were expressed by Cary Schwencke, who said, “My approach is to always use data. If the client is intent on using an approach that is harmless, but not backed by research, I suggest that we collect data in a way that would support or refute the claim.”
Some respondents went a step further, suggesting that consumer empowerment should be a high priority of behavior analysts. Debra Malmberg said we can “teach clients how to evaluate treatments with behavioral measures. Even better, we could provide training on this in our dissemination efforts/marketing of behavioral treatments.”
A strong theme throughout the responses was the importance of adhering steadfastly to the scientific underpinnings of ABA. As Lynne Stevens said, “our foundation is firmly rooted in the scientific method, which is what sets us apart.” This was echoed by Rosemarie Bonomo, who said, “At the core of practicing responsibly as a behavior analyst is to always employ scientific methods.”
What is a behavior analyst to do when treatments are proposed that lack verification of their effectiveness? It is imperative that we remember the responsibility to provide effective treatment, and to base our recommendations on the quality of evidence that exists for various procedures. In some cases, we may be faced with a treatment that has already been shown to be harmful. In these situations, the only responsible action is to inform the team about the evidence that exists and actively recommend against the treatment. In other cases, data may be lacking, but the treatment has not been shown to be ineffective. Our discomfort in these situations remains high, given our value on effective treatment and our reluctance to waste the client’s time on intervention that will not produce benefit. However, when we are on teams that are pursuing an alternative treatment of this type, we can use our training in ABA to help document whether this particular treatment is effective for this individual. In this way, we use data to guide the decision of the team about its continuance or termination over time.
And please consider our next dilemma...
Ethics Challenge #3
Some parents of consumers of ABA services have become BCBA’s or BCaBA’s. Should those individuals provide services to their own children? Is this a dual role? Does it place the parent in a conflict-of-interest situation? Should funding agencies pay parents with these credentials to provide services to their own children?
We look forward to hearing from many of you again! Click here to send in your response.
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