|Analyzing Scope of Competence in a Rapidly Evolving Landscape: Ethical Considerations for Practicing Behavior Analysts
|Sunday, May 29, 2022
|3:00 PM–3:50 PM
|Meeting Level 2; Room 257B
|Area: AUT; Domain: Service Delivery
|Chair: Erick M. Dubuque (The Council of Autism Service Providers)
|CE Instructor: Erick M. Dubuque, Ph.D.
|Abstract: In contrast to scope of practice, which refers to the range of activities in which members of a profession are authorized to engage, by virtue of holding a credential or license, scope of competence encompasses the range of professional activities of the individual practitioner that are performed with proficiency (Brodhead, et al., 2018). In a field that is growing at a rapid pace, ABA organizations must position themselves to respond not only to market demand, but also to evolving standards related to ethics, quality, clinical practice guidelines, patient outcomes measurement and reporting, and insurance coverage criteria. Failure to adapt to these changes – by providing the organizational supports individual practitioners require to continuously build and maintain new proficiencies – may increase the risk of poor outcomes, harm to patients, or damage to the field. In this symposium, we will discuss current assessment and treatment trends within the field and response strategies to ensure responsible and ethical service delivery in the face of industry change.
|Instruction Level: Intermediate
|Keyword(s): Assessment, Ethics, Outcome Measures, Punishment
|Target Audience: Behavior analysts within their first 5 years of practice, practitioners, supervisors, and senior leaders.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) differentiate scope of practice from scope of competence; (2) identify ethical codes relevant in the administration of clinical assessments; (3) identify strategies to mitigate risk of practicing beyond the boundaries of competence.
|Current State of Training on Clinical Assessment Measures: A Survey
|KRISTIN M. HUSTYI (LittleStar ABA Therapy), S. Shanun Kunnavatana (Easterseals UCP North Carolina & Virginia)
|Abstract: Obtaining a credential or license as a board-certified behavior analyst (BCBA) can be thought of as an entry-level requirement for practicing in the field of applied behavior analysis (ABA). Ongoing professional development is necessary to meet increasingly complex public, payor, and patient needs and standards. Survey research has documented the variability in staff and supervisory training opportunities offered to BCBAs working in applied settings (Reed and Henley, 2015; Columbo, Taylor, and Hammond, 2020; Padilla, 2020). In this study, we partially replicated and extended this line of research by surveying BCBAs working at several unaffiliated ABA organizations on their training experience with clinical assessment measures recommended within the field of ABA, including criterion-referenced assessments, norm-referenced assessments, and functional assessment methodologies. Respondents reported their experience with formal training that met the minimum assessor qualifications to ethically administer, score, interpret, and use the results of each measure as defined by the test publisher and whether they used each measure in their clinical practice irrespective of formal training. Implications regarding boundaries of competence and future directions for research will be discussed.
|Recommended Strategies to Promote Ethical Administration of Treatment Outcomes Measures
|LAURYN TOBY (LittleStar ABA Therapy)
|Abstract: Reporting on treatment outcomes is quickly becoming the expectation by insurance providers and patients worldwide. With a focus on improving clinical standards, several organizations have published recommendations on assessment measures that may be used for evaluating treatment outcomes in applied behavior analytic treatment for individuals with autism (e.g., Behavioral Health Center of Excellence [BHCOE], International Consortium for Health Outcomes Measurement [ICHOM]). In addition, insurance providers have begun to request increasingly diverse sets of data to demonstrate patient progress. Given the scope of the recommended measurement sets, important concerns are raised about practice limitations for behavior analysts. Many of the recommended measures are those traditionally administered by psychologists who may be offered a breadth of training in testing and measurement that is uncommon in behavior analysis. Indeed, research suggests that behavior analysts have limited training and exposure to the some of the measures recommended (Padilla, 2020). Recommendations for building internal infrastructure and clinician training to ensure responsible adoption of new outcome measures will be discussed.
|The Punishment Review Panel as a Practical Safeguard in the Treatment of Severe Challenging Behavior
|JESSE LOGUE (LittleStar ABA Therapy)
|Abstract: Punishment should only be used under rare circumstances, such as when behavior must be suppressed rapidly to prevent serious physical harm or when reinforcement-based strategies have been exhausted, and punishment should never be used in isolation. While these guidelines exist, it is estimated that up to 50% of behavior analytic research published on punishment procedures failed to report prior treatment approaches or indicated punishment as the sole component of treatment (Lydon, et. al. 2015). Concerns about the use of punishment are further complicated by the rapid expansion of our field and the need to report significant reductions to continue treatment. Research indicates that new BCBAs are sometimes assigned severe behavior cases without receiving initial training or ongoing supports (i.e., 43% did not receive training; Columbo, Taylor, and Hammond, 2020). The development of a Punishment Review Panel (PRP) is a practical safeguard for evaluating the merit of punishment in practice. The PRP process provides a critical support to BCBAs by identifying alternatives to punishment and ensuring comprehensive assessment prior to treatment, thereby reflecting ethical best practices. Sample data will be discussed, which include only 15% of proposals being accepted.