|Ethical Decision-Making in Applied Behavior Analysis Practitioners: Models, Behavior, and Organizational Culture
|Monday, May 30, 2022
|9:00 AM–9:50 AM
|Meeting Level 2; Room 258A
|Area: AUT/OBM; Domain: Applied Research
|Chair: Videsha Marya (Endicott College)
|CE Instructor: Videsha Marya, M.S.
Ethical decision-making can be described as involving several components. First, a set of responses that can occur sequentially or non-sequentially and that culminate in a final decision. Second, comparison of that final decision with social standards of 'right' and 'wrong'. Finally, personal and professional contingencies that shape ethical decision-making over time. In this symposium, three presentations describe recent work surrounding ethical decision-making in clinical ABA practice settings. In one presentation, Kinsella and colleagues present the results of a literature review analyzing trends and similarities across 55 ethical decision-making models published across medical and clinical literatures. Next, Almeida and colleagues present the results of an experiment that evaluated the effectiveness and preference for ethical decision models by BCBAs responding to ethical dilemmas. Finally, Woolf and colleagues discuss how organizations can create ethical cultures that align and balance the competing contingencies associated with decision-making that impact care quality and an organization's financial health. Together, the presentations that comprise this symposium highlight the many systems that impact ethical decision-making in ABA practice settings and many avenues for fruitful future research.
|Instruction Level: Intermediate
|Keyword(s): decision models, ethical decision-making, ethics, OBM
General understanding ethical codes, organizational systems, and the basic literature on decision-making.
|Learning Objectives: At the conclusion of the symposium, participants will be able to: (1) Describe common components to ethical decision-making models in healthcare and education; (2) Describe how ethical decision-making models can influence the decisions BCBAs make. (3) How organizational leaders and administrative professionals can create systems that balance quality care and financial health.
|A Systematic Review of Ethical Decision-Making Models for Clinical and Educational Settings
|ALAN KINSELLA (Endicott College), Victoria Suarez (Endicott College), Videsha Marya (Endicott College), Mary Jane Weiss (Endicott College), David J. Cox (Behavioral Health Center of Excellence; Endicott College)
|Abstract: Ethical decision-making models are sets of verbal stimuli designed to help the user emit behavior deemed “right” or avoid behavior deemed “wrong”. Over the past decade, ethical decision-making models have increasingly been published in behavior analysis journals and books. These models have ranged in focus from specific topics (e.g., responding to changes in medication) to generalized frameworks spanning many contexts. Outside behavior analysis, ethical decision-making models have been studied in related allied fields for decades (e.g., education, medicine). Despite this prominence, the consistency of steps across models and the empirical support for
model effectiveness are unknown. In this presentation, we discuss the results of a literature review wherein we analyzed 55 ethical decision-making models from 61 articles across education and healthcare. Through initial review, we identified nine prominent steps and coded articles for whether they included that step as well as the profession; whether it involved problem-solving; and whether it was linearly sequenced. This presentation discusses the resulting trends, the prevalence of each step, and the empirical support for each model. Behavior analysts interested in taking an objective, empirically supported approach to ethical decision-making will
benefit from this discussion of the current strengths and limitations of existing ethical decision-making models.
|An Empirical Study of Ethical Decision Making by BCBAs
|DANIEL ALMEIDA (Beacon Services), Lauren Beaulieu (Newton Public Schools), Corina Jimenez-Gomez (Auburn University)
|Abstract: Clinical decision-making models have been proposed in the behavior analytic literature (Colombo et al., 2020; LeBlanc et al., 2016; Rosenberg & Schwartz, 2019; Virués-Ortega et al., 2014) and recently the BACB urged behavior analysts to use a decision model to guide ethical-decision making (BACB, 2020). However, little is known about how these models impact decision making and clinical outcomes. Therefore, evaluating the effectiveness and preference for ethical decision models is important for the field and was the purpose of this study. In baseline, eighty-four BCBAs were presented with scenarios that posed ethical dilemmas and were instructed to use their own method to identify solutions to the ethical dilemmas and factors that led to their decision. Of all participants, 42% of participants relied on the ethical code when making ethical decisions, 38% on professional experience, and 19% on personal experience. Next, participants received brief instructions, a sample of a completed decision model, and one practice opportunity. Lastly, participants were instructed to choose their way or the decision model via a concurrent chains arrangement. During the concurrent chains condition, when asked what method they preferred, 69% selected their own method, while 31% chose the decision model. Implications for practice will be discussed.
Organizational Ethics: Establishing an Ethical Culture that Aligns With Business Practices
|STEVE WOOLF (Butterfly Effects), Joy Pollard (Behavior Change Institute; Stanford University), Shawn P. Quigley (Melmark)
The business of providing ABA-based treatments to children has increased exponentially over the last ten years. The combination of ASDs’ high prevalence, shortage of providers, nationwide treatment mandates, and other factors set the occasion for robust business opportunities for autism treatment providers and investors. The ASD ABA treatment market was valued at $1.87 billion in 2017 with a projected market valuation of over $2.23 billion by 2022 (Research and Markets, 2017). Balancing competing contingencies of providing quality care, while also reporting to investors who may not have direct knowledge of best practice ABA treatment, can be not only challenging but also create ethical distress among the providers rendering care within the organization. As such, it is important for our field to engage in open dialogue about the ethical dilemmas that may arise and how to promote high-quality, ethically sound ABA treatment within the evolving landscape of applied behavior analysis treatment. To this end, the purpose of this presentation is to focus on organizational ethics as it refers to the ethical issues from an administrative or management perspective within a healthcare organization, rather than addressing ethical issues purely related to clinical practice.