Chap 4 Frequent Ethical Problems

Report
CHAPTER 4:
MOST FREQUENT
ETHICAL PROBLEMS
Kelly Carlile
Caldwell College
OVERVIEW
 Introduction
 Top 5 Ethical Concerns
 Top 10
 Standards Related to 6-10
 Standards Related to Other Fields
 Ethical Concerns for Other Fields
 Another Big Concern
 Related Codes of Ethics
 Questions
INTRODUCTION
 No official, systematic surveys of behavioral practitioners to determine
the most frequently occurring
 Based on scenarios written by workshop attendees
TOP 5 ETHICAL CONCERNS
Ethical Concerns
Ethical
Standard
1
Right to Effective Treatment
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
Behavior Analysts Assessments are
Sufficient to Provide Appropriate
Substantiation for their Findings
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
3
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 2.10 Treatment Efficacy
 (b) Clients have a right to effective treatment (i.e., based on the research literature
and adapted to the individual client)
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 Funding
 Unwillingness for school districts to pay
 Difficult to get insurance companies to reimburse
 Some still consider it experimental
 Not medically necessary
 More public school programs being started
 Lack of understanding of need
 Some states have age cut off and caps lifetime expenditures
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 $35 billion (Ganz, 2008)
 Direct Medical Costs
 Direct Non-Medical Costs
 Indirect Costs
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 Data Taking and Data Faking
 Don’t have time
 Know without the data
 Nonbehavioral professionals are in leadership roles
 Fake data and present as valid
 What are other reasons people may “fake” data?
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 Alternative Nonevidence –Based Treatments are Preferred
 Parents see as a “choice”
 More available than ABA services
 “Quick fix”
 What document exists now to assist with promotion of ABA?
RIGHT TO EFFECTIVE TREATMENT (2.10B)
 Competing Lines of Authority
 Working as a team, but under guidance of psychiatrist
 Medication often chosen as treatment
 School district representative overshadows parent and teacher
RESPONSIBILITY TO RECOMMEND
SCIENTIFICALLY SUPPORTED AND MOST
EFFECTIVE TREATMENTS (2.10A)
 2.10 Treatment Efficacy
 (a) The behavior analyst always has the responsibility to recommend scientifically
supported most effective treatments
RESPONSIBILITY TO RECOMMEND
SCIENTIFICALLY SUPPORTED AND MOST
EFFECTIVE TREATMENTS (2.10A)
 Choice
 Like having options, rather than being told
 Want to do what is best
 What’s the harm in trying?
 Want hope
 Bored
 Why don’t we give parents a choice?
RESPONSIBILITY TO RECOMMEND
SCIENTIFICALLY SUPPORTED AND MOST
EFFECTIVE TREATMENTS (2.10A)
 Competing Professions and Their Theories
 Importance of exercise
 Sensory diets
 Relaxation techniques
 What do you do when you are asked to implement a sensory diet?
BEHAVIOR ANALYSTS ASSESSMENTS ARE
SUFFICIENT TO PROVIDE APPROPRIATE
SUBSTANTIATION FOR THEIR FINDINGS (3.0A)
 3.0 Assessing Behavior
 (a) Behavior analysts’ assessments, recommendations, reports, and evaluative
statements are based on information and techniques sufficient to provide
appropriate substantiation for their findings
BEHAVIOR ANALYSTS ASSESSMENTS ARE
SUFFICIENT TO PROVIDE APPROPRIATE
SUBSTANTIATION FOR THEIR FINDINGS (3.0A)
 Start intervention without assessment
 Recommend without seeing child
 Decisions not based on data
 What do you do when you are asked recommendations for a child you
have never seen?
DUAL RELATIONSHIPS AND CONFLICTS
OF INTEREST (1.06A,B)
 1.06 Dual Relationships and Conflicts of Interest
 (a) In many communities and situations, it may not be feasible or reasonable for
behavior analysts to avoid social or other nonprofessional contacts with persons
such as clients, students, supervisees, or research participants. Behavior analysts must
always be sensitive to the potential harmful effects of other contacts on their work
and on those persons with whom they deal.
 (b) A behavior analyst refrains from entering into or promising a personal, scientific,
professional, financial, or other relationship with any such person if it appears likely
that such a relationship reasonably might impair the behavior analyst’s objectivity or
otherwise interfere with the behavior analyst’s ability to effectively perform his or
her functions as a behavior analyst, or might harm or exploit the other party.
DUAL RELATIONSHIPS AND CONFLICTS
OF INTEREST (1.06A,B)
 Dual Relationships and Conflicts of Interest
 Any interaction with client beyond role of therapist
 Accepting gifts or food
 Many deny this effects judgment
 Also felt like they should cut family a break financially
 What is too much?
 Is it less ethical to accept a gift or to deny a gift?
 What should be done as a field to address this?
FUNCTIONAL ASSESSMENT (3.02)
 3.02 Functional Assessment
 (a) The behavior analyst conducts a functional assessment, as defined below, to
provide the necessary data to develop an effective behavior change program.
 (b) Functional assessment includes a variety of systematic information-gathering
activities regarding factors influencing the occurrence of a behavior (e.g., antecedents,
consequences, setting events, or motivating operations) including interview, direct
observation, and experimental analysis.
FUNCTIONAL ASSESSMENT (3.02)
 Lack of resources
 Professional judgment
 Descriptive assessments
TOP 10 ETHICAL CONCERNS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
STANDARDS RELATED TO 6-10
#
Standard
Description
Least Restrictive
Procedures
The behavior analyst reviews and appraises the
restrictiveness of alternative interventions and always
recommends the least restrictive procedures likely to be
effective in dealing with a behavior problem
2.10c
Treatment Efficacy
Behavior analysts are responsible for review and
appraisal of likely effects of all alternative treatments,
including those provided by other disciplines and no
intervention
2.03
Responsibility
The behavior analyst’s responsibility is to all parties
affected by behavioral services.
4.05
Reinforcement/Punishment
The behavior analyst recommends reinforcement rather
than punishment whenever possible. If punishment
procedures are necessary, the behavior analyst always
includes reinforcement procedures for alternative
behavior in the program.
4.03
Environmental Conditions
that Hamper
Implementation
If environmental conditions hamper implementation of
the behavior analytic program, the behavior analyst
seeks to eliminate the environmental constraints, or
identifies in writing the obstacles to doing so.
4.10
PT CODE
OF ETHICS
BACB Guidelines
Treatment Efficacy (2.10A,B)
Assessing Behavior (3.0A)
Dual Relationships and Conflicts of
Interest (1.06A,B)
Functional Assessment (3.02)
Least Restrictive Procedures (4.10)
Responsible for Appraisal of
Alternative Treatments (2.10C)
Responsibility to All Parties Affected
by Behavioral Services (2.03)
Reinforcement/Punishment (4.05)
Environmental Conditions that
Hamper Implementation (4.03)
OT CODE OF ETHICS
OT CODE OF ETHICS
OT CODE OF ETHICS
OT CODE OF ETHICS
OT CODE OF ETHICS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
ASHA CODE
OF ETHICS
ASHA CODE
OF ETHICS
ASHA CODE
OF ETHICS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
ART THERAPY
CODE OF ETHICS
ART THERAPY
CODE OF ETHICS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
NEA CODE OF ETHICS
 Least detailed
 Do not address any of the standards of the BACB guidelines
 Only address commitment to student and commitment to self
NEA CODE OF ETHICS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
APA CODE
OF ETHICS
 2.04 Bases for Scientific and Professional Judgments
 3.05 Multiple Relationships
 3.06 Conflict of Interest
 3.10 Informed Consent
 9.01 Bases for Assessments
 9.02 Use of Assessments
APA CODE
OF ETHICS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
ETHICAL ISSUES FOR OT/PT
 Recommendations not honored due to budget
 Space to treat
 Group students
ETHICAL ISSUES FOR SPEECH
 Told limited number of students they can classify
 Told students will not be eligible, so do not assess
 Back to back sessions reduce IEP times
 Forced to group students
ETHICAL ISSUES FOR TEACHERS
 Advocate for district first and student second
 Asked to address issues outside expertise
 Given behavior plans to implement with no training
ETHICAL ISSUES FOR CST
 Told not to classify students with specific diagnosis, even though meet
criteria for it
 Parent requests not always considered in “team” decision
 Public vs. Private Programs
 General education teachers not in agreement and sabotage placement if
not in agreement or argue with parents unnecessarily
 Hold back special education students
 Advance grade levels without exposure to curriculum
PROFESSIONAL ETHICS THAT RELATE TO
TOP 10 CONCERNS
Ethical Standard
1
Treatment Efficacy
2.10B
2
Responsibility to Recommend
Scientifically Supported and Most
Effective Treatments
2.10A
3
Assessing Behavior
3.0A
4
Dual Relationships and Conflicts
1.06A,B
5
Functional Assessment
3.02
6
Least Restrictive Procedures
4.10
7
Responsible for Appraisal of Alternative
Treatments
2.10c
8
Responsibility to All Parties Affected by
Behavioral Services
2.03
9
Reinforcement/Punishment
4.05
10
Environmental Conditions that Hamper
Implementation
4.03
CAN YOU THINK OF AN EVEN
BIGGER ETHICAL ISSUE NOT
MENTIONED??
ETHICS AND TECHNOLOGY
 YouTube search revealed many
 Social Media
 Ethic guidelines need to be updated to reflect new technological
advances.
HOW TO HANDLE ETHICAL PROBLEMS
 To be continued . . . Chapter 17
QUESTIONS?
RELATED CODES OF ETHICS
 Art Therapy Code of Ethics
 APA Code of Ethics
 OT Code of Ethics
 PT Code of Ethics
 NEA Code of Ethics
THANK YOU!

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