As a Board Certified Behavior Analyst (BCBA) and business owner, I’ve had my share of conversations about ethics, and they aren’t easy to navigate. Ethics is a word that gets thrown around a lot. As BCBAs, it's critical we follow our code of ethics and expect the organizations we work for to do the same. But what about corporate ABA organizations that don’t have BCBA owners? They aren’t held accountable to the code, but BCBAs are. That creates conflict.
Applied Behavior Analysis (ABA) practice owners and managers need to balance a lot of priorities, including:
Applied Behavior Analysis (ABA) practice owners and managers need to balance a lot of priorities, including:
While trying to balance so many competing priorities, it can be difficult to do so ethically, but it’s necessary to. Think about a compliance issue that comes up from a regular compliance review. In one case at an organization I manage, our compliance process discovered a Behavior Technician had been billing for sessions at a school when they weren’t present. As we looked deeper at the issue, cross-checked records with the school, signatures in-person and through our Electronic Health Record (EHR), it became clear this was an issue going back a few months. The total amount of fraud exceeded $17,000 USD. This was a lot of money for us at the time and painful to report, but it was the right thing to do. The steps we took included a full investigation, terminating the employee, and self-reporting to the insurance funder. Following our compliance process, we also reported to the attorney general’s office, local police and more agencies. It was a long, painful process resulting in financial strain, but ethically it was the right thing to do.
We of course increased compliance checks further and re-trained other staff to learn from the experience. We addressed antecedents to ethical behavior by increasing training and messaging from leadership.
How did we arrive at these decisions? First of all, we understand that ethically if we find a compliance problem we know we need to fix it. I know of business owners that go the easy route and turn a blind eye, but that’s incredibly short-sighted. Ignoring compliance or ethics concerns might be less work in the short term, but if left unchecked, unethical behavior can grow into much larger problems. Our leadership team talked and posed serious questions:
We of course increased compliance checks further and re-trained other staff to learn from the experience. We addressed antecedents to ethical behavior by increasing training and messaging from leadership.
How did we arrive at these decisions? First of all, we understand that ethically if we find a compliance problem we know we need to fix it. I know of business owners that go the easy route and turn a blind eye, but that’s incredibly short-sighted. Ignoring compliance or ethics concerns might be less work in the short term, but if left unchecked, unethical behavior can grow into much larger problems. Our leadership team talked and posed serious questions:
It turns out that the insurance funder was willing to deduct the payback from future payments, in installments over a few months. That helped alleviate the immediate financial question. Engaging with their compliance team early in the process was helpful, and being transparent. While investigating how and why this happened, we discovered the supervising BCBA didn’t do unannounced supervision, and did a lot of supervision by telehealth. Those issues were addressed along with all the other improvements. Additional checks by the back office team were added too.
Ethical dilemmas like this have simple answers when we do the right thing and follow the code of ethics, which require us to self-report. But what about when a BCBA reports something to their organization and they aren’t sure action was taken? What about other situations that don’t clearly fall within our code?
Ethical dilemmas like this have simple answers when we do the right thing and follow the code of ethics, which require us to self-report. But what about when a BCBA reports something to their organization and they aren’t sure action was taken? What about other situations that don’t clearly fall within our code?
OBM Ethics
Organizational Behavior Management (OBM) is used to manage the behavior of employees within organizations like ABA practices. Administrators of well-run ABA practices use our own science to manage, and it works well. As BCBA business owners, we’re required to follow our own code of ethics, as well as adhere to general business ethics.
Most businesses don’t fall under a BACB Code of Ethics because they aren’t run by BCBAs, but the concept of ethics still exists. Harvard Business School has defined business ethics as “principles that guide decision-making.” and state on their website:
Most businesses don’t fall under a BACB Code of Ethics because they aren’t run by BCBAs, but the concept of ethics still exists. Harvard Business School has defined business ethics as “principles that guide decision-making.” and state on their website:
BCBA Expectations of Organization Ethics
Regardless of what organization a BCBA works for, there should be a basic expectation that the organization behaves ethically. That can mean a lot of things, but at a high level, every business should be expected to:
Organization Expectations of BCBAs
On the flip side, as BCBAs we need to behave ethically towards the organizations we work for. This isn’t always easy, but again the right thing to do isn’t often the easy path. Think about a job offer you received as a BCBA for a Director position requiring management of dozens of staff. Did the salary look appealing, but you had reservations about your scope of competence to fulfill the job requirements? That’s an ethical dilemma and you need to be transparent with a prospective employer about your scope of competence. At a base level, Organizations expect very similar things from their BCBAs:
Notice the similarities in the list of ethical expectations for organizations and BCBAs. We should all behave ethically. What differentiates the ethical concerns is the consequences. BCBAs have the BACB that can investigate them - no BCBA would want their certification taken away, so this is a large potential negative punishment looming over our heads. Organizations are different.
Organization Ethical Enforcement
Businesses need to stay compliant with federal, state, local laws and contractual obligations or face large punishments. This sounds similar to the BACB oversight of BCBAs, but enforcement is lacking. Oftentimes there aren’t reporting mechanisms for ethical concerns. Even when reporting mechanisms exist, enforcement can be scarce, especially when dealing with the government.
Ethical organizations should have systems in place for any stakeholder to learn about ethics, and report alleged ethics violations. These act as antecedents to help encourage ethical behavior, and report unethical behavior. These should include:
Ethical organizations should have systems in place for any stakeholder to learn about ethics, and report alleged ethics violations. These act as antecedents to help encourage ethical behavior, and report unethical behavior. These should include:
If a BCBA suspects an organization of behaving unethically, there are consequences. Of course, the first step should always be a conversation with a supervisor. In fact, if you lodge an ethics complaint with the BACB, the first thing they will ask you is whether or not you have addressed this with the other party directly. What someone suspects of being unethical behavior might be a misunderstanding and a simple conversation can go a long way to solving the problem. Even if there is an issue, organizations can’t always go back to the BCBA to tell them what the resolution was for privacy reasons. However if a BCBA has reported something to their supervisor and suspect no appropriate action was taken for a legitimate concern, there are reporting mechanisms in many cases:
It’s worth noting that not all perceived ethics violations are in fact ethics violations. I’ve heard plenty of staff that aren’t receptive to genuine feedback, and allege discrimination or ethics violations. Constructive feedback isn’t necessarily a reason to claim discrimination or ethics violation. When considering raising an ethical concern, first take a moment to pause and think if it’s legitimate or not.
If you truly feel there’s an ethical concern, and no one in your organization or third party to report to, that’s where social media comes in. Organizations rely on reputation to recruit staff and attract clients. Write a review on Indeed, Glassdoor, or something on Reddit. Let others know about your situation so they can learn from your experience.
The staffing shortage in the ABA field doesn’t show signs of going away. Now more than ever, ethics is critical to get right. If you're a BCBA running an ABA organization, leading with ethical behavior might feel like an added burden, but it will set you up better in the long run. BCBAs want to work for ethical organizations, and leave unethical ones. Organizations that leave unethical behavior unchecked will eventually get caught, and by that time the problems might be too big to fix. ABA practice owners do still need to behave ethically as there are real consequences, even if they haven’t experienced them yet.
ABA practice owners can reach out for support any time. We don’t do paid consulting, and are simply happy to have conversations with like-minded BCBAs trying to improve the field.
Jamie Turner
MBA, PMP, BCBA
