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BCBA Interview: Ethical Dilemmas and Cultural Challenges
A face-to-face interview session was conducted with John Winters on November 5th, 2022. Winters is a Behavior Analyst Certification Board (BACB) professional whom I met while attending an education workshop several months ago. From our discussion, the respondent reveals that ethical dilemmas are common in professional life. In this case, certified entities like BACB are bound by professional duty to safeguard the clients safety and not cause unnecessary harm.
An individuals inability to determine the optimal solution to such difficulties may lead to a breach of the set guidelines and disciplinary sanctions. Regarding working with clients from multi-ethnic groups, Winters stated that this could present a significant challenge, especially when ABA professionals lack cross-cultural skills. Understanding how to navigate ethical concerns and possessing cross-cultural skills are the key prerequisites for success in an Applied Behavior Analysts career.
Ethical Dilemmas
Working closely with clients and their families can become a possible ground for ethical dilemmas. In this case, some ethical dilemmas Winters highlighted include receiving gifts and having dual or multiple relationships. These ethical concerns emanate from long hours working with a single client, usually in a familys home. As the respondent indicates, the circumstance makes it easy for a professional in the field to build a personal relationship.
Although Applied Behavior Analysts (ABA) providers must maintain professional boundaries, this is one of the most challenging ethical issues. For example, Winters had a client inviting him to stay for an expensive dinner and engage in private conversations. These scenarios violate sections 1.11 and 1.12 of the code of ethics (Behavior Analyst Certification Board [BACB], 2020, p. 10). A dual relationship is defined as having a client-ABA rapport that extends, deliberately or unknowingly, to include activities or encounters beyond established ethical boundaries. Thus, a behavior analyst must avoid multiple relationships because they may lead to a conflict of interest that can harm all involved.
Giving and receiving gifts is a cultural way people show indebtedness and gratitude. In this regard, such appreciation may be in monetary and non-monetary rewards. Code 1.12 applies to this situation because ABAs must know that gifts may be offered for various reasons, and agreeing to certain gestures may compromise their work. Individuals must find a polite way to reject or decline frequent client offers. However, if a behavior analyst manipulates a client into thinking that giving rewards is necessary to obtain services, this violates section 1.13 of the code of ethics (BACB, 2020, p.10).
In this case, ABAs are required not to abuse their authority over their clients by exploiting or coercing them to engage in activities that may stretch professional boundaries. Although accepting an invitation may have seemed appropriate or polite, such offers are a source of stress for therapeutic relationships (Rosenberg & Schwartz, 2018, p. 475). For example, when a gift is rejected, this might offend a client. Conversely, if accepting a token and the desired result is not achieved, a service user may become resentful.
How the Behavior Analyst Handled the Situations
The best practice include not giving and accepting gifts of any kind, even if it is a sign of gratitude. Sometimes it may be viewed as a motive to secure preferential treatment or personal friendship (Brodhead, 2019, p. 827). Thus, when a client invited Winters to dinner, he thanked his host. A No Gifts regulation may entail different things, such as not accepting food of any value, sharing meals with a client, attending family social gatherings, and receiving money amounting to over $10 (BACB, 2020, p. 10). As the interviewee indicates, this reassured the client that he appreciated her invitation and did not take it for granted. Consequently, such an expression helps maintain a good relationship and prevent them from being disappointed for declining their offers. When behavior analysts thank their clients, it shows their appreciation for offering gifts.
An ABA professional should consider the clients motive when accepting or rejecting presents or invitations. Sometimes such gestures may be based on pure generosity or involuntary, simply because certain people derive pleasure from rewarding others (Brodhead, 2019, p. 828). In this regard, clients exhibiting such habits may not in any way intend to influence the behavior analysts work. If that is the case, Winters suggests, a gift is an expression of generosity and not a risk to professional conduct, but still accepting them should be avoided. However, when favors or rewards are used to influence services provided, this must be detected and prevented before it jeopardizes the therapeutic relationship.
If an ABA practitioner has not established appropriate professional boundaries, spending personal and work hours with clients outside the formal settings under the guise of a professional visit constitutes multiple roles. As the respondent indicates, presuming he befriended his client and accepted the dinner request as if they were friends, this might have led to a conflict of interest. For example, if accepting clients rewards influences behavior analysts judgment, this may create a different relationship besides the recommended one. Although a close association may strengthen treatment and enhance interactions between clients and ABA professionals, this can also be an obstacle to the therapeutic process and cause immediate or permanent harm to the service users.
Cross-cultural Challenges Affecting Behavior Analysts
According to Winters, ABAs often experience several cross-cultural challenges because they deal with a multi-ethnic client base daily. The language barrier is one of the biggest problems in this profession (Dennison et al., 2019, p. 888).
For instance, Winters remembers an incident where he faced a great challenge in conducting a functional analysis with a Spanish client. In this case, he realized that the client demonstrated more problematic behaviors and responded inappropriately whenever he issued instructions in English. However, when the clients caregiver translated the instructions into Spanish, there were decreases in challenging behaviors and significant increases in correct responses to the guidelines. In addition, ABA professionals may experience communication barriers due to the wrongful interpretation of non-verbal cues because different gestures have unique meanings in each culture.
Divergent beliefs and values present a severe challenge to many ABAs when dealing with multi-ethnic clients. Patients and caregivers are less likely to comply with behavioral changes or treatment approaches that conflict with their cultural beliefs (Beaulieu et al., 2018, p. 557).
Winters narrates an ordeal where an Asian caregiver rejected behavioral therapies to help manage their childs cerebral palsy due to the belief that westernized treatment approaches were inferior to Chinese traditional medicine. In this case, it took a lot of effort to convince the caregiver to try the therapies and revert to the traditional herbals if the programs failed. Similarly, Winters observes that communicating with clients living with disabilities is a significant problem for ABA professionals. Most professionals lack adequate information on how to interact with special needs children to train them on effective changes to better adapt to their environments (Dennison et al., 2019, p. 888). This greatly impedes the treatment plan because the ABA practitioners cannot assess and evaluate the needs of this population without understanding their values and preferences.
Sexual orientation is another major problem for many ABA specialists. Winters notes that, at times, a professionals personal biases may hinder their ability to create rapport with the clients and their families, resulting in the termination of the service (Dennison et al., 2019, p. 891). In this case, a practitioners assumption that a client can either identify as male or female may evoke a negative reaction from a transgender person turning them away from the much-needed help. Not to mention, LGBTQ clients may have a negative perception of ABA practitioners due to the stigmatization they face in the healthcare system resulting in non-compliance with recommended approaches.
Recommendations for Managing Ethical Challenges
Based on the information collected from the interview, Winters offers various recommendations using established standards to help novice ABA professionals learn how to handle ethical dilemmas that may arise when interacting with clients and families. In this case, he advices the practitioners to attend seminars and workshops to interact with experts from the field. As a result, ABA professionals will have the opportunity to expand their understanding of the best practices. For example, providing case studies during seminars can stimulate reflective discussion and generate concepts to address these dilemmas. Therefore, through such programs, professionals and students will stay up-to-date on the latest trends, shared experiences, and challenges in the field and be inspired to navigate work-related challenges effectively.
Winters offers a variety of approaches to address dual relationships. In this regard, he suggests that people should consult various documentation. The code of ethics addresses the potential harm that can result from multiple roles (Behavior Analyst Certification Board, 2019, p. 5). Therefore, he emphasizes that abstaining from informal interactions is the better approach. Suppose an ABA becomes attracted to the sister of the child he attends to; to avoid a dual relationship, the professional must declare his interests and transfer the case (Rosenberg & Schwartz, 2018, p. 435).
Apart from using professional codes, individuals can also utilize a problem-solving model to address these emerging ethical issues. In this context, ABA professionals should adhere to the eight-step model. The concept entails considering the context, consulting the ethics code, determining risks and benefits, critically implementing set guidelines, assessing diverse perspectives, identifying others expectations, clarifying own role, and discussing personal concerns. Finally, ABA professionals should evaluate electronic communications and social media use during professional relationships with clients. Conversing through smartphones, emails, or social media can create opportunities for multiple roles and relationships to develop. Therefore, Winters suggests that it is essential to establish parameters around using these communication tools.
Cultural Competency Recommendations
Ignored or unknown cultural variables may hinder effective treatment delivery. According to Winters, several strategies may assist ABA practitioners in becoming culturally competent. In this context, these specialists need to understand their own cultural beliefs, values, and preferences and how they may influence their relationship with their clients (Wright, 2019, p. 807). Such awareness may help them correct their biases towards other cultures, hence improving their working relationships with clients from different cultural backgrounds (Dennison., 2019, p. 889).
In addition, Winters suggests that there is a need for ABA professionals to learn about other cultures. Since these practitioners deal with a multi-ethnic client base, they should receive adequate training on working with diverse cultures. Learning about different cultures can also be achieved through interacting or consulting with professionals from distinct ethnic backgrounds (Beaulieu et al., 2018, p. 559). The cultural awareness of both self and clients is critical because evidence-based treatment approaches necessitate a combination of a clients preferences and clinical expertise.
ABA practitioners can improve their cultural competence by developing their skills to gather information about other ethnicities to incorporate into the intervention strategies. It is impossible for ABA experts to learn about all cultures. Therefore, collecting the appropriate data can help analysts to identify the antecedents and motivators of certain behaviors (Beaulieu et al., 2018, p. 564). The skills to gather correct data can allow a specialist to comprehend how a culture may impact reinforcements, objectives, and interventions of a particular treatment approach. The lack of information about cultural norms and preferences may lead to the unintentional delivery of suboptimal services (Dennison et al., 2019, p. 892). All these strategies may enhance communication between the clients and the ABA professionals resulting in positive health outcomes.
In conclusion, ethical dilemmas are among the major challenges behavior analysts encounter in their daily operations. Working with clients and their families presents circumstances that can make multiple relationships thrive. In this case, ABA professionals must not receive gifts from clients because it may lead to dual relationships. Consequently, this might negatively affect therapeutic work and violate specific regulations outlined in the BACB code of ethics. Nevertheless, attending workshops creates opportunities to interact with experts and learn from them. Similarly, ABA practitioners experience several cross-cultural problems when dealing with their multi-ethnic clients. These may include language barriers and misinterpretation of non-verbal communication cues, and differences in cultural beliefs. However, identifying ones biases towards other cultures and receiving training about handling a diverse client base may assist an ABA expert in becoming more culturally competent.
References
Beaulieu, L., Addington, J., & Almeida, D. (2018). Behavior analysts training and practices regarding cultural diversity: The case for culturally competent care. Behavior Analysis in Practice, 12(3), 557575. Web.
Behavior Analyst Certification Board. (2019). Professional and ethical compliance code for behavior analysts. Web.
Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Web.
Brodhead, M. T. (2019). Culture always matters: Some thoughts on Rosenberg and Schwartz. Behavior Analysis in Practice, 12(4), 826830. Web.
Dennison, A., Lund, E. M., Brodhead, M. T., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering home-supported applied behavior analysis therapies to culturally and linguistically diverse families. Behavior Analysis in Practice, 12, 887898. Web.
Rosenberg, N. E., & Schwartz, I. S. (2018). Guidance or compliance: What makes an ethical behavior analyst? Behavior Analysis in Practice, 12, 473482. Web.
Wright, P. I. (2019). Cultural humility in the practice of Applied Behavior Analysis. Behavior Analysis in Practice, 12(4), 805809. Web.
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