Choosing a therapist means more than checking proximity and insurance coverage. Ethics are critical. An applied behavior therapy (ABA) provider should abide by ethics rules in each and every meeting with you or your child.
The Behavior Analyst Certification publishes two sets of ethics rules, made for different types of ABA providers. You don't need to memorize them, but the more you know about them, the better you'll be able to identify who is ethical and who should be avoided.
Other ethics rules may apply, including those created by the American Psychological Association and the American Counseling Association. Learn all you can about these rules too.
Screening questions help you choose the right therapy provider, but watch your child's ABA sessions too. Red-flag behavior indicates the need to restart your search for the right provider.
Formal Ethics Documents to Study
The Behavior Analyst Certification Board is the governing body for trained ABA professionals. You'll know them by the formal designations behind their names, such as BCBA, BCaBA, or RBT.
The certification board drafted two types of ethics documents: one for supervisors and one for technicians.
The Professional and Ethical Compliance Code for Behavior Analysts is for board-certified behavior analysts (BCBAs) and those with even more advanced degrees. These professionals can deliver ABA, but they also supervise technicians. They hold a great deal of responsibility, and ethics are crucial.
The official ethics code for this group is 24 pages long, and it includes rules about:
- Responsible conduct. BCBAs must rely on scientific knowledge, avoid exploitive relationships, and avoid conflicts of interest.
- Responsibility to clients. BCBAs must explain plans about treatment, recordkeeping, payments, fees, and confidentiality carefully. They must put clients first.
- Assessment. BCBAs must assess behavior before making recommendations or crafting plans. They should work with doctors as needed.
- Treatment. BCBAs must follow ABA best practices when creating plans. Patients must be involved in planning. Sessions should stress reinforcement over punishment, and the least restrictive option must be prioritized.
- Supervision. BCBAs supervising others are responsible for the work done. They can't watch over too many programs or oversee programs that are too complex for them to handle.
- The profession. BCBAs must agree to uphold ethics standards and ABA principles.
- Colleagues. BCBAs often work with other BCBAs. When they do, they should look for ethical violations and intercede when appropriate.
- Statements. BCBAs should be truthful and honest in all public comments.
- Research. Ethical issues may appear in research settings. BCBAs are careful to put clients first.
BCBAs have plenty of responsibility, especially if they supervise a team of technicians. It's reasonable to expect them to adhere to this long list of rules in everything they do.
Registered behavior therapists (RBTs) don't supervise others. They work directly with clients under the guidance of BCBAs.
RBTs have their own ethical rules from the Behavior Analyst Certification Board, but the list is shorter. It includes rules about:
- Conduct. RBTs must be truthful and behave in an ethical manner. They can't date clients or supervisors. RBTs must follow through on their promises and behave with integrity throughout their work.
- Clients. RBTs protect confidential information, so they don't share notes on social media, talk about cases with friends, or otherwise violate privacy laws.
- Program delivery. RBTs only practice with supervision, and they speak up when asked to do something they're not qualified to do.
How Are Ethics Rules Applied?
Ethics rules seem straightforward, and when professionals are certified, they agree to uphold those rules. But in practice, professionals have decisions to make. Sometimes, the rules conflict.
For example, ABA therapists agree to consult others when cases are too challenging. Someone with no experience in handling physical attacks, for example, should ask another professional for help or refer the client to someone else if the problem repeats, experts explain.
But therapists working in remote areas may have no local colleagues. They can't leave a client without assistance, per the ethics rules. They must find a solution, such as referring the client to an out-of-area professional who can help, even if that help is provided via telehealth sessions.
Studies suggest that ABA therapy providers tend to apply ethics rules in the same manner, no matter where they live. But professionals may wrestle with ethics occasionally. Sometimes, they may need extra time to answer a question or consult with a colleague on an issue.
Other Ethics Rules Apply
The Behavior Analyst Certification Board is made just for ABA therapy providers. But these professionals may also be psychologists, psychiatrists, or similar mental health professionals. Other ethics rules may apply to them, and they must abide by them too.
The American Psychological Association, for example, has ethics rules regarding:
- Billing. Professionals must bill families and insurance companies accurately. You should understand a professional's policies when treatment starts.
- Consent. The therapist should discuss everything beforehand, from the length of treatment to the goals of the therapy to the alternate methods available. Parents typically hold these discussions for their children, but verbal kids should also understand the basics of consent.
- Confidentiality. Therapists must protect the records of their clients. If something happens and personal data is leaked, they must report that issue per state and federal laws.
The American Counseling Association also has ethics rules. Most importantly, this organization says that the primary responsibility of a counselor is to respect the dignity and welfare of clients.
Your ABA therapy provider may not have signed documents proving alliance with all of these rules. But skilled professionals understand that they have both legal and ethical obligations to their clients. They do what is necessary to honor these obligations.
How Can You Identify an Ethical Therapist?
If you can't ask a professional for signed ethics documents, what can you look for? Some signs make it clear that you are dealing with an principled professional.
An ethical ABA therapy provider will:
- Get regular ethics training. Some organizations designate ethics trainers, and each member of the staff works with that professional regularly. If you're interviewing someone who is part of a large organization, you can ask about this position.
- Respect boundaries. Ethical providers don't date clients, their family members, or former clients. They also don't ask clients or families for gifts or money. They are professionals, and they conduct themselves as such.
- Use positive ABA methods. ABA is an old therapy, and it has changed with time. Modern ABA providers don't lean on outdated techniques like punishment or flooding. Sessions are frequently fun for kids, and they often participate willingly.
- Remain open to feedback. You should feel able to observe or participate in sessions, and you should have a voice in how treatment is progressing. Ethical therapists won't hide their work.
Some of these are factors you'll spot before you hire your therapy provider. Others won't become clear until later.
Stay engaged and involved in therapy, and don't be afraid to advocate for your child.
- Professional and Ethical Compliance Code for Behavior Analysts. (March 2019). Behavior Analyst Certification Board.
- RBT Ethics Code. (February 2019). Behavior Analyst Certification Board.
- When Ethical Guidelines Conflict in ABA Practice. (March 2016). Behavioral Science in the 21st Century.
- Ethical Issues in Rural Programs for Behavior Analysis for Students. (May 2017). Rural Special Education Quarterly.
- Potential Ethical Violations. American Psychological Association.
- 10 Ways Practitioners Can Avoid Frequent Ethical Pitfalls. (January 2003). American Psychological Association.
- 2014 ACA Code of Ethics. American Counseling Association.
- Teaching and Maintaining Ethical Behavior in a Professional Organization. (2012). Behavior Analysis in Practice.
- Is This Therapy or Something Else? (August 2013). Psychology Today.