As an Applied Behavior Analysis (ABA) professional, you’ll inevitably encounter potential ethical dilemmas during your career. While some ethical situations can be anticipated and planned for, others are trickier to navigate. That’s where BHCOE’s Standards for Effective Behavioral Organizations come in.

The standards help promote access to safe, quality, and effective clinical services for patients receiving ABA services. In a recent webinar, BHCOE leadership outlined section A of BHCOE’s standards related to Ethics, Integrity, and Professionalism.

“These standards are about form, not function,” says Sara Litvak, BHCOE CEO. “We’re not telling you how to do things; we’re providing the standard and asking you to show us how you’re meeting it. It’s really up to you as an organization to look internally at what your gray areas are related to ethical considerations and apply policies consistently across the board.”

The webinar detailed the intent for each standard, suggested verification, and practical examples of how to ensure compliance. Here are highlights of the 10 ethics standards:

1. Healthcare regulatory laws

Your organization must follow all applicable healthcare regulatory laws, including those spelled out by the U.S. Department of Health and Human Services (False Claims Act, federal anti-kickback statutes, and Stark Law). Several other agencies focus on workplace safety and compliance, including the Office Safety and Health Administration (OSHA) and the Federal Emergency Management Agency (FEMA).

A regulatory breach can be as seemingly innocuous as rounding up to 2:15 p.m. for billing purposes when you actually finished a session at 2:10 p.m. It’s important to be mindful of all of the different aspects of regulatory compliance.

2. Owner or organization legal issues

Your organization must not be engaged in any healthcare regulatory breaches. In addition, owners, officers, and directors must not have been convicted or involved in any legal proceedings, especially those relating to healthcare regulatory law.

“This standard adds a layer of protection to consumers, ensuring those leading the organization don”‘t have a history of legal issues,” adds Litvak.

3. Staff compliance with ethical and professional requirements

Your organization must also promote ethical practices of staff and support them in complying with the ethical and professional requirements of their credentialing or licensing body. In addition, the organization must not direct staff to act in violation of those requirements.

Scenarios include asking a BCBA to take on a self-injurious behavior patient when it is outside their scope of competence or requesting a change in dosage or treatment recommendation for a patient in the best interest of the business.

4. Fair competition

This standard ensures that an organization is dedicated to ethical and fair competition and does not improperly attempt to sabotage or undermine other ABA service organizations. Fair competition encompasses basing competitive practices on price, quality, and customer service rather than, for example, predatory pricing. Other examples of unfair competition include running false advertisements and stealing trade secrets.

5. Dual relationships

Another important ethical guideline is avoiding dual relationships, which may impair the ability to make objective and fair decisions. Dual relationships include relations between employees in differing levels of power and supervision or employment of a relative toward their certification.

6. Employee privacy

Most organizations are careful to comply with HIPAA requirements to maintain patient confidentiality. However, when it comes to staff, BHCOE sees some common and often unintentional mistakes, such as mishandling of personal records, medical records, or drug screening.

Scenarios that violate employee privacy include accidentally emailing personnel information to the wrong email address or storing confidential employee information on a shared drive. It’s vital to have clear policies about what employee information you can and can’t monitor and what employees” rights are in regard to their privacy.

7. Patient incentives and remuneration

ABA organizations must not offer incentives or remuneration to current patients in exchange for attendance or recruitment of other patients. Litvak says these incentives can distort the therapeutic relationship. “Incentives can skew expectations and compromise the trust that is the foundation of the relationship between a provider and a patient. Compensation also doesn’t teach the patient or family the importance of attending sessions or the utility of them,” she says.

8. The exchange of gifts

This standard covers gifts between staff in business functions and external partners, including payers, suppliers, vendors, and prospective employees. To avoid conflicts of interest, your policy should define what is and is not appropriate to accept as a present, offering, award, or token of appreciation.

Holiday gifts are an area where organizations can run into problems. If an agency sends extravagant gift baskets to case managers, for example, are the case managers more inclined to send referrals to that organization because of the gift? “There’s a lot of nuance around the exchange of gifts, so organizations really need to think through different gift-giving scenarios,” says Litvak.

9. Ethics officer or committee

Organizations must have an ethics officer or committee to address ethical issues related to patient programming and staff or patient concerns. Litvak says that the responsibility can rotate between individuals. “I highly recommend this be someone in a supervisor role, and it can rotate between people quarterly or every six months. This ensures your team is invested in the cause and is updating policies and procedures regularly,” she says.

In addition, organizations need to have a system for addressing and adjudicating issues internally as they arise.

10. Confidential reporting mechanism

In addition to an ethics officer or committee, organizations must provide employees and volunteers a confidential means to report suspected impropriety, such as a compliance hotline. A policy prohibiting retaliation must also be in place.

Litvak emphasizes the important of having well-defined systems for reporting and resolving potential ethics violations. “You don’t want to go through a situation where someone is reporting you to the labor board or a regulatory agency. That’s really going to make it a much more challenging process as opposed to resolving an issue internally,” she notes.

To learn more about BHCOE’s standards related to Ethics, Integrity, and Professionalism, watch the full webinar.

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