Problem
Scenario:
Amy has worked at an ABA clinic for eight years and has been Jack's BCBA for six years. She has decided to resign from her current position because she wants professional development; however, the clinic does not have any other positions available for her to move into. Jack engages in severe self-injurious behavior (i.e., head banging/hitting). He has been hospitalized for cuts and injuries to his forehead and head. Behavior technicians have noticed behaviors decreasing while at school using their behavior plan to decrease the behaviors, but at home, the behaviors remain the same. Amy has discovered that the family is having difficulty consistently with plan intervention and staying close to the child. Before resigning from her position, Amy and the clinical director scheduled a meeting with Jack's mother and his new BCBA so they could adequately transition services. However, the mother was upset that Amy would no longer be Jack's BCBA. The mother decided to discontinue Jack's services a year later and relocated to Amy's new clinic. Amy was surprised because she didn't inform the mother about the clinic she relocated to. The mother informed Amy's current clinical director that she looked up Amy on social media and found out. Amy is concerned because she has a full caseload and cannot accept more clients.
At the new center, Jack is under a new BCBA, Nathaniel; however, the mother continues to reach out to Amy about her concerns. The mother reports to Amy that insurance had suggested using a helmet for the behaviors, which was brought up previously by Amy when Jack's SIB behavior was severe. Amy reached out to discuss this with Nathaniel, as she is no longer Jack's BCBA.
Nathaniel has extensive experience with SIB and has been a BCBA for ten years. After hearing the suggestion to use a helmet by insurance, he immediately decides to implement helmet use at home. However, the mother does not want the helmet, but the family is unable to implement a less restrictive plan, and the client continues to get severely injured. Instead of informing her concerns to Nathaniel, the mother calls Amy through her direct line and asks if she could talk to Nathaniel on her behalf.
8 Steps (Below)
A. Collect all relevant data that could help with resolving the matter.
B. Identify principles involved and explain how they relate to the case
C. Consider whether principles conflict in this situation or whether there is uncertainty about a particular principle (e.g., beneficence, respect for autonomy) directs you to do.
D. Formulae a question that reflects the conflict
E. Decide which principles should have priority in the case and support that choice which factors are relevant to the case, or find an alternative that avoids the dilemma.
F. When uncertainty persists, note whether there is some missing information that would help you resolve the dilemma. Which information? How will it help resolve the dilemma?
G. Evaluate your decision by asking if it is what a consensus of exemplary BCBAs would agree to do.
H. Plan the practical steps that you should take, focusing on the details of the case and the future issues that you forsee.