vignette 2 suggested responses


Problem-Solving StepApplication to Tom's Problem
Identify the problemThe program is ineffective, despite several modifications
Tom does not have a plan for what to do next
The absence of an effective program presents a safety risk to the client
Relevant ethical codes1.02 Boundaries of Competence
2.03 Consultation
2.09 Treatment Efficacy - (a) client right to effective treatment (b) responsibility to advocate for client
2.15 Interrupting or Discontinuing Services
4.09 Least Restrictive Procedures - the current placement may not be the least restrictive effective treatment (more restrictiveness may be needed to be effective)
Considering other dimensions of the problemTom may consult the research to consider assessments and interventions he has not tried
Tom may research alternative placements in the area
Review current state laws on the use of restraint and seclusion when considering alternative treatments
Consult with a former classmate from his BCBA program who works in a similar field
Consider courses of action & potential consequencesTom is fairly certain that he has implemented all the assessments and treatment options in his boundaries of competence and considers talking to his director about consulting with the research hospital. There may be some cost for the consultation, but Tom is certain that Kyle's program needs additional supports he cannot provide without additional help.
An alternative is to do nothing and continue making adjustments to Kyle's current program. The risk associated with this option is Kyle's safety.
Select a course of actionTom decides to advocate for consultation with an expert in the field who researches SIB. Tom is comfortable with this decision with regard to the ethical codes and the best outcomes for Kyle.
Implement and evaluate course of actionThe consultant was able to offer some help with a new FA. The outcome was a slightly different approach to treatment that made a big difference on Kyle's behavior rates.