|Problem-solving step||Your response||Response example|
|Identify the problem||
Kevin is using the most restrictive intervention which results in a mechanical restraint. This is unethical.
|Kathy’s trainee is using a procedure that put the client in danger through the client’s continued escalation and eventual restraint. The procedure is also considered a mechanical restraint, which is not permitted by the state where Kathy and Kevin work.|
|Relevant ethical codes||
1.04 2.05 2.09 4.09
|Some of the codes that may pertain to Kathy’s situation with Kevin:
4.09 Least Restrictive Procedures – Escape extinction may likely be too restrictive for noncompliance with desk work
5.03a Supervisory Delegation – Kevin is not handling the matter competently, ethically, and safely
5.03b Supervisory Delegation – As his supervisor, Kathy has a responsibility to teach Kevin how to provide a more appropriate intervention
5.06 Providing Feedback to Supervisees – Kathy’s initial feedback to Kevin was not effective in changing his performance. She is ethically required to persist with teaching Kevin until the desired performance is achieved.
7.02 Ethical Violations by Others and Risk of Harm – The intervention is leading to a mechanical restraint, a behavioral escalation, and physical restraints which all present a risk of harm to the client
9.01 Conforming with Laws and Regulations – Use of the chair in this manner is a violation of applicable laws
|Consider dimensions of the problem||
The intervention being used in the above scenario is unethical and interferes with the client’s rights which is illegal.
|Kathy may investigate further how this intervention was developed by reviewing the assessment and treatment history of the client.
Kathy might also follow-up with how behaviors are addressed by the client’s other staff and family. The issue may be larger than just Kevin’s approach with the client.
This issue may signify a culture of restrictive procedures within the company. Kathy might talk to other behavior analysts and consider the need for staff training.
|Consider courses of action & potential consequences||
The consulting BCBA observed the intervention, determined it to be inappropriate, and requested the intervention to be changed.
|– Repeat what she had already said to Kevin (though since this did not have an affect the first time, she may want to try something else)
– A one-on-one meeting to discuss how the client’s program may be revised to minimize behavioral escalations
– Call an IEP meeting and share the issue with the school and parents
– Write Kevin up with a formal disciplinary note, warning him that additional disciplinary notes could lead to termination of supervision
– Consult the supervision contract, review what is stated about following through with a supervisor’s feedback
|Select a course of action||
The consulting BCBA directed the intervention to be changed to be less restrictive. The appropriate course of action is for the intervention to be changed but it was not.
|After giving it some thought, Kathy decides to bring Kevin in first thing the following morning for a meeting. The last-minute meeting stresses the urgency of the situation and communicates that this is a priority matter. At the meeting, Kathy asks Kevin why the procedure is still in place. After listening to his struggles with identifying an alternative procedure, Kathy reviews the assessment report and options for escape motivated behavior with Kevin. Together, they come up with an alternative protocol. Kathy and Kevin practice the new procedure together and Kathy provide Kevin with a procedural checklist that she to evaluate implementation of the new procedures. Kathy is present when Kevin implements the procedure for the first time with the client and provides feedback.|
|Implement and evaluate course of action||
Due to the inability to change the unethical intervention Kevin should be removed from the client’s case and attend a meeting/training on what was wrong and how to improve. This matter needs to be taken seriously due to the significance of the client’s rights being violated.
|A week later, Kathy makes another observation of Kevin and he is implementing the new protocol with a high degree of integrity. She is happy with Kevin’s performance and decides to invite him to speak about the situation with his client and its resolution at the next all-staff meeting.|