RBT Professional Conduct and Scope of Practice

RBT Review

• An RBT is a paraprofessional who practices under the supervision of a BCBA or BCaBA.

• The RBT's primary responsibility is the direct implementation of treatment plans developed

by the supervisor.

• The RBT may also collect data and conduct certain types of assessments

• The RBT does not design intervention or assessment plans. It is the responsibility of the des-

ignated RBT supervisor to determine which tasks an RBT may perform as a function of his or her training, experience, and competence.

RBT Roles

• Prepare data collection, implement measurement and recording procedures, and maintain

data

• Assist with student assessment procedures (e. g., curriculum-based, developmental, social

skills, assist with functional assessment procedures, observational recording of behavior

and environment)

• Implement a variety of teaching procedures (e. g., discrete trial, naturalistic teaching,

stimulus control, stimulus fading, discrimination training, use of contingency reinforce-

ment)

• Understand essential components of a behavior plan and implement behavioral reduction

interventions (e. g., differential reinforcement procedures, extinction procedures)

• Accurate documentation and reporting and effective communication with supervisor

• Manage student behavior utilizing de-escalation and support hold training techniques

• Willingness to learn new software and use of adaptive equipment as appropriate

• Meet student and environmental needs as required

• Assists in the creation of instructional materials

• Effectively responds to and manages crisis situations which may include physical aggression

Communicating with Family and/or Caregivers

The RBTTM role in communicating with family and/or caregivers is a support role. The supervi- sor will train and consult with the family and/or caregivers. The RBTTM will identify and sup- port information regarding the treatment plan and behavior intervention plan to the family and/or caregiver during their ABA sessions as needed. The RBTTM will maintain a clear and consistent line of communication with the supervisor at all times throughout the time they work within a behavior analysis paradigm with the client through to discharge directly and indirectly.

Communicating with Other Professionals

• The RBTTM role and the supervisor role in communicating with other professionals are dif- ferent. Consultation with other professionals helps ensure client progress through efforts to coordinate care and ensure consistency. Treatment goals are most likely to be achieved when there is a shared understanding and coordination among all healthcare providers and profes- sionals. An example involves a consistent approach across professionals from different disci- plines in how behaviors are managed across environments and settings.

• Professional collaboration that leads to consistency will produce the best outcomes for the client and their families.

• The RBTTM role in communicating with other professionals is a support role as well. The super- visor will always be the primary contact with the other professionals. If, during ABA sessions when the RBTTM is there and other professionals are there for observation purposes or to com- munication with the parents and/or caregivers and the other professionals ask RBTTM questions regarding the treatment plan and behavior intervention plan, the RBTTM will identify the areas of questions and support the other professional by referring them to the supervisor of the cli- ent. Also, the RBTTM will communicate with the supervisor after the session to follow up with the same information.

• The RBTs' responsibility is to all parties affected by behavior-analytic services. When multi- ple parties are involved and could be defined as a client, a hierarchy of parties must be es- tablished and communicated from the outset of the defined relationship. RBT's identify and communicate who the primary ultimate beneficiary of services is in any given situation and advocates for his or her best interests.

Responsibility

• "The RBT's responsibility is to all parties affected by behavioral services"

Rights and prerogatives of clients

• "The RBTTM supports individual rights under the law"

• "The client must be provided on request an accurate, current set of the RBT's credentials"

• "Permission for electronic recording of interviews and service delivery sessions is secured

from clients and relevant staff of all other settings. Consent for different uses must be

obtained specifically and separately"

• "Clients must be informed of their rights, and about procedures to complain about profes- sional practices of the RBTTM"

• "The RBTTM complies with all requirements for criminal background checks"

Maintaining confidentiality

• "RBT's have a primary obligation and take reasonable precautions to respect the confiden- tiality of those with whom they work or consult, recognizing that confidentiality may be established by law, institutional rules, or professional or scientific relationships"

• "Clients have a right to confidentiality. Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant"

• "In order to minimize intrusions on privacy, RBTTM include only information germane to the purpose for which the communication is made in written and oral reports, consultations, and the like"

• "RBT's discuss confidential information obtained in clinical or consulting relationships, or evaluative data concerning patients, individual or organizational clients, students, research participants, supervisees, and employees, only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters"

Effective behavioral treatment

RBT's have the responsibility to implement accurately and appropriately the treatment plan

and behavior intervention plan the BCBATM developed. Clients have the right to effective

behavioral treatment

Characteristics of treatment environments to ensure dignity, health and safety

• The environment is engaging

• Functional skills are taught and maintained

• Behavior issues are ameliorated

• The environment is the least restrictive alternative

• The environment is stable

• The environment is safe

• The client chooses where to live (if of the age to choose)

Scenario: Many of our clients know each other. What about when Family A asks about how Family B is doing?

Response: I'm not sure about that, or I am not really supposed to discuss clients with other clients.

Scenario: Family/client asks the therapist about his/her private plans.

Response: I'm not allowed to discuss this with clients.

Scenario: Using a client's name in a datebook, email or while talking with a co-worker in the open.

Response: Please use codes (i.e. first two letters of the first then last name, or what your or-

ganization uses to protect PHI) in email subject lines, non-encrypted emails and when discuss-

ing a client in the open.

Scenario: A client's parent asks you to talk to a third party.

Response: Refer the client to speak with the supervisor.

Scenario: You see a client in public.

Response: Do your best not to address them and if they come to you, do not share any per-

sonal information or ask for any personal information.

Scenario: Client asks about co-workers.

Response: If it is related to the job, please refer to the Lead. If it is personal information not

related to the team or job, relay that you are not allowed to discuss that kind of information.

Scenario: You are out in the community and a stranger approaches you with questions.

Response: Always protect privacy; if you are unsure just state that you are not allowed to dis-

cuss details of the child with anyone. It is good to have a plan before you go, maybe have the supervisor discuss what the clients' parents prefer. Some like to advocate while in the com- munity, others will want total privacy. Always choose privacy when you do not know.

Scenario: A co-workers asks what clients you have or who is on your teams.

Response: Unless it is relevant to the team, do not discuss client loads or teams with your

coworkers.

Scenario: You need to take pictures or videos.

Response: Request a photo release through the Lead from parents before taking pictures and

the supervisor will return the release to the office.

Reliance of Scientific Knowledge

"RBT's rely on scientifically and professionally derived knowledge when making scientific or

professional judgments in human service provision, or when engaging in scholarly or profes-

sional endeavors"

Competence

RBT's provide services, teach, and conduct research only within the boundaries of their competence, based on their education, training, supervised experience, or appropriate professional experienceRBT's provide services, teach, or conduct research in new areas or involving new tech- niques only after first undertaking appropriate study, training, supervision, and/or consulta- tion from persons who are competent in those areas or techniques"

Professional Development

RBT's who engage in assessment, therapy, teaching, research, organizational consulting,

or other professional activities maintain a reasonable level of awareness of current scien- tific and professional information in their fields of activity, and undertake ongoing efforts to maintain competence in the skills they use by reading the appropriate literature, attending conferences and conventions, participating in workshops, and/or obtaining BCBATM certifica- tion

Integrity

• "RBT's are truthful and honest. The behavior analyst follows through on obligations and

professional commitments with high quality work and refrains from making professional

commitments that he/she cannot keep"

• "RBTTM conforms to the legal and moral codes of the social and professional community of

which the behavior analyst is a member"

• "The activity of a RBTTM falls under these guidelines only if the activity is part of his or her

work-related functions or the activity is behavior analytic in nature"

• "If the RBTs' ethical responsibilities conflict with law, RBT's make known their commitment to these guidelines and take steps to resolve the conflict in a responsible manner in accord-

ance with law"

Professional and Scientific Relationships

• "RBT's provide behavioral, therapeutic, teaching, research, supervisory, consultative, or other behavior analytic services only in the context of a defined, remunerated professional or scientific relationship or role"

• "Where differences of age, gender, race, ethnicity, national origin, religion, sexual orienta- tion, disability, language, or socioeconomic status significantly affect RBTs' work concern- ing particular individuals or groups, RBT's obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they communicate to their supervisor and follow their supervision"

• "In work-related activities, RBT's do not engage in discrimination against individuals orgroups based on age, gender, race, ethnicity, national origin, religion, sexual orientation,

disability, socioeconomic status, or any basis proscribed by law"

• "RBT's do not knowingly engage in behavior that is harassing or demeaning to persons with

whom they interact in their work based on factors such as those persons' age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconom- ic status, in accordance with law"

Dual Relationships and Conflicts of Interest

• "In many communities and situations, it may not be feasible or reasonable for RBT's to

avoid social or other nonprofessional contacts with persons such as clients, students, super- visees, or research participants. RBT's must always be sensitive to the potential harmful effects of other contacts on their work and on those persons with whom they deal"

• "RBT's must refrain from entering into or promising a personal, scientific, professional, financial, or other relationship with any such person if it appears likely that such a relation- ship reasonably might impair the RBT's objectivity or otherwise interfere with the RBT's ability to effectively perform his or her functions as a RBTTM, or might harm or exploit the other party

• "If a RBTTM finds that, due to unforeseen factors, a potentially harmful multiple relation-

ship has arisen (i.e., one in which the reasonable possibility of conflict of interest or undue influence is present), the RBTTM attempts to resolve it with due regard for the best interests of the affected person and maximal compliance with these guidelines"

• "RBT's do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship"

Exploitative Relationships

• "RBT's do not exploit persons over whom they have supervisory, evaluative, or other au-

thority such as students, supervisees, employees, research participants, and clients"

• "RBT's do not engage in sexual relationships with clients, students, or supervisees in train-

ing over whom the behavior analyst has evaluative or direct authority, because such rela-

tionships easily impair judgment or become exploitative"

• "RBT's are cautioned against bartering with clients because it is often clinically contraindi-

cated, and prone to formation of an exploitative relationship"

Job Commitments

• "The RBTTM adheres to job commitments made to the employing organization"

Conflicts with organizations

• "If the demands of an organization with which RBT's are affiliated conflict with these guidelines, RBT's clarify the nature of the conflict, make known their commitment to these guidelines, and to the extent feasible, seek to resolve the conflict in a way that permits the fullest adherence to these guidelines"

Affirming principles

• "The RBTTM upholds and advances the values, ethics, principles, and mission of the field of

behavior analysis. Participation in both state and national or international behavior analysis organizations is strongly encouraged"

Disseminating behavior analysis

"The behavior analyst assists the profession in making behavior analysis methodology avail-

able to the general public"

Promotion in society

"The RBTTM should promote the application of behavior principles in society by presenting a behavioral alternative to other procedures or methods"

Statements by others

• "RBT's make reasonable efforts to prevent others whom they do not control (such as em-

ployers, publishers, sponsors, organizational clients, and representatives of the print or broadcast media) from making deceptive statements concerning behavior analysts' prac- tices or professional or scientific activities"

• "RBT's who engage others to create or place public statements that promote their profes- sional practice, products, or activities retain professional responsibility for such state- ments"

• "If RBT's learn of deceptive statements about their work made by others, behavior analysts make reasonable efforts to correct such statements"

• "A paid advertisement relating to the RBT's activities must be identified as such, unless it is already apparent from the context"

Avoiding false or deceptive statements

• "RBT's do not make public statements that are false, deceptive, misleading, or fraudulent,

either because of what they state, convey, or suggest or because of what they omit, con- cerning their research, practice, or other work activities or those of persons or organiza- tions with which they are affiliated. RBT's claim as credentials for their behavioral work, only degrees that were primarily or exclusively behavior analytic in content"

Being familiar with these guidelines

• "RBT's have an obligation to be familiar with these guidelines, other applicable ethics

codes, and their application to RBTs' work. Lack of awareness or misunderstanding of a

conduct standard is not itself a defense to a charge of unethical conduct"

discouraging misrepresentation by non-certified individuals

• "RBT's discourage non-certified practitioners from misrepresenting that they are certified"

testimonials

• "RBT's do not solicit testimonials from current clients or patients or other persons who be- cause of their particular circumstances are vulnerable to undue influence"

in-person soliciation

• "RBT's do not engage, directly or through agents, in uninvited in-person solicitation of

business from actual or potential users of services who, because of their particular circum- stances, are vulnerable to undue influence, except that organizational behavior manage- ment or performance management services may be marketed to corporate entities regard- less of their projected financial position"

ethical violations by behavioral and non-behavioral colleagues

• "When RBT's believe that there may have been an ethical violation by another behavior

analyst, or non behavioral colleague, they attempt to resolve the issue by bringing it to the attention of firstly their supervisor and if the supervisor finds it appropriate that individualif an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. If resolution is not obtained, and the behavior analyst believes a client's rights are being violated, the behavior analyst may take addition- al steps as necessary for the protection of the client"

Intellectual property

"RBT's give appropriate credit to authors when delivering lectures, workshops, or other

presentations"

truthful and accurate information provided to the BACB

• "RBT's only provide truthful and accurate information in applications and documentation submitted to the BACB

Defining responsibility

• It is more that adhering to the BACBTM codes of conduct

• It is more than keeping the client's welfare in the forefront of decision making

• It is more than the 'Golden Rule'

• A RBTTM must be self-regulating. The ethical and responsible RBTTM seeks ways to adjust

decisions over time to ensure values, contingencies, and rights and responsibilities are com- bined and an informed combination of these is considered