Ensuring Client Dignity Through the Behavior Change Process

Ethical Treatment in ABA Services

Introduction to Ethical Treatment

• Individuals receiving ABA services often face risks of not being treated with dignity and respect.

• Ethical guidelines exist to ensure that the behavior change process respects human rights.

• Focus of this lesson: Understanding human rights and RBT responsibilities under the ethics code.

Human Dignity

• Definition: Human dignity relates to a moral principle of human rights, emphasizing that everyone deserves to be treated with dignity.

• Historical Context:

  • In 1948, the UN General Assembly drafted a document establishing general human rights standards for all individuals.

  • Key rights include:

    • Right to life, freedom, and safety.

    • Protection from torture and inhumane treatment.

    • Right to education and participation in communities.

Understanding Behavior Change

• Behavior Change Definition: The process of increasing or decreasing specific behaviors, primarily through reinforcement strategies in ABA.

• Examples of Behaviors to Increase:

  • Using words for requests

  • Following directions

  • Hygiene practices (e.g., hand washing, using utensils)

• Behavior Reduction Strategies:

  • Differential Reinforcement: Reinforcing alternative behaviors while reducing undesired ones (e.g., Max receives a token for not yelling).

  • Extinction: Ignoring unwanted behaviors (e.g., Lori’s tantrums go ignored).

  • Contingent Punishment: Consequences for undesired behaviors (e.g., Chuck loses video game access).

• Approach to Interventions:

  • Identify needs and behaviors of individuals.

  • Set goals and create step-by-step intervention plans.

  • Train staff and families on implementation.

  • Collect data and monitor progress, adjusting as necessary.

Defining Ethical Treatment

• Ethical Treatment Definition: Ensures safety, competence, and the dignity of individuals receiving ABA interventions.

• Professional Responsibility: RBTs and behavior analysts exert significant control over clients, increasing the risk of potential unethical practices.

Key Ethical Concepts for RBTs

• Effective Treatments: Must provide clients with opportunities to acquire useful skills.

• Least Intrusive Intervention: Start with methods that minimize discomfort or risk.

• Necessity of Behavior Change: Clients or guardians must recognize and consent to the need for behavior changes.

Case Studies and Ethical Decision-Making

• Examples of Ethical Dilemmas:

  1. RBT Overprompts: Mary indicates concern about Jim’s lack of progress, suggesting ineffective treatment.

     • Ethical Concern: Treatment effectiveness was not adhered to.

  2. Nonessential Skills: Sandy attempts to enforce knitting on Joni, although it is unnecessary and more intrusive than needed.

     • Ethical Concern: Necessity of behavior change is overlooked.

Ethics Codes

• BACB Established:

  • Created in 1998 with the objective of setting practice standards.

  • The RBT ethics code was launched in 2018 and revised in 2022, outlining responsibilities for RBTs.

• Sections of the RBT Ethics Code:

  1. General responsibilities: Professionalism, competence, and discrimination.

  2. Providing behavior technician services: Supporting clients ethically.

  3. Responsibilities to BACB and supervisors: Ensure compliance with standards.

Risks to Clients

• Major Risks:

  • Limited self-advocacy and communication skills of clients.

  • Interventions that lack informed consent can threaten dignity.

  • Treatment plans should minimize the infringement of clients' rights and support their dignity.

Conclusion

• Ethical behavior in ABA is fundamental to ensure clients are treated with respect and dignity. RBTs must be attuned to potential ethical issues and are responsible for effectively implementing interventions within an ethical framework.