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Example Case Scenario Scope of Malpractice
?Example Case Scenario: Scope of Malpractice
Oberon is a newly minted BCBA, who has passed the BCBA exam in the last month. During his supervision, he specialized in working with children with Autism Spectrum Disorder, specifically those individuals who needed acquisition skills training. He helped create programs to teach kids to request for items, or ask for a break, and to stay on task with assignments. Some of the kids had tantrums, but they were relatively minor. He was head-hunted by a company, SunTrust Behavioral, and the director of the company, Miles OBrien, has asked him to take on five cases. Mile is a doctoral level behavior analysts, a BCBA-D and has had over 20 years of experience working in the field.
One of the cases is an adult male that engages in serious self-injurious behavior in the form of flopping to the floor and head banging. When a mat is put down, this individual tries to avoid the mat and make contact with the concrete, and has previously suffered a detached retina from engaging in this behavior. Oberon immediately raises his concerns to the Miles. However, Miles says he will learn on the fly, and he will offer him supervision if anything goes wrong. He indicates that for now it is up to him to earn his keep, and show him why he hired him in the first place. He mentions this is how he learned back in his day, and he did not get kid gloves to learn the skills he needed to be effective. Later Miles emails him that day some articles to read to make Oberon feel more comfortable with the case. Oberon notes that because Miles is the director, and is far more experienced, it probably means he should just defer to his judgement. He takes on the case and decides to keep Miles in the loop if anything goes wrong, as it appears if he asks for help too early, Miles will likely think less of him. After reading the articles, and creating a behavior plan based on an assessment previously completed about 8 months ago by the previous behavior analyst working with the client, Oberon is very successful and the self-injurious behavior ends up decreasing to near zero levels. Miles is pleased with his work, and Oberon continues with SunTrust Behavioral. However, Oberon sometimes ponders what would have happened if the behavior did not go in the expected direction.
Contingency Map Example: The Unethical Decision
Antecedent Behavior Consequence
Despite his concerns about taking a case that is outside of his scope of practice, Oberon does not want to go against his supervisors guidance or make a bad impression at his new job. It seems likely that Oberon will receive praise from his supervisor if he is able to learn on the fly. Oberon takes the case that is out of his scope of his practice. He decides to make a new behavior plan based on old information and strategies he learned from reading articles.
The clients self-injurious behaviors decreased after Oberon implemented the behavior plan he created.
Oberons worry about this case decreases and he feels confident with his work.
Private Thoughts
Thought #1 (supporting the unethical decision):
Oberon feels pleased that he was able to impress his supervisor and is more confident in his ability to take on cases that he doesnt have much experience with.
Thought #2 (prompting a more ethical decision next time):
Oberon has a private feeling that things could have gone the wrong way easily, and wishes he had a backup plan if things did not have the same outcome.
Contingency Map Example: The Ethical Decision
Antecedent Behavior Consequence
Oberon is nervous about taking a case that is outside of his scope of practice. He has worked with individuals with autism in the past but does not have experience with adults or with severe self-injurious behaviors. Despite his concerns, Oberon does not want to go against his supervisors guidance or make a bad impression at his new job.
Oberon discusses the case with the BCBA-D. He tells his supervisor he is not comfortable with the case and requests more oversight/training. Oberon also tells his supervisor that he will not take on the case without a proper training plan in place.
Oberon is no longer nervous about the case because he has received proper training while the current case was transferred to a more capable BCBA. Self- injurious behavior decreases. Oberon feels confident about his request for more training and feels better about taking on a similar case in the future or continuing to help out with the current case.
Oberon also believes he has the interpersonal skills to manage conflict in the workplace, and feels this experience gave him room to grow professionally.
Case Scenario A: Burning Hours
Jack Bean has been working with a company Downstar Horizon for 11 years. It is a company that offers behavioral services for individuals funded by Medicaid. The company has recently not been doing well financially. During the monthly meeting the owner mentions the financial issues, and says that they are implementing an incentive program for BCBA that bills the most hours. Each month the individual that bills the most will receive a $50 amazon gift card to reward the winners hard work. One of the senior BCBAs notes that the Medicaid service authorizations have a specific number of hours allocated to each client that must last throughout the year. The owner, acknowledges the BCBAs input and thanks them for their insight, but goes on to note that the new Governor has been cutting Medicaid funding without consideration for the clients. The owner then states that five cases that had roughly 100 service hours each remaining at the end of the fiscal year had reduced cost plans the following year. This resulted in them having each 100 hours cut even though this year they desperately need those extra hours. The Senior BCBA says: if you dont use them
you lose them in this system! Its probably best to make sure that we use them up, and then we can request additional hours by submitting a crisis report
indicating that the individual is in need of more hours. The owner looked pleased that they were on the same page with the Senior BCBA in terms of the evaluation of the position the company was currently placed by the harsh political terrain.
Jack Bean immediately starts working on trying to win the prize. Jack keeps track of his hours diligently, and sometimes bills for phone calls, and indicates treatment that is at the group level is sometimes individual 1:1 work. Jack Bean earns the first prize for 3 months, but realizes many of his cases are running out t of hours. The owner asks Jack to make the appropriate crisis reports to request additional hours, and sends him a draft which has some language that hypes up the issues Jack is experiencing with his clients, for example, one the kids crumples paper and throws the crumpled paper, but the draft indicates that this kid throws projectiles as weapons. Not sure how best to interpret the wording, as he has been hit previously albeit accidentally by the crumpled paper, and because it would sound better to receive funding, Jack decides to submit the draft and see if he can get the best result for his client in terms of getting additional funding.
Contingency Map B: The Unethical Decision
Antecedent Behavior Consequence (provide two outcomes)
0.5 points 0.5 points 2 points
Private Thoughts
Thought #1 (supporting the unethical decision):
0.5 points
Thought #2 (prompting a more ethical decision next time):
0.5 points
Contingency Map B: The Ethical Decision
Antecedent Behavior Consequence (provide two outcomes)
0.5 points 0.5 points 2 points
Case Scenario A: Burning Hours- Discussion Questions
List at least 2 specific codes from Bailey and Burch that were violated in the case scenario Burning Hours. (0.75 points)
List at least three barriers to making an ethical decision in this case scenario. (0.75 points)
How could you overcome those barriers to make sure you make an ethical decision? Describe three specific plans that go along with each of the barriers you listed in #2. (1.5 points)
Case Scenario B: Most Restrictive Not Effective
After passing the BCBA exam, you open a private practice. You receive your first inquiry for services from a parent named Elena who lives in the neighboring school district. She is seeking your services because her son, Matt, who is eight-years-old, is exhibiting challenging behaviors at home. When you follow-up about specific behaviors that are problematic, she says that he rarely finishes his homework, is refusing to do his chores, consistently uses disrespectful language, and does not comply with her directions. Elena says that she has sought help from the school but what they have suggested has resulted in little improvement and the school says that they cannot control his behavior at home. You meet with Elena to discuss the situation and take Matt on as a client. You obtain parental consent to conduct a functional behavioral assessment and identify what you believe to be the function of the behavior. You then take the time to explain the results of the FBA and your ideas for an intervention/treatment plan. When doing this, you are careful to describe the goals and rationale for your intervention procedures in easy to understand language and also model them for Elena. Satisfied that she understands the plan and is capable of carrying it out, you and the parent sign a contract to begin the treatment that was agreed upon. As part of the contract, you will visit the house weekly to work with Matt and record data on progress each week. After working with Matt for one month, you sit down for your treatment effectiveness meeting with Elena at which time you share the data that has been collected. During this meeting, she tells you that although she is generally happy with the course of therapy and appreciative of your work with Matt, she does not agree with your plan of providing rewards (e.g., attention; tokens; praise) to Matt for things that he should be doing already (e.g., homework; using respectful language; complying with requests). She desires to move forward with treatment but wants to significantly reduce the amount of rewards Matt receives and focus on using punishment as this is the only way that kids learn what and what not to do. She states that she does not want to implement anything cruel (e.g., hitting; screaming, deprivation of food) but does want to raise him how she was raised and not reward him for things that she did as a child without rewards. You decide to implement a punishment protocol and remove the reinforcement based system, hoping to appease the mother. You decide if it works then the mother will be happy, and if it does not you can revisit the change with the mother at that point.
Contingency Map B: The Unethical Decision
Antecedent Behavior Consequence (provide two outcomes)
0.5 points 0.5 points 2 points
Private Thoughts
Thought #1 (supporting the unethical decision):
0.5 points
Thought #2 (prompting a more ethical decision next time):
0.5 points
Contingency Map B: The Ethical Decision
Antecedent Behavior Consequence (provide two outcomes)
0.5 points 0.5 points 2 points
Case Scenario B: Most Restrictive Not Effective- Discussion Questions
List at least 2 specific codes from Bailey and Burch that were violated in the case scenario Most Restrictive Not Effective. Make sure to explain why you think the codes were broken. (0.75 points)
List at least three barriers to making an ethical decision in this case scenario. (0.75 points)
How could you overcome those barriers to make sure you make an ethical decision? Describe three specific plans that go along with each of the barriers you listed in #2. (1.5 points)
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