Case Study: Sample

Jennifer is a Behaviour Analyst who has recently started working with a young child in a centre-based ABA
program. During the initial family meeting, before Jennifer started working with the child, she spoke to the
parents about the importance of their involvement in treatment. She described the evidence supporting parent
engagement, specifically around how parental involvement can increase intervention success by generalizing
the skills the child has learned in treatment to the home environment.

Two months into treatment, the parents have continued to put off scheduling parent coaching sessions.
Whenever she has tried to schedule a session, they say they are too tired, that things are going fine at home, and
tell her they will get back to her next week about scheduling the session. In the meantime, the client is
demonstrating success in treatment; however, these skills are not generalizing to the home environment.

What should Jennifer do?

Ethical Decision Making Solution Chart

STEP 1: Identify the Problem

In this scenario, Jennifer would clinically recommend that the parents participate in parent coaching in order
for the child to receive the most beneficial outcomes of treatment. The parents, however, are choosing not to
participate due to their own personal circumstances (i.e., feeling tired, lack of urgency, etc.).

STEP 2: Apply the BACB Guidelines Involved

BACB Guideline 1 BACB Guideline 2

2.01 Providing Effective Treatment - Jennifer 3.01 Responsibility to Clients - The family, ultimately,
knows that the child has the right to effective have the legal right to decide what is best for their child
treatment, which would ideally involve the parents. and their family. They may decide that, at this time, it is
Jennifer is obligated to advocate for and educate the in their best interest for the child to receive slightly less
parents about scientifically supported, most- effective treatment so that they can get some rest or
effective treatment procedures, such as their perform other tasks.
involvement in parent coaching.

STEP 3: Determine the Nature and Dimensions of the Dilemma

Benefitting Others – Jennifer knows that if the parents were involved in parent coaching, the child would
potentially make greater behaviour changes. Jennifer wants to effectively work with the client and the family
to place the clients’ interests first.

Treating Others with Compassion, Dignity, and Respect – Ultimately, the parents are the child’s guardians and
they have the right to make decisions for their family and on the child’s behalf. According to the Core Ethical
Principles, we must acknowledge that “personal choice in service delivery is important by providing clients
[…] with needed information to make informed choices about services”. They have also explained that they
are exhausted, so these boundaries should be respected.

STEP 4: Generate Potential Courses of Action

Option A Option B

Jennifer could advocate for parent coaching to be a Jennifer could speak with the family about their current
mandatory component of treatment and let the situation and plan to schedule parent coaching sessions
family know that in order for treatment to be in the future when the family is in a better place to
delivered effectively, they must participate. participate in coaching.

STEP 5: Laws and Other Considerations that May Influence Your Decision:

No laws apply in this situation. The family has the right to decide what type of treatment their child receives.

STEP 6a: Consider the potential consequences of all options

Option A Option B

Benefits Benefits
- The child receives effective treatment. - The family can maintain their autonomy in
- The child learns skills that will be helpful deciding what’s best for their child and their
later in life. family.
- The parents gain an understanding of ABA - The relationship between Jennifer and the family
principles that could benefit the child in the remains positive.
future.
Risks
Risks - The child may access lesser quality of treatment.
- The parents may lose sleep and their quality - Skills may take longer to learn and generalize to
of life may decline. the home environment.
- The may resent Jennifer for creating this - It may take more work for Jennifer to teach
mandatory component of treatment. skills in a way that helps promote generalization
- They may decide to end treatment. in the absence of parent coaching.

STEP 6b: Choose a Course of Action

Option B – It is recommended that Jennifer work with the family to create the best possible treatment for their
child. This respects their right to choose what is best for their child and family, and uphold their autonomy.
This aligns with both sections of the Code described in Step 2, as Jennifer is both allowing the family to
ultimately decide what is best for their child and family (3.01) while also upholding as much treatment efficacy
as possible by creating a treatment plan that helps the child generalize skills without parent coaching (2.01).
By meeting the family where they’re at, Jennifer can continue to benefit the client (Core Ethical Principle 1)
and treat the family with compassion (Core Ethical Principle 2).

STEP 7: Evaluate the Selected Course of Action

Test of Justice: Test of Publicity: Test of Universality:

Yes, it passes because this Yes, if this went to the media, I would Yes, I would recommend this to
would be the most fair for feel comfortable knowing I am working other clinicians or clients as it is a
everyone involved. with the family to create the best possible more family-centered approach to
treatment that meets the needs of the treatment.
family as a whole.

STEP 8: Professionalism

Jennifer should be sensitive in how she shares this information with the family. She would be respectful of
their situation and work collaboratively with them to decide on a treatment plan that both meets the child’s
needs as well as the family’s needs.

STEP 9: Implement the Course of Action

I would make sure that I arrange a face-to-face to meeting to go over the behaviour plan and the family’s
request. I would let them know that although I recognize how hard it must be for parents raising a child with
ASD and that I would like to work with them in creating a treatment plan that works best with their current
situation. I would explain that there are specific elements that are necessary in order for me to upload the
BACB Code and deliver evidence-based treatment, but that parent coaching can be introduced at a later time
when the parents are more available to participate. I would also discuss what possible options are available that
they could access in the meantime, such as scheduling monthly review meetings, sharing strategies via a paper
report, sharing videos with them of the strategies being used, etc. Finally, I would schedule a time in the future
(perhaps in 1-2 months) when you could sit down together and re-assess the family’s situation and their
readiness to participate in treatment. Afterward, I would speak with my organization to seek support in
learning strategies that help promote generalization of skills in the absence of parent coaching.