Picture the worst that could happen.
Can you even imagine it?
And if you’re a seasoned therapist or behavior analyst, how do you communicate about this with your students and supervisees, who almost certainly can’t really go there?
If you’re like many of us, you don’t know what you don’t know. Suppose a client wants to gift your staff a gourmet coffee gift card, or a mother wants to step out quickly to get her dry cleaning. “It’s a five minute drive, I’ll just be a second”, she calls, as you work with her child in an upstairs therapy room. “No problem”, you start to call… but your ethics bone starts to tingle. Surely you’re over-reacting. What, if anything, could go wrong?
When the worst case scenario relates to our vulnerable clients affected by trauma, the consequences may be even more dire– and yet, those who haven’t faced the possibilities may not recognize the dangers.
Should I accept this client in foster care with severe challenging behavior and a history of abuse although I have never treated similar cases? Should my agency supervise our new BCBA to take on a new trauma case (we have funding, after all) when we haven’t experienced this situation?
For those of us tasked with supervising and teaching others, or working with families, we can help students, supervisors or parents picture the worst case scenarios so they can better prepare for, predict, and prevent dangerous outcomes. The Compliance code helps give guidance and rules that we follow, but for those of us who have NOT encountered situations that make us keenly aware of the reasons for these, some of the code items may seem “nit-picky” or unreasonable, and may be disregarded in a dangerous way.
To support our own cases and our supervisees where it counts, we must have a wealth of experience, stellar training that exposed us to a variety of worst case outcomes and possibilities and some solutions, or a great imagination- and a few good teaching and documentation tools.
I get a new wake up call every semester I teach ethics students about the origins of Behavior Analysis’ Ethics Code, which was spurred in part by atrocious, life changing and widespread abuses by those doing “behavior modification” in recent decades.
When I ask “what do you think? Could those things ever happen here?”, invariably, some well-meaning and positive-thinking behavior analyst-to-be, their master’s degree and teaching license already in hand, says “No way!… not in this day and age.”
Yes, it seems long ago. Yes, those were different times. But many of the same contingencies in play then may still be present in our teaching environments, rural practice settings, and the wild west frontiers of behavior analysis where good supervision is still not extremely accessible. For any one of us, or any agency, “But for the good supervision I’ve received, and but for the ethical verbal community in which I actively participate, there go I”.
So I have my supervisees consider the worst case scenarios for everyday situations. Some of them are related to my experience across many different types of clients and treatment settings. Others are related to the student-described “weird” code items that evoke questions like “why is this little thing unethical?”.
What could possibly go wrong?
(C’mon… that probably won’t happen.)
Ok. But what if it did? What would happen then… where would it lead? What would happen eventually… to the client? To your agency? To their family? To your career? To the field?
And what about good training? Can’t we all just get some?
Well, with the addition of the RBT or Registered Behavior Technician credential and insurance requirements for behavior analysis coverage, behavior analysis is growing at a rapid pace. And there are just not enough pages in ethics texts, or items in the Compliance Code, to prepare even the most diligent student for the variable real-world situations.
That’s actually fine with me. I am happy to not rely exclusively on memorizing the rules of ethics. I’m much more interested in shaping the repertoires of behavior analysts, parents and staff, to problem solve in the real world. Worst case scenarios help me prepare my students and supervisees to think preventatively and ethically, even in new situations they have never encountered.
So in addition to rules tools, I’ll keep giving supervisees and students opportunities to consider and respond to others who are discussing the Worst Case Scenario. Bonus for BCBA’s is that this also gives people great experience that they will need when documenting and communicating about risks versus benefits, an invaluable consultation skill!
Stay tuned; one of our upcoming Resource Wednesdays will share a resource to help your team introduce the Worst Case Scenario into your training repertoire.