Caught in the middle
July 16, 2007 11:20 PM   Subscribe

I'm a new ABA therapist, and the family I work with has decided to fire the consultant.

I've been working as an ABA therapist for about six weeks; I was hired by the behaviour consultant to start working with a new family (new to him as well). The mother pays me my wages. The consultant didn't keep his promises to show up on the days that he promised the mother, and was basically neglectful of the child (and me; I was promised and expected training so I could do my job properly, since I'm new to this, but that hasn't happened). The mother told me today that she plans to fire the consultant and find a new one, but she would like me to continue working with her child until and even after she finds a new consultant.

Do I have any obligations to this consultant (the one who hired me)? Apparently most families have to find and screen their own therapists, and it's a little odd that this consultant looks for and comes with his own therapists. I never signed any contracts when I agreed to work for him, and as far as I remember, we never discussed a situation like this. He also owes me wages from another family (who I worked with briefly, but who ultimately decided to replace me in favour of a properly trained preschool teacher).

I would like to keep working with this child and her mother, but I'm just a little uneasy about the proper way to handle this situation. It's possible that if I decide to stick with them, the consultant won't call me and offer me positions with other families, but at this point I'm highly skeptical of his reputation and character.

Any advice would be great, including maybe ways I can educate myself about this/avoid this in the future (I'm from Canada, if that helps). Thank you!
posted by anonymous to Work & Money (7 answers total)
There's not enough information to answer you properly, so I'm going to point you in the right direction.

You don't mention anything about your training or your professional licensure. Did you train somewhere? Are you licensed to practice where you are? (Canada's a big place; where are you?) The reason that it is relevant is that you are supposed to be educated about professional ethics when you train, and your licensing board is supposed to provide oversight of these sorts of ethical problems. There are usually old professors or licensing-board ombudsmen to turn to when confronted with these sorts of issues in practice, but it's not exactly clear what your situation is in terms of who the responsible parties are, so it's difficult to advise you.

It's quite clear, however, that if Ask MetaFilter is the first place you thought to turn to ask this kind of question, that something has gone seriously wrong with your training and your current level of oversight.

I have no idea what a behavioral consultant is, by the way, and I had to look up ABA therapist, which is short for Applied Behavioral Analysis, a behavioral-based therapy given to autistic kids. Is your "behavioral consultant" a licensed professional of some sort, maybe a psychiatrist?

You might email one of our mods and clear up some of these questions.

Meanwhile, let me tell you something about the field you're practicing in. You're delivering psychotherapy. That means that your responsibility and duty is first and foremost the well-being of your patient.

If you've been working for someone for only six weeks and you've already formed the opinion that working for this person creates an ethical conflict with your duty to help your patient appropriately, you ought to quit working for this person in your professional capacity immediately. You are jeopardizing not only your professional career but your patients' right to responsible, ethical mental health care.
posted by ikkyu2 at 1:26 AM on July 17, 2007 [1 favorite]

You are performing the role of a therapist without the education, training and, most importantly, the supervision to be a therapist, also called an instructor therapist. A tough place to be and not what you signed up for. Since the mother is paying your wages your employment is with her, not the consultant. You will be able to find work with other families without the consultant; it takes a very special person to keep up the energy to work with children with ASD. I agree with ikkyu2 to step away, far away from this consultant and find another professional to supervise your work.

The first thing you need to do is educate yourself and build up a support network of other caregivers so you do not get burned out or frustrated when you hit a plataeu with your family. You also can use the network to find other families to work for or use a site like abaculist (for Ontario). Although school is out you might want to contact the Superintendents of Special Education for your local school boards for direction on what is available in your community. If your are in Ontario, the Ontario Early Years Centres have a special needs area as well. Health is a provincial responsibility so you need to contact your provincial autism society to network and explore resources as well as your provincial Ministry of Health (in Ontario you would also access the Ministry of Children's Services AIP).

There is training available, in kind of a scattered way. If finances are an issue you might want to approach the mother and ask her to subsidise some courses through a college or Autism Community Training (BC).

Sorry so much of my information is Ontario based, if you would like to contact me I can give you information from other provinces/territories.

I hope you enjoy your work and consider upgrading your education, you can definately have a very rewarding (emotionaly and financially) career with so many facinating off-shoots and so much research around the world.
posted by saucysault at 6:46 AM on July 17, 2007

As a BCBA, here is my advice: although you are not obligated to the consultant who hired you, you simply do not have enough experience or training to continue working without supervision (you say so yourself). ikkyu2 is right, you are obligated to the client. In this case, providing services without proper training runs the risk of being damaging instead of helpful. It sounds like you enjoy working with this particular child and their parents, so let them know that you'll start up again once they find a new consultant (preferably one who is board certified).

I wouldn't be put off by the fact that the consultant has their own set of therapists, especially if they've worked with them on other cases. Or, (s)he might have found it to be more efficient to hire their own therapists. Regardless, the consultant has obviously violated many ethics guidelines by not providing the services they are supposed to and since you never signed a contract you have no legal obligation.
posted by puritycontrol at 6:47 AM on July 17, 2007

I have two boys on the Autism spectrum, one worse than the other. I do not like flaky therapists who are not able to keep their appointments since my kids CAN NOT handle changes well. Ditch the consultant, post haste.

I would encourage you to discuss the issue of your relative inexperience with the family and offer to continue current treatments until they find a new consultant. I would not be happy if both people my son was used to seeing every week suddenly quit coming. He has a hard enough time when the networks change the SpongeBob air times.

Licensing is all well and good, but if the parents are happy with you, I wouldn't worry about it over the short run. My wife supplies about 50% of our sons' therapy and she has a degree in business. We're not talking about the potential to kill the little fella if you screw up, you'll just have an unproductive day.
posted by CRS at 7:04 AM on July 17, 2007

CRS, do you realize what you just said? You complained about "flaky therapists," but then went on to say that licensing doesn't matter.

How do you think you get a competent, ethical, well-behaved professional who knows how to keep the parents happy? Do you think we grow on trees? These traits need to be taught and periodically assessed.
posted by ikkyu2 at 12:01 PM on July 17, 2007

ikkyu2, I think you are really being thrown off by the OP calling themselves a therapist. It is the correct term in Canada (I don't know about the US) but the role is not a traditional psychotherapist with a lot of post-secondary education. I've certainly never heard one refer to themselves as a psychotherapist. ABA therapists work daily (or several times a week) for several hours one-on-one with the ASD client at the family's expense (I know the government covers some, but it is never enough). The ABA therapist works under the direction of a clinical supervisor (also called a consultant, who does have a lot of post-seconday education and a higher price tag too). If a high level of education was required for the job parents would be unable to afford the frequent one-on-one treatment. And it is the frequency that is the most important part of ABA therapy. I've seen jobs advertised for minimum wage but normally they are a bit higher, not enough to justify years and years of specialised post-secondary education though.

Right now, the OP is consistantly showing up and taking some of the caregiving burden off the mother so she can recharge her batteries, as well as giving focused attention the the client. If I was that mother I'd be pretty happy. In an ideal world all ABA therapists would be highly trained AND affordable; meanwhile, families with special needs just make do, especially in rural areas of Canada. The OP _wants_ to be supervised and be given direction to do the job to the best of their ability. I disagree with puritycontrol that all contact should cease, that is too disruptive the the client and family and IMHO more damaging than the relationship-building that is currently taking place. If the OP uses the links I provided to find educate themselves and find a new supervisior then everyone will be happy.

Right now there is a gap between the large number of ABA clients and the small number of clinical supervisors and instuctor therapists; it was only recently that the Ministry of Health began funding ABA. The gov't is providing grants for education to encourage more people to enter the field. I think it is more helpful to the OP to provide relevent information rather than judging them based on a misinterpertation of the term "therapist". As CRS points out, many parents spend all day with their ASD children and use ABA wihout formal training too.
posted by saucysault at 5:44 AM on July 18, 2007

ikkyu2, sorry about the confusion, but what saucysault said.

Autism treatment is not the same as typical psychological treatment. My youngest son sees regularly, one licensed psychologist, three licensed child psychologists, one licensed speech therapist, two licensed occupational therapists, two licensed physical therapists, at least five unlicensed ABA "therapists". The unlicensed folks work under the direction of one or more of the licensed folks.

Autism treatment is intensive. And expensive. Any person can provide the interactive face-time an autistic child needs. Heck, some of the stuff is basically just playing - like working puzzles, stringing froot loops, or rolling a ball. What my wife and I look for is someone who likes children, is patient with them, and doesn't let our very intelligent son manipulate them. I believe that the OP does not need constant supervision to be effective in this role.
posted by CRS at 7:18 AM on July 18, 2007

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