Welcome to Aba Ultimate Showdown a podcast promoting constructive respectful and professional discourse to advance the field of behavior analysis. This is round 3 of The Showdown. Our third topic will center around ethics. Primarily the ongoing controversy surrounding receiving gifts. We want to make it clear that while we are not experts on the specific topics. We discuss we consider ourselves lifelong Learners always looking to gain more knowledge during this debate. We will construct Arguments for both sides to present the audience with a comprehensive and balanced view of two sides of a controversial topic. Participating today are Cara Graham and Megan Miller and I'm your host Jillian play nerdy Tiberius. I am a bcba and The Clinical Director of Graham Behavior Services. I graduated with my undergraduate degree in Psychology from Rowan University and my masters in a ba from Caldwell University. I have worked in public and private schools and with individuals with special needs in home and in their communities for the past 10 years. Hi, I'm Megan Miller. No, not that one. I was actually born and raised on the Jersey Shore and worked as a special education teacher for the first 12 years of my career. I'm Abby CBI currently working as a clinical supervisor for Grand Behavior Services. I graduated with a special education undergraduate degree from the College of New Jersey my master specialization at Kane University included High incidence disabilities emotional disturbance. I received my postgraduate certification in a ba from Penn State University. Hello. I am Carol Graham. I'm a bcba and the founder and executive director of Graham Behavior Services. I received my master of arts degree in special education from Kean University and completed my course work and applied Behavior Analysis at Caldwell University. Most of my work focuses on providing Home and community-based Services to individuals with developmental disabilities and providing parent coaching to families of children with behavior challenges. Thanks. Ladies. Let's get started with the debate while researching round 3 Kara and Megan have worked together to research relevant sources. Each source is cited in the show notes found at Graham Behavior services.com Showdown today. We will include a coin toss to determine speaking Order. Each debater will have equal structured speaking time and will have an opportunity to ask and respond to questions. If you're interested in learning more about the debate format. We used check out our show notes or Listen to our podcast introductory episode. We want to emphasize our most important modification to traditional debate formats. There is no winner and there is no loser. Our intention is to present a different point of view of a controversial topic that you may not have previously considered. We are aiming to disseminate the science in a constructive way by sharing knowledge and respect the motion for this episode will be Behavior analysts should not accept gifts because it creates a dual relationship. Megan Miller will wear Furs and the pro side of the debate that behavior analysts should not accept gifts Kara Graham will represent the con side that behavior analysts can accept gifts under some circumstances during this debate. We will use the term client to refer to the primary client parents/guardians family members and caregivers. We also want to review the ethical guidelines that will be referenced in the debate. The bacb is professional and ethical compliance. Code for Behavior analysts Identify two main areas in which they specifically comment on gifts section 1.06 under responsible conduct of behavior analysts is entitled multiple relationships and conflicts of interest. It states that quote a due to the potentially harmful effects of multiple relationships Behavior analysts avoid multiple relationships be behavior analyst must always be sensitive to the potentially harmful effects of multiple relationships. Ships if Behavior analysts find that due to unforeseen factors a multiple relationship has arisen they seek to resolve it see Behavior analysts recognize and inform clients and supervisees about the potential harmful effects of multiple relationships and D behavior analyst do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship section 2.1 for under behavior analyst responsibility. Clients is entitled referrals and fees behavior analyst must not receive or promote money gifts or other enticements for any professional referrals. It states that quote referrals should include multiple options and be made based on objective determination of the client need and subsequent alignment with the repertoire of the referee when providing or receiving a referral the extent of any relationship between two parties is disclosed to the client. End quote the BAC be compliance code does not define quote gives in its glossary nor in its explain or is it explained how gift giving or receiving constitutes a multiple relationship? However, the May 2015 be a CB newsletter clarifies the be a CBS position on gifts in the newsletter. It states that quote gives may include a variety of items including but not limited to store gift cards. Food clothing tickets to events housing vehicles and just about any other tangible or financial item exchanged between the behavior analyst and the client outside the scope of a contract for services and quote. Now that we have highlighted the specific ethical guidelines. We will be debating. Let's start this party off right with a coin toss. The winner will get to choose whether to speak first or second heads goes to Megan representing the pro side and Tails goes to Kara representing the con side Its Tail's Kara. Do you want to go first or second? I'll go first awesome. Let's get started. Okay, Cara, you will speak first for the con side and give the opening remarks discussing that behavior analysts can accept gifts under some circumstances again. The motion is behavior analyst should not accept gifts because it creates a dual relationship behavior analyst should be able to evaluate on an individual basis. If accepting a gift from a client could create a dual relationship. Before I dive into a discussion about the ethics of giving and receiving gifts. It is important to explore more closely the importance context plays in all ethical decision making in the book practical ethics for effective treatment of autism spectrum disorders in 2018 by Broadhead and colleagues. They begin with a discussion of how categorizing Behavior as right or wrong is not always so simple even something that would seem to always be categorized as wrong such as taking someone else's life truly. Pens in the context in one context this Behavior would be deemed as wrong and results in the death penalty or prison in another context such as during war this Behavior might be seen as right and even result in public praise. I believe most Behavior analysts want to behave ethically however differences in learning histories and previously reinforced Behavior will lead to individual differences in the belief of which behaviors are right or wrong. This is why it is absolutely essential that we have. The BAC be professional and ethical compliance code we want to ensure that as a group. We are behaving ethically and not behaving in a way that is detrimental to our clients or to our field as a whole is my argument that having a hard and fast rule such as code 1.06 D quote behavior analyst do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship and quote has the potential to cause detrimental effects for individual Behavior analysts and our as a whole because this ethical guideline leaves no room for interpretation. It can quote Place professionals at risk for undeserved sanctions and may potentially harm patients themselves by frightening the professionals into rigidity and therapeutic interactions in this comes from Gothel and gabbard 1998. I know myself the holiday season is very anxiety-ridden for me each time. I go to a client's home. I am praying that they don't try to give me any type of gift the interaction of having to deny. Gift from someone who has spent their time and money both of which are often Limited in the families. We work with to show their appreciation for the work I have done with their child is extremely uncomfortable. It is not only unnatural but feels completely rude it goes against our society's Norms in not only makes the behavior analyst feel uncomfortable but the family as well and these are situations in which the family has been repeatedly informed of our ethical guidelines at the start of services. We outlawed a contract fact that we are not allowed to accept any type of gifts and have a discussion with the family about this and the potential problems it can cause we also send a reminder e-mail at the start of the holiday season to all of our clients reminding them of our ethical code and offering suggestions for replacement behaviors such as a handwritten note or drawing from the client or their siblings. It begs the question, why are caregivers who have established learning histories of rule-governed behavior not following the rules. We outlined for them in regard to gift-giving the You have given gifts to those we appreciate is something that has been reinforced for most of us throughout our lives. It is the behavioral repertoire that we teach to our own children and the norm in our society for how to show appreciation giving and receiving gifts is also part of how Society our society establishes trust and builds Rapport as Behavior analysts. We need to recognize that having such an explicit statement on gift giving in our code of ethics creates a situation where be cba's may be seen as cold and socially word Another important point is what exactly constitutes a gift in ethics for Behavior analysts by John Bailey and Mary Birch. They discuss how Behavior analysts are quote drawn into dual Relationships by innocent offers of gifts drinks or snacks and quote our drinks and snacks really gifts. Yes, an expensive bottle of wine as a gift. However is a glass of tap water really a gift. What about when offering a drink or snack is very much a part of the family's culture the bacb ethical code also outlines the importance of cultural competence in ethical decision-making code 1.05 e States quote Behavior analysts do not knowingly engage in a behavior that is harassing or demeaning to persons with whom they interact in their work based on factors such as those persons age gender race culture ethnicity national origin religion sexual orientation disability language or socio-economic Sabbath's in accordance with the law and If part of a client's culture is to offer food or drink to anyone who enters their home and refusal is seen as rude or disrespectful the behavior analyst may do irreparable damage to a relationship before it even begins, there are even documented cases of one professionals have refused gifts and it resulted in termination of services and a negative impact on the clients therapeutic progress, it is these cases that we must begin focusing more closely on instead of assuming that every Act of gift-giving will automatically In a dual relationship, we should begin evaluating if refusing a gift has a detrimental impact or if engaging in gift-giving could even strengthen therapeutic relationship as a feel that relies on science and data to drive our decision-making. I would love to see more data to evaluate the impact of gift-giving on therapeutic relationships whether negatively or positively thank you cara Now we move on to Megan who will give the opening remarks representing the pro side of the debate stating that behavior. Analysts should not accept gifts again. The motion is behavior analyst should not accept gifts because it creates a dual relationship. Thanks Jill as Behavior analysts. We pride ourselves on Strictly adhering to the seven dimensions of Applied Behavior Analysis, right? So we need to look also at the ethical guidelines with the same respect and reverence in all my coursework. And whenever I hear people speak about our emergence of a few as a field, I hear a phrase similar to a quote from Bailey and Birch second edition quote. Our goal as a profession is to gradually emerge onto the scene with a terrific reputation for truth honesty and reliability and quote billion Birch also state that quote. It does not seem too much to ask of professionals that they recognize the legal code of their community and maintain high moral principles and quote the September 2014 newsletter put forth by the beasts bacb specifically states that quote effective January 1st, 2016 all BAC be searched. If accounts and registrants will be bound by the professional and ethical compliance code for Behavior analysts and quote broad had Cox and Quigley state that quote a benefit of direct and explicit statement from the bacb is Clarity. There is no room for interpretation and quote. We need to follow the ethical guidelines. Not only for the preservation of our own personal certification, but also to uphold the standards of the field of behavior analysis. So I think that pretty much sums up my And the pro side rests. All right, just kidding. But in all seriousness the ethical guidelines were created to establish Behavior Analysis as adhering to a higher ethical standard. Let's keep that in mind as we debate this motion that behavior analysts should not accept gifts primarily as stated in the motion. The accepting of gifts has the potential to create dual relationships. So the bacb and May 2015 in their newsletter. They said quote Behavior analysts often work with clients and their caregivers and such an extended and extensive manner that multiple relationships are prone to arise and must be diligently guarded against for example gifts pose a special problem for Behavior analysts who provide services and clients home because of the familiarity of the setting and the ease in which with which critical boundaries can be compromised and quote now billion Birch said quote the primary concern is that the Behavioral Analyst would have his or her objectivity impaired and And really that is the problem. It is important that we maintain that professional relationship and that those lines don't get blurred by accepting gifts. So billion Birch wrote the 25 essential skills and strategies for the professional behavior analyst so they say that quote the very nature of our work with clients puts us right in the middle of their life. We help people adapt to complex environments teach them appropriate response is arranged contingency so that they get more out of life and improve their relationship with others for this the clients and their families. Ali's and surrogates are often grateful and want to show their appreciation in tangible ways. This may include offering gifts or invitation to participate in family events such as birthday parties becoming a friend of a client or the clients family is often the start of a slippery slope that can ultimately undermine the behavior analysts professional judgment the possibility that it will impair. They Behavior analysts judgment or interfere with the behavior analysts ability to effectively perform his or her functions and quote as ethical examples are some And hypothetical we really could come up with countless examples of how this would affect our objectivity one example Bailey and Birch gives is that it that they find it difficult to give parents bad news on an assessment. But that's just really one of many examples. Another may be altering Insurance authorizations to are in favor of the client essentially after accepting a gift the family may assume that quote the bcba is expected to return the favor at the right time and that's from billion Birch. Even if this is not the intent of the Not accepting a gift transforms a professional relationship into a personal one or at least partially personal right which has the potential to Cloud our judgment billion Birds also make a valid argument that quote preventing befriending clients or their families supervisees or research participants can create the impression of favoritism and quote. So this is going to damage that relationship with clients and supervisees even outside of the relationship that you are compromising in the first place. So let's talk about why Initial gift is a big problem the legendary slippery slope. So ABI inside track episode 71 says that that slippery slope would be a successive approximation of increasingly unethical behavior and they had the Young Pelton article that stated that quote heading down a slippery slope first occurs. When an ethical boundary is minimally crossed leading to an increased likelihood that unethical Behavior will be strengthened and the frequency and magnitude of us. Ethical Behavior increased and quote. So bailing Burch says that quote the concern here is that the client may expect a favor in return at some point and the behavior analysts judgment about the case could easily become compromised and quote so that one gift turns into a mini culture of giving gifts the behavior analyst may feel the need to reciprocate by giving either a tangible gift or giving some aspect of their services their time their talent or like something even worse like Crossing some ethical. For example altering official plans or even insurance fraud. So in their third edition book The billion Birch states that a pattern can develop where the rule actually is don't cheat but becomes don't get caught and then that's like one violation after another so that one gift again isn't the problem. It's everything that that one gift opens the door to allow following it, but why not give gifts of any value. So that's a fair question the rest of that broad head Cox and Quigley quote. I used at the beginning of my statement. States that quote a legitimate concern is how to draw a gray line and quote all gifts have an Associated dollar amount when you say small gifts. The problem comes with operationally defining how much a homemade card or written note maybe a small gift, but it took someone's time and someone's time has a value placed on it tokens are from a garden seem small but seeds soil water and the massive amount of attention and time that goes into it all have an Associated value. Obviously a thousand dollars is too much. But where do we draw that line? So billion birds in their third edition again states that quote in some professions. There is an understanding that small gifts like values less than $10 do not present a problem unless they lead to manipulation which we interpret to mean that there is some reciprocation which then produces the aforementioned slippery slope even token gifts given to a behavior analyst may have some subtle impact on their professional Judgment at a later time a gift is symbolic of appreciation for services rendered. Nerd in a kind and considerate way so it would be a hard-hearted individual indeed who would not feel the need to exercise a little flexibility at some point in the future regarding billing or signing a waiver or attesting to the person's good character and quote. They go on to say furthermore quote by setting some upper limit to the value of a gift that puts the behavior analyst in the position of having to estimate the asking cost retail or wholesale of the item. Is this really less than five dollars worth of candy. I know these flowers cost. Than $10. You got it on eBay for $5. Right? Surely. This is worth $100 once trying to determine the value of a gift becomes part of the practice the behavior analyst must face the uncomfortable situation of returning certain gifts because they exceed the limits to some clients but not to others and quote. Okay, so I don't tell anybody but I'm going to make a confession here and don't to tell my colleagues or friends or my kids teachers for the holidays. I use credit card points to get gifts of his as a token of my appreciation. For everything that they do for me and my family essentially it's free for me. I don't pay for it. But let's say I'm a parent of a child with autism and I give my child's BCB a $100 gift card. We would probably all assume that that gift would be too much but if I use credit card points it was free. So how would that work? Let's forget about credit card points for a minute and look at socioeconomic status for some families who are on the higher end of that. So socio-economic scale 100 dollars isn't much money at all for some families on the lower end though. Hundred dollars could be a month's worth of worth of groceries. Should we create a sliding scale based on the value of the gifts and the socioeconomic status of the family. I know really that sounds like absurdly complicated and unnecessary, but it's a valid point not all families are created equal. So how do we draw that line? So we also have unintended consequences and billion Birch in their third edition of the ethics book state that an example of a company with a policy expressing expressly not accepting gifts there. As a girl she politely resisted for a long time and then the supervisor told her like I just go ahead and accept the gift. Let's not upset the parents any further. So the employee accepts the gifts. So a few months later something happened that affected their relationship and made the parents upset with the employee and the agency and the parents filed a complaint with the agency that the student accepted the gift against company policy. So that's unfortunate and had the the student followed the recommendations of the company and the BAC be in the first place that would have Happen we really need to not risk that disciplinary action the BAC be in there May 2015 newsletter states that quote a gift exchange that is clearly evidence of a multiple relationship will likely result in disciplinary action, especially in circumstances where the multiple relationship becomes sexual in nature in addition. The monetary value of a gift is often an indicator of whether professional proof personal boundaries have been crossed. I'm just going to State it clearly accepting Gifts of any value is not worth your certification and the Double Jeopardy zation of our field thanks Megan. The next segment of our debate is the crossfire both sides will have the opportunity to ask and respond to each other's questions. We will begin with a question from Kara representing the con side of the motion Megan representing the pro side will answer and then follow up with her own question. This alternating pattern will continue until the end of the segment again. The motion is behavior analysts should not accept gifts because it Two-door relationship Debaters, please. Make sure you answer the question to the best of your ability and ask for clarification if necessary as always keep it respectful Megan, I agree that dual relationships with clients are unethical and need to be avoided. However, how do you suggest handling when a caregiver has purchased a gift and tells you that they quote will feel so offended. If you do not take this gift that they don't want you working with their child anymore end quote. What did not accepting the gift. If to be detrimental to the client and thus violate ethics code 2.15 which states that quote Behavior analysts act in the best interest of the client and supervisee to avoid Interruption and discontinuation of services and quote. Yes. That is the valid argument and it's actually a big area that I grapple with. I think the ultimate answer is that while it is crucial that we understand our clients individual and larger cultures. We ultimately need to practice within our own. We have created our own culture within Behavior. This this is the standard that we need to live by for example, if I was to practice within the context of every culture that I experienced while working with clients families, there's huge potential that I would compromise my own cultures values, right? So providing services for a group who let's say for example, commonly uses Rachel racial slurs. They may be offended by the absence of me using racial slurs. So do I compromised my personal values in order not to offend them? No, that's just one extreme example. Oh, but I say it to kind of draw a parallel between what you are expecting of behavior analysts abandon your own cultural values to fit in the context of other cultures. And again, where do you draw that line? I just I don't know. I just can't ask people to do that. Okay. So question for you Kara. I do love the point that you discuss. However, I may not share your optimism regarding the ethical behavior of behavior analysts at least some of them. Well, I hope that all of us strive to follow the code. I have heard about too many examples of ethical violations among bcba. To be confident that this is the case. So if you loosen the ethical guidelines as you suggest, how would you account for Behavior analysts who are not looking out for the best interests of their clients and the field in general? How do you protect those families? Great question Megan, I'm not looking to or suggesting that we loosen our ethical guidelines, but to re-evaluate if the specific guideline on gifts needs to be so stringent most more specifically. Is it in the best interest of our clients for this code to be written? In in such a black-and-white manner be CPAs who are not interested in Behaving ethically probably are going to be violating more ethical guidelines than just accepting a small gift and those individuals should be reported and sanctioned appropriately. However, what I am advocating for is a recognition that accepting a small gift like a candle or a $10 gift card is not going to automatically create a dual relationship and cause the bcba to provide a better service to one client over another but may strengthen the Missions rapport with the family. Let me try to put this in Behavior analytic terms. If a family gives a small gift and it is well received the families behaviour and self concept of quote being an appreciative person and quote is reinforced and pairs that bcba as a reinforcer. If a family gives a small gift and it is not well received. It can have the opposite effect and pair the bcba as a Punisher. All right Megan question for you if you Want to draw a hard and fast Line in the Sand and say that behavior analysts should accept absolutely no gifts then what about the drink of water scenario if you are coughing and ran out of water in your water bottle and your client offers you not tap water, but an ice-cold Poland Spring bottle. What do you do and furthermore? What about using the bathroom in a client's home when you use the bathroom technically you were accessing the electricity Plumbing water bathroom fixtures all of which costs money to use and maintain And therefore could constitute a gift. The glass of water question. I think this argument is used in many sidebar discussions when talking about gifts. Let's use a little Common Sense here fulfilling basic human needs needs to be an exception if I have seen for clients throughout the day. Let's say I've gone to the bathroom at rest stops or at 7-Elevens early in their day. I had two bottles of water, but it's 97 degrees out and I ran out in the last half hour of my last client asking for some tap water isn't going to be cause for losing your certification using the bathroom. Room during long sessions. I would say is also okay. I can't speak for them. But I would assume that the board would agree. You're right that there's a cost associated with all of these but I think it would be common sense to allow Behavior analysts to have clients families help meet their basic needs for survival. If all the other parameters have been put into place prior to that try to avoid it when possible don't make a habit out of it, but use common sense. Okay. So this is a long question. So stay with me the 2015 bacb newsletter states that quote context is always considered by a bacb Review Committee if professional judgment can be described that demonstrates that rejecting the gift would have proven more harmful than otherwise than a violation may not have occurred end quote. So they are basically stating that sometimes accepting gifts may not be a violation. So let me play Devil's Advocate and throw out a scenario you were proactive. You've outlined your company's. You've reviewed and made sure that the family understands it you've presented Alternatives you've sent out the reminder email around the holidays your carefully walking the line to avoid a cultural clash and the family still gives you a gift you accept the gift but asked not to give a gift in the future, aren't you intermittently reinforcing their gift-giving behavior in addition if they didn't follow your requests the first time why do you think they would in the future and if they offer you gifts in the future and then you refuse them aren't you in a worse spot than if initially refusing? And if you accept them, haven't you fell down that slippery slope? Well your where you'll accept a gift around the holidays are around birthdays every year births of babies or other significant life Events, maybe because it's cool to give holiday gifts, isn't it? Cool to give other gifts to I'm sorry. That's like five questions in one. All right. Let me try to address this in Parts if the bacb is stating in their newsletter that context is important and always considered then why isn't that Written into the code itself. What are you even saying is that it might be more beneficial to practitioners and clients. If the code itself was written that way perhaps something to the effect of you know, it is in the best interest to not accept or give gifts with clients as this may cause a dual relationship. However, the behavior analyst should use his or her clinical judgment to determine if rejecting a gift would prove to be more harmful than otherwise something like that. To address your points about a slippery slope. Let's first look at the definition of the Merriam-Webster Dictionary defines a slippery slope as quote a course of action that seems to lead inevitably from one action or result to another with unintended consequences and quote and Google dictionary defines it as quote an idea or course of action, which will lead to something unacceptable wrong or disastrous and quote my argument is that accepting gifts doesn't always Lead to something unacceptable wrong or disasterous direct disastrous in some cases not accepting a gift could lead to unacceptable wrong or disastrous consequences such as a family discontinuing Services because they don't like or feel comfortable with their bcba. Another potential negative consequence is that when a bcba is worried about being punished for accepting a gift a bcba May intentionally create a less emotionally supportive relationship to overcompensate. Date for accepting a gift because they're worried about being sanctioned for a dual relationship. This would lead to worse intervention for a client or cause a b c bi to discontinue Services. Really what I am saying is that context needs to be evaluated in each situation and a bcba is behavioral responses need to be individualized to a family as much as they are individualized for the clients that we work with. All right Megan, so bear with me on this one. I'm not trying to get political just trying to draw a parallel but over the last 10-15 years what we've accepted as normal in the political Arena has changed drastically and their field has adjusted accordingly since things change so drastically in other professions and those professions stay current shouldn't the bacb do the same the culture of gift-giving is important in the United States and especially in some subcultures within the US shouldn't we adjust our Accordingly that's a fair point. So what is that quote just because it's popular doesn't always mean that it's right. Right. So I feel like I live my life like that and I feel really strongly about that in all aspects of life. Just because people are giving gifts now doesn't mean that we should change our culture the Constitution was written in the 1700s and although it needs some amendments every now and again basically with stands. The test of time the code was not written to make everyone happy. It was written to protect our clients their families and our profession and we need to take that seriously. Okay. So Cara if the guidelines were Rewritten, let's say to include nominal gifts. How would you define them if food and drinks are okay. Where do you draw the line assigning a monetary value to some gifts becomes very subjective. I completely agree which is why I don't think assigning a monetary value would be the right direction to go as I stated earlier. I think using a statement such as quote. It is best not to accept or give Gifs with clients as this may cause a dual relationship. However, the behavior analyst should use his or her clinical judgment to determine if rejecting a gift would prove to be more harmful than otherwise and quote. This would give practitioners the flexibility. They need to be more compassionate and human in their interactions, which I think could help shake the cold persona persona be cba's have a reputation for Another model that could be followed is that of the American medical association's ethical guidelines their code States quote any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value accordingly textbooks modest meals and other gifts are appropriate if they serve a genuine educational function and quote and quote individual Gifts of minimal value are permissible. As long as the gifts are related to The Physicians work example pens or notepads and quote. And another part of their ethical guidelines States quote. No gifts should be accepted if there are strings attached for example, physician should not accept gifts given in relation to the Physicians prescribing practices and quote. So following the ethical guidelines of the American Medical Association might not be a bad model for us as Behavior analysts to kind of take a look at if we are going to be re-evaluating our code to be kind of more in line with you know, what's actually happening in the field. That was awesome. Ladies really thoughtful questions and responses. Our next segment will be the rebuttal Kara representing the con side will speak first Cara. It's your turn Megan. You've made some really strong Arguments for the continued compliance with the be a CBS ethical code regarding accepting gifts while is important that BCAAs adhere to the code. It is also important that we recognize that societal norms and perceptions Drive what constitutes right and wrong and that we need to continue to revise and And edit the code, so it allows practitioners to act in the best interests of their clients without fear of overly punitive sanctions while the be a CBS ethical code explicitly states that behavior analysts should not accept gifts the fact remains that behavior analysts are accepting gifts. What's and colleagues in 2018 publish an article in Behavior, Analysis and practiced titled behavior analyst accept gifts during practice. So now what they surveyed 60 Behavior analysts from around The globe and found that 75% had accepted non-monetary gifts. 40% had accepted Gifts of small monetary value 12 percent had accepted Gifts of monetary value of monitor moderate monetary value and zero percent had accepted Gifts of high monetary value 68% also endorsed accepting beverages while at work. This study also found that quote accepting gifts is just is being justified by some because they argue that refusing gifts might potentially harm the therapeutic relationship often appealing to respect for cultural traditions and Other similar Fields such as psychology and Medicine have explored the importance of not having to rigid practices regarding boundary Crossings and violations glass 2003 stated that Scholars have quote cautioned against a ridge defecation of techniques that could obscure subtleties in cultural expectations that could be critical for optimal treatment and quote. He defines two categories of ethical violations boundary Crossings and boundary violations. Boundary Crossings refer to gray areas such as accepting a small gift of gratitude from a client that could result in an improved clinical relationship boundary violations revert a gray areas that result in the gross negligence or disrespect for the client such as receiving sexual favors and quote glass and colleagues highlight the importance of over generalizing the concept of a slippery slope just because a gift has been accepted doesn't mean you will definitely end up in a dual relationship in which the client is being exploited. Additionally, the BCB is the only certifying board that codify is giving and receiving the giving and receiving of any gifts as an ethical violation. I understand and see the application of the Bailey and Birch quote that you stated in your in your opening Megan, which I'm going to repeat now for for clarification purposes. It's quote our goal as a profession is to gradually emerge onto the scene with a terrific reputation for truth honesty and reliability end quote. However, it is equally important to have a reputation as being compassionate and unfortunately, that's not a reputation that be cba's have and the 2018 article Compassionate Care and behavior analytic treatment can outcomes be enhanced by attending to relationships with caregivers by Taylor and LeBlanc. They state that quote the highly Technical Training and shaping a verbal precision and graduate programs may lead to over use of technical. Jargon that can be off-putting or abrasive and it may lead Behavior analysts to be perceived as authoritarian or expert rather than collaborative and flexible. A rigid stands on accepting gifts will lead to continued negative perception of behavior analysts. Thank you so much Cara. Those were excellent points. Now Megan representing the pro side will give her rebuttal take it away Megan. Thanks Jill. I'd like to take a minute to look at the argument that we need to compare ourselves to other disciplines like the medical field cherry picking the field that we compare ourselves. Who is limiting and sometimes misleading? So let's look at the music industry and don't give me credit for this example. This is also in Balian Birch in their third edition in the 1950s radio disc jockeys were paid commercial bribes to play certain songs more frequently than others to increase record sales this Payola Scandal is it was called put DJs in a poor light for years to come and also called Ripple effects. There were Congressional hearings and the industry was marred for many years after that. We don't want something like that to happen in Behavior. Asus behave alien Birch in their third edition also state that quote by restricting a behavior analyst from receiving any enticements for referral and requiring that we suggest multiple options. This greatly reduces any contingency for Kickbacks in our field. End quote we shouldn't be concerned with keeping up with the Joneses AKA other fields. What we should do is morally and ethically right to look out for our clients best interest and professions under the behavior analytic umbrella. So let's look at the cultural discussion billion Burton their third edition state that quote In some cultures refusing a gift is considered rude at worst or very poor manners at best. But these are normal circumstances where a family is receiving a guest a behavior analyst coming. Work with a child in the home of a client is not a guest any more than a plumber or electrician would be a guest and it seems nonsensical to expect these trains people to bring gifts or to accept them and quote in Hawaiian culture. When you receive a gift in a container, it is a custom to return the container filled with some token. So let's say I get a container of brownies right not a big deal brownies is maybe a box is maybe a few dollars when I return the container. It would be culturally inappropriate. Appropriate to return it empty. So by accepting this gift, I would also have to give a gift in the future. But what if my gift is too small what if it's not appropriate for the family what if it's not appreciated or maybe it's offensive and I didn't really realize that like I mentioned before we need to understand others cultures, but of ultimately practice within our own so let's change gears a little bit and talk about what to do. I work at this awesome company where the director will email will talk about gift. In their initial in her initial meeting with clients and let her know and let them know about the the code but then she also sends a follow-up email around the holidays. That's a great way to approach this this dilemma and billion Birch in the third dish in they also said quote in developing the at that initial relationship with that in-home client. It is Paramount that the behavior analysts used the Declaration of professional practice. We're in the culture of behavior. Analyst analysis is explained. So it states that we are are in your home to provide treatment to your child. We are not guests and do not expect to be treated as such we have to abide by professional practices in our country. Please do not offer us food or drink or expect that you should give gifts or tokens of appreciation. We derive all of our awards from the improvements that your child will show as a result of treatment and an occasional thank you is more than enough and quote the bacb and their main 2015 newsletter states that gifts are unique in that they have the potential to compromise The Professional Chip, whether the professional accepts or refuses the gift as such it is important to help minimize this risk before the gift is even offered one explicit way to do. This is to provide a policy about gift receipt to new clients and review it. Annually, especially before gift Laden holiday holidays one way to avoid the problem of complete prohibition is to include in the policy examples of what constitutes a gift and what does not having a well-considered policy ensuring that your staff follow. Oh it and ensuring that clients understand it will mean likely minimize the probability that you find yourself in a situation in which you are ill prepared to avoid a professional compromise while maintaining strong Rapport and trust with your clients. Although a gift policy is a good start. It is equally important for organizations to prepare all staff members to handle the inevitable gift and counter Behavior analysts are aware that providing information is seldom sufficient to affect Behavior. So even though a policy has been presented to Consumers some Them will likely still offer gifts and quote and that was from the bacb. So there's a B-side 21 article and they give a few examples and one kind of mirrors that bacb article on its states that like alternate offer an alternative. They say quote in the email alerting clients and parents of the no gift rule offer them the opportunity to say something nice or give feedback to you about your staff kind words can mean more than a plate of cookies or a gift card. It could also provide. An opportunity for clients and parents to provide feedback on services and quote. They also have this hilariously adorable printed printable card and the little card states that quote. Thanks for the gesture you made my day though. I won't don't want to offend you in any way. I cannot accept in keeping with my ethical code the best gift you gave was the kindness you showed and then it quote as the ethical website and that's end quote. So yeah, maybe you want to reword that to put your own spin on it. And but the be I see the B-side 21 article states that quote giving a card like this is cheesy, but it can help disperse the awkwardness and the situation and can help the family understand that you're grateful for the gesture besides. They say look at how cute that son is and quote. All right. So back to that 2015 May our newsletter from the bacb. They state that the behavior analyst quote must use professional judgment to determine the best time and method to reject a gift without Sizing the professional relationship by offering the client. For example one might be able to thank the client remind the client of the gift exchange policy and state that they wish they could accept it but per organization policy. They cannot however of the gift was offered in a group. It might be best to Simply. Thank the client in the moment and return it later in the context of a sensitive and respectful discussion in most cases. It is important to acknowledge the thought and gratitude behind the gift and make certain that that by rejecting the to the behavior analyst is not appear to imply ulterior motives or suggest that professionals who do accept the gifts are less ethical as described later context is always considered by a bacb Review Committee if professional judgment can be described that demonstrates that rejecting the gift would have proven more harmful than otherwise than in violation may not have occurred and quote so Thanks, Megan. Those points were very thought-provoking. The next segment of our debate is the second Crossfire is the moderator will ask questions of both sides. We will attempt to keep an alternating pattern of responding Debaters. Please make sure you answer the question to the best of your ability and ask for clarification if possible as always keep it respectful. All right, this question is for both of you. I know the BAC B's code of ethics on gift giving is meant to help practitioners avoid. Really harmful dual relationships. However, would you agree that there are circumstances where accepting a small gift of gratitude from a client could result in improved clinical relationships actually helping to build rapport and Foster a more human connection between client and provider Megan. Would you like to respond first? Sure. Yeah. I actually do agree with you drawing that Hardline is really difficult. I personally think that accepting a homemade card or drawing from a client or even a Written Letter. ER from the parents or Guardians could be acceptable beyond that though. I just really think you're walking a fine line between abiding by ethical guidelines and crossing boundaries. Like I said, it's so easy to blur lines and fall down that slippery slope especially because the service we provide has the potential to make such a lasting and lifelong impact and people want to show their appreciation, right? So accepting that initial gift May improve your relationship with the client and the family in the short term but over time and we're ABA we know this Client in the family may just assume that since you accepted the gift once you will accept more gifts and larger gifts and so on. So just like in our practice our Focus really needs to be on the long-term game. Thanks so much Megan. Kerik. Could you also respond to this? Absolutely. I do agree with Megan's points in some aspects. I think the general practice should be to avoid giving and receiving gifts. However, the way the code is currently written does not give any leeway to the bcba to use their best judgment to determine if it accepting a gift could strengthen a relationship or if not accepting a gift could deteriorate it recently. I was discussing this topic with a colleague and she really did a story about how one family she was working with identified sleeping as an issue for their family. The learner needed the mom present in order to fall asleep and stay asleep at night. However, the family wasn't comfortable working on it with the bcba the bcba built rapport with the family by talking with the clients mom during sessions and accepting small snacks when offered which Part of the family's culture eventually this mother felt more comfortable with her and allowed her to work on the skill of sleeping and now the clients sleeps independently. This is just one example of how accepting small tokens of appreciation can build rapport and lead to better clinical outcomes as a field. We give BCBS a lot of power by teaching them how to shape and change someone else's Behavior. If we as a field feel that someone has a strong enough moral and ethical Compass not to abuse that I feel that we should allow them. Them the judgment to determine how accepting a gift would affect the therapeutic relationship. Thanks, Kara Megan. The next question is for you. How would you respond to the situation that Kara was refer referencing before if you returned or declined a gift and the family said they didn't want to work with you or wanted to discontinue services or even worse what if from that interaction they determined that ABA wasn't for them since be cba's are cold or uncaring. Then this is it's crucial that we address the BAC B's policy on gifts from that initial interaction with the family had this been addressed at the beginning and an inappropriate way. Ideally it wouldn't be a problem giving alternative options for gift-giving Behavior like we mentioned before Also may have prevented this and then in addition bcba should be taught the interpersonal skills to successfully navigate these kinds of situations so that it doesn't affect services. But okay, let's play Devil's Advocate and say that someone does could Tin you Services? It's a really tough one. I would try to find another bcba within your company who may be a better fit for the family. If that doesn't work out. Maybe I would try to refer to a different company and let the family start fresh. I would alert the company to stress that they would do anything for the success of the client. But that the only caveat is that they can't accept gifts. It really is an unfortunate situation and I hope that it just remains a hypothetical situation and doesn't really become reality. Thanks so much Megan. Okay Kara. This one is for you. Don't you think that receiving gifts creates a quid pro quo situation where families will expect something in return or one family is getting some better service than another I think yes, that could be possible. However, I honestly think that that can happen with or without the act of giving a gift as humans. We develop relationships with people who we might just click more with things are going there are going to be some clients that a bcba might just like more or enjoy working with more and I think it would be even more possible for our bcba in this situation to give extra time or their talent or maybe even engage in some ethical Line crossing like altering official plans or even committing insurance fraud, you know, these things constitute a dual relationship and are an ethical violation with or without giving a gift the point is Quid pro quo situation is wrong and constitutes a dual relationship. However, receiving a gift doesn't always constitute a pretty quid pro quo situation and doesn't always constitute a dual relationship. That is an excellent point Cara. All right. This last question is also for both of you. It is a valid argument to state that behavior analysts should have training and subsequent autonomy to make ethical decisions. How would you suggest setting up oversight within supervision to monitor this Kara will go to you first. Okay, so I think the same way as Uncle violations are handled now if someone observes or is privy to information that they feel violates our ethics code they address it directly with the individual and then report it to the bacb in terms of training. This is something that as a field we need to develop just the way do we develop any skills-based training individual Ace providers should focus on developing this content, but I do think it would be helpful if the BAC be provided some out. Line up. The type of skills is providers should be teaching similar to the 8-hour supervision training or the RBT training. Yeah, I agree with that. Just backing up a minute. We need to stop coming top down to students and new behavior analyst with this gift rule. We need to not accept gifts. But we also need to teach how to appropriately do that. The best way is to be upfront from the initial meeting but this takes cooperation from companies and supervisors when they meet with new clients. I also think that like Cara said there's a huge deficit in our training when it comes to teaching interpersonal skills training is focused primarily on teaching skills. Content we don't adequately teach the crucial skills of working with families. Let's bridge that Gap and hopefully this becomes a non-issue in the future. Yeah, if I could just say one more thing, I completely agree Megan. This is a bigger problem within our field as a whole that were not teaching those soft skills or those people skills that are just as necessary as Behavior analytic skills. So Megan, well, we might not agree on gifts we do agree on this. I think that's a great way to wrap. Things up. Thank you so much for those answers are final segments now will be the summary and final Focus Kara representing. The con side will speak first Kara you have the floor. With some colleagues from 2018 make recommendations for how the field of behavior analysis could revise their ethical guidelines and practices to be more in line with other similar professions, which would allow behavior analyst to behave ethically while behave well being culturally sensitive. They State quote answering questions about how multiple relationships develop and how and to what extent these practices might damage or improve. The therapeutic relationship will call for a new way of thinking. Born of empirical evidence rather than exaggeration and generalization consider. For example, the relation between cultural competence gift acceptance and Boundary Crossings instead of eliminating gift receiving from the behavior analyst repertoire. It might be more helpful for practicing behavior analyst to undergo concept training and culturally appropriate and inappropriate instances of gift receiving this training might take place practicing the this training might Place practicing Behavior analysts. In a better position to respond appropriately such as being culturally competent when faced with small gift offerings during their service delivery, thereby, potentially strengthening the therapeutic relationship further educating practicing behavior analyst would allow for them to recognize when inappropriate gift offerings arise and how did you know I the gift in a culturally appropriate manner such steps are in line with the be a CBS News letter clarifying clarification regarding factors that influence weather. Accepting gifts constitutes a violation of the compliance Coke and quote while Bailey and Birch compare the work of behavior analyst to that of Trades people such as Carpenters or plumbers where it wouldn't be typical to give or receive gifts. Perhaps a closer comparison is to that of a physician and as with some colleagues State quote like many Physicians we too should be open to the idea that accepting gifts can foster a better not worse working relationship and quote. Thanks so much Cara now giving her summary and Final Focus Megan representing the pro side will make her closing remarks Megan you have the floor. Thanks Jill. I'm going to start with that quote. I'm going to reiterate it because I feel like it's so poignant to this discussion just because it's popular doesn't mean that it's right. We need to hold ourselves to a higher standard of Ethics. Then many other professions. We're dealing with such an extremely powerful tool in Behavior Analysis the ability to alter people's behavior. We have to carefully scrutinize our decisions to make sure that they benefit the client and are socially significant the bacb that 2015 newsletter they that their quote says that the probability of this encounter might increase proportionally to treatment success and quote. The more successful treatment is the more likely the family will be to show their appreciation in a tangible way and they the bacb goes on to quote a gift is often a simple gesture of gratitude rather than a more per Nick youis attempt to undercut objectivity and otherwise compromised the relationship and quote. I got this. I understand why this behavior is Portent to some families, but again, we need to practice within our own culture not others as Bailey and Birch in their second edition State quote. It does not seem too much to ask of professionals that they recognize the legal code of their community and maintain high moral principles and quote I go back to what broad had Cox and Quigley state that quote a benefit of direct and explicit statement from the bacb is Clarity. There is no room for interpretation end quote we To follow the ethical guidelines not only for the preservation of our own personal certification, but also to uphold the standards and ethics of the field of behavior analysis, and let's remember why it was written in the first place right to to benefit the client and to make sure that nothing interferes with the clients treatment for and subsequent success Minds greater than mine came up with that ethical code and that sets us apart from many other professions. They consulted with other disciplines and in an episode of behavior. Observation John Bailey himself stated that he even consulted our country's founding documents. These great minds put a lot of effort into creating a code that would not only protect us and our clients but also acts as a means to preserve the Integrity of our field and profession. Let's put this argument to rest and support the code that was written to benefit us. Let's take the moral and ethical high road and not sacrifice our values and culture to fit into someone else's be upfront with the clients. Beginning and don't accept the gifts. Thank you ladies for your thoughtful thoughtful and thorough defense of your sides. So many important points were made today. This is really a tough point with a lot of considerations that need to be made while we should follow the bacb guidelines. Each individual bcba needs to take their own cultural and ethical boundaries into consideration, too. Now stay tuned at the beginning of every month for a new ABA Ultimate Showdown episode. Look out for our September topic you won't be able to restrain yourselves. If you have ideas or topics for future debate have respectful suggestions on ways. We can improve this podcast or if you are interested in being a guest debater, please email showdown at Graham Behavior.com. If you have enjoyed what you heard and found your aha moment, please subscribe to our podcast visit our website at Graham Behavior services.com Showdown like or follow Graham Behavior Services on Facebook Twitter LinkedIn or Instagram. And visit our YouTube channel to be alerted when new episodes are out. We also appreciate your thoughtful review on the platform you listen to us. Finally. We asked our audience to things be respectful and thoughtful when you respond to other people and their ideas remember that everyone has a unique learning history that has brought them to this moment. It will make you a better person and further promote Behavior Analysis go forth and deliver. Good Aba. 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*Behavior analysts should not accept gifts because it creates a dual relationship. *   Welcome to ABA Ultimate Showdown - a podcast promoting constructive, respectful, and professional discourse to advance the field of behavior analysis. Round 3 of the Showdown attempts to answer that longstanding question - to accept gifts or not to accept gifts? We cover the legendary glass of water question, compare us to other disciplines, and bring up a lot of points you may not have thought of. Most importantly, we attempt to help practitioners in the field make ethical decisions surrounding gifts. Join us as we debate whether or not behavior analysts should accept gifts. A lot of women hours went into this one researching, collaborating, publishing, and editing. During this debate, we construct arguments for both sides to present the audience with a comprehensive and balanced view. For a list of references used in this podcast, please visit www.GrahamBehaviorServices.com/showdown   If you have ideas or topics for future debate, have respectful suggestions on ways we can improve this podcast, or if you are interested in being a guest debater, please email showdown@grahambehavior.com   If you have enjoyed what you heard and found your Aha moment, please subscribe to our podcast, visit our website at grahambehaviorservices.com/showdown, like Graham Behavior Services on Facebook and Twitter, and visit our YouTube channel to be alerted when new episodes are out! Thanks for listening and we hope to have helped you experience some Aha moments! 