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Introduction to Applied Behavior Analysis Practice
The Department and the Board for Applied Behavior Analysis has chosen to prepare this Practice Alert on this topic to clarify professional standards of care as they relate to licensed practice of applied behavior analysis (ABA) in New York.
It is of the utmost importance for licensed behavior analysts (LBAs) and certified behavior analyst assistants (CBAAs) to be aware of what constitutes best treatment practices based on evidence. LBAs and CBAAs should seek out research evidence for specific procedures and treatment packages by consulting peer reviewed publications, such as randomized clinical trials, single-subject designs, systematic reviews, and meta analyses. In all cases, LBAs and CBAAs should determine whether the evidence supports the use of particular procedures and treatment plans and collect their own data to verify whether the treatment is effective for their own patients/clients. Therefore, the best treatment practice can be viewed as an integration of the current treatment literature with the professional's judgment and experience regarding the unique factors that will impact a particular patient’s/ client's course of care over time, and ongoing assessment of the effects of the treatment. The Office of the Professions licenses and regulates LBAs and CBAAs with the aim of protecting the public and ensuring the maintenance of professional standards of care. Practitioners, not procedures, are licensed. As such, it is the professional who must ultimately exercise professional judgment based upon the person's knowledge, training, and experience in determining how to intervene with those individuals who seek their assistance.
Professional Standards of Care in ABA Practice
This Practice Alert is a general discussion of the practice issues a licensee may be faced with in those situations in which concerns about best treatment practice, including evidence-based practice, vis-à-vis their professional practice are raised. Practitioners are advised that this discussion serves as a guideline not as a directive or mandate to pursue a course of action. LBAs and CBAAs in New York State are individuals who have met the regulatory requirements for licensure and, therefore, should provide services within the scope of their respective practices. The regulations governing the practice of these professions in New York State set a standard of care which requires competent and adequate provision of care to the public (see Part 29 of the Rules of the Board of Regents on Unprofessional Practice and Section 6509 of Title VIII of the Education Law on Professional Misconduct). The Rules of the New York State Board of Regents, as well as the State Education Law and regulations, are designed to protect the public by, among other things, promoting good practice.
Practitioners should be aware of the efforts within and outside of the profession to make practitioners accountable to their patients/clients by using treatments/interventions discussed in the research literature as being effective. The scientific base for the practice of ABA is well established. Indeed those licensed to practice in New York State have met the regulatory requirements to engage in practice, which include coursework in concepts and principles of ABA, research methodologies and assessment and measurement tools, as well as having completed supervised training requirements in the provision of ABA services.
Providing patients/clients with effective treatments includes, but is not limited to, the following recommendations:
- As an informed practitioner, exercise professional judgment when providing professional services.
- Become familiar with the body of rules governing the practice of the professions in New York State.
- Be aware of the limitations on your scope of practice to provide ABA treatment only to those diagnosed with autism, autism spectrum disorders, and related disorders. Part 29 of the Rules of the Board of Regents requires you to practice within your licensed scope of practice. If you know or have reason to know that you are not competent to provide a service that you are legally allowed to provide, then you should not provide that service. Additionally, if you know or have reason to know that the person you are delegating professional responsibilities to is not qualified by training, experience or licensure to perform them, then you should not delegate such professional responsibilities to them. As a licensed professional, it is your responsibility to practice within the scope of your license. If you practice outside your licensed scope of practice and/or level of competency, you may be charged with professional misconduct.
- Be sensitive to professional ethics.
- Stay abreast of current issues in the field of ABA.
- Critically evaluate the context, including source, application, and results, of publicized findings regarding ABA and/or ABA related issues.
- Be aware of the issues concerning best practices, empirically supported treatments, and evidence-based practice by taking courses, attending conferences/workshops, etc. to maintain continuing professional competence.
- Know the boundaries of and utility of interventions chosen.
- Know the limitations/restrictions of patient/client characteristics as benefiting from empirically supported treatments to determine whether the recommended treatment is appropriate.
- Make efforts to insure culturally competent practices which reflect knowledge of the impact of diversity on human behavior.
- Document your professional decisions about appropriate patient/client care needs in your records, demonstrating your awareness of ethical and legal codes of professional practice.
- When you select treatments, be appropriately trained to implement these treatments competently.
- Regardless of the policies, practices or contracts with third party payers or other outside external agencies and entities, know that treatment decisions are ultimately the responsibility of the practitioner.