Anonymous Perspectives of the ABA Community Response to COVID-19
Hey, I’m Ryan O. Due to my involvement as an online creator I was receiving a lot of questions and concerned statements that there wasn’t a safe place to share what was going on or how people struggling with the chaos that COVID-19 is causing in the Applied Behavior Analysis Industry and field. After seeing posts in various forums being deleted (e.g., in ABA Facebook groups) or asked specifically not to occur, I made a form to try and gather some of these anonymously. This is the collection gathered until March 26th at approximately 3 pm eastern. At the bottom, you can submit your own, but I do not plan to update this post. However, the statements are available to review as well.
I shared a number of these as posts on various social accounts linked to this website. As of today I’m listing what was gathered here, and discontinuing the form. If you want to contribute to solving some of the inherent issues being uncovered as a result of this pandemic I can put you in touch with two leaders attempting to do that, please email me at info@thedailyba.com with the subject “I WANT TO HELP.”
Public Statement 001
"I have worked in various positions in EMS, and have also been trained in working with hazardous materials. Originally, my path led me towards ABA accidentally, so to speak. When I suggest a data driven approach to assess risk of contamination, it is out of concern for a very serious virus we are not equipped to face as a society, and particularly in the field of Applied Behavior Analysis.
Currently, Registered Behavior Technicians are by and large the bread and butter of many agencies. Due to issues of sustainability of the position itself, and funding sources (and lack there of diversification of funding) many are faced with a dilemma, risk contamination, or be fired. In any field I have been a part of (3, so far) those on the front lines tend to be the lifeblood financially of organizations, and tend to have the most difficult jobs. For far too long we have had a culture of looking down upon those in these positions, while ironically relying on their work and dedication to keep organizations afloat. We are not equipped to protect ourselves or colleagues against the spread of this virus, and many look at this as a moot point.
Time and time again in my various conversations I have encountered a few things. First, the terms medically necessary versus essential; we sure know our ABA jargon, but we are not sure how to use these in exchange of dialogue when assessing the issue of risk versus benefit. When I bring this up, cordially, don’t patronize me. I have seen things in other jobs medically and have seen human suffering that would give you nightmares for the rest of your life. We have been comfortable in our ABA insurance Autism service delivery corner of the world for quite some time, but the reaper is coming for us. I applaud so many business owners, and friends of mine, who have made very difficult decisions which they will suffer for financially to maintain safety and treat human life with dignity and respect. Additionally, I do not downplay that without services many of the recipients of our services and their families will suffer. There are no easy answers. This time is a call for us as scientist practitioners to get back to compassion, respect, and should serve as a serious call for us to make our science valuable to other industries. We talk about changing the world, let’s get to it."
Location: Undisclosed.
Identified as: Service Stakeholder (e.g., parent, guardian or loved one of ABA service recipient), Student of ABA (e.g., current Master's Student), Background in emergency medicine
Public Statement 002
"Remaining open despite state shelter-in-place order. Have announced plans to close at multiple milestones and when those arrive corporate office says we can’t close. No learners served would be in risk of imminent physical harm to selves or others; other impacts of losing services for weeks may be significant for some. Trying to get telehealth up and running. Foresee massive layoffs and a lot of misinformation is running rampant as executives don’t communicate with clinical staff effectively."
Location: Michigan, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 003
"It took some convincing for my ABA company to close its centers. Now, some clients are being offered in-home options while others are trying out telehealth (compliance not the best with this.) Just got word today that the city is requiring everyone to stay home unless essential, and behaviorial health is on the list of essentials. It’s great that we are considered essential, but should we be going into people’s homes during this time? Feeling so conflicted listening to the advice of experts to stay in so this virus can stop spreading but then feeling pressured to do in-home options from my company. We are small and of course I want to help them and the clients, but they are wanting us to possibly wear gas masks when working with the clients. Since we bill insurance for pay, working these minimal hours might actually get me a significant less paycheck than unemployment. Which is more heroic right now- to stay home or to enter the homes of others to provide these services?"
Location: Colorado, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 004
"I work as an RBT and am also in school to become a BCBA. The past few weeks have been frustrating and stressful. My company is still open and working towards telehealth options. I have had a hard time with balancing feelings of not wanting to miss sessions that are still available to me/ being there for my clients but also prioritizing my health. Somewhere in there falls my financial well-being. We are now having apply for partial unemployment each week and or use our Paid-Time off benefits. This has been difficult for every single person- and I can’t imagine what families are going through. I miss my clients and my routines. RBTs are taking big loss right now though."
Location: Georgia, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 005
"Providing ABA therapy during a shelter in place and global pandemic is a violation of the ethical code which states behavior analysts protect client safety above all else and do no harm to clients. Unless clients pose a serious risk to themself or others and not receiving services is more dangerous than potentially spreading the virus, services should be suspended or continued via teletherapy."
Location: Illinois, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 006
"In order to keep clients and staff working we have switched to mostly telehealth services, using a parent coaching model and the clinician on the other side of the video call taking the data. This has been necessary for continuity of care and for our staff who need income. However, telehealth is almost unknown to me and even though I took 6 hours of CEUs yesterday and today and feel better about it, now I have to train all of our staff...who are already implementing the telehealth services."
Location: Northern California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 007
"Our State just issued a stay in place order for all nonessential businesses. However, there is no clarity if ABA falls into the category of essential or nonessential. The governor also stated that no more than 5 people should be together and we should be staying 6ft apart. Centers are staying open including mine and it’s terrifying. I don’t want kids without services but the harm that continuing center services could do is scary. We have over 5 kids and 5 RBTS at our center at a given time and our space is small so 6ft apart is not necessarily feasible. We even sent home a kid with a cough and fever today. Personally, I think the centers should close and telehealth should be offered but this isn’t happening right now."
Location: New Mexico, USA
Identified as: Direct Care (e.g., RBT, DSP)⠀
Public Statement 008
"I’ve never been more stressed! I’m conflicted between keeping myself and my clients healthy and keeping my job. Furthermore, I feel pressured by my employer to provide services due to unspoken contingencies to keep my salary."
Location: Undisclosed.
Identified as: Master's Level Clinician (e.g., BCBA, LBA)⠀
Public Statement 009
"One of my technicians informed me that they had a potential COVID-19 exposure from someone getting tested (who also had symptoms). This was after I supervised them that morning. After calling HR they decided they were low risk but they would have to cancel a week of work for them. And I should resume working. A week later a client in that household started to develop symptoms, they canceled their sessions for a week. I'm still told to work."
Location: California, USA
Identified as: Student of ABA (e.g., current Master's Student), BCaBA
Public Statement 010
User submission error, not a complete response.
Public Statement 011
"Business owner insists we most continue to collect all of our billable hours in client's homes. No PPE, or sanitization supplies have been provided. President is not willing to see clients face to face, but is fine with us going into to multiple homes risking the safety of the clients and ourselves."
Location: Chicagoland, USA
Identified as: Student of ABA (e.g., current Master's Student)
Public Statement 012
"I am immunocompromised - higher ups don't give a fuck whether I become ill or transmit the virus to others, as long as she's getting reimbursed."
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 013
"Let me first start out by saying that I absolutely love what I do and the families I serve. With that being said - I feel the response (or lack thereof) to the current COVID-19 crisis, from my company as well as the other companies in our area, was irresponsible and reckless.
Initially, it was said that when the schools close - we will. Schools closed and we did not. Then it was said when restrictions get to 50 people max we would close - this happened, and we did not. Next it was issued to have no groups over 10 - and yet still we stayed open and continued to have both RBTs and clients in groups larger than 10 at our clinics. Many BCBAs and case specialists began asking to work from home via telehealth and were treated horribly. Higher ups continuously bashed this decision and shamed/bullied those that wished to work from home (even though this was continuously recommended by the CDC and our state government).
Finally, shelter in place orders began coming out and only then did we stop services (while still contemplating sending RBTs into certain homes). This is a hard time for EVERYONE. I worry about how I will get by without a paycheck. I worry about all of our RBTs and how they will get by. I worry for our families and our clients the most. But I also recognize I/we are not alone nor special in this feeling. Millions all over the world feel this way.
As behavior analysts we abide by an ethics code. Above all else is client and staff safety. I feel ABA companies have failed their employees and clients during this time by refusing to act quickly and take the necessary measures to keep our community safe. I understand continuing services for those with extreme behaviors that could potentially be harmed without services BUT this was not the reason nor the clientele most companies were serving while continuing to have sessions and send people into homes. The term “medically necessary” kept getting thrown out and while I agree are services are that... in times of severe crisis - we need to humble ourselves. The true medically necessary services at this time are those that are in the hospitals working tirelessly to save lives. It’s not accurate or ethical to act as if all the services we provide are on this same level at this time. I hope this is a learning experience for many companies so that if this were to ever happen again, we are more prepared and are able to act as leaders with safety, NOT profits, TRULY being our first priority."
Location: Undisclosed.
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 014
"I’m pregnant. My husband has been unemployed and was only recently trying to go back into the field (we are both in ABA). My company is small and we are trying to stay open. We live in a place with a high cost of living. This is my first pregnancy and I’m afraid I’ll have to do it all alone because of the visitor restrictions. They won’t even let my husband go to medical appointments with me."
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 015
User submission error, not a complete response.
Public Statement 016
The ethical concern I would like to discuss is that ABA providers are continuing to offer services when a shelter in place order has been issued. From the current science being offered about COVID-19 it seems to endanger the health of clients, clinicians, and direct care workers, or all parties involved. There is a risk that the virus will be transmitted even if no symptoms are shown. I know we have an obligation to do no harm as BCBAs. My other major concern is that the stakeholders involved are not familiar with our ethical code. I was fired from my BCBA position on Thursday. I was lied to about the reason I was fired and have evidence that I was fired due to downsizing/restructuring due to COVID-19. My first question I asked when they told me they were letting me go was, "I cannot abandon my clients I need to make arrangements for them first". My office manager refused to allow that and then walked me out. Thanks for letting me share this difficult experience. I'm now looking for employment else where and I'm hopeful to begin teaching future BCBAs. Thanks for hearing me out Ryan!
Location: Texas, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 017
My company has switched to remote. We are vendored thru IRC. I am eternally grateful!
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 018
In Colorado, we have a few clients that have BCBS but we are running into issues where our BCBS clients are from different states so we just cannot do telehealth with them at this time. It hurts all of us because now clients are losing services, staff are losing hours, BCBAs are losing clients and we are not sure how long this will last. I would love to get insurance companies to just give a straight answer or be required by governmental agencies to allow services via telehealth during this time to ensure our client's needs are still being met regardless of insurance providers.
Location: Colorado, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 019
Where do you draw the line between being an essential service that is medically necessary and not doing harm to clients by continuing to provide services where social distancing is not possible?
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 020
I'm a parent and both my children are out of school in addition my spouse is "mission essential" and every third week is working a 12-hour shift. Every 3rd week I can't work because there is nobody to care for my children and I can't provide telehealth because the payor does not authorize those services. Nobody knows how long this schedule will last.
Location: Northern Virginia, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 021
I am concerned about the state of ABA after this. After years of advocating that ABA is medically necessary, all of a sudden ABA companies are closing and saying it isnt necessary.
Location: South Carolina, USA
Identified as: Service Stakeholder (e.g., parent, guardian or loved one of ABA service ricipient)
Public Statement 022
I have asthma so I have symptoms that are similar to the virus, only no fever. There is no way for me to know if I have the virus or not because I don’t meet the criteria for testing. I am still working and seeing clients because my job is still asking us to and I worry for their safety.
Location: Florida, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 023
Our company is asking us to create reasons to request additional hours from insurance companies to justify our salary. Ie, I need approximately 25 billable hours a week and I’m being asked to look at my clients and see how much we can increase among those to meet that, rather than do intakes for PT only in a telehealth model.
Location: Massachusettes, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 024
I am a behavioral therapist providing in-home therapy for children diagnosed with ASD. I do not feel comfortable continuing services during the "stay-at-home" order in Illinois for several reasons.
1. I live in an apartment building with a variety of people that share hallways, doorknobs, laundry facilities, etc. Some of their professions include nurses, pilots, and flight attendants. I also have a roommate who worked in a building with a confirmed COVID-19 case.
2. One of my clients only receives services when school is in session, so I am left with only two other clients.
3. With one of my clients, they had previously had a fever, cough, and runny nose so they had cancelled a couple sessions. The fever went away and the family told me that he was feeling better so I showed up for session on that day. By the end of session, the child had coughed and sneezed several times without covering them properly. The mother told me at the end of session that his teachers asked him to stay home from school because of the cough. I started feeling uncomfortable that families were not taking this seriously and that just because they say they are not sick, is not necessarily the case and CANNOT be guaranteed.
3. The clients I have left that are wanting hours primarily work on educational skills: counting, matching, play, listener discrimination. The parents have training to generalize these skills and prevent regression if services are temporarily put on hold. I cannot see how there is any justification that the services I provide to teach these skills are considered "medically necessary" during a pandemic.
4. In our Governor's "stay-at-home" order, it states "To the greatest
extent feasible, Essential Businesses and Operations shall comply with Social Distancing
Requirements as defined in this Executive Order, including by maintaining six-foot social
distancing for both employees and members of the public at all times". This is not feasible when providing services to my clients. They do not have strong enough skills to ensure that they are following the CDC guidelines of not touching their face, no hand-to-mouth, washing hands thoroughly, and covering coughs or sneezes properly. It is nearly impossible for me as a therapist to maintain the 6-foot social distancing, and even if I did, therapy would be rather pointless.
In response to the COVID-19 pandemic, my company has decided to continue providing services due to being classified as "medically necessary" and given therapists and families the option of continuing or not. I have declined to continue with services and have decided to observe the "stay-at-home" order. They are not providing layoffs and are keeping us as active employees. This eliminates the chance for employees to collect unemployment during this time. They are also not offering any paid opportunities to work from home. They are pursuing telehealth options for those clients who qualify - but this would only be offered to BCBAs. This leaves employees who do not feel comfortable continuing face-to-face sessions with no pay or benefits (insurance or PTO) until at least April 7th.
Location: Undisclosed
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 025
A word for word copy of 027
Public Statement 026
A word for word copy of 027
Public Statement 027
Our company is clinic based and due to the coronavirus is moving to an in home model - for now. They are providing everyone with the “choice” to work but we all know that choice means walking away from the job and families and we won’t be hired back when this is all over. They are promising us personal protective gear when in home - However they can answer the question if hospitals can’t get it where are they getting this gear ? They are pooling our RBTs and BCBAs and assigning everyone cases based on addresses (to save money on driving) in conjunction with the surrounding centers. so a bcba might be assigned a client they have never met with an RBT who they’ve never met and never met the client. They are expecting this transition to happen over night with no time for BCBAs to prep families or a therapy space in the home. Let alone train staff on the new ethical dilemmas providing services in home instead of a clinic setting. The company is doing everything in terms of money and not keeping the staff and client safety in mind. We are still in the center all week. This behavior is absolutely something I’d leave a company for but in this current climate they keep reminding us “we’re just lucky to have a paycheck!” And that we are a medically essential service. Please tell me
How taking a few weeks off from teaching billy to match is going to be detrimental to his life? It won’t. But not containing this virus could be.
Location: Southwest Florida, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 028
There is a nationwide shortage of PPE for people in life-saving positions and there are companies who have opted to continue services (using up limited PPE) without a true, individualized risk-benefit analysis. It frustrates me that there are nurses in hospitals who have to use unsafe PPE while ABA providers continue services for clients who will not die without therapy for a few weeks.
Location: Illinois, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 029
We are now being told that each analyst must bill 35 hours per week of telehealth services in order to keep jobs. (In comparison, our in-person billable expectations during normal times are 24 hours per week.) Apparently, the choice was between that and laying off 100% of our staff and potential permanent closure of our clinic.
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 030
Neighbor's 4.5 year old on the spectrum, not receiving services. I have no supervision what so ever and am watching them struggle. Before this mess I suggested the mother reach out to an advocacy group to get a family navigator. Kid has no words and only receives service through school and those might be shut down. Clearly a duel relationship and I have stayed in lane of kind neighbor saying hey you are not alone, call this number and good luck. Pandemic was not covered in ethics training.
Location: Undisclosed
Identified as: Student of ABA (e.g., current Master's Student)
Public Statement 031
This pandemic has highlighted some key areas of concern within the field of ABA, particularly in regard to individualizing to each client.
As a field, we continue to struggle with individualization. I call myself a provider of last resort because I am not in network with any insurance and I am not affiliated with any entity that diagnoses. As such, I work with a variety of diagnoses and typically only serve children with autism once all of the other providers in my area that accept insurance will not work with the child or family for a variety of reasons. Time and time again I get diagnostic and recommendation reports from BCBAs that are templated. These reports, which are essentially entirely copied and pasted, are from top notch hospitals, "centers of excellence," and BCBA-Ds. In the past two years, I have not received a report from a colleague that actually included individualized recommendations. The families that come to me have zero understanding, even after many years of ABA, of what actually works for their child. Instead, they know that they just need "25-40 hours of ABA." So now, we have this pandemic and we need to help children and what do we see on social media? BCBAs expressing expressing opinions on what OTHERs should do with their clients. Any ABA clinic, organizations, or professional needs make decisions that are individualized to each of their clients, just deciding whether they stay "open or closed." It is terrifying to see the lack of understanding regarding individualization during this time. This also stems into the use of RBTs, many of which have better stimulus control and are more reinforcing than the BCBA. Many RBTs need to stay included on their cases, even if they are not providing direct treatment or reimbursable services, based on their client's needs.
Location: Midwest
Identified as: Master's Level Clinician (e.g., BCBA, LBA), ABA Business Owner
Public Statement 032
My company is continuing services at this time in both the home and clinical setting. The only precautions being taken are extra cleaning and temperature screening. We’ve had to fight to have clients sent home when they come in with low grade fevers, and respiratory symptoms like coughing. Clients are allowed to return after being fever free for 24 hours, even though research shows that this isn’t enough time to no longer be contagious if you contract the virus. We aren’t given any PPE to use, except limited gloves in the clinic for diaper changes. Clients hours in the clinic have been increased and there isn’t any efforts to socially distance being taken. We have had zero communication from upper management in over a week regarding COVID-19. Staff have been told to take PTO or unpaid time off if they don’t want to work, but HR has not communicated how this affects health insurance, or any other financial options for staff during this time including the bill that was passed by our government and how that applies to us. Most staff does not have PTO built up because it is so hard to accrue with client cancellations. We have high risk staff and clients still present in the clinic, and these staff are working because they fear job security and don’t want to lose their healthcare. There has been no telehealth discussion. We are remaining open out of medical necessity, which I understand to a degree, but even after The BACB issued ethical guidelines there has been no attempt to weigh the risks and benefits based on the guidelines stated by our board. We have clients who have zero self injurious behaviors or maladaptive behaviors that are having their hours increased at this time when per our ethics advice, these clients should be moving toward telehealth or being placed on hold. This whole thing has been an anxiety nightmare for RBTs and BCBAs who are losing jobs, risking their health, etc. No one in the field can agree on how to interpret medical necessity. There are so many companies that are not handling this ethically, causing RBTs and BCBAs to act unethically, and are leaving staff out to dry with no guidance or protection. But, what are we to do?
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA), ABA Business Owner
Public Statement 033
Company gave us two options.. A.) choose to work at the clinic or in home (with no real protection), they moved us from salary to hourly..kids are barely coming in as days go by. Option B.) Go on furlough But be safe in your own home.
I think a lot of people are in this weird stage where they want to support their patients or clients but also want to protect them and yourself from the virus.
Location: Texas, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 034
A word for word copy of 033.
Public Statement 035
A word for word copy of 033.
Public Statement 036
There’s the letter of the law, and then there’s the spirit of the law. The letter of the law lets big ABA companies determine that we are “essential” based on what they are interpreting. The spirit of the law would have shut down these services a long time ago and we would all be doing our part to flatten the curve. A child died of COVID 19 in a nearby city and yet our ABA agency assures it’s staff and clients that in home services are at low risk. However, there has been no formal testing to clear the clients and/or behavior technician of a potential exposure. When we first start services, families are to agree to a contract that includes to provide a safe and comfortable working environment for clinical staff. We analyze this when we first enter the home. We make sure that the home is clean and clear of any harmful substances. However, COVID 19 cannot be seen with the naked eye. We cannot “analyze” the home for safety from this virus. This would clearly be against this contract. When will ABA agencies put short term financial gain aside and contribute to what is really at stake here. If a client or staff is to get sick, services will still continue for our other families. It’s not right. It’s unethical. It’s irresponsible. If we continue at this rate, at this point, an ABA agency will be responsible in letting a child get sick and potentially die because we considered ourselves “essential.” Is the discontinuation of services really worth the risk of a child or staff dying? Is the risk of some regression really worth the value of someone’s health and life?
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 037
I understand that we are essential service providers and that some of our clients would be harmed if services were paused for a few weeks, but the majority of our clients would not be substantially harmed. The majority of our clients would not master any goals for one month, and that’s unfortunate, but it’s probably better than potentially exposing them to COVID-19. Our company is implementing all sorts of safety measures, including a health screening questionnaire, but so far we haven’t been provided a COVID-19 RISK assessment questionnaire, and that’s what we need. Many many families are choosing to go on hold, and every time I’m notified, I’m grateful that our BTs and myself have one less family to be exposed to. Personally, I’d rather be laid off during this than risk catching the virus. Or worse! I’d feel haunted if I somehow infected a client or a parent and they die.
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 038
I’m literally losing sleep because we continue to provide services and I’m responsible for sending young behavior techs out into the field. Many don’t want to go, but they need to get paid to care for themselves. I feel like this is a wake up call that our part time techs need access to more benefits like paid time off. I could “choose” to go on leave right now, but I would risk not having a job when this is all over if I don’t help my company stay open. Prior to COVID-19, I loved my job! I loved this company! But now I feel like we are mostly being irresponsible. We can provide “medically necessary” service normally, and still choose to pause during a pandemic. I see other providers (e.g., Dentists) all around us reducing access to important services as a response the pandemic. Executive Managers aren’t bad people. They aren’t “money grubbing”. They’re trying to keep the business afloat, and I understand that and appreciate that, but staff and families could literally die from this virus. We need to shut down for a time, or we need to go client by client, evaluate risk, and then put a lot of clients on hold.
Location: Undisclosed
Identified as: Regional Director in a Large Company
Public Statement 039
Due to the recent national crisis of COVID-19 my 4 year old son’s school closed, which required me to be home with him during this time. I explained to the company that due to my son’s school being closed I would need to stay home with him until I could try to figure something else out for him, but considering he has respiratory issues I didn’t really know what would be best. The company provided the option of in-home services for the patients families who did not feel comfortable bringing their child to the center due to COVID-19; the company said they understood the families "fear." The company informed me that a possible option would be for me to bring my son to work and RBTs could rotate babysitting him while I worked; they said it could be like a "daycare." Ultimately, I decided that was not the best option for my son (as I mentioned he has respiratory issues and I did not want to take that risk) and not to mention the ethical concerns I had with RBTs "babysitting" my son at work. The company provided me with the information needed for me to move forward with working from home and performing my job responsibilities via Telehealth. I did this for 4 days that next week and on the fourth day the company informed me via video chat that it had been decided that I wasn’t a “team player” because I was choosing to stay home with my son instead of physically coming into work and because I discussed my concerns about COVID-19 in regards of my son's health. This conversation completely came out of nowhere as no one from the company expressed any concern of me working from home and even provided me with the information to do so. My job can be performed via Telehealth, as many around the country are doing so at this time. As a mother, I am hurt that there are people in this world that will make you feel guilty for staying home with your child during a national crisis and that a company does not afford the same "grace" for their employees as it does for patient families.
Location: Texas
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 040
Clients are asking to suspend services due to health concerns and are being told they have to go back on a wait list if they choose to stop services due to their own concerns.
Location: Virginia, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA), ABA Business Owner
Public Statement 041
We were informed that we are a “medical facility and should operate as such”, the only medical equipment we have are gloves, and AED, a basic first aid kit and some sanitizing products. What happens when we can’t get anymore hand sanitizers, lysol, bleach or gloves to protect ourselves and our clients? What happens if one of the clients or staff at my clinic get the virus? Im in a tough choice between possibly losing my job because I want to protect my health , my family and the health of my clients over possibly contracting the COVID19 and stay home until this is over.
Location: Georgia, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 042
Threatening staff with their jobs if they don’t go into clients homes during a global Pandemic in the name of “medical necessity” isn’t appropriate and violates ethical codes of conduct and isn’t the measure for which we should be setting for ABA services. We should have a greater sense of dignity than that.
Location: Massachusetts, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 043
(Preface: We chose to close).The amount of stress as an owner has been overwhelming. The decisions I am making impact hundreds of lives and the pressure to do right by all is taking its toll. The options are horrible either way: Risk the health and safety of clients if we stay open. Risk losing the business, have already financially struggling staff go on unemployment, and leave clients without care, if we close. Trying to find alternative business avenues, fighting insurance companies and state authorities on telehealth, trying to stay up to date on new and constantly changing information, it is exhausting. What about my own family? Myself? Haven’t even thought about it. What will the next 2 weeks look like? The next 2 months? The next year? It cannot even be processed. It’s day by day, hour by hour, moment by moment. Is there light at the end of the tunnel? I can’t see it, but my only hope is that it’s there.
Location: Washington, USA
Identified as: ABA Business Owner
Public Statement 044
If we want to stay on as salaried employees, we have to risk going into a number of families homes with no protective equipment (our director said the CDC didn't recommend it so they weren't going to buy any or make them available). Otherwise, you are asked to leave or find enough hours in your current caseload and convince clients that you can still help them to provide telehealth as parent training- as a clinician, I feel so wrong being asked to invent reasons why I need to increase hours to justify getting a paycheck, and I hate having to choose between our ethical code and financial security. Unfortunately, I ended up choosing unemployment. I love my job and am passionate about my career and the change we can make every day- I never thought I would be asked to commit insurance fraud to justify my ability to provide 'medically necessary' services.
Location: New England, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 045
I don’t sleep. I don’t eat. I’m worried about my staff’s financial well being. I’m worried about my staff’s health. I’m worried about supporting our clients during shelter at home. I’m worried about our client’s health. I’m worried about having a company to come back to. But the part that hurts the most is finding out team members are making comments that I am selfish. I’m putting your payroll & benefits on my credit card. I am putting everything on the line to meet the bottom line.
Location: Undisclosed
Identified as: ABA Business Owner
Public Statement 046
People really need to see that the risks outweighs the benefits during this pandemic. Unless a client is posing serious risk or harm to themselves, then services should be on hold or through telehealth.
Location: Undisclosed
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 047
Many (I believe the majority) of ABA service providers in IL have closed their clinics, put in person sessions on hold (clinic and in home), and are providing services via Telehealth where possible. One company, which has remained open and providing all services as usual, is using the current pandemic as an opportunity to poach clients and staff. This clinic is actively advertising for new clients to come for assessments, recruiting staff, as well as exploring adding a therapeutic preschool. I was formally employed with this company, and left due to their prioritization of financial gains over staff and client well-being. These decisions are being made by administrative staff who are not BCBAs, and therefore not accountable to the code. Is this a situation that should be reported to a business ethics organization or some sort? In my opinion, they are exploiting a pandemic for financial gain.
Location: Illinois, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 048
ABA company in CA continues to conduct therapy. Leaving the decision to attend session with parents and families. The center is open and in home continues. It is not with clients who pose a risk. They state they are following the guidelines of shelter in place since they are exempt. However they are not able to comply with the 6 ft distance and they are not providing safety equipment to their staff. They also lay off half their employees. The cost to continue running is too much. I don’t know what to do. They have legal council to back them up as well.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 049
Although my company is having us call the client and ask if anyone is sick, has a fever, and so on, we could be carrying the virus and transmitting it without realizing it. Unless a client has serious problem behaviors, I don’t think we should be going at all and it’s frustrating that services are still offered. If we don’t take care of our health, what good is any amount of money anymore?
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 050
I'm scared of what is going to happen to my clients after 4 weeks of no school or ABA services, I'm scared I wont pass my BCBA exam because my professors are only sharing powerpoints without explanations or voiceovers or meetings over video chat, I'm scared of when services will go back, I'm scared of going to the 2 clients that have kept services and me contracting the virus (but they both are two that without anything they would regress and become aggressive), I'm scared of not having money because I'm only working 10 hours a week instead of my 40 and unemployment has not contacted me, I'm scared of not being able to afford my schooling, and I'm scared I wont have a practicuum placement
Location: Pennsylvania, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 051
Our company closed for two weeks due to COVID-19. We’re currently working on giving telehealth parent training services. Dilemmas include none of us being trained on how to do so, families not wanting these services, insurance companies not all covering these services, and our RBTs being out of work. Our state is on a shut down but we’re still essential so we’re hoping to resume some in-person services in a week. However, that would only be in clinic with health screens each day. How do we go about letting clinic clients have services but not picking back up home services while still being ethical? We also can’t have every family in the clinic as it’s not big enough
Location: Washington, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 052
I’m a BCBA and the center I work for is remaining open. Although many sessions have been moved to the home setting, the clinic is still operational and serving several clients a day. While we are given the opportunity to opt out and stay home, many of my families and RBT’s are opting to continue sessions. I am so torn ethically. I personally think it is reckless to blatantly violate the isolation order in these unprecedented times, but I also cannot not let these cases go unsupervised, so I am still providing in person supervision. Telehealth is not currently supported by the insurance company covering all of my clients (you know who you are, shame on you!).
Location: Washington, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 053
My company is allowing telehealth for in home services but we are opening new cases every week even now and BCBAs have to attend on the first day to help train the staff. I went to a home yesterday and the mom informed us when we were inside the home that her husband was getting the test for covid. I’m so scared and mad but my company wants me to continue to open new cases.
Location: Arizona, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 054
Deciding whether to discontinue services or not should depend on the needs of the client. Most ABA sessions with school age kids can be placed on hold or move to telehealth. However, if you work with severely aggressive individuals that can harm themselves or others, it would not be in anyone’s best interest to discontinue. The majority of our clients have opted to discontinue services as of two weeks ago. Our remaining (not intense) clients have opted for telehealth to work on skill acquisition and our most intense cases are still receiving in home direct services with remote supervision. Our office has shut down to avoid staff coming in and out for supplies and to avoid clients being dropped off. Staff receive regular reminders to monitor their health, follow safety precautions, and limit their contact to their own home and that of their client. In sum, neither stopping all ABA services nor continuing all services would be appropriate. Use good judgment and do what is best for the individual client. 🤷♀️
Location: California, USA
Identified as: Service Stakeholder (e.g., parent, guardian or loved one of ABA service ricipient), Master's Level Clinician (e.g., BCBA, LBA), ABA Business Owner
Public Statement 055
I work in a residential facility that can't shut down. I live alone and feel safe, I'm worried about keeping kids safe and busy during isolation from families, support and social outings. So I'm spending 12 to 16 hours a day planning antecedent measures to prevent an increase of behaviors in an environment where extreme behaviors are already the norm. I dont know how to maintain self care right now.
Location: Southwestern, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 056
I lost my job because of this pandemic. The company I worked for was already struggling financially ... when this crisis hit and 75% of our clients cancelled, tough cuts were made.
I’ll be okay because I am a BCBA and will find other work to do... but I worry for the therapists and corporate admin staff during this time.
The thing is, the company is still open. They had to have lost tens of thousands of dollars to stay open because they had to pay for the RBTs who showed up to work, not knowing the session had been cancelled.
They are clearly worried about cash flow (understandably so) but are going to put themselves out of business by continuing to operate the way they are.
Services are important - but to put lives at risk?
Companies seem to be putting so much energy into staying afloat. I believe that energy is misguided. We need to be focusing on protecting everyone from the virus and how to modify our services to accommodate this situation.
If you cannot comfortably leave you client in the care of their family after a year of working with that client and their family ... what does that say about the effectiveness of your parent training? Why are you unable to support that family at a distance? What is so essential about DTT work that you can’t teach a parent to do it over teleconference and have to risk the client, their family, and your employees and their families???
I can understand severe behavior suppport. 100% essential because they are posing a risk to themselves or others.
But skill building??
We have research on telecommunication. We can easily set up webinars to train staff to do it (it’s already happening).
Thank you for the space to vent anonymously.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 057
I feel like this pandemic has dramatically changed our company culture. My supervisees are scared to voice their concerns of still providing in person services out of fear of judgement from higher level staff. I also feel conflicted when I tell my supervisor I have to provide Telemedicine only to my clients due to my high risk (autoimmune disease and asthma) to be met with long pauses and sighs. Our staff also was informed they could face further disciplinary action if they request not to work directly with clients. I understand that there is a business need but I feel very uncomfortable with the position that I have been put in as a supervisor based on the decisions of staff outside of my team.
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 058
Being asked to go in home to kids who have reported being sick. Of course with out any type of ppe or training in use if there were any provided. Keeping kids in the center who are showing symptoms. Not enacting protocols to comply with sanitation or social distancing.
Location: California, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 059
This pandemic has proven that we were not equipped with the supplies to be medical providers and many of us were still living like educators. As a center director, responsible certificant, and supervisor, I had RBTs working 1:1 with clients up until Friday who did not have PPE or any necessary supplies to prevent the spread of COVID-19. Centers should of been fully staffed with necessary supplies, protective gear, and cleaning materials to protect everyone a month ago. Staff were terrified of possibly getting infected and worried they would harm our clients. They could not adhere to the 6 feet social distancing rule imposed by the Federal Government that was required for essential businesses including those that were medically necessary. Like other BCBAs across the country, I was required to keep the center open per the CEO’s memo knowing my staff and clients were not safe.
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 060
I'm a clinical supervisor. We are still open. My kids' daycare is closed. I asked if I could work part time with only evening clients so I could stay home with my kids during the day while my husband also continues to work. While upper management initially agreed, they laid me off a week later. What am I supposed to? Sure I could have worked full time from home providing remote supervision. While caring for my 4 year old and 1 year old. But that is definitely not quality supervision and the clients deserve better than that. I deserved better than being let go (and losing health insurance!) because I have a family to take care of during a PANDEMIC!
Location: Western NY, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 061
I’m high risk due to having asthma. I told my work I was high risk and I worry for my health being we have children from all different counties coming in. My work told me there’s really nothing they can do for me and we just have to keep working through this.
Location: California, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 062
I expressed my concerns for my scheduled in-home and in-office appointments today. I explained that the growing number of cases, that are rapidly increasing and getting closer to home, are frightening to me (impacting my mental health). I was told that if I have no prior health issues and I'm making sure to keep my workspace clean, I'm fine. In my opinion, even being 6ft away from a client, 1 sneeze from either of us could be harmful if either of us were to be infected! I'm really struggling with putting my foot down and potentially losing my job.
Location: Southeast, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 063
Recently given the ultimatum to continue to go in client’s homes or take a leave of absence until I’m ready to go in client’s homes again.
Location: Midwest, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 064
I can’t sleep - I wish I had enough capital to stop services AND ensure my front line RBT’s aren’t screwed with no income. We’ve moved to telehealth for BCBA’s to limit potential spread of the virus, but I get more and more worried for my front line staff and clients each day, as well as our bottom line and the ability to be able to restart once all this is over. Some of my clients don’t want to or really shouldn’t stop services, and I’m trying to make sure my staff don’t end up having to work for Walmart if I lay them off, because what or who does that help? I’ve been spending every minute applying for grants and watching the latest stimulus packages, if the unemployment piece is accurate and sticks through to what is signed, I will shut down the next day.
I initially wanted to make sure we were not abandoning our clients, but now, I just want to make sure I’m not abandoning my staff.
Location: East Coast, USA
Identified as: ABA Business Owner
Public Statement 065
I’m so torn by the between the short and long term contingencies put in place by this pandemic. Right now, we have an ethical duty to ensure no harm is done to our clients or our employees. My clinic is abiding by all public health guidelines and then some but we are still providing services (increasingly via telehealth) but it’s impossible to guarantee zero exposure. In the long term, I know the financial viability of ABA providers and their employees is at stake if there are extensive closures. I would hate for in 6 months from now clients who need services end up on year long waitlists or have to make due with insufficient treatment because well established providers have folded. Finally, public health guidelines have designated us as medically necessary. We spent decades convincing funders and the public we were more than a “nice to have” service; we are a necessary part of our clients lives and essential for them to reach their full potential. If we decide, as a field at large, to suspend treatment for an extended period of time I worry we are implying that we are not medically necessary for our clients. I don’t trust funders to use that to deny treatment to individuals in the future.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 066
It’s challenging. My company is small and did not offer any employee compensation for the cancellations for hourly mgmt staff or BIs. I am still being asked to provide services to families who are terrified of what may come and are willing to have us via in person. My case load went from 15 to 6. They say their only normal is my presence. My new normal has become being overwhelming aware of my body, checking my temperature multiple times a day, and reassuring families that this to shall pass, when in actually, I am unsure myself.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 067
I feel that allowing 1:1 services in person by an RBT while the BCBA is only doing telehealth sends a message that those DSPs are disposable and their health means less than the health of the BCBA. It’s disguised as medical necessity and continuity of services but it is 1000823% about the money. We should let RBTs start filing for unemployment and the company can rely on the stimulus bill. We are putting clients and their families more at risk by continuing to provide services than not. That is why SO many families are asking to put services on hold. Come on - the families don’t even want us there, what are we really doing? It is all just...ick.
Location: Virginia, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 068
Employer not giving us any answers as to what will happen to our jobs. They keep increasing the number of hours to bill during this pandemic. If we are not billing supervision then we have to do direct, which exposes us to more families. The company continuously says we need to keep billing in order to pay our salaries and keep the company from closing (this is a big company with various resources). If we are uncomfortable going out, we were told be looking into part time or taking time away from work.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 069
Our company is staying open although they have said they support the choices made by staff who are “unwilling” or “unable” to do their job. They also have staff asking families a list of health questions before sessions start to determine if anyone is potentially contagious (which is not within any of our staff’s boundaries of competence).
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 070
Had a staff meeting with CEO and basically told me get Virtual services going ASAP with or without qualified staff just get them on to start billing, we are solely school district funded. I understand the need to get our direct care staff working and paid. But putting our quality of care in jeopardy.
Location: California, USA
Identified as: BCaBA, Administrator
Public Statement 071
Some of us are torn between being grateful we still can consider ourselves “essential” and having a paycheck, and the ethics of delivering services during a pandemic. Not to be a jerk, but if we’re so “medically necessary” why aren’t we paid like we are? Some of our clients definitely NEED these services but not all. Additionally, we have not been notified from the higher ups what will happen to us if we’re forced to close. I’m frightened for our health-physical, mental, and financial.
Location: Mountain West, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 072
We are being placed under a mandatory stay at home order today. My clinic director refuses to close and says he will try to stay open no matter what. Despite the fact that multiple staff members are in the process of being tested. Many employees say they don’t feel like their health is being taken seriously. They are already considering other employment options for when this is all over.
Location: North Carolina, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 073
Prior to COVID-19 and schools closing, was talking with BCBA to begin supervision. Will this now delay through the BACB my testing upon the accrual of my hours?
Location: South Carolina, USA
Identified as: Special Education paraprofessional with M. Ed in ABA
Public Statement 074
We are still providing home based services. I was able to reduce myself only to telehealth appointments but my BTs are still going in the homes. Teletherapy is still a new concept and it is being reserved for our RBTs not entry level BTs. I feel uneasy because disrupting ABA for my clients is tough but if one of my BTs gets sick I will blame myself.
Location: Illinois, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 075
My employer is continuing to keep the company open through in-home services. Clinicians are traveling to multiple homes a day. High-risk employees are still being asked to work, I am pregnant and still being asked to work. Their only offer; a small amount of PTO, and threatening that they won’t hire us back after furlough. Employees are literally crying daily for fear of getting sick and now for fear of losing their jobs and missing their clients. BCBAs and other higher ups (especially CEO) get paid to work from home so that must be nice for them.
Location: Undisclosed
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 076
We have had multiple staff fired over the past few days because they stated they didn't want to come in for direct sessions (center or home) when the county is on a lockdown. They want to stay home and quarantine until the stay at home order is lifted. A layoff I can understand but this is not a layoff. Where are the protections for those that don't want to risk exposure for themselves or loved ones (especially those living with older family members)? Why are we punishing safety behavior?
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 077
Our company originally planned to keep going in-home and providing services, but after feedback from technicians that they were running out of sanitary equipment and felt anxiety in continuing to go in-home, we suspended all in-person services and furloughed techs for two weeks (with job security once shelter in place is lifted). We are strictly doing telehealth services with BCBAs, BCaBAs, and senior level clinicians. Proud to work for a company that listens to their technicians concerns and still works to provide services in a safe manner when possible via telehealth.
Location: Chicago Suburbs, USA
Identified as: Direct Care (e.g., RBT, DSP), Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 078
I'm starting to become irrationally angry at the families who say "we are fine in the home, you can come still" or the ones that have no problem taking one month off of services for a vacation, but demand we still provide services now. I am disliking that we need to push telehealth to families that do not want it. I'm also annoyed that we can't take time off to be with our families right now who also need us. I fear that this will make me want to change careers because this stress is not worth it if I can't take care of my own first.
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 079
I’m happy to report my company still wants to support our learners, limiting to one staff member per learner in a given week. BCBAs are doing tele-health observations and parent trainings. We have weekly meetings with our three PhD level directors to discuss the variations in how to support staff and families. And while it’s a struggle and adjustment, I’m fortunate and proud of myself for finding a company that is practices ethical decision making, is clinically sound, and in line with my values. Evaluate who signs your paychecks.
Location: California, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 080
I work for an ABA company that has grown exponentially since they started four years ago. They are telling all of us now that they don't have the funds to pay us our full wage with the state shutting down (most feel because we've grown too fast), and all of us are worried about how we will be paying our bills. They had us file for unemployment but that isn't enough to make ends meet. We "closed down" but are still being expected to work through this. I care deeply for our company, but ethically don't understand how we can be told we're closed but then forced to continue work while knowing we will not be paid what we are owed. I worry for the families and clients effected by this, but know our company is pushing us to work solely to make money. I hope that we are able to follow our mandatory stay home laws so that we can get back to helping these clients immediately. I've started looking for other jobs in case this all falls apart.
Location: Washington, USA
Identified as: Direct Care (e.g., RBT, DSP)
Public Statement 081
Just some brightness....my employer has asked us to honor the governor’s request to stay at home. They have stressed that it is important to our health and the health of our clients. They take this seriously and put our health first.
Location: Colorado, USA
Identified as: BCaBA
Public Statement 082
Visiting families that do not Social distance completely (still going to family homes on weekends) obligation to go to other client homes with older parents (parents really need the support) 2 ASD teens/ can be some aggressive without Intervention.
Location: Colorado, USA
Identified as: Direct Care (e.g., RBT, DSP), Student of ABA (e.g., current Master's Student)
Public Statement 083
Hospitals are currently preparing policy regarding who to save, and who not to, if America finds themselves in a ventilator shortage. How does this affect the special needs population?
www.latimes.com/world-nation/story/2020-03-19/ethical-dilemmas-in-the-age-of-coronavirus-whose-lives-should-we-save%3f_amp=true
Location: Undisclosed
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
Public Statement 084
We are in the same boat. Our employer insists on opening our center back up as soon as possible and would like to send our RBTs to homes before opening back up. Parents and RBTs have all stated their concerns but she is still insisting. This is messed up because if your employer is offering you work, filing for unemployment is less likely to get approved. So, we are all backed up against a wall. Get paid and risk our health or choose not to work and don’t get paid. It is sad and unethical. It seems like all ABA business owners have such tunnel vision that they can’t see the danger they are putting people in.
P.S. WHY WONT TRICARE ALLOW US TO USE TELEHEALTH!?
Location: Oahu, Hawaii, USA
Identified as: Master's Level Clinician (e.g., BCBA, LBA)
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