“Teamwork makes the dream work!” or “group projects are the worst”. When it comes to multidisciplinary collaboration, it should be the first of these two statements.
Imagine it is the summertime and you are riding the subway, when suddenly you faint. Could this be due to the heat, dehydration, drop in blood pressure, vasovagal syncope, or some other unknown cause? Being the health-conscious person that you are, you want to get to the bottom of this. First, you would visit your general practitioner, who then might send you to get a bunch of tests run, and referrals for specialists such as a neurologist and haematologist.
When disciplines collaborate, rather than collide, the client benefits. As Behaviour Analysts, that is our goal. No one person is going to be able to be the best at everything, that is why there are specialists for different aspects of our lives.
Who Are The Players?
In the field of Applied Behaviour Analysis (ABA), you are likely to come across many professionals from all types of disciplines. If you are working in the field of ABA, you may be a Board Certified Behaviour Analyst (BCBA) ®, Board Certified Assistant Behaviour Analyst (BCaBA) ®, or a Registered Behaviour Technician (RBT) ®.
Check out our previous post about What Is A BCBA here!
You may be familiar with more common professionals that collaborate with the ABA field regularly, such as Occupational Therapists (OT), Speech-Language Pathologists (SLP), and Physio Therapists (PT). There are also medical professionals that are important members of our clients’ health teams – such as Paediatricians, Registered Dieticians, Psychologists (developmental, clinical, counselling), General Practitioners, Nurses (RPN, RN, NP), and more.
Some less thought of professions that a BCBA may collaborate with are Social Workers, Special Education Teachers, Classroom Teachers, Educational Assistants (EA), and although not a ‘professional designation’, parents.
What Makes Collaboration Successful?
With so many hands in the pot, how do all these cooks not spoil the soup? One of the most important things you can do at the outset of any multidisciplinary collaboration (and all professional relationships) is have a contract that outlines the roles, responsibilities, fees, protocols, confidentiality, and structure of everyone’s involvement. Having a clearly defined contract at the beginning of the professional relationship will contribute to respect and trust between team members and promote the best mix of skills within the team.
Multidisciplinary approaches help to illustrate a clearer picture and to provide a complete intervention package for clients. Since Autism Spectrum Disorder (ASD) affects several developmental domains, and commonly has comorbid conditions, incorporating the different specializations is essential for ethical and effective treatment.
What Role Does Ethics Play?
One of the great things about the field of ABA and the BCBA’s who work in the field, is the Professional and Ethical Compliance Code for Behaviour Analysts. When working on a multidisciplinary team, it is vital that our decisions are ethical and follow the compliance code (see the Behaviour Analysts Certification Board® for the most up-to-date and complete version of this Code).
Although all parts of the Compliance Code apply to our work as BCBA’s, some codes are more pertinent when working on a multidisciplinary team.
1.0 Responsible Conduct
1.02 Boundaries of Competence
We know that one person cannot be fully trained in every specialization, which is why it is important for Behaviour Analysts to operate within their own boundaries of competence. At some point in your career, you will come across a client that involves services outside of your boundaries of competence – collaboration with others who are competent in those areas is necessary.
1.05 Professional and Scientific Relationships
At the start of every professional or scientific relationship, the Behaviour Analyst will have a contract that outlines the roles, responsibilities, wages, etc. This is an expectation for all professional relationships, but even more important with multidisciplinary collaborations (as explained above, What Makes Collaboration Successful?).
2.0 Responsibility to Clients
It is the responsibility of the Behaviour Analyst to ensure that when multiple parties are involved, that the client is identified and a hierarchy of all the collaborating parties is defined in the contract prior to starting services.
Clients have complex needs, where consultations and referrals are likely to be a part of complete treatment packages. When doing so, it is important for the Behaviour Analyst to gain appropriate consents and follow evidence-based interventions – which may come into conflict with other professionals who do not use similar empirically strong approaches.
2.04 Third-Party Involvement in Services
Behaviour Analysts ensure that clients, and/or their guardians, understand that there will be some limits to confidentiality if a multidisciplinary approach is taken, as the different professionals on the team communicate. With third-party involvement, the Behaviour Analyst works in the best interest of the client who is receiving their services.
2.06 Maintaining Confidentiality
Although there may be some limits to confidentiality with a multidisciplinary approach, it is the Behaviour Analysts responsibility to maintain confidentiality to protect the client. At the start of professional relationships with clients and multidisciplinary teams, confidentiality is outlined, and limits explained, but as services change, so do the limits of confidentiality – these need to be communicated as they come up.
When it comes to issues regarding confidentiality, Behaviour Analysts do not disclose information without the consent of the client, and/or guardian. Multidisciplinary teams change, as well as the needs of the client. When this happens, Behaviour Analysts communicate with the client(s) about the disclosure of potential information to other professionals who become part of the multidisciplinary team.
2.12 Contracts, Fees, and Financial Arrangements
Prior to starting services, a contract for the professional relationship should be communicated and agreed upon. It is not sufficient to do this solely at the beginning of the professional relationship as treatments and interventions change over time. When there are changes, the contract needs to be adjusted accordingly.
3.0 Assessing Behaviour
3.02 Medical Consultation
As we know, clients can have multiple and complex conditions, involving additional medical consultation. Behaviour Analysts recommend that clients seek medical consultation to rule out medical or biological variables before implementing a behavioural intervention. Medical consultations are a part of the multidisciplinary collaboration, and Behaviour Analysts should seek consent from clients and/or guardians about confidentiality and disclosures at the outset of the professional relationship.
4.0 Behaviour-Change Program
4.07 Environmental Conditions that Interfere with Implementation
There may be additional variables that interfere with behavioural therapy, some of which may require the client to receive support from other professionals. Behaviour Analysts only operate within their boundaries of competence and can provide referrals and recommendations for additional professional assistance.
Remember, the whole is greater than the sum of its parts.