Declaration of

Professional Practices and Procedures

For Behavior Analysts

____________________________

[YOUR NAME, Degree]

Board Certified Behavior Analyst

___________________________________________

[Your cell number and email]

For My Prospective Client and Stakeholders

This document is designed to inform you about my background and ensure that you understand

our professional relationship.

AREAS OF EXPERTISE

I have been practicing as a behavior analyst for XXX years. I obtained my degree in [field of study] in [year]. My specialty is working with children with autism disorder. My role entails helping these children to develop physical and motor skills, and learn fundamental social skills. I also target and deal with problematic behaviors such as self-harm in children with autism and provide other early intervention services.

PROFESSIONAL RELATIONSHIP, LIMITATIONS, AND RISKS

What I Do

My main focus as a behavior analyst is to evaluate the connection between behavior and environmental circumstances. I strive to apply behavioral ideas to help bring changes in behavior. I work with children with autism to help them improve their interpersonal skills, such as task completion and skill acquisition, improve their maintenance practices like self-regulation and self-control, and help them reduce behavioral issues like harming themselves. I am able to achieve this through the input of the parents or guardians.

How I Work

Since I work with underage children, I ensure that all arrangements and contracts are signed by the parents or guardians. Also, I work collaboratively with the parents to ensure that we successfully improve the behavior of their children. Also, as a Board-Certified Behavior Analyst, I do not make judgments regarding a person’s behavior. I effectively perform a structured and descriptive behavioral evaluation to determine how an individual’s behavior relates to what is going on in their surroundings. I also strive to pinpoint the factors that set off behavior as well as the subsequent events, which frequently establish whether the behavior will repeat itself and develop and implement effective intervention strategies for use in a variety of cases.

I will engage my clients in the treatment process. Here, parents or guardians will tell me what they want their children to achieve. I will then do my assessments and provide my detailed feedback using plain English. I will share my treatment plan with the client and will only implement it if it is approved by the client. In cases where the client will not be satisfied with the services, they will be free to terminate the working relationship.

While it is impractical to guarantee specific results regarding client goals, I want to promise you that I will work to the best of my capabilities, and together we will achieve the best possible results for your child. When the predetermined criteria for termination are met, such as when a sequence of predetermined or amended needs a strategy has been achieved, I will also end the relations with clients.

For the cases where the length of treatment is open-ended and should be determined by progress made toward therapeutic goals, I will discuss this with the parties involved before signing the contract. In case I feel my services are not bearing any results, I will request the client that we terminate the contract but will provide a referral as per the client’s needs.

CLIENT RESPONSIBILITIES

To ensure that I provide informed consent that is appropriate from the client’s perspective, I will ensure that my client is informed prior to any system introduction of assessments or behavior-change interventions, when making significant changes to interventions, and when exchanging or disclosing confidential information or records.

Also, I will ensure that the client fully understands what is required before they sign a contract. In the event the client does not I will involve a next of kin, a witness, or a lawyer where the need arises.

Clients will be required to carry themselves with dignity and respect me and my staff. Verbal threats, defamatory statements, accusations, culturally based comments, and any other form of misconduct may result in service discontinuation.

Clients in ongoing treatment will be required to show up for their planned visits. Any client who will miss more than 30% of their appointments, including those due to planned absences or illness, will have their services terminated.

I will expect that clients provide 24-hour advance notice for any appointment cancellation. In case the client provides a notice in less than 24 hours or fails to provide any notice at all, they will be charged for that session using the standard rates.

New clients who will not show up will be placed at the bottom of the waitlist but will not be billed for the session.

ETHICS CODE FOR BEHAVIOR ANALYSTS

I will always remain professional and strictly adhere to the Ethics Code for Behavior Analysts. As a behavior analyst, it is my duty to be aware of and abide by all circumstances in which informed consent from clients and stakeholders.

I will not establish multiple relationships, particularly business, personal, and familial links with clients and associates. This is because doing so could lead to a conflict of interest that could be detrimental to one or more parties. For the dual relationships that are unavoidable, I will handle them by carefully following the ethical guidelines and maintaining a healthy relationship with my clients. I will not accept gifts of any form or any informal invitations by clients.

I highly recommend that clients who are dissatisfied with my professional services speak up immediately. In case I do not resolve your concerns please feel free to report them to

Board using a Notice of Alleged Violation Form, available at https://www.bacb.com/ethics-information/ethics-codes/.

CONFIDENTIALITY

In Florida, therapists are required to have a privileged and confidential relationship with their clients. Therefore, I will ensure uphold confidentiality. I will do so by ensuring that client records are not shared with a third party. Also, as soon as the client’s data is no longer required, I will destroy it to avoid access by a third party. Also, if a third party is served with a subpoena for client records or is called to testify in a case involving a client, I will provide legal counsel. To ensure confidentiality, I will maintain and dispose of records in compliance with applicable laws or regulations and corporate policy. Also, I will develop a comprehensive privacy policy. I will also hire a committed security staff to ensure HIPAA. I will also perform a frequent internal auditing process to facilitate risk assessments in order to determine the possibility of a breach and to implement remedial action as needed. Lastly, I will also institute explicit HIPAA-related security and record-keeping protocols for clients and stakeholders.

Confidentiality limitations that are stipulated by the law will be applied. The law mandates that I can disclose the information if:

I get written consent from the client to release information.

After evaluation, I determine that the client is a danger to themselves or others.

I am mandated by the judge to disclose information.

I have reasonable grounds to suspect neglect or abuse of a disabled person, a child, or an elder adult.

APPOINTMENTS, FEES, AND EMERGENCIES

All appointments will be set on the basis of the common availability of my clients and I. Booking appointments will be free of charge. The duration of the appointment will be set based on the client’s interest.

I will charge a fee based on a 45-minute session. Assessment and therapy sessions will require about 120-180 minutes that will take place in multiple sessions. Please see the standard fees below.

Assessment Session Therapy Session Program Development

Fees

$60/45 minutes $50/45 minutes $70/45 minutes

Note: I do not have a contract with any insurance company, therefore, my services are not covered by any insurance company.

The client’s accounts will be closely monitored by my billing coordinator. Clients will receive a monthly statement for any service rendered to them during the previous month. Clients will be required to contact the billing coordinator for deposits or general billing queries. Clients will be required to make their payments on time to avoid discontinuation of services. Services will be discontinued on grounds of reasonable late payments and balances.

In case of emergencies, clients will contact me anytime at the Phone number or email address.

Please sign below indicating that you have read and understood the information in this declaration.

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CLIENT Signature

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Date

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WITNESS/STAKEHOLDER

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Date

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BCBA Signature

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Date

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