The Evidence-Free Request
You are the QASP-S on a clinic team serving Marcus, age 7, whose aggression (mean 6 per hour) was shown by a functional analysis eight months ago to be maintained by escape from task demands. His mother recently attended a community workshop and now asks you to (a) add a 90-minute daily 'sensory diet,' (b) apply a weighted blanket restraint whenever Marcus drops to the floor, and (c) drop the demand-fading steps because 'he needs to learn compliance.' She also asks you not to mention any of this to the supervising BCBA, who must sign off on plan changes under the funding authorization. When you hesitate, she says she will withdraw consent for the entire behavior-reduction plan.
1. Identify the professional-conduct issues raised by this request and describe exactly what you do in the next 24 hours.
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Issues embedded in the request.
- Concealment from the supervisor. A request to keep clinical information from the supervising BCBA is not a request you can honor. It breaks the supervisory chain, and it would leave you accountable for implementing a procedure that was never authorized.
- Restrictive procedure without a basis. A weighted blanket used contingently on floored behavior is a restraint-based consequence. It requires a functional link, a least-restrictive review, explicit consent, and authorization above your level.
- Intervention not matched to function. The FA identified escape. A 90-minute sensory diet and a compliance-focused demand schedule have no demonstrated relationship to escape-maintained aggression, so proposing them as the primary fix is not evidence-based practice for this case.
- Scope of competence and role boundaries. You may evaluate, educate, and recommend; you may not unilaterally amend an authorized plan.
- Consent pressure. Consent is voluntary and revocable. A threat to withdraw it is information to respond to, not a lever to be argued with.
Next 24 hours. Do not implement any of the three changes. Respond warmly and without defensiveness, thank her for advocating, and explain that plan changes come through the BCBA and team so that her ideas get a real review rather than a hallway decision. Notify the BCBA the same day. Book a team meeting within the week. Provide written, plain-language information on the proposed procedures, the known risks, and the function-based alternatives. Document the request verbatim, what you said, and the consent conversation, in the record that day.
2. The mother repeats that she does not want the BCBA told. How do you respond, and what do you do if she makes that a condition of continuing?
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Respond honestly and without moralizing. Say plainly that you cannot agree to withhold clinical information from the person who supervises your work and signs the plan, and that you would not want her to be told only part of what is happening with Marcus either. Then redirect to the part you can do: 'I can put your three requests in front of the team myself, in your words, and you can be at that meeting.' That converts a secrecy demand into a participation offer.
Do not promise to 'keep it between us,' do not agree to 'just try it quietly,' and do not imply the BCBA will refuse before the BCBA has been asked.
If she makes it a condition: treat it as a clinical event, not a debating point. Restate the limit once, offer the meeting, and document the exchange. Consult the BCBA and, if needed, your agency's clinical director or ethics resource about how to proceed with a family who is conditioning services on concealment. A family asking a practitioner to hide information from a supervisor is a signal worth escalating, not a preference to be accommodated.
3. She follows through and withdraws consent for the behavior-reduction plan. What is your response?
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Honor it immediately. Withdrawal of consent is a right, not a negotiation, and you stop the components she has withdrawn that day. Do not retaliate, do not withdraw unrelated services as leverage, and do not continue 'informally.'
Then do four things.
- Explain foreseeable risk in plain language: what is likely to happen to aggression without the plan, what the safety implications are at home and at the clinic, and what a return to services would involve if she changes her mind.
- Offer what remains available. Skill-acquisition goals, assent-based supports, caregiver coaching, and any less restrictive antecedent strategies that fall outside the withdrawn consent may continue.
- Put a safety plan in place for the clinic and the home and document it, including who to call and what to do if aggression escalates.
- Notify the BCBA, and the funding source if the authorization requires it, and involve the clinical director about whether services can be delivered safely and consensually.
Document everything: the request, your refusals, the withdrawal, the risk discussion, and the alternatives offered. If at any point there is imminent risk of serious harm, follow mandated-reporting and agency policy - consent withdrawal does not suspend your duty of care.