How to Help Client Families Demonstrate Appreciation While Preventing Potential Harm to Client Success

Devon Sundberg, MS, BCBA
Chief Executive Officer, Behavior Analysis Center for Autism
Conference Director, Women in Behavior Analysis

How does gifting relate to multiple relationships?

While the Behavior Analyst Certification Board’s Professional and Ethical Compliance Code section 1.06 (d) explicitly states, “Behavior analysts do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship,” there are other ethical requirements that also support this action.

Code 1.06 Multiple Relationships and Conflicts of Interest.

(a) Due to the potentially harmful effects of multiple relationships, behavior analysts avoid multiple relationships.

(b) Behavior analysts must always be sensitive to the potentially harmful effects of multiple relationships. If behavior analysts find that, due to unforeseen factors, a multiple relationship has arisen, they seek to resolve it.

(c) Behavior analysts recognize and inform clients and supervisees about the potential harmful effects of multiple relationships

While most gifting involves an innocent demonstration of appreciation, it could be intended to establish a quid pro quo (i.e. “If I give you an extravagant gift, I expect you to work with my child for an extended amount of time and provide preferential treatment over your other clients.”)

Sometimes the gift is just a simple token of appreciation with no strings attached. However, gifting is a symptom of ill-defined professional boundaries and very often results in an unfortunate, negative multiple relationship or increased pressure on the individual that accepted the gift to ignore professional boundaries. Not accepting gifts is a very simple way to prevent stress and disruption of service for the client, staff and yourself.

Establishing antecedent controls preventing the delivery of gifts, is one of the simplest ways to prevent harm to a client through multiple relationships.

Why should we work so hard to avoid multiple relationships?

The profession of applied behavior analysis, especially in the realm of treatment for individuals with developmental disabilities, is loaded with emotion ranging from difficult conversations with parents regarding a child’s progress, to disagreements over appropriate program goals. It is paramount that we maintain professional boundaries to ensure our objectivity and compassion when having those difficult conversations. Multiple relationships add layers of complexity to already complex situations that so often result in some detriment to the client, additional stress to the family and all employees involved. At the very least these fires take time away from your mission, but most often result in hurt feelings, staffing changes, and ultimately disruption in services or staffing for a child in need of consistency.

How can I make refusing a gift less awkward?

The best way to implement a No-gifting Policy is to establish strong antecedent conditions and provide an alternative way for families to demonstrate their appreciation. One way to do this is by creating staff appreciation committees much like a Parent Teacher Organization. The appreciation committees can be organized by client families to ensure that any demonstration of appreciation is collective (from all families to all employees) and anonymous as well. This appreciation system should be a part of a company’s handbook materials delivered to families at the onset of services and reviewed regularly at progress meetings. Donations of any size can be collected anonymously to host a staff appreciation event.

In the event an employee still receives a gift (and they will), take note that more communication regarding the policy and the purpose it serves needs to occur with that particular family. Also note that it would be beneficial to send a notice to families regarding the staff appreciation committee so that they may engage in that manner to demonstrate their appreciation.

Helpful messaging to families involves a restating of our shared values…client success. Why would we ever open the door to something that might jeopardize that?