Conflict of interest

A conflict can exist before a decision changes

The current BACB Ethics Code defines a conflict of interest as an incompatibility between private and professional interests that creates risk or potential risk to services or a professional relationship. Personal, financial, or professional considerations may influence research, consultation, supervision, training, or service delivery.

A conflict does not prove misconduct. It tells the team that ordinary judgment may need disclosure, separation of roles, independent review, recusal, or another control. Waiting for a bad outcome misses the preventive purpose.

Common conflicts in ABA care

A clinician may recommend more service while being paid according to billable volume. A practice may refer every family to an affiliated company. A supervisor may evaluate a relative or business partner. A researcher may study a product they own. A school, payer, or employer may fund services while asking the clinician to prioritize its goals.

Each situation requires its own analysis. A financial connection can be manageable when disclosed and controlled. A coercive or exploitative relationship may require a stronger response. The client’s welfare and rights stay central.

Disclosure is a starting control

A useful disclosure identifies the interest, who benefits, which decision it could affect, available alternatives, and the proposed safeguard. It should arrive before the affected decision when practical and use language the person and family understand.

Disclosure alone cannot repair every conflict. Someone facing a strong incentive may need to leave the decision, obtain independent review, transfer supervision, offer unaffiliated referrals, or end one role. Record the decision, owner, due date, client response, and later review.

Referral choice should remain real

A referral list should explain meaningful affiliations and avoid presenting one financially connected option as the only appropriate path. Families can ask whether the provider receives payment, shares ownership, exchanges referrals, or controls the recommended service.

Clinical fit, access, insurance, location, wait time, language, and family preference may make one option practical. State the facts supporting that choice. Preserve other viable options and the family’s freedom to choose.

Supervisory conflicts affect power

Supervisors control feedback, evaluations, assignments, and sometimes employment or credentialing progress. A second relationship can make honest disagreement harder. The BACB ethics page identifies the current Code, which addresses multiple relationships, gifts, coercive relationships, supervisory competence, delegation, and conflicts in research.

Practices should provide a reporting route outside the direct supervisory chain. Retaliation protections, documented escalation, and an alternate reviewer matter when the concern involves the usual decision-maker.

A fictional referral example

Riverstone ABA reviews ten referrals made during one quarter. Four went to an affiliated speech-language practice. The original records disclose the affiliation in 1 of 4 affected referrals. The denominator is every referral to that affiliate, including those where the family later chose another provider.

Riverstone adds a plain-language disclosure, three unaffiliated options when available, and review by someone without a financial interest. In the next six affected referrals, all six contain the disclosure and documented choice, or 6 of 6. This measures completion of the safeguard. It does not show that every referral was clinically appropriate or freely chosen.

Questions families can ask

Ask who owns, pays, supervises, sells, or benefits from the recommended service. Request the clinical reasons for the recommendation, available alternatives, and the name of an independent contact. Ask whether changing providers could affect current care, employment, training, research participation, or access to records.

A family can also ask how conflicts are recorded, who reviews them, when recusal is required, and how concerns are protected from retaliation. An ethical practice should answer directly and preserve the person’s ability to decline.

Practices need an organizational process

Because BACB has no separate jurisdiction over corporations, a practice needs its own conflict register and decision route. Staff should disclose personal, financial, referral, supervisory, research, vendor, and ownership interests when they arise. The record should identify the affected decision, interim safeguard, independent reviewer, resolution, and recheck date.

Leadership should review patterns across cases. Repeated referrals to one affiliate, unusual gifts, concentrated supervision relationships, or incentives tied to a clinical choice may reveal a system conflict that one case review will miss.

Publish the reporting route where clients, families, staff, trainees, and vendors can find it.

Before closing a conflict review, document the disclosed interest, affected decision, alternatives, recusal or safeguard, independent reviewer, client communication, and recheck trigger. Preserve any unresolved power imbalance or financial incentive instead of treating disclosure alone as resolution.