Helping children with autism reach their full potential

CEO to CEO: Private Agencies Providing Government-funded Services

The ABA industry involves incidents of great family stress, which can sometimes lead to blame-casting. Private Agencies Providing Government-funded Services

Some parents mistakenly assume they are entitled to more from ABA-providers than we could ever reasonably deliver—even if we wanted to. Maintaining appropriate expectations begins when services are initially established.  Of particular significance is the difference between what is owed to citizens by public agencies and what is owed to clients by private agencies dispensing government-funded services.
Government agencies generally owe the same service to every qualifying member of the public.  Private agencies do not.  Private agencies have the power to select which clients they take on and which clients they want to keep.
If client parents fail to understand the distinction between public services to which they have a right and private services to which they ultimately have no right, they may assume that once signed up for ABA services, the private service provider is no more than the arm of government meeting its obligation to them.  Such a notion torpedoes a healthy provider-client relationship.  Just as they have a right to cancel services, providers likewise have the right to walk away (though ethics and professionalism dictate they do so in an orderly manner).
The parent with delusions of entitlement may think little of violating myriad obligations necessary to a healthy working relationship.  They may blow off parent training, cancel appointments with abandon, speak inappropriately with techs and other personnel, and otherwise interfere with the proper provision of ABA services.
By contrast, parents who understand that nobody has to continue in any job for a minute longer than they please might not so carelessly provoke those seeking to help them.

Private vs Public Agencies

Since the Thirteenth Amendment, slavery is illegal in the United States of America.  The courts have determined that any employee anywhere can quit their job and nobody can force them to stay in it.  In rare circumstances, there can be repercussions for the doctor who quits in the midst of surgery or enlisted military personnel who go AWOL, but parents should know that ABA personnel walk away from clients every day.  If the client wants to retain services, it won’t happen by force.
While an ABA practice has an ethical obligation to mitigate such events by replacing personnel and/or fading off services, those obligations do not exceed what is practicable and should never extend to continuing a client relationship beyond the free-will desire and consent of all parties.
If a government agency owes a service, it’s different.  If you buy a home and take your deed to the courthouse to record it among the land records, the county owes you that service—even in the midst of courthouse personnel quitting their jobs or some other disaster.  As the situation resolves, you will have the legal right to your place in line as a general member of the public.
Private Agencies Providing Government-funded Services
Not so for those obtaining government-sponsored services such as ABA.  That’s why some people get services at age three while others, even though they have full Medicaid qualifications, are sometimes on waiting lists for fifteen years and never get services at all.  Nor do they have any legal right to such services because the government does not provide them directly.  Private providers get to choose their clients.
Parents also need to understand that even after they sign up, you don’t owe them services beyond the context of your policies and procedures, beyond the availability of personnel you deem best assigned to their case, and/or (ultimately most importantly) beyond your interest in continuing a professional relationship with them.  Your reasons likely require no explanation.  It’s easier to say why you might cancel a client, just as it’s nice if they tell you why they might discontinue services; but it’s critical that both parties know the other is ultimately free to terminate at any time.

Setting Appropriate Expectations

As a practical matter, you want to operate according to reasonable expectations.  You want to fulfill the authorization period unless there is a good reason to the contrary.  You want to communicate well, go above and beyond legal minimums, and act professionally at all times.
But don’t let parents think they own you.  If the relationship isn’t based upon mutual respect and mutual free will, then it cannot proceed to a good end.  And whether a description of how the relationship works is well-framed from the beginning or not, confront inappropriate attitudes of entitlement promptly when they arise.  Appropriate respect for your professional role is a prerequisite to the successful provision of ABA.

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