There are a lot of factors that affect service implementation when working in rural settings. For service providers in this type of setting, things come up that may not be as concerning or relevant in more urban setting.
Some factors that may come about when working in a rural setting in ABA or applied Behavior Analysis services include things such as encountering clients and or their families in the community, having the service providers children and client child or client’s siblings interact in other non-professional settings such as at school, child care, church, etc.
This puts a potentially ethical dilemma in place related to the ethical guideline about preventing and not having dual relationships between clients and service providers. This refers to code 1.06 of the Professional and Ethical Compliance Code for Behavior Analysts. Because it is common to encounter client’s and/or their families in public (outside the workplace) when working in a rural community due to a small population and limited resources in the area, it is important to think critically about these relationships and to set clear professional boundaries with clients.
Another issue that may come up is running into clients and or their families in the community such as at a grocery store or gas station or parade. Again having clear professional boundaries and respecting confidentiality are essential to protecting our clients and maintaining our ethical obligations (Code 2.06). Although it can be awkward when seeing a client and/or their family it is important not to disclose private information or break any confidentiality or HIPAA regulations.
It may be helpful for service providers to express to clients and their families in advance that the nature of the relationship must remain professional and cannot develop into a personal relationship. Additionally, informing clients ahead of time that when you see them in public, you will not address them due to confidentiality reasons may prevent some of the awkwardness when the situation does arise as they will know what to expect and what is expected of them.
If clients do begin a conversation with you certainly keep it short and do not disclose confidential information in front of others who do not have the right to know their information.
Another common issue in rural settings is a lack of resources and the likelihood of poverty or lower socioeconomic status compared to more urban populations which may have higher socioeconomic status families or a population which has a larger range of income levels. This issue of limited resources may impact ABA Services due to challenges that may possibly occur such as lack of transportation, lack of healthcare, lack of funds for the child’s belongings such as clothing, food, winter items, etc.
Additionally, scheduling ABA Services may be impacted by the parents’ schedule and ability to attend sessions as there may be less families with typical 9 to 5 jobs or a stay-at-home parent with access to transportation. ABA scheduling may also be impacted by the weather more often in a rural setting than in an urban setting do to longer distances of travel needed to attend center-based services or community outings; therefore things like snow may get in the way of safe transportation and attendance.
Transportation may also be a barrier to the service provider. When the cliens’t homes are further apart, this can take up a lot of the service provider’s time just driving from one location to another. An option to help with this may be the use of telehealth services.
For ABA providers in rural settings, it may be that specialization in particular populations is not as feasible as it would be in an urban setting with a higher population and higher referral rate. For instance a provider may not be able to sustain a caseload or a business with only serving ages 3 to 5 years old. They may need to consider accepting older clients as well financially speaking.
Another issue that may come up with rural communities with few ABA providers (and even in some urban areas) is the fact that there may be a high level of need for ABA services. However, code 2.01 requires behavior analysts to only take on a caseload that they are effectively able to manage. It may be beneficial to families in need for them to be referred to other providers who may have openings in their caseload. Additionally, finding ways to expand the field of ABA for under-served populations and areas is a task that should be considered.
There are some differences in providing ABA in a rural versus an urban setting. These are just some of the things to consider when working with this population.
Please let us know in the comments if you notice anything else about providing ABA services in rural settings?
Professional and Ethical Compliance Code for Behavior Analysts. Behavior Analyst Certification Board. https://www.bacb.com/wp-content/uploads/2017/09/170706-compliance-code-english.pdf Retrieved 11/27/17
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