Termination of Services in Behavior Analysis: Ethical and Practical Considerations

Introduction

In behavior analysis, the termination of services (TOS) is an essential yet often overlooked aspect of professional practice. Whether services are discontinued due to treatment success, financial constraints, or ethical concerns, behavior analysts have a duty to ensure the process is handled professionally and in the best interest of the client.

A recent study by Green, Lewon, Lewon, and Ghezzi (2024) explores the complexities of TOS, highlighting ethical responsibilities, common challenges, and areas needing improvement in current practice. This blog post summarizes their findings and offers best practices to help behavior analysts navigate termination ethically and effectively.

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Understanding Termination of Services (TOS)

What is TOS in Behavior Analysis?

Termination of Services refers to the discontinuation of applied behavior analysis (ABA) treatment for a client due to various reasons. A well-executed TOS ensures that the client’s progress is preserved while upholding ethical and professional standards.

Common Reasons for TOS

According to Green et al. (2024), services may be terminated for several reasons, including:

1. Achievement of Treatment Goals: The client has met all objectives, making further intervention unnecessary.
2. Financial Constraints: Lack of funding or insurance coverage.
3. Consumer-Provider Mismatch: A poor fit between the client and therapist, affecting treatment outcomes.
4. Boundary Violations: Ethical or professional boundaries are crossed.
5. Absenteeism: Excessive cancellations or no-shows by the client.
6. Illness or Death: Involves either the provider or client.
7. Treatment Noncompliance: The client or caregiver does not follow prescribed interventions.
8. Lack of Treatment Progress: Despite reasonable efforts, no meaningful improvement occurs.
9. Exceeding Scope of Competence: The client’s needs extend beyond the provider’s expertise.
10. Legal or Ethical Concerns: Issues such as abuse, fraud, or conflicts of interest necessitate termination.

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Ethical Responsibilities of Behavior Analysts in TOS

Behavior analysts have clear ethical obligations when terminating services, as outlined by the Behavior Analyst Certification Board (BACB) Ethics Code. Key responsibilities include:

1. Providing Advance Notice: Clients and caregivers should be informed as early as possible.
2. Ensuring Continuity of Services: Whenever possible, services should transition smoothly to another qualified provider.
3. Making Appropriate Referrals: Recommending alternative providers if further intervention is needed.
4. Documenting TOS Decisions: Keeping detailed records of termination reasons and communications.
5. Avoiding Abandonment: Ensuring the client is not left without necessary support.
6. Prioritizing Consumer Welfare: Making termination decisions that prioritize the client’s well-being.
7. Training Staff on Ethical TOS: Providing clear guidelines and training to ensure consistency.
8. Communicating Clearly: Using direct and compassionate communication during the termination process.
9. Complying with State Laws: Adhering to legal requirements regarding service discontinuation.
10. Preventing Unethical Terminations: Avoiding discontinuation based on frustration or convenience.

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Survey Findings: Current State of Training and Practice

Green et al. (2024) conducted a survey of behavior analysts and revealed critical gaps in TOS training and implementation. Key findings included:

1. High Importance but Low Training: While most behavior analysts recognize the importance of TOS, few receive formal training.
2. Learning on the Job: Many practitioners learn TOS practices through experience rather than structured education.
3. Inconsistent Consumer Communication: Some clients are not appropriately informed of plans to terminate services.
4. Low Familiarity with Professional Wills: Few behavior analysts have a plan in place for sudden service disruptions due to illness or death.
5. Limited Post-TOS Follow-Up: Many providers do not systematically track client outcomes after termination.
6. Financial Constraints Impact Decisions: Funding sources often dictate when and how services are terminated.
7. Neglect of Consumer’s Long-Term Outcomes: Limited consideration is given to clients’ progress after services end.
8. Variability in Documentation Standards: There is no industry-wide consistency in TOS documentation.
9. Confusion on Ethical vs. Administrative Terminology: Practitioners may conflate ethical termination with administrative discharge.
10. Need for Standardized TOS Protocols: Organizations lack uniform policies to guide ethical TOS practices.

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Best Practices for Termination of Services

General Preparation

To ensure ethical and effective TOS, behavior analysts should:

1. Develop clear policies and procedures for service termination.
2. Train staff on ethical TOS protocols and legal responsibilities.
3. Create contingency plans, including professional wills for unexpected disruptions.

Consumer Communication

Clear, transparent communication is essential throughout the termination process:

1. Notify clients and caregivers about potential termination criteria early.
2. Provide adequate notice before discontinuing services.
3. Use understandable, compassionate language when discussing TOS.

Continuity of Care

A smooth transition reduces the negative impact of service discontinuation:

1. Offer referrals to other providers, if needed.
2. Share treatment records with appropriate consent.
3. Provide caregivers with guidance on maintaining progress post-TOS.

Ethical and Legal Compliance

Behavior analysts must adhere to professional and legal standards:

1. Follow BACB ethics guidelines on TOS.
2. Keep thorough documentation of all termination-related decisions.
3. Ensure that termination does not result in harm or abandonment.

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Conclusion

Termination of services is a critical yet under-discussed component of behavior analysis. Green et al. (2024) highlight the need for stronger training, clearer communication, and more consistent policies in managing TOS ethically. By applying best practices—such as providing advance notice, ensuring continuity of care, and maintaining ethical documentation—behavior analysts can make TOS a thoughtful and professional process.

For a more in-depth exploration of this topic, read the full study: Green, K., Lewon, M., Lewon, A. B., & Ghezzi, P. M. (2024). All Things Must Pass: Termination of Services in Behavior Analysis. Behavior Analysis in Practice, 17, 854–869.

By prioritizing ethical termination, behavior analysts not only protect their clients but also uphold the integrity of their profession.