April 12, 2022

Virginia Board of Medicine

9960 Mayland Drive, Suite 300

Henrico, VA 23233

Subject: Comments regarding behavior analyst certifying organizations

Colleagues:

I am writing on behalf of the Association for Behavior Analysis International (ABAI) which is the international professional organization for behavior analysis, the natural science of behavior, and its Licensing Committee. ABAI is uniquely positioned to address questions that arise regarding the practice and profession of behavior analysis.

We have been asked to comment regarding the discussion occurring in Virginia related to organizations issuing certification to behavior analysts. We recognize the concern possibly arising that some organizations may certify individuals as being sufficiently qualified when, in reality, a person does not possess the knowledge or supervised experience to provide appropriate services for clients. We think that identifying specific certifying organizations as holding acceptable certifying criteria to be unwise as the number of behavior analyst certifying organizations may shift over time and we would not want to take action might contribute to restricting timely decisions being made in Virginia regarding qualifications. To be clear, we cannot endorse any particular organization that certifies behavior analysts. We can, though, describe some considerations that we believe are important when reviewing such organizations.

Given that the rationale for licensing behavior analysts is protection of the public, of utmost importance is ascertaining how well a behavior analyst certification issued by an organization promotes protecting the public. How might that be evident? Some facets of how that be done are summarized immediately below with more details discussion following. Some essential factors include:

1. Making sure that the certification criteria are relevant to the area in which licensure would be provided, specifically relevance to behavior analysis, per se.

2. Ensuring that the knowledge, competencies, examination content, and supervised experience requirements for behavior analyst licensure are intended to apply broadly and not just be relevant or especially relevant to a subset of the population.

3. Determining that expected supervisory experience maximizes the likelihood that trainees have adequate relevant experience to develop the complex skills needed to provide effective and safe  services needed by the public.

4. Ensuring the results of certification examinations accurately reflect the knowledge of a candidate for certification and then licensure.

5. Exploring whether the certifying organization has and enforces a code of ethics for people that it certifies.

6. Considering how certification decisions by an organization could facilitate financial gain accruing to private parties.

7. Addressing whether the behavior analyst certifying organization is accredited by a nationally or internationally recognized organization that accredits organizations that issue professional credentials, a necessary but not sufficient factor for adequate protection of the public.

Expanded consideration of those factors follows.

1. Making sure that the certification criteria are relevant to the area in which licensure would be provided, specifically relevance to behavior analysis, per se. If the license issued to behavior analysts is an unrestricted license (i.e., behavior analysts are not restricted to providing their services to only a subset of the populations such as Autistic people or minors), then the criteria for the certification required for behavior analyst must pertain completely to behavior analysis, rather than some other profession or to behavior analysis plus some other topic. Issuance of an unrestricted license requires that licensees’ training and experience NOT be restricted to or primarily emphasize only one subset of the population; this is essential so that licensed behavior analysts will have received broad training that will facilitate their ability to provide appropriate and effective services to a broad array of clients. A crucial implication of this expectation for certificants is that the competencies a behavior analyst has received must reflect the fully range of behavior analysis, and not be restricted to or primarily emphasize what is relevant to only a subset of the population to whom behavior analysis services should be provided and that will seek behavior analysis services. The same holds true for the required training, supervised experience, and testing of persons to be certified. A behavior analyst certification program can contribute to protecting the public by having requirements that ensure that behavior analysts are prepared to provide the services people need in a manner that is safe, effective, and ethical. Inadequate standards increase the risk that certified behavior analysts will provide services and conduct themselves in ways that could cause some form of harm to the people to whom services are provided.  The information to address this set of concerns should be readily available in the publicly available information provided by a certifying organization such as on its website. If the information is not readily available or what is available indicates that the issues mentioned here are not adequately addressed, then one should proceed with great caution regarding whether that organization is operating openly and is likely to provide the best available protection for the public.

2. Ensuring that the knowledge, competencies, examination content, and supervised experience requirements for behavior analyst licensure are intended to apply broadly and not just be relevant or especially relevant to a subset of the population, is not sufficient to maximize protection of the public. The expected knowledge, competencies, examination content, and supervised experience requirements for behavior analyst licensure must validly reflect what actually is necessary for provision of effective behavior analysis services. The state of the art procedures are well articulated and available from a variety of sources pertaining to examination development and professional credentialing (e.g., the Council on Licensure, Enforcement & Regulation, www.clearhq.org). In brief, the knowledge, competencies, examination content, and supervised experience requirements for behavior analyst licensure should be derived from a systematic, validated representative query of persons practicing behavior analysis with preliminary item development by subject matter experts (SMEs). The findings from such surveys should be reviewed by SMEs, revised as needed and then, when any preliminary surveys are shown to be adequately broad and to be psychometrically reliable and valid, the finalized survey should be administered to a large representative group of behavior analysts. An important consideration in this regarding is that the validation sample is sufficiently representative. That is, the validation sample definitely should not be limited primarily to employees and associates of one company or organization nor to persons known to be working primarily with only a subset of the population. The validation of the items for competencies, examination content, and supervised experience must involve reasonable statistical procedures currently standard for professional examinations, a time consuming and potentially costly undertaking. Failure to do so could result in certification criteria that are too lenient, resulting in inadequately prepared persons being licensed and allowed to provide services to the public, causing harm due to inappropriate services being provided or failure to provide needed services. On the other hand, similar methodological inadequacy could result in certification criteria that are too stringent, resulting in too few adequately prepared persons being licensed and allowed to provide services to the public, causing harm due to restricting unduly the number of professionals available to provide behavior analysis services to persons needing them, resulting in avoidable reduction in quality of life and/or safety for persons not receiving needed behavior analysis services. Information relevant to this set of concerns should be readily available in the publicly available information provided by a certifying organization such as on its website. If the information is not readily available or if the procedures for determining the knowledge, competencies, examination content, and supervised experience requirements for behavior analyst licensure lack the rigor briefly summarized here, then one should proceed with great caution regarding whether that organization is operating openly and is likely to provide the best available protection for the public.

3. Determining that expected supervisory experience maximizes the likelihood that trainees actually have adequate relevant experience to develop the complex skills needed to provide the effective and safe services needed by the public. Such supervised experience requires persons who could be certified and, thus, licensed, and should explicitly mandate that a large percentage of supervised experience involves direct service provision to clients/ patients. A trainee must not be allowed to possibly satisfy the supervised experience requirements without having demonstrated under rigorous expectations that they, in fact, can provide effective behavior analysis services. Such could happen by the certifying organization allowing trainees to count large amounts of time in activities other than service delivery, while recognizing that some time for activities of that sort is necessary. Another level of threat to the adequacy of supervised experience involves the trainee’s supervisor not being required to possess credentials reflecting their having the knowledge and skills necessary to adequately evaluate the trainee’s activities as behavior analyst services, per se. A supervisor with license or credentials in another profession without also having credentials in behavior analysis is highly unlikely to be adequately prepared to supervise a trainee to competently and safely provide behavior analysis services.  A trainee without adequate supervised experience represents a high risk of causing harm because, if licensed, that person, would provide inappropriate services or fail to provide needed services.  Further, without sufficient supervision the person would likely act outside their scope of practice and scope of competence, resulting in inadequate referrals for services from other disciplines (e.g., physicians, speech language pathologists). The information to address this set of concerns should be readily available in the publicly available information provided by a certifying organization such as on its website. If the information is not readily available or what is available indicates that the requirements for supervised experience are inadequate, then one should proceed with great caution regarding whether that organization is operating openly and is likely to provide the best available protection for the public.

4. Ensuring the results of certification examinations accurately reflect the knowledge of a candidate for certification and then licensure. A crucial step in realizing that outcome is ensuring that the examination results of behavior reflect that a person having the knowledge of behavior analysis necessary to pass the examination, being certified, licensed as a behavior analyst, and then independently provide services to people. That is on contrast to someone obtaining a passing score fallaciously due to cheating in some manner while taking the test. Thus, information should be readily available regarding the conditions and monitoring of administration of the examination. That information should make clear that the person taking a test is directly monitored, preferably in person and not virtually in locations such as in the United States where staffed, secure testing centers are available. Examination administered solely virtually should be considered more vulnerable to results being affected by extraneous influences. Such influences could result in an examination score of a candidate being falsely inflated to the level of a passing score despite the fact that the persons lacks sufficient knowledge or has acted unethically. As a result, that person lacks knowledge regarding behavior analysis to criteria worthy of receiving a license to practice behavior analysis and is likely harm recipients of their services due to providing inappropriate services or failing to provide needed services.  If information regarding the conditions and monitoring of examination administration is not readily available or what is available indicates that the requirements for examination are inadequate, then one should proceed with great caution regarding whether that organization is taking all reasonable precautions to ensure the validity of testing and of validity of examination results, information needed to determine whether the organization’s certification is likely to provide the best available protection for the public.

5. Exploring whether the certifying organization has and enforces a code of ethics for people that it certifies. A code of ethics articulates in written form, expectations- including general principles- for how certificants are to interact with people and conduct themselves (e.g., honestly, within their scope of competence). The point of a code of ethics or conduct is to have standards by which behavior analysts are held accountable for their behavior. Persons violating the code very often behave in ways that harm the public in various ways including physically, financially, emotionally. Just having a code of ethics or conduct by itself is not enough. If the certifying organization’s code is aspirational, and is not accompanied by actions being taken when a violation is substantiated to correct the violator’s inappropriate behavior or remove their certification and, thus, their authorization to provide behavior analysis services, then the public has much more limited protection from harm by behavior analysts acting unethically than they should and could have. Information should be readily available providing the code of ethics or conduct and regarding enforcement of the code, sanctions having actually been taken regarding certificants shown to have violated it.  If the code is not presented or no information is provided clearly indicating that certificants violating the code have been experiencing and/ or will experience meaningful sanctions for doing so, then that certifying organization is falling short of what it could and should do to help protect the public from harm by behavior analysts acting unethically, allowing them to continue doing so and harming increasingly more people.

6. Considering how certification decisions by an organization could facilitate financial gain accruing to private parties. Certifying organizations that are nonprofit with their financial information readily available to the public seem less likely to tailor certification criteria and decisions in a manner that increases the likelihood of candidates being certified. Specifically, when the volume of certificants is accompanied by increased revenue for private parties, the certification criteria are likely to be adjusted be easily met, resulting in an accompanying increase in revenue due to the number of people applying for certification being increasing due to the criteria for gaining and maintain certification being considered relatively easy.

7. Addressing whether the behavior analyst certifying organization is accredited by a nationally or   internationally recognized organization that accredit organizations that issue professional credentials, a necessary but not sufficient factor for adequate protection of the public. Such accreditation organizations have specific standards for credentialing organizations in various professions and industries. Those standards        address numerous factors including, very broadly, the organization’s governance, administration, clearly stated standards for its credentials (basis and development of them), assessment development and administration procedures, personnel matters, financial resources, financial management, quality assurance program, updating of       standards, defensibility from challenges, and numerous other factors. In the United States two of the organizations most often accrediting organizations that provide professional credentials are the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE) and the American National Standards Institute (ANSI) and its subsidiary ANSI National Accreditation Board (ANAB).          One of these organizations should accredit any behavior analyst certifying organization. That said, note should be taken that a certifying organization being certified does not ensure that it adequately addresses the issues raised above. Accreditation of a behavior analyst certification organization is necessary but in itself is not sufficient to ensure that a credential from it provides all the protection of the public that can and should be provided. The points above illustrate specific ways potential protection of the public can be optimized or limited by a behavior analyst certifying organization.

We would be happy to provide additional information and engage in discussion regarding this important issue of selecting what behavior analyst certifying organizations provide credentials suitable for being the foundation of behavior analyst licensure. My contact information is provided below.

Thank you for your consideration.

Gordon Bourland, Ph.D., BCBA-D, LBA

Chair, ABAI Licensing Committee