Behav Analysis Practice (2017) 10:45–51 DOI 10.1007/s40617-014-0033-0

DISCUSSION AND REVIEW PAPER

Blurred Lines: Ethical Implications of Social Media for Behavior Analysts

Patrick N. O’Leary & Megan M. Miller & Melissa L. Olive & Amanda N. Kelly

Published online: 6 January 2015 # Association for Behavior Analysis International 2015

Abstract Social networking has a long list of advantages: it enables access to a large group of people that would otherwise not be geographically convenient or possible to connect with; it reaches several different generations, particularly younger ones, which are not typically involved in discussion of current events; and these sites allow a cost effective, immediate, and interactive way to engage with others. With the vast number of individuals who use social media sites as a way to connect with others, it may not be possible to completely abstain from discussions and interactions on social media that pertain to our professional practice. This is all the more reason that behavior analysts attend to the contingencies specific to these tools. This paper discusses potential ethical situations that may arise and offers a review of the Behavior Analysis Certification Board (BACB) guidelines pertaining to social networking, as well as provides suggestions for avoiding or resolving potential violations relating to online social behavior.

K In eywords Social networking . Ethics . Online media .

ternet behavior

This manuscript has not been previously published, and has and will not be submitted elsewhere during the review process.

P. N. O’Leary (*) Area Cooperative Educational Services, North Haven, CT, USA e-mail: [email protected]

M. M. Miller The Ohio State University, Columbus, OH, USA

M. L. Olive Applied Behavioral Strategies LLC, New Haven, CT, USA

A. N. Kelly Keiki Educational Consultants, Inc, Waialua, Hawaii

An Introduction to Social Media

“The growth and development of the social media phenome- non has been one of the most extraordinary advances in the Internet world during the last few years” (Ahlqvist et al. 2008). Websites like Facebook, Twitter, YouTube, and LinkedIn afford companies and individuals the opportunity to quickly communicate and connect with one another. Cur- rently, one out of every seven people on earth has an active Facebook account (Zeevi 2013). Twitter, which launched in 2006, is an online social networking website that allows users to post and read text-based messages (i.e., tweets) of up to 140 characters. Twitter currently reports 271 million monthly ac- tive users, with 500 million tweets sent per day. LinkedIn, which launched in 2002, may be considered the world’s largest professional network. Currently, the site has 238 mil- lion members in over 200 countries territories (Forbes 2014) and is reported to be growing at a rate of two members per second (Hueber 2013).

With increased growth and usage of social media, information and resources are available for wide dissemination. Consequent- ly, resources have been created on various social media outlets by and for behavior analysis. For example, at least 12 general pages exist on Facebook related to behavior analysis (e.g., Behavior Analysts for Autism, Students of Behavior Analysis, Applied Behavior Analysis). This number does not include university pages (e.g., Institute for Behavioral Studies—Endicott College), local behavior analysis companies (e.g., Alpine Learning Group), state association pages (e.g., CTABA, HABA), and personal blogs (e.g., Behaviorman, Behaviorbabe, Behaviorguy). Mem- bership in these groups is rarely exclusive to behavior analysts. Since access is not restricted to behavior analysts, consumers and non-behavioral colleagues can read, respond, and share their own information. A quick glance at each of these pages reveals that many posts relate to questions about service delivery in the field of behavior analysis. The posts come from parents, educators,

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students in behavior analysis, and Board Certified Behavior Analysts (BCBAs). It is clear: social media allows easy access for posting questions and receiving responses from individuals a behavior analyst might not otherwise have easy contact with.

Codes of Ethics and Social Media

The inevitability of social media interactions occasion a strong need for behavior analysts to learn to use these tools appropri- ately. Thus, we sought to look for input from existing ethical guidelines. To accomplish this, we looked to the Behavior Analysis Certification Board (BACB). We also looked at the ethical guidelines from disciplines that behavior analysts are often tasked to work next to. In this regard, we searched the ethical guidelines and codes for social workers, medical physi- cians, counselors, occupational therapists, and speech thera- pists. This review revealed several guidelines and principles that may be interpreted with regards to social media. A review of relevant associated disciplines will be presented first.

National Association of Social Workers

The current code of ethics was originally approved in 1996 and was recently revised in 2008 by the National Association of Social Workers (NASW) (NASW 2008). This code of ethics does not specifically discuss social media, though as- pects of the code certainly may apply. With regards to in- formed consent, for example, social workers are advised to inform clients of the limitations and risks associated with service provision via electronic means. Additionally, confi- dentiality is addressed in the context of public and semi-public areas. Social workers are advised against discussing confiden- tial information in these areas, such as hallways, waiting rooms, or restaurants. Currently, however, no specific ethical considerations are provided for social media outlets.

American Medical Association

The American Medical Association (AMA) published a report in 2011 regarding the use of social media. Opinion 9.124 discusses professionalism related to its use (AMA 2011). While this code of ethics is not considered lawful, it describes honorable and appropriate behavior expected of AMA members.

Specifically, physicians are advised to be aware of the limits of privacy and confidentiality in social media environ- ments, and are subsequently advised to refrain from posting identifiable patient information online. It is also recommended that physicians monitor information that they post, and infor- mation posted about the physicians themselves. It is suggested

that frequent monitoring of this information will assure its accuracy and appropriateness.

Interactions between physicians and clients are also discussed. Recommendations include assuring appropriate professional boundaries are established, similar to boundaries established outside of social media. Further, it is recommend- ed that physicians consider separating personal and profes- sional content when online.

American Counseling Association

The American Counseling Association’s (ACA) code of ethics (ACA 2014) has developed a full section related to social media and technology. Section H.6 specifically ad- dresses social media in four content areas. Section H.6.a. advises the creation of two separate pages and profiles for social media use: one for personal use and one for professional use. The purpose, to clearly distinguish between the two types of presence online, parallels the recommendation by the AMA. H.6.b. pairs the use of informed consent with social media, and discusses the importance of clearly explaining the limitation, benefits, and boundaries of social media with cli- ents. With respect to privacy and confidentiality, H.6.c. asks counselors to respect the privacy of their client’s social media behavior unless given direct consent to view that information. Finally, H.6.d. again stresses the importance of confidentiality by advising counselors to take precautions to avoid and pro- tect confidential information.

American Occupational Therapy Association

The American Occupational Therapy Association (AOTA) does not discuss any specific guidelines related to social media (AOTA 2010). Here, the code of ethics provides the same general guidance as others stated above. For example, confidentiality, monitoring of dual relationships, and interactions with clear boundaries are all discussed and expected of occupational therapists. However, no specific discussion of social media or its impact on ethics or practice is presented.

American Speech-Language-Hearing Association

As with AOTA and others listed above, the American Speech- Language-Hearing Association (ASHA) does not provide any ethical rules or standards related specifically to social media (ASHA 2010r).

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The BACB Guidelines for Responsible Conduct

The Behavior Analyst Certification Board (BACB 2010) has published guidelines for responsible conduct, which all behavior analysts are required to follow. Specifically, Guideline 7.03 states, behavior analysts have an obligation to be familiar with these Guidelines, other applicable ethics codes, and their application to behavior analysts’ work. Lack of awareness or misunderstanding of a conduct stan- dard is not itself a defense to a charge of unethical conduct.

While none of the BACB guidelines point directly to behavior analysts and social media, several guidelines are relevant to this discussion, specifically 1.0 Responsible Con- duct of a Behavior Analyst, 3.0 Assessing Behavior, 7.0 Behavior Analyst’s Ethical Responsibility to the Field of Behavior Analysis.

Each guideline will be presented and analyzed with respect to social media. Hypothetical examples that illustrate the importance of, and potential ambiguity in, ethical practice on social media will also be provided. We will conclude with a summary of recent “misuses” of social media and recommen- dations for moving forward.

Responsible Conduct of a Behavior Analyst Under guideline 1.01, behavior analysts rely on scientifically and profession- ally derived knowledge when making scientific or professional judgments in human service provision, or when engaging in scholarly or professional endeavors. Response effort is al- tered in social media, specifically the effort necessary with regards to how much information is obtained. For example, as of November 9, 2014, the Applied Behavior Analysis Facebook group had 9860 members. A discussion on a given topic can occasion responses from hundreds of individuals, each with their own history related to the topic. While other outlets allow collaboration and discussion (i.e., calling a trusted colleague, an online journal club), only on social media can the discussion reach so many individuals in such a short time. Often, these resources are found simply by asking a question to the social media community. However, a conditional discrimination needs to be established before resources are obtained. Only requests in behavior analytic- related groups will yield relevant resources. A question is asked and the individual receives links to companies, article/ book citations, and, at times, professional advice. This access may potentially circumvent an important behavior that should be in all behavior analysts’ repertoires: accessing the scholarly literature (Carr 2010).

& A newly minted BCBA posts a question regarding a student in her classroom who climbs on furniture. She asks if anyone has any resources. Responses include (a) conducting a functional behavior assessment (FBA) to

identify function first, (b) putting a token economy in place, and (c) checking out the work done on behavioral momentum. The BCBA spends time researching behav- ioral momentum when it was not an appropriate interven- tion and, in the interim, the frequency of the behavior increases.

& A special education teacher asks for help on stopping stereotypic vocalizations because they disrupt her class. One response discusses the importance of an FBA; three other responses discuss putting a response interruption and redirection (RIRD) program in place. The teacher may research RIRD further, which should be applauded. She imp l emen t s R IRD w i thou t r e s ea r ch ing reinforcement-based procedures and side effects of the punishment procedure begin to appear.

A search on an internet search engine for information related to a procedure or scientific concept may yield results as to what that procedure or concept is. The same search on a social media outlet may yield results as to whether or not that procedure or concept should be used. The difference here is important. The provision of resources, combined with the minimal effort in obtaining them, potentially may maintain the behavior of circumventing the literature. In the future, it is possible that (a) the individual is guided to literature, by which she may make a data-based clinical decision after reviewing potential evidence-based treatments; and (b) the individual is provided the specific advice and uses that advice without referencing the literature. The former response increases the likelihood that behavior analysts will refrain from completing the work for that individual (J. Bailey, personal communica- tion, January 29, 2014), and increases the likelihood that a culture of professional scientists who study and are familiar with the research of the science which they study is cultivated.

& A BCBA, with a large caseload, needs to address elope- ment for an in-home case. She requests guidance on how to address this behavior since it is attention maintained. Responses include non-contingent attention on a fixed- time schedule. The BCBA immediately puts in place an FT 5 min schedule for non-contingent delivery of atten- tion, without researching these schedules or understanding the need for an additional consequence-based contingen- cy. The behavior actually increases in rate because the consequence is not altered and adventitious reinforcement occurs.

& A student studying for the BCBA exam goes to her local, state ABA association on Twitter. She is taking the exam tomorrow, and needs a quick refresher on how to deter- mine the initial interval for a differential reinforcement of other behavior (DRO) procedure. The response is provid- ed by another student, who was taught that the best way to learn a concept is to teach it. However, the suggestion is

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inaccurate. The student takes the exam and answers the question incorrectly, and further, may implement an inef- fective DRO in the future.

& A parent needs support with their child who “whines” to leave a non-preferred store. She states this scenario on the blog of a local behavioral service provider. The parent is advised to ignore the behavior. The parent ignores the behavior, but finds the extinction burst (louder whining) aversive—she eventually gives in and they leave the store. Without being advised of the potential extinction burst, she has made an unfortunate mistake.

Behavior analysts should continue to look to the literature for scientific information and not rely solely on social media outlets. Moreover, practicing behavior analysts must continue ongoing professional development (1.01) by reading the ap- propriate literature, attending conferences and conventions, participating in workshops. This, of course, does not mean that obtaining information on social media and through con- ferences, literature reviews, and the like are mutually exclu- sive. It is in fact likely that many individuals who search social media for guidance are also looking through these other resources simultaneously. The important point here is that obtaining continuing education from peers on Facebook, Twitter, and LinkedIn alone is simply insufficient. Information obtained via these venues should be weighed and compared against information from other scholarly sources.

Guideline 1.05a states that behavior analysts provide be- havioral diagnostic, therapeutic, teaching, research, supervi- sory, consultative, or other behavior analytic services only in the context of a defined, remunerated professional or scientific relationship or role. When behavior analysts post suggestions or respond to questions on social media outlets, they may not consider their relationship with the readers. This may lead to the reader utilizing social media as their primary source of guidance and advice. Potential or current consumers, who have no training in behavior analysis, may ask and obtain information in these forums. If this is the case, there is the potential that consult with a professional who can directly observe the behavior of interest will not occur. This may result in poor implementation of behavior analytic techniques since specific, individualized training and guidance are not deliv- ered. Thus, we recommend behavior analysts take precaution- ary steps to ensure that professional relationships are clearly defined and not compromised in any way.

& A parent has observed intermittent self-injurious behavior by her 5-year-old son. The parent requests advice on Facebook and is advised to tell her son “hands down”. The parent provides the mild punisher contingent on SIB. However, when the punisher is delivered, the son also attempts to bite the parent. Biting contacts reinforcement and increases in rate in the future. The advisor had not

been aware that prior aversive procedures had been attempted and were unsuccessful, and the parent never mentioned it since the conversation was so brief.

& A frontline therapist is working in a home with a student who emits aggression. She is under the supervision of a BCBA and meets with her regularly, but does not have a very trusting relationship with her. The therapist attempted the interventions prescribed in the behavior plan, but was not in agreement with them. She requested advice on social media as to how to manage the aggression. The responses include utilizing a brief physical hold for safety. Assuming it to be relatively harmless, she attempts a brief physical hold the next time aggression occurs. During the hold, she slips and the student bangs his head on a table. The therapist was not familiar with the specific techniques associated with that procedure needed to maintain safety.

Guideline 1.06 (dual relationships) recognizes that there are situations where it may not be possible to avoid nonpro- fessional interactions with clients, supervisees, research par- ticipants, or students. However, behavior analysts must rec- ognize the possibility of harmful effects that outside interac- tions may have on work and how those interactions my affect the reader and the reader’s perception about the relationship. Bailey and Burch (2011) explain that having social contacts with clients can interfere with our objectivity as behavior analysts and can increase the chance of harm or exploitation. To determine whether it is ethical to connect with clients on social media, it is important to examine the impacts of this action on your ability to provide effective services to the client. Connecting with clients on social media opens your private life and the client’s private life to one another. Connecting on social media allows this to happen because you can see the private activities of each other’s lives.

& A parent sent a friend request to the BCBA that works at their daughter’s school. The BCBA has always done good work, and the two had a healthy working relationship. On Friday night, the BCBA went out with some friends and had a few too many glasses of wine while watching a college basketball game. Pictures were posted online of the BCBA smoking cigarettes and behaving in a clearly drunken manner. The parent saw these pictures and began to question whether she could fully trust someone who would behave in that manner and show it off to so many people.

& A supervisor follows one of his supervisees on Twitter. The supervisor is a die-hard, and outspoken, democrat. He reads a tweet from his supervisee that is highly critical of the democratic leadership in their state, and advocating for republicans to take lead. The supervisor behaves differ- ently towards the supervisee and does not provide the same quality of supervision.

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& A frontline therapist accepts a friend request from the parent of a child with whom she works. The therapist posts comments about her upcoming birthday and the plans she has. The parent decides to buy a gift for the therapist to reward her for all her hard work, a US$50 gift card to a local wine bar. The therapist, not wanting to insult the parent, accepts the gift card. The parent is confused and upset when the frontline therapist does not reciprocate and buy a gift on her birthday. She asks the supervisor that the staff be removed from the case for being disrespectful.

Guideline 1.06c states If a behavior analyst finds that, due to unforeseen factors, a potentially harmful multiple relation- ship has arisen (i.e., one in which the reasonable possibility of conflict of interest or undue influence is present), the behavior analyst attempts to resolve it with due regard for the best interests of the affected person and maximal compliance with these Guidelines. It is imperative that behavior analysts re- member that the information on these “private” accounts is actually quite public. Unless specific steps are taken to assure the privacy of an account, the information is much more public than is assumed and these conflicting contingencies must be attended to.

Assessment Under this guideline, behavior analysts must en- sure that appropriate assessments are completed and that the results of assessments are used accordingly. Thus, when post- ing in social media outlets, behavior analysts should use caution to ensure that they do not lead a parent or guardian to believe that the behavior analyst has assessed the child in any way. Behavior analysts must use caution and recommend a process rather than actual treatment. For example, Dr. Olive publishes a blog wherein parents write in asking for behavior- al assistance. Rather than prescribing what the parent should do to treat the behavior, Dr. Olive directs the parent to the process of behavior intervention (e.g., “an assessment should be completed first” or “be sure to rule out other underlying medical concerns before treatment”).

Also under this same guideline (3.0c), behavior analysts must use caution when making predictions about treatment effectiveness. While Functional Communication Training (FCT) has been proven effective through research (Tiger et al. 2008), it would be misleading to parents to guarantee that FCT would help their child. As a profession that relies heavily on scientific inquiry and data-based decision making, it is easy to gain confidence in available technologies. How- ever, without appropriate assessment and knowledge of the client, it is impossible to predict, sight unseen, the outcome of any treatment.

& A BCBA requests information on whether planned ignor- ing is appropriate for a student who drops to the floor in

the hallway of her school. The consensus from the Facebook group is that it will definitely be effective since attention may likely be a high value reinforcer in that environment. Those providing advice were not aware that the student also takes his pants off when he drops to the floor. Without observing the behavior, an important aspect of the behavior was ignored, as was the student’s dignity.

& A speech therapist is looking for advice on whether a Picture Exchange Communication System (PECS) pro- gram would be appropriate for a client of hers who is diagnosed with traumatic brain injury. The responses she receives in the group are from those who have experience with autism, but have found PECS to be very useful. The speech pathologist implements PECS with her client, without an understanding of the specific deficits associat- ed with TBI and the program is ultimately unsuccessful.

This guideline underscores the importance of direct observation of the relevant behavior of interest. While technologies are available that allow for distance consulta- tion and supervision (i.e., Skype), these still allow the practitioner to directly observe the behavior. Social media is somewhat unique in that those providing advice and guidance have not directly observed the behavior of inter- est, nor do they have the relevant histories and back- ground of the client, prior interventions and environment. This limited information should serve as a red flag for those providing guidance and advice.

The Behavior Analyst’s Ethical Responsibility to the Field of Behavior Analysis Under this guideline, the behavior analyst has a responsibility to support the values of the field, to disseminate knowledge to the public, to be familiar with these guidelines, and to discourage misrepresentation by non- certified individuals (BACB 2010). One benefit of social media is that the individual seeking advice has access to so many other professionals (Bik and Goldstein 2013). The benefit here is that guidance is available from individuals with greatly varying specialties, histories, and expertise. It is quite possible that the individual lives in a country with very few behavior analysts or perhaps in a remote area with few residents in general. What needs to be considered here is not necessarily what is posted, but who can access the post. Posting a question within a large group of individuals will likely occasion numerous responses, some of which may conflict with others. On the other hand, a request to collaborate with an expert may yield fewer responses, but result in the behavior analyst developing a professional relationship, outside of the social media out- let. For example, the first author e-mailed two experts in behavior analysis with regards to guidance on a particular topic. Both e-mails subsequently led to continued, collab- orative relationships.

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& A graduate student in educational psychology heads to Facebook to find out if a time-out from positive reinforce- ment would be effective for a student with attention main- tained screams. The post yields a multitude of responses, some advocating for the use of time-out and others op- posing it. Those opposing its use made arguments that convinced the student against using it. The student’s de- cision was shaped via the information received on social media, and not by a review of the literature.

Social Media “Mishaps”

We find it pertinent to include examples from society of instances in which an individual has used social media inap- propriately, and the consequences of that use. While many of the examples provided above are hypothetical, inappropriate use of social media is very real and has real, profound impacts on those who use it. While the motivation behind these posts may have been justified, the point here is that information provided in these public arenas can have real consequences for those who provide said information.

In May 2013, a school bus driver in Georgia was fired for criticizing the public school district that employed him. The criticizing post attracted 250 “likes” and over 2000 “shares” (Fastenberg 2013). It is not hard to see how quickly his post reached such a vast audience. The consequence of his post was apparently outlined in the district’s social media policy, which stated that employees whose posts cause “substantial disruption to the instructional environment” would be subject to discipline.

July, 2010 saw the termination of a husband and wife after they posted videos to YouTube about their jobs (Roth 2010). Anchors at a local TV station created videos and publicly insulted their supervisors and customers, under the guise of creating a parody for a film contest.

A Pennsylvania English teacher was suspended after post- ing comments for which she only intended friends to see. Between August 2009 and November 2010, numerous posts were made that discussed her frustration in dealing with “rude, lazy, disengaged whiners.” While several posts had positive work-related comments, the negative comments became the focus of parents and administrators (Grinberg 2011).

In 2009, an employee of the Philadelphia Eagles football organization was fired for comments he made on Facebook after a controversial trade was conducted between the Eagles and the Denver Broncos (Gonzalez 2009). The employee vented on Facebook that his team was “retarded” for trading the player. While the employee met with the administration to delete the comment, the damage had been done and the 6-year professional relationship was terminated.

Suggestions to the Members of the Field

We hope that this discussion has increased your awareness of your ethical responsibilities when communicating on various social media outlets. We have several suggestions for the members of the field of behavior analysis to consider further in these situations. We offer these suggestions based on our own experience with social media forums. The reader must determine whether, and under what conditions, each of these suggestions applies.

1. Real clients should be heavily disguised. Though unlikely, there is the potential that individuals in a group could identify the person being discussed. Only relevant information should be included. For example, is a specific age necessary or will a 5-year age range suffice? The potential of identification is what is most important. Many characteristics of the poster are available, including name, location, and place of employ- ment (if available to the public). These characteristics may be enough to identify clients, especially if someone reading the post knows the client. 2. Avoid making treatment recommendations. Those responding to posts have limited access to the client. At best, there is a short summary of client characteristics. There is simply not enough information to recommend any specific treatment. In addition, the responder has had no direct obser- vational contact with the client. Treatment recommendations would likely be based upon subjective report of client behav- ior. The “snapshot” provided is insufficient to base treatment recommendations upon. 3. Refer readers back to the literature. As in #2 above, access to the client is limited. Therefore, it is unknown whether the treatment will apply to this specific client. It is up to the person working with the client to determine appropriate treatments. A recommendation to “look into” functional communication training may be appropriate, but only when combined with references to works by scientists such as Edward Carr and V. Mark Durand. The client’s behavior analyst then must analyze the relevant research to determine if it is appropriate to the client in question. 4. Write a disclaimer. In posts in which information may appear to be a treatment recommendation, a disclaimer should be included clarifying that a professional relationship has not occurred. While the responder may not believe a relationship is established, it is upon them to explicitly state so. Without this unequivocal statement of the relationship, the potential exists that the individual receiving support and recommenda- tions will assume a relationship was developed when, in fact, it was not. Again, while unlikely, the potential of this occur- ring is enough to warrant such proactive measures. 5. Provide resources. We recommend a commitment to providing posters with resources such as topics to search in the literature, helpful websites, and experts in the area.

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We also recommend discussing the post offline instead of providing specific advice directly on a post for others to misinterpret. 6. Organizational Training. Our final recommendation is for organizations and companies who are tasked with training and teaching their employees. Given the current status of social media usage and the implications of that use, we recommend- ed ongoing training with regard to appropriate social media usage. This training should be a part of the initial and ongoing training that employees received contingent on their starting a new job.

Summary and Next Steps

Effective January 1, 2016, all BACB applicants, certificants, and registrants will be required to adhere to the Professional and Ethical Compliance Code for Behavior Analysts (BACB 2014). This code is similar to the current Guidelines for Responsible Conduct for Behavior Analysts, but has addition- al aspects that provide a more comprehensive code for emit- ting ethical behavior. Our analysis did not include aspects of this Code, as it is not currently in place. It is recommended that future researchers and authors analyze social media behavior with regards to this new Compliance Code, to determine its application and necessity for improvements.

In today’s social media-driven society, behavior analysts will find it difficult to abstain from conversations in groups designed to meet the needs of behavior analysts. Understand- ing one’s responsibility to clients while adhering to the BACB Guidelines for Responsible Conduct is crucial, now more than ever. Given the potential for ethical violations, behavior ana- lysts should use caution when participating in social media by relying on scientific knowledge, engaging in professional and scientific relationships, avoiding dual relationships, protecting client confidentiality, completing appropriate assessments, obtaining consent prior to disclosing information, and making sure that readers do not assume a professional relationship when responding to posts.

Acknowledgments The authors would like to thank Dr. Carla Schmidt for her helpful feedback on an earlier version of this manuscript.

Disclaimer The Behavior Analyst Certification Board (BACB) does not sponsor, approve, or endorse the information identified herein.

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