Three things you can do instead of accepting gifts from clients

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By Emaley McCulloch, M.Ed, BCBA

bSci21 Contributing Writer

Gift-giving is an expected norm in most cultures.  Thus, many behavioral professionals will find themselves in the awkward situation of having to turn-away a gift offered by a client or client’s family. The BACB’s Professional and Compliance Code for Behavior Analysts has recently made the issue very cut and dry: “Behavior analysts do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship.” This leaves little room for interpretation. “Any gifts” would include anything that is of monetary value, large or small. Because of the nature of our job as a helping profession, many well-meaning clients and family members want to show appreciation through a gift card, plate of cookies or handmade item. Typically, these gifts are tokens of respect and appreciation and may not cause any problems.  In some cases, however, the exchanging of gifts can open up a complicated set of boundary and relationship issues.

The fact of the matter is, the BACB has decided to prohibit the accepting of all gifts of any kind from clients.  As a result, both BCBAs and RBTs are required to comply or risk being reported. So, here are some things you can do instead of accepting gifts from clients.

  1. Be Proactive. You or your agency should send an email to clients and parents informing them of the code of ethics and that no gifts will be received. This may prevent awkward situations for you or your staff.
  2. Offer an alternative. In the email alerting clients and parents of the “no gift” rule, offer them the opportunity to say something nice or give feedback to you or about your staff. Kind words can mean more than a plate of cookies or a gift card. It could also provide an opportunity for clients and parents to provide feedback on services.
  3. Give them this printable card. When someone does offer you a gift—which is inevitable—it can be really hard to not accept without offending or embarrassing the giver. Giving a card like this—although cheesy—can help disperse the awkwardness in the situation and help them understand that you are grateful for the gesture. Besides, just look at how cute that sun is.

It’s important to note that the BACB also recognizes that it’s important to acknowledge the gesture and thoughtfulness of the gift-giver. We should be careful how we explain the ethical code as not to imply that the gift may have strings attached to it and that other professionals who accept gifts are less ethical than we are.  Or, most importantly, that we are grateful for the kindness they show and the trust they put in us.
What are some other ways you can avoid awkward conversations or ways to communicate this ethical practice to clients and their families? Let us know in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

 

Emaley McCulloch, M.Ed, BCBA co-founded Autism Training Solutions, LLC in  2008, and is currently the Vice President of Relias Institute at Relias Learning. Relias Learning is the premier provider of online health care training for Health and Human Services, Senior Care and Public Safety. Emaley is a Board Certified Behavior Analyst and holds an MA in Special Education. She has served in the field of ABA for over 18 years and has provided and overseen services to individuals between the ages of 18 months to 24 years in homes, schools and clinical settings. For eight years she served as a consultant and supervisor at agencies based in Hawaii and Japan where she trained groups of professionals and parents. Emaley’s passion is elearning, staff training, dissemination of evidenced-based interventions, research, film and videography and using technology in the field of behavior analysis and special education.  You can contact her at emcculloch@reliaslearning.com.

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5 Comments on "Three things you can do instead of accepting gifts from clients"

  1. What do you suggest for BCBA’s who work part of a multidisciplinary team? Other professionals do not see it as a problem and do not want to necessarily change the message around gift giving as a company?

  2. “Behavior analysts do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship.”

    This is clearly not the case. Let’s break it down.

    First, what is a gift? As far as I’m aware, the BACB does not provide a definition. It seems clear that an expensive watch or a holiday constitute a gift. A gift card – as the name suggets constitutes a gift. But what about a thank you card? A Christmas card?

    A painting by a client? Does the monetary value of the painting affect the situation? For example, if the clients paintings sometimes sell for £100 dollars is that different from a situation where they have no monetary value.

    A Starbucks coffee would seem to constitute a gift. But what about a glass of water? If your client is a business and you take a free water or coffee at reception, are you taking a gift? If working in a client’s home, does the water consitute a gift when it comes from a bottle or a tap in a situation where people do not pay for tap water?

    Accepting a wedding gift for a client seems unprofessional. But what about something like a funeral card. Mass cards are given in some Catholic communities whereby somebody will pay to have a mass offered up for a loved one or the loved one of somebody they know. They may cost up to 20 dollars. If somebody receives such a card where a client has effectively paid a priest to pray for one of your loved one’s, do you return the card? Do you then contact the cleric and ask that they do not pray for your mother or father?

    It seems clear that what constitues a gift depends on context and that there is no clear definition. The BACB is not helpful in defining “gift”.

    Next, let’s move to the “multiple relationship” that is somehow established. When you work in certain sectors, at certain times of the year or folllowing certain events, it is normal to provide your colleagues or clients with gift baskets or cards of gratitude. The recipient and the giver both understand that this does not alter the nature of their relationship. It is simply customary that in these contexts you provide tokens of esteem, gratitude and respect to business colleagues. If I run a small recruitment company and I, like all of the other companies that provide recruitment services to a local IT company, receive a hamper from that company, I do not imagine that the CEO of the IT company and I will soon by going for drinks together at my local bar.

    In some communities, it is customary to provide workers who work in the home with offers of food or drink. And in some, it is considered rude or offensive to refuse. You can of course refuse and explain, but given that within many of these communities, it is customary to strongly refuse and offer justifications for refusal when the offer is made, you are not communicating what you are saying.

    Which raises another issue. Refusal to accept gifts can lead to an alteration to the professional relationship in much the way that we fear accepting gifts can. A professional relationship is usually based on respect for the client and in a good professional relationship, you ensure that the client and other stakeholders also feel respected. The refusal to accept a gift in a context where it is customary to do so within the context of a professional relationship can often be interpreted by the rejected client or stakeholder as a deliberate act of disrespect. With accepting gifts, we fear that clients may believe that we are friends. When we reject gifts, we, in some cases, risk clients believing that we are enemies.

    Lastly, I think we need to be realistic about our relationships with clients. Multiple relationships are inevitable. Let’s take the example of an ABA tutor who works in the home of a client on a daily basis for 5 hours per day. They’re working with a three year old child. They provide them with care and therapeutic input under the supervision of a BCBA consultant. After 5 years of working with that child for 5 hours per day, is there anybody who would have a purely professional relationship with that child? If that child were to die, would they not feel pain and loss? Is it possible to care for somebody for that long and over such a period of time and not love that child? I’m talking about love that is essentially the same as that of a family member, but I’m not sure that I would want anybody working with my son or daughter who could feed them, clothe them, toilet them, teach them how to speak and to listen, play with them etc. and not hold some degree of affection for that child? We say that the code applies to those who are seeking certification and yet many of them will find themselves in such situations.

    The intent of the rules related to multiple relationships is good, but they are not good rules. They are not based on evidence and they fail to acknowledge the fact that behaviour analysts operate in a large number of different contexts across the planet. In fact, worse than not being based on evidence, it is quite clear that the claim that accepting a gift “constitutes a multiple relationship” is false.

    The issue is tackled in more depth here:

    http://mattbrodhead.squarespace.com/new-blog/2017/12/22/behavior-analysts-accept-gifts-during-practice-so-now-what

    The alternatives offered in the piece above are useful but they don’t solve the problem. There is a reason that other professional organisations do not prohibit accepting gifts where it would be culturally inappropriate to refuse them. This rule may be useful in terms of disciplining those who engage in unethical behaviour but it creates far more problems than it solves.

    • Fred, very thoughtful response.
      As a clinical behavior analyst (FAP, ACT, DBT), paying attention to interpersonal dynamics is central, and we see that the therapist’s relationship with the client is a “real relationship” that is in some ways constrained by the commitment to be therapeutic for the client and to not exploit in any way. I feel certain that to have rejected gifts (again, the issue of just what is a gift and what might be considered “appropriate and acceptable”) from my long-standing (5 plus years) most severe depressive/suicidal &/or borderline clients would be a severe setback or would break the relationship. I have had a weeks long crisis after gently interrupting a client almost 10 minutes after session ending time to ask that we end the session. I would gladly have accepted the “gift” of ending on time without conflict.

  3. Jody Hunsberger | February 22, 2018 at 7:03 am | Reply

    It is important to recognize that various cultures will find offense for rejecting food and drinks offered to them, as this is a token of respect when you enter the homes of Hispanic, Chinese, Arabic and English households. As Behavior Modification was derived from North America, if you are practicing BA abroad, it is important to establish relationships with individuals. Building relations often center around primary reinforcement. If you have walked several kilometers to reach your client’s house in a hot climate with no possible source of water other than your client’s home, is it suggested that you remain dehydrated as to adhere to the ethical code of BA? Maybe within the paradigm of the United States and other developed nations this code is possible; however I question the people’s ethnic background, history and environment that leads to such narrow views on establishing relationships. What if the pilgrims rejected the offers of the natives to use fthe remnants of fish for farming their crops? If you refuse the drink of a local Amazon tribe? These are the very reasons why Behavior Analysis suffers the ability to expand as a field.

  4. Monica Gaitonde | June 6, 2018 at 6:36 pm | Reply

    Hi I have a question. Are we allowed, as RBTs, to accept gifts from the family when it is their last day receiving services from our company? My kiddo will be moving to another state and this means I will no longer be giving therapeutic services to this child. Am I still not allowed to accept any “going away” type gifts or even a card?

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