Case scenario

"I am a BCBA, and I work for a firm that offers ABA treatment to children with autism." Our clinic just began a year ago, and there has been a strong drive to develop as rapidly as possible in order to become financially viable. We were requested to do a burst of first assessments around 2 1/2 months ago, with the promise that a third BCBA would be appointed within 6 weeks to take on these extra clients. It's been two months, and that BCBA still hasn't been employed. In a meeting with my direct supervisor (who is not a BCBA), I inquired whether our existing caseloads would be capped until another BCBA arrived. I was assured that our existing caseloads have no restriction and that we would continue to accept any customers in our pipeline in the future. I inquired whether we would be allocated additional billable hours per week to handle this increase, and she indicated it was possible since a BCBA in another area already has a caseload of 75 billable hours per week. When I inquired whether there were any ethical problems with giving such big caseloads to our BCBAs, she said she didn't know and would bring it up with other corporate management. She then put a stop to the conversation.

Please answer the following:

If all of the clients that I have assessed up to this point actually begin services, I will have a caseload of 40 billable hours per week, and that doesn't account for time needed for non-billable treatment activities, or billable parent consultation hours. I feel like I need to protest but I suspect my job may be on the line when I do, as I've already been told that my salary could potentially be cut if I do not bill enough.

I have significant reservations about stating in my assessment reports for these clients that a particular number of behavior consultation hours are medically necessary and then having such a large caseload that it is impossible to follow through on actually providing all of those hours."

In your response, please be sure to identify the relevant codes that informed your decision-making process as you review the case and suggest a viable solution.