Dealing with uncertainty: A systematic approach to addressing value‐based ethical dilemmas in behavioral services

Huang et al. (2023) wrote a how-to paper for BCBAs. They list six clear steps to use when family values clash with clinic rules or funding limits.

The steps fit on one worksheet. You can use it in telehealth or in-person cases. No new data were collected; the paper is a tool.

The authors show that filling out the worksheet slows you down just enough to see every stakeholder’s values. This lowers the chance you will act on autopilot and later regret a decision.

Newhouse-Oisten et al. (2017) gave BCBAs a four-step tree for medication changes. Huang’s six-step sheet is wider; it covers any value clash, not just pills.

Piazza et al. (2025) later tested a remote BST package that teaches trainees to run ethical scenarios. Their package builds on Huang’s worksheet; trainees learn by walking through the same six boxes.

Colombo et al. (2020) offered a crisis triage matrix. Both papers give BCBAs a fill-in form, but Colombo focuses on keeping medically necessary sessions alive, while Huang focuses on whose values win when people disagree.

Next time the parent wants prayer-based treatment and the funding source wants pure ABA, pull up the worksheet. Five minutes of writing protects you from an ethics complaint and shows the BACB you used a system. That single sheet can save your license and the client’s dignity.