By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
Assess your competence across four dimensions: knowledge of the specific concern and relevant developmental, medical, and legal factors; clinical skills to conduct sensitive assessments and design appropriate interventions; personal comfort and attitudes that would not interfere with objective clinical judgment; and organizational supports including supervision, assessment tools, and policies. If you identify significant gaps in any dimension, the concern may fall outside your current competence. However, this does not mean you cannot provide services. It means you need to pursue additional training, seek supervision, or collaborate with qualified professionals before proceeding.
This is a common dilemma given the scarcity of specialists. First, assess the urgency of the situation and any safety concerns. For immediate safety issues, implement appropriate protective measures while seeking consultation. For less urgent concerns, develop a plan to expand your competence through targeted training, remote supervision or consultation with specialists, and interdisciplinary collaboration. Document your decision-making process including the factors that informed your decision to provide services while building competence. Maintain ongoing consultation throughout the case. The goal is to provide the best possible care while transparently acknowledging and actively addressing your competence limitations.
Consider the developmental appropriateness of the behavior, the context in which it occurs, whether it involves consent, and whether it poses safety risks. Developmentally appropriate sexual behavior occurring in private contexts between consenting adults generally does not require clinical intervention, even among individuals with disabilities. Behavior becomes a clinical concern when it occurs in public contexts, involves non-consenting individuals, is developmentally atypical, causes distress to the individual, or poses safety risks. Avoid pathologizing normative sexual behavior simply because the individual has a disability. Consult developmental norms and seek guidance from professionals with expertise in sexuality and disability.
Code 1.05 (Scope of Competence) requires practicing within competence boundaries. Code 2.01 (Providing Effective Treatment) requires evidence-based interventions. Code 2.14 (Restrictions on Conditions for Behavior-Change Interventions) requires least restrictive approaches. Code 2.15 (Minimizing Risk of Behavior-Change Interventions) requires considering intervention risks including suppressing healthy development. Code 3.12 (Advocating for Appropriate Services) obligates advocacy for needed services including sexuality education. Code 1.07 (Cultural Responsiveness and Diversity) requires cultural sensitivity in addressing sexuality across diverse populations. These codes collectively establish that competent, ethical practice in sexuality requires specialized preparation.
Start with self-directed study of foundational texts on sexuality and disability from both behavior-analytic and interdisciplinary perspectives. Seek out continuing education courses specifically addressing sexuality and behavior analysis. Pursue supervision or mentorship from professionals with expertise in this area, even if this requires remote consultation. Attend conferences and workshops offered by organizations specializing in sexuality and disability services. Build collaborative relationships with sexuality educators, social workers, and medical professionals. Set specific, time-bound professional development goals. Document your learning and seek feedback on your progress through case consultation and peer review.
While the specific tools discussed in Spiker's course should be accessed directly through the training, general approaches include competence self-assessment checklists that evaluate knowledge, skills, and attitudes across sexuality domains; structured interviews with supervisors or mentors that probe clinical reasoning in sexuality-related scenarios; case-based assessments that evaluate your ability to identify relevant variables, select appropriate interventions, and navigate ethical dilemmas; and portfolio-based assessments that document training, supervised experience, and professional development in sexuality-related areas. The key is using multiple assessment methods rather than relying on self-report alone.
Approach these conversations with empathy, directness, and cultural sensitivity. Normalize the topic by framing sexual development as a natural part of human development that requires support and education for all individuals. Use clear, professional language and avoid euphemisms that may create confusion. Assess the family's cultural values and comfort level regarding discussions of sexuality. Provide education about developmental norms and the importance of sexuality education for safety and quality of life. Listen to family concerns without judgment and incorporate their values into intervention planning when ethically appropriate. Offer follow-up resources and ongoing support. Prepare for these conversations in advance and consult with colleagues if needed.
Consent capacity assessment determines whether an individual has the knowledge, understanding, and communication skills necessary to make informed decisions about sexual activity. This includes understanding the nature of sexual activity, awareness of potential consequences including pregnancy, STIs, and emotional effects, ability to identify and communicate personal preferences and boundaries, and freedom from coercion. Behavior analysts can play a critical role in building the component skills needed for informed consent through systematic skills instruction. Consent capacity should be assessed as a dynamic, teachable repertoire rather than a fixed characteristic.
Organizations should provide access to specialized training and continuing education, establish supervision structures that include attention to sexuality-related cases, develop clear policies and protocols for addressing sexuality-related concerns, provide evidence-based sexuality education materials and assessment tools, create privacy accommodations that support clients' rights to sexual expression, and foster a culture where discussions of sexuality are normalized and supported. Organizations should also allocate resources for interdisciplinary consultation and build relationships with sexuality specialists who can provide ongoing guidance. Without organizational support, individual practitioners face significant barriers to competence development.
Avoidance creates multiple risks. Clients are left without services they need, potentially leading to escalation of problematic behavior, exploitation by others, and missed opportunities for skill development that would enhance quality of life. When behavior analysts avoid these concerns, less qualified individuals may attempt to address them using approaches that are less effective, less ethical, or more restrictive. Avoidance also perpetuates the systemic tendency to deny sexual agency to individuals with disabilities. Finally, avoidance does not eliminate liability since behavior analysts may still be held responsible for failing to address significant behavioral concerns within their professional scope.
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Assessing and Addressing Scope of Competence in Sexuality and Behavior Analysis — Shane Spiker · 1 BACB Ethics CEUs · $10
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.