Hi All,
Has anyone seen the feeding therapy video making rounds? It is a video of a child undergoing escape extinction at a hospital-based center, and the anti-ABA camp has latched on to the video, reporting it to news stations. To be fair, the video is definitely not a good look, as the child is under a lot of distress (thankfully he was pulled from therapy), and appears to have a cut. However, on a related note, I am concerned for the image of the therapists and the protections of extern students and interns as they move forward in their careers; as well as the need for ongoing, effective, in vivo supervision when working on tough cases!
Also, how do we, as a discipline, address these events while protecting the patient and family?
These are complicated questions regarding a complex situation of which we only have limited information. Let's assume that the video is of an actual attention extinction/escape-extinction (AE-EE) procedure (which it does seem to be). It's a pretty invasive procedure, with a non-trivial risk of at least physical harm to all participants, as well as a strong potential for "emotional harm" as well (to child, obviously, but also to the therapists). AE-EE has been shown to be an effective treatment for food refusal and associated negative behaviors in numerous peer-reviewed studies. In order to say that it's ethically appropriate in this specific case, I'd need a whole lot more information, such as:
-What, specifically, is the focus of treatment? (e.g., food refusal? over selectivity?) Has this been operationalized? Are there reliable measures of it?
-Has there been a thorough assessment, including medical, psychological, and family history?
-How severe is the problem? (e.g., what the child's body weight to height percentile?)
-Has a functional analysis/assessment been conducted?
-Have less intrusive procedures been attempted and found unsuccessful, or ruled out? (e.g., because they are too slow acting given the severity of the problem ?)
-What are the risks of non-intervention? (e.g., more invasive/surgical procedures- such as g-tube, with significant negative side-effects)
-Has real INFORMED consent been given, with an accurate description of the specifics of the procedure, as well as the risks/benefits of other procedures, including doing nothing at all?
-Is there an appropriate IRB, peer review, and human rights committee that reviews such programs?
-Is there appropriate interdisciplinary oversight, including by an appropriately trained physician and nutritionist?
-Are there clear and realistic safety protocols in place to address any medical emergencies?
-Are there systems in place to identify, monitor, and address any deleterious emotional side-effects of the
-Are the staff adequately trained to competency with such procedures?
-Do the staff receive adequate supervision, including peer supervision and consultation if they are higher-level independently licensed clinical staff
-Are there specific written protocols, with appropriate measures of treatment integrity?
-Are there ongoing and adequate measures of the client's progress with the treatment and are these reviewed thoroughly and compared with typical or expected patterns of response?
-Are there regular measures of the social validity of the procedure? Are these done with all appropriate stakeholders?
-Are these reactions extreme for this particular child? Does he react similarly to less intrusive interventions or events?
-Does he quickly return to "baseline" affect and disposition once the treatment is terminated?
-Are there procedures in place to address any negative effects of the treatment on significant stakeholders? On the therapists?
I think that, as a discipline, we need to recognized that there are often issues with treatment that require appropriate and ongoing input from people outside of the discipline, including current and former clients, their caregivers, and representatives from their communities. If the info on the facebook page is true (and I just don't know what is or isn't- some of it seems a little questionable) then this parent either did not know what she was consenting too, did not understand the risks/benefits of the treatment, and may have felt like she had no other choice (e.g., existing services at another clinic were being terminated). None of that is acceptable, and if any of it could've been anticipated, she should have been provided resources to help her make truly informed consent, including access to objective and knowledgeable third parties not affiliated with the treating facility.
