It is the Proud Moments’ policy to preserve the rights of patients and to facilitate the staff’s awareness of these rights. The values of Proud Moments support the need to foster the dignity and preserve the rights of each patient. We recognize that no catalogue of rights can guarantee the kind of treatment a patient has the right to receive. Therefore, in addition to the rights contained in this policy, we will continue to carry out all aspects of patient care with primary concern for the value and dignity of the patient.
Following is a list of patients’ rights and responsibilities:
- Patient Rights
- Appropriate and compassionate care:
Patients have the right to appropriate and compassionate care at all times and under all circumstances. Patients will not be denied appropriate care on the basis of age, race, religion, color, national origin, ethnicity, religion, sex, sexual orientation, gender identity or expression, physical or mental disability, marital status, socioeconomic status, or source of payment. Patients have the right to receive care that takes into consideration the psychosocial, spiritual and cultural values that influence the way the patient views their illness.
- Staff Identification:
Patients have the right to know the identity and professional status of individuals providing care to them. All staff members are required to introduce themselves and explain their role in patient care.
- Information regarding medical condition:
Patients have the right to receive information about their medical diagnosis, proposed course of treatment, procedures, and prospects for recovery unless this is medically contraindicated. This information should be communicated in terms the patient can reasonably be expected to understand. If the provider withholds this information, he/she must record the reason in the patient’s record. When it is not medically advisable to give such information to the patient, the information should be available to a legally authorized individual.
Patients have the right to expect reasonable safety in the performance of procedures and safety in the environment.
- Advance Directives:
Patients have the right to formulate advance directives and have their care providers comply with these directives in accordance with applicable law.
- Refusal of treatment:
Patients have the right to refuse treatment to the extent provided by law and to be informed of the medical consequences of that refusal. Patients who refuse care or treatment are responsible for the results of that decision. When refusal of treatment prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the patient may be terminated upon reasonable notice.
- Research, educational or experimental procedures:
Patients have the right to information concerning research or experimental procedures proposed as a part of their care and have the right to refuse to participate in any such activity and refusal to participate will not jeopardize or affect care in any way.
- Request for service:
Patients have the right to expect that within its capacity, the organization will respond to a patient’s request for service. Evaluation, service and/or referrals will be completed as indicated by the urgency of the case.
- Freedom from restraints:
Patients have the right to be free from restraints except when necessary to protect the patient from injury to self or others. The least restrictive restraint will be used whenever possible. Restraints must be administered in accordance with applicable and standard state code and regulations.
- Access to the medical record:
Patients have the right to read their medical record. Patients also have the right to read and/or obtain copies of their completed medical record upon request.
- Confidentiality of records:
Patients have the right to expect that communication and records regarding their care will be treated confidentially. Records will not be released except as authorized by patients or their legal representative.
- Privacy - personal and informational:
Patients have the right to privacy in treatment and in caring for their personal needs.
- Presenting a complaint:
Patients and their family members or guardians have the right to present complaints to Proud Moments about any aspect of the patient’s care from Proud Moments.
- Continuity of care:
Patients have the right to expect reasonable continuity of care, including discharge planning and discharge instructions. Patients are entitled to information concerning continuing health needs, alternatives for meeting those needs and be involved in discharge planning.
- Information regarding reimbursement charges:
Patients have the right to receive an explanation of their reimbursement charge regardless of the source of payment.
Patients have the right to reasonably informed participation in decisions involving their health care. Patients should not be subjected to any procedure without their voluntary, competent, and understanding consent or that of their legally authorized representative. Where medically significant alternatives for care or treatment exist, the patient shall be so informed.
- Other rights:
Patients will be notified when they are no longer eligible for insurance or when payment of their bill by others will end. Whenever possible, advance notice will be given.
Patients, and when appropriate, their families, will be informed about the outcomes of care, including unanticipated outcomes.
Proud Moments specifies to parents what factors are considered in making dosage recommendations (e.g., assessment results, behavioral needs, etc.) and what factors cannot be considered solely in recommendations (e.g., parent scheduling preferences, funder restrictions, etc.).
When determining the recommended dosage of hours for treatment, your BCBA will take the following into consideration: assessment results, behavioral needs, scheduling availability and overall deficit level of the learner.
- Patient Responsibilities
Healthcare is a cooperative effort among patients, physicians, and other staff. In addition to rights, it is expected that patients will assume these responsibilities to the best of their abilities.
- Following the organization’s rules and regulations as they are explained or as described in printed material.
- Providing, to the best of their knowledge, a complete and accurate medical history when requested to do so.
- Informing their provider if they do not understand their treatment plan or what they are expected to do.
- Following the recommended treatment plan presented by the provider (or designate).
- Informing their provider or organization representative if there is an unexpected change in their condition or if problems arise in treatment.
- Paying their reimbursement charge or for informing the organization if they cannot pay the bill so that other arrangements can be made. Patients are responsible for being familiar with the nature and extent of their insurance coverage including referral and authorization requirements.
- Patients and their families are responsible for reporting perceived risks in their care and unexpected changes in the patient’s condition. Patients and families also have the right to education about their role in helping to facilitate the safe delivery of care.
- Preventing and Responding to Abuse/Neglect
Proud Moments ABA is committed to providing a safe and respectful environment that supports the health and well-being of all our clients. We have instituted guidelines and resources for our staff and enforce zero tolerance for any actions which may jeopardize the health and safety of any client. Should you ever be concerned about the treatment of your child or anything you see in one of our locations, please let management know. You can also report any concerns anonymously by calling our hotline at 1-866-538-4427.
Please note that Proud Moments ABA and our staff are subject to Mandated Reporting laws in all states.
What Mandated Reporting Means?
Mandated reporting means a legal obligation to file a report when a provider has reason to suspect child abuse or neglect. Reports are filed with a State or Local governmental office for investigation. Mandated reporting is not optional – it is required.
Who are Mandated Reporters?
All Proud Moments staff are mandated reporters. All states have a list of mandated reporters which may vary by state, but usually include, teachers, childcare providers and medical professionals.
What Mandated Reporters must Report?
Every state has slightly different requirements. However, most states require reporting to state or police authorities about any suspected neglect, emotional abuse, sexual abuse or physical abuse. Some examples of neglect include a child who arrives without warm clothes in winter, a child who is not fed at home or who has hygiene problems. Some examples of abuse include a child with multiple unexplained bruises in places unlikely to be from play, defensive wounds, burn marks or bites. As a behavior health provider, it is essential you notify us of any concerns so that we can document and develop plans around self-injurious behaviors that could appear like abuse/neglect.
- Abuse Prevention
Proud Moments is committed to providing safe and respectful environments that support the health and well-being of all clients receiving our services. Proud Moments seeks to institute guidelines and resources for staff and enforce zero tolerance for any actions which may jeopardize the health, safety or welfare of any client. This policy establishes that a thoughtfully crafted abuse prevention policy is necessary to balance effective safety measures with efforts to empower people receiving services to lead self-directed, meaningful lives.
All staff will follow this policy and be trained on the prevention of abuse and recognizing/reporting potential abuse.
Personnel Screening and Selection
Screening and hiring procedures provide safeguards to strive to eliminate from consideration any candidate who demonstrates behavior that indicates a high risk for violating this policy. Screening and background information required to comply with law depend on the position and its level of involvement with people receiving services. The procedures outlined in this section pertain to those who have regular contact, or that level as required by law, with people receiving services.
Candidates for positions that involve regular interaction with people receiving services are screened and selected as follows:
- Standard employment application that includes signed authorization to perform necessary background checks;
- Exclusion list checks (of all government payors/programs)
- Criminal background checks including signed authorization to perform the check;
- Sexual offender registry checks in any and all states where the candidate has lived;
- In-person or video interview of the candidate that includes questions about experiences and thoughts on how to handle challenging behaviors, conflicts, or other unexpected circumstances when providing care, as well as how they feel about providing care to this vulnerable group. Any remarks indicating unwillingness to accept legal definitions of abuse and neglect and related reporting procedures are thoroughly explored.
- Three professional/personal references are required, contacted directly via telephone and asked questions from an established reference check guideline.
- If hired, sexual offender registry checks are conducted annually for those who have regular contact with people who receive services.
All information collected about any candidate is reviewed to determine if the candidate is appropriate for the respective position. If hired, all information collected during the hiring process is included in the staff’s permanent file.
All information collected about any candidate is reviewed to determine if the candidate is appropriate for the respective position. If hired, all information collected during the hiring process is included in the staff’s permanent file.
Treatment Guidelines (In-Center & Home)
All programs are designed to encourage safe interactions between staff and clients receiving services. The following guidelines are meant to maintain effective safeguards while upholding the dignity of individuals.
Individual Staff Never Alone with Clients: Staff scheduling in centers is accomplished to ensure that individual staff members are never alone with a client. There should always be at least two staff when servicing clients in a center. In home settings, a responsible adult must be present when servicing a client.
Visitors: All visitors will check in with staff and share the purpose of their visit. Proud Moments will notify staff they have a visitor, identify an appropriate location for the visit and reject/set limits with visitors who are unwelcome. Particulars of visitors will be kept in a log.
Community Integration: Proud Moments BCBAs will train the BTs on how to respectfully safeguard the client when supporting them in a community setting prior to use of community settings.
Abuse prevention training is provided to all staff to ensure they understand what constitutes abuse, signs and symptoms of abuse, and their responsibilities to protect clients receiving services from abuse and neglect. The training includes guidance on how to step in and stop an incident, as well as procedures to assess the impact of an incident on an individual, to monitor the individual for behavioral changes following an incident, and to identify and address any negative impact on other people receiving services.
Training shall occur at the onset of employment and at least annually thereafter.
Staff will also receive training on mandated reporting requirements.
Interactions and Conduct
The Proud Moments Code of Conduct outlines expectations for staff to exercise safe, responsible and respectful behavior in their interactions with clients. The culture of Proud Moments is modeled by all leadership to reinforce the Code of Conduct.
The following standards are meant to further guide staff during their interactions with clients. These guidelines do not and cannot outline every potential situation, thus we require staff to act with a certain degree of personal and professional discretion. Because a certain action is not expressly prohibited in this section does not mean it is acceptable behavior. Proud Moments reserves the right to take disciplinary action against staff whose actions are found to be inappropriate regardless of whether they appear in this section.
- Staff treat all clients with respect and consideration. Treatment must be fair and equitable, and must not impose bias due to gender, race, religion, sexual orientation or identity, economic or social status, or disability.
- Diligent effort is made to avoid preferential treatment or the appearance of such.
- Staff do not use harsh, demeaning or inappropriate language, degrading punishment or any type of unauthorized restraint in the name of behavior management.
- Staff do not participate in or allow others to engage in any form of hazing, unwelcome teasing, ostracism or bullying.
- Staff do not intentionally connect with a client or their family outside of the course of their work and limit unintentional contact to brief greetings and conversation.
- Staff do not connect with a client or family via social media.
- Staff do not share sleeping locations with clients/families, except as deemed necessary by the individual treatment plan and client’s guardians to meet individual needs.
- Staff do not engage in certain types of physical contact that may be unwelcome or misconstrued by the individual or others. This includes bear hugs, pats on the head, pinching cheeks, pat on the buttocks, etc. Staff may provide supportive, affectionate physical contact, as indicated by each individual’s needs/preferences, and as defined by the treatment plan.
- Staff, to the best of their ability, identify when circumstances beyond their capabilities to address in a productive manner, and request support from supervisors and peers.
- Staff intervene and provide support when they observe co-workers exhibiting a loss of ability to safely and effectively manage a challenging behavior, or other circumstance involving a client.
- Staff do not use physical punishment in any form. The only time physical force is permitted with a client is when their actions place themselves or others at immediate risk for serious harm, and such interaction is guided by trained staff in Proud Moments crisis management procedures.
- Staff do not have any sexual contact with clients or their families, including the touching of non-sexual body parts for the purposes of sexual stimulation for either party.
- Staff address and manage their own sexual reactions to clients/families by requesting support from their supervisor as needed, requesting limited contact or other safeguards to protect professional boundaries.
- Staff do not dress, undress, shower or bathe with, or in the presence of clients.
- Staff do not discuss their own sexual history, preferences, or fantasies, nor their use of illicit or pornographic materials while in the company of clients/families.
- Staff do not possess any sexually oriented materials when conducting business in the name of Proud Moments.
- While representing Proud Moments, staff do not possess, distribute, use or allow others to use or be influenced by any alcohol or drugs.
Monitoring and Supervision of Staff
Proud Moments has developed certain monitoring and supervision standards for its services. This encourages active supervision of cases not ensure not only effectiveness of treatment but also to prevent abuse. All cases should be supervised by a BCBA at not less than 10% of direct care hours. In clinics, management should be actively involved to spot check and ensure appropriate treatment.
Proud Moments staff are mandated reporters of abuse/neglect and any suspected abuse or neglect must be reported to authorities. Please see the abuse and neglect reporting policy for more details.
- Beware of Non-evidence based treatments
All parents want their children to lead healthy and fulfilling lives. Unfortunately, as parents of children with autism strive to help their children they can fall victim to duplicitous claims that encourage them to try unsafe, expensive and ineffective non-evidence-based treatments. Before beginning any treatment, parents should question whether there is a coherent scientific rationale behind it, and think critically about its associated risks and benefits. They should also ask their healthcare practitioner whether the treatment has been proven effective and safe in objective scientific studies and whether those studies have been published in well-established, highly reputable, peer-reviewed medical journals.
It is important to remember that anyone can start a journal or post a study on the Internet to tout the efficacy of dangerous or useless interventions. Healthcare fraud is a huge business in the US, and parents of children with autism are often targeted. Fringe treatment providers prey on desperation and fear, and deceive parents with numerous unfounded claims.
To be considered evidence-based, a treatment must be thoroughly investigated in multiple well-designed scientific studies and show measurable, sustained improvements in targeted areas. A study’s design largely depends on its focus and purpose, but there are some characteristics that well-designed studies tend to have. These include but are not limited to:
- Use of well-matched comparison groups – participants receiving the new intervention should be compared to a group of participants receiving a standard community intervention, and/or a group receiving no intervention. The comparison groups should match the ‘new treatment group’ in average age, gender distribution, diagnosis, level of functioning, and any other potentially confounding variables.
- Random assignment of participants to treatment/comparison groups.
- Pre- and post-test design – performance on a given test is measured before and after the intervention to measure change.
- Use of representative samples – study participants should be representative of the target population. That is, a study testing an intervention for toddlers with ASD and average IQs should not use a sample of autistic school-aged children with an uncharacteristically high rate of intellectual disability.
- ‘Blinding’ of individuals involved in the experiment – where appropriate, investigators and participants should not know group assignments (e.g., placebo v. medication) in order to prevent biases during data collection.
- Use of adequately large samples based on past research and statistical analysis.
Proud Moments only provides Applied Behavior Analysis interventions, an evidence-based approach to treating the core symptoms of autism. Proud Moments will not implement any non-evidenced based interventions, including the therapies described below. In the event that you choose to engage in a non-evidenced based intervention, Proud Moments will take the following approach:
- In the event that the intervention is not interfering with the treatment team's ability to deliver ABA, the BCBA will use their parent training time to discuss the harms of using non-evidenced based interventions and reiterate that Proud Moments only uses evidence based interventions
- If a intervention prevents the treatment team from delivering effective ABA, the BCBA will use their parent training time to discuss the conflict and ask the client to stop engaging in the harmful intervention
- If the client chooses to continue the interfering intervention, the RCD and Administrative Director will meet with the client to discuss possible resolutions, including client discharge"
Below is an overview of commonly discussed treatments that currently are not scientifically validated:
Biomedical Non-Evidence-Based Treatments
Chelation: Chelation therapy involves administering chemicals designed to bind to heavy metals and eliminate them from the body. Chelating agents have a legitimate use in the treatment of poisoning from lead, mercury and other metals. There is no evidence that supports chelation as a safe treatment alternative because autism is not caused by metal poisoning. In 2005, a child with autism died from chelation therapy, when the chelating agent bonded with calcium in his body and caused his heart to stop. No paper published in the peer-reviewed literature has reported abnormal levels of mercury in individuals with autism spectrum disorder. Moreover, symptoms of mercury poisoning are unlike symptoms of autism, making chelation an impractical way to improve symptoms.
Lupron Therapy: Lupron is a testosterone-inhibiting drug used in the treatment of precocious puberty (which is rare) and prostate cancer, as well as for the “chemical castration” of sex offenders. Its use for autism is based on the hypothesis that testosterone magnifies the toxic effects of mercury (see above). There is no evidence that Lupron is safe or effective for the treatment of autism. In addition, it can have harmful side effects including hives, difficulty breathing/ swallowing, numbness, tingling, weakness, painful or difficult urination, blood in the urine, bone pain, testicular pain and osteoporosis.
Hyperbaric Oxygen Therapy (HBOT): HBOT has been proven effective for treatment of gangrene, carbon monoxide poisoning, “the bends” and various other conditions related to oxygen in blood. There is no evidence to support ASD as an insufficiency of oxygen in the blood. Evidence also fails to support HBOT as safe or effective for the treatment of autism. Furthermore, the benefits of hyperbaric oxygen delivered in a soft-shelled chamber are no different than with a less expensive oxygen tent, or nasal cannula.
Gluten Free-Casein Free (GFCF) Diet: Those who promote gluten (protein found in wheat, rye, and barley products) and casein (protein found in dairy products) free diets claim that children with autism have “leaky guts” that allow opioids to escape into the bloodstream and then travel to the brain and cause autistic behaviors. There is no evidence for this claim, and studies have found that compared to typically developing children, children with autism have no more opioids in their blood. Furthermore, children on the GFCF diet have been found to have lower bone density than controls, which could lead to osteoporosis. A large-scale study of the safety and efficacy of the GFCF diet indicated that children on the diet had similar outcomes to those who were not on the diet.
Stem Cell Therapy: Stem cell therapy for autism is illegal in the United States, but that hasn’t stopped some from offering this as a treatment for autism in Costa Rica, China, and other countries. There is no evidence that the treatment is safe or effective for autism, and no guarantee that the stem cells used in these countries are even human.
Secretin Injections: Secretin is a hormone that controls digestion. It is currently prepared from pigs as a synthetic human form is not available. The FDA has approved use of single doses of secretin in diagnosing gastrointestinal problems such as ulcers or impaired pancreatic function in adults, but it has not formally approved the hormone for autism treatment. No data exists on the safety or efficacy of repeated doses of secretin or its use in children. In a report, the National Institutes of Child Health and Human Development states that the efficacy of secretin in ASD treatment is currently unknown.
Antifungal Agent Therapy: Some people believe that bacteria in the gut cause autism, and since antifungal medications can eliminate bacteria they believe they can simultaneously cure autism. There is no evidence to support any antifungal agent as an autism cure. Importantly, treating children with antifungal agents is potentially harmful; possible side effects include itching, irritation, burning, diarrhea, stomach pain, and skin rashes. Some antifungal treatments, including Diflucan, Sporanox, Lamisil, and Nizoral, are absorbed in the body and can impede liver functioning over time.
Vitamin Supplements: It is important to maintain a healthy and balanced diet. To achieve this goal, healthcare providers may recommend nutritional supplements to people with and without autism. Use of supplements can be problematic however, when they are misused in an attempt to cure an individual of autism. There is no scientific evidence suggesting that vitamin supplements can cure autism. Using supplements without consulting a healthcare provider can be dangerous. Some supplements (e.g., vitamin A) can be toxic when taken in high doses for sustained periods; others may not contain what they claim.
Raw Camel Milk: Raw camel milk has been alleged to cure autism-related ills with benefits ranging from improved eye contact and motor skills to decreased inflammation. Although it may be nutritious, there is no scientific research that upholds claims that raw camel milk is an autism “cure-all.”
Marijuana Therapy: Marijuana is an illicit drug whose use in ASD treatment is neither medically nor scientifically supported for the core symptoms of autism. Reported short-term side effects of marijuana use include distorted perception; impaired coordination; and impaired thinking, problem solving, learning and memory. Long-term marijuana use has been associated with decreased learning abilities, increased risk of respiratory diseases associated with smoking, and decreased motivation. There are studies ongoing on specific chemical components called cannabinoids for treatment of epilepsy.
Nicotine Patch Therapy: Research studies have uncovered abnormalities in nicotinic acetylcholine receptors in the brains of people with autism, and some scientists have posited that core symptoms of ASD could be attributed to these alterations. Some findings specifically indicate a shortage of these receptors, leading some to believe that stimulating or increasing these receptors could eliminate ASD symptoms. Proponents of nicotine patch use in individuals with ASD believe that the nicotine released into the body from the patch activates and upregulates receptors, and thereby reduces ASD symptoms. Despite having a rationale that is based on scientific findings, use of this treatment is not supported by scientific evidence. No clinical trials have demonstrated that nicotine patches are safe or effective in the treatment of ASD. Common side effects reported in clinical studies evaluating safety and efficacy of the patches include skin irritation; sleep problems, including insomnia and nightmares; headaches, indigestion, and nervousness.
Bleach Therapy: In bleach therapy, an individual with ASD is given a diluted form of bleach orally or through an enema in an attempt to cure their symptoms. Bleach doses are given repeatedly; supporters of this treatment have recommended that children drink the bleach mixture up to eight times per day or receive an enema up to three times per week. The rationale for the treatment is that bleach can eliminate bacteria, parasites, yeast, and heavy metals and consequently eliminate ASD symptoms. This treatment has been widely denounced for the harm it can cause as well as its complete lack of scientific basis. Ingesting bleach can lead to severe fever, diarrhea, vomiting, and other complications.
Transcranial Magnetic Stimulation: TMS is a procedure in which magnetic fields are used to stimulate nerve cells in the brain to enhance or reduce certain functions. TMS is currently used to treat mental illnesses, including depression and schizophrenia. The most commonly reported short-term side effects include headaches and scalp discomfort. Therapeutic TMS is relatively new so long-term side effects, if any, are unknown. Investigations into the efficacy of TMS in ASD treatment are currently underway, but presently there is no evidence to support its use.
Psychological and Behavioral Non-Evidence-Based Treatments
Therapeutic Horseback Riding: Horseback-riding therapy for individuals with ASD aims to foster motor, communication, and social skills, while improving responses to external stimuli. Although a few studies touting the benefits of therapeutic riding have been published in peer-reviewed journals, they are either mainly descriptive, involve small samples or rely on poor outcome measures, and thus cannot support the therapy as a useful, evidence-based intervention.
Dolphin-Assisted Therapy: When undergoing dolphin-assisted therapy (DAT), an individual with autism swims, touches, and interacts with dolphins. Alleged benefits of dolphin therapy include improved emotional control and communication skills, as well as increased attention. Some proponents also claim that the emotional experience created by DAT helps individuals become more receptive to more conventional treatments. There is no scientific evidence suggesting that DAT is efficacious in the long-term improvement of ASD symptoms. Moreover, DAT involves significant safety risks given that dolphins are powerful animals that are capable of harming humans despite extensive training.
Prism Glasses: Prism glasses alter the visual perception of individuals with ASD and are thought to improve behavior and challenging vision-related symptoms as a result. Supporters believe that some individuals with ASD suffer from distorted perception and compensate using abnormal movements and postures such as head tilting. Prism glasses aim to ameliorate perceptual distortions and aid visual development. Their purported benefits extend to other areas, including spatial localization, visual awareness, decrease in sensory seeking behaviors, organization, gait, eye contact, mood, facial expressions, and fine and gross motor skills. Unfortunately these benefits have no scientific backing; no studies with strong experimental designs have supported the use of this expensive therapy in individuals with autism.
Holding Therapy: Holding therapy is based on the erroneous notion that autism is a disorder of attachment caused by a parent’s failure to bond with their child. In a holding therapy session, a caregiver physically restrains a child with autism in order to force eye contact and repair attachment. This treatment has been deemed ineffective and dangerous. There is no scientific evidence suggesting that holding therapy works and fatalities have resulted from its use.