Cultural Competency in ABA Practice

The Behavior Analyst Certification Board (BACB) on their website lists credentialed behavior analysts from 99 countries spanning across 6 continents. Behavior analysts and consumers of behavior analysis are now establishing footprints across the globe. Each of these countries comes with its own set of cultural practices and norms. Leon Megginson, author of Small Business Management said, “it is not the strongest, or the most intelligent who survives, but the one most responsive to change”. Considering the high rates of global migration and the international dissemination that our field desires, practitioners find themselves serving an increasingly diverse population. A recent article in Behavior Analysis in Practice by Andrea Dennison and colleagues highlights the variations in cultural norms, caregiver and practitioner linguistic competencies that a culturally competent ABA therapist must consider when designing a home program.

What are the barriers?

The Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board requires that behavior analysts consider the role of culture in service delivery (BACB code 1.05c), involve clients and families in treatment process (BACB code 4.02), and individualize the treatment plan to meet client needs (BACB code 4.03). Yet the BACB Fourth Edition Task List and the upcoming Fifth Edition Task List which define the scope of practice of a credentialed behavior analyst do not make much mention of culture – which means that training programs do not typically include cultural competence. Dennison and colleagues (2019) identified several barriers in ABA treatment for culturally and linguistically diverse families and highlighted ways to overcome them.

Do we hold stereotypes?

With the influence of the media or the people around us, we tend to categorize people into social groups and create a simplified conception of the group based on some assumptions – we create stereotypes and hold prejudices. Implicit biases held by a practitioner towards certain cultural sub-groups may result in a subtle, yet observable bias towards the client, and adversely impact treatment outcomes. Dennison et al (2019) suggest that a practitioner’s “self-reflection and introspection regarding cultural attitudes and practices towards clients” may be a first step towards undoing these biases.

Are we aware of cultural norms?

Practitioners often find themselves in a variety of contexts and situations with varying contingencies. Each culture comes with its own set of learned behaviors, beliefs, and norms. Dennison and colleagues add that some cultures might prefer a warm, informal discussion with a service provider prior to a formal meeting to discuss goals. A violation of this might seem off-putting to the client, and conversely, such an expectation for an informal discussion might catch the analyst unaware. In some cultures even a simple handshake for greeting might be offensive They recommend that practitioners monitor clients for signs of discomfort or displeasure during the course of the treatment to identify whether a cultural norm has been violated.

What to do when a practitioner doesn’t speak the home language of the client?

A language mismatch between the practitioner’s language and the home language of the client might lead to information loss. A client might not be able to completely express their priorities in terms of the services they need. Dennison urges practitioners to make every attempt to invite a bilingual practitioner or interpreter either in-person or online, to future family meetings. Providing the family with access to ABA textbooks written in their home language might be a good way to introduce ABA terminology and lead to better acceptability of services delivered. The authors caution against using loosely translated words; online tools might not be ideal for activities that require precise definitions.

Cultural analysis

“A cultural analysis involves an individual analysis of the cultural factors affecting an individual’s environment and the resulting contingency”, the authors add. A re-assessment of priorities in goals might be warranted, and a cultural analysis might inform what behaviors are identified as the primary targets for intervention. Dennison refers to the importance of social etiquette and the value placed on conflict avoidance in Latin cultures as an example. Measuring social validity might give the analyst information about whether the family sees the behavior change as meaningful.

Empathy grows as we learn

Try not to stigmatize immigrant families as “uncaring” for not seeking services earlier. Several socioeconomic stressors such as lack of housing and transportation availability likely play a role in their decision. The authors urge practitioners to empathize with these families and add that attempts to empathize can be made even if the practitioner and family do not share a common home language.

Finally, the lack of diversity in research with the omission of demographic details such as language and ethnicity of participants in scientific publications overlooks the critical value of such information. This calls for a shift in the field towards intentionally inclusive subject recruitment and the reporting of such information.

A culturally competent behavior analyst is not one who knows everything there is to know about every culture. This would be impossible. It is someone who can acknowledge that patterns of cultural difference may be present, and are then able to view a situation from a different cultural perspective than one’s own. Maintaining a curiosity about each client’s culture, and having an open dialogue with them about their background, ethnicity, and belief system can result in a positive outcome for the client and the analyst.

“If we are going to live with our deepest differences then we must learn about one another.”  ― Deborah J. Levine

References

Dennison, A., Lund, E., Brodhead, M., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice, OnlineFirst, 1-12.


About The Author

Maithri Sivaraman is a BCBA with a Masters in Psychology from the University of Madras and holds a Graduate Certificate in ABA from the University of North Texas. She is currently a doctoral student in Psychology at Ghent University, Belgium. Prior to this position, Maithri provided behavior analytic services to children with autism and other developmental disabilities in Chennai, India. She is the recipient of a dissemination grant from the Behavior Analysis Certification Board (BACB) to train caregivers in function-based assessments and intervention for problem behavior in India. She has presented papers at international conferences, published articles in peer-reviewed journals and has authored a column for the ‘Autism Network’, India’s quarterly autism journal. She is the International Dissemination Coordinator of the Association for Science in Autism Treatment (ASAT) and a member of the Distinguished Scholars Group of the Cambridge Center for Behavioral Studies.

ABA Journal Club: A Response from Dana Reinecke

A quote from this week's ABA Journal Club response from Dana Renecke

Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Check out last week’s discussion questions here!

Behavior analysts engage in many different professional activities, many of which are more or less likely given specific clinical or research settings. For example, some behavior analysts who work with individuals with disabilities are likely to conduct preference assessments and use token economies, while those who work with organizations are less likely to use these technologies. One part of the behavior analyst’s repertoire that is always important, however, is the careful and accurate collection of data. This skill set is necessary for understanding and assessing behavior, as well as for ongoing monitoring of the effectiveness of behavioral interventions. 

It is important to understand not just how to measure behavior, but when to use each type of measure.  LeBlanc, Raetz, Sellers, and Carr (2016) describe some of the critical questions that should be considered when choosing a measurement procedure and offer a clinical decision-making model to guide behavior analysts in making these choices.  This article is useful for helping trainees to practice choosing measurement procedures, and reminding more experienced behavior analysts about the considerations involved in measurement. 

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice9(1), 77-83.

Why is this article important for practitioners to read?

Measurement of behavior is one of the most important activities that a behavior analyst engages in.  Without accurate, meaningful measurement, assessment of both behavior and intervention effectiveness is impossible.  Trainees should read this article to learn about the important variables involved in choosing appropriate measurement systems, and more seasoned behavior analysts should read it to remind themselves about those variables.  Even though the article is focused on the measurement of problem behavior, the same principles can be applied to the measurement of behavior targeted for increase.

The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?

Length of observation period might be a relevant factor in choosing a measurement procedure.  Consideration of the availability of resources may be influenced by the goal for how much observation is desired.  To use the case example provided by the authors, Joey’s teacher and aide might not be able to continuously record his work engagement throughout the day, but one of them might be able to do so for a limited sample of each day.  They could choose to conduct continuous measurement during a sample interval, and compare it to the longer period of discontinuous measurement to ensure that the discontinuous measure does not result in an over- or under-estimate of behavior. 

Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.

As a consultant, I need to measure behavior based on limited samples when I can observe, and I also need to design data collection plans for the staff who are there for the rest of the week.  Staff are often responsible for more than one student, and may not have the resources to conduct continuous event recording.  Behavior is also often not discrete (e.g., crying) or occurs too frequently to count (e.g., stereotypy).  I often use partial-interval recording when I consult in school programs.  This allows for a very easy, non-intrusive overview of the pattern of behavior across the school day.  Another common measure is duration of behavior, because it is also relatively easy to start a timer when behavior begins, and stop it when it ends.  Frequency data are pretty rare in my practice, and reserved for low-frequency behavior that only occurs under specific circumstances.

In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?

When training staff to collect data, it’s important to acknowledge any unintended bias.  Depending on the staff member’s level of experience, I will conduct more or less frequent IOA to reduce the risk of observer drift, and will also regularly review behavioral definitions to ensure that we are still talking about the same thing.

In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?

The importance of each dimension of the behavior will depend on the situation, the behavior, and the target or goal for the behavior.  For example, if a student is able to answer social questions but only does so after a delay, we would want to target, and therefore measure, latency to respond instead of frequency.  Or, a learner might engage in several very brief tantrums throughout the day.  In that case, I would expect that duration would be less important, and frequency a more meaningful measure.  By contrast, if a learner engages in one or two very long tantrums per week, we would want to measure duration and possibly intensity, rather than highlighting frequency.

One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

One possible way to validate this model would be to provide several experienced behavior analysts with some case studies, and ask them to use the model to recommend measurement procedures for each case study.  High levels of agreement between the behavior analysts might indicate some validity for the model.  Further validity could be achieved by using the model to select measures, and then conducting those measures and comparing them to true values (e.g., permanent products or continuously-collected event recording).


About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

Misconceptions About Reinforcement

ABA often gets a bad rap due to misunderstandings about reinforcement. In my career alone, I’ve had people tell me that people are not like rats and pigeons, that reinforcement harms intrinsic motivation, and that when I do produce behavior change, it has nothing to do with ABA but with my abilities as a teacher. Today, I’d like to clear up some misconceptions about reinforcement.

Reinforcement is not equivalent to rewards.

Reinforcement is anything that occurs immediately following a behavior that increases the future likelihood of that behavior. For instance, I am more likely to say hello to my neighbor down the street because in the past he has responded by saying “hello” back to me. However, I do not say hello to my next-door neighbor because she has never responded to my greeting. My history of reinforcement with the neighbor down the street increases the likelihood that I will greet him upon seeing him.

Reinforcement occurs in the natural environment all the time, whether we are conscious of it or not.

We are reinforced by paychecks for going to work, by our favorite dessert for visiting a restaurant 30 minutes out of our way, by compliments when we get a new haircut and more. ABA utilizes reinforcement when an individual is not acquiring skills in order to help them learn. And when ABA is implemented correctly, reinforcement should be as close to naturally occurring reinforcers as possible and should be reduced systematically over time to levels that would naturally occur in their environment.

Reinforcement works for dogs and for humans.

The previous two points illustrate that humans do respond to reinforcement, and decades of scientific research back that up. Comparing the work behavior analysts do with humans to the work behavior analysts do with other animals is not far off base. What is off base is using such a comparison to imply that behavior analysts treat people with disabilities like dogs. As with other professionals who work with individuals with disabilities, (such as speech therapists, physical therapists, nurses, etc.) most behavior analysts are professionals who put a lot of time, care, and love into their work.

Reinforcement is individualized.

Everything we do in ABA is individualized because human beings are wonderfully complex creatures that cannot be characterized by statistics, averages, or norms. One of my students may find stickers reinforcing; another may show no interest. One student may find listening to music reinforcing; another may cover his ears and ask me to turn it off. In ABA, we seek to find the items and activities that are motivating for individuals; then use those as tools not only for reinforcement but for increasing skills and broadening interests and opportunities. In an ideal ABA session, my students spend a lot of time engaging with items and activities that they enjoy while also learning and growing.

It’s easy to fall prey to misconceptions about reinforcement, but such misconceptions can make it impossible for us to understand how to alter the environment in order to provide the best possible outcomes for our students. As Skinner put it, “The ideal of behaviorism is to eliminate coercion: to apply controls by changing the environment in such a way as to reinforce the kind of behavior that benefits everyone.”

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WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges. You can read more of Sam’s posts for DRTL here!

ABA Journal Club # 6: A Response From Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This month’s response comes from Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS. Sam’s original blog can be seen here.

  • How does Skinner’s definition of culture differ from how you typically consider culture?

Fong: I think that Skinner did a nice job of linking a person’s actions and beliefs within the context of their environment.  At times, I feel it’s an oversimplification of a term, and behavior analysts should explore (on a deeper level) what that means. It defines culture, but lacks in helping us to understand it, or on a more practical level, what this means for our practice of ABA. I’m in agreement that our histories and the contingencies that we come into contact with shape who we are.  But as clinicians, what does this mean? When I think of culture, I consider things like history, contingencies and the environment in which the person operates, but I also try to draw out more information about what this means for my work as a clinician – if at all.  Culture is deep and rich, and sometimes I feel that relying on just Skinner’s definition doesn’t take all this into consideration. We can take that as a starting point, on how to conceptualize culture, but we need to go further into truly trying to understand what it is. Some interesting articles to review on the topic are: Muchon de Melo, C., & de Rose, J. C. (2013). The concept of culture in skinnerian Radical Behaviorism: Debates and controversies. European Journal of Behavior Analysis14(2), 321-328; Glenn, S. S. (2004). Individual behavior, culture, and social change. The Behavior Analyst27(2), 133-151.

  • Have you encountered situations in which by cultural contingencies impacted an intervention you planned? What might you have done differently if you could go back in time?

Catagnus: I’d like to share the story of two of my colleagues, Stacee Leatherman and Ashley Knochel. They are both doing really important work in this area that exemplifies this issue. And, you’ll likely see their papers on the topics published soon, so this will be a preview. Stacee was a therapist working with a family from a different country that had immigrated to her local area. She reported at a recent ABAI conference event that she felt ill-prepared by her behavior analytic training to adequately assess and intervene in a culturally appropriate way. The family ultimately left ABA services, and Stacee went to the literature to see what their consulting group could have done to better serve the family. She found almost no relevant empirical research in ABA journals that addressed implementation or culturally adapted interventions with non-Western families of children with Autism. We recently submitted a manuscript presenting her findings and making some recommendations of our own.

Leatherman, S., Catagnus, R. M., Brown, T. W., Moore, J., Torres, I. (2019). A systematic review of strategies to improve treatment services provided by cross-cultural practitioners working with individuals with autism spectrum disorder. (Manuscript in preparation).

Ashlee, along with co-researchers, has conducted one of the rare empirical studies of ABA with non-Western learners (and is submitting this manuscript soon). She was working in Ghana at a school for children with ASD. She helped the teachers implement a common behavior analytic technique, behavior specific praise. She did so in a way that is typical here in her culture in the US, in terms of using language to label the behavior, specifically, vocally, and with excitement. For cultural reasons, the way she’d learned to conduct the procedure in her culture caused a decrease in the desired behavior of working on task! So, she met with the stakeholders in the setting, engaged in culturally sensitive and humble question asking, and was able to collaboratively identify why the commonly used approach was not culturally appropriate or helpful – why it was detrimental to learning. Together, they revised the way the reinforcement was delivered, assured it was culturally correct, and the on-task behavior improved, and the staff reported feeling that Ashley’s interactions were culturally relevant. The outcome, and consultation process, was impactful. This is some of the first empirical data I’ve seen to explain how ABA interventions repeated ‘the way we learned to do them in our own culture’ can negatively impact those we service if we don’t approach the planning and implementation in a culturally interactive and open way.

Knochel, A., Blair, K. C., Sofarelli, R. (2019). Culturally focused classroom staff training to increase praise for Ghanaian students with autism spectrum disorders. (Manuscript in preparation).

  • Do you currently engage in any of the suggestions the authors provide for self-reflection? What has been your experience with self-reflection?

Catagnus: I regularly engage in self-reflection in the forms of mindfulness practice and formal meditation. In fact, I developed a mindfulness and ABA course at TCSPP and get to regularly talk about this with our students. I think and talk about my own cultural frameworks and background regularly, too, because of the types of research and implementation we conduct for culturally relevant pedagogy at the University. Luckily, the work that I do is immersive in terms of cultural topics, and I continue to develop my self-awareness. I also seek out experiences of diversity, by traveling, engaging in study abroad programs for myself and creating them for my students. I’ve worked with amazing local early educators in South Africa, visited cultural and academic sites in Denmark, taken classes in Spain, and am about to do visit Singapore, Malaysia, Vietnam, and Qatar. Developing relationships with people around the world has helped me stay reflective and to grow personally and professionally. Learning never stops for this process.

  • Do your current functional assessments incorporate cultural variables? If not, what can you change to improve your functional assessment process?

Fong: I do not think most FAs incorporate cultural variables. While the principles of ABA might be considered to be universal, the way in which we complete an FA is very Eurocentric.  Most of the places I have worked at present the FAI in English and if another language is required a translator is used. The translator may or may not have the clinical understanding to accurately communicate the question. Also, some of the questions are more direct, closed ended.  Some culture may do better by telling a story. Generally, there are no questions that directly address culture – for example, preference on pronouns, holidays, languages used, the role of the clinician in the family’s mind, background information about caretakers, what behaviors are reinforced/valued by a culture and which are not, etc.  I think incorporating things like this, into FAs would help to make them more culturally sensitive. Maybe each culture, create their own? I will ask clients if there is thing anything else that they feel that I should know, which might be relevant to intervention. Sometimes I prompt for information about language, holidays, manners, norms, preferences, etc. A good article on the topic is: Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice3(2), 215-233.

  • One of the recommendations by the authors is to use readily available resources. What resources are available to you? How can your organization better provide resources to help behavior analysts address cultural variables?

Fong: I like this family therapy book – McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press. The Special Interest Groups (SIG) of ABAI are another good resource, I’ve found that people are responsive if you email them questions.  There is also the Culture and Diversity SIG of ABAI. I also tend to look outside the ABA, to fields such as psychology, who have done a superior job addressing the need to examine the role that culture plays in treatment. Recently, there has been an increase in behavior analytic articles and presentations addressing culture, so I try to read those.           

Catagnus: TCSPP has an institutional learning outcome related to diversity, so we embed learning, resources, assignments and outcome measures throughout our program. It is a deeply held value and a strong focus of our program. For this reason, our students often research topics related to culture, diversity, and inclusion. They have access to carefully curated curricular materials like articles, books, lectures, and tutorials on many different related topics. Our classes are regularly evaluated and updated to represent more global perspectives. And, the process of students’ learning is supported from the day they start until graduation, with the goal of developing their own resources and skills in cultural awareness. We are also implementing some innovative advising and learning laboratory programs to further help students connect with personal resources for cultural competence.

  • The authors suggest the use of social validity surveys as one method for addressing cultural values. How can you incorporate this into your current practice?

Fong: I think, by just asking a client/family member/guardian if they agree with the goals and treatment suggestions would be a good start. Incorporating more relevant people into intervention planning would also be a good step.  I tend to get better participation in data collection when I do this, as well (i.e. buy-in).

Catagnus: Bobbie Gallagher and a few of us from TCSPP recently published a paper that addressed the cultural values of females with limited language (LL) and autism (ASD), and their families and nurses. The study was designed to gather social validity about what strategies would be doable, preferable, and acceptable to communicate with women with LL and ASD during a gynecological exam. These women are at risk because, statistically, they don’t access this important health service very often, if at all. The study gathered quantitative and qualitative data about concerns, fears, and preferences for how women could be more effectively and respectfully involved in the process of a diagnostic exam. As Bobbie wrote, “Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.”

Gallagher, B.J., Flynn, S.D., Catagnus, R.M., Griffith, A. (2019). Social validity of strategies to assist females with ASD during gynecological examinations. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-018-9654-5

  • The authors state that one limitation of their article is that they did not provide systematic guidelines for working with culturally diverse clients. If you were going to introduce such guidelines, what might you include?

Fong: I think the guidelines I referenced here: Hughes Fong, E., & Tanaka, S. (2013). Multicultural Alliance of Behavior Analysis Standards for Cultural Competence in Behavior Analysis. The International Journal of Behavioral Consultation and Therapy. 8(2): 17-19. Are a good start.  APA did a fantastic job on their guidelines – so again looking at other fields to see what they have done (https://www.apa.org/about/policy/multicultural-guidelines) and learning from other fields would be helpful.

Catagnus: Ashely Knochel, Kwang-Sun Blair, Stacee Leatherman, and I are working on a manuscript now related to this topic. We hope to provide the ABA community with a systematic review of relevant cultural adaptation models, highlighting one that is most useful as a framework to guide the process. We recommend that ABA look to other fields that have created and researched frameworks or developed guidelines. Examples include Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations from the APA, and AMA Code of Medical Ethics’ Opinion on Cultural Sensitivity and Ethnic Disparities in Care.


About The Authors

Dr. Robyn Catagnus is an expert on learning and behavior change. A board-certified behavior analyst, she is an associate professor, associate chair, and former national chair of Behavior Analysis at The Chicago School of Professional Psychology. She’s owned and operated a successful behavior consulting firm and held executive roles in behavioral health and educational technology organizations. As a management consultant and researcher, she also develops human capital initiatives to improve organizational behavior.

Dr. Catagnus’ helps educators promote inclusion, success, performance, and growth. She is a trustee of the Cambridge Center for Behavioral Studies; reviewer for the Diversity in Behavior Analysis section of the APA journal Behavior Analysis: Research and Practice; reviewer for Behavior Analysis in Practice, and former member of the editorial board for Perspectives on Behavior Science. Dr. Catagnus has degrees in instruction and technology, education, leadership and strategy, and a certificate in mindfulness.

Ms. Hughes Fong has over two decades of experience in the fields of behavioral health, education, and management. Her educational background is in clinical and counseling psychology and applied behavior analysis. She is currently a PhD candidate studying Clinical Psychology with a concentration in Forensic Psychology.

In 2011, Ms. Hughes Fong founded Multicultural Alliance of Behavior Analysts (MultiABA), now call the Diversity and Culture SIG. This is a special interest group of the Association of Behavior Analysis International (ABAI). Ms. Hughes Fong is the founder of “Diversity in Behavior Analysis” a section in Behavior Analysis Research and Practice, and serves as an Associate Editor for the journal. Ms. Hughes Fong, also serves on the Executive Committee for the American Psychological Association’s (APA) Division 35, as the Website Coordinator. She has been a reviewer for Behavior Analysis: Research and Practice, Behavior Analysis in Practice, and the National Multicultural Conference and Summit. She is also a “Distinguished Scholar” with the Cambridge Center for Behavioral Studies, and a member Association for Behavior Analysis International (ABAI)  Diversity, Respect, and Inclusion Task Force

In addition, to Ms. Hughes Fong activities, she is a Board-Certified Behavior Analyst and licensed as a Behavior Specialist in Pennsylvania, a trainer in the Pennsylvania Bureau of Autism’s Functional Behavior Analysis training, and has received training certificates in the area of Trauma-Focused Cognitive Behavior Therapy and Trauma-Focused Cognitive Behavior Therapy Childhood Traumatic Grief. In addition, she received her level one certification in Pivotal Response Training and Gottman Couples Therapy. Her primary areas of interest are in the application of ABA to multicultural populations, telehealth, social validity, health and behavior analysis, and examining child custody and parental competency when a child has developmental disabilities.

ABA Tools of the Trade: A book review from ASAT!

This month’s ASAT feature comes to us from Karrie Lindeman, EdD, BCBA-D, LBA and David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Save 20% on ABA Tools of The Trade and our Tools of the Trade kit now through June 17th!

Data collection is the core of the success of our science. Without data, are we are not providing behavior analytic service to our clients; however, data collection can be a scary new journey for many. What do I collect? How do I collect it? What do I put it on? How do I manage the other children in the class? What do I do with the data once I have it? How do the data guide my decision-making? All of these questions pose roadblocks to the individuals attempting the collection.

To date, many training manuals and books have attempted to provide insight and guidance for struggling data-collection newbies. Some of these books have fallen short of delivering a clear and concise message to its readers. ABA Tools of the Trade provides a unique take at explaining the what, why, and most importantly, the “how-to” of data collection.

The authors start off describing the purpose of the book, addressing concerns that teachers and technicians face in the field every day: Why am I doing this? And how can I create easy to navigate data sheets with simple graphs for analyzing after I have collected the data? ABA Tools of the Trade breaks down their material into five sections which simplify the anatomy of a data sheet, review different types of data collection systems available, discuss how to utilize them with simple behavior change procedures, and offer activities to ensure supervisees are competent (huge bonus!). Throughout the sections, the material is organized in a way to help you identify exactly what you need to do, with helpful vignettes providing real-world examples.

The breakdown of the five sections allows the reader to easily find the information they are looking for, along with supporting documents. The first section delves into the Anatomy of Data Collection, describes not only why we collect data, but how to do so in the most simplistic way. This section is great for someone new to data collection or looking to expand their practice. A bonus includes describing different tools that may be helpful in your data collection journey with informative descriptions and visuals. Examples include tally counters, interval timers, and time timers, to name a few. A useful hints page highlights how the specific tools can be matched to the different measures of behavior that need to be tracked.

The second section is the Data Collection Systems sectionwhich describes more complex systems and strategies that work in different settings. It starts off with a comprehensive list of 10 rules of data collection. These rules are extremely important as they lay the groundwork for ethical data collection and reviews potential issues that may arise as you begin to collect data. These include examples of consent issues, confidentiality mishaps, and an important reminder to adhere to state and local laws. Finally, a handy task analysis of data collection steps provides a simple way for readers to grasp the needed components for specific targeted behaviors and wraps up the section.

The third and fourth sections include Behaviors and Simple Behavior Change Systems, which describes the Functional Behavior Assessment and Behavior Intervention Plan process in user-friendly terms. This is a great introduction for those starting out and looking to brush up on appropriate procedures. This section reviews what qualifies as efficient data collection in an FBA and how to analyze results. An added bonus is the discussion on antecedent strategies, which provides the reader with tactics and corresponding examples. Following the breakdown, vignettes of very specific behavioral episodes are provided, which allow the reader to apply the knowledge derived from the reading in everyday situations. Each vignette is followed by a general solution and helpful hints on dealing with the presented issue. For those interested in learning more about the topic, references and recommended readings are provided after all examples. Great source!

The fifth and final section, Supervision Practices, is a bonus for those supervising candidates for board certification in behavior analysis. It is comprehensive, well organized, and synched with the 5th Edition of Task List providing not only lessons but scenarios for practice with corresponding rubrics. Please note, as the Task List is updated, the alphanumeric codes may change. Three phases are addressed:

  • The Pre-Data Collection Phase addresses information gathering from parents and professionals surrounding prior attempts to address behavior (what was implemented and for how long) including defining behavior and determine how best to measure it.
  • The Data Collection Phase involves implementing the data collection system and making timely modifications, as well as proper training of the data collectors and determining an adequate schedule. Interobserver agreement is also addressed.
  • The Post-Data Collection Phase involves reviewing the collected data, preparing for graphic representation, and using data-based decision making.

Given that many newly credentialed BCBAs are assuming a supervisory role for the first time, this section is very helpful. Learning objectives and activities for each lesson are clearly articulated and rubrics are provided to support application and assess the skill level of the supervisee.

This short, well-organized, and easily-accessible resource belongs on the shelves of those first working towards BCBA certification, BCBAs who are starting out, and current BCBAs providing Registered Behavior Technician and BCBA supervision. The content spans all data collection needs, from the very basics on how to ensure those we supervise understand and demonstrate necessary skills from the Task List. It would also be a practical, yet easy supplemental read for students progressing through their coursework in college programs. To maintain quality service, it is imperative to ensure the next generation of BCBAs have the skills necessary to provide and supervise quality service provision. The inclusion of sections related to modifying one’s behavior as well as supervisory considerations only strengthen the utility of this already informative guide. This book is a great resource, and recommended without reservation!


About The Authors

Karrie Lindeman completed her undergraduate degree at C.W. Post University with a major in psychology. She went on to Queens College to complete her Masters in Psychology and advanced certificate in Behavior Analysis. From here, she worked in a school for children with autism for 10 years before moving on to consult in the public school and early intervention setting. Karrie completed her doctorate in learning and teaching at Hofstra University in 2015. She continues to provide direct service, parent training, and consultation in a variety of settings. Karrie is currently the Program Director of the Behavior Analysis program at Touro College in New York City.

David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Co-Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

ABA Journal Club: A Response From Elizabeth A. Drago, M.A., BCBA, LBA

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?

The majority of my clinical practice is primarily situated in home-based settings.  Delivering behavior analytic services in home-based settings presents with a multitude of circumstances contributing to variable rates of success in teaching new skills for both the client and caregivers.  Two variables contributing to such challenges in service delivery is caregiver accessibility and limited service hours allotted, particularly if the services are funded through insurance-based sources.  Formal Behavior Skills Training (BST) often requires time intensive performance and competency- based components, creating a challenge to implement in the home setting at times. With careful planning and caregiver commitment to participation, BST training in the home setting is quite “do-able”.

To address time constraints, a ‘train the trainer’ model or pyramidal training (Pence, St. Peter, & Tetreault, 2012), may be a beneficial strategy to assist in training multiple caregivers as well as contribute to increased proficiency in treatment fidelity.  A pyramidal training model involves a senior trainer (e.g., a behavior analyst) training a small group of staff or caregivers who in turn train other staff or caregivers.  This type of training model may be particularly beneficial to clinicians working in settings where time constraints may be a factor (such as residential services).  

  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?

The researchers in this study utilized a concurrent multiple-baseline-across-modules design to analyze the effects of the BST module training delivered to parents to teach their children mands. Concurrent multiple-baseline-across modules design allows for simultaneous measurement to occur for all clients. Research suggests concurrent measurement controls better for threats to internal validity and result in somewhat stronger inferences than do nonconcurrent designs (Watson and Workman, 1981). Multiple baseline designs are appropriate when target behaviors are not reversible. Use of a concurrent multiple-baseline design to evaluate treatment effectiveness minimizes the ethical concerns related to a withdrawal design. Training skills sequentially using a multiple-baseline-across-modules design is beneficial since it allows trainers to teach skills gradually and gave trainees repeated rehearsal opportunities on previously trained skills. The trainer could also monitor ongoing caregiver performance and make decisions to advance caregivers through the training based on the consistency and accuracy of their performance on trained skills.  Researchers of the study required caregivers to reach specific mastery criterion rates to advance to additional modules in the BST to assess the maintenance of the caregiver’s accuracy of procedural integrity and the child’s mands.

Upon visual analysis of the data, results of the study support effects of a BST model for training caregivers to implement mand training procedures.  In addition, after training, caregivers did not exhibit difficulties generalizing the skills to implement mand training procedures to the child.  Additional training was provided to caregivers during sessions with the child when mastery criterion was not achieved.  The researchers found by staggering the training across modules, caregivers learned to capture and contrive motivating operations contributing to the emergence of spontaneous mands.

  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?

Training caregivers to effectively generalize behavior analytic treatment strategies and interventions to the child outside of training sessions is one of the goals of family support behavior analytic services.   Strategies to fade out the necessity of behavior analytic services is developed in the client’s treatment plan at the initiation of services.   Delivering BST to a caregiver who demonstrates proficiency of the designated steps is invaluable in the treatment process.  Through BST,  trained caregivers who have demonstrated mastery of a skill, have the ability to train additional caregivers (e.g., grandparents and siblings) in the client’s environment, facilitating generalization of treatment effects. 

In addition, research has supported the finding that providing caregivers with training and education to increase their family member’s functional skills (such as communication) may reduce caregiver stress by increasing the caregiver’s confidence levels (Bebko et al. 1987).  Researchers have also found that parents who reported high levels of confidence in managing their child’s major difficulties and perceived others in the family as similarly successful also reported lower stress rates (Sharpley and Bitsika 1997).

In my practice, I utilize BST to teach caregivers skills related to communication and socialization training and areas of daily living such as toileting, dressing, toothbrushing and community safety.  I recently utilized BST to teach a modified PECS (Picture Exchange Communication System) to a client’s caregivers. After reaching fluency criteria for each step of the target skill, the trained caregiver was capable of effectively training the modified PECS procedure to the second caregiver.  Success rates for each steps of the BST procedure were measured by observation, data collection and data analysis of procedural integrity demonstrated by the second parent during sessions with the client.  Success rates were also measured by data analysis  of the client’s rate of progress in reaching various communication targets via use of the modified PECS taught by caregivers. 

  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?

According to Alberto & Troutman, 2013, ‘maintenance’ is defined as “performing a response over time, even after systematic applied behavior procedures have been withdrawn”.  Maintenance is demonstrated over time when the skill continues to occur after all direct teaching of the particular skill has been discontinued. 

 Maintenance data could also be utilized to assist in shaping additional skills.  For example, prior to teaching a client receptive discrimination skills related to picture identification in a field of 3 stimuli, it is important to evaluate the presence or absence of certain prerequisite skills such as attending, gesturing (i.e., pointing or eye gaze), following direction and ability to identify objects depicted in the array.  Without information gathered from maintenance skill probes (i.e., attending, pointing, tact repertoire, etc.), teaching the skill of receptive discrimination may not be possible if the client has not exhibited mastery of specific prerequisite skills first.

During skill acquisition training, I typically teach a targeted behavior until the recipient exhibits fluency in exhibiting that behavior.  The computer- generated data system I utilize in my practice includes pre-set monitoring schedules of maintenance data based upon a timed schedule.  Maintenance probes are automatically scheduled in a staggered fashion.  For example, if the client exhibits proficiency in engaging in a specific skill during baseline, that skill is automatically scheduled for a maintenance probe on a monthly basis.  If a client reaches fluency of a specific skill after commencement of treatment, the target is scheduled for maintenance in a staggered time frame (i.e., weekly, bi-weekly, monthly, bi-monthly and annually). After the client reaches mastery criterion for annual maintenance, the target is considered ‘closed’.  If at any time the target fails maintenance, the target is added back into treatment.  

If a clinician is teaching skills to fluency, the necessity of relying on maintenance data to determine if the skill remains in that client’s behavior repertoire becomes less relevant. 

  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?

A particular skill BST could be utilized to teach is use of utensils during mealtime.

Instruction – For this step, if a client exhibits adequate receptive skills related to vocal/verbal instruction, one may say to the client, “When you eat certain foods, such as spaghetti or vegetables, you use a fork to pick the food up. You wouldn’t use a fork to eat foods such as cereal or pudding.”

If the client does not exhibit adequate receptive language skills, one may describe the skill to the caregiver.  For example: “We teach the skill of eating with utensils to assist with independent functioning.  We will practice this skill first, with a fork and upon reach specific mastery criteria, we will proceed in teaching use of additional utensils, such as a spoon.  It’s best to practice this skill when motivation to eat is high in order to increase rate of reinforcement and eventually, acquisition of mastery criteria (i.e., if the client is hungry, his motivation to follow the rule to use a fork to eat may be higher compared to times when he is not hungry). Reinforcement for use of the fork is naturally built in, as the food he eats with the fork will serve as reinforcement for the targeted behavior.”

Along with vocal/verbal instruction of the BST steps, I may also provide the caregiver with written steps to the procedure to assist with fluency.

Modeling – For this step, during mealtime, I model the steps described above to the caregiver.  I provide a description of each step as the step is being performed to the caregiver.

Rehearsal –For this step, encourage the caregiver to implement the steps to practice the skill.  During these practice sessions, data recording is critical to determine fluency of the practice of the targeted skill.

Feedback – Prior to this step, I discuss with the caregiver the form of feedback they prefer to receive (in-situ feedback or feedback after each trial session has ended).   Throughout my career I have learned the importance of tailoring my delivery of feedback to individual preference (some caregivers prefer feedback while they are performing the step, while others prefer to receive feedback after they have completed the step).  Once I have determined the timing of my feedback, I deliver the feedback in the context agreed upon.

  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

To streamline the often time-intensive process BST requires, I typically stagger the trainings across multiple sessions.  Delivery of insurance-based family training services is generally provided in a time intensive and structured fashion. To meet these stringent guidelines and to ensure I deliver the most effective and efficient services, I provide the caregiver with written and verbal steps to BST across several consecutive sessions.  I review each step with the caregiver and assign weekly assignments to practice specific steps.  During each family training visit, I review and model the steps and request the caregiver to perform the step they worked on the week prior.  After the caregivers reach specific fluency rates in responding accurately,  additional steps are introduced.  

One method of training I may consider including in my caregiver trainings when delivering BST, is use of video modeling.  Video modeling is a teaching procedure that involves an individual viewing a videotaped sample of a model performing a specific, scripted activity or task. Immediately following having viewed the video-based model, the individual is directed to perform the activity or script he or she observed in the video (e.g., MacDonald, Clark, Garrigan, & Vangala, 2005). Use of video modeling may further address time constraints to training that is often a barrier in delivery of home-based services.  Video modeling may also assist in in higher rates of procedural integrity when working with caregivers who learn more effectively through use of visual guides as opposed to textual guides only.

BST is an incredibly invaluable method of teaching new skills.  With careful planning and commitment to learning, caregivers have a unique opportunity to actively participate in their family member’s treatment to help them engage in socially meaningful ways.

References

Alberto, P., & Troutman, A. C. (2013). Applied behavior analysis for teachers. Boston: Pearson.

Bebko JM, Konstantareas MM, Springer J. Parent and professional evaluations of family stress associated with characteristics of autism. Journal of Autism and Developmental Disorders. 1987; 17:565–576.

MacDonald, R., Clark, M., Garrigan, E., &Vangala, M. (2005) Using video modeling to teach pretend play to children with autism. Behavioral Interventions, 20, 225-238. 

Parsons M. B., Rollyson J. H., Reid D. H. Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice. 2012; 5:2–11. 

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching Practitioners to Conduct Behavioral Skills Training: A Pyramidal Approach for Training Multiple Human Service Staff. Behavior analysis in practice6(2), 4–16. doi:10.1007/BF03391798.

Pence S. T., St. Peter C. C., Tetreault A. S. Increasing accurate preference assessment implementation through pyramidal training. Journal of Applied Behavior Analysis. 2012;45:345–359.

Sharpley, C. F., & Bitsika, V. (1997). Influence of gender, parental health, and perceived expertise of assistance upon stress, anxiety, and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22, 19–29.

Watson, Paul & A. Workman, Edward. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of behavior therapy and experimental psychiatry. 12. 257-9.


Elizabeth A. Drago, M.A., BCBA, LBA, is a Board Certified and Licensed Behavior Analyst and a consultant at Proud Moments Therapy located on Long Island, New York and Comprehensive Behavior Supports, located in Brooklyn, NY.  She has over 15 years’ experience working with individuals with developmental and related disabilities and has advanced training in areas of autism, behavior disorders, sleep disorders, intellectual disabilities and positive behavior supports.  As a consultant in home and educational settings, she clinically oversees client cases, provides parent training, implements comprehensive skill assessments and programming goals for children diagnosed with ASD, conducts staff trainings for effective performance improvement practices and behavior analytic practices and procedures. She holds professional memberships in organizations such as New York State Association for Applied Behavior Analysis, Association for Behavior Analysis International, Association of Professional Behavior Analysis.

Elizabeth is a Board member of the New York State Association for Behavior Analysis (NYSABA), serving the role of Representative at Large. She is also an active member of NYSABA’s Legislative Committee, focusing on efforts to remove the licensure scope of practice restriction in Behavior Analysis in New York State. Elizabeth has contributed significantly to disseminating information related to the scope restriction in Behavior Analysis in NYS. Some of Elizabeth’s achievements in these efforts include developing initiatives such as the video series entitled, ‘This is ABA’.  The purpose of the video series is to highlight the effectiveness and applicability of the practice of Behavior Analysis to individuals of varying diagnoses, not only for those diagnosed with an Autism Spectrum Disorder. This video series is currently featured on the NYSABA website.   Elizabeth also works collaboratively with NYSABA’s Executive Director, Mari Wantanbe-Rose in the development and oversight of NYSABA’s Inaugural ABA Ambassador Award. The NYSABA ABA Ambassador Award recognizes future behavior analysts, or students, who help to disseminate the usefulness and versatility of behavior analysis in various settings.

Elizabeth has presented at NYSABA’s annual professional conference on the topics of Systematic Desensitization (2017) and Self-Care for the Behavior Analyst (2018). She has been invited as a speaker at a roundtable meeting at Proud Moments ABA, presenting on the topic of the use of technical jargon when interacting with caregivers. Elizabeth has also been featured in a newsletter (August 2018 edition) generated by Comprehensive Behavior Supports in recognition of the many significant contributions to the agency and families she serves across Long Island as a Licensed and Board Certified Behavior Analyst.  Elizabeth has been a guest speaker on a Behavior Analytic podcase, ‘Behaviorbabe’, hosted by Dr. Amanda Kelly, discussing the NYS licensure law scope restriction on the practice of Behavior Analysis in NYS. Elizabeth received a Bachelor’s Degree in Clinical Psychology from St. John’s University, graduating Summa Cum Laude. She continued her education, earning her Master’s Degree in Clinical Psychology at Teacher’s College, Columbia University, where she received an honors certificate in education and teaching and was a member of Kappa Delta Phi- Honor Society in Education.   Elizabeth attended post-graduate studies at Penn State University, where she completed coursework in Applied Behavior Analysis.  She earned her BCBA certification and licensure in Behavior Analysis in 2014.

Your Child’s Autism Diagnosis Long Term

In the years immediately after a parent learns of a diagnosis of autism, it can be especially challenging to think of your child’s autism diagnosis long term. But as parents advocate for their child, and as practitioners work with the family to create goals for that child, the long term must be considered. Here are a few suggestions to help with considering the long term, while focusing on short-term goals:

  • Create a vision statement. One of my favorite books is From Emotions to Advocacy: The Special Education Survival Guide by Pam Wright and Pete Wright. This book covers everything parents need to know about advocating for a child with special needs. One of the first things they suggest is creating a vision statement. They describe this as “a visual picture that describes your child in the future.” While this exercise may be challenging, it can help hone in on what is important to you, your family, and your child with special needs in the long term.
  • Look at your child’s behaviors, then try to imagine what it might look like if your child is still engaging in that behavior in five or ten years. Often, behaviors that are not problematic at three are highly problematic at 8 or 13 years old. Such behaviors might include hugging people unexpectedly or (for boys) dropping their pants all the way to the ground when urinating (which could result in bullying at older ages). While it is easy to prioritize other behaviors ahead of these, it’s important to remember that the longer a child has engaged in a behavior, the more difficult it may be to change.
  • Talk to practitioners who work with older students. Many practitioners only work with a certain age group of children. While they may be an expert for the age group they work with, it may be helpful to speak with a practitioner who works with older kids and ask what skill deficits they often see, what recommendations they may make, and what skills are essential for independence at older ages.
  • Talk with other parents. Speaking with other parents of children with special needs can be hugely beneficial. Over the years, I’ve worked with hundreds of parents who are spending countless hours focusing on providing the best possible outcomes for their children. And while it’s impossible to prepare for everything that will come in your child’s life, it may be helpful to find out what has blindsided other parents as their children with special needs have grown up.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges

ABA Journal Club: Interventions and RBTs (response)

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This week, Solandy Forte, PhD, LCSW, LBA, BCBA-D provided a response to some of Sam’s questions about the article below:

I am thrilled to contribute to the conversation about RBT as it deserves the attention particularly as we continue to grow as a field.  We are a young field that is experiencing growing pains but they are good ones.  I appreciate the contributions that many practitioners in our field have shared relating to credentialing of RBTs.  At the end of all this, I am confident we will have established training and experience standards to will lead to positive outcomes for our consumers.  We have a long road ahead. 

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?

The field of behavior analysis is practically in its adolescence.  There are many other helping professions such as psychology, psychiatry, and social work that have experienced growth for over a century and have had to navigate through barriers impacting the practitioner’s ability to provide quality behavioral healthcare with the increasing demand of service.  It is not unusual for a growing field to consider identifying ways to meet the healthcare needs of the population particularly when the number of qualified practitioners is not sufficient to meet the demands.  For instance, in the nursing field, registered nurses are often supported by nursing assistants and nurse aides.  The nursing field developed training and experience standards for each of these credentials and these standards have likely been modified as the profession has studied the impact on the overall delivery of services and its impact on the patient. 

Sure, the concerns raised are valid and should be evaluated carefully by researchers so that they can inform special matter expert groups established by the BACB®.  However, the field of behavior analysis cannot ignore the obvious increase in demand for applied behavioral analysis services.  It will take decades for the field to assess what are the most appropriate training and experience requirements to promote optimal consumer outcomes.  This is not only the case for RBTs® but also for BCBAs®.  Again, this is a growing field and we should expect to see modifications in the credentialing requirements. 

  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?

Any training of behavior technicians in early studies were developed by science practitioners who based their training procedures (e.g., topics, hours, teaching methodology, etc.) on either previous studies that evaluated training methods or training procedures that best fit their setting, staff, and client needs.  These research studies were not evaluating the training requirement of the RBT®.  Regardless, these studies contributed to the field of behavior analysis particularly when practitioners were developing in-house training requirements and adjusting along the way as they observed the behavior technician’s ability to implement behavioral technology with fidelity and retain what they had learned in the initial training overtime.  Currently, research studies are evaluating training packages that are aligned with the RBT® requirements and these will contribute to any revisions to credential requirements. 

  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?

Every organization is responsible for setting their own standards with regard to training of staff.  Training requirements will vary depending on the setting and in some cases requirements will expand beyond RBT® training.   For instance, there are organizations that require staff to receive physical management training, CPR, and first aid, to name a few.  It is common for training to occur on a regular or annual basis for an organization to remain in compliance with state regulations or enhance the delivery of services.  With regard to the RBT® credential, organizations are responsible and should carefully evaluate mastery of skills.  Further, organizations should include in their training protocols procedures for evaluating generalization and maintenance of acquired skills.  It is not only to important to meet mastery for each item on the RBT® task list but it is critical for staff to implement the skills they have acquired in a variety of setting over time.  RBTs work a variety of settings including home, school, and community; therefore, mastery of skills cannot just be mastered in the classroom setting but also must be generalized to the settings in which will be applied. 

  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

There is no doubt that research should be conducted to further evaluate the training and experience requirements for RBTs® but again this is going to take time.  Research studies take years to plan, execute, and disseminate.   This is not an easy feat but one that should be charged by the practitioners in the field and the demand for the delivery of high-quality behavioral services.  Our goal is to contribute to the solution by collecting and sharing data that experts can use to revise RBT® requirements.  We cannot ignore the obvious need for research in this area that will ultimately contribute to the positive growth of our field. 


Solandy Forte, PhD, LCSW, LBA, BCBA-D, is the Director of Consultation Services and Community Outreach at Milestones Behavioral Services.  She is a doctoral level Board Certified Behavior Analyst licensed in Connecticut and Massachusetts and a Licensed Clinical Social Worker.  Dr. Forte provides consultation services to the school programs at Milestones serving individuals with a diverse set of complex learning needs.  In addition to providing direct consultation to children within the private school setting, she also has provided consultation to multi-disciplinary teams within the public school setting where she assisted with program development initiatives to promote building capacity for educating children with autism and related neurodevelopmental disorders within the least restrictive educational setting.  Dr. Forte has experience working with children and young adults with special needs in their homes, schools, and community settings. She is an adjunct professor for the Institute of Autism and Behavioral Studies at the University of Saint Joseph in West Hartford, Connecticut and the Institute of Behavioral Studies at Endicott College in Beverly, Massachusetts. 

What Is Procedural Fidelity In ABA?

It is not uncommon for parents or practitioners to implement a new intervention that appears to be working well, then after a few weeks or months report that the intervention has stopped working. Often, the change in behavior in feels like a mystery and leaves people scrambling for a new intervention. But before searching for a new intervention, you should consider the possibility of problems with procedural fidelity, which “refers to the accuracy with which the intervention or treatment is implemented” (Mayer, Sulzer-Azaroff, & Wallace, 2014).

Problems with procedural fidelity in ABA are common, and you will experience more success with your interventions if you take steps to address fidelity at the outset. Here are a few suggestions:

  • Post the steps in a visible spot. Clearly list the steps of the procedure and put them in a spot where you will see them often. This might be on the actual data collection sheet or on the wall. One parent I worked with had a Post-it® note with the steps for our intervention attached to her computer screen. Another parent kept the steps inside the ID part of his wallet, where they were protected and visible each time he opened his wallet.
  • Plan meetings to go over the steps. As part of your intervention, set brief monthly or quarterly meetings to go over the steps of the intervention and be sure everyone is maintaining procedural fidelity.
  • Assess for procedural fidelity. Schedule observations to ensure that each step of the intervention is implemented as described. If you do not have someone who can supervise you, take video of yourself implementing the intervention, watch it and compare your actions to the steps outlined in the intervention plan.
  • Outline steps for systematic fading of the intervention. When implementing an intervention, the goal is to have the learner eventually exhibiting the desirable behavior without prompts or planned reinforcement. Sometimes when a parent or practitioner sees the learner’s behavior improving, they begin to remove the prompts or planned reinforcement before the learner is quite ready for it. By writing a plan for fading the intervention into the plan, you make it clear to everyone involved what the requirements are for each step towards mastery.

REFERENCES

Mayer, G.R., Sulzer-Azaroff, B., & Wallace, M. (2014). Behavior analysis for lasting change (3rd ed.). Cornwall-on-Hudson, NY: Sloan Publishing.


About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services.

ABA Journal Club #2: Ethics and Social Media

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Head to our Facebook page to join the discussion and let us know your thoughts!

It is important in our field to maintain an open conversation about ethics. The Professional and Ethical Compliance Code outlines how behavior analysts are expected to conduct themselves, but sometimes situations are not so black and white. And as the world changes, so do the expectations for ethical conduct. In recent years, issues related to social media have been especially relevant. This month, I’ve selected the following article which addresses the special concerns that come up with the use of social media.

O’Leary, P. N., Miller, M. M., Olive, M. L., & Kelly, A. N. (2017). Blurred lines: Ethical implications of social media for behavior analysts. Behavior Analysis in Practice10(1), 45-51 .


  1. The article reviews the codes of ethics for other professions. Why is this valuable for us to do as a profession? Did you learn anything surprising or interesting form this portion of the article?
  1. Since this article was written, our field has a new Professional and Ethical Compliance Code. How does this code differ from the previously used Guidelines for Responsible Conduct? What aspects of the code directly apply to ethical situations related to social media?
  1. “A search on an internet search engine for information related to a procedure or scientific concept may yield results as to what that procedure or concept is. The same search on a social media outlet may yield results as to whether or not that procedure or concept should be used (p. 47.) Discuss this difference.
  1. Behavior analysts and others interested in the topic may turn to social media to get answers to their questions due to the low response effort involved and the speed of reinforcement. How can we decrease response effort and increase reinforcement for referring to the scientific literature to answer our questions?
  1. The authors provide suggestions for how behavior analysts should behave on social media. Are there any suggestions you might add? Are there ways you can increase the likelihood of other behavior analysts following these suggestions?
  1. Consider your own behavior on social media. Based on recommendations from the article, what is one change you can make to increase your own ethical behavior in this context?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.