Unit 4 Flashcards
When a behavior analyst interacts
with other professionals in providing
treatment, fluency with the entire
Task List is required.
However, some specific tasks relate to the behavior analyst coordinating with others, sometimes an advocate, other times a translator, ambassador of the behavioral model, or teammate
A Note Before We Begin
Practice within one’s limits of professional competence in applied behavior analysis, and obtain consultation, supervision, and training, or make referrals as necessary
Note: this task applies here, but also
pertains throughout this unit
Task G-07
1.02 Boundaries of Competence
a) All behavior analysts provide services, teach, and conduct research only within the boundaries of their competence,
defined as being commensurate with their education, training, and supervised experience
b) Behavior analysts provide services, teach, or conduct research in new areas (e.g., populations, techniques, behaviors) only after first undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas.
Related Code Element task G-07
Workgroup members Collegial advice/mentoring Clinical consultation/collaboration Academic collaboration/conference presentations Attending conference presentations of other behavior analysts
Networking
Supervisor/supervisee interaction
Peer review
Interactions with the BACB
Common Relationships Between
Professional Behavior Analysts
In some large state and/or private institutions, a team of behavior analysts provide caseload-based services, typically under the supervision of a seasoned BCBA® or BCBA-D
Less common but beneficial
These positions are becoming more rare
They can provide supervised experience with many differentclinical populations, including
individuals with severe and dangerous challenging behavior
Institutional Workgroups
Private ABA agencies of various
sizes can provide similar (but somewhat less centralized) services to individuals in the community
Group and individual supervision with a BCBA is typical
Regular case presentations and group reviews can be very useful
Agency Workgroups
Especially for behavior analysts early in their career provides:
- Support - Collegial interaction - Exposure to new problems -Closely supervised training in new clinical areas
Benefits of Group Practice
Seek support and/or advice from colleagues to maintain an ethical practice
.
Everyone benefits from supervision, collegial advice, oversight, outside guidance
If working alone,
a)Behavior analysts arrange for appropriate consultations and referrals based principally on the best interests of their clients, with appropriate consent, and subject to other relevant considerations, including applicable law and contractual obligations
BACB (2014)
Code Element 2.03 Consultation
A formal (typically paid) relationship
Driven by the specific clinical needs of the recipient of services
Consent and confidentiality pertain
All ethical issues relating to Code sections 1.0, 2.0, 3.0, and 4.0 are pertinent to both the consultant and the behavior analyst who seeks outside consultation
Clinical Consultation/Collaboration
Takes Several forms:
Co-authorship on research articles or other publications
Conference presentations
Curriculum development
Departmental interactions
Academic collaboration takes several
forms, including:
Each supervisee must document each and every supervision period when it occurs
The supervisee and supervisor are responsible for collecting documentation for each supervision period on the Experience Supervision Form*.
One form should be completed at the end of each
supervisory period.” – BACB®, 2015 * As of 1/1/19 each supervision period is documented with a Monthly Experience Verification Form
When Must Forms Be Completed?
You cannot fill out supervision forms late! must be filled out as you proceed
through your supervision meetings.
Use of a supervision form to back-date a
session from more than two weeks ago that
you forgot to document – strictly forbidden!
Remember: BACB® forms are dated
Failure to properly document supervision will lead to the incorrectly documented sessions being deemed invalid
Improperly Documented
Supervision
The BACB® also requires the supervisee and supervisor to document the supervisee’s experience(s) at the conclusion of the experience being used to meet the BACB®requirements.
The “BACB Experience Verification Form”
Required as of 1/1/19: Monthly and Final versions
These forms and detailed instructions are
currently included on the section of the BACB®
website titled, “Experience Standards”
A Second Required Form
This issue is NOT addressed in the
BACB ethics Code
5.03(b) is entitled, “Supervisory Delegation” but it addresses the ethics required for the supervisor in
terms of his or her expectations and responsibilities as related to the skill set of the supervisee
The Ethical Responsibility of the
Supervisee
Inform the supervisor of all activities relating to the case; maintain complete, accurate, and timely service records
Obtain prior approval from the supervisor before changing program components
Maintain confidentiality in regard to supervision-related issues. Refrain from such discussions with the consumer, guardian, or surrogate
A Suggested Partial List of Ethical
Requirements for a Supervisee
Generally refers to individuals
outside of the direct treatment team who monitor the effectiveness of the behavior program
A behavior analyst’s clinical supervisor is somewhere in the middle, part treatment team member and part program monitor
-Dual role/conflict of interest
Monitoring and Oversight
Provided by;
Peer Review Committee
Human Rights Treatment Committee
Advocacy groups
State identified oversight boards (e.g., statewide Program Review Committee)
Legal counsel (in rare cases)
Institution Review Boards (IRBs) and Human Rights Committees (HRCs) research oversight)
Oversight
A group of behavior analysts who review behavior programs in their local area
- May provide feedback
- Usually provide some kind of FORMAL approval
- NOT identified in the Task List or the Ethical Compliance Code
Peer Review
Requires the behavior analyst to present program plans and data to an outside impartial panel
- panel is comprised of behavior analysts that may Identify potential problems the behavior analyst might have missed
Ensures program services show PROGRESS or that barriers to success are identified
May assist in RESOLVING issues (such
as obtaining additional necessary resources)
Provides the practitioner with back-up in case of investigations/legal proceedings
Peer Review Benefits
Provide the plan in ADVANCE of the meeting
Provide your formal program, but use your step-by-step plan to guide the committee through the procedures
Keep it SIMPLE – flow charts help
Present accurate and COMPREHENSIVE data. If possible, show on the chart when the last formal program review occurred.
Know what you want going in: approval, advice, assistance, etc…
Do not personalize Feedback
Presenting a Program To Peer Review Committe
Be respectful and helpful
You are not the presenter’s supervisor
Follow a list of program requirements
- Use a CHECKLIST if available - If not, suggest the development of one to assist everyone (presenter included) to look for what is required
In many states, peer review is about
ADMINISTRATIVE review: Does the program meet regulatory/statutory requirements?
If and when peer review becomes, “I am going to make you do what I would do if this were my client,” it becomes aversive for the presenter
Sitting on a Peer Review
Committee
Regularly check the BACB website,keep up with current news
Be sure to look for any changes in requirements for certification, or other updates on information on the website
This is part of what you agree to when you agree to remain in compliance with all rules and regulations
Read and regularly refer to the following documents:
The current 4th Edition Task List, as of
01/01/15
-The BACB Professional and Ethical Compliance CODE for Behavior Analysts
Remaining Current with the Board
Providing the Board with timely information regarding certain issues which may impinge upon the behavior analyst’s ABILITY to perform
Must occur both before certification is provided (as part of the application process) and after certification is obtained
Self-reporting
Part C: Eligibility Affidavit of the BACB
-The BCBA/BCaBA application requires the applicant to answer questions pertaining to issues upon which the behavior analyst is expected to SELF report The applicant must self report on: 1.Any physical or mental condition or addiction that could impair competent and objective performance and/or jeopardize public health and safety
The applicant must self report on: 2.Any investigation, disciplinary action*, investigation/charge/ conviction of a felony or misdemeanor directly relating to behavior analysis services or public health and safet
Self-Reporting Before Certification
Code element 10.02 Timely Responding, Reporting, and Updating of Information Provided to the BACB Applicants/certificants must report within 30 days the occurrence of: A change in name address or other vital information The filing of any criminal or civil charges against the applicant/certificant The initiation of any disciplinary charges, investigations or findings/ sanctions by a healthcare organization, federal or state agency, or other professional association against the applicant/certificant. Any other change in information provided by the applicant/certificant to the BACB
Self Reporting After Certification
Disciplines with which a behavior analyst is likely to interact include, but are not limited to: Teachers Psychologists Speech and language pathologists Occupational therapists Licensed clinical social workers QIDPs (previously QMRPs)
Non-Medical Treatment and
Education-Related Professionals
General practitioner M.D.s Specialists e.g., neurologists, dermatologists, etc. Dentists Medical technicians (medical tests) Nurses Psychiatris
Medical Professionals
Lawyers Advocates Guardians Human Rights Committees Legislators Media Representatives
Professionals Related to
Legal Issues
b) When behavior analysts provide behavior-analytic services, they use language that is fully understandable to the recipient of those services while remaining
conceptually systematic with the
profession of behavior analysis. They
provide appropriate information prior to
service delivery about the nature of such
services and appropriate information later
about results and conclusions
BACB (2014
1.05 Professional and Scientific
Relationships
Behavior analysts have a responsibility to operate in the best interest of clients. The term client as used here is broadly applicable to whomever behavior analysts provide services, whether an individual person (service recipient), a parent or
guardian of a service recipient, an organizational representative, a public or private organization, a firm, or a corporation
Behavior analysts’ responsibility is to all
parties affected by behavior-analytic
services. When multiple parties are involved
and could be defined as a client, a hierarchy
of parties must be established and
communicated from the outset of the defined
relationship. Behavior analysts identify and
communicate who the primary ultimate
beneficiary of services is in any given
situation and advocates for his or her best
interests
2.0 Behavior Analysts’
Responsibility to Clients
Groups of individual professionals
who interact and coordinate services
for an individual
Typically an interdisciplinary team is led by a case manager or a QIDP They are more likely to be face-to- face meetings in institutional and/or agency settings
Interdisciplinary Teams
- Leadership and management
Clear leader of the team; provides clear direction and management; both listens and acts; support and supervision; democratic - Communication
Individuals with communication skills - Personal rewards, training, development
Learning, training, individual and career - Appropriate resources and procedures
Structures (team meetings, members in the same location, administrative support) - Appropriate skill mix
Sufficient/appropriate skills, competencies, practitioner mix, timely replacement, coverage for a velopment opportunities - Climate
Culture of trust, valuing contributions, nurturing consensus - Individual characteristics
Knowledge, experience, initiative, listening skills - Clarity of vision
Having a clear set of values that drive the direction of the service and care - Quality and outcomes of care
Client-centered, outcomes and satisfaction, encouraging feedback, recording evidence of effectiveness of care and using that as part of a
feedback cycle to improve care
10.Respecting and understanding roles
Sharing power, joint working, autonomy
Nancarrow et al., 2013
Ten Characteristics of a Good Interdisciplinary Team
On the IDT, the behavior analyst must be able to explain behavioral principles and processes in both technical and non-technical language, according to the needs of the moment
See Tasks G-04 and G-05
A Closer Look at #2: Communication
Ten Characteristics of a Good Interdisciplinary Team
Task I-05: Organize, analyze, and
interpret observed data
For IDTs, the behavior analyst must be able to translate graphical displays: Team members must learn to clearly see Variability Levels Trends Comparisons across conditions
Graphs as Communication
We must translate and communicate
the behavior analytical model for
others (non-behavior analysts)
Leaders in our field have identified this as an important component in the repertoire of a successful behavior analyst. However….
Within and Without the IDT
Foxx (1996) states, “We must recognize that innovators are
frequently not good disseminators and that many scholars find dissemination to be a base activity and a dirty word because it becomes
promotion” (citing Sherman, 1992)
But he goes on to cite a personal communication he received from Jerry Shook:
“Yet, dissemination creates a market for scientific discoveries. We must not devalue dissemination.”
The Catch-22: The scientist who built
a better mousetrap, but..
Who also dismisses marketing and dissemination might call it the…
Small Animal Spinal Crack Mechanism”
“Sugar-coated Acid Delivery System for Alimentary Liquefaction and Euthanasia” (Sad-Sale)
The Scholar-Disseminator
Catch-22, Part 1
You must read this article.
“Historically, we have been a maverick group with an outsider mentality that has been passed to our students
“We delight in asking, ‘where are your data?,’ poking fun at other models, and engaging in vigorous and withering discourse regarding
our science. Although this repertoire may have served us well in establishing our field, it may be non-functional now…
What makes a good behavior analyst can be bad for public relations. What is a blessing for a scientist can be a curse for a disseminator.” (pp.149)
Richard Foxx: Translating the Covenant (1996)
Foxx cites Neuringer’s 1991 article of
the same title as this slide, which states that we have a “tendency to maintain that our language is better than others” which contributes to our image as self- assured and overly-
aggressive philosophical purists
The words we use… Behavior: Aubrey Daniels found out.. Extinction: Like with dinosaurs? Response: You don’t mean reaction? Consequence: That’s bad, right? Control group: Who is the controller? Manipulate variables: Like I said…! Intervention: Isn’t that like invasion? Punishment: Ah, yes. Punishment…
Humble Behaviorism
Foxx cites Sciba & Deno (1991)
The term “punishment” is irreversibly
contaminated by its association with colloquial usage, often as inhumane
Misconceptions confound any discussion of efficacy or ethics
And let me quote Foxx again directly:
“Our association with and use of the word punishment places behavior analysts in the uncomfortable position of defending a term that
serves as a discriminative stimulus for the very practices we find abhorrent.” (pp.152)
Lets take a look at “Punishment”
To paraphrase Merrill Winston’s various presentations on this topic at various conferences:
Without punishment, none of us would be
alive! Natural punishment keeps us from continuing to do really dumb stuff. In other words, “Punishment not bad; it make you not die.”
Punishment is, at least in part, the crux of
selectionism
It is the word, not the process that is the problem in public discourse
As a therapeutic procedure, we should see punishment as the behavior analytical equivalent of surgery.
But do surgeons call what they do,
“Slicing You Open”?
Bailey, 1991 in JABA Marketing behavior analysis requires different talk That is the name of the article Kind of says it all Lets do what we do and analyze the problem
Punishment as a Procedure
Foxx (pp.151) states, “Our technical
language has been constructed via what philosophers call conceptual revision (Harzem & Miles, 1978), in that we either invent a new word e.g., operant) or stipulate that an
existing word be used in a new waye.g., punishment).
Conceptual Revision
- Coining a new term
More difficult at first
May meet with resistance from others in the field - Using a pre-existing word in a new way
A source of conceptual or communicative confusion
Examples
New terms: Mand, tact, motivating
operation, operant
Old words used in a new or idiosyncratic way: response, consequence, radical, negative
Foxx cites Dietz and Arrington saying, “Fewer problems are created when it only involves
inventing new terms or labels”
But in a way, this leaves us back where we started: Jargon
What is the solution?
Become an Ambassador. And be a Translator
The Two Types of Conceptual Revision
Forge alliances with other disciplines! Get involved in the professional organizations of other disciplines Consider alternative views and support diversity Be selective in terms of confidently asserting your own accomplishments
Become an Ambassador
Learn their language
Read their journals
Try to blend your analysis rather than insist on its superiority
Keep it simple! Jargon may confuse your audience and have negative associations (for example, using negative” as a way to reinforce!)
And be a Translator
“Roughly speaking, cooperative arrangements are productive. Things are done which would not be done otherwise. New ways of doing things may be discovered as contingencies interlock and are mutually altered.”
B.F. Skinner
What we are all saying is this:
Maintain our technical language– all
scientific disciplines require precisely defined technical terms
But find alternative ways to clearly communicate your ideas to non-behavior analysts
Work With Your Audience
Recognize that other professions
have ethical codes that may differ
from our own
Ethics in Other Professions
Medical/dental appointments for clients Hospitalization of clients Institutional settings Professional teams (including IDTs) Psychotropic medication management
The Relationship The doctor is in charge. When medical issues are involved, M.D. has the license, and the responsibility The behavior analyst is there to help We will expand on this in the section on medication management
Behavior analysts interact with M.D.s
and other medical professionals in
many contexts, including
Many consumers have difficulty with
medical contexts and interventions
The behavior analyst must be available for consultation with medical staff to assist in helping the client accept medical care Desensitizing a consumer to medical treatments may require formal
programming
Coordination with medical staff/practice sessions
However, sometimes situational interventions (without formal programming) may be necessary
E.g., one-time medical tests/procedures;
post-operative protective interventions
Behavior and Medical Interventions
The behavior analyst may have vital
information as to how to best work with the individual within the general hospital context
With all due consents, make yourself available to help
Realize that consent for release of information is not always necessary
Hospitalizations
a) Behavior analysts never disclose confidential information without the consent of the client, except as mandated by law, or where permitted by law for a valid purpose, such as 1) to provide needed professional services to the client
Code element 2.08 Disclosures
Limits to Confidentiality
when immediate health and safety issues are at stake, you may be allowed (or even expected to):
Break confidentiality
Engage in short-term emergency use of restrictive” procedures (e.g., physical restraint)
Imminent Harm
Psychiatric hospitals
Outpatient crisis centers
Regular hospitals
Developmental centers
• Residential ID facilities
Community-based treatment clusters
Behavior analysts and medical doctors and/or psychiatrists may interact in a variety of settings, including:
Coordination of services is always
vital to the welfare of the individual
Provide a particularly fertile setting for
interdisciplinary cooperation
Pyles et al. (1997) provides a model for institutional decision making
Institutional IDTs- Institutional Settings
The HDC paradigm is predicated on the idea that problem behavior is most likely related to one or more of the following: Medical concerns Functional/environmental variables Psychiatric illness
Three Tenets of the Model
1. If possible, medical etiologies should be ruled-out prior to initiating behavioral interventions
- Conduct a functional assessment to rule out ecological variables prior to making a psychiatric diagnosis
- One cannot say a psychiatric diagnosis is appropriate based solely on aggression or self-injury
Other characteristic symptoms of the diagnosis must be present
• Social withdrawal
• Disorganized behavior
• Delusions, pressured speech, etc.
The Howe Developmental Center’s
Behavioral Diagnostic Paradigm-HDC
If an individual is already receiving
psychotropic medication, a psychiatric diagnosis is necessary
If one is not present in the consumer record, then the process of ruling out medical and/or environmental causes must be initiated
Psychiatric Diagnosis-
The Howe Developmental Center’s
Behavioral Diagnostic Paradigm-HDC
This is not a review of the full model
The main points are these:
If you work in an institutional setting, we strongly recommend reading this article
Coordination of services can fully address the ethical considerations of all involved disciplines
Use of This Model
The Howe Developmental Center’s
Behavioral Diagnostic Paradigm-HDC
Behavior analysts are sometimes
asked to participate in other types of
professional teams where medical doctors are involved
Human rights committees
Policy groups
Medical case management teams
• The Florida Experience
Psychotropic (adj.) is defined as:
-Having an effect on the mind
-Affecting mental activity, behavior, or
perception, as a mood-altering drug
Psychotropic (n.) is defined as:
A psychotropic drug: a tranquilizer, sedative, antidepressant
Psychotropic (adj.) is defined as:
Typical antipsychotics Atypical antipsychotics Anxiolytics Antidepressants Mood-stabilizers Anti-seizure medication
Types of Psychotropic Drugs
Psychotropic medication is
specifically designed to change
someone’s behavior
These medications are prescribed specifically when someone engages in some type of problem behavior, which has been deemed necessary to reduce
Why Must Behavior Analysts Know
About Psychotropic Medication?
His findings: “Aggression” is the primary reason for institutional placement and the #1 reason cited when medication is used for “behavioral control.” However: “There is no information in the literature suggesting that anti- psychotic agents are effective means of treating aggression”
Matson (2000) provided an extensive
survey of literature regarding use of
psychotropic medication with people
with intellectual disabilities
“Interventions based on applied
behavior analysis have the strongest
empirical basis, although there is some evidence that some other therapies have promise.”
Sturmey (2002)
Article titled, “Mental Retardation and
Concurrent Psychiatric Disorders:
Assessment and Treatment”
Pyles quotes Reudrich (1992) in Current Opinion in Psychiatry, who said that by using graphic displays and single subject design, “the developmental field may take the lead in expanding this practice to more traditional psychopharmacology with the non-retarded people.” (p
In Pyles (1997) On the HDC Model
Clearly defining target behavior
Collecting and presenting data
Analyzing environmental functions as distinct from endogenous causes)
Educating team members about ABA and single-subject designs (when the opportunity arises)
Behavior Analysts’ Skills
Learn common medical terms and
language
Coordinate with the physician
• what information regarding any behavior would be useful, and then provide it
• Use graphs, but with care (initially
Learn the drug effects
Learn the drug side effects
Contrast this with secondary
effects)
Skills to Improve
One effect is the primary effect
Other effects are called side effects
The diagnosis determines what is primary therapeutic effect and what’s the side effect
Medication Effects
Same drug, two names:
Wellbutrin for depression
Zyban for smoking cessation
Same drug name, two effects:
Benadryl for allergies
Benadryl for sleep
Examples of Primary and Side
Effects
Most antipsychotics: Anticholinergic
effects (Antihistamines dry you out)
Haldol: Akathesia (need to move)
Risperdal: Weight gain, Gynocomastia
Mellaril: Heart problems
Tardive dyskinesia
Tics, rolling tongue, abnormal movement
Can be irreversible
Increasing risk over time
Initially thought less likely with atypical
Neuroleptic malignant syndrome
Looks like flu, fever with rigidity
Fatal if untreated
Some Key Side Effects
Defined as the critical or lethal
reaction to an erroneous dosage of a
medication
Toxicity is not exactly a side-effect,
but can have important behavior
components
Examples: Lithium, Depakote
Toxicity
A broader term used in many contexts referring to a cause and effect relationship
Effects on target behaviors
E.g., SIB and proprioceptive feedback
Effects on other behaviors
E.g., sedative effects in teaching
contexts, attention span
Secondary Effects of Medications
Changes in the effectiveness of
specific stimuli as evocative or consequent variables
E.g., light sensitivity, sound sensitivity, loss or increase in appetite, anti-cholinergic effects Example: Wilson and the Water Fountain
Secondary Effects as EOs
If at all possible, attend medication management meetings. There is no real substitute. You must make every effort to do this. Keep trying.
Facilitate Communication with the
M.D. or Psychiatrist
Behavior analysts are most likely to come into contact with the legal system in the following three broad areas (this list is not comprehensive) Documentation/confidential information Contracts and fees for service Investigations and/or litigation
Where ABA Meets the Law
