Association for Behavior Analysis International

As access to information increases with internet searches and almost instantaneous global communication, behavior analysts become exposed to a wide-variety of perspectives and strategies for treatment implementation. This exposure can cause behavior analysts’ worldview to shift from applying the theoretical foundations of behavioral science to incorporating other worldviews (e.g., mentalistic, non-scientifically supported theories) into their clinical practice. Some behavior analysts have confused the technologies of behavior analysis (e.g., curricula, assessments, etc.) for behavior analysis itself or have not adopted a behavioral worldview. “If this were a theoretical issue only, we should have no cause for alarm; but theories affect practice… Confusion in theory means confusion in practice” (Skinner, p. 9, 1968). This symposium, which includes four presentations and a discussion, will examine the variables that impact the shift to or away from a behavior analytic "worldview", the necessity for incorporating a behavioral worldview into ethical practice, and the impact for not utilizing a behavioral worldview.

Practicing behavior analysts, students of behavior analysis, clinical supervisors.

A worldview is the lens through which we look and make sense of the world. A worldview constructs the foundation of what we believe, and dictates how we explain, assess, and deal with the phenomena of interest. Behavior analysts, through their training, are exposed to and supposedly embrace the worldview of behaviorism and all that that means, such as adherence to scientific attitude and practice, that informs our assessment and treatment of behavior. However, there is accumulating evidence that behavior analysts are using and supporting treatments and interventions that are not based upon the behavior-analytic worldview or conceptualization of behavior. Such practice hurts consumers, hurts our field, and demonstrates ethical disarray on the part of the behavior analyst. Behavior analysts have an ethical and practical responsibility to adhere only to behaviorism as their worldview and behave according to only its tenets and philosophy.

Despite ethical requirements that behavior analysts function under a behavioral world view, it appears that some behavior analysts have adapted more of a conspiracy theory – flat earth world view not based upon our science. In fact, evidence indicates that some behavior analysts believe that the behavioral world view only applies to specific populations and age groups – not the full earth. This may be due to a lack of understanding and application of the fundamental philosophy of the science or an over-reliance on marketing behavioral analysis to specific populations and commercialized guides as easy to use as a point-and-click google search. Marketing may have been appropriately conducted to disseminate to the public behavior analysis’ effectiveness for specific populations, it may have marketed too well – changing behavior analysts’ world view. Although curriculum and guides initially may have been appropriately developed to assist behavior analysts, but not replace the fundamental applications of the science, the over reliance on their simplicity may be replacing the comprehensive understanding and use of the behavioral world view and application of such. Without a thorough understanding and application of a comprehensive behavioral worldview, behavior analysts may evolve into superficial and unethical, point-and-click behavioral technicians and not analysts.

Consent is embedded in the foundation of behavior analytic research and clinical practice. The processes of obtaining consent and assent require that researchers and practitioners share information regarding procedures in a way that is understandable to the recipient, which often appears to be a straight-forward process. Beyond the process of information sharing, though, are important matters related to whether or not someone has the capacity to consent or assent and whether that capacity has changed or will change over time. Additionally, it is often incumbent on researchers and practitioners to use their judgement when deciding whether or not assent has been provided noncoercively. This can be especially difficult when working with more vulnerable populations like individuals with developmental disabilities or dementia. This symposium will address issues related to decision-making capacity, commonly used capacity assessments and assent procedures, and socially valid methods for gaining assent that avoid coercive procedures. These issues will be discussed as they relate to older adults with dementia and children and adults with developmental disabilities.

BCBAs

Determinations of decision-making capacity affect a person’s civil rights. When reasoning or decision-making capacity is in question, the onus is to balance autonomy and safety, maximizing self-reliance and independence while programming for assistance to prevent harm and maintain safety. Assessment of decision-making capacity is a research area, nevertheless, myths about decision-making capacity abound. Contrary to common belief, decision-making capacity is not unitary – it is specific to the task or domain in question (e.g., financial, medical, research consent or assent); cognitive difficulties do not automatically imply a lack of capacity; and individuals may lack capacity in one area of functioning while retaining capacity in other domains. Individuals may also transition from more to less assistance with decision-making, and capacity can be regained. This primer will review basic tenets of decision-making capacity and broadly introduce research and currently existing guidelines, considering the impact on a person’s life and advancing providers’ competency to navigate ethical and practical issues.

Behavior-analytic research with adults with dementia is often conducted with people who lack the capacity to consent on their own behalf. However, commonly used capacity assessments and assent procedures are often ill-defined and subjective. Although there are some objective behavioral measures of dissent (e.g., moving away from the area, indices of unhappiness), assent procedures requiring vocal responses may produce verbal behavior under stimulus control of past or unobservable events. For example, “Can I sit with you today and show you some activities?” might result in the topographically-irrelevant response, “I told him that the birds are blue.” Researchers must then judge whether assent has been given, which can be uncomfortable. We will discuss the utility and pitfalls of our ethics committee-approved assent and consent procedures, and the use of compassionate misinformation in relation to the BACB Professional and Ethical Compliance Code for Behavior Analysts. We will present data showing the prevalence of vocal responses not under conditional control of discriminative stimuli used in assent procedures. We will discuss the need for socially valid, effective vocal and non-vocal methods for gaining assent from participants with dementia to enable people to be involved as much as possible in the consent process (i.e., have choice).

Whether conducting behavior analytic research or providing behavior analytic services to individuals with developmental disabilities, it is important to gain consent for the provision of the procedures in question. Several issues arise when considering how informed consent is obtained to ensure individuals with developmental disabilities who are their own guardians are not coerced into providing consent. There are also several considerations that must be made to ensure consent is effectively informed. When adults with developmental disabilities are not their own guardians or when children with developmental disabilities are involved, they may not be able to legally provide consent. However, the majority of the time, such individuals must still provide assent. Thus, similar issues apply. This presentation will provide an overview of the concerns that can arise when attempting to gain consent or assent from individuals with developmental disabilities. We will provide a behavior analytic perspective on these issues, as well as present potential solutions behavior analysts might consider as ways to evaluate assent and consent that avoid coercive procedures.

Collaborating with professionals in other disciplines is vital to the success of those we serve but is also one of the most difficult parts of the job. Teachers, speech pathologists, occupational therapists, pediatricians, social workers, and psychiatrists bring unique areas of expertise, and collaboration means finding common ground. Successful collaboration may also require some persuasion and translating behavior analytic terms into their language to teach others what our science has to offer. This panel includes experienced behavior analysts from school, hospital, and mental health settings who have experience collaborating with diverse professionals from other disciplines. They will provide their perspectives on the benefits of working with others and provide strategies for how to navigate potential challenges. They will give insight into navigating ethical issues that may arise when working with multidisciplinary teams. They will offer recommendations on how to make friends and influence people to provide the best services possible for those we serve.

The target audience in practicing behavior analysts who work in setting that require collaboration with professionals from other disciplines.

In the last two years, diversity, social justice, and cultural humility have received a surge of interest in the applied behavior analytic (ABA) community, likely largely bolstered by social movements such as MeToo and BlackLivesMatter. This symposium brings together four presentations that provide practical action items for research and practice. The first presentation, by Elizabeth Fong, will bring a broader historical perspective to the conversation surrounding diversity in ABA and will engage the audience in some brief self-reflective and group activities. The second presentation, by Jacqueline Ramirez, reviews research on cultural humility training and provides specific actionable recommendations that the audience can put into practice today. The third presentation, by Robyn Catagnus, presents results of a review of research published in six behavior analytic journals and assesses the presence of cross-cultural research published in these journals. The fourth presentation, by Zoey Ulrey, presents a conceptual functional analysis of leadership behaviors relevant to preventing harassment in organizations. The symposium concludes with a discussion by Denisha Gingles.

Any behavior analysts

The topics of cultural competence and cultural humility have received increasing attention in the behavior analytic profession. Although the terms are often taken as synonymous, they are not the same. The concept of cultural competence assumes that, after sufficient training, one might become competent in another’s culture. The concept of cultural humility asserts that one can never become fully competent in another’s culture, so a more realistic and productive goal is to become humble and open with respect to culture. The field of applied behavior analysis has done very little research addressing the topic. In fact, few training programs in behavior analysis include training in cultural humility as a requirement. A best practice for teaching these frameworks has not been identified and there is a critical need to outline the relevance of cultural humility and to expand on studies from similar disciplines that have a head start in identifying what works. Identifying best practices will enable practitioners to provide ethical, socially significant, and socially validated interventions to our consumers and families, thus remaining true to our ethical code and dimensions of applied behavior analysis.This presentation will make specific, testable recommendations for how behavior analytic training and research may be brought to bear on establishing culturally humble clinician repertoires of behavior.

Collaboration amongst interdisciplinary teams to manage treatment outcomes should be a first line of defense in effective behavior support with adults. Most of the time, figuring out the function of the target problem behavior is an easy task. The difficulty arises when treatment objectives are targeted in isolation thus creating a significant barrier to effective intervention. Often times adults with disabilities are served by various providers including behaviorists, psychiatrists, mental health professionals and non-behaviorally trained direct support staff. More often the consultation model for behavior services is used and the behaviorist is charged to work with a team of professionals and paraprofessionals that may or may not be focused on the same objectives. Initial and ongoing collaborative treatment planning will allow for more effective interventions. The talks that are presented in this symposium show measurable effects of professionals and paraprofessional who use a collaborative treatment model to support various individuals.

The target audience for this presentation includes any professionals working in the field alongside other professionals and paraprofessionals.

When working with dually diagnosis adults, behavior analysts want to minimize the need for medication for behavior challenges. The treatment evaluations presented here include collaboration between a Board Certified Behavior Analyst (BCBA) and a psychiatrist to achieve medication stabilization and behavior reduction. The targeted individuals include (1) a 59 year old woman diagnosed with Schizoaffective disorder, Depressed type and Moderate Intellectual Disability, (2) a 41 year old woman diagnosed with Bipolar Disorder, Severe Intellectual Disability, and Autism, and (3) a 30 year old woman diagnosed with Anxiety Disorder, Schizophrenia, Moderate Intellectual Disability, Epilepsy and Pseudo-Seizures. All of the ladies live in a group home setting (not all in the same home) and have a history of frequent hospitalizations as well as residing in state-run facilities. A collaborative model was used with the psychiatrist and direct staff that included development and implementation of a behavior plan, as well as visual/graphical feedback for decision-making with medications. Across all individuals, behavior challenges reduced and medication changes due to increasing behavior problems was no longer needed.

Working with adults usually means utilizing a consultative approach where the BCBA is the consultant and paraprofessionals are the direct line staff. When this happens, collaboration with the service providers who employ the paraprofessionals and the paraprofessionals themselves is essential. In addition, the behavior program must include a strong staff training component to ensure accurate and consistent delivery of the behavior program. Without collaboration and staff training, the behavior program cannot be fully adopted to ensure effective support for the individual. This presentation includes treatment evaluations of collaborative models for three males, ages 23-28. All have dual diagnoses and have 2:1 staffing ratios due to the intensity of problem behaviors. Attendees will be presented with data that represent collaborative work with paraprofessionals that is focused on behavior plan implementation and overall behavior excess reduction.

Skinner (1987) stressed that acting to solve the world’s problems required changing the environment of which the problem-solving behavior is a function. In the ensuing decades since he called on behavior analysts to become more involved in system level change, the relevant environment did change – e.g., the introduction of new or stronger journals, organizations, researchers, grant programs, etc. – and behavior analysis matured into a discipline that now applies its theoretical and methodological approach to the remediation of social and cultural problems. This symposium presents a sample of current behavior analytic work addressing systems-level change, with presenters drawn from chapter authors of the forthcoming book Behavior science perspectives on culture and community (Mattaini & Cihon, Eds.). Presenters will discuss behavior analytic advances in promoting environmentally sustainable practices, moderating problematic climate change via both community organizing models and working with the corporate sector, fostering social justice through research and clinical practice, and engaging in activism and advocacy efforts to promote progressive social change. The four topics are interrelated with each other and, combined with discussant remarks and 20 minutes for audience questions, will offer a rich introduction or update to cutting edge applications of behavior analysis to saving the world

Graduate students and professionals

The humans of today are among the most important to share the Earth. The efforts that lay ahead—reducing our carbon footprint, preserving our natural landscapes, drastically changing our resource consumption—are likely to yield outcomes we may never directly experience. Although technological ingenuity will be critical, efforts by behavioral scientists to encourage sustainable lifestyles will be among the leading means by which to proactively maintain Earth’s habitability. In this vein, behavior analysis has a rich history of work promoting sustainable living. We conducted a systematic review of behavior analytic research in sustainability using key phrases derived from leading climate and Earth science reports (e.g., Intergovernmental Panel on Climate Change). We coded the resulting fifty-two empirical studies published across six primarily behavior analytic journals according to intervention methods and target behavior to reveal gaps in the existing literature. The goals of this presentation will thusly be to (a) summarize the efforts of behavior analysis to-date in the areas of sustainable living, (b) highlight areas for which empirical research is lacking, and (c) highlight areas where future behavior analysts can make the most meaningful contribution to advance global sustainability

Global warming (GW) will continue to accelerate unless exceptional efforts are taken soon to reduce carbon emissions and greenhouse gases. Increasingly dire consequences are apparent now across the globe. GW is a behavioral problem at its root -- a "super wicked problem" whose solutions seem unsolvable within the time available for action. A science of the behavior of individuals is relatively clear about the contingencies that influence individuals to reduce their greenhouse gas emissions and behavior analysis has made significant contributions to our understanding but has little impact on the problem, given the lack of evidence on strategies for influencing entire populations. This talk outlines a theoretical account of the behavior of individuals and the practices of organizations relevant to the trajectory ahead. The challenge for the behavioral science community is to identify, understand and manage the variables that will bring about massive, crucial changes in individual behavior and organizational action to prevent further warming or help prepare for what lies ahead. Prevention may be beyond behavior science community skill set, but successes in applications of behavior analysis suggest that this community may be orchestrated to address behaviors needed for adaptation to a warming planet and resilience during climate crises.

A wide array of populations and communities are trapped in complex, multi-level systems of interlocked behaviors that offer no clear path toward dignity and social justice. The impact behavior analysts can have with progressive social change is enhanced through the strategic adoption of three key repertoires: activism, advocacy, and accompaniment (AAA) and a thorough analysis of evidence-based policy change efforts. Understood as value-oriented practices whose effects are primarily observed at the systems level, activist activities involve building knowledge about issues impacting various social communities and engaging in on-going efforts to improve the quality of life on a large scale. Advocacy and accompaniment actions are functionally related to these values, which are discrete plans of action with specific operationalized outcomes. AAA efforts may be enhanced with support from the behavior analytic community, armed with evidence-based strategies that effectively produce policy change, and more importantly, improvements to quality of life for society at large. In this presentation we provide a conceptual analysis of social change efforts and provide suggestions for establishing systemic behavioral change as an aggregate product of the behavior analytic community.

Estimated 75,000 board certified behavior analysts (BCBAs) are needed in order to support the growing need for behavior analytic services in the United States (Hartley et. al., 2016) with only 32,000 current BCBAs (Behavior Analysis Certification Board, 2018). The United States employment demand for Behavior Analysts from 2010 to 2019 found that increases were observed for each state from 2010 (BACB, 2019). Furthermore, there are many other countries, such as Japan, where there are simply not enough behavioral service providers to serve people with developmental disabilities. With such rapid increases in the demand for ABA services within US and possibly even more in other countries, how can the field of Behavior Analysis and organizations work together to provide the services for people with varying socioeconomic and cultural backgrounds? How can we modify our traditional service delivery to better-accommodate to their various needs or level of resources? The panelists will discuss how behavior analytic services in the above-mentioned areas can be implemented and their experience on delivering services across socioeconomic and cultural backgrounds.

Business owners, managerial level BCBAs

Students with intellectual and developmental disabilities (IDD), when compared to typical developing peers, continue to have lower post-secondary outcomes (e.g., employment rates, community integration) (Migliore & Butterworth, 2008; Papay & Bambara, 2014). As the transition pathways expand beyond employment (i.e., education, independent living, community integration), multidisciplinary teams are searching for ways to better prepare students with IDD for life after high school. Behavior analysts can support education personnel in all major facets of the Individuals with Disabilities Education Act (IDEA; 2004). This panel aims to discuss how Behavior Analysts can collaborate with multidisciplinary teams on assessment, intervention, and thoughtful programming, highlight areas for improvement within the transition process, and discuss how to approach conflicting views on best practices.

The target audience for this panel are professionals who work as behavior analysts within school districts and consult with school staff members on transition programming. A secondary target audience are behavior analysts who have a vested interest in assessing students with IDD.

Acceptance and Commitment Training is a topic that has received substantial increased attention within the applied behavior analytic community in recent years. Among the most common concerns ABA practitioners have is about how to actually implement ACT inside of daily mainstream ABA service delivery. This symposium brings together four presentations that describe practical efforts at incorporating ACT into ABA agencies. The first presentation, by Michelle L. Zube, describes how to become versed in ACT and the ways in which organizations can expand professional development and scope of practice with ACT. The second presentation, by Ehren Werntz, describes the use of ACT as part of caregiver training. The third presentation, by Kate Harrison, describes the utility of ACT on a personal level and with colleagues to help reduce stress. The fourth presentation, by Erin Bertoli, describes the use of ACT with struggling youth, including when, why and how behavior analysts can do so while staying within their scope of practice. The symposium concludes with a discussion by Dr. Stuart Libman.

Board Certified Behavior Analysts. Parents are also welcome!

Behavior analysts working in public school settings may face ethical and logistical challenges. As an applied area of behavior analysis, practicing in education requires in-depth understanding and application of the Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board®. For behavior analysts, supervision in the public school setting can be broadly defined and can encompass a variety of roles and responsibilities. Behavior analysts may provide supervision to those who are both familiar and unfamiliar with ABA. It is often a behavior analyst’s responsibility to juggle administrative duties and supports, ethical standards, and education for staff, all while ensuring appropriate service delivery and effectiveness for students. Additionally, many roles filled by behavior analysts in public schools are not evaluative, thus creating additional challenges for effective supervision. Yet, success for students depends upon staff providing quality services, often supported or overseen by the behavior analyst. This panel discussion will specifically focus on behavior analysts providing supervision and supports in public schools. The targeted audience for this panel includes those currently working in public school settings, those who consult in these settings, or those teaching future behavior analysts who may work in the public school setting.

BCBAs or BCBA-Ds currently working in public school settings BCBAs or BCBA-Ds who consult in public schools BCBAs or BCBA-Ds teaching future behavior analysts who may work in the public school setting

Behavior analysts have the potential to encounter ethical challenges on a daily basis. While the Professional and Ethical Compliance Code for Behavior Analysts (Behavior Analyst Certification Board; BACB, 2014), includes clear and concise guidance and direction, many behavior analysts find there is significant ambiguity, misunderstanding, and interpretation when applying the Code to real-life professional circumstances. Practitioners may find themselves in an uncomfortable conflict between adhering to the Code and integrating their own appraisal and perspective of challenging scenarios. Fortunately, behavior analysts are adept at assessment of the events surrounding targeted behavior and can directly apply this skillset toward understanding behaviors associated with ethically difficult situations. The panelists will discuss ethical decision-making models for incorporating and analyzing the function of ethically precarious behavior within context while remaining consistent with ethical standards of the field and ensuring quality care for clientele.

The target audience for this presentation is anyone interested in the study or practice of applied behavior analysis including Board Certified Behavior Analysts (BCBAs), Board Certified Assistant Behavior Analysts (BCaBAs), Registered Behavior Technicians (RBTs), psychologists, psychiatrists, clinicians, graduate students, professors, teachers, and parents. The primary audience will be those practicing, teaching or studying in applied behavior analysis.

In 2005 Ioannidis proclaimed “Why Most Published Research Findings Are False.” RetractionWatch has cataloged over 20,000 scientific papers that have been withdrawn since 2010. The “replication crisis” is not the result of a few bad actors but rather is a systems problem. This presentation reviews “replication crisis” from a behavioral systems analysis perspective, identifies the metatcontogencies of the “countability culture” in academia and research that maintain the problem, and proposes solutions based on open science practices, ethical standards and methodological pluralism, noting that OBM research has been a leader in this regard.

Researchers, scholars, scientists, and graduate students.

Donald Hantula earned undergraduate degrees from Emory University and graduate degrees from University of Notre Dame and is currently with the Department of Psychology, Decision making Laboratory, and Interdisciplinary Program in Applied Behavior Analysis at Temple University. He has previously held academic positions in Occupational Health Promotion at the Johns Hopkins School of Medicine, Human Resource Management at King’s College and Management Information Systems at St. Joseph’s University, and also as Director of Decision, Risk and Management Sciences at the National Science Foundation. He is the immediate past editor of Perspectives on Behavior Science and presently serves as Coordinator of the ABAI Publications Board and on the ABAI VCS board. He has published over 100 articles and chapters and his research interests include finding rational explanations for seemingly irrational decisions, quantitative analysis of behavior, consumer choices for sustainable products and practices, integrating behavioral and digital technology and ethical implications of OBM.

The Practical Functional Assessment and Skill-Based Treatment process has been shown to reduce problem behavior by teaching individuals functional communication, toleration of delays to reinforcement, and contextually appropriate behavior during those delays. Teaching procedures typically involved some form of escape extinction. Some settings and circumstances, however, have necessitated the development of procedures that do not rely on escape extinction for their efficacy. One promising model, called the Enhanced Choice Model (ECM, Rajaraman, et al. 2019), involves the participant having the choice to (a) participate in treatment sessions, (b) leave the treatment sessions and access reinforcers noncontingently, or (c) leaving the treatment context altogether (e.g., going back to their regular classroom). This current symposium highlights extensions of this model to a public-school setting in which three educators learned and implemented treatment components as a means of generalizing treatment outcomes. The second presentation will examine specific mands as a generalized outcome of the public school application. The third presentation describes a distance-based telehealth case in which the caregivers implemented all assessment and treatment components. The final presentation will be a literature review on the tendency for individuals to prefer contingent reinforcement, a potential factor in the efficacy of the ECM model.

The target audience for this session includes practicing behavior analysts who oversee behavior change programs that address severe problem and behavioral scientists who would like to learn more about the extent to which organisms will allocate their responding to contingent vs. non-contingent access to reinforcement when concurrent schedules of reinforcement are available.

Santiago, Hanley, Moore, and Jin (2016) showed that the interview-informed synthesized contingency analysis (IISCA; see Hanley, Jin, Vanselow, & Hanratty, 2014) and skill-based treatment process can result in socially validated outcomes when caregivers serve as interventionists during treatment sessions. However, many families who would benefit from receiving similar functional analytic services do not have access to professionals trained to implement functional analyses or function-based treatments. Advancements in teleconferencing technology may allow families without access to local professional support to receive functional analytic services. For example, Suess et al. (2016) demonstrated that when a BCBA provides implementation support via teleconference, parents can assess and treat their children’s problem behavior in their homes. We taught parents of children with autism to implement the IISCA and skill-based treatment process in their homes exclusively through teleconference support. To address additional safety concerns in the home setting, the enhanced choice model of treatment (Rajaraman et al., 2019) was used with one participant. Parents achieved differentiated functional analyses and a 100% reduction in problem behavior relative to baseline.

The voice and inclusion of people of diverse cultural identities is expanding within the world and within our discipline. This expansion presents both tensions and possibilities. Ideally, applied behavior analysts should be developing increasingly more cultural responsiveness in all aspects of research and practice. That is not the case. Cultural responsiveness is closely yoked with lived experience, social justice, and the kyriarchy. The purpose of this presentation is to explore worldviews in the context of coloniality and to then relate this to our disciplinary and personal responses to power and efforts to contribute to a more socially just world. This includes consideration of global trends, the aims and history of our discipline, womanist and determinist worldviews, and ethics. The presentation will close with a discussion of pathways to cultural responsiveness and social justice.

Behavior analysts interested in culture, social justice, applied research, practice

Leaders, managers, organizational members, and consumers in human service industry.

Credentialed behavior analysts are expected to follow the Professional and Ethical Compliance Code (BACB, 2014). The Code itself provides general and specific guidance on acceptable behavior. As the practice of behavior analysis continues to expand (i.e., number of credentialed behavior analysts, breadth of applications of the science, and depth of application within a practice area), discussion of how the Code applies to various situations and variables is important. An area of need is understanding how credentialed behavior analysts and support personnel (e.g., finance, human resource) perceive the application of the Code in practice. Understanding these perceptions can guide the profession, organizations, and individual practitioners in developing preventive and responsive ethical practices. Additionally, current practice situations (i.e., rural practice and international dissemination) warrant specific discussion and relevance to specific Codes. The purpose of this symposium is to share survey data of employees from a mid-sized human service agency regarding ethical perceptions, discuss practice of behavior analysis in rural areas, and the ethical international dissemination of behavior analysis.

Practice organization administration, practitioners, university personnel responsible for training behavior analysts, supervisors of students completing fieldwork requirements, and students.

The practice of Applied Behavior Analysis in rural communities provides ample fodder for unique situations and ethical code violations. Surveys were sent to Board Certified Behavior Analysts (BCBAs) in the state of Oklahoma, a state with only 103 certified individuals, regarding ethical codes most observed to be violated. In addition to few practitioners in the state, almost 80% of Oklahoma’s certificants live within a 20 mile radius from two main hubs of service delivery. This leaves a small number to provide services for the rest of the state's mostly rural areas. Results of the survey indicate multiple relationships, poor supervision and boundary of competence as the greatest areas of concern. Aside from the short supply of supervisors putting a strain on the supervisee: supervisor ratio, other possible variables that contribute to these violations include a lack of resources within the schools, physical distance to other BCBAs for referrals, working in tight knit communities, and within a culture that defaults to the use of punishment procedures. Knowing the most violated codes within a particular community allows preventative strategies to be implemented. In this case, having a network of mentors, holiday gift reminders, and strict practices for social media are a few of those suggested for our rural practioners.

Preface. A Board Certified Behavior Analyst (BCBA) holds the minimum credential necessary to offer Applied Behavior Analysis (ABA) services within the certificant’s scope of experience/expertise. A BCBA wishing to offer services in their own name, by starting a private practice, faces substantial considerations beyond basic clinical competence. Ethical Considerations. Section 1.02 of the Behavior Analyst Certification Board (BACB) Ethics Code provides that BCBAs only offer services within the boundaries of available competence. In addition to basic clinical competence, operating a private ABA practice requires expertise in various administrative areas including: insurance contracts and procedure, personnel management, billing and collections, business law, accounting and payroll, cashflow management, and general business administration. Personal/Market Surveys. To evaluate the practicality of establishing a practice, the prospective entrepreneur should survey: (1) personal resources and existing responsibilities, and (2) the ABA business conditions existing in the prospective geographic market (demand for services, competition, funding sources, population density, traffic, technician availability, pay rates, etc.). Business Plan. A business plan typically reflects: specific goals/expectations, timelines, key personnel, defined target market(s), pro-forma budgets, cost-analyses, detailed consideration of in-house vs. outsourcing of administrative functions, personnel recruitment and training plans, definition and assignment of specific management team functions, policy/procedural documentation, and clinical/administrative quality control.

BCBAs interested in starting or participating in the opening and/or operations of an ABA practice constitute the target audience.

Within certain areas of healthcare, it has been documented that treating patients with compassion and empathy can have important benefits, such as increasing patient satisfaction, enhancing adherence to treatment, and improving clinical outcomes (e.g., Beach, et al., 2006; Hojat et al., 2011; Weiss et al., 2017). Treating oneself and others with compassion is also believed to promote individual wellbeing and improve mental health (e.g. McClelland, et al., 2018; Neff, 2011; Scarlet et al., 2017). While current empirical support for these outcomes is mixed (Kirby, Tellegen & Steindl, 2017), there is increasing scientific interest in the benefits of compassion. That broad-based interest notwithstanding, the data-driven field of behavior analysis has only recently begun to advocate for the importance of relationship variables that could positively impact our work (e.g., Taylor, LeBlanc & Nosik, 2018; Leblanc, Taylor & Marchese, 2019). This presentation reviews survey data documenting parent perception of compassionate care by behavior analysts, as well as behavior analysts’ impressions of training in this area. Behavioral responses that may comprise compassionate care will be presented, along with considerations for how compassionate care of our clients and ourselves can enhance our work as behavior analysts and potentially improve clinical outcomes.

BCBAs, BCBA-Ds, BCaBAs, supervisors and trainers of behavior analysts, autism specialists.

Dr. Bridget A. Taylor is co-founder and CEO of Alpine Learning Group and is Senior Clinical Advisor for Rethink. She holds a Doctorate of Psychology from Rutgers University, and received her Master’s degree in Early Childhood Special Education from Columbia University. She is a Board Certified Behavior Analyst and a Licensed Psychologist. Dr. Taylor is President of the Behavior Analyst Certification Board and serves on the Autism Advisory Group for the Cambridge Center for Behavioral Studies. She is past Associate Editor for the Journal of Applied Behavior Analysis. She also serves on the editorial board of Behavioral Interventions. Active in the autism research community, Dr. Taylor has published numerous peer-reviewed articles and book chapters on effective interventions for autism. She is a national and international presenter and serves in an advisory capacity for autism education and treatment programs both locally and abroad. Dr. Taylor was recently recognized by the Association for Applied Behavior Analysis International for her outstanding contributions to behavior analysis and was given ABAI’s Fellow designation.

Graduate students and practicing professionals interested in punishment procedures (e.g., BCaBA, BCBA, BCBA-D).

In this study, the use of positive punishment was examined with an individual diagnosed with Arnold Chiari Malformation (Type I), autism spectrum disorder, intellectual disability, and personality change due to Viral Meningitis who displayed severe forms of self-injurious, destructive, and aggressive behaviors. Reports indicated the participant had a history of unsuccessful behavioral and psychiatric treatments of their problem behavior. The use of a positive punishment procedure involved a court-approved contingent skin shock in combination with differential reinforcement of alternative, incompatible, and other replacements behaviors. Treatment as usual was compared to treatment plus positive punishment. Results demonstrated clinically significant improvements in quality of life through substantial decreases in the monthly frequency of problem behaviors when positive punishment was in place. The evidence provides support for contingent skin-shock as the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of this individual.

In an effort to decrease severe and persistent problem behaviors that substantially impeded the quality of life in an eighteen year old male, diagnosed with mood disorder not otherwise specified and anti-social personality disorder. The participant had a documented history of unsuccessful treatments (i.e., multiple psychotropic medications, changes of treatment locations, programs utilizing differential reinforcement, and antecedent manipulations) of their problem behaviors (i.e., aggression and self-injury that put their quality of life in jeopardy). A positive punishment treatment plan involved court-approved contingent skin shock in conjunction with differential reinforcement of alternative, incompatible, and other replacement behaviors. Through the course of treatment, a reversal design was implemented over a duration of 11 months and demonstrated the effect of the same treatment plan with and without the positive punishment component. Overall, the treatment demonstrated a substantial reduction of all targeted problem behaviors. When punishment was removed, the monthly frequency increased to pre-treatment equivalent levels. The evidence provides support for contingent skin-shock as the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of this individual.

A severe behavior disorder is an umbrella term used to describe constellations of problem behaviors that are characterized by several factors such as the frequency, intensity, form, and treatment refractory nature. The effects of a severe behavior disorder are absolutely devastating. Severe self-injury can cause blindness (because of repeated head hitting, head banging, or eye gouging), deformation (because of biting, abrasions), bone fractures, hematomas, head injuries, infection (because of chronic open wounds), and death. Aggressive behaviors result in harm to caregivers, law enforcement involvement, emergency hospitalization, and can be a primary factor in placing a child outside of their natural home. The continued occurrence of such behaviors have devastating effects on quality of life. Thus, professional to consumer, professional to professional, and other statements about treatment efficacy are of tremendous importance. Here, the presentation of such information in science, government, and media are described. In addition, systematic methods to evaluate various statements about risk and benefit are reviewed.

Compliance programs were formally introduced into the healthcare space only 30 years ago. Historically, the focus of these programs has been mainly on hospitals, insurance providers, and nursing facilities; however, attention is rapidly turning to Applied Behavioral Analysis providers. As the incidence rate of Autism Spectrum Disorder rises, the cost of treatment by insurance companies, state programs, and federal funding sources increases exponentially. The government has several programs in place to monitor fraud, waste, and abuse, and maintains acute interest in those who are misusing funds. Applied Behavioral Analysis providers have recently come under scrutiny in matters of fraud, waste, and abuse; these allegations bring stigma for the industry and necessitate a call to action. Further, as funders become increasingly concerned with assessing value against costs, providers will need to develop increasingly robust systems in order to ensure proper documentation and outcomes-driven processes, in order to avoid devastating payment recoveries. This panel presents a full range perspective, bringing together both providers and funders to discuss healthcare compliance from multiple vantages, in order to provide participants with a path forward to ensuring quality care and upholding ethical standards.

The target audience are providers, funders, and industries associated with the delivery of Applied Behavioral Analysis treatment.

Cognitive loss and associated functional decline can reflect many different physiological processes, some of which are progressive and neurodegenerative, others stable or even reversible. Behavior analysts, through their measurement-based practice, are uniquely positioned to detect fluctuations in proficiencies and skill levels that are potentially indicative of decline, and to implement assessment and intervention. The goals of this tutorial are twofold: (1) to provide an overview of neurocognitive disorders, such as those from Alzheimer’s, Lewy body disease, or stroke, and prominent risk factors, such as age and an already compromised nervous system due to prior traumatic brain injury, chronic disease, lifestyle factors, or particular preexisting neurodevelopmental disorders; and (2) to offer a practical step-by-step guide to ruling out reversible conditions, ascertain the appropriate level of social and physical support, and address potential behavioral and emotional changes. Video and audio examples will be provided for training purposes, to illustrate the heterogeneity of individuals’ reactions to functional decline, the difficulties of family members to follow behavioral plans or adapt to their loved one’s loss of skills or repertoires, and the need for medical care navigation. The tutorial will introduce cognitive loss and functional decline as a high-need specialty practice area, amenable to workforce development in behavior analysis.

Students; behavior analysts interested in an introduction to the specialty area or in expanding their practice; behavior analysts encountering individuals with neurodevelopmental disorders and decline; and family care partners.

Claudia Drossel is an assistant professor at Eastern Michigan University, a researcher and a clinical psychologist who specializes in advancing neurobehavioral health, including how to best understand and manage cognitive loss and associated behavioral changes. Claudia holds doctoral degrees from Temple University’s experimental psychology and from University of Nevada Reno’s clinical psychology programs, and she completed post-doctoral training in neuropsychology and rehabilitation psychology at the U.S. Department of Veterans Affairs and the University of Michigan. She was the associate director of the Nevada Caregiver Support Center from 2005 until 2010. In addition to journal articles, chapters, and training videos for professionals, she has co-authored a step-by-step manual that guides healthcare providers in working with people who have problems thinking, remembering, or problem-solving. Past and current projects were funded by the Michigan Health Endowment Fund and the Anna Botsford Bach Fund for Seniors.

With its growth, the field of applied behavior analysis (ABA) is encountering practice issues ranging from negotiating insurance reimbursement, developing formal treatment guidelines, and gaining the trust of consumers. One controversial practice issue is the use of non-compete clauses (NCC’s) in employment contracts. NCC’s have the potential impact how, when, and who practitioners can serve. NCC's are used in some fields and banned in others (i.e., law practice, some human services/medical fields in some states). Although widely used in ABA businesses, to our knowledge no discussion of NCC's has occurred in our own field. Results of a recent survey and personal experiences of the panelists and audience will be used to engage the attendees in discussing practical and ethical issues related to the use of NCC's in ABA.

All BACB certificants (RBT's, BCaBA's, BCBA's, BCBA-D's), individuals who work in agencies services individuals with autism or other developmental disabilities, and owners of businesses providing services to individuals with disabilities.

The ways in which Acceptance and Commitment Training (ACT) is made accessible for individuals within mainstream ABA are predominantly couched in the ACT "hexaflex". The current panel discussion will highlight other, potentially viable conceptualizations of facilitating competence regarding ACT's core processes for practicing behavior analysts. Further, we aim to tether objective process and outcome measures to the core processes such that practitioners may be better equipped to confidently use ACT within their efforts to promote habilitation in the individuals with whom they work. Finally, we seek to demystify stigma around ACT as being unethical in behavior analysis.

Beginning-Advanced BACBs/behavior analysts; graduate students of behavior-analytic programs