Clinical practice

Cultural awareness in behavior analytic service provision

Applied behavior analysis is a highly social endeavor.  Behavior analysts might work within clients’ homes or schools, or directly with organizations to promote meaningful behavior change.  In this sense, the provision of behavior analytic services is social, as high levels of social interaction are typically required for the job.  To effectively promote behavior change, behavior analysts must pay close attention to both the behaviors of interest and their surrounding environments.  Our descriptions of behavior focus on what our clients are doing.  However, the actions of others represent a large component of our clients’ environments.  This relationship between client behavior and other people’s actions also contributes to the social nature of our profession.

Social MediaThe design and implementation of effective behavior change programs will necessarily include supports from the individuals making up our clients’ environments.  In order to garner that support, behavior analysts must be both aware and sensitive to their needs, in addition to those of our clients.  This task becomes more difficult when working with individuals from diverse cultural backgrounds.  This post will discuss some strategies to facilitate the successful provision of behavior analytic services among culturally diverse populations.

Let’s begin by answering the following question.

What is culture?

Skinner (1971) defined culture in terms of behavior.  That is, a culture is the collective behavior of a group of people.  These behaviors persist due to shared values (i.e., reinforcers).

A practitioner might first begin her pursuit of cultural awareness by identifying her own cultural practices and values (Salend & Taylor, 2002).  Since cultures consists of common behaviors among groups of people, a practitioner might continue her pursuit of cultural awareness by obtaining general information about relevant cultural practices from other members of the culture.  One might also seek the assistance of behavior analysts who have experience with the culture.  In this manner, the practitioner becomes informed about general cultural practices and values.  The practitioner may also take these factors into consideration when conducting behavioral assessments and making treatment recommendations.  Once the practitioner has identified the behaviors and values of her own culture and familiarized herself with those of potential relevance to the client, the practitioner can examine and resolve conflicting features that may exist between the two perspectives.  Although cultures are defined by the behaviors exhibited among a group of people, one must also be careful to not assume all members of a specific culture behave similarly.

At this point, you might be wondering –  if a culture is defined by common behaviors and an individual within a specific culture might not engage in all of the customary behaviors, how do I determine which cultural components are relevant to my client?

The identification of relevant cultural factors can be incorporated into the functional assessment process.  Salend and Taylor (2002) recommend the inclusion of family, community members, and other professionals who are familiar with the client’s cultural background.  Interviews might include questions related to the client’s family and community dynamics. Information regarding religious preferences and access to community resources may assist the practitioner in developing treatment strategies (Fouad & Arredondo, 2007).  Collaborations with family and community members might include the development and prioritization of goals, as well as the identification of preferences related to potential intervention strategies.  During the assessment process, the practitioner might also collect information about the client’s individual and shared interests, hobbies, and preferences.  A functional assessment that collects information about collective behaviors and shared values in addition to individual behaviors and reinforcers should equip the practitioner with relevant information and enable the delivery of effective behavior analytic services to culturally diverse populations.

In summary, a behavior analytic practitioner might consider the following strategies when working with culturally diverse populations.

  • Identify your own cultural practices
  • Become familiar with general features of the client’s culture
  • Identify factors relevant to the client’s specific culture via the inclusion of community members in the functional assessment process

What strategies have you used to become more culturally aware?  Share them below and keep an eye out for more from BAM Network!

References

Fouad, N. A., & Arredondo, P. (2007). Implications for Psychologists as Practitioners. In, Becoming culturally oriented: Practical advice for psychologists and educators (pp. 51-64). Washington, DC: American Psychological Association.

Salend, S., & Taylor, L. S. (2002). Cultural perspectives: Missing pieces in the functional assessment process. Interventions in School and Clinic, 38, 104-112.

Skinner, B. F. (1971). Beyond Freedom and Dignity. Indianapolis, IN: Hacket Publishing Company Inc.

Can control be a function of behavior? – A follow up

In an earlier post, I described a scenario consisting of a client’s engagement in problem behavior in the presence of activities previously identified as high preferred and discussed why control could not be the function of the problem behavior. I also explored how standard functions of behavior (i.e., escape from or access to stimuli), in addition to the presence of various motivation operations (MOs) might offer more adequate behavioral explanations. Relevant MOs and their potential contribution to problem behavior were listed as follows.

  • During a task interruption, the occurrence of a simultaneous, ongoing activity might reduce the client’s preference for the practitioner requested activity.
  • There may be a functional relation between the client’s preference for an activity and the time of day.
  • The client’s history with aversive task presentations from others may have generalized to all requests, effectively reducing the client’s preference for any activity initiated by others.

Child pupil with parent or teacher reading a book in public library.

The purpose of the current post is to discuss potential strategies to address these problems. Hagopian, Bruzek, Bowman, and Jennett (2007) evaluated a demand fading intervention to address problem behavior occasioned by activity interruption. During the intervention, clients were exposed with altered presentations of two discriminative stimulus cards. One card indicated clients could engage in uninterrupted play. The other card indicated compliance with interruptive demands would be reinforced, client demands would not be reinforced, and preferred activities were restricted. Over the course of the intervention, the amount of time spent in uninterrupted play was gradually reduced while the time spent in the interruption condition was increased.
When instability in client preferences are a problem, one might address these preference shifts by conducting multiple and frequent preference assessments to identify the events most likely to be effective reinforcers at that point in time (DeLeon, Graff, Frank-Crawford, Rooker, & Bullock, 2014). One may also provide clients with opportunities to choose between potential reinforcers. Instead of selecting activities for the client, the practitioner could arrange the provision of choice selections prior to or following an instruction or task.

McLaughlin and Carr (2005) discussed how poor rapport might contribute to problem behavior exhibited by clients following task demands. Poor rapport might be due to a history of negative interactions between the client and practitioner, such as the practitioner’s high rates of aversive nonpreferred stimulus presentations. When this happens, the presence of the practitioner might become related with upcoming aversive events. McLaughlin and Carr (2005) implemented an intervention to improve rapport between clients with disabilities and staff members. In this case, the clients engaged in problem behavior with some staff members and not with others, suggesting a problem with client – staff member rapport. An intervention to improve rapport focused on establishing staff members as generalized reinforcers by conditioning them with a wide array of social, activity, and tangible reinforcers. That is, staff members were trained to noncontingently present preferred stimuli. Staff members were trained to identify and respond appropriately to the client’s verbal and nonverbal communicative attempts (i.e., the function of various client behaviors and how to respond with a functionally equivalent consequence). Staff members were also trained to strengthen reciprocity (e.g., turn-taking) by participating in activities of shared interest with the client. Activities of shared interests were identified with client-staff member dyads and staff members were trained how to initiate and include equal participation in these activities with the client. Following the intervention, compliance with task demands improved and problem behavior decreased.

A scenario that was not mentioned in the previous post, but is also relevant to this discussion includes problem behavior occasioned by noncompliance with client mands. That is, the client tends to engage in problem behavior when she makes a request and others do not comply with the request. Bowman, Fisher, Thompson, and Piazza (1997) systematically evaluated the environmental variables contributing to problem behavior occasioned by noncompliance with a variety of client demands. Because the specific demands varied within and across sessions (e.g., consisted of mands for the onset or offset of attention and tangibles, as well as the dictation of others’ activities), standard functional analysis procedures (where one type of reinforcer is tested at a time) could not adequately assess the behavioral function. Modifications to the standard functional analysis methodology were necessary. The results of the modified functional analysis suggested that problem behavior was maintained by compliance (or an increased likelihood of compliance) with mands. Following the completion of the functional analysis, the investigators implemented functional communication training (FCT) to reduce problem behavior.

During the FCT procedure implemented by Bowmen et al. (1997), appropriate mands were reinforced according to an FR1 schedule. Maintaining treatment integrity with dense schedules, such as the FR1, might be difficult in typical applied settings. O’Conner et al (2003) implemented an intervention to address problem behavior maintained by compliance with client mands that might be more practical for applied settings. Their intervention consisted of a three-tier level system. At level 3, a discriminative stimulus in the form of a card indicated the client could play his way and the therapist complied with all reasonable demands. The therapist also delivered continuous attention and provided access to high preference items. If the client engaged in moderate intensity problem behavior, he was moved to level 2. At level 2, lower preferred items and minimum levels of attention were provided. Therapists did not comply with demands. The client remained at level 2 until 15 min had progressed without problem behavior. Engagement in severe problem behavior resulted in the client moving to level 1. At level 1, the client was place in an exclusionary time-out. Once 10 min had passed without problem behavior, the client was moved to level 2. During scheduled academic activities, compliance with work demands were reinforced with breaks. The level system was incorporated into the break intervals, based on the presence or absence of moderate and severe problem behavior.

Throughout this post, we discussed several interventions to address problem behavior occasioned by very specific environmental events. The practitioners’ design and implementation of these effective procedures was enabled by their ability to identify the relevant contributing environmental events related to the problem behavior. Identification of the environmental events maintaining problem behavior is key to effective treatment. The use of ambiguous terms such as ‘control’ in functional statements do not assist in the development of function based procedures. Without this information, use of the most effective procedures is not possible.

References

Bowman, L. G., Fisher, W. W., Thompson, R. H., & Piazza, C. C. (1997). On the relation of mands and the function of destructive behavior. Journal of Applied Behavior Analysis, 30, 251-265.

DeLeon, I. G., Graff, R. B., Frank-Crawford, M. A., Rooker, G. W., & Bullock, C. E. (2014). Reinforcement arrangements for learners with autism spectrum disorder. In J. Tarbox, D. R. Dixon, P. Sturmey, & J. L. Matson (Eds.), Handbook of Early Intervention for Autism Spectrum Disorders (pp. 205-228). Springer New York.

Hagopian, L. P., Bruzek, J. L., Bowman, L. G., & Jennett, H. K. (2007). Assessment and treatment of problem behavior occasioned by interruption of free-operant behavior. Journal of Applied Behavior Analysis, 40, 89-103.

McLaughlin, D. M. & Carr, E. G. (2005). Quality of Rapport as a Setting Event for Problem Behavior: Assessment and Intervention. Journal of Positive Behavior Interventions, 7, 68-91.

Strategies to facilitate successful collaborations with caregivers

Businesspeople shaking hands in office with coworkers and staff sitting at the table with them

Collaborating with caregivers and other stakeholders is a necessary component of behavior analytic service provision.  Stakeholders are typically responsible for seeking out and funding services provided to the client.  Stakeholders close to the client, such as parents or teachers, may also function as primary behavior change agents.  It is apparent from the various stakeholder roles that the establishment and maintenance of good rapport with stakeholders is essential to the efficacy of behavior analytic services.

How does one arrange for successful collaborations throughout the provision of services?

You can start by engaging in activities similar to those conducted during initial direct client sessions.  That is, start with rapport building.  Establishing rapport is typically recommended as the first step in the provision of behavior analytic services.  The goal is to establish yourself as a reinforcer for the purpose of facilitating program efficacy.  Of course establishing rapport with stakeholders will not consist of the same behaviors as rapport building with direct clients.  During initial sessions with stakeholders, you should focus on smiling, making eye contact, and listening to stakeholders (Bailey & Burch, 2010).  Listening activities might include acknowledging stakeholders’ concerns by paraphrasing what they have previously said.

Once you are ready to implement the intervention, set stakeholders up for small successes.  You can do this by assisting them with minor environmental arrangements that are likely to be quickly reinforced.  Keep in mind these activities do not have to be directly related to the client.  For example, I once taught a caregiver how to put appointments and set reminders in the calendar on her phone.  She had difficulty keeping track of appointments and often double booked herself.  The few minutes I spent with her on the activity prevented future double bookings and the associated missed appointments.  The activity also functioned as a rapport builder for me.  By assisting stakeholders with procedures that are both easily implemented and likely to produce quick results, you work to promote the stakeholders’ confidence in your abilities.  During the later stages of service provision, stakeholders may demonstrate patience with procedures yielding delayed results as they begin to trust your recommendations.  Rapport building activities should continue throughout the course of service provision.  In addition to the previously stated activities, one should deliver praise and positive feedback for stakeholder contributions, strengths, and successes.

Rapport building is only one set of behaviors involved in fostering successful collaborations. Setting expectations and relevant goals during the initiation of services will also facilitate positive stakeholder relations. When setting expectations, you can briefly explain the nature of behavior analytic services by describing how you will provide services to the client.  You should discuss your expectations of relevant stakeholders throughout the provision of services, as well as what they should expect from you.  Adherence to our standard of social significance requires that program goals correspond with clients’ and/or stakeholders’ goals (Wolf, 1978).  Be sure to consider stakeholders’ values when setting goals.  Prioritize treatment goals by considering how much time is allotted for the provision of services, as you will not be able to address every need at once.  When service hours are limited, you may only be able to effectively target a small number of behavioral concerns.  Stakeholders may request that you address much more than is possible during the allocated service time.  Rather than prioritizing treatment goals on you own, you can include stakeholders in the process by asking them to choose from a list of priorities.

After you have set goals and reviewed expectations, additional actions to promote positive collaborations should occur throughout the intervention phase.  Relevant stakeholders should be made aware of and approve of procedures involved in all aspects of the intervention.  Consider the stakeholders’ ability to implement procedural recommendations.  Be careful not to overwhelm them by suggesting too many changes at one time.  When recommending multicomponent interventions, you can set stakeholders up to successfully follow-through by gradually assigning more intervention components as stakeholders proficiently execute them.  Further into the intervention phase, the practitioner who has established and maintained good rapport with stakeholders and has demonstrated successes with the client might be asked to address additional behavioral concerns.  In cases where the practitioner is unable to accommodate additional targets, the practitioner may continue to facilitate collaborations by orienting stakeholders back to previously agreed upon goals.  At this time, it may be necessary to reevaluate program goals and relevant stakeholders might be asked to restate their priorities.

The development and maintenance of successful stakeholder collaborations is a process that occurs throughout one’s provision of behavior analytic services.  Activities such as rapport building, setting expectations and goals, and offering choices can facilitate positive collaborations and assist in the delivery of effective services.   What activities have contributed to your successful collaborations?  Comment below and continue following BAM Network!

References

Bailey, J. S., & Burch, M. R. (2010). 25 essential skills & strategies for the professional behavior analyst: Expert tips for maximizing consulting effectiveness. New York, NY: Routledge Taylor & Francis Group.

Wolf, M. M. (1978). Social validity: The case for subjective measurement or How applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.

Can control be a function of behavior?

Discussions regarding control as a function of behavior tend to be a reoccurring topic on behavior analytic forums.  These discussions typically include a practitioner’s description of a scenario consisting of a client’s engagement in problem behavior following requests to complete tasks that have been identified as high preference activities.  Due to an absence of problem behavior during the client’s independent engagement with the same high preference activities and the presence of problem behavior when these activities are initiated by others, practitioners suggest the client’s problem behavior is maintained by the client’s wish to control his/her environment.

Sad little boyLet’s tackle this problem by first addressing what we mean by ‘control’.  A quick Google search for its definition resulted in the following, “the power to influence or direct people’s behavior or the course of events.”  That definition sounds reasonable.  However, we are behavior analysts and our explanations for behavioral phenomena should be based on the science of behavior.  So what does our science say about control?  The discussion of control by Cooper, Heron, and Heward (2007) directly references the functional relation.  A functional relation exists when manipulations to one event (the independent variable) can reliably produce changes to another event (the dependent variable).

Let’s apply this definition to the above scenario by asking – What exactly is our client doing when she is attempting to ‘control’ her environment?  In the presence of a specific event (i.e., the practitioner’s request), the client engages in problem behavior (that has produced certain results in the past).  By assessing the situation in this manner, attempting to identify the actual function of the client’s behavior becomes a more apparent solution.

This is a good time to briefly discuss the relevant functions of behavior.  Generally speaking, the purpose of operant behavior is to either make something appear (access via positive reinforcement) or to make something go away (escape via negative reinforcement).  These processes can occur under socially mediated contexts (such as the one described in the scenario above) or automatic ones (which includes sensory stimuli).  This means the client is engaging in problem behavior to either escape the practitioner’s request (regardless if the requested activity had been identified in the past as high preferred) or to access another activity.

The next question to address is – Why is the client engaging in problem behavior in the presence of high preference tasks?  The short answer is

the task is not a high preferred task at that moment.

The presence of various motivating operations (MO) may have reduced the reinforcing efficacy of the specific task.  Here are a few suggestions for why a once high preference task may no longer be preferred when paired with a practitioner’s request.

  • Are you interrupting the client’s engagement in another activity when delivering tasks demands? If so, task interruption might be the problem. The occurrence of a simultaneous, ongoing activity may have reduced the client’s preference for the practitioner requested activity.
  • The client’s preference for specific activities may be sensitive to the time of day. An activity that is high preferred in the morning might not be preferred in the afternoon or evening.  Time of day is the relevant MO in this situation.
  • The client might have a history of others presenting her with aversive tasks. Her history may have generalized to all requests from others.  In this situation, the practitioner’s request is an MO reducing the client’s preference for the activity.

We have discussed why control cannot be the function of behavior, as the term refers to a relationship between environmental events.  We determined the function of problem behavior in the above scenario must either be in the form of escape from an aversive event or access to an appetitive event.  Finally, we discussed the role of MOs in the possible reduction of client tasks preferences.  In a future post, we will discuss some strategies to address the problems listed above.

Do you have questions or comments about this topic?  Share them with us and stay tuned for more from BAM Network!

Reference

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis. (2nd ed.) Upper Saddle River, NJ: Pearson Education Inc.