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Professional practice of behavior analysis

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The professional practice of behavior analysis is the fourth domain of behavior analysis, the other three being behaviorism, experimental analysis of behavior, and applied behavior analysis. [1] The professional practice of behavior analysis is the delivery of interventions to consumers that is guided by principles of behaviorism, and the research of the experimental analysis of behavior and the applied behavior analysis. Out of the four domains, professional practice seeks maximum precision to change behavior most effectively in specific instances.[2] The professional practice of behavior analysis ranges from treatment of autism, developmentally disabled individuals to behavioral coaching, and behavioral psychotherapy. In addition to treatment of mental health and corrections[3][4], the professional practice of behavior analysis also has areas including organizational behavioral management, behavioral safety, and even how to keep astronauts in good shape while in orbit.[5]


Defining the practice of behavior analysis

The Behavior Analysis Certification Board BACB defines behavior analysis as:

"The field of behavior analysis grew out of the scientific study of principles of learning and behavior. It has two main branches: experimental and applied behavior analysis. The experimental analysis of behavior (EAB) is the basic science of this field and has over many decades accumulated a substantial and well-respected research literature. This literature provides the scientific foundation for applied behavior analysis (ABA), which is both an applied science that develops methods of changing behavior and a profession that provides services to meet diverse behavioral needs. Briefly, professionals in applied behavior analysis engage in the specific and comprehensive use of principles of learning, including operant and respondent learning, in order to address behavioral needs of widely varying individuals in diverse settings. Examples of these applications include: building the skills and achievements of children in school settings; enhancing the development, abilities, and choices of children and adults with different kinds of disabilities; and augmenting the performance and satisfaction of employees in organizations and businesses"

Behavior analysis is thus defined as one of the dominant models of behavior modification, behavioral engineering, and behavior therapy. By behavior analysis's very nature of being an active, environmental based approach- behavior analytic procedures are considered highly restrictive (see Least Restrictive Environment). For example, these service may block access to preferred items and make the contingent on performance. This has led to abuses in the past in particular where punishment programs have been involved.[6]. In addition, failure to be an indepdenant profession often leads behavior analysts and other behavior modifers to have their ethical codes supplanted by other professions [7] For example, a behavior analyst working in the hospital setting designs a token system, a form of contingency management. He may desire to meet his ethical obligation to make the program habilitative and in the clients best long term interst. The physicians and nurses in the hospital who supervise him may decide that the most important thing that the token system could do would be to create order in the nursing routines so that clients quickly and efficiently get their medication without hasseling the hospital staff. Instead of the ethical code of the Behavior Analysis Certification board and the Association for Behavior Analysis International's position that those receiving treatment have a right to effective treatmentABA:I and a right to effective education.ABA:I. In addition, failure on the part of a behavior analyst to adequately supervise his work could lead to abuse[8]


The Behavior Analysis Certification Board offers a technical certificate in behavior analysis. This certification states the level of training and requires an exam to show a minimum level of competence to call oneself a behavior analyst. Recently, a move has occurred to license behavior analysts [28][9]. The goal of licensing is to protect the public. To do so, the model licensing act states that a person is a behavior analytst by training and exerience. The person has mastered behavior analysis by achieving a masters degree in behavior analysis or related subject matter. Like all other master level licensed professions (see counseling) the model act calls not just for a masters degree but an actually doubling of this level of mastery (60 graduate master level credits instead of 30). This requirement states that the person certainly has achieved book knowledge of behavior analysis, which can be then tested through the exam offered by the Behavior Analysis Certification board to determine how much is retained. However, it does not stop there. It calls for an internship in which a behavior analysts works under another master or Ph.D. level behavior analyst for a period of one year (750 hours) with at least two hours/week of supervision. Finally, those 750 are considered tuteledge time. After that the behavior analyst must engage in supervised practice under a behavior analyst for a period of another 2 years (2,000 hours). Once this process is complete the person applies to a state board, who ensures that he or she has indeed met the above conditions. If yes, the person is granted a license by the state. If no, the application is rejected. Once the person is licensed, public protetion is still monitored by the licensing board, which makes sure that the person receives sufficent ongoing education and licensing board investigates ethical complaints. Thus, a licensed behavior analyst would have equal training, knowledge, skills, and abilities in his discipline as a mental health counselor or marriage and family therapist would have in his/her discipline.

Service delivery models

Services of an applied behavior analyst can be delivered through consultation and/or therapy; the former involves three parties - consultant, consultee, and a client whose behavior is changed.[10] Consultation can involve working with the consultee (i.e. a parent or teacher) to build a plan around the behavior of a client (i.e. a child or student), or training the consultees themselves to modify the behavior of the client. Within the domain of parent-child consultation, standard intervention includes teaching parents skills such as basic reinforcement, time-out and how to manipulate different factors to modify behavior.[11] Direct therapy involves the relationship of behavior analyst and client, usually one-on-one, in which the analyst is responsible for directly modifying the behavior of their client. Direct therapy is also used in schools, but can also be found in group homes, in a behavior modification facility and in behaviour therapy[10] (where the focus may be on tasks such as quitting smoking or modifying behaviors related to mood disorders) or to encourage job seeking behavior in psychiatric patients [12][13].

Two older less used models still exist for the delivery of behavior analytic services. These models worked mostly with normal/typically developing populations. The two models are the Behavioral Coaching and the Behavioral Counseling model. Both were very popular in the 1960-1980s but have recently seen a decline in popularity in spite of its success as proponents argued the merits of holding strictly to learning theory. [14] [15][16][17][18][19][20]

The behavioral coaching model is sometimes referred to as life coaching. However, like counselors and psychologists life coaches can have varied orientations/change theories (see Behavioural change theories); behavioral life coaches operate exclusively from a behavior analytic orientation. Unlike therapy, this model is applied to typically developing people, who desire to achieve a specific goal[21] such as increasing their assertivenss with others[22][23]. This is a model is educative in behavioral principles and presented as an alternative to therapy. Coaches use behavioral techniques of goals and objective setting, self-control training, behavioral activation, and other techniques to help clients to achieve specific life goals [[29]]. Behavioral coaching sometimes was used with those with mental retardation or head injury to teach job skills. In this area, the model made extensive use of task analysis, direct instruction, role play, reinforcement, and error correction [24]. Often this approach employs techniques of Direct instruction.

Behavioral counseling was very popular throughout the 1970s and at least into the early 1980s [25][26] Behavioral counseling is an active action oriented approach that works with the typically developing population also but also assists people with specific/discrete problems such as drinking, smoking, or rehabilation after injury.[27] [28].

Behavioral counseling was largely seen as a growth model, that tried to increase the individuals sense of "freedom" be helping the client reduce punishment or coercion in their lives, build skills, and increase access to reinforcement.[29] Even B.F. Skinner himself created a video discussing the processes involved and the imporatnce of reinforcement to increase the sense of "freedom". [[ http://alc.alc.org/uhtbin/cgisirsi.exe/x/0/0/57/5?user_id=HSUWEB&searchdata1=799277{CKEY} ]]Behavioral counseling attempts to (1) use in-session reinforcement to improve decision making[30] [31], functional assessment of the clients problem[32] and (3) use behavioral interventions to reduce problem behaviors.[33] Some behavioral counselors approach therapy from a social learning perspective [34] but many held a position based on the use of behavioral psychology with a focus on the use of operant, respondent conditioning procedures[35]. Some who did adopt a position on modelng held closer to the behavioral view of modeling as generalized imitation developed through learning processes[36]. The behavioral counseling approach became very popular in weight reduction[37][38] [39] and is on APA's list of evidenced based practices for weight loss. Behavioral counseling for weight loss by Richard B. Stuart led to the commercial program called Weight Watchers[30] Recently, efforts have been made to resurge interest in behavioral counseling [40][41]

Summary of Service Delivery

Behavior analytic services can be delivered through various treatment modalities. These include:

Consultation- an indirect model in which the consultant works with the consultee to change the behavior of the client.

Therapy- (individaul, group, or family) in which the therapist works directly with a person with some form of pathology to lessen the pathology.

Counseling- where the counselor works directly with a person who has problems but no pathology.

Coaching- in which the coach works with a person to achieve a life goal.

Treatment of autism

Among the available approaches to treating autism, ABA therapies have demonstrated efficacy in promoting social and language development and in reducing behaviors that interfere with learning and cognitive functioning.[42][43][44][45][46] The ABA approach teaches play,[47] [48]social, motor, and verbal behaviors as well as reasoning skills.[49] ABA therapy is used to teach behaviors to individuals with autism who may not otherwise "pick up" these behaviors spontaneously through imitation.Imitation can also be directly trained [50] ABA therapies teach these skills through use of behavioral observation and reinforcement or prompting to teach each step of a behavior.[51] Generally treatment based from ABA involves intensive training of the therapists, extensive time spent in ABA therapy (20–40 hours per week) and weekly supervision by experienced clinical supervisors known as a board certified behavior analyst.[52]

An increasing amount of research in the field of ABA is concerned with autism; and it is a common misconception that Behavior Analysts work almost exclusively with individuals with autism and that ABA is synonymous with discrete trials teaching. ABA principles can also be used with a range of typical or atypical individuals whose issues vary from developmental delays, significant behavioral problems or undesirable habits.

ABA is often confused as a table-only therapy. Properly performed, ABA should be done in both table and natural environments depending on the student's progress and needs. Once a student has mastered a skill at the table, the ABA team should move the student into a natural environment for further training and generalization of the skill.

Frequently, the Assessment of Basic Language and Learning Skills (ABLLS) is used to create a baseline of the learner's functional skill set. The ABLLS breaks down the learner's strengths and weaknesses to best tailor the ABA curriculum to them. By focusing on the exact skills that need help, the teacher does not teach a skill the student knows. This can also prevent student frustration at attempting a skill for which he or she is not ready. Bridget_Taylor is one of the first popularized autism therapists as a major proponent in Catherine Maurice's book: Let Me Hear Your Voice.

Many families have fought school districts for such programs. Don Baer, a behavior analyst who often testified as an expert witness has provided several letters to lawyers before he passed. Ohio state has archieved a reading of those letters at [31]

Discrete trials

Discrete trials were originally used by people studying classical conditioning to demonstrate stimulus - stimulus pairing. Discrete trails are often contrasted with free operant procedures like one ones used by B.F. Skinner in learning experiments with rats and pigeons how learning was influenced by rates of reinforcement. . The discrete trials method was adapted as a therapy for developmentally delayed children and individuals with autism. For example, Ole Ivar Lovaas used discrete trials to teach autistic children skills including making eye contact and following simple instructions and advanced language and social skills. These discrete trials involved breaking a behavior into its most basic functional unit and presenting the units in a series.

A discrete trial usually consists of the following: The antecedent, possibly combined with a prompt (a non-essential element used to assist learning or correct responding), the behavior of the student, and a consequence. If the student's behavior is what is desired, the consequence is something positive: food, candy, a game, praise, etc. If the behavior was not correct, the teacher offers the correct answer, then repeats the trial, possibly with more prompting if needed.

There is usually an inter-trial interval that allows for a few seconds to separate each trial, to allow the student to process the information, teaches the student to wait, and makes the onset of the next trial more discrete. Discrete trials can be used to develop most skills, which includes cognitive, verbal communication, play, social and self-help skills. There is a carefully laid out procedure for error correction and a problem solving model to use if the program gets stuck [53]

Free Operant Procedures

In language training, many free operant procedures emerged in the late 1960s and early 1970s (e.g., [54] ). These procedures did not try to train discrimination first and then passively wait for generalization but instead worked from the start on activiely promoting generalization [55]. Intitally, the model was referred to as incidental teaching but later was called milieu language teaching and finally natural languaged teaching. Peterson (2007) completed a comprehensive review of 57 studies on these training procedures [56]. This review found that 84% of the studies of the natural language procedures looked at maintenance and 94% looked at generalization and were able to provide direct support of its occurrence as part of the training.

Current areas of application in the clinic

In Dougher's book on clinical applications of behavior analysis to adult outpatients, he highlights four current areas: Stephen Hayes, et al's Acceptance and Commitment Therapy (ACT), Behavioral Activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy and community reinforcement approach for addictions. In addition, he highlights several recent areas of functional analysis research for common clinical problems. There are multiple journals devoted to clinical applications of applied behavior analysis.

Community reinforcement approach has considerable research supporting it as efficacious[57]. Started in the 1970s, community reinforcement approach is a comprehensive operant program built on a functional assessment of a clients drinking behavior and the use of positive reinforcement & contingency management for nondrinking [58]. When combined with disulfiram (an Aversives procedure or see Aversion therapy), community reinforcement showed remarkable effects [59]. One component of the program that appears to be particularly strong is the non-drinking club [60]. Applications of comunity reinforcement to public polcy has become the recent focus of this approach [61]

An off-shoot of the community reinforcement approach is the community reinforcement and family training approach [62]. This program is designed to help family members of substance abusers feel empowered and get drinker or drug users to engage in treatment. The rates of succes have varied somewhat by study but seem to cluster around 70% [63] [64][65]. [66]. The program uses a variety of interventions based on functional assessment including a module to prevent domestic violence. Partners are trained to use positive reinforcement, various communication skills, and natural consequences.

With children, applied behavior analysis provides the core of the positive behavior support movement ,[67][68] and creates the basis of teaching family homes. Teaching family homes have been found to reduce recidivism for delinquent youth both while they are in the homes and after they leave ,[69] Finally, operant procedures form the basis of behavioral parent training developed from social learning theorists. The etiological models for antisocial behavior show considerable correlation with negative reinforcement and response matching see matching law [70] [71][72]. Behavioral parent training has been very successful in the treatment of conduct disorders in children and adolescents with recent research focusing on making it more culturally sensitive[73] Recent studies showing that behavior modification based on behavior analysis can reduce recidivism has led to a resurgence in behavior modification facility[74]. In addition, behaviorally based early intervention programs have shown effectiveness [75]

Methods of counter conditioning and respondent extinction—called Exposure Therapy—are often employed by many behavior therapists in the treatment of phobias, anxiety disorders such as post-traumatic stress disorder, and addictions (cue exposure). Several procedures to block respondent conditioning such as blocking and overshadowing are sometimes used in behavioral medicine to prevent conditioned taste aversion for patients with chemotherapy treatments. Exposure with Response Prevention (ERP is a respondent extinction procedure often used to treat obsessive compulsive behavior. For post traumatic stress disorders, exposure therapy is one of the few evidenced based techniques [76]. Recent research suggests exposure therapy is an excellent means of alleviating both the anxiety and cognitive symptoms specific to PTSD, with no additive effect for additional cognitive components (see review by [77]). Several authors have argued that exposure by itself is necessary and sufficient to produce behavior change in reducing fear in social phobics and helping them engage more effectively with others [78] The Washington Post ran a story that only exposure therapy is proven for PTSDT and that cognitive therapy or even drug therapy are not shown at this time to be effective (see [32] )

Current areas of application in organizations

Behavior Analysis with organizations combined with systems theory (an approach called organizational behavior management) has shown some success particulary in the area of Behavior-based safety. Behavior saftey research has lately become focused on factors that lead programs to being retained in insitutions long after the designer leaves. [79] For other areas see behavioral engineering

Current areas of application in education

Direct instruction and Direct Instruction with the former representing the process and the latter a specific curriculum that highlights that process remain both current and controversal in behavior analysis[80]. The essential features are a carefully structured fast paced-program based on teacher directed small group instruction [81]. One controversey that remains is that teacher creativity is admonsished in the program [82]. Even with such issues to be worked out, postive gains in reading for the approach have been reported in the literature since 1968 (see [83][84] An example of the positive gains reported Meyer(1984) found that 34% of children in the DISTAR group were accepted to college as compared to only 17% of the control school [85]. Current research is focused on peer delivery of program [86]

School wide positive behavioral support[87] is based on the use of behavior analytic procedures delivered in an organizational behavior management approach. School wide behavioral support has been increasingly accepted by adminstrators, lawmakers, and teachers as away to improve saftey in classrooms [88][89]

Curriclum based measurement and curriculum matching is another active area of application [90]. Curriculum based measurement uses rate and reading erformance as the primary variable in determining reading levels. The goal is to better match children to the appropriate curriculum level to remove frustration, as well as to track reading performance over time to see if it is improving with intervention.

Functional behavioral assessment was mandated in the United states for children who meet critieria under the individuals with disabilties education act [91]. This approach has procuded many procedures for modifying and maintaining children in not just the school system but in many cases the regular education setting [92][93] Even children with severe behavior problems appear to be helped [94]

Teaching children to recruit attention [95] has become a very important area in education. In many cases one function of children's distruptive behavior is to get attention[96]

Maintaining consumer and professional relationships

An adequate communication and a supportive relationship between educational systems and families allow the student to receive a beneficial education. This pertains to typical learners as well as to individuals who need additional services. It was not until the 1960s that researchers began exploring Behavior Analysis as a method to educate those children who fall somewhere on the autism spectrum. Behavioral analysts agree that consistency in and out of the school classroom is key in order for children with autism to maintain proper standing in school and continue to develop to their greatest potential.

Applied behavior analysis involves an entire team working together to address a person's educational or behavioral needs. This team includes professionals such as speech therapists as well as the primary caregivers, who are treated as key to the implementation of successful therapy in the ABA model. The ABA method relies on behavior principles and a recommended curriculum that reflects an individual's needs and abilities. As such, regular meetings with professionals to discuss programming are one way to establish a successful working relationship between a family and their school. When a caregiver can be the outlet source for the generalization of skills outside of school, it helps the therapy process by catering to the student's individual needs. In the ABA framework, developing and maintaining a structured working relationship between parents or guardians and professionals is essential to ensure consistency of thought and practice of behavioral methods.

Goals of Behavior Analytic Intervention

When working directly with clients, behavior analysts engage in a process of collaborative goal setting. Goal setting ensures that the client is already under stimulus control of the goal and thus is more likely to engage in behavior to achieve it [97]. Behavior analytic programs should ultimately build skills[98], enhance functioning, lead to higher quality of life, and build self-control [99][100][101][102][103][104][105][106][107]. Indeed, one of teh most distinguishing features of behavior analysis has been its core belief that all individuals have a right ot the most effective treatment for their condition[33] and a right to the most effective educational strategy available [34]

Ethical Practice

The use of Punishment (psychology) and Aversion therapy procedures are a constant ethical challenge for behavior analysts.

Notes and References

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