Professional practice of behavior analysis
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The professional practice of behavior analysis is a domain of
The professional practice of behavior analysis is a hybrid discipline with specific influences coming from counseling, psychology, education, special education, communication disorders, physical therapy and criminal justice. As a discipline it has its own conferences, organizations, certification processes, and awards.
Defining the scope of practice
The Behavior Analysis Certification Board (BACB) defines
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: managing behavior of children in school settings; enhancing the abilities, and choices of children and adults with different kinds of disabilities; training animals; and augmenting the performance and satisfaction of employees in organizations and businesses.[3]
Behavior analysis is based on the principles of
Currently in the U.S. some behavior analysts at the masters level are licensed; others work with an international certification where licenses are unavailable, although this may not be allowed in some states or jurisdictions. At the doctoral level many are licensed as psychologists with Diplomate status in behavioral psychology or licensed as licensed behavior analysts. Diplomate status alone, however, does not allow one to practice in every state and each state's regulatory statute must be reviewed for the appropriateness and legality of practice.
Certification
The Behavior Analyst Certification Board (BACB) offers a technical certificate in behavior analysis. The American Psychological Association offers a diplomate (post PhD and licensed certification) in behavioral psychology.[4]
The meaning of certification
BACB is a private non-profit organization without governmental powers to regulate behavior analytic practice. However, it does wield the power to suspend or revoke certification from those certified if they violate the strict ethical guidelines of practice. As many states are without a licensure act, this has been sufficient to deter violators as it removes their ability to vendor with the state, schools, and insurance companies under that certification. While the BACB certification means that candidates have satisfied entry-level requirements in behavior analytic training, certificants are able to practice independently within the scope of their practice and training. Thus, a BCBA (such as those who go into marketing, engineering, or other approved fields in which BCBAs work) who has never trained to work nor worked with children diagnosed with autism are discouraged to do so independently. Most health insurance companies also recognize the BCBA credential as one conferring the capability and the right to practice independently in many states (including California with the passage of SB 946 into law).
Some states still require certificants to be licensed by their respective jurisdictions for independent practice when treating behavioral health or medical problems, and a number of states including Arizona and Nevada have created a specific BCBA licensing program. Licensed certificants must operate within the scope of their license and within their areas of expertise. Where the government regulates behavior analytic services, unlicensed certificants may be supervised by a licensed professional and operate within the scope of their supervisor's license when treating disorders if that jurisdiction allows such supervision. Unlicensed certificants who provide behavior analytic training for educational or optimal performance purposes do not require licensed supervision, unless the law or precedent prohibits such practice. Where the government does not regulate the treatment of medical or psychological disorders certificants should practice in accord with the laws of their state, province, or country. All certificants must practice within their personal areas of expertise.
Licensure
The model licensing act for behavior analysts has been revised several times to reflect best practices and policy. Previous versions included provisions that would have made it in practice more difficult to obtain the necessary experiential hours for license and independent practice as a clinical psychologist.[5]
Once the person is licensed public protection is still monitored by the licensing board as well as the BACB, both of which make sure that the person receives sufficient ongoing education, and the BACB and licensing board investigate ethical complaints. In February 2008, Indiana, Arizona, Massachusetts, Vermont, Oklahoma and other states now have legislation pending to create licensure for behavior analysts. Pennsylvania was the first state in 2008 to license behavior specialists to cover behavior analysts. Arizona, less than three weeks later, became the first state to license behavior analysts. Other states such as Nevada and Wisconsin have also passed behavior analytic licensure.
In California, after the defeat of a bill to create a license for BCBAs in 2011, the state government instead passed SB 946 which mandates that all non-governmental insurance agencies reimburse for BCBA for behavior therapy in treating autism, starting in 2012. Unlike many other bills mandating that autism be covered by insurance, SB 946 does not currently impose a cap on services by age or funding amount – in this it is similar to other treatments such as those for heart attacks or other chronic conditions.[6]
Service delivery models
Definitions
Behavior analytic services can be and often are 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 – (individual, 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.
Primary methods
The two primary methods for delivering behavior analytic services are consultation and/or direct therapy; the former involves three parties: consultant, consultee and a client whose behavior is changed (who may or may not be present for all meetings).[7]
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
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
History of behavior models
Two older and less used models still exist for the delivery of behavior analytic services. These models were used mostly with normal or typically developing populations. These two models are the Behavioral Coaching and the Behavioral Counseling model. Both were very popular in the 1960s–1980s but have recently seen a decline in popularity, as proponents argued the merits of holding strictly to learning theory.
History of behavioral counseling
Behavioral counseling was very popular throughout the 1970s and at least into the early 1980s.[18][19] Behavioral counseling is an active action–oriented approach that works with the typically developing population but also assists people with specific/discrete problems such as career decision making, drinking, smoking or rehabilitation after injury.[20][21]
Life coaching
The behavioral
Goal of increasing reinforcement
Behavioral counseling was largely seen as a growth model that tried to increase the individuals sense of "freedom" by helping the client reduce punishment or coercion in their lives, build skills, and increase access to reinforcement.[25] B.F. Skinner created a video discussing the processes involved and the importance of reinforcement to increase the sense of "freedom".[26] Behavioral counseling attempts to use in-session reinforcement to improve decision-making,[25][27] functional assessment of the clients problem,[28] and behavioral interventions to reduce problem behaviors.[29]
Social learning in behavioral counseling
Some behavioral counselors approach therapy from a social learning perspective[30] but many held a position based on the use of behavioral psychology with a focus on the use of operant, respondent conditioning procedures.[31] Some who did adopt a position on modeling held closer to the behavioral view of modeling as generalized imitation developed through learning processes.[32]
Weight loss
The behavioral counseling approach became very popular in weight reduction[33][34][35] and is on the American Psychological Association's list of evidence-based practices for weight loss. Behavioral counseling for weight loss by Richard B. Stuart led to the commercial program Weight Watchers.[36] Recently, efforts have been made to resurrect interest in behavioral counseling as a method to effectively deliver services to normal problemed populations.[37][38]
Treatment of autism
Among the available approaches to
Therapy qualifications
These are generally treatments based on applied behavior analysis (ABA) and involve 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 board certified behavior analysts.[45] ABA therapy often employs principles of overlearning to help acquire mastery and fluency of skills.
Children with autism
The ABA approach attempts to teach skills such as appropriate play, which behavioral psychologists believe to be a precursor to social interaction and engagement with the world and others.[46][47] It also aims to increase appropriate social, motor, verbal, and reasoning skills as well as the ability to self-regulate.[48] ABA therapy is used to teach behaviors to individuals with autism who may not otherwise observe these behaviors spontaneously through imitation.
In recent years the ABA approach has been criticized by members of the autistic community.[49] Many have reported suffering from post-traumatic stress disorder as a result of being forced to comply with training procedures.[50]
Imitation
Imitation can also be directly trained.[51] ABA therapies teach these skills through use of behavioral observation and reinforcement or prompting to teach each step of a behavior.[52]
Research and treatments
Some research exists to show that behavior analysis is an effective treatment for autism with many studies showing its effectiveness with persons of all ages in enhancing functioning, building skills and independence as well as improving life quality.
An increasing amount of research in the field of
According to practitioners, curriculums should carefully task analyze the skill(s) needed to be learned and then ensure that proper tool skills have been taught before the skill itself is attempted to be taught.
Frequently standardized assessments such as the
Many families have fought school districts for such programs.
Discrete trials
Discrete trials were originally used by people studying
A discrete trial usually consists of the following: the antecedent, the behavior of the student and a consequence. If the student's behavior matches 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, and may also use aversives.[57]
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, teach the student to wait and make 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.
Free operant procedures
In language training, many free operant procedures emerged in the late 1960s and early 1970s.{{cite journal}}
: CS1 maint: multiple names: authors list (link)</ref> Initially the model was referred to as incidental teaching but later was called milieu language teaching and finally natural language teaching. Peterson (2007)[citation needed
Other applications of applied behavior analysis
Clinical behavior analysis
Clinical Behavior Analysis
Community reinforcement approach and family training
The study of behavioral factors related to addictions has a long history.
An offshoot of the community reinforcement approach is the
Children with disruptive disorders and parenting
With children,
Recidivism
Recent studies showing that behavior analysis can reduce recidivism have led to a resurgence in behavior therapy facilities.
Exposure therapy
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
Operant-based EEG biofeedback
Kamiya (1968) demonstrated that the
Organizational
Behavior analysis with organizations is sometimes combined with systems theory in an approach called organizational behavior management. This approach has shown success particularly in the area of behavior-based safety. Behavior safety research has lately become focused on factors that lead programs to being retained in institutions long after the designer leaves.[91]
Educational
School-wide positive behavior support[72] 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 administrators, lawmakers and teachers as a way to improve safety in classrooms.[99][100]
Functional behavioral assessment was mandated in the United States for children who meet criteria under the individuals with disabilities education act.[102] This approach has precluded many procedures for modifying and maintaining children in not just the school system, but in many cases in the regular education setting.[103][104] Even children with severe behavior problems appear to be helped.[105][106][107]
Teaching children to recruit attention[108] has become a very important area in education. In many cases one function of children's disruptive behavior is to get attention.[109]
Hospital settings
One area of interest in hospitals is the blocking effect—especially for conditioned taste aversion. This area of interest is considered important in the prevention of weigh loss during chemotherapy for cancer patients. Another area of growing interest in the hospital setting is the use of operant-based biofeedback with those suffering from cerebral palsy[110][111][112] or minor spinal injuries.[113][114]
Brucker's group at the University of Miami has had some success with specific operant conditioning-based biofeedback procedures to enhance functioning.[115][116] While such methods are not a cure, and gains tend to be in the moderate range, they do show ability to help remaining central nervous system cells to regain some control over lost areas of functioning.[113]
Residential treatment
Behavioral interventions have been very helpful in reducing problem behaviors in residential treatment centers.[117] The type of residential versus mental retardation does not appear to be a factor.[118] Behavioral interventions have been found to be successful even when medication interventions fail.[119]
Space program
Probably one of the most interesting applications of
Consumer and professional relationships
Open 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 along the autism spectrum. Behavior 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 analysts sometimes work with a team to address a person's educational or behavioral needs. Other professionals such as speech therapists, physicians and the primary caregivers are treated as key to the implementation of successful therapy in the applied behavior analysis (ABA) model. The ABA method relies on behavior principles to develop treatments appropriate for the individual. Regular meetings with professionals to discuss programming are one way to establish a successful working relationship between a family and their school. It is beneficial when a caregiver can conduct generalization procedures outside of school. In the ABA framework, developing and maintaining a structured working relationship between parents or guardians and professionals is essential to ensure consistent treatment.
Intervention goals
When working directly with clients, behavior analysts engage in a process of collaborative goal setting.[122] Goal setting ensures that the client is already under stimulus control of the goal and is thus more likely to engage in behavior to achieve it.[123] Behavior analytic programs are ultimately skill building,[124] they enhance functioning, lead to higher quality of life, and build self-control.[125][126][127][128][129][130][131][132][133] One of the most distinguishing features of behavior analysis has been its core belief that all individuals have a right to the most effective treatment for their condition.[134] and a right to the most effective educational strategy available.[135]
History
Applied behavior analysis is the applied side of the
The research basis of ABA can be found in the theoretical work of
Work in respondent conditioning (what some would term
Over the years most behavior analysts have existed and conducted research in many areas and University departments: behavior analysis, psychology, special education, regular education, speech–language pathology, communication disorders, school psychology, criminal justice and family life. They have belonged to many organizations including the
Current research
Behavior analysis remains one of the most active research areas in all of psychology, developmental disability, mental health and other studies of human behavior. Current research in behavior analysis focuses on expanding the tradition by looking at setting events, behavioral activation, the Matching law, relational frame theory, stimulus equivalences and covert conditioning as exemplified in Skinner's model of rule-governed behavior Verbal Behavior.[132][141]
Experimental psychopathology
Experimental psychopathology is a behavior therapy area in which animal models are developed to simulate human pathology. For example, Wolpe studied cats to build his theory of human anxiety. This work continues today in the study of both pathology and treatment.[142]
Controversy
Initially, applied behavior analysis used punishment such as shouting and slaps to reduce unwanted behaviors.
Homosexuality
In 1973 the APA
Ethical practice
Punishment and aversion therapies
The use of
Sex offenders and recidivism
A study in 1991 showed that
With sex offenders who have retardation, comprehensive behavioral programming has been effective at least in the short run.[158] This treatment included formal academic and vocational training, sex education, a unit token economy, and individual behavior therapy including sexual reconditioning. In addition it included supported competitive employment, fading of program structure, and increased community participation.
Journals
There are multiple journals which produce articles on the clinical applications of applied behavior analysis.[159] The most popular, and widely used, of these journals is the Journal of Applied Behavior Analysis.[160] There are many other journals dedicated to this field. Some of these include The Behavior Analyst Today, the International Journal of Behavioral Consultation and Therapy and three new journals scheduled for release in 2008: Behavior Analysis in Sports, Health, Fitness and Behavioral Medicine, the Journal of Behavior Analysis in Crime and Victim: Treatment and Prevention as well as the Association for Behavior Analysis International's Behavior Analysis in Practice.[161]
Professional organizations
The
The
Doctoral level behavior analysts who are psychologists belong to the
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