Assessing Behavior (Guideline 3) Bridget Spanarkel Caldwell College

Overview Introduction to Guideline 3 Assessing Behavior (3.0) Behavioral Assessment Approval (3.01) Functional Assessment (3.02) Explaining Assessment Results (3.03) Consent– Client Records (3.04) Describing Program Objectives (3.05) Case Discussions

Introduction to Guideline 3 In Guideline 3.o, Assessing Behavior, the BACB clearly specifies what goes into a behavior assessment. It is a bedrock principle of behavior analysis that it is necessary to “take a baseline” before any treatment is contemplated. The reasoning behind this might not be so obvious to those who are outside the field of ABA. The methodology used to take a baseline also might not be clear to other professions.

Introduction to Guideline 3 In the field of ABA, “taking a baseline” means the following: A referral has been made of a behavior that is problematic The behavior is observable and has been operationally defined in a way that allows quantification A trained observer has visited the setting where the behavior occurs and has documented the occurrence and circumstances under which it occurs

Introduction to Guideline 3 Behavior analysts do not work on rumor or hearsay. Very often, they: Want to see the problem for themselves Get a sense of the variability from day to day Determine if there are any trends in the data Understand the circumstances under which the behavior occurs Get a sense of the function of the behavior

Referral “This kid is driving me crazy. He is constantly out of his seat, talking with other children, and he never completes an assignment that I hand out. I spend all of my time sending him back to his seat and telling him to sit down.” – Third grade teacher

Referral Principal, Vice Principal, School Counselor, or School Psychologist might: immediately start giving the teacher advice base their advice on their experiences with past students schedule a battery of IQ and/or personality tests BCBAs would: Assess the behavior first Take data on the time the child is out of his seat (duration) Identify stimuli that set the occasion for this behavior to occur Assess the types of assignments given to the student to see how many, how appropriate, etc. Identify the types of prompts the teacher uses Identify the type of reinforcement that is maintaining the behavior Assess the degree of peer involvement in the child’s behavior Take enough baseline data to ensure there is indeed a problem that needs treatment

Without taking a baseline first, the Behavior Analyst would: have to rely on an untrained, possibly biased person’s estimate of the frequency of target behaviors have to take the person’s opinion of likely causes have no basis for evaluation of any suggestions made

Assessing Behavior (3.0) “Behavior analysts who use behavioral assessment techniques do so for purposes that are appropriate in light of the research. Behavior analysts recommend seeking a medical consultation if there is any reasonable possibility that a referred behavior is a result of a medication side effect or some biological cause.”

Assessing Behavior (3.0) What it says: What it means: The BA is obligated to learn about the research associated with any assessments used The BA is obligated to make sure assessments are used within the boundaries of reliability and validity that have been established The BA must consider the possibility that a specific behavior referral might be caused by or affected by some biological factor or by a medication side effect Any doubt about the origin of a behavior– best to make a referral to a physician or consult medical professional “Behavior analysts who use behavioral assessment techniques do so for purposes that are appropriate in light of the research. Behavior analysts recommend seeking a medical consultation if there is any reasonable possibility that a referred behavior is a result of a medication side effect or some biological cause.”

Discussion The text identified head banging, eye gouging, arm, leg, or head scratching, lip biting, or other forms of self-injury as dangerous behaviors that can be modified by behavioral procedures, yet warrant a medical consult before beginning treatment. Head banging could be a result of severe headaches, scratching could be a symptom of allergies, etc. Have you come across any similar situations in your clinical experiences? How did you handle the situation?

Assessing Behavior (3.0) A) “Behavior analysts’ assessments, recommendations, reports, and evaluative statements are based on information and techniques sufficient to provide appropriate substantiation for their findings” BAs should know precisely how assessments’ standardization samples compare with their client Should be able to interpret the results using the test manual Should be able to interpret associated research that may have been done with the assessment

Assessing Behavior (3.0) B) “Behavior analysts refrain from misuse of assessment techniques, interventions, results, and interpretations, and take reasonable steps to prevent others from misusing the information these techniques provide” Most likely form of misuse: going beyond the data that are actually collected We should not overstate the results of our assessments and we should discourage others from doing so.

Assessing Behavior (3.0) C) “Behavior analysts recognize limits to the certainty with which judgments or predictions can be made about individuals” Stay very close to the data, rather than make unsubstantiated predictions about behavior Acknowledge that an assessment is not perfect or definitive

Assessing Behavior (3.0) D) “Behavior analysts do not promote the use of behavioral assessment techniques by unqualified persons, i.e., those who are unsupervised by experienced professionals and have not demonstrated valid and reliable assessment skills.” Only those who are well trained should be involved in behavioral assessments Supervised by BCBA

Behavioral Assessment Approval (3.01) “The behavior analyst must obtain the client’s or client-surrogate’s approval of the behavior assessment procedures in writing before implementing them.”

Functional Assessment (3.02) A) “The behavior analyst conducts a functional assessment, as defined below, to provide the necessary data to develop an effective behavior change program.” B) “Functional assessment includes a variety of systematic information-gathering activities regarding factors influencing the occurrence of a behavior (e.g., antecedents, consequences, setting events, or motivating operations) including interview, direct observation, and experimental analysis. “Best practice” to determine the function of a behavior prior to writing a behavior change program Common functions: escape from demands, attention, tangible reinforcers The same behavior may have different functions in different environments. BAs should not make assumptions or base decisions on hearsay

Explaining Assessment Results (3.03) “Unless the nature of the relationship is clearly explained to the person being assessed in advance and precludes provision of an explanation of results (such as in some organizational consultation, some screenings, and forensic evaluations), behavior analysts ensure that an explanation of the results is provided using language that is reasonably understandable to the person assessed or to another legally authorized person on behalf of the client. Regardless of whether the interpretation is done by the behavior analyst, by assistants, or others, behavior analysts take reasonable steps to ensure that appropriate explanations of results are given.” Results should be explained “in plain English” or other appropriate language Essential to assure that everyone understands the basis for treatment that is to follow We want all parties to feel comfortable with what we do

Consent – Client Records (3.04) “The behavior analyst obtains the written consent of the client or client-surrogate before obtaining or disclosing client records from or to other sources, including clinical supervisors.” Occasionally necessary to share information about a case with supervisors, other professionals, or an agency. In these cases, obtain written permission from the client to do so.

Describing Program Objectives (3.05) “The behavior analyst describes, in writing, the objectives of the behavior change program to the client or client-surrogate before attempting to implement the program. And to the extent possible, a risk-benefit analysis should be conducted on the procedures to be implemented to reach the objective.” Standard practice to specify in writing the objectives of all behavior change programs This statement should be shared with client or client-surrogate

Case Discussion: #1 Dr. Stuart W., a Doctoral-level BCBA, has been working on Tom’s behavioral issues for two years. Tom lives in a supported living apartment in the community, and he works at a job with supervision from vocational rehabilitation. Dr. W’s data shows that Tom frequently arrives late or completely misses work. Tom would rather stay home and sleep; a variety of incentive programs have been ineffective. Dr. W. is wondering if Tom would benefit from counseling. He has a friend and colleague who is a counselor; his plan is to invite his colleague to lunch and tell him about Tom. Can Dr. W. ethically talk to another professional about Tom to determine if the person would consider taking Tom as a client?

Bailey & Burch say: Dr. W. must obtain the written consent of the client (Tom) or his guardian before disclosing Tom’s records or giving information such as his name or behavioral specifics to another professional, regardless of the purpose.

Case Discussion: #2 Susan is a 52 year old woman with developmental disabilities. She lives at home with her mother, who is her legal guardian, and she attends a vocational training program. Susan is a client of developmental services, and she receives behavioral programming as needed. Angie is a BCBA who works with clients at the vocational program. She has been asked to provide behavioral services for Susan. It seems that Susan has been spending all of her money on junk food. Then, so that she has money, she has been asking staff to give her loans or pay her for small favors. This behavior has escalated to the point that Susan has no money for bus transportation and is making everyone uncomfortable with her begging. Because begging is not really an appropriate behavior, Angie feels that it would be okay to instruct the staff to immediately begin treating begging with social disapproval. At what point does Angie need to get approval from Susan’s mother?

Bailey & Burch say: Before implementing any procedures to change Susan’s behavior, Angie needs to outline the objectives of the behavior plan in writing for Susan’s mother (her legal guardian). It could be that the mother feels Susan has the right to spend her money on snacks as long as she goes to work. The intervention for this problem may well be something for which the mother wishes to have some input.

Questions? Comments?

References Bailey, J., & Burch, M. (2011). Ethics for behavior analysts: Second expanded edition. New York, NY: Routledge Taylor and Francis Group.