lauren a. goodwyn ethics for behavior analysts caldwell college conducting a risk-benefit analysis
TRANSCRIPT
Lauren A. Goodwyn
Ethics for Behavior Analysts
Caldwell College
CONDUCTINGA RISK-BENEFIT ANALYSIS
OverviewHeadlinesGuidelinesWhere’s... the research?Why…do a risk-benefit analysis?What…is risk?How…to perform risk-benefit analysis?In practice …Benefits for BCBA and field
How to Prevent Such Headlines …
BACB Task-List 3rd Edition, 1-6“initiate, continue, modify or discontinue
behavior analysis services only when the risk-benefit ratio of doing so is lower than the risk-benefit ratio for taking alternative actions”
BACB Task-List 4th EditionNothing specifically stated about risk-benefit
analysis
Guidelines for Responsible Conduct(3.05a)
“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”
Where’s …the researchBehavior Analysis and Treatment ed.
By Van Houten & Axelrod (1993)Chapter 8 “A Decision-Making Model for
Selecting Optimal Treatment Procedure”
Where’s …the researchTo predict risk v. benefit of behavioral
program must consult experiences of practicing behavior analysis because evidence in literature is lackingClues about risk factors in articles in which
measures were taken to ensure treatment procedure was followed to a T
Research often implemented by trained / experienced master’s-PhD level therapists
Highly controlled lab settings doesn’t generalize well to discover risks that may be uncovered in natural setting
Spreat (1982)
Probability of treatment success
Period of time it takes to eliminate a behavior
Distress caused by procedure
Distress caused by the behavior
Assess risk factors for each behavior procedureAssess general risk factors for behavior treatment
Assess benefits of behavior treatment
Reconcile risks/benefits w/ key parties involved
Old school vs New SchoolBailey & Burch
(2011)
Why …risk-benefit analysis
Goal is not to frighten but to enlighten
Presenting information in this manner requires that you have an upfront & honest discussion w/ client so that no one is surprised if unexpected side effects emerge
Need to clarify for practitioners that some procedures can increase probability of unintended behaviors Can anyone think of some unintended behaviors that
could result from a procedure?
What …is risk“exposure to injury, loss, or danger”
“possibility of experiencing an outcome that is different from what is expected”
“Uncertainty arising from possible occurrence of given events; insured or property to which an insurance policy relates”
“we need to think of ourselves in part as risk analysts who determine the factors that can cause ‘volatility’ in our treatment process”
Related Topic: Therapeutic Dose
When taking a drug Death / toxicity vs effectiveness
When implementing a procedureRisk of failure / harm vs benefit of success
How …to conduct risk-benefit analysis
Should conduct risk-benefit analysis for each behavioral procedure suggested for implementation
Generally can use worksheets
Should research each procedure and prepare worksheet ensuring that the summary is balanced and objective
8 General Risk Factors
•More severe or intense problem behavior, greater risk of failure
Nature of behavior
•Rely on mediators in natural environment to play significant role in treatment
Sufficient Personnel
•Sufficient # of staff does not guarantee success
Well trained mediator
•BACB Guideline (3.01, 3.02, 3.08)
Appropriate setting
•Operating outside of one’s competence can cause risk to proper implementation and safety of client
Experienced BCBA
•Settings can present possible safety risks to nearby clients and staff when implemented
Risk to others
•Others should agree w/ program and ensure it is implemented correctly
Buy-in
•Competence of BCBA to handle the case and mitigate problem situations
Personal Liability
5 Benefits of Treatment
•Terms of change of rates of behavior & time frame for success of each target behavior
Client Direct
•Change of atmosphere in classroom / home should be considered
Indirect to Setting
•If successful, can produce sense of confidence & pride in accomplishments
Mediators / Caregivers
•Peers / siblings may benefit from more attention from teachers / parents
Peers in Setting
•Clients who cease engaging in dangerous behaviors leads to less stress for administration & fewer calls for attorneys
Liability in Setting is Decreased
The SITUATION …Joanna, a BCBA, is asked to consult for a third grade classroom.
Mrs. Hobbs has complained about one of her students, Jared, continuously getting out of his seat, talking to his classmates while
doing work, and constantly raising his hand to make disruptive comments. This results in Jared’s poor performance in school,
classmates being distracted from their work, and teacher attention and time spent trying to get Jared back on task. Mrs. Hobbs has
been teaching for several years but has never implemented a behavioral procedure before but is eager for any help in the
classroom. After conducting a functional assessment and several observations it is found that Jared likely engages in this behavior in order to escape from or delay work. Joanna suggests implementing
a NCR escape procedure in which Jared can have access to 2 minutes of a leisure activity at his desk (i.e. playing on his iPod)
every 5 minutes during independent work time.
Let’s Practice …Risk-Benefit Worksheet
ABA Procedure: Noncontingent Reinforcement
Special methods: positive reinforcement (i.e. access to tangibles, attention, etc); negative reinforcement (i.e. escape from work); automatic reinforcement (i.e. object manipulation)
RISK NOTES
May reduce motivation to engage in adaptive behavior
Chance pairings with problem behavior could strengthen that behavior NCR escape can disrupt instructional process
BENEFITS NOTES
Ease of application
Helps create positive learning environment
Package treatment w/ extinction procedure may reduce extinction burst Chance pairing with appropriate behavior could strengthen that behavior
Summary Risks vs Benefits:
Let’s Practice …General Risk Factors
Instructions: After completing a Risk-Benefit Worksheet for each proposed procedure fill out this form and review w/ the relevant parties
RISK FACTORS NOTES
1. Nature of the behavior to be treated – is it SIB or dangerous to others? 2. Are there sufficient personnel or mediators to administer the treatment?3. Are they skilled and able to administer it correctly?
4. Is the setting appropriate for the treatment? Safe, well-lit, clean, temperature-controlled?
5. Is the BA experienced in the treatment of this type of case?
6. Is there any risk to others in the setting?
7. Is there buy-in from the key people associated with this case? 8. Is there any liability to the BA? Summary of General Risks:
Let’s Practice…Benefits of Behavioral Treatment
Instructions: After completing a Risk-Benefit Worksheet for each proposed procedure fill out this form and review w/ the relevant parties
BENEFITS NOTES1. Client behavior is greatly improved, comes into contact w/ many new reinforcers and more choices
2. Client environment is greatly improved because of change in behavior – less stress for caregiver, peers
3. Caregivers feel more in-charge, improved morale, eagerness to move forward with client
4. Peers in setting may change their behavior toward the client, providing more opportunities for social reinforcers
5. Liability to the setting is greatly reduced
Summary of Benefits:
Risk-Benefit Analysis in PracticeIntake FA review literature for appropriate
treatment
Meeting held w/ consumerGive & take; if there are questions about certain
side effects or possible unpredictable behavioral effects, this should be noted & revisions made
If consumer isn’t comfortable with a procedure, may need to withdraw 1 method for another
Important to have meeting before implementationAt conclusion, all parties should reach consensus on
course of actionSign & file paperwork, treatment can begin
3 Additional Benefits for the BCBA and the FieldIf BCBA can make significant improvements in
target behaviors, improve quality of life for client & others it will increase confidence in ability to take on similar cases
Positive effects improves morale & encourages future participation in profession
Reduction of liability to designer of behavior plan
Possible contribution to body ofknowledge of ABA & good public relation for the field
ReferencesBailey, J. S., & Burch, M. R. (2011). Ethics
for behavior analysts (2nd Expanded Edition). Routledge.
Cooper, J., Heron, T., & Heward, W. (2007). Applied Behavior Analysis. New Jersey: Pearson Education.
http://uwf.edu/rconstand/FIN3403web/T4-RiskReturn/T4-riskreturnP02.htm
http://www.irmi.com/online/insurance-glossary/terms/r/risk.aspx