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