Maintaining Professional Relationships in an Interdisciplinary Setting: Strategies for Navigating Nonbehavioral Treatment Recommendations for Individuals with Autism

When Cultural Awareness Reveals Conflicting Cultural Values: A Pragmatic Approach

Cultural awareness reminds ABA service providers of the importance of considering the cultural practices of others when programming for behavior change. Decisions about the appropriateness of services may be difficult, however, when the values of the client conflict with the values of the culture(s) to which the client belongs or with the cultural biases of the practitioner. To minimize such conflicts, we propose a decision-making model that integrates client-centered and culture-centered assessments of habilitative validity. Throughout the proposed evaluation process, the behavior analyst and the recipients of services collaborate to refine program goals that will increase access to reinforcers for the client and their cultural groups. Given that cultures arrange reinforcers and punishers for the individual, assessing habilitative and social validity for the cultural groups affected by services is emphasized as an essential component of the model. We illustrate how the proposed model could be used to suggest appropriate courses of action by analyzing a situation that may involve conflicts of values.

The Evolution of the Conceptually Systematic Dimension and Its Current Functions in Applied Behavior Analysis

What does it mean to be conceptually systematic in contemporary applied behavior analysis (ABA) research and practice? To answer this question, the present study conducted a historical analysis of ABA scholars' interpretations of the conceptually systematic dimension of ABA over the last 55 years. The present article found the current characteristics of the conceptually systematic dimension are indeed sufficient to suggest ABA's conceptual independence from the experimental analysis of behavior or any other subdisciplines of behavior analysis. Based on this finding, this article addresses the challenges in contemporary ABA field such as ABA's own basic and applied continuum, translational research, and its relationship with other disciplines' research and practice.

Behavior Analysts' Use of Treatments for Individuals with Autism: Trends within the Field

Previous surveys revealed the majority of certified behavior analysts reported using applied behavior analysis (ABA) as a treatment for individuals on the autism spectrum. However, some certificants have also reported using treatments without evidence (Schreck et al. Behavioral Interventions, 31(4), 355-376, 2016; Schreck & Mazur Behavioral Interventions: Theory & Practice in Residential & Community- Based Clinical Programs, 23(3), 201-212, 2008). The field of ABA has undergone many changes in the last five years. This survey evaluated trends in the use and variables influencing the use of autism treatments over that time. Results indicated that study participants (N = 921 BCBA-Ds, BCBAs, BCaBAs, and RBTs) were significantly less likely to report current use of ABA and some unestablished treatments (e.g., DIR Floortime, sensory integration therapy) than participants in 2016 (Schreck et al. Behavioral Interventions, 31(4), 355-376, 2016). Participants frequently cited persuasion by others as an influence for their treatment selections. Because behavior analysts' use of unestablished treatments may be detrimental to client outcomes and the reputation and success of the field of ABA, future research is needed to identify methods for increasing behavior analysts' use of empirically supported treatments.

The Ethical Obligations, Barriers, and Solutions for Interprofessional Collaboration in the Treatment of Autistic Individuals

With an estimated 1 in 44 children having been diagnosed with autism and given the variety of types of service providers that treat autism, collaboration among these professionals is a necessary part of the overall treatment package for an autistic individual. However, like with any professional skill, competence in collaborating effectively must be developed, especially because behavior analysts have been criticized for being resistant to collaboration. Competence with collaboration may be developed through coursework, professional development opportunities, and supervision by someone who has demonstrated competence with collaboration. With the 2020 update to the Ethics Code for Behavior Analysts, the behavior analyst's role in collaborating with other professionals has been clarified by several expectations. Current literature also provides additional guidance on the potential barriers to collaboration as well as recommendations for how to support a collaborative team. In order to facilitate successful collaboration, it is also important to evaluate the effectiveness of the collaborative team and to take advantage of opportunities to learn about the methodologies and perspectives of the other professionals to ensure that the client's best interests are met.

Promoting Reciprocal Relations across Subfields of Behavior Analysis via Collaborations

Several barriers may inhibit the growth of behavior analysis as a more integrated and collaborative field. Two such barriers are siloed environments that reinforce a basic-applied distinction, and a lack of translational research pathways. We describe the perils of silos, and elaborate on potential solutions to increase reciprocal relations among subfields in behavior analysis. We promote a five-tiered system to classify research in behavior analysis, and discuss literature on cultivating effective intra and cross-disciplinary collaborations, including using the framework of metacontingencies to understand collaborations. We also propose quantitative and qualitative measures to examine whether the potential solutions increase intra and interdisciplinary interactions. These measures include bibliometric (e.g., citations across fields), sociometric (e.g., social network analysis), and narrative analysis. We apply some of these measures to publications from 2011-2022 from the Journal of the Experimental Analysis of Behavior and Journal of Applied Behavior Analysis, and argue that behavior analysis overall may benefit from a more collaborative approach.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-023-00386-x.

Examination of Ethical Decision-Making Models Across Disciplines: Common Elements and Application to the Field of Behavior Analysis

Human service practitioners from varying fields make ethical decisions daily. At some point during their careers, many behavior analysts may face ethical decisions outside the range of their previous education, training, and professional experiences. To help practitioners make better decisions, researchers have published ethical decision-making models; however, it is unknown the extent to which published models recommend similar behaviors. Thus, we systematically reviewed and analyzed ethical decision-making models from published peer-reviewed articles in behavior analysis and related allied health professions. We identified 55 ethical decision-making models across 60 peer-reviewed articles, seven primary professions (e.g., medicine, psychology), and 22 subfields (e.g., dentistry, family medicine). Through consensus-based analysis, we identified nine behaviors commonly recommended across the set of reviewed ethical decision-making models with almost all (n = 52) models arranging the recommended behaviors sequentially and less than half (n = 23) including a problem-solving approach. All nine ethical decision-making steps clustered around the ethical decision-making steps in the Ethics Code for Behavior Analysts published by the Behavior Analyst Certification Board (2020) suggesting broad professional consensus for the behaviors likely involved in ethical decision making.

Teaching clinicians and nurses to prepare for and present at interdisciplinary meetings through behavioral skills training

Behavior analysts frequently collaborate with interdisciplinary colleagues to share information and make decisions about client services. This study evaluated the effects of behavioral skills training on preparation for and presentation during interdisciplinary review team meetings by clinicians (n = 4) and nurses (n = 4) at a residential school for students with intellectual and neurodevelopmental disabilities. The primary dependent measure was the percentage of preparation and presentation steps from task-analyzed behavior checklists that the participants implemented correctly. As evaluated by multiple-baseline designs, the participants improved their preparation and presentation skills to nearly 100% following behavioral skills training, maintained performance 1 month after the study, and rated training positively. We discuss elements of the training program, practice implications, and research directions.

Teaching Graduate Students to Translate Nonbehavioral Treatments Into Behavioral Principles

Behavior analytic translations of nonbehavioral treatments were recommended by Brodhead in Behavior Analysis in Practice, 8(1), 70-78 (2015) as part of a decision-making framework for practitioners working on interprofessional treatment teams. Professionals from different disciplines often have overlapping scopes of practice and competence, yet each recommends interventions according to their discipline-specific worldview and training. Nonbehavioral treatment recommendations may be especially challenging for behavior analytic practitioners who are committed to the science of human behavior and who are also ethically obligated to work cooperatively and in the best interest of the client. Learning to translate nonbehavioral treatments into behavior analytic principles and procedures may function as a valuable means of improving professional judgment, thereby promoting evidence-based practice and effective collaboration. Behavioral translations may expose procedures that are, in fact, conceptually systematic, creating more opportunities for behavior analysts to partner in interprofessional care. Using a behavioral skills training package, graduate students of applied behavior analysis were taught to translate nonbehavioral treatments into behavior analytic principles and procedures. All students produced more comprehensive translations following training.

Incorporating merged treatment procedures for children with autism: A case report

We examined interprofessional collaboration in a pre-service training model which incorporated the merging of three treatments: Occupational Therapy, Speech-Language Pathology, and Applied Behavior Analysis. We examined the effects of changes in the clinician interprofessional skill repertoire on therapeutic outcomes for children with Autism Spectrum Disorder. Three licensed professionals modeled core techniques from their respective professions to establish benchmark standards for skill demonstration in the treatment of children with autism. Treatment phases were implemented sequentially targeting multiple therapist and child behaviors within a multiple-baseline across participants' single case experimental design. Therapist skills improved to show a diverse repertoire of intervention techniques to match supervisor proficiencies. These interprofessional skills were delivered simultaneously in a timely and efficient manner. Assessed outcomes for children with autism included increased frequency of verbalizations, engagement during adult-directed interactions, visual-motor task productivity, and improved postural alignment. The study suggests that integrated training across interprofessional techniques enhanced a diverse repertoire of clinician skills, while systematically demonstrating child improvement on many interprofessional treatment goals.

Evaluation parameters for evidence-based practices for people with autism spectrum disorder: a narrative review of group and single-subject design studies

Recommendations for using evidence-based practices have become increasingly common in services for individuals diagnosed with autistic spectrum disorder (ASD). The aim of this study was to conduct a narrative literature review to identify differences and similarities in evidence-evaluation criteria for group and single-subject designs that empirically support interventions for people with ASD. Data sources used in this analysis were reports and articles elaborated by different clearinghouses (i.e., National Autism Center, National Professional Development Center, and the National Clearinghouse on Autism Evidence and Practice). The criteria for evaluating evidence, as defined by these documents, contained specific components or quality indicators for each type of study design. The different criteria for evaluating evidence and for classifying the interventions (once evidence was evaluated) were identified and described. This manuscript discusses the need for (a) expanding the analysis beyond the evidence identified by different researchers and organizations such as the clearinghouses, (b) proposing interventions that are based not only on scientific evidence but also on social validity — which is directed by client idiosyncrasies, and (c) attention to the fact that EBPs should not be seen as static information regarding interventions with empirical support: evidence-based practices are the result of constant analysis of the intervention implementation data added to professional training and client values and context. Some additional issues and the study limitations are also presented.

Cultural Responsiveness Framework in BCBA® Supervision

Behavior analytic supervisees need to master technical and conceptual skills in their fieldwork and training. Recently, the profession has recognized the need for cultural responsiveness to be emphasized and woven throughout clinical practice and supervision. However, findings from research within applied behavior analysis (ABA) yield limited information on specific methods to increase one's cultural responsiveness, as well as few tools to identify areas of development. This paper highlights challenges BCBA®s face in providing culturally responsive supervision. The authors also make recommendations for specific areas of focus in the pursuit of culturally responsive training and skill development through the introduction of the Culturally Responsive Supervision Self-Assessment (CRSS) tool. Cultural constructs that could be addressed using the CRSS tool include, but are not limited to, race, religion, gender conformity, and intersectional paradigms of culture.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-022-00688-7.

Psychotropic Medication Monitoring in a Human Services Organization for Children with Autism Spectrum Disorder: Description and Evaluation of Interdisciplinary Team Review

Children with autism spectrum disorder (ASD) are often prescribed psychotropic medications but pharmacotherapy is typically conducted and evaluated based on clinical judgement without reference to objective measurement of treatment effectiveness and combined efficacy of pharmacological-behavioral interventions. We describe an interdisciplinary review team (IRT) model at a human services organization for children with ASD that was designed to standardize a process of psychotropic medication monitoring through (1) coordinated involvement of medical, nursing, behavior analyst, and special education professionals, (2) parent-guardian participation, (3) data-driven decision making, and (4) high-level administrative support. Our description includes case illustrations of medication reduction-elimination trials with five students and social validity assessment of IRT clinicians, nurses, and parent-guardians. Key components of the IRT model are emphasized with associated practice and research recommendations.

Humble Behaviorism Redux

The need to bring behavior analysis to scale is no more obvious or urgent than now. Collaboration between behavior analysts and healthcare workers, educators, policymakers, mental health clinicians, social workers, and so many other professionals is critical to reaching under-resourced and traditionally marginalized populations. First, however, interprofessional collaboration must be adopted widely and reinforced within the behavior analytic community. Disciplinary centrism and hubris pose barriers to effective interprofessional collaboration, leading one to assume the position that practitioners of the same discipline are better trained and smarter than those of a different field. However, cultural humility (Wright, Behavior Analysis in Practice, 12(4), 805-809, 2019) is an alternative to disciplinary centrism that allows professionals to retain identities born of cultural histories and training (Pecukonis, Journal of Teaching in Social Work, 40(3), 211-220, 2020). Furthermore, cultural reciprocity is a process of self-observation and collaborative inquiry that involves questioning one's own assumptions and forces individuals (and professions) to confront the contradictions between their values and their practices (Kalyanpur & Harry, 1999). In this paper, we revisit the call for Humble Behaviorism first made by Alan Neuringer in 1991 and the recommendations of fellow behavior analysts since. Specifically, we introduce a framework of cultural reciprocity to guide humble behaviorists as they acquire behaviors necessary to establish and maintain productive interprofessional relationships. We encourage them to act on their ethical and moral duties to address social problems of global concern and bring behavior analysis to scale.

Continuum of Care Screener: A Risk Mitigation Tool to Guide Decision Making When Environmental Factors Affect Service Delivery

Navigating novel, unpredicted service disruptions can be complex and unparalleled. To effectively handle service interruptions, board certified behavior analysts (BCBAs®) must make sound clinical decisions, comply with the Behavior Analyst Certification Board’s Ethics Code for Behavior Analysts (2020a), and critically engage in ongoing risk/benefit assessments for each individual client. Unfortunately, most BCBAs do not receive coursework, training, or fieldwork supervision in advanced risk mitigation. Those who have been practicing longer may have more experience in organizational systems and mitigating risk; however, half of all BCBAs have been certified in the last 5 years and two thirds have been certified in the last 7 years (BACB, 2021). This rapid growth of the profession poses significant challenges in navigating novel situations outside of the practitioner’s scope of competency and learning history. In this article, we present a systematic formalized approach to risk management through an organizational behavior management lens. The article includes a screening tool, a summary of the model, and case examples of ongoing risk assessment during unexpected service disruptions. This screener is designed to help BCBAs think critically and systematically as they consider social and contextual factors across stakeholders, the client’s behavioral status and treatment needs, state policy and law, and professional and ethical obligations during the decision-making process.

Interdisciplinary Collaboration Training: An Example of a Preservice Training Series

In recent years, there has been discussion of the need for training behavior analysts in collaboration skills. There is some consensus that these skills are needed to improve outcomes with clients and with colleagues. Specifically, students of behavior analysis and behavior-analytic practitioners need to learn the skills associated with functioning effectively in interdisciplinary teams. At Melmark, a model of training in this skill set has been developed and integrated into supervision modules for those seeking Board Certified Behavior Analyst certification. In this model, supervisees are exposed to information about the expertise and value of the allied professions of speech-language pathology, occupational therapy, physical therapy, and developmental pediatrics. Rotations are done within these fields to expose trainees to the expertise of these fields and to build skills in collaboration with members of those professions. Trainees are also assigned tasks that require them to identify the contributions of other professions and display appropriate collaborative behavior. Future directions for the model are discussed, including extending it across the organization and developing performance-based assessments and social validity measures.

Standards for Interprofessional Collaboration in the Treatment of Individuals With Autism

Interprofessional collaboration has become an essential component in the treatment of individuals with autism spectrum disorder, as practitioners from a range of disciplines are often necessary to address the core features and co-occurring conditions. Theoretically, such cross-disciplinary collaboration results in superior client care and maximal outcomes by capitalizing on the unique expertise of each collaborating team member. However, conflict in collaborative practice is not uncommon given that the treatment providers come from varying educational backgrounds and may have opposing core values, fundamental goals, and overall approaches. Although the overarching interest of each of these professionals is to improve client outcomes and quality of life, they may be unequipped to effectively navigate the barriers to collaboration. This article reviews the potential benefits and misconceptions surrounding interprofessional collaboration and highlights common sources of conflict. As a proposed solution to many of the identified issues, we offer a set of standards for effective collaborative practice in the interprofessional treatment of autism spectrum disorder. These standards prioritize client care and value each discipline's education and unique contributions. They are intended to function as core standards for all treatment team members, promote unity, prevent conflict, and ultimately help practitioners achieve the most integrated collaborative practice among professionals of varying disciplines.

A Behavior-Analytic Perspective on Interprofessional Collaboration

Collaborative service delivery models have gained considerable popularity in health care, education, and clinical settings. Despite the unique opportunity that this new popularity provides for the dissemination of applied behavior analysis, the majority of practicing behavior analysts have received little or no formal professional development on how to participate in teams with nonbehavioral colleagues. The purpose of this article is to elucidate the larger movement toward collaborative service delivery with an emphasis on interprofessionalism. The four core competency domains presented by the Interprofessional Education Collaborative (IPEC) Framework are interpreted through a behavior-analytic lens. This article is an initial attempt to operationalize constructs commonly associated with interprofessional educational and collaborative practices including (but not limited to) cultural sensitivity and responsiveness, cultural humility and reciprocity, empathy, and compassion.

Ethical Considerations of Behavioral Feeding Interventions

Children with autism spectrum disorder (ASD) often display repetitive and restrictive patterns of behavior, which can be seen in food selectivity and other feeding problems. Feeding problems in children with ASD not only lead to medical complications for the child but also can lead to increased caregiver stress. In order for behavior analysts to ensure adherence to the Professional and Ethical Compliance Code for Behavior Analysts, many factors need to be addressed prior to and during feeding assessments and interventions. The need for interdisciplinary collaboration and ethical situations that may arise are reviewed. The purpose of this article is to assist the behavior analyst in determining best practices for feeding assessments and interventions while maintaining ethical compliance.

Collaboration between Behavior Analysts and Occupational Therapists in Autism Service Provision: Bridging the Gap

Interdisciplinary collaboration is challenging, but necessary, to meet the needs of individuals with autism spectrum disorder. Among the dyadic interactions in interdisciplinary teams, the relationships between occupational therapy practitioners and board certified behavior analysts are uniquely challenging. The disciplines define evidence-based practice differently and approach intervention from different angles. Furthermore, there are fundamental differences in worldview between the disciplines. Both disciplines offer necessary treatment, and successful collaboration between these disciplines is essential for maximizing outcomes. Hence, finding ways to help bridge the gap between these professions, in particular, is essential. Common barriers to developing collaborative alliances include misperceptions of the other discipline, differences in terminology, and unprofessional behavior. This article reviews the history and foundational concepts of both disciplines, and the common approaches associated with each. In addition, models of collaboration are discussed, with suggestions for enhancing interdisciplinary communication and treatment. Successful collaborative treatment is predicated on an understanding of the value and expertise offered by different disciplines, and requires mutual respect and professional dialogue.

Six Useful Websites for Practitioners Working in Schools

A substantial, and seemingly increasing, number of Board Certified Behavior Analysts work in pre-K-12 schools. Many of them will be unfamiliar with the roles and activities of other school professionals, as well as with the structure, function, and mandates of schools. This article introduces 6 websites that are devoted to education. Accessing these free and user-friendly sites can provide practitioners with information and training activities that will help them function comfortably and competently in schools and benefit their clients to a greater extent. Our purpose in writing this article is to introduce and recommend these websites.

Behavior Analysis Goes to School: Teacher Acceptability of Behavior-Analytic Language in Behavioral Consultation

Effective communication is a vital component of behavioral consultation. Behavioral consultants (e.g., behavior analysts, school psychologists) are responsible for drafting behavior intervention plans, delivering accessible training, and providing concise and consumable feedback to teachers. Their reliance on technological descriptions to communicate behavioral principles and procedures may yield poor social validity and hinder the consultant-teacher relationship. In this study, we recruited 164 teachers through Amazon Mechanical Turk and administered a survey to (a) evaluate the social acceptability of technical and nontechnical language used in behavioral consultation across a variety of student populations and (b) gain information about teachers' experiences with behavioral consultation. Implications are discussed for training and the provision of behavioral consultation services.

Developing and Enhancing Adherence to a Telehealth ABA Parent Training Curriculum for Caregivers of Children with Autism

The current COVID-19 pandemic poses unique challenges to the delivery of applied behavior analysis (ABA) services, and there has been a growing demand for evidence-based practices on how to develop a telehealth ABA service model. The current article provides a detailed technological guide on how to develop a telehealth ABA parent training curriculum. Our model also includes a series of brief acceptance and commitment training (ACT) protocols to enhance parental adherence. We provide the details for replicating our telehealth model and also demonstrate its effectiveness. To begin, a step-by-step guide on how to develop this curriculum is presented, as well as protocols used in a 60-day telehealth ABA parent training program. Afterward, we describe a randomized controlled trial design to examine the effectiveness of this protocol. Thirteen families from the southern Illinois region participated in the curriculum before the COVID-19 outbreak. Obtained data indicated training was effective to teach skills, and parents with supplemental ACT material made significantly more progress than those in the control group, t(11) = 2.36, p = .038. Halfway through the training, the outbreak of COVID-19 occurred, and parents in the ACT group were more likely to continue the program, whereas parents in the control group were significantly more likely to postpone their participation, χ2 = 6.96, p = .008. Social validity measures indicated that parents rated the curriculum favorably. Limitations and suggestions for practitioners are discussed.

The Use of Demand Assessments: A Brief Review and Practical Guide

It is important for practitioners to first conduct an indirect demand assessment to identify appropriate stimuli to include during the direct demand assessment. Information obtained from an indirect demand assessment is useful not only for identifying which demands to evaluate during the direct assessment but also for selecting stimuli associated with each demand. Conducting an indirect demand assessment with caregivers provides practitioners the opportunity to identify whether specific demand stimuli are associated with more challenging behavior (e.g., writing with a pen vs. a pencil) and whether demand presentation may be an establishing operation for challenging behavior (e.g., presenting one math problem at a time vs. presenting an entire math worksheet). The purpose of this article is to review the current literature on demand assessment procedures and to provide practitioners with a practical guide for conducting demand assessments in clinical settings. We provide a summary of our findings along with a brief description of the procedures used for implementing the indirect and direct demand assessments. Further, we created a decision-making guide to help practitioners select which type of demand assessment to conduct with their clients.

Ethical Considerations in Clinical Supervision: Components of Effective Clinical Supervision Across an Interprofessional Team

Within the practices of behavior analysis, education, occupational therapy, physiotherapy, speech-language pathology, and other health professions, professional practice focuses on each discipline's ethics, assessment, and treatment practices. However, maximizing outcomes for some clients is achieved only by combining the strengths of multiple disciplines to include all the competencies required for comprehensive client care. Thus, understanding and acquiring the core competencies for working collaboratively within an interprofessional framework is essential for working together effectively to garner the best outcomes for clients. Furthermore, the interprofessional team clinical supervisor has the added responsibility of ensuring optimal client outcomes while managing a diverse group of professionals, each with their own set of perspectives, clinical training, and evidence-based practices. In many areas of applied practice, the behavior analyst assumes the role of interprofessional clinical supervisor, which necessitates additional training in collaboration, supervision of allied professionals, and ethics. Successful interprofessional and collaborative working relationships require a number of key competencies and subcompetencies as outlined by the Interprofessional Education Collaborative, as well as knowledge of others' ethical and professional codes and/or guidelines for professional conduct, along with additional training and resources in the navigation and handling of ethical dilemmas among disparate team members. Working together and maintaining professional relationships within an interdisciplinary team are fraught with barriers and issues that may impede collaboration. The interprofessional team clinical supervisor requires various strategies, processes, and resources to enable them to navigate challenges and assist the team in working cohesively to achieve more positive client outcomes.

When Rules Are Not Enough: Developing Principles to Guide Ethical Conduct

Currently, certified behavior analysts are required to adhere to the ethical rules established by the Behavior Analyst Certification Board® (BACB®) known as the Professional and Ethical Compliance Code for Behavior Analysts (BACB, 2014; hereafter referred to as the BACB Code). Applying these rules without context, however, can result in an overly simplified and mechanistic approach to ethical problem solving. Ethical rules that lack guiding principles may also pose dissemination challenges for behavior analysts tasked with communicating the field's ethical ideals to nonbehavioral colleagues and stakeholders. This article describes the process that our applied behavior analysis organization used to develop a set of guiding ethical principles to supplement the BACB Code. These principles guide our members' ethical decision making and assist them in disseminating our organization's ideals. Following a description of the principle development process, we present our organization's ethical principles and discuss how behavior analysts can use them to make clinical and ethical decisions, and address dissemination challenges.

Culture Always Matters: Some Thoughts on Rosenberg and Schwartz

The purpose of this paper is to draw attention to and highlight some particularly enlightening arguments described by Rosenberg and Schwartz (2019). First, I emphasize the importance of the role of culture in ethical analysis and describe how the Behavior Analyst Certification Board (BACB) Professional and Ethical Compliance Code for Behavior Analysts (2014; hereafter referred to as the BACB Code) unintentionally underplays the importance of culture. Second, I express support for the model of ethical analysis proposed by Rosenberg and Schwartz and explain how their model provides an excellent and much-needed framework for the observation (and subsequent study) of ethical decision-making in behavior-analytic practice. Finally, I go all in and join Rosenberg and Schwartz in their call for scholars to critically analyze and discuss the BACB Code and to challenge the status quo (or call into question those who do). Such a discussion is healthy for our science and understanding of ethics and behavior analysis.

Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding

In an effort to provide clarity about the unique contributions of several professions within the context of multidisciplinary treatment, we reviewed the definitions, philosophical underpinnings, and national requirements pertaining to both scopes of practice (i.e., model licensing acts, legislation, and regulatory boards) and training (i.e., task lists, accreditation standards and course requirements, and exam blueprints) of 4 behavioral health professions. The professions we selected (behavior analysis, psychology, speech-language pathology, and occupational therapy) are likely to provide treatment alongside one another and often to the same clients. In a review of documents pertaining to scopes of practice and training for each profession, we found overlapping content. However, the similarities between professions diminished when we reviewed more specific guidelines such as learning objectives, educational requirements (i.e., coursework), supervised clinical experience (e.g., internships), and national examinations. This was especially true when considering each profession's underlying approach to treatment (i.e., philosophical underpinnings) and, hence, service activities. We discuss our findings in light of service overlap and make a call for greater collaboration between professions, as related to the separate content knowledge and expertise of professionals in each field and the impact on client outcomes.

Seeking Team Collaboration, Dialogue and Support: The Perceptions of Multidisciplinary Staff-Members Working in ASD Preschools

Autism spectrum disorder (ASD) impacts various developmental domains, requiring interventions by professionals from multiple disciplines. In Israel, ASD community preschools' multidisciplinary teams aim to provide each child with an integrative intervention program. The current study focused on the working experience of 21 professionals from multidisciplinary teams in ASD-preschools, with special emphasis on their perceptions of the intra-staff dialogue in their teams. Interviews were transcribed verbatim and analyzed through grounded theory. Arising themes covered: challenges characterizing the delivery of intervention to children with ASD in a community setting; challenges met by professionals when attempting to navigate multidisciplinary teamwork; and factors that facilitate multidisciplinary work. Practices that support multidisciplinary team cohesion at the team, the organizational, and the policy-making levels are discussed.

A randomized clinical trial of three prompting systems to teach tact relations

Prompts are commonly used during discrete trial teaching for individuals diagnosed with autism spectrum disorder (ASD). Three commonly used prompting systems include constant time delay, most-to-least prompting, and flexible prompt fading. Most of the research demonstrating the effectiveness of these three prompting strategies have been completed through the use of single subject experimental designs. Some within the field of behaviorally based approaches to ASD interventions have called for more randomized clinical trials of these approaches. The purpose of the present study was to compare these 3 prompting systems to teach tact relations for 27 individuals diagnosed with ASD through a randomized clinical trial without a control group with respect to pre-post responding, generalization, sessions to mastery, and responding during teaching. Overall, minimal differences were observed across the 3 systems. The results are discussed with respect to future research and clinical application of the methods evaluated.

A Call for Discussion About Scope of Competence in Behavior Analysis

The field of behavior analysis has defined its scope of practice through credentialing and licensure efforts. However, scope of competence in behavior analysis has received little discussion. Scope of competence refers to activities that the individual practitioner can perform at a certain criterion level (e.g., the functional analysis is conducted accurately and safely, a skill acquisition program includes critical program components and establishes accurate stimulus control). Given the successful efforts of behavior analysts in growth and recognition of the field, it is time for a robust conversation about scope of competence for the field of behavior analysis. This discussion can clarify how behavior analysts self-evaluate their own scope of competence and how they might expand their scope of competence if the needs of consumers require practitioners to expand into new areas.

Toward an Understanding of the Essential Components of Behavior Analytic Service Plans

Baer, Wolf, and Risley (1968) indicated "technological" was one of seven core dimensions of applied behavior analysis (ABA). They described this dimension as being met if interventions were described well enough to be implemented correctly. Often in the applied settings, a behavior plan is the method by which interventions are communicated to staff and parents for implementation. The necessary components of a behavior plan have been discussed in relation to compliance with regulations (e.g., Vollmer, Iwata, Zarcone, & Rodgers, Research in Developmental Disabilities 13:429-441, 1992), in school settings (e.g., Horner, Sugai, Todd, & Lewis-Palmer, Exceptionality: A Special Education Journal 8:205-215, 2000), and other applied settings (e.g., Tarbox et al., Research in Autism Spectrum Disorder 7:1509-1517, 2013) for the last 25 years. The purpose of this research is to review the literature regarding components of behavior plans and synthesize it with a recent survey of behavior analysts regarding essential components of behavior plans. The results are discussed in light of training, treatment fidelity implications (i.e., Registered Behavior Technician Task List), public policy development (e.g., state initiative for a single behavior plan template), and research opportunities (e.g., comparison of different visual structures).

Board Certified Behavior Analysts and Psychotropic Medications: Slipshod Training, Inconsistent Involvement, and Reason for Hope

People with autism spectrum disorder often receive psychotropic medications and two drugs, risperidone and aripiprazole, are approved for treating "irritability" in this population. A number of authors have suggested that behavior analysts can contribute to the prudent use of such drugs, but little is known regarding Board Certified Behavior Analysts' involvement in practices relevant to the use of psychotropic drugs. We e-mailed Board Certified Behavior Analysts an anonymous web-based survey regarding such practices. A majority of respondents work with individuals with autism spectrum disorder who take at least one psychotropic medication but respondents' training relevant to psychotropic medications is inconsistent. Many report that their training is inadequate, they do not regularly work as part of interdisciplinary teams concerned with medication, and behavior-analytic interventions are not typically evaluated before drugs are prescribed. Nonetheless, the majority of respondents reported that medications sometimes produce beneficial effects. Those involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians. • Psychotropic drugs are often prescribed for people with autism, and both risperidone and aripiprazole are approved for reducing "irritability," which comprises self-injury, aggression, tantrums, and other challenging responses. • Respondents are not consistently involved in monitoring the effects of psychotropic drugs, which are often administered prior to evaluating an alternative, less restrictive, intervention. • Respondents are not trained consistently with respect to matters relevant to psychotropic drugs, and many apparently are not trained adequately. • People involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. • Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians.

Tactics to Evaluate the Evidence Base of a Nonbehavioral Intervention in an Expanded Consumer Area

The purpose of this article is to provide tactics for the behavior analyst to effectively evaluate the evidence base for an unfamiliar nonbehavioral intervention when expanding services. Just as behavior analysts must be aware of fad treatments in autism likely to be encountered, so, too, should practitioners become familiar with potential fad treatments in any expanded area of practice. The present article extends previous work by considering challenges surrounding contact with nonbehavioral literature in the context of an expanded consumer base. The article also considers ethical interactions with nonbehavioral professionals following appraisal of the intervention, and how adopting the strategies listed here can aid in establishing oneself as a resource. Associated barriers and solutions are presented around four tactics: (a) searching the literature, (b) recognizing and evaluating the common properties of fad treatments, (c) distinguishing quality of evidence, and (d) ascertaining behavioral mechanisms of action. Examples from gerontology will be provided to illustrate the use of the proposed tactics.

Guidance or Compliance: What Makes an Ethical Behavior Analyst?

In 2016, the Behavior Analyst Certification Board (BACB) made effective a new, revised ethical code for behavior analysts, the Professional and Ethical Compliance Code for Behavior Analysts, replacing the code that had been in effect since 2001. In this revised code, the certification board has shifted the language of the code from that of a set of guidelines to that of a set of enforceable rules. This important shift has not been well discussed in the field. This article explores the potential implications and possible consequences of such a shift and describes other ways that ethical behavior has been approached historically. The authors then propose an ethical decision-making process that might provide a better area of focus for the field of behavior analysis in seeking to develop the highest levels of ethical behavior in its professionals and provide a case example using that process to resolve an ethical dilemma.

Lost in Translation: A Reply to Shyman (2016)

A recently published article sought to determine the extent to which behaviorism and humanism can be reconciled ( Shyman, 2016 ). However, the "current" conceptions of behaviorism and applied behavior analysis (ABA) used for the analysis were based on mischaracterizations, rendering moot many of the points made. Nevertheless, Shyman (2016) highlighted a very important question we believe all helping professionals should attend to: Should normalization be the focus of therapeutic goals? This response article was written to provide readers of this journal an accurate representation of behaviorism and ABA. We have also offered an alternative approach to answering the question of normalization that uses a behavior-by-behavior approach and individual client values as the deciding factors.

Social Thinking®, Pseudoscientific, Not Empirically Supported, and Non-Evidence Based: a Reply to Crooke and Winner

J. B. Leaf et al. (Behavior Analysis in Practice, 9, 152-157, 2016) wrote a commentary on social thinking (ST), an intervention commonly implemented for individuals diagnosed with autism spectrum disorder (ASD). The authors described what constitutes scientific, pseudoscientific, and antiscientific evidence and contended that ST aligns with the definition of pseudoscience and, to date, is not empirically supported or evidence based. Crooke and Winner (Behavior Analysis in Practice, 9, 403-408, 2016) responded, arguing that ST meets their definition of an evidence-based practice and identifying purported misconceptions and inaccuracies described by J. B. Leaf et al. In the current article, the authors clarify the original arguments, critically evaluate Crooke and Winner's definition of what constitutes evidence-based practice, further evaluate the research on ST, discuss issues regarding how ST is conceptualized, and express concerns about the endorsement and use of an eclectic approach to treating ASD. As this response was written by behavior analysts, it specifically addresses the conceptual consistency of this approach from a behavior-analytic worldview.

How to Identify Ethical Practices in Organizations Prior to Employment

Behavior analysts likely can evaluate multiple organizations prior to accepting a job due to recent increases in the number of organizations providing ABA services. We argue that evaluating the ethical values of an organization is paramount during the job search process. We provide strategies for evaluating the ethical values of an organization prior to employment and describe considerations from the pre-application process through contract negotiations. Ultimately, we add to the growing body of literature that provides guidance for common problems behavior analysts may face over the course of their careers.

Ethical Considerations for Interdisciplinary Collaboration with Prescribing Professionals

Behavior analysts often work as part of an interdisciplinary team, and different team members may prescribe different interventions for a single client. One such intervention that is commonly encountered is a change in medication. Changes in medication regimens have the potential to alter behavior in a number of ways. As such, it is important for all team members to be aware of every intervention and to consider how different interventions may interact with each other. These facts make regular and clear communication among team members vital for treatment success. While working as part of an interdisciplinary team, behavior analysts must abide by their ethics code, which sometimes means advocating for their client with the rest of the team. This article will review some possible implications of medicinal interventions, potential ethical issues that can arise, and a case study from the authors' experience. Finally, the authors propose a decision-making tree that can aid in determining the best course of action when a team member proposes an intervention in addition to, or concurrent with, interventions proposed by the behavior analyst.

Developing the Cultural Awareness Skills of Behavior Analysts

All individuals are a part of at least one culture. These cultural contingencies shape behavior, behavior that may or may not be acceptable or familiar to behavior analysts from another culture. To better serve individuals, assessments and interventions should be selected with a consideration of cultural factors, including cultural preferences and norms. The purpose of this paper is to provide suggestions to serve as a starting point for developing behavior analysts' cultural awareness skills. We present strategies for understanding behavior analysts' personal cultural values and contingencies and those of their clients, integrating cultural awareness practices into service delivery, supervision, and professional development, and becoming culturally aware in everyday practice.