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Lauren A. Goodwyn Ethics for Behavior Analysts Caldwell College CONDUCTING A RISK-BENEFIT ANALYSIS.

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Presentation on theme: "Lauren A. Goodwyn Ethics for Behavior Analysts Caldwell College CONDUCTING A RISK-BENEFIT ANALYSIS."— Presentation transcript:

1 Lauren A. Goodwyn Ethics for Behavior Analysts Caldwell College CONDUCTING A RISK-BENEFIT ANALYSIS

2 Overview Headlines Guidelines Where’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

3 How to Prevent Such Headlines … BACB Task-List 3 rd 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 4 th Edition Nothing specifically stated about risk-benefit analysis

4 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”

5 Where’s …the research Behavior Analysis and Treatment ed. By Van Houten & Axelrod (1993) Chapter 8 “A Decision-Making Model for Selecting Optimal Treatment Procedure”

6 Where’s …the research To predict risk v. benefit of behavioral program must consult experiences of practicing behavior analysis because evidence in literature is lacking Clues 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

7 Spreat (1982) Old school vs New School Bailey & Burch (2011)

8 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?

9 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”

10 Related Topic: Therapeutic Dose When taking a drug Death / toxicity vs effectiveness When implementing a procedure Risk of failure / harm vs benefit of success


12 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

13 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

14 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

15 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.

16 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:

17 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:

18 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 BENEFITSNOTES 1. 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:

19 Risk-Benefit Analysis in Practice Intake  FA  review literature for appropriate treatment Meeting held w/ consumer Give & 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 implementation At conclusion, all parties should reach consensus on course of action Sign & file paperwork, treatment can begin

20 3 Additional Benefits for the BCBA and the Field If 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 of knowledge of ABA & good public relation for the field

21 References Bailey, 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. RiskReturn/T4-riskreturnP02.htm RiskReturn/T4-riskreturnP02.htm glossary/terms/r/risk.aspx glossary/terms/r/risk.aspx

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