Process versus content in delivering ABA services: Does process matter when you have content that works?

Abstract

Almost all of clinical science, including applied behavior analysis, encourages practitioners to apply effective treatments with sensitivity to client preferences. Interestingly, applied behavior analysis has focused largely on measuring preferences to treatment content (i.e., the procedures we use) and little on treatment process (e.g., the way those procedures are delivered). However, clinical evidence suggests that the process by which treatment is delivered can matter to clients and to referral sources in primary care. The purpose of this study was to evaluate the value assigned to the therapeutic process by parents and caregivers seeking treatment for their children in both traditional and in integrated primary care settings. Using a modified delay-discounting methodology, parents were asked to make choices that reflected how much they would prefer treatment effectiveness content over various therapist process characteristics. Results showed that parents were willing to tolerate a treatment with significantly less empirical support in favor of numerous preferred therapist characteristics. Implications for a field that prides itself on effectiveness but values dissemination and integration in primary care are discussed.

There is no such thing as a bad boy: The Circumstances View of problem behavior

“…An emerging emphasis on compassion in behavior analysis in general (e.g., Killeen, 2020) and behavior analytic treatment in particular (e.g., Taylor et al, 2019) does indicate that the field may be starting to focus on variables (e.g., relationships) that are less operational than those typically studied in its research programs (e.g., rate) but that may be just as important. For example, a large literature shows that the relationship between provider and client is a significant determinant not only of whether a treatment will be adopted but also whether it will actually work (e.g., Allen & Warzak, 2000;Chadwell et al, 2018;Friman, 2015;Patterson & Forgatch, 1985). Actually Wolf (1978) and this literature on relationships mirrors similar messages that have been present in western culture from the beginning of the first millennia (Aurelius, 1862) through the 20 th (e.g., Carnegie, 1981) and 21 st centuries (e.g., Martin, 2005).…”

Dissemination of Direct Instruction: Ponder These while Pursuing That

“…Multiple variables other than outcomes influence whether persons will adopt behavior change programs. For example, a recent study shows that parents of children receiving behavioral treatment will discount the value of the effectiveness of those services if they do not feel valued by the provider (e.g., Chadwell et al, 2018 ). A pertinent question is whether nonbehavior-analytic members of the educational community feel valued by the behavior-analytic members of that community—in particular because those members attempt to persuade the nonbehavior-analytic members to adopt DI.…”

Humble Behaviorism Redux

“…IPE is largely missing in behavior analytic training programs, which likely contributes to the expression of disciplinary-centric attitudes when newly certified professionals are released into IPP contexts. To align ourselves with other professions (LaFrance et al, 2019 ) and to become known for humble and effective collaboration, we need to integrate IPE into our curricula and training programs and within our competence standards (Bowman et al, 2021 ; Callahan et al, 2019 ; Chadwell et al, 2018 ; Slim & Reuter-Yuill, 2021 ; St Peter, 2013 ).…”

“…It is not scientific.” On the other hand, the behavior analyst could align their actions with Ethics Code 2.10 (BACB, 2020 ), interprofessional competencies (IPEC, 2016 ), standards for interprofessional collaboration (Bowman et al, 2021 ), and the evidence-based practice of behavior analysis (Slocum et al, 2014 ). After all, families prefer behavior analysts who actively collaborate with other service providers (Callahan et al, 2019 ; Chadwell et al, 2018 ; Monz et al, 2019 ). Ultimately, in their consideration of family values and preferences, clinical expertise, and knowledge of the best available evidence, the behavior analyst adopts a position of humble behaviorism.…”