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Looking Through an Ethical Lens: Applying the Ethics Code to Common Clinical Practices |
Saturday, May 25, 2024 |
4:00 PM–4:50 PM |
Convention Center, 200 Level, 202 AB |
Area: PCH; Domain: Applied Research |
Chair: Videsha Marya (Endicott College) |
CE Instructor: Videsha Marya, Ph.D. |
Abstract: The Ethics Code for Behavior Analysts (BACB, 2020) acts as a guide for all behavior analysts and for their practices. In addition to having a responsibility towards evidence-based practices and interventions, behavior analysts also have a responsibility towards their clients and to use interventions that are compassionate, incorporate assent, and prioritize reinforcement. In this symposium, we will have three presentations that evaluate existing literature through an ethical lens. In the first talk, the presenter will present data from an extensive review evaluating existing research on the use of self-management procedures in reducing problem behaviors in adults diagnosed with intellectual disabilities. The second presenter will present a review of the literature on the use of escape extinction within the field of Applied Behavior Analysis (ABA). Finally, the third presenter will present results from their study evaluating the effect of a decision-making model on the selection of assessment and treatment measurement procedures for problem behavior. Through the presentations, the presenters will highlight the importance of ethical considerations when choosing clinical interventions and making clinical decisions. |
Instruction Level: Intermediate |
Keyword(s): clinical interventions, ethical considerations, evidence-based interventions |
Target Audience: Presentations during this symposium will be delivered at an intermediate instruction level. Target audience members should be familiar with the ethics code for behavior analysts (BACB, 2020), clinical interventions (e.g., escape extinction, self-management), and have prior experience in clinical decision-making. |
Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) The participants will be able to describe the ethical implications of some common clinical procedures; (2) The participants will be able to discuss the importance of evaluating published literature through an ethical and critical lens; (3) The participants will be able to apply this understanding and knowledge to their own settings. |
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Evaluating the Usefulness of Decision Trees in Measurement Selection |
LAURA FRANCES WEIL (Endicott College), David J. Cox (RethinkFirst; Endicott College) |
Abstract: Many clinical decision trees have been published that purport to improve clinical decisions. Most, however, have yet to demonstrate experimentally their utility toward the purported function. In this study, we evaluated how clinical decisions were influenced by access to a published decision tree (LeBlanc et al., 2016) for selecting appropriate assessment and treatment measurement procedures for problem behavior. Participants were provided with six vignettes that contained details about variables relevant to the decision tree and that mimicked patient descriptions commonly found in intake forms for ABA services. Each participant completed three phases: baseline (no access to the decision tree), intervention (access to the decision tree), and post-test (1-week post-experiment). The primary dependent variable was the measurement technique they thought most appropriate based on the information in each vignette with results also analyzed across a variety of participant characteristics (e.g., years of experience, primary setting of work). Importantly, the results of this study highlight critical ethical considerations around measuring and analyzing clinician decision-making in everyday settings to help optimize patient outcomes following ABA services. |
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Escape Extinction: A Critical Review |
MICAH HOPE (University of North Texas and Endicott College), Nicole Radzilowicz (Endicott College), Justin B. Leaf (Autism Partnership Foundation), Mary Jane Weiss (Endicott College) |
Abstract: Escape extinction is frequently and effectively used to reduce escape-maintained behavior, especially in children with feeding disorders. However, there are several drawbacks to using escape extinction such as difficulty with treatment fidelity, low social validity, temporary increases and/or spontaneous recovery of problem behaviors, and the inclusion of restrictive procedures. In this presentation, we will review the empirical literature on the use of escape extinction within the field of Applied Behavior Analysis. While the literature shows that escape extinction is effective in certain contexts, we will discuss potential drawbacks and ethical challenges with the use of escape extinction, along with the limitations of the literature review. We will discuss parameters to consider before the implementation of escape extinction, including a checklist for clinical considerations prior to the implementation of escape extinction, safeguards to be used in conjunction with the procedure, and alternatives to escape extinction. Research demonstrating the effective treatment of escape-maintained behavior without the use of escape-extinction will be reviewed. While escape extinction is an effective treatment, it is not the least restrictive intervention and should not be implemented without careful consideration and planning. |
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Can Self-Management Procedures Used by Adults With Autism to Decrease Problem Behavior Be Considered Evidenced-Based? |
ASHLEY MCHUGH (Eden Autism Services), Thomas L. Zane (University of Kansas), Amalia Monroe-Gulick (University of Kansas) |
Abstract: The ethics code for behavior analysts emphasizes the role of behavioral science in the practice of Board-Certified Behavior Analysts. That is, BCBAs are obligated to use science to guide the professional activities in which they engage. A major part of this obligation is to use evidenced-based treatments in all clinical activities. That is, behaviorists must use science (and research with high rigor) to vet the degree to which treatments are causally related to positive changes in the clinical targets. The purpose of this literature review was to examine the state of the research on the use of self-management procedures in reducing problem behaviors in adults diagnosed with an intellectual disability, with the goal of determining whether or not self-management strategies with this population can be considered evidenced-based. Studies were located using a systematic search of literature across various journals. Seventeen studies were included in the review and were evaluated along the dimensions of adherence to quality research design and outcomes. Results showed that self-management techniques were associated with decreased levels of challenging behaviors across adults with an Intellectual Disability and Autism Spectrum Disorder. However, the quality of the research design was inconsistent, decreasing confidence in a causal relationship between self-management and reduction in challenging behaviors. Thus, at present time, self-management interventions for adults with ASD for reducing challenging behavior cannot be viewed as an evidenced-based strategy. This review should encourage more research in using self-management procedures with individuals with Intellectual Disability, especially with adults. |
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