Association for Behavior Analysis International

Applied behavior analysis (ABA) has developed a plethora of empirically validated technologies with the capacity to improve the lives of others through behavior change. These technologies are frequently utilized in service to individuals with a diagnosis of intellectual disability or autism spectrum disorder (ASD). Application of these same principles within clinical settings to address behavioral issues typically associated with mental health disorders has become a more prominent topic in recent years (Danforth, 2016). Residential treatment settings offer a unique opportunity to demonstrate the effectiveness of behaviorally based interventions across a wide-ranging level of severity within that population but may be criticized for the restrictive nature of these settings. This is especially relevant considering the recent emphasis on assent-based treatments in the field and the underlying absence of assent in many or most aspects of residential treatment programs. The purpose of this symposium is to 1) Describe the application of effective behavior analytic technologies to improve a range of severe behavioral issues to several individuals with mental health disorders 2) To examine the use and limits of assent-based treatment in these settings, and 3) to offer a conceptual analysis of assent as it relates to clinical and real-world conditions.

Participants should have already obtained BCBA certification and have independent experience practicing while upholding the Ethical Code of Conduct. This panel is targeted to behaviour analysts who have already developed strong ethical practice skills but who are seeking further development with the changing guidelines.

Clinical application of behavioral technologies to address behaviors typically associated with mental health disorders has garnered increased attention in recent years. Demonstrating the effectiveness of behaviorally based procedures within clinical populations further illustrates the range and efficacy of behavioral science. A portion of this work takes place within residential treatment centers. These settings are often populated by individuals with well-established repertoires of dangerous or potentially dangerous behaviors and who carry a variety of diagnoses from Diagnostic and Statistical Manual of Mental Health Disorders-Fifth Edition (DSM-5). Some of these individuals do not possess legal decision-making authority due to their juvenile status or the lawful appointment of a guardian. These factors limit the scope of individual control that is central to assent-based treatment and can occasion countercontrol behavior. Countercontrol is human operant behavior that occurs in response to socially mediated aversive control (Fontes & Shahan, 2019). Engagement in countercontrol is a challenging aspect of service delivery within this population which is impacted by the ineffectiveness of prior interventions. Data will be provided across multiple participants in support of a function-based treatment. Discussion will encompass development of such repertoires, assessment, and treatment planning.

The Ethical Code for Behavior Analysts introduces the term ‘assent’ under 2.11 (Obtaining Informed Consent), stating that behavior analysts are ‘responsible for obtaining assent from clients when applicable’. Client assent is broadly thought of as agreement and voluntary participation in treatment procedures, but there is limited research describing assent procedures or studying the implications for treatment outcomes (Morris, Detrick, & Peterson, 2021). This presentation will provide a conceptual analysis of assent, discuss where assent was derived from, and examine some of the challenges and unintended consequences with its use within the ethical guidelines of behavior analytic practice. Embedded within this analysis is a commentary about choice behavior, as well as considerations about how to maximize and honor client assent to the greatest degree possible in settings or contexts that typically preclude or limit the scope of assent-based treatment options. Reasonable alternatives to assent when obtaining it is difficult, questionable, or in conflict with other ethical guidelines will be presented.