Abstract
Approximately 10,000 new behavior analysts entered the field in 2021 alone, accounting for nearly 20% of the current workforce. As the field of behavior analysis continues to experience exponential growth, it is critical that organizations develop infrastructure to support the professional development of novice practitioners and the delivery of high quality and ethical services for patients. Although it is ultimately the responsibility of the individual practitioner to determine and practice within their own scope of competence, research indicates that many behavior analysts do not receive the necessary training and case oversight to adequately manage some of the patients assigned to them, particularly those with severe challenging behavior (Colombo et al. Behavior Analysis in Practice, 14(1), 11–19, 2021). Practitioners with inadequate training and oversight may be at risk of adopting restrictive procedures to manage seemingly intractable behaviors when less restrictive evidence-based treatment options are, in fact, available. This article describes the development of a procedural review panel (PRP) as an organizational strategy for aligning assessment and treatment procedures with ethical practice guidelines when working with patients with severe challenging behavior. Data from the first year of implementation were evaluated within an implementation science framework indicating that, within the current sample, the PRP process successfully mitigated the use of restrictive treatment procedures in 80% of cases and promoted the adoption of additional evidence-based practices in 79% of cases resulting in reductions across 72% of target behaviors across the sample.
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Data Availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Notes
Among the five patients for which different function(s) were identified, four patients received FBAs that included three different FBA methods, including informant, descriptive, experimental procedures, and one patient received an FBA including two different methods, including informant and descriptive procedures. In each case, one or more new procedures were implemented per panel recommendation.
Powell et al. (2015) conceptualized 73 discrete implementation strategies available for consideration when developing an implementation intervention. Proctor et al. (2011) offer 17 potential outcome domains to consider for an implementation study, and the Society for Implementation Research Collaboration (2020) has compiled a repository of over 400 implementation-related measures.
References
Azrin, N. H., & Holz, W. C. (1966). Punishment. In W. K. Honig (Ed.), Operant behavior: Areas of research and application (pp. 380–447). Appleton-Century-Crofts.
Baer, D. M., & Wolf, M. M. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20(4), 313–327. https://doi.org/10.1901/jaba.1987.20-313
Bailey, J., & Burch, M. (2010). 25 essential skills & strategies for the professional behavior analyst: Expert tips for maximizing consulting effectiveness. Routledge/Taylor & Francis Group.
Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. In Yearbook of Medical Informatics 2000: Patient-Centered Systems (pp. 65–70). Schattauer Verlagsgesellschaft.
Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1), 32. https://doi.org/10.1186/s40359-015-0089-9
Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Retrieved August 1, 2020, from https://bacb.com/wp-content/ethics-code-for-behavior-analysts/
Behavior Analyst Certification Board. (2022). US employment demand for behavior analysts: 2010–2021.
Behavior Analyst Certification Board. (n.d.) BACB certificant data. Retrieved August 1, 2022, from https://www.bacb.com/BACB-certificant-data
Brodhead, M. T., & Higbee, T. S. (2012). Teaching and maintaining ethical behavior in a professional organization. Behavior Analysis in Practice, 5(2), 82–88. https://doi.org/10.1007/BF03391827
Brodhead, M. T., Quigley, S. P., & Wilczynski, S. M. (2018). A call for discussion about scope of competence in behavior analysis. Behavior Analysis in Practice, 11(4), 424–435. https://doi.org/10.1007/s40617-018-00303-8
Chowdhury, M., & Benson, B. A. (2011). Use of differential reinforcement to reduce behavior problems in adults with intellectual disabilities: a methodological review. Research in Developmental Disabilities, 32(2), 383–394. https://doi.org/10.1016/j.ridd.2010.11.015
Colombo, R. A., Taylor, R. S., & Hammond, J. L. (2021). State of current training for severe problem behavior: A survey. Behavior Analysis in Practice, 14(1), 11–19. https://doi.org/10.1007/s40617-020-00424-z
Courtney, W. T., Hartley, B. K., Rosswurm, M., LeBlanc, L. A., & Lund, C. J. (2021). Establishing and leveraging the expertise of advisory boards. Behavior Analysis in Practice, 14, 253–263. https://doi.org/10.1007/s40617-020-00503-1
Cox, D. J. (2020). A guide to establishing ethics committees in behavioral health settings. Behavior Analysis in Practice, 13(4), 939–949. https://doi.org/10.1007/s40617-020-00455-6
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226. https://doi.org/10.1097/MLR.0b013e3182408812
Desrochers, M. N., Hile, M. G., & Williams-Moseley, T. L. (1997). Survey of functional assessment procedures used with individuals who display mental retardation and severe problem behaviors. American Journal on Mental Retardation, 101(5), 535–546.
DiGennaro Reed, F. D., & Henley, A. J. (2015). A survey of staff training and performance management practices: The good, the bad, and the ugly. Behavior Analysis in Practice, 8(1), 16–26. https://doi.org/10.1007/s40617-015-0044-5
Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism & Developmental Disorders, 41(5), 597–609. https://doi.org/10.1007/s10803-010-1081-0
Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1(1), 1–3. https://doi.org/10.1186/1748-5908-1-1
Fisher, W. W., Thompson, R. H., Hagopian, L. P., Bowman, L. G., & Krug, A. (2000). Facilitating tolerance of delayed reinforcement during functional communication training. Behavior Modification, 24(1), 3–29. https://doi.org/10.1177/0145445500241001
Grant, J., Green, L., & Mason, B. (2003). Basic research and health: a reassessment of the scientific basis for the support of biomedical science. Research Evaluation, 12(3), 217–224. https://doi.org/10.3152/147154403781776618
Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36(2), 147–185. https://doi.org/10.1901/jaba.2003.36-147
Hutchinson, R. R. (1977). By-products of aversive control. In Handbook of Operant Behavior (pp. 415–431). Routledge/Taylor & Francis Group.
Kurtz, P. F., Boelter, E. W., Jarmolowicz, D. P., Chin, M. D., & Hagopian, L. P. (2011). An analysis of functional communication training as an empirically supported treatment for problem behavior displayed by individuals with intellectual disabilities. Research in Developmental Disabilities, 32(6), 2935–2942. https://doi.org/10.1016/j.ridd.2011.05.009
LeBlanc, L. A., Onofrio, O. M., Valentino, A. L., & Sleeper, J. D. (2020). Promoting ethical discussions and decision making in a human service agency. Behavior Analysis in Practice, 13(4), 905–913. https://doi.org/10.1007/s40617-020-00454-7
Lerman, D. C., & Vorndran, C. M. (2002). On the status of knowledge for using punishment: Implications for treating behavior disorders. Journal of Applied Behavior Analysis, 35(4), 431–464. https://doi.org/10.1901/jaba.2002.35-431
Linscheid, T. R., & Meinhold, P. (1990). The controversy over aversives: Basic operant research and the side effects of punishment. In Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities. Sycamore Publishing.
Moore, J. W., Fisher, W. W., & Pennington, A. (2004). Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury. Journal of Applied Behavior Analysis, 37(1), 73–77. https://doi.org/10.1901/jaba.2004.37-73
Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180
Oliver, A. C., Pratt, L. A., & Normand, M. P. (2015). A survey of functional behavior assessment methods used by behavior analysts in practice. In Journal of Applied Behavior Analysis, 48(4), 817–829. https://doi.org/10.1002/jaba.256
Olonoh, A. (2006). Formstack.com
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., Glass, J. E., & York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123–157. https://doi.org/10.1177/1077558711430690
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10, 21. https://doi.org/10.1186/s13012-015-0209-1
Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Administration & Policy in Mental Health, 36(1), 24–34. https://doi.org/10.1007/s10488-008-0197-4
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration & Policy in Mental Health, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7
Reese, H. W. (1966). The analysis of human operant behavior. William C. Brown.
Roscoe, E. M., Phillips, K. M., Kelly, M. A., Farber, R., & Dube, W. V. (2015). A statewide survey assessing practitioners' use and perceived utility of functional assessment. Journal of Applied Behavior Analysis, 48(4), 830–844. https://doi.org/10.1002/jaba.259
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The evidence-based practice of applied behavior analysis. The Behavior Analyst, 37(1), 41–56. https://doi.org/10.1007/s40614-014-0005-2
Society for Implementation Research Collaboration. (2020). Instrument repository. https://societyforimplementationresearchcollaboration.org/measures-collection
Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
Westerlund, A., Sundberg, L., & Nilsen, P. (2019). Implementation of implementation science knowledge: The research-practice gap paradox. Worldviews on Evidence-Based Nursing, 16(5), 332–334. https://doi.org/10.1111/wvn.12403
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This study was conducted retrospectively from data obtained for clinical purposes during routine care. All procedures were performed in accordance with the ethical standards of the institution and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Logue, J.J., Hustyi, K.M., Toby, L.M. et al. Promoting Ethical and Evidence-Based Practice through a Panel Review Process: A Case Study in Implementation Research. Behav Analysis Practice (2023). https://doi.org/10.1007/s40617-023-00807-y
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DOI: https://doi.org/10.1007/s40617-023-00807-y