#103 Tips for Supporting the Adult Population as a Board Certified Behavior Analyst (BCBA)

Tip #103- Paradigmatic Shift in Adult Applied Behavior Analysis (ABA) Practices 

As a BCBA supporting the adult population, you are trained to utilize a pathogenic approach. What is a pathological approach from an ABA lens? Well, from a pathological perspective, a clinician provides treatment based on the individual's clinical diagnosis. If you've worked in the field long enough, you know that typically the additional recommendations along with ABA practices involve a psychiatric provider overseeing psychotropic medication and other therapeutic practices.

Let's consider a paradigm shift in our daily practices and utilize a more parsimonious approach. We can accomplish this by considering the ecological factors that are resulting in the behavioral challenges. By getting to the root of the problem, we can develop more effective interventions. Yes, medication and other therapeutic approaches can be helpful recommendations. However, from a behavior-analytic perspective, if the deeper function of the behavior is not addressed, the individual will likely engage in response generalization whenever certain stimuli are present, whether covertly or overtly.

Thomas et al. (2018) published a systematic review emphasizing "whole person care" and how it should be applied to patients. The article illustrates how the following components should be considered to integrate and attend to the whole person: their context, including biological, psychological, social, and possibly spiritual and ecological factors.

The Ethics Code for Behavior Analysts (Behavior Analyst Certification Board, 2024) supports this approach in Code 2.19: Addressing Conditions Interfering with Service Delivery. This code states that behavior analysts should actively identify and address environmental conditions (e.g., the behavior of others, hazards to the client or staff, disruptions) that may interfere with or prevent service delivery. In such situations, behavior analysts should remove or minimize the conditions, identify effective modifications to the intervention, and/or consider obtaining or recommending assistance from other professionals. Behavior analysts should also document the conditions, all actions taken, and the eventual outcomes.

As we transition into 2025, let's consider applying the following strategies to create a culture of paradigmatic shift in ABA practices supporting adults:

Motivational Interviewing: As a clinician, when you have the skill of motivational interviewing, you can ask the right questions to identify the ecological factors and the learning history of the individual. This will also help with identifying setting events (i.e., CMOs), rule-governed behaviors, confounding and extraneous variables, that lead to the function of behavior. Below are some resources to assist you with motivational interviewing:

• Books or peer-reviewed literature: Enhance your skill set during the indirect assessment process when you conduct interviews.
• Resource: Gilbert, M. (2020). How to Stop Talking and Start Communicating: Motivational Interviewing: A Behavior Therapist's Guide on How to Effectively Collaborate with Caregivers. Crystal Minds Psychological Services.
• YouTube videos: Find videos on the topic by searching the keywords "Motivational Interviewing ABA."
• Resource: Behavioral Observation Podcast. (2023, August 22). What is Motivational Interviewing? Session 236 with Callie Plattner [Video]. YouTube. https://www.youtube.com/watch?v=ET48ySU04hM&t=1s

Record Review: I know we are rushed due to high job demands and caseload needs. However, taking the time to review previous and current reports helps you gain further insight into the individual's background and assess what additional resources may be needed to support the person.

Data Monitoring: Data is essential! Always collect data and closely monitor the case. This way, if additional supports are added, you can conduct a component analysis to identify the effectiveness of different treatments and services and how they may be impacting the individual's behavioral progress.

If you read this, the seed has been planted... the question is how are you going to apply it...

From the one and only... Shanda J Your BCBA

Resource: 

Behavior Analyst Certification Board. (2024). Ethics Code For Behavior Analyst. [PDF]. Retrieved on https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Thomas, H., Mitchell, G., Rich, J., & Best, M. (2018). Definition of whole person care in general practice in the English language literature: a systematic review. BMJ OPEN, 8, 1-12.  https://bmjopen.bmj.com/content/bmjopen/8/12/e023758.full.pdf