But Does it Matter?

We typically want a simple answer to the question, “Is treatment effective?” Ideally, the answer is “Yes” or “No.” But people will accept a graph as the answer to that question. When a school district, attorney, parent, or insurance company wants information on the effectiveness of treatment, BCBAs are likely to respond (appropriately) with graphs of the relevant behavior changes. In most situations, these types of answers with the visual display will be readily acceptable:

Question: “Was the treatment for self-injury effective?”

Answer: “Here is the graph for self-injurious behavior collected over the previous six months showing a 93% reduction in self-injury from baseline levels.”

Question: “Was the teaching program to answer questions starting with “where” effective?

Answer: “Here is the graph showing baseline levels at 0% correct. After treatment, data demonstrate 100% correct on 3 consecutive sessions.”

Even assuming the data are completely accurate (which is a very questionable assumption in many environments), there are still a very large number of ways the data can be completely misleading.

  1. The treatment was temporarily effective but doesn’t last over time.
  2. The treatment was effective, but staff or parents are using interventions that make it look better than it is in reality.
  3. Data was collected in a way that while accurate, did not practically measure the skill.
  4. The treatment was effective but caused other negatives to occur.

There are other possible ways for data to be misleading, but an exhaustive list is beyond my scope for today. The key point is that having graphs of your behavior changes is essential, but it is not sufficient. We need to make sure that we have really made a socially significant difference. Sometimes the data on behavior changes will look great and the program is still a failure.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

Did You Check For Negative Branches?

In most cases, when BCBA’s make a behavior change, they will have one graph corresponding with each behavior change made to evaluate the effectiveness. Usually, that is completely appropriate. However, problems can arise because just about any behavior change you make may have multiple, unplanned effects on other behaviors. If you don’t look for these potential negative effects, your data may be seriously misleading.

Goldratt, who wrote a book on thinking skills, uses a tree metaphor for many of his thinking processes. If you add a positive branch (e.g., effectively help a child with autism), but your procedure has unintended negative consequences, Goldratt refers to that as a negative branch–extending the tree metaphor.

Some simple and common examples:

  1. You taught the child to request (mand), and now there are tantrums when the parent says “no.”
  2. You successfully potty trained a child, but now they are pulling down their pants before they get into the bathroom and close the door.
  3. You taught the child to label (tact) cows, but now previously mastered animals are also being called cows.
  4. You taught the child to have a conversation with peers at lunch, but now he is annoying the peers by talking about the same things too much.
  5. You taught the child to follow a rule like “raise your hand in class,” and now the child acts as the class policeman, yelling at children who aren’t following the rules.

In my experience, this happens very frequently in everyday practice. There are two simple and practical things you can do to prevent this from causing problems. First, anytime you implement any new program, try to predict negative branches the program could cause. Then, plan for them:

  • What should the parent do when they can’t say yes to requests?
  • If we teach this new language skill, is it likely to be confused with anything that we have already taught? How can we prevent that?

Second, when reviewing data, don’t rely solely on the graphs. Ask the team if any new problems are occurring. Often, at least some of those new problems are related to some part of our programming.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

The Importance of Not Drinking Coffee in the Office

During my first internship in behavior analysis, I was worried that I wasn’t going to make it as a behavior analyst as it seemed one of the most critical skills was drinking coffee in the office, and I don’t drink coffee. When I was at that internship, I would joke with my girlfriend (now wife), Cheryl, that I didn’t drink any coffee at the office.

That was way before there was a BCBA certification, but often you will find there are some BCBA’s that rarely work with the actual individuals being served. They are always in the office drinking coffee. The “office BCBAs” might be doing valuable and necessary work. We all need to be in the office some of the time for report writing, data analysis, planning, training, administrative tasks, and or some types of Deep Work.

But too often BCBAs become consultants who attempt to make organizational changes mostly in the office. Some are extremely reluctant to ever work with a client. The thinking goes that my job is to “expand capacity” and to “train the trainer” so that more clients can be served. Those are fine activities and well worth pursuing. But in my view, there are at least four reasons that BCBAs should be actively working with clients at least some of the time:

  1. Often staff and parents don’t respect people who can’t work with a client. That’s especially true if you are talking about something like toilet training or dealing with problem behaviors. If you want to be an effective trainer, you have to be able to demonstrate the skills you are suggesting.
  2. New research comes out and best practices change over time. If you haven’t implemented a procedure in many years, you probably are not on a Poogi.
  3. Some cases are complicated and require high-level expertise. The best outcomes sometimes require the BCBA doing some of the therapy.
  4. It is fun to work with clients. If you don’t enjoy working with clients and just want to direct others, you are probably in the wrong profession.

It is easy to get distracted by a variety of contingencies that keep you away from the clients. That might happen from time to time and isn’t usually a problem. It is also not a problem if a BCBA decides that their individual goals are somewhere different; like financial management, administration, systems, or even university teaching that might not require much client contact.

Just don’t be the person that only wants to tell staff and parents what to do and never actually work with a client.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to POOGI.