POOGI for ABA

At some point in the last 35 years or so, the phrase behavior modification went out of favor and the field started to use the term behavior analysis. There were good reasons for this. First, some people had done some terrible things in the name of behavior modification and there was a desire to not associate with the term. Second, behavior modification is not what good programming is about. Good programming comes from the analysis. Unfortunately, despite what it is called, many of us are still behavior modifiers and not really behavior analysts despite what the certification and ethical rules say.

A common phrase among poor behavior modifiers is to “throw spaghetti against the wall and see what sticks.” So, when we work with kids, we try things to see what works:

• He won’t come away from the computer. How about trying a timer?
• He doesn’t want to sit for instruction. Have you tried a token board?
• She is getting bored easily. What about mixing and varying some different tasks?
• He gets upset during transitions. Maybe we try giving him a visual schedule?

There is nothing wrong with these interventions if used as part of a carefully planned program. But often they aren’t.

There is no doubt that these types of interventions work sometimes. If they don’t, poor behavior modifiers will just throw more spaghetti. It’s likely that eventually an intervention will be effective (at least temporarily). But we are fooling ourselves.

No matter how much spaghetti we throw, we will always end up with a big problem. Maybe the spaghetti will last for two weeks, two months, or even two years. But the problem always comes up: The intervention doesn’t last over the long-term. That’s because we have a huge pot of spaghetti and no analysis. We are judging the intervention on the wrong criteria. Is there problem behavior? Sure, that’s important- but just one aspect of the problem. What do we expect the parent or teacher to do? Remember to implement this carefully crafted list of often cumbersome strategies that are often impractical in natural settings? Forever?

One thing this is great for- blaming parents and teachers when the intervention doesn’t last. We can say, “well the plan worked great with us, but the teacher, parent, paraprofessional, or grandma won’t implement it.”

The only thing that matters in the long run when treating problem behaviors is: Are the alternative behaviors naturally reinforced? If not, we should not expect it to maintain.

 

Why We Need to Aim for Natural Contingencies

In an old article on treatment of problem behavior, the researchers compared two treatments for problem behavior maintained by attention from adults.

The first treatment was a time-out. The second treatment was communication training which taught the children to say “Am I doing good work?” The researchers found that both treatments were highly successful.

But then the twist: The researchers had the children work with naïve adults who didn’t know the history. Under those conditions, the children who had previously had been treated with time-out went right back to problem behavior. The children treated with communication training remained successful in the new situation. The students who were originally treated with time-out became successful with the naïve adults after they received the communication treatment.

The article demonstrates how we can fool ourselves into thinking our treatment is more effective than it really is. All the time-out students were looking good. Imagine teachers raving about the student progress at IEP meetings. But all it takes is a novel person showing up and the behavior falls apart. In reality, treatments in practical settings are almost always dramatically more complicated than the article describes, which makes it even more difficult to maintain progress. It is not if the behavior will deteriorate, it’s when.

Now, do we believe all these children who experienced the brief communication training treatment were likely successful in the long-run? Not likely unless they got a lot more therapy.

But I do think the article beautifully captures what our ultimate goal should be. The behaviors we teach have to be effective in the real world. And in order to be effective, they must meet a natural contingency. That means it was reinforced without any specific person having to think about it or plan it. The children said, “Am I doing good work?” Then the naïve adult was able to respond in a way that was reinforcing to the child. No one had to train the adults to follow the behavior plan since most adults will naturally respond to “am I doing good work” with attention. There are many examples in the research literature, but not enough. If you don’t get to this point, the behavior is unlikely to maintain.

Many programs working with children with autism have huge problems with turnover. Now there are many reasons for turnover- and they will differ as schools and other programs will have their own individualized issues. The usual suspects- pay, benefits, commute, schedule, advancement opportunities, and quality of managers- are, of course, very important. If the school or program doesn’t have at least minimally acceptable levels of those six components the program will likely have ongoing problems with turnover.

A typical thought process among behavior analysts often goes like this: Well, there is nothing we can do about reimbursement rates, the health insurance, the fact that the therapist lives an hour away, the school schedule, or the fact that the family needs someone on weekends. There are so many things that are simply out of the typical behavior analyst’s control that there is sometimes a hopelessness about improving retention.

As a behavior analyst, there is one thing that is largely under your control. And if you do it well it will drastically reduce turnover. In my experience, a simple thing you can do that substantially improves retention is having high quality programs.

High quality programs lead to many staff reinforcers. First, it is exciting to come to work when you see kids making great progress. Second, if the program is high quality the staff feel like they are learning which is often highly motivating. Third, the staff feel a sense of satisfaction when through their own efforts they are seeing huge improvements in children’s lives. Fourth, time during the day starts to feel like it is moving quickly. They are enjoying themselves so much they forget they are working. When this is happening, turnover is lower. Some staff will get a 2^nd job if the pay at your agency isn’t high enough. They will deal with the long commute- if the child they are working with is making exciting progress. They might even deal with a manager they don’t like- if the person is really good and helping them achieve excellent progress with kids. (Sorry to all the folks that had to deal with Barry from the Bronx in the early years.) Will everyone stay? Of course not. But we underestimate the reinforcers that come to staff with high quality programming.

Low program quality leads to many staff punishers. The job starts to feel boring. Staff begin to not really try to teach and just go through the motions of running programs. Looking at the time to see how much time you have left in the day becomes common. Under these circumstances people will jump at any opportunity to get out. We dramatically underestimate how much low program quality impacts turnover. Will everyone leave? Of course, not. Some people will stick around for your other six components. But if they are sticking around just for pay or health benefits, you probably don’t want those people anyway.