Behavior analysts can face a disconnect between training and practice when helping clients from different cultures. Simmons scholars are on the case.
As a master of arts candidate in applied behavior analysis at Columbia University, Chrissy Barosky worked at schools in two affluent New York suburbs that provided services to youngsters with emotional and behavioral disabilities and autism. “I thought I had been well trained in how to work with children coping with these issues,” says Barosky, now a doctoral student in behavior analysis at Simmons. But her first post-master’s job was akin to a trial by fire.
After graduating in 2008, Barosky moved to Phoenix, Ariz. where she worked as a special education teacher and then as a clinical supervisor and assistant director at a center that serves individuals with developmental disabilities. The contrast with her graduate school experiences was stunning.
“Arizona was different culturally and socioeconomically,” recalls Barosky, who is also an adjunct faculty member in the department of behavior analysis at Simmons. “I had to find ways to edit my interventions based on the resources available to me.” In some instances, language posed a barrier. “I came into contact with a lot of Spanish-speaking people and since I didn’t speak Spanish I had to edit what I said and how I implemented interventions to make sure the families I was working with understood me.
“I had to learn as I was going how to present interventions and work with people to meet their diverse needs,” recalls Barosky, now chief operating officer for Bierman ABA, in Needham, Mass., which provides behavior analysis services to young children with autism. “That was something I didn’t learn in school.”
Barosky’s experience isn’t the exception. In recent years, educators and practitioners in the field of behavior analysis have become increasingly aware of a disconnect between the training of behavior analysts and the needs of the diverse individuals they encounter on the job. And while it is a training gap that the field has called attention to, professors in the Department of Behavior Analysis at Simmons, along with several students, are already taking steps to improve the training of master’s and doctoral students so they can interact effectively with people from different cultures.
“As behavior analysts, we need to better understand who our clients are and how the research we base treatment decisions on may or may not apply to clients with different demographic backgrounds,” says Noelle Neault ’14PhD, program director of BehaviorAnalysis@Simmons, the University’s online master of science in behavior analysis. “We also have to recognize how our individual history and training may influence our judgment. We have to make decisions for clients that are in their best interests and also grounded in science.”
A Cultural Divide
Developed in the 1930s, the science of behavior analysis is concerned with behavior—what influences it and how it can be changed. Practitioners treat people with a range of issues, including autism spectrum disorders; intellectual and developmental disabilities; attention deficit disorder; movement disorders; brain injuries and disease; and behavior and substance abuse disorders. But the science is also used in areas such as home and workplace safety; organizational behavior management; parenting; child welfare; sports, and even animal training, according to the Association of Professional Behavior Analysts.
The need to be sensitive to cultural differences is included in the professional and ethical compliance code of the Behavior Analyst Certification Board. “We are ethically obligated to ensure that we consider diversity factors in our clinical practice,” says Neault, who is also an associate professor of practice in the department of behavior analysis. But there’s the rub: “There aren’t widely adopted standards for getting our practitioners to the point where they are adequately equipped to deal with issues related to diversity,” explains Neault.
“Anybody who works in human services should be considering how their biases are impacting the selection of treatment goals and communication with families.” —Doctoral student Renee Hartz
Neault says her own education and early work experience are prime examples of what she means. “I’ve been training as a behavior analyst since 2001, and it wasn’t until I entered the doctoral program at Simmons, in 2009, that I was required to take a course on diversity,” she explains. “I remember being pleased that the course was there, but feeling that it had taken too long to have a course like that built into my educational program. I had already learned that because of cultural differences, what I was reading in journals or learning in class did not always carry over into the field.”
A one-size-fits-all approach to treating patients, Neault adds, doesn’t work in a society where people hail from diverse backgrounds. All sorts of factors, including race, gender, religion, ethnic background, socioeconomic class, nationality, disability, and sexual orientation can influence how clients, and their families, respond to the interventions a behavior analyst recommends. On the flip side, an analyst’s background, beliefs and values can also influence how she interacts with clients.
“You really don’t know this until you are out in the field,” says Neault. “All the diversity training I received had to be provided by my employer. It would have been helpful to have had that at the outset.”
Indeed, Barosky says she spends much of her time at Bierman ABA “training behavior analysts to make sure they have that cultural awareness and to ensure we provide the best possible services for our clients.”
Addressing a Need
Recognizing the need to give behavior analysts a foundation in cultural awareness, Simmons’ department of behavior analysis is taking steps to improve instruction provided in the ethics course that master’s students must take. “We are designing and will be evaluating an instructional unit that outlines best practices for incorporating cultural consideration tactics into the process of screening clients,” says Neault.
Because there are limited practice guidelines in place to help analysts work with diverse client populations, Neault is engaged in two research projects that she hopes will contribute to the development of minimum requirements and the training of behavior analysts.
One project will examine how the profession stacks up against other helping professions, such as social work, nursing, and special education, in establishing diversity training guidelines. The other will focus on the ethical considerations practitioners should consider before recommending reinforcers—or rewards—to help, say, young clients make better choices. “Reinforcement programs are often the foundation of a behavior intervention plan,” says Neault. “Behavior analysts need to look at how they select reinforcers so they are an appropriate fit for the client.” For example, some parents may be fine with giving a child extra video game time if she completes her homework, explains Neault. But for others, the cost of buying a game app to use as a reinforcer may be prohibitive.
Diversity research isn’t solely the domain of Simmons professors. For her thesis, doctoral student Jescah Apamo-Gannon ’06MSEd will explore how to help behavior analysts better connect with clients from diverse backgrounds. Originally from Kenya, Apamo-Gannon earned her undergraduate degree in general education from the University of Nairobi in Kenya, followed by a master of science degree in special education from Simmons and an advanced post-graduate degree in applied behavior analysis from Northeastern University. “Because I come from a different culture, I have had to learn firsthand every day how to interact with people,” she says.
Apamo-Gannon is the director of home-based services for the ACCEPT Education Collaborative in Natick, Mass., where she oversees about 72 students across 17 school districts and more than 50 staff members. She says staffers sometimes get frustrated when they recommend an intervention for a child and encounter resistance from parents because it does not align with their beliefs. To reach the children, “you have to connect with the family and understand their beliefs,” she explains. “You are not there to judge.” In one instance, she says, a youngster wasn’t showering. When the staffer recommended that he shower daily, the family resisted because their norm was to shower two to three times per week. “The staff member had to respect that and work with the norm of the family,” says Apamo-Gannon. Over time, she says, as the family learned to trust the analyst, she was able to suggest more frequent showering.
This fall Apamo-Gannon will test a pool of master’s online students on their cultural awareness; assess their beliefs about people from other cultures; teach the students empathy towards people from different cultures; and evaluate the students to see if the strategies have made a difference. The ultimate goal is to incorporate a module based on her findings into a class within Simmons’ behavior analysis program. “When behavior analysts go out into the field,” she says, “it is important for them to know how to tailor their services to people from all backgrounds.”
“We need to better understand who our clients are and how the research we base treatment decisions on may or may not apply to clients with different demographic backgrounds.” —Associate Professor of Practice, Behavior Analysis, Noelle Neault ’14PhD
Like Apamo-Gannon, doctoral student Renee Hartz is interested in improving diversity training. She’s the educational coordinator at Melmark New England, in Andover, Mass., which serves children and young adults with autism spectrum disorders, brain injury, and neurological disease, and she intends to focus her thesis research on the development of biases and how they influence the workplace. “How does one come to attribute certain characteristics to certain types of people?” she asks. “If people were able to self-reflect on their thinking and how the rules—or stimuli—that govern behavior develop, perhaps they could change their behavior,” she explains. “Anybody who works in human services should be considering how their biases are impacting the selection of treatment goals and communication with families.”
Even if the conclusions she draws from her research aren’t “perfect,” she adds, “I am hoping that just shining a light on this topic will keep the research ball rolling.”
An April panel discussion at Simmons called “Diversity Considerations for Behavior Analysts: A Look Forward,” was designed to keep the diversity conversation front and center. “I wanted to call attention to some of the work that our students are engaged in and encourage further discussion about the need for improved professional standards for diversity training,” says Neault, who led the discussion. It was part of a one-day conference titled “Contemporary Developments in Behavior Analysis” that attracted attendees from across New England. (The conference was organized by the behavior analysis department and overseen by Russell Maguire, chair of the graduate program in behavior analysis.) Another benefit of such a panel: “The audience starts to think about diversity a little more; how they can take this topic back to their workplace and make sure it has diversity training in place,” says Barosky, who was among three doctoral students on the panel.
The Push for Practice Guidelines
The push to help behavior analysts better serve culturally diverse clients has been “gathering steam” in recent years, says Elizabeth Hughes Fong, a visiting instructor in the department of health services at St. Joseph’s University in Philadelphia. That’s partly due to two reasons, she notes: More women and individuals from diverse backgrounds are entering the profession, which has traditionally attracted white males. And the demographics of individuals who need the services of behavior analysts have also become more diverse. Other human services fields have guidelines “to ensure that practitioners are culturally aware,” adds Hughes Fong, who founded the Multicultural Alliance of Behavior Analysts, a special interest group of the Association for Behavior Analysis International.
Hughes Fong says it is vital that behavior analysts “know the questions to ask clients as well as their interaction styles, cultural considerations, and socioeconomic limits.” Practitioners also need to know how to tweak evidence-based interventions to accommodate an individual’s needs and preferences without compromising the science. “Behavior analysis is a very precise discipline,” says Hughes Fong, who is also the founder of “Diversity in Behavior Analysis,” a section in the journal Behavior Analysis Research and Practice. “Fidelity to intervention is important.”
But while Hughes Fong is “hopeful” that the field’s professional organizations will develop guidelines to improve cultural awareness, “change may not be immediate or easy to implement since it involves so many individuals,” she adds.
That’s where universities and colleges such as Simmons can step up to the plate. What Simmons is doing to advance the field is “fantastic,” says Hughes Fong. Faculty and students “are filling a need clinicians have. They are taking initiative.”
Neault is especially proud of the Simmons students who have embraced the issue. “It is reassuring that our students want to take this topic on and help make meaningful contributions to our field,” she says. “They are the future. And they are doing the hard work to help the field evolve, which ultimately will improve the quality of services for students who are training to be analysts or who need experience in the field and for clients. Their passion and commitment are inspiring.”