Integrating Research and Practice within Applied Behavior Analysis

Gina Green interviewed by Joi Bay

Gina Green is a Board Certified Behavior Analyst and has a PhD in psychology. She has been Director of Research at the New England Center for Children, Clinical Associate Professor at the University of Massachusetts Medical School, and is the former president of the Association for Behavior Analysis. She has published numerous articles in research journals on autism and behavior analysis, and she has co-edited the books Behavioral Intervention for Young Children with Autism and Making a Difference: Behavioral Intervention for Autism. Currently she is a consultant in behavior analysis and serves on the Board of Directors of the Behavior Analyst Certification Board.

Within applied behavior analysis there are several different certification systems. Besides the certifications of the Behavior Analysts Certification Board, the Lovaas Institute of Early Intervention has its own certification system. And in Europe private ABA consulting centers have their own certification systems. This situation is rather confusing to parents of children with autism and to authori­ties that are responsible for services to children with autism.

Those are different kinds of certification. The Lovaas group certifies people in their treatment model – not in behavior analysis in general. But it is not good for consumers to have all these different systems. A real certification or licensor program for a profession has to meet some very specific features. It cannot be defin­ed by one group of people, by one agency, or by one research team, but must be the consensus of the experts of the field who say that this is the kind of supervised training, courses, and degrees that people need to have. And this is the kind of examination you have to pass to demonstrate your knowledge and this is how to maintain that knowled­ge. If a real professional credential program is going to be worth anything, it has to be creditable to the agencies that pay for services and to the insurance companies that pay people to provide treatment. They want to see something solid. They are not – for the most part – going to accept a certificate from the Lovaas program or a certificate from Andy Bondy's PECS-workshops as evidence that someone is professionally credential in behavior analysis.

Does this mean that the Lovaas certification – as opposed to the certifications of the Behavior Analysts Certification Board - is specific to autism treatment?

It is not just autism oriented – it is the Lovaas model of autism treatment, which is circum­scribed – and it is not exactly the same as other applied behavior analysis models of early autism treatment. Before someone should be going out and claiming they are Lovaas therapists or taking money from parents or from school districts they must be certified. I think it is the right thing to do when the Lovaas group is saying: 'No wait a minute! We are putting our stamp of approval. We are saying what it takes to implement our particular model'.

Because there has been this increased visibility and demand for something called ABA, we know there are a lot of people claiming to do it but who are in no way qualified, they are not trained in research or at least not very well trained. They are out there – there are people who are driven by money and they are out there to get paid and there is no requirement for them to keep up to research. Parents who are desperate for help hire anybody who comes in and says 'I have worked in a Lovaas-program', or 'I worked at the New England Center for Children'. 'I am a behavior consultant in autism'. Parents hire these people all the time and what they have learned to do is just a little, very narrow fragment of ABA.

And they are not trained in universities but through a kind of apprentice system with a mentor?

Or less, you know they are on these 2 or 3 days workshops and think they are trained. It is a big problem. I have been on the practice side and have worked in those settings. When you have responsibility for children and their families day in and day out, it is very demanding. It is awfully hard work. If you do it with any degree of conscience, it is difficult work. And people do not have the time to read the research literature and to keep up.

That is one of the reasons that the certification program in behavior analysis is so important, because, like any professional credentialing program, it is a requirement that once you meet all the standards and you are certified, you have to get continuing education to maintain certification. The continuing education within applied behavior analysis is a little bit loose at this point, but we do have standards saying what can be accepted as continuing education. For example people often get continuing education credits by going to behavior analysis conferences or going to workshops. So that is a way to try to keep practitioners at least in some contact with the new research that is coming out.

Is a certification from the Behavior Analysts Certification Board a requirement to be employed at the major early interven­tion programs?

The certification program is fairly new and the number of certified behavior analysts is limited. Most programs will prefer people who have had some training in applied behavior analysis – but it not always possible to find these kinds of people. And most programs will encourage their staff to get this certification. But at the moment most staff in ABA programs has just been taught the basic principles of behavior analysis and has been trained to apply those things in the context of the particular program's model.

What are the differences between the certification of the Behavior Analysts Certification Board and the certification of the Lovaas Institute for Early Intervention?

It gets very confusing to consumers and parents who don't know that the Lovaas model is just one model of applied behavior analysis within autism: It is for younger children, it starts in the home, they have combined certain techniques in behavior analysis into a package, but their model does not include a lot of other techniques that have been developed by other behavior analysts and tested by others. If you go to a different program like the Princeton Child Development Institute – which is an outstanding applied behavior analysis program for children and adults with autism – it will look similar to the Lovaas program, but you will see them doing things somewhat differently. They have been doing their own research, they are fine behavior analysts, and they have been doing it – just as Lovaas - in more than 25 years, but they treat the full range of ages. And while they also do early intervention in the home with parents they have been mainly doing treatment in the school setting. So you see there are differences in those models.

If you go to the New England Center for Children where I worked for years you will see services to children from very young mainly in the home up to and including adults. We had kids and adults with autism but we also had students who had mental retardation without autism. Our model was based on behavior analysis, so the framework was very similar to framework of Lovaas and the Princeton Children Development Institute but we did some things differently.

I make the analogy to physics and engineering. Let’s say that you got ten different engineers that have all learned the principles of physics. But when the ten engineers design a bridge to cross a span of water – each of them individually – each bridge might look a little different from the others even though there will be certain commonalities. If you know the principles and you apply them to a problem, there are only so many ways you can do it. Applied behavior analysis is the same. The principles of behavior can be applied in different ways.

Patricia Krantz and Lynn McClannahan – the two directors of the Princeton Children Development Institute – are very well trained behavior analysts who received their PhDs at the University of Kansas when it was the flagship program in applied behavior analysis. But they don't call their program the Krantz & McClannahan Program – they call it applied behavior analysis.

For an outsider it looks like some of the old and well-reputed ABA centers and schools on the East coast have succeeded in integrating practice and research in a very productive way. Why is that?

Well, I think that this combination of research and practice is fairly rare in our business. My opinion is that the best programs serving children with autism combine research and practice and that is why they are the best programs. They are doing research themselves. If you are doing research and you are trying to publish it, you will have to keep up with the good research, you have to read the literature, you have to say how your own research relates to the work of others. And that is going to make it a better program. It also means that you constantly are evaluating what you are doing in a very systematic way. Lovaas did that too. For years he and his colleagues have done research to get the information necessary to revise their program. Lovaas' group were the ones that years ago showed that if you work with kids with autism in a school or a center you can get very nice improvements, but when the children go home or go to the community they are just as autistic as before. He used that information to conclude that we need to train the parents in behavior analysis because the parents are the ones who will be with them and the parents have to carry on if we want skills to carry over. This research was done long ago but they too had the model of integrating research and practice. The Princeton Child Development Institute and the New England Center for Children and a few others have done the same. They are still – I think – the exception. I see a lot of ABA-programs in a lot of different schools and there are not that many that are actively doing research.

How was it possible to integrate research and practice at the New England Center for Children when you were the director of research?

When I became the director of research at the New England Center for Children they had done some purely applied research but not that much and that was why they wanted me to take the position and try to build it up. What I did at the New England Center was to say, 'Look, we are behavioral analysts, we are doing a behavior analytic treatment program, we are already collecting data on the way we teach children, the techniques we use, the way we train staff, the way we work with parents. If we start to tighten up the measurements we use within subject research designs, we can get data that will push on to be published'.

I tried to look at the sort of questions that the staff was asking every day anyway: If we use this particular set of procedures, what will the effect be on children's communications? What if we train staff in this particular way? How would that affect their skills and how would that influence their students’ performance? It is this kind of questions ­that the staff was already interested in and data that they had to do anyway.

At the New England Center we also had a number of master degree students. Northeastern University and Boston University offered a joint master degree that was taught to people who were working full time in a service situation and it was taught at our site. At the end of the day when the children left school staff that was in the master’s program would take their classes at the New England Center. Typically they would take one or two classes per semester, so a full study would take them a while. But they would eventually get a master’s degree in behavior analysis and they would have got the job experience and the training at the same time. The master degree students all had to do research projects. They had to do a thesis. So what I did as director of resear­ch was to get them do studies that addressed practical issues that we were dealing with anyway.

Did you reuse the data from the treatment programs in your research?

Well, we would try to do that, but the data that people were collecting daily for the students would often not meet the standards for publication.

We had research meeting about every two weeks, where all the senior staff met, and many of them were in the master program. Others already had a master degree or a PhD. We would use those meetings to develop research ideas and help people develop their methods and it would literally be integrated with treatment. Sometimes the master students didn't know what they wanted to do research on, but I had a pretty good idea of some of the topics that needed an investigation and research.

We had – as an example – a lot of children who did not have a lot of communication skills, and we knew from other research that giving them choices – choices of reinforcers, choices of what activities they did – would probably enhance their acquisition of skills and decrease problem behavior. When you have children that don’t talk very much, how do you understand what their choices or their preferences are? How do you teach them to make choices? So we did at whole series of studies on ways to access the preferences of children with severe disabilities. We published many of them and we just did them in a way where the data we collected anyway could be used for research purposes. We had data that other people were interested in, we could tie to other research, we could get our research published, and we could present it at conferences. So that is really how we did the research there.

How did the early intervention program at the New England Center for Children start?

When I started at the New England Center for Children they were not doing any early intervention. Children in their programs were age 5 or higher. Of course I became aware of Lovaas’ work and other research on early intervention and I presented this research to the directors of the New England Center for Children. I consulted with people like Patricia Krantz, Lynn McClannaha­n, and Richard Taylor who I knew had been working with younger kids a while and we set up the Early Learning Program – a home based program and an intensive preschool program. By then I was getting very interested in early intervention and I could see all kinds of research questions that should be addressed. We had a team of people who were responsible for that early learning program and who right form the beginning would get some data on early intervention and build it right into what we are doing. These were almost all people who had responsibility for kids and staff on an every day basis and they just worked overtime doing research.

The management wanted research and wanted to publish research and disseminate informa­tion, and the staff had good data, they went to conferences and presented their data, and the management would give them recognition – if they were getting articles published, they would get bonuses because it is hard work to publish research. Getting the data is hard enough, writing it up is a long process, so we had arranged reinforcements. We did not have great funds; we just bootstrapped the whole process.

We also tried to disseminate our research locally. We would hold local conferences or seminars and we would invite people from the community to come and hear what we were doing. I talked to our parent group once or twice a year about why research is important, and I wrote a research letter where I would give a synopsis of some of the research projects we had been working on and some of the other research coming out on autism. This newsletter was sent to all the school districts in the area and to other agencies. So everybody knew that we did research and they seemed to like it. Obviously we never did research without the consent of parents and most of them agreed. They wanted their kids to be part of it. But if they did not, that was fine too - it would never jeopardize the treatment of the children.

In Denmark and in several other European countries applied behavior analysis is an expanding treatment model and an expanding industry. Parallel with the excitement over the new possibilities there is also a growing concern among parents and authorities about the quality of ABA treatments. If you should give us some advice on how we could make use of the experiences you got regarding the relationship between research and practice and the training of professionals - what do you consider to be the most important things to work towards?

There are many problems, many aspects, and multi facets. You really have to attack them from many different places. One of the things I have been doing for a number of years is trying to get research information out to parents. And I think what you are doing – going to conferences and finding out and being critical and skeptical about research – is a great thing, and we got a lot of parents in the last few years coming to the behavior analysis conferences. That is pretty new and a part of the whole grass-roots movement within behavior analysis. So the first thing is that parents must become as well informed as they can about research. That means going to conferences, striking up partnerships or acquaintanceships with professionals who can help you interpret research and doing research. That is really central.

As far as getting behavior analysis programs for kids with autism more widely available, we see parents going to their local university and saying, 'We need people who are trained in this discipline and here is why', and they bring in videotapes and the literature they know about and try to get that going. Because ultimately, what you want to do, is to build capacity within your local area, instead of importing behavior analysts from overseas.

Can university programs in applied behavior analysis from a non-English speaking country be approved by the Behavior Analysts Certification Board?

Yes they can, and in fact some international university degrees are approved by the Behavior Analysts Certification Board. The only tricky thing about it is that the certification program that we have was developed and tested over many years in the state of Florida. So obviously it started out as a US-based program. Therefore the initial requirements for the degree and the specific courses that people have to take in behavior analysis and the examination was based on the US higher education model. But if someone who wants the certification got their degree in another country - we know there are differences in the way classes and courses are defined – there is an international body that will take transcripts and evidence of course works.

From a consumer´s point of view one of the advantages of the Behavior Analysts Certification Board certification system is that it ensures that certified practitioners have had some training in using scientific research literature. Is the dissemination of research within applied behavior analysis a special problem?

Yes and no! Well it is like any science – there is an experimental component, there are people who do conceptual and theoretical work and there is the applied part. I can't speak for other sciences from first hand knowledge but from talking to people from other sciences it seems that all of them have the same problem. Most of us lay people consider medicine as a whole scientific enterprise but practitioners of medicine are not scientists and I have actually seen several studies showing that practicing physicians – in the US anyway – are not using treatments for heart diseases and diabetes that medical research have shown to be the treatment of choice. In some studies, 90% of physicians dealing with patients who have the first heart attack are not prescribing the treatment that research has shown to be the best. So it is not just behavior analysis that has this problem. It is one that we have had in the field and have talked about for a long time.

What has been done to encourage the clinical use of research within applied behavior science?

There have been some efforts. Two of the principal journals within behavior analysis are the Journal of the Experimental Analysis of Behavior and the Journal of Applied Behavior Analysis. In the Journal of the Experimental Analysis of Behavior there has been an increase in studies that are looking at human behavior instead of studying animal subjects; this research is still laboratory research but is addressing questions that are very close to applications. An example is the research in how to teach discrimination and match­ing skills to persons with learning disabilities. That has been done mostly in learning laboratories where children or adults with a disability come into a small comfortable room and they will have tasks presented to them on a computer with a touch screen and things are very precise and give very rich information about the earliest teaching procedures. So we have had an increase of research that is very close to application.

The editors of the Journal of Applied Behavior Analysis have for several years strategi­cally been inviting researchers writing articles about findings that have ramifications for practice – some beautiful articles. Very nicely done by either experimental researchers who are able to take their own findings or some one else's and say: 'Here is what this means -- here is what can be used in practice', or practitioners who read the experimental literature and make their own translation. So there have been some efforts. And there are conferences – at the Association for Behavior Analysis conference every year, there will be a number of symposia papers that will present experimental research that has applied implication. Not enough for my prefer­ences. I wish we had more.

Have these efforts had any positive effects on the work of practitioners?

I have not seen any data on that. I suspect that it varies quite a bit. If you look at our ethics codex, behavior analysts should be using techniques with our clients and with our students that are based on the best available research. So people who are well trained and who understand the value of research will at least read the journals that publish practice-work pretty often but I'm certain that there are lots of practitioners who don't even know about those journals.

Notes

Maurice, C., Green, G., & Luce, S. C. (1996). Behavioral intervention for young children with autism: a manual for parents and professionals. Austin, Tex.: Pro-Ed. Maurice, C., Green, G., & Foxx, R. M. (Eds.). (2001). Making a Difference: Behavioral Intervention for Autism. Austin, TX: Pro-Ed.

The Behavior Analyst Certification Board (BACB) is a nonprofit corporation established as a result of credentialing needs identified by behavior analysts, state governments, and consumers of behavior analysis services. http://www.bacb.com/.

 

 

Joi Bay/ 03.10.2004