Ethical thinking involves everything you have explored in this course. It is fundamental to becoming an effective professional behavior analyst. Evolving to ethical practice doesn’t mean you leave ethical thinking behind. It means that you extend into understanding the critical aspect not just thinking about ethics, but also communicating ethics. Strong communication skills is a critical part of ethical practice. It includes learning what to communicate, whom to communicate it to, and determining how and when it is most appropriate to communicate these ethical issues.

For this Discussion, you will consider what “evolving from ethical thinking to ethical practice” means to you. You will reflect on the importance of ethical practice on your future professional work, and you will interact with your colleagues and consider their perspectives and responses on the ethical practice of behavior analysis.

To prepare:

Review the readings and the required media programs found in this week’s Learning Resources to develop an understanding of extending ethical thinking to ethical practice. Note: It is important for you to review all media for this week prior to completing this Discussion

Post a reflection on the statement “evolving from ethical thinking to ethical practice.” How does this statement resonate with you in your future professional work? Do you foresee any situations that may challenge you ethically in your decision making?

Course Reflection Course Reflection Program Transcript [MUSIC PLAYING] STEVEN LITTLE: Hi and welcome to week 11. Yay, week 11, the last week of the quarter. As you know, I'm Dr. Steven Little. And we've been talking about a lot of things over the past roughly 2 and 1/2 months. So hopefully, you learned a lot in this course. Hopefully, a lot of this will stick with you. And you will go on to finish the courses in the verified course sequence to go get your field work experiences and go on and take the BCBA exam and go on to become a practicing behavior analyst. Some of you will, maybe your interest in pursuing this further or pursuing a higher degree has been stimulated enough and you'll want to go on for that. Whatever you do, I wish you only the best. And I've enjoyed the times that we've spent together. Now what I'm going to do today is I'm going to recap each week. So I'll go through what we talked about, but I also have some questions, one, two, three, depending on the week, questions to make you think about things. So I'll talk about what we went through that week. And then we'll take a little pause. I'll give you some time to just think about things. Don't worry if things don't come to you right away in the time that I pause for you to think about it. But you may want to even jot down some of these questions. My hope is that you take some things out of this course, out of every course, that you can-- that you'll be using, that you think are significant in your future career as a behavior analyst. And I hope I can stimulate some of your thinking. And that means just not me telling you information and having it into your short-term or medium-term memory, but rather the things that are really important getting into your long-term memory and thinking about applications. And then when you are practicing, when you're doing fieldwork, and when you're actually working, thinking, oh, I remember when Dr. Little said this. Now I can see how it applies. That's my goal. I always remember back when I was in graduate school. One of my professors told me or told the class definition of a lecture. And I've always-- I told it to my students many times over the years. And he said what a lecture is is where words go from the notes of the professor to the notes of the student without passing through the brains of either. And I have seen that. And I hope that's not actually the case. I hope there's some processing that goes on in there. We're behavior analysts. But even though we can't directly study what goes on in the brain, we don't deny that there are cognitive processes there. They're just © 2019 Laureate Education, Inc. 1 Course Reflection difficult to study because you can't see them. That's what Skinner said. Skinner said that he didn't deny that there were cognitive processes. He just said that they weren't a valid unit of study because they are not observable. But you do some self-observation on your cognitive processes. And hopefully, you are monitoring what's going on in your head, and you're actually thinking about some of these things and not just thinking about, OK, this is a requirement. I have to listen to this and get a grade for this course, a passing grade for this course, and then move on. Hopefully, some of these things will stick with you throughout your career. And I know there are things that I had many decades ago in my graduate education that I still think back on today. Now things have changed dramatically since I was in graduate school. I mean, I was-- in my master's program, we didn't even have laptop computers, not even-- we didn't have desktop computers. You used the mainframe. And that was about as best you could get. When I did my master's thesis, I typed it on an IBM Selectric typewriter. When I had to make edits, I had to retype everything. While I did get pretty good at typing, it took a lot of time. When I started in my PhD program, desktop computers were basically in their infancy. For those of you who have been around and remember things, I remember my first computer was-- it was actually a Candy, which was sold by RadioShack, which doesn't even exist anymore. But it was an 8088 processor and anybody used that, you know how ancient it is compared to the technology we have today. So things have changed. But some things that I learned even back in those days pre-personal computers still affect how I think about some things today, still have an impact on me. And I'm hoping that some of these things affect you in a similar manner. So let's go through the different weeks. And let's think of some things, starting with what is ethics. That was the first thing we talk about in this course. 10 weeks ago, we talked about what is ethics. And I tried to define ethics for you in general and then getting a little bit more specific relative to behavior analysis. And we talked about some broad ethical principles, talked about some ethical questions, talked about how the BACB task list and ethics go together, not that the task list has specific things saying, you do this ethically, you do that ethically, but rather the idea that it goes through all of the tasks on the task list that you should be doing everything in an ethical manner. We talked about ethical questions. We talked about ethical dilemmas in both general and specific to ABA. Now what I'd like you to do now after we've had the first 10 weeks of the course, and we've talked about ethics in general, we've © 2019 Laureate Education, Inc. 2 Course Reflection talked about specific ethics, we've talked about ethics in certain areas, we've talked about ethical codes, we talked about the ethics of restraints, we've talked about the ethics of aversives. Now think about it. What is ethics? And think relative to when you first started this course, and we were in week 1, has your conceptualization of ethics, what it is, why it's important, has it changed at all? And my guess is most of you will have evolved. You won't have changed dramatically from like, oh, I didn't believe in ethics before, and now I think they're important. No, you all, I know started off with a baseline level of what ethics are important and what ethical behavior entails. But have evolved from that? Have certain aspects of it changed? And overall, have your-- has your definition of ethics changed at all over the course of this class? How have you changed since week 1? It would be real nice if I could get direct feedback from you as you are thinking about it. But I can't do that in this format. But I surely hope that you would be giving me, if we did have that opportunity, some excellent, well-thought-out answers to those questions. But always think about that. No matter where you are in your career, whether you're still a student, whether you are in fieldwork, whether you're a practicing behavior analyst at the beginning of your career, whether you have worked 30, 40 years as a behavior analyst, technology will have changed just like it's changed in the 40 years since I got my master's degree, in the 30-plus years since I got my PhD. Things have changed. And they will change for you also. But the conceptual of ethics, it may have to be modified to fit some of those changes. But hopefully, the foundation is intact. And it's there. That was week 1. Week 2-- we went and talked about specific ethical standards and guidelines, went into more detail on specific ethical codes. I didn't go into the New Zealand psychologist ethics like I did in 6731 because I thought that would just give a general outline of it. But I focused on US-based organizations and their ethical codes. I talked about APA. You're not eligible to be a full member of APA unless you have a doctoral degree in psychology. Some of you may go on and get that. But the aspects of their ethical code are important for us as behavior analysts. As I've said before, I conceptualize behavior analysis as a discipline of psychology. I know many behavior analysts will say that behavior analysis is a distinct discipline. That same argument's gone on in school psychology where-- and my PhD is in school psychology. I mean, I've seen other areas of psychology also make that argument. But it comes out of the base of psychology. © 2019 Laureate Education, Inc. 3 Course Reflection Fred Skinner didn't say, I'm a behavior analyst. He was a psychologist. He was a behavioral psychologist. He taught in the psychology department. He published in psychology journals. So the code of ethics for APA is important to us. But when you look at that code as we did, and then you look at like, say, the BACB code, and you'll see the general principles that we talked about before are in both codes. While the BACB code was called the Guidelines for Responsible Conduct for Behavior Analysts, while that is specific to behavior analysis, the general themes are the same in both codes because APA covers many, many areas of psychology. It tends to be more general. But the things that are important are in both codes. So recognizing those codes. We also talked about some ABAI policy documents that, while not ethical codes, should help guide our behavior, such as the right to effective behavioral treatment. We all, anybody, especially individuals with disabilities, has the right to effective behavioral treatment. Our technology, behavior analysis, is here. It has been exploding in popularity over the past one or two decades. Why? Because it works and ethically. And this is we're bringing the ethics part. Everyone has the right to the most effective treatment for them. And in many cases, that is in a behavior analytic intervention being administered by a qualified behavior analyst. We define qualified behavior analysts, most cases, by having a BCBA. Having the credential doesn't guarantee you're good. It doesn't guarantee you know what you're talking about. People can get credentials because they're good at memorizing things and taking tests and doing the things that are necessary. But it is a quality control. Individuals with the BCBA, we know that they have gone through a rigorous training with specific contents to get to that point and that others who have judged that is the training and content that's necessary. So while it doesn't guarantee that the individual's going to be a competent behavior analyst, if someone doesn't have a BCBA, there'll be a lot greater question as to whether they are competent in behavior analysis. So everyone has that right. And our technology does work. And I use the term technology because that is what it is. We're not talking about electronic technology. But we're talking about procedures and theoretical underpinnings. They work. And we as qualified behavior analysts make sure that they work and everyone that needs those services has the right to those services. Remember there are a lot of treatments out there that don't have the empirical base of behavior analysis that may make some really far-fetched, incredible claims on how they can help people. But they don't have the research support, the decades and decades of © 2019 Laureate Education, Inc. 4 Course Reflection research support that we have. And some of them are less than efficacious. Just leave it at that. Similarly, ABAI had a policy statement on the right to effective education. As behavior analysts, we're likely to work with children, with individuals between the age of birth and 22, in which case, they are guaranteed a right to a free, appropriate public education. That public education may be provided in a regular school. It may be provided in a special school within a school district or an area-wide educational cooperative. It may be provided in-- by an agency. It may be in a residential facility. But and if they are between the ages of 2 and 22, they have the right to an effective education. And we need to recognize not just that we are there for ameliorating problem behaviors or assisting an individual with autism to improve their social skills, we're also part of the education of those individuals with traditional education outcomes hopeful, depending on their level of functioning. Whatever is in their realm of capabilities, we can assist on all that. And that includes things like reading. Behavior analytic approaches to reading and to general education is enormous. There's great research out there to support that. Excuse me about that. So keep those things in mind. They have a statement on restraints and seclusion that we went over in week 2. We talked in a later week-- I can't remember exactly which week it is, but it's towards the end, maybe 9 or 8. Yeah, I think was 8. But we talked about restraint and seclusion. I'm not going to review it here because we're going to talk about it when I get to that summary of that week. We talked about facilitated communication and the statement that ABAI put out on that back in 1995 in which they used the term a debunked technique. And that's what we have to guard against. Because believe me, facilitated communication sounded great when it came out. I remember seeing something on TV about that. And I thought, oh, wow. And I can remember, I still remember. I was teaching at CSUN, California State University at Northridge. I was teaching in a school psychology program. And I remember seeing that. And I remember going into my class, my school psychology seminar class, and discussing that with my students the next day. And I thought, wow, this is amazing if this works. I mean, I had some concerns, especially when something gets in the public media, and they play it up like it is just the next best thing to sliced bread and the greatest thing since sliced bread. © 2019 Laureate Education, Inc. 5 Course Reflection But it sounded real good. And we talked about it. And gradually, we started getting the information on hey, this may not be what they say-- the results may not be what they're saying. And then overall, more and more controlled studies showed that it was not working. And that's what we have to guard against. I talk about facilitated communication now not so much because I think you're going to jump, run out, and go, oh, that sounds great and go do it, but rather so you'll be on guard against other types of interventions that sound great, but may not have an empirical support. And another thing we used to say in graduate school-- in God we trust, all others must have data. And the key-- we do make our decisions based on data. You are first and foremost a scientist. And you bring that scientific thinking into the habilitative or rehabilitative or educational context where you're working. But think of yourself as a scientist and that you need to see these things proved beyond doubt, that you have to have adequate research data to support it before you will jump on the bandwagon. And that's the key thing about facilitated communication because we can see how we went wrong, how people jumped on it before there was adequate support for it. And then, well, obviously, we talked about BACB and their code of conduct and how ethics and the task list all relate. Now what I want you to think about right now leading out of week 2, reflect back on that. And was there anything in any standard or guideline that surprised you? Is there anything that stands out? And it could be surprised you that, oh, I mean, I just was surprised that's there, or it could surprise you by how you're thinking about it has increased its saliency and its importance in how you view things. The key thing from week 1 and 2 that I'm hoping you're getting out of this is that yes, we have general principles. yes, we have specific guidelines and standards given by our professional organizations. But how do they apply to you, not just to somebody else who's working out there, but to you? And how is it personalized? And what stands out as most important to you in how you are going to proceed with your education, your field training, and your work as a behavior analyst? What's going to really carry through for you? My taking frequent glasses of water is something that you may, oh, I remember you. You may see me at graduation, you go, oh, you're the guy who's always drinking water. Yep, that's me. And hopefully, I will see many of you at graduation because I go to all the graduations. So hopefully, in the not too distant future, I will see you at graduation. And then you could tell me some of these things on how maybe something in one of the © 2019 Laureate Education, Inc. 6 Course Reflection lectures in one of the courses, it doesn't have to be this course, really stood out for you and was important to you. Now we're getting to week 3. I mean, I've already talked over 20 minutes just about weeks 1 and 2. So I'll-- don't worry-- I'll speed up as we go along. And we won't go through quite as much. But we talked about state licensing and the BCBA. And first, I discussed the BACB, the Behavior Analyst Certification Board, who you will become very familiar with because they are so more of the gatekeepers. They're the ones who will award you your credential. But they have four levels of BC in the BCBA track in which RBT is the bachelor's level. These are the individuals who actually do the work. They sit down with the client and induce discrete trials. That is the lowest level of credentialing. This is basically a high school level with some additional training. Then there's the bachelor's level, which is the BCABA, board certified assistant behavior analyst, who still does direct work, but at a little bit more responsibility and assists the behavior analyst in more ways. I should say assists the BCBA because the BCBA, which is a master's level credential. Although, there are many people with a doctorate who, after they got their doctorate, went back and got their-- the necessary education, or that their program may have had appropriate education for them to apply for the BCBA. That's how I ended up getting. I didn't go to a behavioral analysis program. My PhD is in school psychology. And I got the BCBA based on my coursework in my school psychology program and as well as my field work in my professional work. I was able to get credit for that. Because when I graduated, there was no such thing as a BCBA. So I was able to use a lot of my experience. Things have become more strict since then. Because if they had a real strict criteria at the very beginning, they wouldn't have gotten very many people because there weren't very many behavior analysis programs at that time. But anyway, I'm getting off track. BCBA is the-- basically the master's level credential. And this is the level that's required for independent practice in behavior analysis. This is what you all are working towards. I went through the specifics of all of that. Well, actually, let me get to the highest level is the BCBAD. This is what I have. I have a doctorate. And I have been recognized as having an appropriate doctorate and the appropriate experiences to get that credential. It does not give me any rights and privileges above that of a BCBA. It's just a little status thing that's the D is tacked on at the end of the BCBA for me. It may be situations where you say, OK, the BCBAD may be better prepared, or they have more education, more experience, better prepared to work with the © 2019 Laureate Education, Inc. 7 Course Reflection more complex cases. In my practice, I tend to focus more on problem behaviors. Sometimes things that don't occur as frequently in everyday practice, but the severe maladaptive behaviors, that's usually when I'm called in as a consultant, is on the basis of somebody who is having-- they have a very difficult time controlling an individual's behavior, including SIBs. So I'm able to focus a little bit more as a BCBA-D. But I don't have any rights and practice privileges over the BCBA, and this is the independent practice level. BCBA BCBA-D, both independent practice. And I firmly believe that you, and hopefully every single one of you, will get your BCBA in hopefully the next few years. In order to get it, you got to get the field work, and that is time consuming. It does take time to get that, and in getting supervised by somebody who has the right training, to be a supervisor. But you will get there, and then you will be independent practice. So we talked about all those things and how BACB-- the specific requirements for each. And then state licensure. As I prepared this lecture, there were 31 states that license behavior analysts. If you are in a country outside of the United States, chances are just the BCBA will be accepted. In those states that do not license behavior analysts, most of them will accept the BCBA for jobs, showing that you are competent. And to get license in a particular state, in most cases, you have to have the BCBA. So the BCBA is still an integral part of it, but licensure is the state supervising the practice and who gets to call themselves a behavior analyst. And that's what the licensing entails. Some states, BCBA by itself is sufficient to become licensed in that state. In other states, there are additional requirements. Some states allow a broader level of practice than some other states. So there are differences. So what I want you to do as far as reflecting on week three is first of all, is your state one that has the credential for a licensed behavior analyst? Most of them call them that-- LBA, Licensed Behavior Analyst. Do you live in one of those states? And hopefully what you have done is you have gone and looked at the requirements for your specific state to become a licensed behavior analyst to make sure that you are doing everything in your power to get to that point. And again, most of them are totally based on a BCBA. Some have additional practice requirements, but in most cases, BCBA is going to be sufficient. So that's what you are shooting for first. If you live in a state that does not have an LBA, have you heard anything in your state about what a licensed behavior analyst credential being discussed? It's usually authorized by state legislature. Sometimes it can be done by, say, a psychology board or somebody else that is authorized to license professionals. I know most about New York state, and it was passed by the state legislature and signed by the governor. And that's how they got licensed behavior analyst. And © 2019 Laureate Education, Inc. 8 Course Reflection it's organized under the State Department of Education, but any licensed professional, all the way from the individual who gives you a manicure to a brain surgeon, are all licensed through the Department of Education, Office of the Professions, in New York state. They handled it. It's not like some states that I know, for example, Minnesota, where Walden University is based. Currently they're one of the states that does not have a licensed behavior analyst position. And right now, as I'm talking about this, they are in the process of discussing this in the psychology board, the board of psychological examiners. So it would come through the psychology board in that state. And some other states have done the same thing. New York doesn't have a specific psychology board. They have this Office of the Professions. So you want to keep abreast of what's going on in your state. If they do not have a licensed behavior analyst, keep your eye open for the possibility of that coming up as you're continuing your training. Maybe join your state behavior analytic association. They're usually associated with ABAI. In New York, it's NYSABA, New York State Association for Behavior Analysts. Because they will be more closely involved in what's going on in that state and be able to keep you up to date on that. So I recommend that you do that, to keep up on those issues that are going to relate to you. And think about your plan. How are you going to go through the rest of your verified course sequence? What are you going to do as far as your supervised field work? Do you have a place to do that? If not, it's not too early to start looking. And then getting your BCBA and getting licensed, if that is an option in your state. So think about it. It's not too early to have a plan, which leads us to week four. In week four, we talked about regulations, laws-- how laws and court cases have affected us in the practice of behavior analysis. I talked about the legal foundation, in other words, the United States Constitution. And if you're in another country, the Constitution of your country probably has similar type of protections. And I've talked about the 10th in the 14th Amendments more than anything else. I talked about some important court cases in the United States, the earliest one being from 1914 and the most recent one being from 2017, and how they have shaped some practice things. And a lot of the court cases preceded some legislation. So things that were ruled in a court case were then incorporated into legislation. And I went through some important legislation-- Section 504 of the Rehabilitation Act I think was in 1973. I talked about FERPA, Family Educational Rights and Privacy Act, and HIPAA, which you're all familiar with if you go to a doctor. It's a form you have to sign ensuring privacy, ensuring how records are kept. FERPA, which a lot of you will © 2019 Laureate Education, Inc. 9 Course Reflection fall under by working with children who are school age, is somewhat stronger and provides a little bit more protections than HIPAA. But they're very similar. I talked about laws relating to handicapped children in their education, starting with Public Law 94-142, the Education of All Handicapped Children's Act of 1975, I believe, and how that has been reauthorized over the years, as [INAUDIBLE] called IDEA, or I-D-E-A, Individuals with Disabilities Education Act. And then the most recent one is being called I-D-E-I-A, Individuals with Disabilities Education Improvement Act. But things that they have put in, things such as free appropriate public education- that's a term that specifically used in all of this legislation. If you work with children, you will fall under this. And all of its components-- I'm not going to go through them again here. We did that in week four. But it's very important for you. Similarly, I'm going to try to bring some things in on another one related to education in schools, which is No Child Left Behind. And that has been incorporated a lot, especially into the more recent revisions of I-D-E-I-A, Individuals with Disabilities Education Improvement Act. I also talked about ADA, Americans with Disabilities Act, passed in the early 1990s when George HW Bush was president. Now all these things, the regulations, the laws-- I want you to reflect back a little bit. How do they affect you in your proposed practice? How do these legal principles, from the Constitution, to court cases, to the legislation-- how does it affect you? How do you need to think about these things? OK. now you've had a thought. These will affect your practice, these laws. So when you get and do things, you will see their effect more directly. And by the way, the school laws require in certain cases an FBA, which I think is done inappropriately many times by individuals who don't have good behavioral training and are not behavior analysts-- being done by school psychologists who have training primarily in doing the norm reference, the assessment part of it. You as a behavior analyst know what that means. So if you're working in a school, you'll be the ones that most likely will be doing the FBAs that are mandated by I-D-E-I-A. So let's switch on to week five. And week five I titled Client Services. And what we tried to do in week five was talk about various applications of behavior analysis, that behavior analysis is more than just working discrete trials directly with individuals on the autism spectrum. A lot of times, some people's perception of a behavior analyst is working just with children with autism. And what I tried to do was show you how expansive the practice of behavior analysis can be, and that you as a behavior analyst-- most of you will probably work with children on the autism spectrum, maybe with individuals with an © 2019 Laureate Education, Inc. 10 Course Reflection intellectual disability, possibly both. But I wanted you to be clear that there are many, many options out there for behavior analysts. There are many different things that you can do as a behavior analyst. I talked about animal training. I talked about organizational behavior management. Yes, this is a subcategory of behavior analysis, organizational behavior management, and they work in businesses and large organizations applying behavioral principles. You can see behind me some of my book bookcases. Up there, there is a book at some point called Organizational Behavior Management that I used when I was in graduate school back in the mid 1980s, that I was exposed to that. I wasn't trained in a lot of the specifics, but I was exposed to it. So you, too, can go and focus on some things, even get your BCBA. And then if you need to get some additional training to go into one of these areas, go get that training that's specific to that. You have the credential, you can do that. I talked about sports psychology. While I haven't done much outside of a couple of dissertations and directing them-- I haven't done any in practice, but think about it. It's very applicable there. What I have had more opportunity to do is in behavioral pediatrics and health psychology. I told you how early in my career I worked for a year at Children's Hospital in New Orleans, in which I did do behavior analytic interventions in many different contexts. In that lecture, I gave an example of one that falls in both behavioral pediatrics and health psychology. There's a need for behavior analysts in that context. You may need, again, to get a little extra training so that you are familiar with that, but that's an option for you. Community psychology-- I haven't seen much in the way of behavior analysis in community psychology. There is some out there. There's not a lot of research on it, but it's something that I think behavioral analysts can help. And especially coming out of a university such as Walden, which has a clear mission of positive social change, community psychology can fit very well with behavior analysis. Clinical psychology-- I am a licensed clinical psychologist. I practice primarily as a behavior analyst, but I am integrating behavior analysis into all aspects of what I do as a clinician. I have a small practice. I do mostly cognitive behavior therapy, but I am always conceptualizing cases from a pure behavior analytic perspective. I'm looking for, what is the function of behavior? I may not do a functional analysis. I may not-- I do an FBA, functional behavior assessment. But I'm trying to conceptualize things when I am working with, say, a 45-year-old woman who's depressed. Now, you'll have to go back and get a PhD in clinical psychology to be able to do that, if you had those interests. But hopefully if you do-- and I think it's an option for you to go get your PhD in clinical. If you do, I'm hoping this behavior analytic © 2019 Laureate Education, Inc. 11 Course Reflection base-- and it does form a base, a foundation, for what you do I taught in the clinical program here at Walden for a number of years. I think you can get a good education at Walden or other places, too. But I hope that if you do decide to go on and pursue a PhD in clinical psychology, or any other area of psychology, that you always consider behavior analysis as your base. It is mine. So even if I'm doing things that are not directly behavior analytic, I'm conceptualizing things from a behavior analytic perspective. And I spent a lot of time in week five focusing on schools, because my PhD is in school psychology. Yes, I did some additional training so that I could work with, like, a 45-year-old woman with depression. I did a postdoc in Rational Emotive Behavioral Therapy, so I had some additional training. But my focus, my base, is working as a behavior analyst-- or I should say a behavioral school psychologist, because when I started, there really weren't behavior analysts working in the schools. But I did what a behavior analyst would do. And I would love to see behavior analysts being hired more and more and more by school districts to work not just with individuals with a disability, not just with children with autism, but in the general education environment with regular general education classes, helping the school set up a positive behavior intervention and support system, PBIS. There's so many things that we can do as behavior analysts that are valuable to that education environment, that are valuable to schools. And hopefully you'll see behavior analysts-- well, I hope by the time you're practicing, they'll just be standard in every school. There are some places where they're more prevalent than others, but I would like to see them in every school across the country, every school have a behavior analyst on staff. Maybe wishful thinking, but, hey, let's be optimistic. Now, what I want you to think back on-- was there anything surprising when we talked about the different areas in which a behavior analyst can work? Did you think, you know, I never thought about it, but I could go, at least on the side, train a dog, do a little dog training business. These are the same principles. I go, you know, I'd love to work in a medical setting. What Dr. Little said about his experience at Children's Hospital, that really made me think I'd really like to search out something like that. Has anybody had those? Or did you come in thinking, you know, I want to work with children with autism. And I'm getting trained for that, and that's really what I want to do. That's great. We need behavior analysts. That's the largest area of practice for behavior analysts. Has anybody thought about going off in different directions? It's what's best for you. But has anybody changed their plan for what you want to do? © 2019 Laureate Education, Inc. 12 Course Reflection This is one of those times that instead of me just staring into a camera on the computer, I wish I could get your feedback right away and we could discuss this. And these are the things that will be discussed. Hopefully they were discussed that week in your synchronous discussion period as you went on. So your instructor should have talked about that a little bit, at least I hope so. Week six, the hump week. Five weeks done, five weeks to go. Week six. It's like Wednesday is the hump day of the week when you're working. Advocacy for change. What is advocacy? We defined it. We talked about activities that comprise advocacy. We talked about myths and misconceptions about advocacy. We even talked about some formal advocacy things such as the Behavior Analysis Advocacy Network. We talked about foundations supporting behavior analysis, such as SABA, the Society for the Advancement of Behavior Analysis. That is part of ABAI, and it is a foundation that goes to supporting behavior analysis, supporting individuals who were training to be behavior analysts, support research in behavior. Every year at the ABAI convention, they have a reception for individuals who have contributed to SABA over the year. We talked about APBA and how they talk about advocacy. APA, which is a broader organization, but they've also been around longer, and they have been an advocate for psychology and for the welfare of people for a longer period of time. So we talked about some of the things from APA. And finally, we talked about Walden University and social change. I said this in the introductory lecture. I said this in week six when we were talking about it. I'm going to say it again right now. When Walden says their mission is positive social change, they really mean it. It's not just the saying. I admit, when I first started to work at Walden back in 2006, I thought it was just the saying. And I quickly learned that no, it really means something from all levels of the organization. Social change is the mission. It's the goal, and for every one of you to graduate and be a mechanism, a conduit, towards positive social change, even if it's just improving the lives of the individuals with whom you work. I shouldn't say even, that's a great thing to do. But even if that's it, you are contributing to positive social change because you are contributing to the betterment of an individual's life. What would they have been like without having had the opportunity to have you working with them? They're better off for it. So recognize that. But what I want you to get out of this one is, how can you best be an advocate? How can you in your-- even as your position right now as a student, but as it goes on-- as you become a BCBA, how can you be an advocate, an advocate for positive social change, an advocate for betterment in the lives of the people with whom we work? Do you think you'd be an advocate primarily for ABA in improving the way people see ABA? It's expanding its role into other areas, which will help more people. If we can use ABA in different contexts that will be © 2019 Laureate Education, Inc. 13 Course Reflection an advocacy role, you will have expanded ABA. Maybe it's advocating for children with ASD. I know a lot of times people come into a program like this because they have a child with ASD, that they're already advocating for it. And the knowledge and skills that you pick up from the behavior analysis program, in your field work, in working with individuals, expands your knowledge and makes you a better advocate. So you were already an advocate, but the knowledge that you pick up in our program will help you be a better advocate. Could be intellectual disabilities, working with individuals with intellectual disabilities. There are many different ways that you can be an advocate. Think about how you can best be an advocate. So let's move on to week seven. Week seven was ethical considerations when doing an FBA. I'm not going to go back and define everything here. What we did was we talked about FBA, Functional Behavior Assessment. We talked about how that fits into the right of behavioral treatment. We talked about the importance of doing a risk assessment, especially if an individual, you're going to be doing a functional analysis, a functional analysis experimentally manipulating conditions to establish, what is the function of the behavior. You're testing conditions to provide evidence that, yes, this is the function of the behavior. How would that work, especially with somebody who may have a self injurious behavior? How can we take the ethical questions that-- like the textbook Cooper, Heron, and Heward talk about-- how can we apply that to a functional analysis, or FBA? I also gave you my suggestions. My suggestions may not be what you directly agree with. That's fine. I don't mind you disagreeing with me. Because of the remote nature of this education, I'll probably never know if you disagree with me or not. But hopefully what I'm talking about will at least stimulate your thinking. And the key thing I was trying to get at is a functional analysis, the experimental manipulation of conditions. Is that necessary? And especially in cases when we're talking about self injurious behavior where the individual could hurt themselves in doing the functional analysis. But can we do an FBA, an informal or an indirect FBA, that can give us enough information on the function of the behavior? I personally believe that by interviewing important other individuals in the client's life, possibly doing some checklists to ask specifically about the function. In doing observations, is sufficient to get a good hypothesis as to the function of the behavior, and that could help you develop an efficacious intervention. That's my bias. You may-- especially when you get into your fieldwork-- you may be exposed to someone who says, no, I think this is really important that you do a functional analysis every time. And here is why. © 2019 Laureate Education, Inc. 14 Course Reflection So don't go just by what I say, but go by what the experiences you get in how that will shape how you think. Just make sure that your thinking is based on data, that there is an empirical reason for you to make that decision. My decisions, my thoughts on this, are based on my experiences and data that I've collected, that I have seen others collect, and interventions that have been designed from those data. So you'll expand. This is the first time you really probably thought about this. It is an issue. And there are many people out there who think like me, that a functional analysis may not-- and it can be done. To me, it's the last step if you can't get enough data in a more indirect, informal fashion. So think about FA. That's what I want you to get out of this week, and to reflect on the need for an FA. Is it necessary? But again, I want you to think for yourself. Don't have others, be it me, your supervisor on your field work, or anybody else telling you, this is the way it must be in all cases. First of all, I'm not saying that. I'm saying, I tend to go that it's not necessary, that you can get the data elsewhere. Others might say it's necessary. Have them show you the data, do what they have to do to prove it to you. Recognize the importance, though, of thinking for yourself and to make your own database decisions. But always make sure your decisions are based on data. Which leads us to week 8. Week 8, the use of aversives. And I could go through the same thing, examples that I gave when I was talking about it, is the difference between aversive and punishment. I use myself, that you may find my voice, my looks, something about me-- the fact that I drink water all the time. It could be the fact that you don't like the blue color of the walls behind the bookcases. You may not like my beard. You may not like my bald head. I might become aversive to you, but you continue doing it. So therefore, it's aversive, but it's not punishment, because it's not changing your behavior. It's not decreasing the likelihood of your going through this. You are working through to get your BCBA. To do that through Walden University, you have to listen to me a lot. I hope it's not bad, but it could be. So I want to, again, illustrate that definition between aversive and punishment. Punishment is defined by its outcome on behavior. It decreases the likelihood it's going to occur in the future. Aversive means it's unpleasant. It can serve as a punishment. It doesn't always serve as a punishment. So we define those type of things. We talked about ethical concerns. That's the whole-- this class is dealing with ethics. So we're talking more about the ethics of the use of aversives. In order for me to talk about the ethical use of aversives, we have to define some of them. And we did. I gave examples of positive punishment. Again, recognizing positive-- now we'll do this over and over again, because I can't see you constantly telling back to me, positive means presentation. It doesn't mean it's © 2019 Laureate Education, Inc. 15 Course Reflection good. You probably would, but I can't see that. So I have to keep telling you, telling you, telling you, so that I know that it's eventually going to get through, if it hasn't already. But I think it already has. But we talked about positive punishment. We talked about the presentation of aversives and examples. We also talked about how-- if we're going to be using punishment, what do we do to make it effective? We don't want to use punishment if we can avoid it. But there are going to be times in your practice when using a punishment will at least be considered. And if you are even considering the use of punishment, you're going to need to know how it can be best implemented. I went through Alberto and Troutman in guidelines for the use of aversives. Alberto and Troutman is a book which is Behavior Analysis for Teachers-excellent book. We don't use it in this class, but I do recommend it, especially if you're working in a school. But they gave some guidelines and what types of aversives would be used. I talked about a facility-- I won't mention their name again here. I did mention their name during week eight-- but a facility in Massachusetts where they do use it. And I talked about things that came directly from their website. So I felt free to use their name and give that information, because it came from them. I wasn't making anything up. I was trying to talk about their use of what they call skin shock in as neutral a way as possible. I admit, there are data out there that support the efficacy of skin shock, shock, using other aversives. We don't want to use them if we can possibly avoid it, if we can use a DRI, DRO type of procedure. Even if you're going to use it, you're going to want to use a differential reinforcement procedure combined with it. But can we do it just with the reinforcement? If you can, yes. But I talked about it in terms-- trying to talk about it in as neutral of terms as possible. You need to do your own research on that and how you respond. And that's the main thing. Is there a place for aversives in your practice as a behavior analyst? And I want you to think and reflect on that this week, in our week of reflection. Is there a place for aversives? And if there is, what type of aversives? If you say, OK, it's OK to put lemon juice in their mouth, but not to use electric shock. That's something I can't answer for you. You have to think about yourself. We get to shock. Should shock be outlawed? It is in some states. And some countries have outlawed the use of that skin shock type of procedures that are used at that facility that I talked about. Now there, there have been court cases that has ruled it legal. And they do have all the safeguards in place. And they're just not using it willy-nilly. They're using it for therapeutic purposes. But is © 2019 Laureate Education, Inc. 16 Course Reflection there a use for it, period? Should it be outlawed? Should they be allowed to use it? Think about that. Week nine, almost done with the reflections. Week 9, restraint and physical management. We defined restraint, talked about the types of restraint-- physical restraint, like holding somebody, mechanical restraint, putting cuffs or some other mechanical thing on them, chemical restraints, using medications to restrain some individuals from engaging in certain behaviors. I talk about the history. I find that interesting. I may bring history into some other things as we go on, but because I find the history of the use of restraint interesting. I talked about when restraint is used. I talked about there's more research with individuals with intellectual disability. So I talked about physical restraint of people with intellectual disabilities. But I also talked about concerns in the use of restraints overall. I talked especially with restraints in schools. I also brought in talking about seclusion, putting somebody into a confined space. Seclusion. And I talked about some proposed guidelines for restraints in seclusion and the ethical issues that go along with it-- trying to avoid the use of restraints with children with autism, and then also crisis intervention. Now what would I like you to get out of this? Now, when should we use restraints? When should we use seclusion? We know that they can be abused. What do we have to do to ensure that we're going to use them that they're not abused? And think about crisis management. Will you get training? Will you get training in crisis management? Probably will as a behavior analyst, but how important that may be for you in your practice. Now we're reaching week 10. We're almost done. I'm not going to really recap the recap, so this is really the last thing I want to recap. In week 10, we talked about research and ethics in research. We reviewed the BACB professional and ethical compliance code for behavior analysts with regards to research. Talked about characteristics of responsible research, and especially informed consent and why it's important to get informed consent, why it's important that we have everybody that's important to approve it approves it ahead of time and understands exactly what you're going to be doing. We talked about accuracy in the use of data, that you don't fudge data. You don't make up data. You don't manipulate data in such a way that it misrepresents what the results really are-- things that you should know already, and you probably do. People that manipulate data, they know what they're doing. It's not ethical, but they know what they're doing. And we talked about some APA, some five principles of research ethics from APA. And we talked about Walden and Walden's research ethics, and especially the IRB, the Institutional Review Board, and how that works, and the things that © 2019 Laureate Education, Inc. 17 Course Reflection they're looking for for them to judge the studies that students and faculty are doing at Walden. And there's going to be an IRB at any university in which research is being conducted. Now what I want you to do as far as thinking about what you're going to be doing if you are going to do research, do you have any plans for research? Have you thought about it at all? Has my talking about it here, and in other aspects of this course, other courses, and other courses you're going to take, have you thought about research more than you did before you started this program? I know when I started my PhD program at Tulane University back in the 1980s-- early part of the '80s, but still the '80s-- I thought what I really wanted to do was I wanted to become more of a pediatric psychologist. I went to a school psychology program. Pediatric psychology was one of my minors. I did work in pediatric environments. That's what I thought I wanted to do with my career. I still love that. If I was going to go into practice, I would probably want to go to work in a pediatric environment. But doing my dissertation, I thought, I enjoy this. Maybe I'd like to do this more. And I did go into an academic track, and I became a professor. And I've done research over the past 30 plus years. Published a few things, quite a few things. But I'm still doing it and written a few books. I've done those things, and I'm proud of what I did. And I think I've done a good job contributing to the research. And that makes me feel good. That's not right for everybody, and I didn't think it was what I wanted to do when I started my education. But I got kind of hooked on research, and I wanted to keep doing it. So I did do that. In most cases, you would get an advanced degree if you're really interested in research. It could be a degree in Applied Behavior Analysis. We don't offer it at Walden, but you could go someplace else for a doctorate in applied behavior analysis. You could get a degree in clinical. It could be at Walden. It could be someplace else. And what you can use your expertise in behavior analysis in other aspects of what you're going to learn as a clinical psychologist, and then go into research. You could go into a more research based line, such as developmental psychology or health psychology or educational psychology. So you could go and get an advanced degree, a PhD, a PsyD-- most likely a PhD. You could do that. And you could go into research as your main vocation. But chances are, most of you aren't going to do that. You're doing this to get your BCBA and to work. Will you bring what you learn about research into the job? I hope so. Whether you do formal research or not, I hope that you bring some-- the logic that underlies the research that you've been taught, that you bring single subject design methodology-- which we'll talk about in more detail in another class-- that you bring that into what you do all the time that you're looking at every case as a © 2019 Laureate Education, Inc. 18 Course Reflection research study, because you are trying to find out the function of the behavior. You are trying to find out the best intervention for either increasing or decreasing the frequency of a behavior. That's what we do. And we do it based on-- we structure things based like we're doing research. But you may also be interested in doing some applied research on the job. That'd be great. I'd love to see more practicing behavior analysts contribute to the literature, contribute to going to conferences-- state conferences, national conferences-- in presenting the interesting things that they have done. Modifications that you may have made in a specific case that, hey, this helped increase the efficacy of the intervention. Or, I tried this, and it worked, but if you structure things such as-- at least as an AB design, baseline and intervention, you have at least the ability to make some inferences. That's the research aspect of things. And I hope you do that. So think about it. And that's what I want you to reflect on this week. How does research affect you in your life? Do you have plans for doing any research? And even if you don't, how does the research impact your practice as a behavior analyst? OK. 10 weeks. I do actually have a little bit of recap for this week and what I want to recap for the whole course. And what I want you to think of, what did you take out of the course? What is the most important things? Was it the ethics stuff? Was it the practice stuff? Was it the professional issues things? What did you take about the course? If you had to evaluate, and you had to put one thing as the most important thing that you have learned in this course, what would you identify that most important thing as? I think there's a lot of things we covered, so there's so many different ways that you could go in identifying what's the most important thing that you're getting out of the class. And overall, what did you get out of the class? What is the takeaway that you have from this class? And I hope it is related to your behavior and how what you learn here can improve your functioning, improve your behavior, once you get out and you're practicing as a BCBA, an LBA. If you do go on for your education, how this may carry over into some of the things you think about in your course of study for that degree. Overall, I'm just glad I had the opportunity to do this with you and to talk to you about these things, and to hopefully stimulate your thinking on these issues. I hope you enjoyed this. I hope you enjoyed all 11 weeks of the course. So you haven't seen the last of me, and I hope you've enjoyed listening to me and watching me give these lectures. So enjoy the break you have between the quarters, the two weeks that you have off before your next class starts. Do some wrestling. Think about yourself. Think about self reinforcement. You've gone through this whole class. Reinforce © 2019 Laureate Education, Inc. 19 Course Reflection yourself some way for doing that. Hopefully it makes you more likely to get into the next class, but hopefully you go into the next class anyway. But I should say reward yourself. Take care of yourself. Look after yourself. Remember the important things you learn in this course. Remember there's a lot more to come. So goodbye again for another course. I'll see you again next term, next quarter. And until then, have a good time during your break. And as always, good behavior. Bye bye. Course Reflection Content Attribution MUSIC: SC_Light&Bright06_T32 and/or SC_Business01_T41 Credit: Studio Cutz © 2019 Laureate Education, Inc. 20 Ethical Dilemmas: Part Two Ethical Dilemmas: Part Two Program Transcript [MUSIC PLAYING] ANGELEQUE AKIN-LITTLE: Welcome, everyone, hello. Welcome to another podcast for Walden University's program in Applied Behavior Analysis. All of you on your way to becoming board certified behavior analysts, I am Dr. Angeleque Akin-Little. I'm joined today again with-STEVEN LITTLE: Dr. Steven Little. ANGELEQUE AKIN-LITTLE: OK. You sound very excited today. So that's very good to hear. If everything could be run via the AVA dynamic, the reliance on data, database decision making, and I think if the whole world could just be run on that, we'd be a lot-- we'd progress a lot more smoothly, wouldn't we? STEVEN LITTLE: We certainly would. ANGELEQUE AKIN-LITTLE: We would. We would. STEVEN LITTLE: As Louis Armstrong used to sing, what a wonderful world it would be. ANGELEQUE AKIN-LITTLE: Oh, I like that. I like that. Excellent. I like that. So, well, as most of you know, when we go through these podcasts for courses, we intersperse a course with a few other topics or an interview. But we go over the lectures a lot of time. And I did want to do a little programming note here. You may wonder why today's podcast will not be about the last lecture, which was Ethics and Research. And we talked about that, and there are really important issues in that last Ethics and Research lecture. But we felt like they were going to touch on those in the research course. STEVEN LITTLE: Right. ANGELEQUE AKIN-LITTLE: Where we talk about ethical dilemmas when you are conducting research, particularly the IRB and that kind of thing. So we're going to touch on that later. And we thought there were some other things we could talk about in this podcast. STEVEN LITTLE: And especially seeing ethics is the first word in the course, thought we'd do a little bit more on ethics. ANGELEQUE AKIN-LITTLE: OK, that's really good. So we've made our tea. We always make a cup of tea to do these, and we're sitting here. I actually was just going to take a sip, but I see it was thrown back to me. So what I'd really like to © 2019 Laureate Education, Inc. 1 Ethical Dilemmas: Part Two do today, and Dr. Little, I'm going to ask you about what you'd like to do first. We did have a pretty-- what? About podcast three or four-- I can't really remember-one of the podcasts previously, we did do some ethical dilemmas. I think we got through two of those. STEVEN LITTLE: Yes. And yes, we did. ANGELEQUE AKIN-LITTLE: Yes, we did. So we want to go back to some of those, but I also thought there were some interesting articles, where we were talking about restraint and seclusion. And I wanted to-- I don't know which one you wanted to go to first, so I'll let you decide what you want to look at. STEVEN LITTLE: I think let's start with doing a couple of the ethical dilemmas. ANGELEQUE AKIN-LITTLE: Why did I know you were going to say that you really enjoy the ethical dilemmas? STEVEN LITTLE: Why don't I read it while you can have a sip of your tea? ANGELEQUE AKIN-LITTLE: OK, OK. Thank you so much. STEVEN LITTLE: OK. Matt works for a public school as a behavior analyst. The school employs several behavior analysts and has ASD classrooms for children that would otherwise require a more restrictive environment. Many students at the school engage in dangerous behaviors, including aggression and SIB, selfinterest behaviors. It is not uncommon for students to be held in restraints or placed in seclusion. The school has provided training for these procedures and oversees their use with the required documentation in reporting per state laws. Matt recently observed a student, not one of his clients, placed in seclusion without continual visual monitoring. He approached the student's behavior analyst about it and was told the monitor got called away to another crisis. Matt responded that he was uncomfortable that students may hurt themselves in seclusion if they are not visually monitored at all times. The behavior analyst said it was out of her control. Matt then went to the school administration, and they said there was nothing they could do. It was a staffing issue that could not be resolved for several months. ANGELEQUE AKIN-LITTLE: Actually, I think it's important. That will not be resolved for several months, is the actual term there. Because could not would mean never in my mind, but will not means that there is a plan. STEVEN LITTLE: Yes. ANGELEQUE AKIN-LITTLE: Ah, this is tough. This is tough. Because I'm assuming what we're going to do here is, what should Matt do as a behavior © 2019 Laureate Education, Inc. 2 Ethical Dilemmas: Part Two analyst, working in an ethical manner, according to the BACB, the ethical code of the BACB? What is Matt's ethical obligation? STEVEN LITTLE: I find this somewhat tricky because Matt did do what he is supposed to do. ANGELEQUE AKIN-LITTLE: Yeah, that's-STEVEN LITTLE: And that is he approached the behavior analyst. When that behavior analyst was really not responsive to his concerns, he then went to the school administration. So the question is where would he escalate next if it is going to be reporting? And I'm not exactly sure. I mean, this, like I said, is a dilemma that doesn't have I think a clear, easy to identify response. ANGELEQUE AKIN-LITTLE: Well, exactly. That's right. And I want to reiterate what you said. And that is that the ethical obligation is to, when you see a colleague behaving in an unethical manner, which this is, even though they may face a situation. I mean, let's take a step back, too. What about the behavior analyst that was called to step away? I think in that instance, I would have to say no. STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: I'm doing visual monitoring. Even though they're saying it's a crisis over here, clearly, if staff's coming to you saying it's a crisis, there's staff to handle that. Think about if the child had been severely injured. STEVEN LITTLE: I know. ANGELEQUE AKIN-LITTLE: Are the most-- been killed in that situation, and you stepped away to another crisis. So step back. All right. Some of the behavior analysts working might have that. All right, they're doing the visual monitoring, and they're called away. Right there, we're going to support them-- absolutely 100% support to say no, I cannot leave this position. STEVEN LITTLE: Right. ANGELEQUE AKIN-LITTLE: Obviously, this behavior analyst, not Matt, this behavior analyst felt like I have to leave. And then we won't even get into, was that the truth? STEVEN LITTLE: I know. ANGELEQUE AKIN-LITTLE: Was there really another crisis? © 2019 Laureate Education, Inc. 3 Ethical Dilemmas: Part Two STEVEN LITTLE: Well, the question is how should they that that staff had responded? If they did have to respond to something that was urgent and their presence was needed elsewhere, the child should be removed from seclusion. ANGELEQUE AKIN-LITTLE: OK, that's another-- that's really good. Because I was going to point out to you, that's what I just said. They should say no. STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: But the other option is excellent point. Then that child comes out and they go deal with this other crisis, if it was indeed this other crisis that had to be attended to immediately. Then, yes, the child should have been removed. So that's another teachable moment for Matt to say, well-because I'm thinking one thing Matt could do-- I hope this isn't a copout. But one thing Matt could do-- and remember, I said the previous behavior analyst, now this is Matt-- is say, well, OK, I'm going to tell everybody here's what's going to happen. And here, we need to train on this. Here's what's going to happen. Try to work within the parameters of the facility. That's why I wanted to point out will versus could. Could not be resolved means I think Matt has to escalate higher above this administrator. STEVEN LITTLE: OK. ANGELEQUE AKIN-LITTLE: That will not be resolved for several months means they are planning to resolve it. It can't be several months though. That's the teachable moment, is it? That's where Matt's going to have some-- need some support. STEVEN LITTLE: He will. And I think they're, as I said, not leaving the child in seclusion. ANGELEQUE AKIN-LITTLE: Right. STEVEN LITTLE: As an alternative, if there are staffing problems, then there has to be some type of rules that if someone is called away from monitoring someone in seclusion that the child is immediately removed from seclusion. ANGELEQUE AKIN-LITTLE: You know what? Why am I making this hard. There's a simple solution here. Don't use seclusion. STEVEN LITTLE: That-- yes. ANGELEQUE AKIN-LITTLE: You and I are not big fans of seclusion anyway. STEVEN LITTLE: No. © 2019 Laureate Education, Inc. 4 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: There can be exclusionary timeout out right in the classroom where there is visual monitoring because a child is right there. Hey, we're making this too hard. STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: No seclusion then. If you don't have proper staffing, and that's-- when I said Matt would need the support, that's the support to say, well, hey, guys-- and you hate to be that person. STEVEN LITTLE: Oh, I know. ANGELEQUE AKIN-LITTLE: Matt's probably like, why did I ever see this? I just wish I'd walked away. But you know, just-- well, look, that's when you have to use, to me, your psychology skills, your behavioral psychology skills to say-- to try to-- and I hate we have to do this. People should just do the right thing. But to get people to do the right thing, to engage, and to develop that rapport to say, all right, well, we don't need to do seclusionary time out then because we don't have the staffing to effectively engage in this intervention. I don't like it anyway. STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: That's a perfect opportunity. STEVEN LITTLE: And that is a good solution. So if you're-ANGELEQUE AKIN-LITTLE: I mean, especially if a student-- oh, I'm so sorry. I interrupted. STEVEN LITTLE: No, that's fine. ANGELEQUE AKIN-LITTLE: But especially if this client or the student-aggression and SIB-- how could that behavior analyst have left? You know, I don't know-- it's aggression. So I'm assuming it's a pretty severe SIB, Self Interest Behavior. That's-- yeah, OK. STEVEN LITTLE: I mean, I-- if there's any SIBs, seclusion would-ANGELEQUE AKIN-LITTLE: Is not the answer. STEVEN LITTLE: --not be of the choice of intervention. ANGELEQUE AKIN-LITTLE: Oh, this is-- yeah, this one isn't hard at all. [LAUGHTER] © 2019 Laureate Education, Inc. 5 Ethical Dilemmas: Part Two At first I would say-- well, I think I was perseverating on-- no pun intended as we're talking about behavioral stuff [INAUDIBLE]. I was perseverating on this idea well, he's done everything right. He's-- you know, when we have that dilemma where I see a colleague and-- I ask you again, you've been so much more intimately involved in the BSB code. If I'm confusing it with the APA code, please correct me. But the steps are you approach that colleague to try to work it out. STEVEN LITTLE: Exactly. ANGELEQUE AKIN-LITTLE: If that doesn't happen, then you approach the person in charge. Guys, that's the same. Everybody who's listening, that's the same with reports of abuse. You know, we're mandated child abuse reporters. It doesn't just stop going to the person in charge reporting. You're supposed to go back and make sure they did something. That is an ethical onus. Actually it's illegal, too, that you're supposed to make sure that that abuse was reported. It doesn't stop with you just reporting to who is in charge. STEVEN LITTLE: Exactly. ANGELEQUE AKIN-LITTLE: Please go ahead. STEVEN LITTLE: In this case, if the escalation was going to [INAUDIBLE]. ANGELEQUE AKIN-LITTLE: But this isn't abuse necessarily, although-STEVEN LITTLE: No, I wouldn't think it would rise to abuse unless-- it could be considered neglect. ANGELEQUE AKIN-LITTLE: Neglect, yes. STEVEN LITTLE: But I would not want to report it, and I would not probably want to escalate unless there was a pattern. ANGELEQUE AKIN-LITTLE: Right, right, right, right. But I think the first step really would be OK, well, then we can't-- if we don't have staffing for more-- it's not going to happen for several more months, then we can't use this intervention. STEVEN LITTLE: Exactly. ANGELEQUE AKIN-LITTLE: I think that was-- we made it too hard as with life with what we do. I still like your Louis Armstrong in ABA. What a wonderful world it would be? I love that. That's really, really good. You want to move on? STEVEN LITTLE: Sure, let's do that. © 2019 Laureate Education, Inc. 6 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: That was fast. We spent like half an hour [INAUDIBLE] time. But that was pretty fast. Well, let's-- and you know what? I didn't-- students, oh, apologies. I didn't suggest if you wanted to pull these dilemmas before you so you could kind of read along and formulate your own opinions. And also some of you may want to pull the articles. So there's not-- we're not going to do a deep dive into every article. There's just one in particular that we thought was really interesting because we did some additional research in that area. So everybody, if you want to stop the tapes, we're going to keep talking. If you want to stop and go grab things-- I forgot to say to people that's something you could do. STEVEN LITTLE: And we're going to talk about the [INAUDIBLE] article. ANGELEQUE AKIN-LITTLE: That's what I've just said. What are you-STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: [LAUGHS] what are you talking about? No, I'm serious. What are you talking about? STEVEN LITTLE: No, no, I'm just clarifying what they [INAUDIBLE]. ANGELEQUE AKIN-LITTLE: I was going to save that. I was going to save that. I wasn't going to-- I was going to say they had to get all the articles and save for the one that we were going to do a deep dive into. STEVEN LITTLE: OK. ANGELEQUE AKIN-LITTLE: But you ruined that. STEVEN LITTLE: I did ruin it. And as people who are listening can tell, we don't have a script. We don't practice anything ahead of time. This is all-ANGELEQUE AKIN-LITTLE: Well, how could it be? If we practice, where would the fun in that be? STEVEN LITTLE: I agree. ANGELEQUE AKIN-LITTLE: But-- no, anyway-- yeah, so I want to go-- we'll do a few more of these. But I did forget to say to people, if you want to pull these, sometimes it can be interesting to have these on hand. And yes, we are going to do more in-depth discussion of the [INAUDIBLE] article because we found some interesting-- there was just some questions we had that we thought students might find interesting. And maybe students will do a little more looking into that. © 2019 Laureate Education, Inc. 7 Ethical Dilemmas: Part Two And then maybe just go through all the articles so if people want to have that available, so it's fine. I just-STEVEN LITTLE: OK. ANGELEQUE AKIN-LITTLE: I was going to try to make them sort of be curious about oh, which one are they going to look at in depth here? But you earned that. OK, so-[LAUGHS] Mona is a behavior analyst in training and is seeking supervision for her fieldwork at her place of employment. She is told all supervisors are maxed out with supervision and have no available slots. That's not good. OK, so anyway, she approaches Kathy, a BCBA with whom she works closely, and asks if there is any way an exception to the caseload max could be made so that she could take her on. Kathy says under one condition, that Mona serve as her Saturday night-- oh, this is easy-- Saturday night baby sitter. This is so unethical. This whole thing is completely unethical. That Mona serve as her Saturday night babysitter for the duration of supervision. OK, well-STEVEN LITTLE: Yeah, that's pretty-ANGELEQUE AKIN-LITTLE: No. STEVEN LITTLE: --clear, no. ANGELEQUE AKIN-LITTLE: No, no, no, no, and you shouldn't-- if you're working at a place and somehow they can't give you supervision, no. That should not happen. STEVEN LITTLE: That should not happen. ANGELEQUE AKIN-LITTLE: That should not happen. STEVEN LITTLE: You shouldn't-- obviously, you're getting supervision for any work that you're doing. And if you needed the experience to qualify for the BCBA, you should be doing that work in your job. ANGELEQUE AKIN-LITTLE: No, that's right. STEVEN LITTLE: So yes, that should be done. But the key thing here, I mean, Kathy is so out of line in that basically [INAUDIBLE]. © 2019 Laureate Education, Inc. 8 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: She should lose her BCBA. I think she should. STEVEN LITTLE: She could. ANGELEQUE AKIN-LITTLE: She should lose certification. You can't-- I can't imagine-- but OK-STEVEN LITTLE: [INAUDIBLE] to provide a service that is really not related at all to what's going on. ANGELEQUE AKIN-LITTLE: I would imagine that supervisors are not that overt with their attempt to have duel relationship in that baby sitter plus supervisor, right? I bet it's a lot more covert. But if that happened, if there's some other covert-- well, if you'll just do this little thing for me. It's probably not like do my babysitting, pick up my dry cleaning, or something that's so clear. STEVEN LITTLE: Right. ANGELEQUE AKIN-LITTLE: It's probably a lot less clear. First thing, go talk to someone else about, OK, how do I handle this? Because this is a person who's going to be marking me, and I'm trying to learn from her or him. So go get some counsel from someone else who's been in the field longer or whatever. Do you understand what I'm talking about there? STEVEN LITTLE: I understand what you're saying very well. There is one point if you don't mind me bringing it up here. ANGELEQUE AKIN-LITTLE: Yes, yes, please. STEVEN LITTLE: And that differs within the behavioral analysts ethical code and psychologists. ANGELEQUE AKIN-LITTLE: Oh. STEVEN LITTLE: And that is behavior analysts in training can pay for their supervision. ANGELEQUE AKIN-LITTLE: Well, that's right. STEVEN LITTLE: And in psychology that is considered an ethical violation. It's a duel relationship. ANGELEQUE AKIN-LITTLE: It's verboten, yeah. STEVEN LITTLE: Yeah, the reason that why psychologists forbid it is the idea that if you are paying somebody, then they don't want to-- they may not come © 2019 Laureate Education, Inc. 9 Ethical Dilemmas: Part Two down on you when you are doing something wrong because then you may leave and go find another supervisor. ANGELEQUE AKIN-LITTLE: That's right. That's right. STEVEN LITTLE: And I was-ANGELEQUE AKIN-LITTLE: Oh, they're rating you. So it's going to effect you're paying for good ratings. That's what psychology is afraid of that you're going to be paying for good ratings somehow. STEVEN LITTLE: And that still exists in behavior analysis. But and I'm not sure exactly why it's not forbidden in behavior analysis. But my guess is that there just aren't enough supervisors out there. And it's a supply-and-demand type of function more than anything else. ANGELEQUE AKIN-LITTLE: That's what I think. I think-- I wouldn't be surprised if BACB in future did go to that where you can't-- you know, it has to be part of-your work has to provide that or your internship. But what I think is in the way they've done this is I really like the way that they started small-- or I'm sorry-they started with accepting everyone. And then they have-- now it's more and more difficult to become a BCBA. I really like the way they've done that, starting large-- excuse me-- and then making it more difficult. And I wouldn't be surprised if what you said is exactly right that because they needed people to get supervision and to become BCBAs, the more people the more power. That's when they allowed that and still continue to allow it. STEVEN LITTLE: And I have supervised students for remuneration. ANGELEQUE AKIN-LITTLE: You've really done one student. STEVEN LITTLE: I did one student. Another student, who I was-- I had started with, but then we had to switch over. And they were-- it actually fell through. But her place of employment was going to hire me as a consultant to come in and provide her supervision. ANGELEQUE AKIN-LITTLE: Yes, because of all the additional requirements. The first person that you did that for, you're in a rural community. And you should be paid your value. You shouldn't do this for free. He really didn't have anyone else available. STEVEN LITTLE: Right. © 2019 Laureate Education, Inc. 10 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: Because our preference is that through your work, you know, that students are not having to pay for this. But through their work, this is provided to them because once they become BCBAs, then-- you know, facilities need BCBAs so that they'll then provide that facility with those certifications that that facility needs to operate. But yeah, we don't feel comfortable with the payment. And the second person you actually sort of worked out for her. Why don't you-- she was working an extra job to pay for things. STEVEN LITTLE: I know. ANGELEQUE AKIN-LITTLE: Not just to pay for you, but to pay for things. And you kind of worked out. Look, your job really needs to do this for you because then you're going to be providing them that service. She was already working, I think, as a speech therapist. STEVEN LITTLE: Speech-- yes. ANGELEQUE AKIN-LITTLE: So I mean, you did work that out. And as psychologist, we are a little uncomfortable, a lot uncomfortable, aren't we? STEVEN LITTLE: Oh, yeah. ANGELEQUE AKIN-LITTLE: We didn't really charge to go [INAUDIBLE]. You didn't. STEVEN LITTLE: No, I didn't. ANGELEQUE AKIN-LITTLE: I've never done that. STEVEN LITTLE: I went over and [INAUDIBLE]. ANGELEQUE AKIN-LITTLE: We never charged-STEVEN LITTLE: And we never charged travel time-ANGELEQUE AKIN-LITTLE: Never charged travel time. You know that-STEVEN LITTLE: --or the mileage. ANGELEQUE AKIN-LITTLE: That's right. That reminds me-- I don't mean to get so off track-- but that in New Zealand-- and those people were becoming educational psychologists working in the schools-- they paid out of pocket most of the time, unless their job paid. They paid out of pocket for psychological supervision because I remember I did some of that and just accept it. © 2019 Laureate Education, Inc. 11 Ethical Dilemmas: Part Two But I did it for a person whose job was paying me, not out of the students pocket because I still felt like-- but I remember I could have charged all this travel time. And I never did that because I just thought, well-- I don't know. We should get-we're valuable. STEVEN LITTLE: Yes, but I-ANGELEQUE AKIN-LITTLE: We're valuable, but it's difficult when it's a student, isn't it? They're trying to-STEVEN LITTLE: Yes. ANGELEQUE AKIN-LITTLE: It's difficult when it's a student. STEVEN LITTLE: And I have no problems with-ANGELEQUE AKIN-LITTLE: It's difficult to charge a lot of money when it's a student. STEVEN LITTLE: I have no problems with an external supervisor. ANGELEQUE AKIN-LITTLE: Absolutely. STEVEN LITTLE: But I think the money that's paying that external supervisor should come from the-ANGELEQUE AKIN-LITTLE: The facility. STEVEN LITTLE: --the facility In which they're working. ANGELEQUE AKIN-LITTLE: Right, because I can remember some cases even in New Zealand, where the person who was supervising was charging for every single penny, every single thing that she ever did. And I always thought, oh, you know, that's-STEVEN LITTLE: I did not like that at all. ANGELEQUE AKIN-LITTLE: I did not-- I don't know. I did not like that because they are students. And they-- I think we have some sort of duty to promote the next generation of behavior analysts of psychologists, particularly in rural areas where they don't have those people who have those skills. That's kind of our duty. That's-- again, I say this is the opinion of Angeleque Akin-Little, not the opinion of anyone at Walden University, except perhaps-STEVEN LITTLE: Dr. Steven Little. © 2019 Laureate Education, Inc. 12 Ethical Dilemmas: Part Two [LAUGHTER] No, I would-- you can't see me right now. ANGELEQUE AKIN-LITTLE: Yes, you're nodding. STEVEN LITTLE: My head was going up and down at a fairly rapid pace. So yes, I do agree with-ANGELEQUE AKIN-LITTLE: Like one of those dolls, you know? STEVEN LITTLE: Yeah, I was a bobblehead. ANGELEQUE AKIN-LITTLE: The bobblehead. That's what they're called. Bobble-- I should have known that. But-- what, you want to do the last one and then dip our toe into these articles? STEVEN LITTLE: I think that's a great idea. It's my turn to read. ANGELEQUE AKIN-LITTLE: Yes, please. That last one was easy. Good, all right. STEVEN LITTLE: Carolyn, a BCBA, working in a practice with several other behavior analysts, all BCBA's or BCBAD's, has a client whose parents are going through a nasty divorce. She learns that another BCBA in the practice has access to the records of this client and released confidential information about a client to an attorney working with one parent without a signed release or court order. After the psychologist reviews the information presented, it is clear to the treating psychologist that any other treating behavior analyst and any other behavior analyst breach confidentiality. What should Carolyn do? ANGELEQUE AKIN-LITTLE: Yeah, I think you might have gotten this from a psychologist [INAUDIBLE]-STEVEN LITTLE: [INAUDIBLE] ANGELEQUE AKIN-LITTLE: --because the word psychologist is in there, sorry. And I was going to say, I think we mean behavior analyst here. But-STEVEN LITTLE: We do, and I think this is pretty clear too. ANGELEQUE AKIN-LITTLE: Boy, oh my goodness, this is horrible. This is lose your license, lose your certification. You can't do this. STEVEN LITTLE: No. © 2019 Laureate Education, Inc. 13 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: We-- now, everybody should remember as a psychologist, confidentiality and privacy is paramount. I don't see it as much in the BACB, but it still-- records are to be kept private. And then particularly when you're releasing a record to harm-STEVEN LITTLE: Yeah. ANGELEQUE AKIN-LITTLE: My goodness, that's-- you know, I can understand it because I've had a student before that had records. They shouldn't-- you shouldn't really do this, but they left them in their car. The car got broken into. You know, all right, I kind of get that even though you really shouldn't keep private records. And this is psychology. This was testing materials. The briefcase-- their briefcase was stolen, all right. So I kind of get that even though you shouldn't do that, even leave it in your car. Do we agree? STEVEN LITTLE: It should be more secure than that. ANGELEQUE AKIN-LITTLE: You should be more secure. But this person is giving harmful information out. STEVEN LITTLE: I know. ANGELEQUE AKIN-LITTLE: And-- wrong. STEVEN LITTLE: Wrong. ANGELEQUE AKIN-LITTLE: Big red lights flashing. A siren is going. STEVEN LITTLE: And this-ANGELEQUE AKIN-LITTLE: Wrong. Lose your license, lose your certification, wrong. That's how I feel about it. STEVEN LITTLE: And this does warrant a complaint to-ANGELEQUE AKIN-LITTLE: Yes. STEVEN LITTLE: --the licensing, or if you're a licensed behavior analyst in your state, [INAUDIBLE] or to the BACB. ANGELEQUE AKIN-LITTLE: It does. I know. STEVEN LITTLE: This is a no-brainer. © 2019 Laureate Education, Inc. 14 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: This is a no-brainer. I know-- these are good. These are sort of like, oh, OK, the first two we had to really talk about. But I like these. These are-- I don't like them what people are doing. But this is easy to say-- and I'm sure students out there are like, OK. One thing though, I would not be against rehabilitation. So when I say lose, I don't want to be so draconian as lose your license forever, lose your certification forever. I do believe that there can be rehabilitation, absolutely, just even when-- the same with MD's, who develops a drug problem. And we had a psych student in particular who was working with MD's who were trying to rehabilitate from drug problems and then trying to earn back their license. I'm not against rehabilitation at all. STEVEN LITTLE: Oh, I agree. ANGELEQUE AKIN-LITTLE: Not at all. So I want to make that pretty clear. STEVEN LITTLE: Yeah, it doesn't have to be forever. ANGELEQUE AKIN-LITTLE: No, no, I want to make that really clear. But restraint and seclusion-- seclusion, obviously, we've made ourselves pretty clear on this. I did-- the first one I want to just-- I just want to go through and then see if you had anything to say about this, this [INAUDIBLE] Professional Practice and Ethical Issues Related to Physical Restraints and Seclusion in Schools. This articles from 2016. I hope people read this carefully. And if you see and hear when they talk about the guidelines, it's a lot of this is what we've already talked about when we were talking about the use of aversive and when we got into the use of any kind of positive punishment procedure, or when we were talking about, of course, restraint and seclusion. And we'll just look through those really, really quickly-the potential ethical issues related to the use of those procedures, the potential for death or injury, this failure-- when you're going to use that, the failure to use the least intrusive intervention. STEVEN LITTLE: While this is specific to schools, it's really not specific to schools. It would involve any-ANGELEQUE AKIN-LITTLE: It's facilities, too. STEVEN LITTLE: --facility that uses restraint and seclusion. ANGELEQUE AKIN-LITTLE: Oh, absolutely, and actually, then inappropriate restrictions on liberty. And we even talked about-- they mentioned Wyatt v. © 2019 Laureate Education, Inc. 15 Ethical Dilemmas: Part Two Stickney. You know, so we've talked about some of the court cases before. Still a really interesting article that brings everything kind of all together. So that was issue three. Issue three, again, inappropriate restriction on liberty and removal from access to education. Issue four, repeated use of a potentially dangerous and ineffective intervention. That's an ethical issue when you are using things like restraint and seclusion. STEVEN LITTLE: Well, I would say especially with that ineffective intervention, that's an ethical issue regarding-ANGELEQUE AKIN-LITTLE: In and of itself. STEVEN LITTLE: --sort of what you're doing because if something is not working, it makes no sense to continue doing it. ANGELEQUE AKIN-LITTLE: Absolutely. And we have to be cognizant of that all the time. And my hope is everybody out there has supervisors who are even better, more knowledgeable than even you and I, if that's possible, more knowledgeable than you are and I, and-STEVEN LITTLE: But-ANGELEQUE AKIN-LITTLE: --and they get really good training in that. STEVEN LITTLE: That being said, just from my experiences, I have seen places and especially the use of seclusion with some sort of a time out rule that they-ANGELEQUE AKIN-LITTLE: I hate that. STEVEN LITTLE: --they have used it even though there are no data to support the efficacy of that intervention because they've always done it, and they just put the person-- it-ANGELEQUE AKIN-LITTLE: We've talked about that. STEVEN LITTLE: I think it's negatively reinforcing-ANGELEQUE AKIN-LITTLE: I know. STEVEN LITTLE: --for the staff more than it is therapeutic for a client. ANGELEQUE AKIN-LITTLE: Yes, and we have-- we've discussed that in other podcasts, our problems with that. Especially when you look at that, you're not using the least intrusive intervention. There's so many-- and then when you think about that, I really like what you said. It's more negatively reinforcing for the staff © 2019 Laureate Education, Inc. 16 Ethical Dilemmas: Part Two to do that removal. They're not even using-- when I've seen it, they're not even using the time out procedure correctly. STEVEN LITTLE: Exactly. ANGELEQUE AKIN-LITTLE: They're bringing them out of there or they're talking to them throughout so it's not even any kind of seclusion. And I understand Steph feels like they're doing this amazing job, talking to him, oh, no, calm down. Now you're going to do good. But that's not the procedure. STEVEN LITTLE: No. ANGELEQUE AKIN-LITTLE: And we won't [INAUDIBLE] because if I keep going- it's not the fault of the intervention. It's the implementation. You know, if there's anything students remember of all these podcasts, the intervention works. Its implementation. The fidelity of the implementation. But anyway, the two other issues-- I thought this was a really good article. The two other issues they talk about, insufficient professional training, supervision, and monitoring. We had an ethical dilemma just now about monitoring. And I think what bothers me the most with the use of these types of positive punishment procedures, disproportionate use with certain critical groups. You see race and diversity. You see that as a factor in the use of these types of interventions, and that is just not tenable. No. STEVEN LITTLE: Exactly. ANGELEQUE AKIN-LITTLE: Enough said. No, no, no, no, no. STEVEN LITTLE: And I think especially when you're looking at corporal punishment. In most states that will still allow corporal punishment in schools Is that African-Americans in particular are-ANGELEQUE AKIN-LITTLE: Boys. STEVEN LITTLE: Yes. ANGELEQUE AKIN-LITTLE: African-American boys. STEVEN LITTLE: --are being-ANGELEQUE AKIN-LITTLE: And it's more-STEVEN LITTLE: --are the recipients of corporal punishment at a much higher rate than anybody else. © 2019 Laureate Education, Inc. 17 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: Again, my opinion, we see this in society as a whole in the American Society that there are more punitive measures. Now I know there's a class issue here, too. But you know, there are more punitive efforts with African-American boys and men, all right, and just in society as a whole. And again, I realized there is also a class issue. So let me just go on. There's-You did pull an article that-- it's more of a European-- authors are Welsh. So this is from 2007 talking about restraint and injury and people with intellectual disabilities. Interesting there. The Edison article-- oh, I didn't know if there was anything you wanted to point out in that particular one. That's the Jones et al.? STEVEN LITTLE: Nothing specific. I mean, I tried to-- in selecting these articles for them to read, I was trying to get a variety of different articles including something like this. This is from Wales. But the issues are exactly the same be it in Wales, be it the United states, be it in Japan. The issues are going to be the same, and we're always running into this issue with the use of any type of physical intervention when we're trying to manage aggressive or destructive behaviors. ANGELEQUE AKIN-LITTLE: But didn't you tell me-- you know, this is from '07. So yeah, we realize it's 12 years old, and the last one was from '16, which is a little more recent. But there wasn't a lot on this, the use of restraint and seclusion, which I found heartening. I'm glad. That means we're really not looking at the use of that. And it really is the use when you have a child who is engaging in a self injurious behavior. So that goes to then-- I did enjoy the one you picked out, Edelson, Understanding and Treating Self Injurious Behaviors. That's autism.com, and that's from '18. So I thought that was really-- that could be really interesting for students to see. Well, where would we actually use this? But also what's some etiology issues, ideological-- where does some of this come from ideologically? STEVEN LITTLE: Right. ANGELEQUE AKIN-LITTLE: Why are we seeing SIB? So I thought that was a good one. STEVEN LITTLE: Although on the Edelson, the one thing that I found most important is the ordering of the entire article. The first thing that they talk about is functional analysis. ANGELEQUE AKIN-LITTLE: Well, OK, there you go. STEVEN LITTLE: And which is so important, especially when dealing with self injurious behaviors is to try to identify the function of the behavior. Because © 2019 Laureate Education, Inc. 18 Ethical Dilemmas: Part Two sometimes these self injurious behaviors may even be a means of communication. ANGELEQUE AKIN-LITTLE: Well, and also-- but look at what they talk about next, physiological reasons. STEVEN LITTLE: Yes. ANGELEQUE AKIN-LITTLE: So they go through the biochemical, seizures, [INAUDIBLE]. And then I liked how they-- I absolutely liked how they-- if we're going to get involved in this, I really liked how they organized it-- what to look for, intervention. So it's a really handy-- you're not reading a lot of extra information. So it can be really handy for someone when you get a client, and that's why it's so good to do those literature searches. I mean, you could even do a Google search, you know, to do a search and have- I really liked how you had this as information for students when they go on their practicum and on their internship. They can say, OK, wait, I have a social attention. What to look for? Here are the interventions. To obtain tangibles, what to look for? And this is all-- this is just SIB, you know, Self Injurous Behaviors. I thought this one was really good for that. So keep that handy for sure. STEVEN LITTLE: Yes. ANGELEQUE AKIN-LITTLE: Keep everything handy, but that one was almost like a how-to, here's what you're looking for, et cetera. STEVEN LITTLE: And I found that doing just a Google search and then looking at places like autism.com. Now you have to be careful and recognize the source. But a lot of these can be very valuable to you. ANGELEQUE AKIN-LITTLE: And then, of course, very valuable, the APBA. We talk about that a lot. Steven and I are both members of the Association of Professional Behavior Analyst. That's the only thing of which I'm a member right now. So-- well, ABAI, but I got in as a full member. ABAI takes a lot. You have to have a dissertation. You have to have recommendations. And I-- I'm [INAUDIBLE] full disclosure. I let my membership lapse a few years, and then they want me to redo the whole thing. And-- so I don't know. OK, guys, full disclosure. But I am definitely a member of APBA. I enjoy their conventions. I think they're-- they're not so big that you can really get to know © 2019 Laureate Education, Inc. 19 Ethical Dilemmas: Part Two people and what research is going on. So I do-- I should say-- I shouldn't-- oh gosh, because ABAI is now crediting your program. [CHUCKLING] I was a full-- I did make the mark as the full member. I just-- I don't know. Sorry. APBA. STEVEN LITTLE: But if you go to ABAI-ANGELEQUE AKIN-LITTLE: Which we will go to this year. STEVEN LITTLE: Yes, but there are usually about 15,000 people in ABAI. ANGELEQUE AKIN-LITTLE: So many, gosh. STEVEN LITTLE: So-- and they have an average around 15,000. We are as APBA is going to have-ANGELEQUE AKIN-LITTLE: It's very small, and you can-STEVEN LITTLE: --maybe 2,000. ANGELEQUE AKIN-LITTLE: Yeah, you can talk to people. You really can see what's going on out there. STEVEN LITTLE: Yeah, it's a lot easier to make connections and to get to know-ANGELEQUE AKIN-LITTLE: It's what we feel. STEVEN LITTLE: --people. And the focus is all on the practice of behavior analysis and less on the more scientific aspects that you may see at ABAI. You're going to get the practice at ABAI. But you got to find-ANGELEQUE AKIN-LITTLE: You're going to get the research at ABAI. Or you get the practice at ABAI. STEVEN LITTLE: Yeah, but you only get things also that are relating to theory. You're going to get things-- you're going to get animal research that may not be as relative to you. ANGELEQUE AKIN-LITTLE: And you may really enjoy that. As a student, you may think-- you may-- I don't want to make it really excited about things like that. But we-- some of that I find very mechanical. I mean, just into the-- just really into the weeds of this and this. And sometimes you just-- I like APBA. © 2019 Laureate Education, Inc. 20 Ethical Dilemmas: Part Two [LAUGHTER] I just-- I don't know. I like APBA. But we are going to ABAI this year probably because of this Walden program. I was a full member. I appreciate the things that they're doing. And it's definitely a convention that students should attend at least a few times if they can afford it. STEVEN LITTLE: Yes, oh, I agree. ANGELEQUE AKIN-LITTLE: It's also-- I will say, honestly, APBA is quite affordable for students. And then when you look at versus ABAI, ABAI is expensive. STEVEN LITTLE: Oh, actually, even tell them how expensive it is. ANGELEQUE AKIN-LITTLE: Well, for you. Maybe-- students-- probably it's less, so-STEVEN LITTLE: The rate for the full convention, not student rate. Students get discounts. ANGELEQUE AKIN-LITTLE: Absolutely. STEVEN LITTLE: But the full-rate for the five days of the convention is over $900. ANGELEQUE AKIN-LITTLE: Yeah, it's expensive. And it's-- I guess I just-- I enjoy APBA. I like how the BACB has run things. So I don't know. But ABAI is still important. You're national, and they're also international. They have international conferences. And we've met some-- we-- while we have never gone to an international ABAI conference, we certainly have met people around the world that are New Zealanders, the Finnish-STEVEN LITTLE: Norwegians. ANGELEQUE AKIN-LITTLE: Norwegians, the Norwegians, who were doing an amazing job at a facility. That's been a few years ago. Portuguese in Portugal's, people who were doing great work. So-STEVEN LITTLE: I especially like those Norwegians because they gave me this hat that had [INAUDIBLE] contingency on the hat. ANGELEQUE AKIN-LITTLE: Yes, OK. STEVEN LITTLE: And I always liked that. © 2019 Laureate Education, Inc. 21 Ethical Dilemmas: Part Two ANGELEQUE AKIN-LITTLE: Moving on, so the last thing I wanted to do, maybe discuss a little more, I found the [INAUDIBLE] article very, very interesting. Now, yes, the date on it, it's 2001. So we're looking at almost 20 years ago this was written. And [INAUDIBLE] is talking about-- he gives you case studies, OK. And he says he's talking about a-- I guess I'll call it a sort of nutrition response or a vitamin, maybe a vitamin response to self injurious behaviors. So as far as I could tell here, Vitamin B6 and magnesium and something called DMG, dimethylglycine, that's what he says over the past 40 years, I've encountered a great many cases of severely SIB individuals, who've responded wonderfully to nutritional supplements but particularly high dose of B6 and magnesium and DMG. All right, he gives you these case examples. They're about 20 years old. He's a highly-- he's passed away now. But he was a highly respected researcher. He's not, as far as I can tell, trying to sell a product because when we were in Portugal we did have a problem with these huge promises that drug companies were making about if you just use this nutritional supplement, you know, and pay this amount of dollars, your child's going to be better. And of course, parents feeling like they weren't good parents if they didn't go and sign up and buy that, and the results were not what the drug companies were promising, I don't think this is what's going on here. B6, as we know, and magnesium, they're not harmful in large doses as some of those other nutritional programs. There were some harmful-- I don't want to get into that too much. But there was some harm that could have happened because of the use of those. So I'll stop there, and I want to hear what you have to say. And then we'll talk about our questions about that. So what was your response to reading [INAUDIBLE]? STEVEN LITTLE: You know, I did assign this. And I think it puts an issue that I think that's-ANGELEQUE AKIN-LITTLE: It's very interesting. ...

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