Conducting a Risk-benefit Analysis

1. Conductinga Risk-benefit Analysis Lauren A. Goodwyn Ethics for Behavior Analysts Caldwell College

2. Overview • Headlines • Guidelines • Where’s... the research? • Why…do a risk-benefit analysis? • What…is risk? • How…to perform risk-benefit analysis? • In practice … • Benefits for BCBA and field

3. How to Prevent Such Headlines … • BACB Task-List 3rd Edition, 1-6 • “initiate, continue, modify or discontinue behavior analysis services only when the risk-benefit ratio of doing so is lower than the risk-benefit ratio for taking alternative actions” • BACB Task-List 4th Edition • Nothing specifically stated about risk-benefit analysis

4. Guidelines for Responsible Conduct • (3.05a) • “The behavior analyst describes, in writing, the objectives of the behavior change program to the client or client-surrogate before attempting to implement the program. And to the extent possible, a risk-benefit analysis should be conducted on the procedures to be implemented to reach the objective”

5. Where’s …the research • Behavior Analysis and Treatment ed. By Van Houten & Axelrod (1993) • Chapter 8 “A Decision-Making Model for Selecting Optimal Treatment Procedure”

6. Where’s …the research • To predict risk v. benefit of behavioral program must consult experiences of practicing behavior analysis because evidence in literature is lacking • Clues about risk factors in articles in which measures were taken to ensure treatment procedure was followed to a T • Research often implemented by trained / experienced master’s-PhD level therapists • Highly controlled lab settings doesn’t generalize well to discover risks that may be uncovered in natural setting

7. Old school vs New School Spreat (1982) Bailey & Burch (2011)

8. Why …risk-benefit analysis • Goal is not to frighten but to enlighten • Presenting information in this manner requires that you have an upfront & honest discussion w/ client so that no one is surprised if unexpected side effects emerge • Need to clarify for practitioners that some procedures can increase probability of unintended behaviors • Can anyone think of some unintended behaviors that could result from a procedure?

9. What…is risk • “exposure to injury, loss, or danger” • “possibility of experiencing an outcome that is different from what is expected” • “Uncertainty arising from possible occurrence of given events; insured or property to which an insurance policy relates”

10. Related Topic: Therapeutic Dose • When taking a drug • Death / toxicity vs effectiveness • When implementing a procedure • Risk of failure / harm vs benefit of success

12. How…to conduct risk-benefit analysis • Should conduct risk-benefit analysis for each behavioral procedure suggested for implementation • Generally can use worksheets • Should research each procedure and prepare worksheet ensuring that the summary is balanced and objective

13. 8 General Risk Factors

14. 5 Benefits of Treatment

15. The SITUATION … Joanna, a BCBA, is asked to consult for a third grade classroom. Mrs. Hobbs has complained about one of her students, Jared, continuously getting out of his seat, talking to his classmates while doing work, and constantly raising his hand to make disruptive comments. This results in Jared’s poor performance in school, classmates being distracted from their work, and teacher attention and time spent trying to get Jared back on task. Mrs. Hobbs has been teaching for several years but has never implemented a behavioral procedure before but is eager for any help in the classroom. After conducting a functional assessment and several observations it is found that Jared likely engages in this behavior in order to escape from or delay work. Joanna suggests implementing a NCR escape procedure in which Jared can have access to 2 minutes of a leisure activity at his desk (i.e. playing on his iPod) every 5 minutes during independent work time.

16. Let’s Practice …Risk-Benefit Worksheet

17. Let’s Practice …General Risk Factors

18. Let’s Practice…Benefits of Behavioral Treatment

19. Risk-Benefit Analysis in Practice • Intake  FA  review literature for appropriate treatment • Meeting held w/ consumer • Give & take; if there are questions about certain side effects or possible unpredictable behavioral effects, this should be noted & revisions made • If consumer isn’t comfortable with a procedure, may need to withdraw 1 method for another • Important to have meeting before implementation • At conclusion, all parties should reach consensus on course of action • Sign & file paperwork, treatment can begin

20. 3 Additional Benefits for the BCBA and the Field • If BCBA can make significant improvements in target behaviors, improve quality of life for client & others it will increase confidence in ability to take on similar cases • Positive effects improves morale & encourages future participation in profession • Reduction of liability to designer of behavior plan • Possible contribution to body of knowledge of ABA & good public relation for the field

21. References • Bailey, J. S., & Burch, M. R. (2011). Ethics for behavior analysts (2nd Expanded Edition). Routledge. • Cooper, J., Heron, T., & Heward, W. (2007). Applied Behavior Analysis. New Jersey: Pearson Education. • http://uwf.edu/rconstand/FIN3403web/T4-RiskReturn/T4-riskreturnP02.htm • http://www.irmi.com/online/insurance-glossary/terms/r/risk.aspx