After reading Fong, et al. (2016), Brodhead (2019), and Wright (2019) describe what steps you will take to ensure that you are aware of your individual biases and how you will promote cultural humility and diversity in your behavioral analytic practice. Do behavior analysts have an obligation to engage in self-reflection regarding their biases and to improve their cultural diversity skills? List applicable Ethical Codes. Provide the rationale for the chosen codes.
*Articles attached
*At least to citations needed
SPECIAL SECTION: DIVERSITY AND INCLUSION
Patricia I. Wright1
# Association for Behavior Analysis International 2019
Abstract
Applied behavior analysis (ABA) has the intent to improve the human condition in a broad range of categories of practice and for
diverse groups of individuals across cultures. The data on the diversity of the professionals practicing in the field of ABA are
sparse. Access to ABA intervention is inequitable, and cultural differences are not adequately addressed in many current
established behavioral interventions. Cultural humility is a framework used by other professional disciplines to address both
institutional and individual behavior that contributes to the power imbalance, the marginalization of communities, and disparities
in health access and outcomes. This article discusses the adoption of culturally humble practices, specifically through the use of
self-reflection, by the field of ABA to address disparities and improve outcomes. A specific framework from the field of social
work is shared, and an adaptation to the behavior-analytic practice of self-management is provided.
Keywords Social service . Disability . Cultural humility . Applied behavior analysis . Self-reflection
Cultural humility incorporates a lifelong commitment to self-
evaluation and critique to address power imbalances and de-
velop mutually beneficial and nonpaternalistic partnerships
with communities (Tervalon & Murray-Garcia, 1998). Hook,
Davis, Owen, Worthington, and Utsey (2013) described cul-
tural humility as the “ability to maintain an interpersonal
stance that is other-oriented (or open to the other) in relation
to aspects of cultural identity that are most important to the
[person]” (p. 2). Multiple social movements (e.g., Me Too,
Black Lives Matter, Stand Up) are actively acknowledging
inequity and encouraging discourse to address injustice for
disenfranchised populations and marginalized communities.
Research documenting implicit bias by health care providers
toward marginalized communities and its deleterious effects
has long been documented (Stone & Moskowitz, 2011; U.S.
Department of Health and Human Services, 2017). Within the
field of applied behavior analysis (ABA), there is inequity in
who accesses effective behavioral interventions (Nguyen,
Krakowia, Hansen, Hertz-Picciotto, & Ankustisiri, 2016)
and in acknowledging that the design of behavioral interven-
tions does not adequately address cultural differences (Fallon,
O’Keefe, & Sugai, 2012).
The concept and process of cultural humility is meant to
replace cultural competence, because the term competence
denotes acquisition of knowledge of other cultures as an end
goal that can be mastered, whereas cultural humility recog-
nizes and requires an ongoing, lifelong learning trajectory
(Freshman, 2016). Cultural humility training was originally
developed to educate physicians to work more effectively with
diverse populations (Tervalon & Murray-Garcia, 1998).
Training in cultural humility has expanded to other profes-
sional fields, including nursing (Fahlberg, Foronda, &
Baptiste, 2016), social work (Fisher-Borne, Cain, & Martin,
2015), and education (Nomikoudis & Starr, 2016).
For the purposes of this article, the core elements of cultural
humility in Fisher-Borne et al.’s (2015) model—individual
accountability and institutional accountability—will be used
as a framework for considering its application to ABA. This
model assumes there are power imbalances that both individ-
uals and institutions must work to address through ongoing
learning and critical self-reflection. Although Fisher-Borne
et al.’s model was developed for the field of social work, it
is applicable to the work of applied behavior analysts. ABA,
like social work, is dedicated to addressing socially significant
behaviors that improve the human condition (Baer, Wolf, &
Risley, 1968, 1987; National Association of Social Workers,
2018). Behavior analysts have individual responsibility as de-
fined by the Professional and Ethical Compliance Code for
Behavior Analysts (Behavior Analyst Certification Board,
2017), and both fields have established institutions that deliver
* Patricia I. Wright
piwright04@gmail.com
1 NEXT for AUTISM, 1430 Broadway, 8th floor, New
York, NY 10018, USA
https://doi.org/10.1007/s40617-019-00343-8
Behavior Analysis in Practice (2019) 12:805–809
18 October 2019Published online:
http://crossmark.crossref.org/dialog/?doi=10.1007/s40617-019-00343-8&domain=pdf
http://orcid.org/0000-0002-1611-0592
mailto:piwright04@gmail.com
social services, including nongovernment, government, and
private agencies. Both professions have professional bodies
guiding the science (e.g., the Association for Behavior
Analysis International, the International Federation of Social
Workers), practice (e.g., the Association for Professional
Behavior Analysts, the Council on Social Work Education),
and certification (e.g., the Behavior Analyst Certification
Board, the National Association of Social Workers) within
their fields. Applying the constructs of cultural humility to
the practice of ABA may afford the field improved effective-
ness and greater influence and promote equity in the distribu-
tion of care.
The Application of Cultural Humility in ABA
Professional Ethics
The Behavior Analyst Certification Board’s (2017)
Professional and Ethical Compliance Code for Behavior
Analysts references both language and culture:
1.05 Professional and Scientific Relationships.
(b) When behavior analysts provide behavior-analytic
services, they use language that is fully understandable
to the recipient of those services while remaining concep-
tually systematic with the profession of behavior analysis.
They provide appropriate information prior to service de-
livery about the nature of such services and appropriate
information later about results and conclusions.
(c) Where differences of age, gender, race, culture, eth-
nicity, national origin, religion, sexual orientation, dis-
ability, language, or socioeconomic status significantly
affect behavior analysts’ work concerning particular indi-
viduals or groups, behavior analysts obtain the training,
experience, consultation, and/or supervision necessary to
ensure the competence of their services, or they make
appropriate referrals (p.5).
This acknowledgment of the importance of language
and culture within the Professional and Ethical
Compliance Code affirms the importance of culture at
an institutional level to ensure professionals are working
within their scope of practice. There are sparse data on
the cultural diversity of behavior analysts. One paper
recently conducted an in-depth analysis of gender
(Nosik, Luke, & Carr, 2018), but other areas, including
race, ethnicity, sexual orientation, and religion, have not
been evaluated. Ongoing institutional and individual as-
sessment of those practicing ABA can be conducted to
further determine where disparities exist.
Ongoing Learning and Critical Self-Reflection Using
Self-Management
The models of cultural competence and cultural humility are
found outside of the field of behavior analysis; however,
behavior analysts are beginning to voice the importance of
cultural competence within their scope of practice. Fong,
Catagnus, Brodhead, Quigley, and Field (2016) published an
initial paper on the topic that was stated to serve as a starting
point for developing behavior analysts’ cultural awareness
skills. Beaulieu, Addington, and Almeida (2018) conducted
a survey of 703 Board Certified Behavior Analysts to learn
about the extent of training for working with individuals from
diverse backgrounds, the perceived importance of training on
the topic, and the degree to which practitioners felt comfort-
able and skilled in the delivery of culturally competent inter-
vention. The majority of respondents felt moderately or ex-
tremely comfortable and reported they were moderately or
extremely skilled at working with individuals from diverse
backgrounds. However, the majority of respondents also re-
ported having little or no training in cultural competence. This
reported confidence without training may be indicative of a
need for behavior analysts to evaluate with greater scrutiny the
application of cultural competence in their practice. One strat-
egy to address cultural competence and humility within the
practice of behavior analysis is to review how other profes-
sional fields adopt culturally humble practices and assess the
appropriateness of these practices for behavior analysis.
Fisher-Borne et al. (2015) provide a framework for the
practice of cultural humility within the field of social work
(Table 1). The questions posed within this framework are
not operationally defined in a manner familiar to behavior
analysts and require examination for use within the practice
of behavior analysis. The well-established behavioral practice
of self-management (Cooper, Heron, & Heward, 2007) might
be considered equivalent to self-reflection and used to develop
culturally humble practices. Self-management requires three
steps: (a) a clear definition, (b) data collection and analysis,
and (c) delivery of consequences. For example, a clear defini-
tion may be that all clients have equal access to treatment,
regardless of socioeconomic status, race, or ethnicity. Data
are then collected regarding clients attempting to access inter-
vention, and those data are assessed for bias. The data can
measure the demographics of those attempting to access ser-
vice against the demographics of the local community where
the practice is located. If bias is identified, strategies are then
developed to improve access and are then applied. If equity of
treatment access is a goal for the organization, these data
might be reported publicly during staff meetings and included
in the annual report, resulting in positive reinforcement for
meeting the goal and serving the community and in punish-
ment by providing public visibility of not achieving a stated
goal and perhaps the public perception of being
Behav Analysis Practice (2019) 12:805–809806
discriminatory. This is an example of self-reflection for insti-
tutional accountability.
Self-reflection can also be used for individual accountabil-
ity, including private events. For example, when prejudicial
thoughts occur during treatment with clients, I will vocalize
these thoughts to my supervisor during our supervision meet-
ing and commit to assessing my bias and attempting to re-
move that bias from my behavioral repertoire. Data can again
be collected and analyzed on this individual behavior to assess
for change and success or lack of success of the intervention.
Individuals can record and report their frequency of prejudi-
cial thoughts during their hours of practice. Positive reinforce-
ment and punishment for this behavior can be provided
through the social praise of a supervisor or through a written
goal on a professional improvement plan. This is an example
of self-reflection for individualized accountability.
Consider the following examples to further illustrate the
application of self-reflection to promote cultural humility into
the practice of ABA.
Case 1 A transdisciplinary team including a speech-language
pathologist, educator, behavior analyst, and school psycholo-
gist are collaborating to support a student exhibiting aggres-
sive behavior toward others in the classroom. All members of
the team agree that the student’s behavior is improving. The
psychologist and educator have verbally stated that the
primary reason the child has had a reduction in aggression is
the school’s commitment to trauma-informed care and that the
educators are all now taking a trauma-informed approach in
their interactions. The behavior analyst perceives that it is a
result of functional communication training and systematic
reinforcement. The behavior analyst is aware that collabora-
tion in a transdisciplinary team can enhance the quality of
services provided, but this behavior analyst has received lim-
ited training on collaboration during preservice and in-service
training (Kelly & Tincani, 2013). The behavior analyst shares
with his supervisor that he does not understand the expertise
and cultures of the other disciplines on the team and how they
came to the conclusion regarding the child’s outcomes.
Applying self-reflection requires the behavior be defined; in
this case, it might be a professional goal set with a supervisor of
improving collaborative behaviors by identifying opportunities
for cross-training with other disciplines (Donaldson, Stahmer,
Nippold, & Camarata, 2014). The behavior analyst requests
and attends training (preferably a competency-based training)
in trauma-informed care to learn about the principles of the
practice and better discern the perceived effect it is having on
the challenging behavior. Data are collected on training atten-
dance and competency outcomes, and the behavior analyst re-
ceives reinforcement from his supervisor for attending a cross-
discipline training. In addition, the behavior analyst, through
attendance at the training, is now able to interpret the
Table 1. Individual and Organizational Questions to Assess Cultural Humility
Essential questions for critical self-reflection Essential questions to address power imbalances
Individual level • What are my cultural identities?
• How do my cultural identities shape my world view?
• How does my own background help or hinder my
connection to clients/communities?
• What are my initial reactions to clients, specifically to
those that are culturally different than me?
• How much do I value input from my clients?
• How do I make space in my practice for clients to
name their own identities?
• What do I learn about myself through listening to
clients who are different than me?
• What social and economic barriers affect a client’s
ability to receive effective care?
• What specific experiences are my clients having that
are related to oppression and/or large systemic
issues?
• How do my practice behaviors actively challenge
power imbalances and involve marginalized
communities?
• How do I extend my responsibility beyond individual
clients and advocate for changes in local, state and
national policies and practices?
Institutional level • How do we organizationally define culture?
Diversity?
• Does our organization’s culture encourage respectful,
substantive discussions about difference, oppression
and inclusion?
• How does our hiring process reflect a commitment to
a diverse staff and leadership?
• Do we monitor hiring practices to ensure active
recruitment, hiring and retention of diverse staff?
• Does our staff reflect the
communities we serve?
• Is our leadership reflective of the population/
communities we serve?
• How do we actively address inequalities both
internally (i.e., policies and procedures) and
externally (i.e., legislative advocacy)?
• How do we define and live out the core social work
value of social justice?
• What are the organizational structures we have that
encourage action to address inequalities?
• What training and professional development
opportunities do we offer that address inequalities
and encourage active self-reflection about power and
privilege?
• How do we engage with the larger community to
ensure community voice in our work? What
organizations are already doing this well?
Note. Reprinted from “Mastery to Accountability: Cultural Humility as an Alternative to Cultural Competence,” by M. Fisher-Borne, J. Caine, and S.
Martin, 2015, Social Work Education, 34, p. 176
Behav Analysis Practice (2019) 12:805–809 807
nonbehavioral terms of trauma-informed care (e.g., promoting
a safe environment) into behavioral practices (e.g., environ-
mental arrangement as a setting event). An understanding of
the behavioral principles of trauma-informed care to which the
other team members are attributing the student’s success might
lead a behavior analyst to want to describe the observed effects
in behavioral terms. However, use of behavior-analytic terms
can create a barrier among team members without behavior-
analytic training, as behavior-analytic language can be per-
ceived as harsh or unpleasant (Critchfield et al., 2017).
Refraining from reframing the practice in behavioral terms
may increase the likelihood of positive interactions with other
team members while collaborating on this case.
Case 2 A behavior analyst who was raised in a family of upper
middle-class socioeconomic status and who currently makes a
salary 400% above the poverty level for her geographic area
of residence is providing parent training to a family whose
financial status is below the poverty level. The training is to
support the family’s engagement in generalizing activities of
daily living into the home environment, including the promo-
tion of independent eating and dressing. The behavior analyst
shares with her supervisor that the family is not following the
treatment plan by purchasing the items suggested for indepen-
dent meal preparation, including microwavable prepared
meals, nor have they purchased the suggested clothing, in-
cluding elastic-waist, pull-up pants. She is concerned about
the family’s lack of compliance with the suggestions and
worries that they are not committed to participating in
treatment.
Improving cultural humility through self-reflection is
targeted as a professional improvement goal for this behavior
analyst. The supervisor and behavior analyst define the behav-
ior change for self-reflection; during supervision, the behavior
analyst will vocally and in writing list the factors that may
contribute to a family’s noncompliance with treatment goals.
The baseline data are the initial lists created by the behavior
analyst compared to the lists postsupervision, when the super-
visor assists the behavior analyst through professional learn-
ing to develop an understanding of the multiple cultural and
financial barriers, including lack of understanding of socio-
economic barriers, that would preclude a family from purchas-
ing expensive food items and limit their ability to purchase
new clothing. Positive reinforcement can be provided for in-
creasing the frequency of items listed as barriers, for identify-
ing alternative targets for treatment, and perhaps for sharing
this learned experience with other behavior analysts as a peer
educator. Negative consequences could result in required at-
tendance at a professional learning event and increased super-
vision when the behavior analyst is treating families with sig-
nificantly different socioeconomic statuses than her own.
Establishing a cultural humility repertoire requires training
and ongoing professional learning. The field of behavior
analysis is early in its application of culturally humble prac-
tices to the field. We can take advantage of principles and
strategies developed in other professional fields and tie our
behavioral practices to their frameworks so that behavior an-
alysts can improve their culturally humble practices.
Discussion
The field of ABA strives to achieve greater influence and
improved outcomes in the application of the science.
Disparity in the application of ABA exists. The application
of cultural humility to the ongoing practice of ABA may me-
diate this disparity and improve outcomes. There are limited
data regarding cultural bias within the practice of behavior
analysis. This article relies heavily on the practice of cultural
humility exhibited by other professional disciplines. The cur-
rent social movements calling for change are encouraging
discourse within the field of behavior analysis. If ABA is
going to expand its influence and ensure equal access, critical
self-reflection and behavior change are necessary. Utilizing
self-reflection may be a first step to analyzing both individual
and institutional behaviors that are limiting the effectiveness
of the application of ABA.
The field of behavior analysis is committed to using data to
understand, motivate, and measure behavior change.
Institutional data on the current cultural diversity of practi-
tioners can be measured and reported regularly. This might
include the voluntary and self-reported identities (e.g., gender,
ethnicity, sexual orientation, socioeconomic status) of those
acquiring certification in behavior analysis and those attend-
ing events catered to behavior analysts (e.g., conferences, con-
ventions, group continuing-education events), as well as at
their career milestones (e.g., fellowships and board appoint-
ments). These data could inform us of the characteristics of the
current membership. An institution delivering behavior-
analytic services can conduct a review of self-reported demo-
graphics of its professionals and clients to determine if the
institution sufficiently represents its local community. If there
is disparity, implementing alternative recruitment processes
can address the lack of diversity. Professional learning can
be offered in cultural humility, and a supportive environment
that affords opportunity for discourse regarding culture can be
fostered. Behavior-analytic service organizations might also
consider utilizing the National Standards for Culturally and
Linguistically Appropriate Services (CLAS), developed by
the U.S. Department of Health and Human Services’ Office
of Minority Health, as an assessment tool to measure their
institutional adoption of culturally humble practices (Koh,
Garcia, & Alvarez, 2014).
This introduction to cultural humility is intended to be a
starting point for applying the concepts to the practice of ABA
with the use of self-reflection as an applied practice. A
Behav Analysis Practice (2019) 12:805–809808
behavior analyst can never become competent in knowledge
and understanding of every culture. The field can begin by
cultivating a culture of practice that accepts that cultural biases
affect treatment. Individually behavior analysts have a respon-
sibility to engage in self-reflection, assessing individual cul-
tural biases and the consequent influences on their behavior
and delivery of treatment. Given the uneven power dynamic
inherent in the service delivery model, inspection and adjust-
ments are necessary to ensure that optimal outcomes for the
client are not inhibited by cultural bias. The development of
culturally humble behavioral repertoires should be encour-
aged in preservice and in-service training. Cultural humility
is never mastered; it is an ongoing practice.
Funding The author received no specific funding for this work.
Compliance with Ethical Standards
Conflict of Interest The author declares she has no conflict of interest.
Ethical Approval This article does not contain any studies with human
participants or animals performed by the author.
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DISCUSSION AND REVIEW PAPER
Elizabeth Hughes Fong1 & Robyn M. Catagnus2 & Matthew T. Brodhead3
&
Shawn Quigley4 & Sean Field5
Published online: 4 February 2016
# Association for Behavior Analysis International 2016
Abstract All individuals are a part of at least one culture.
These cultural contingencies shape behavior, behavior that
may or may not be acceptable or familiar to behavior analysts
from another culture. To better serve individuals, assessments
and interventions should be selected with a consideration of
cultural factors, including cultural preferences and norms. The
purpose of this paper is to provide suggestions to serve as a
starting point for developing behavior analysts’ cultural
awareness skills. We present strategies for understanding be-
havior analysts’ personal cultural values and contingencies
and those of their clients, integrating cultural awareness
practices into service delivery, supervision, and professional
development, and becoming culturally aware in everyday
practice.
Keywords Culture . Cultural awareness . Applied behavior
analysis . Diversity
Skinner (1953) defined culture as variables Barranged by other
people^ (p. 419). That is, humans control contingencies of
Elizabeth Hughes Fong, Robyn M. Catagnus, and Matthew T. Brodhead
shared first author
* Robyn M. Catagnus
rcatagnus@thechicagoschool.edu
1 Arcadia University, Glenside, PA, USA
2 The Chicago School of Professional Psychology, Chicago, IL, USA
3 Purdue University, West Lafayette, IN, USA
4 The University of New Mexico Medical Group, Albuquerque, NM,
USA
5 Western Michigan University, Kalamazoo, MI, USA
reinforcement and punishment that affect the behavior and
learned reinforcers and punishers of a person or a group of
people. Culture may be further defined as Bthe extent to which
a group of individuals engage in overt and verbal behavior
reflecting shared behavioral learning histories, serving to dif-
ferentiate the group from other groups, and predicting how
individuals within the group act in specific setting conditions^
(Sugai et al. 2012, p. 200). Distinguishable stimuli and re-
sponse classes that occur in cultures include race, socioeco-
nomic class, age, religion, sexual orientation, ethnicity, dis-
ability, nationality, and geographic context (Sugai et al.
2012). An individual’s unique set of distinguishable stimuli
and response classes are collectively referred to as an individ-
ual’s cultural identity. One benefit of determining cultural
identity is it can allow behavior analysts to develop an aware-
ness of a client’s personal cultural values, preferences (i.e.,
learned reinforcers), characteristics, and circumstances
(contingencies at the third level of selection; Skinner 1981).
There are possible benefits for society, too, such as to better
guide assessment and intervention practices. By acknowledg-
ing the importance of culture, behavior analysts can help
achieve socially meaningful goals such as reducing disparities
in access to services and improving the quality of services
for diverse populations in behavioral health systems
(U.S. Department of Health and Human Services 2001).
Culturally aware behavior analysts should understand their
own cultural values, preferences, characteristics, and
circumstances and seek to learn about those of their clients.
That is, behavior analysts should be aware about their own
personal biases and how they compare to and may affect their
relationship with their client. This awareness of both self and
clients may be important because, as Spring (2007) suggests,
evidence-based services require a combination of clinical ex-
pertise and knowledge of the client’s preferences and learning
histories. Behaviorally, cultural awareness may be defined as
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mailto:rcatagnus@thechicagoschool.edu
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85 Behav Analysis Practice (2016) 9:84–94
the discriminated operant of tacting contingencies of rein-
forcement and punishment administered by a group of indi-
viduals. In other words, a behavior analyst who is culturally
aware is able to identify the reinforcement and punishment
contingencies that have been established by themselves, their
colleagues, their family, and any other social group they may
belong to or identify with. Behavior analysts’ ability to tact
contingencies for self and others may facilitate development
of a behavior change program that is informed by their clients’
specific cultural contingencies.
Further, cultural awareness may be important because be-
havioral patterns that are viewed as problematic in our own
culture may be the norm in other cultures (Goldiamond 2002;
Vandenberghe 2008). Consider the following example of a
child who was referred for a functional assessment for
Bwithdrawn^ behavior. The behavior analyst and a special
education observed the student became Bwithdrawn^ after re-
ceiving verbal praise. In fact, the student ultimately stopped
engaging in any appropriate behavior which lead to the verbal
praise. While collaborating with the family to gather data dur-
ing the functional assessment, they determined that the stu-
dent’s Bwithdrawn^ behavior occurred because of child’s lack
of comfort with receiving individual attention. In the child’s
culture, the whole (i.e., community) comes before the individ-
ual. However, neither the behavior analyst nor the special
education teacher questioned their personal assumption that
the behavior is inappropriate for the classroom or their prefer-
ences about how children should act after receiving praise.
Because the student’s withdrawn behavior is maintained by
a lack of attention, the behavior analyst and special education
teacher suggest administering praise privately. In this case,
their lack of understanding about how the cultural contingen-
cies support the client’s Binappropriate behavior^ may have
resulted in a treatment recommendation that was incongruent
with cultural values. However, a culturally aware intervention,
which seeks understanding of client values, characteristics,
preferences, and circumstances would honor the client’s cul-
ture and allow the client to successful in a given environment.
A thorough behavior analytic intervention may be effective
with individuals across various cultures (Kauffman et al. 2008;
Tanaka-Matsumi et al. 1996). However, skilled, thorough, and
well-trained behavior analysts may not always consider client
culture. When assessing an individual’s or a group’s behavior,
behavior analysts often collect data about motivating opera-
tions, antecedents, behaviors, and consequences. However,
common functional assessment data collection strategies and
interview forms may not thoroughly explore cultural prefer-
ences and norms. Behavior analysts may consider the intersec-
tion of a cultural and linguistic context with the terms, concepts,
and science of behavior analysis (Jones andHoerger 2009). It is
possible that, without information about cultural preferences
and norms, behavior analysts may unintentionally provide less
than optimal service delivery.
Consider an example of a behavior analyst who provided
in-home and community services to the family of a child with
severe autism. The family, to whom church is very important,
attended a weekly three hour church service. The behavior
analyst, who did not attend church and was not a religious
person, failed to inquire in detail about the family’s and child’s
experience at church. Eventually, the family specifically asked
the behavior analyst to teach the child the necessary skills to
participate in the church service. However, the behavior ana-
lyst still did not assign a high priority to teaching the child the
skills needed for successful church attendance. The behavior
analyst’s choices demonstrated a lack of understanding of the
client’s values, characteristics, preferences, and circum-
stances. In contrast, a culturally aware behavior analyst may
be aware that Bthe selection of target behaviors is an expres-
sion of values^ (Kauffman et al. 2008, p. 254) and that paren-
tal expectations of children are likely controlled by cultural
contingencies (Akcinar and Baydar 2014).
In addition to the previous two examples, being culturally
aware may also increase the probability that behavior analysts
will engage in behaviors that are socially acceptable to people
from diverse cultural backgrounds. These behaviors include
selecting culturally appropriate treatments (see Rispoli et al.
2011), recognizing that Bparenting styles that are culture spe-
cific could lead to distinct behavioral consequences for a
child^ (Akcinar and Baydar 2014, p. 119), and implementing
culturally appropriate language acquisition programs (see
Brodhead et al. 2014). Cultural awareness could also ensure
that behavior analysts treat service delivery as Balways a two-
way street^ (Bolling 2002), meaning that the relationship be-
tween the behavior analyst and the stakeholders should in-
clude input about what cultural contingencies and values
may contribute to an effective relationship and intervention.
Finally, increasing cultural awareness may also decrease
the probability of behavior analysts expecting the clients they
serve to conform to their own cultural and scientific values
and contingencies. The science of applied behavior analysis
(ABA) is a unique cultural system (see Glenn 1993). Given
that the science of ABA inherently embodies a certain set of
values such as aWesternizedmodel of science and health care,
the cultural values and contingencies of ABA may not always
align with those of the client. As Bolling (2002) noted,
It is difficult for people in the US cultural mainstream,
including researchers, to believe that there are any assump-
tions other than their own about how the world works,
what a ‘person’ is, howwe function, how timeworks, what
feelings are, how to use language, what the goal of life is,
how people interrelate, [and] how and where it is appro-
priate to show feelings or to seek help. (p. 22)
Awareness of cultural differences and similarities may al-
low for programmatic modifications that result in more
86 Behav Analysis Practice (2016) 9:84–94
culturally appropriate models of behavior analytic service
delivery.
In summary, there may be many important reasons for be-
havior analysts to develop cultural awareness skills.
Although there is a growing interest in conceptual (e.g.,
Brodhead et al. 2014; Fong and Tanaka 2013) and applied
strategies for administering behavioral interventions for cli-
ents from diverse cultural backgrounds (e.g., Padilla
Dalamau et al. 2011; Rispoli et al. 2011; Washio and
Houmanfar 2007), there is little guidance concerning how
practicing behavior analysts can become culturally aware or
further develop that awareness. Therefore, guidance on how to
become culturally aware may be an important resource for
behavior analysts.
The purpose of this paper is to offer suggestions that can
serve as a starting point for how behavior analysts may further
increase their cultural awareness. We believe that cultural
awareness, as described herein, reflect Baer et al. (1968) state-
ment that the Bbehavior, stimuli and/or organism under study
are chosen because of their importance to man and society^
(p. 92). Individuals participating in behavior change programs
and those who provide significant support for them should
determine what is important to them, to their society, and to
their culture. In this paper, we discuss strategies for under-
standing a client’s cultural values and contingencies, as well
as those of the behavior analyst. Then, we describe strategies
for embedding cultural awareness practices into behavior an-
alytic service delivery, supervision, and professional develop-
ment. Finally, we conclude with additional discussion and
considerations for becoming culturally aware in everyday
practice.
Strategies for Developing Cultural Awareness
The following two sections describe how behavior analysts
can become more aware of personal cultural values and con-
tingencies and how they can develop skills to learn about their
clients’ cultural identities. We will refer to cultural values and
contingencies as the cultural system, except where values or
contingencies play an independent role in our analysis of de-
veloping cultural awareness. We will refer to cultural identity
as characteristics that extend beyond individual differences to
those traits that members of a given culture share with one
another (Adler 1998). For example, an individual from Africa
may express their cultural identity through their belief struc-
ture, attire, foods eaten, or hair style. Even though this indi-
vidual might identify as African, there are subcultures to
which they might further identify with. Our suggestions are
meant to serve as a starting point for furthering a behavior
analytic understanding of cultural awareness and how that
awareness can be integrated and improved upon in everyday
practice. It is recommended that behavior analysts
concurrently engage in cultural awareness practices
concerning their own behavior as well as those of their clients.
It is important to be aware of one’s own biases or
preconceived notions as a behavior analyst, as well acknowl-
edging limitations in one’s cultural knowledge. Lastly, our
suggestions are not intended to result in a rigid set of rules
or practices. Rather, our hope is the suggestions will lead to
broad practices that develop and continually refine cultural
awareness, which will hopefully allow behavior analysts to
be more open and flexible to the various cultures that will be
experienced. Openness and flexibility in the presence of var-
ious cultures will hopefully result in better outcomes for those
we serve.
Developing Cultural Awareness of Self
From a behavior analytic perspective, self-awareness can be
defined as verbal discrimination of our own behavior (Barnes-
Holmes et al. 2001). Sugai et al. (2012) describe culture as
common behaviors related by comparable learning histories,
social and environmental contingencies, contexts and stimuli,
so self-awareness might also include verbal discrimination of
these aspects of personal experience. An understanding of our
own cultural system may be an important first step toward
correcting biases that affect our interactions with others
(Lillis and Hayes 2007). The American Psychological
Association’s (APA) (2003) multicultural guidelines encour-
age clinicians to Brecognize that, as cultural beings, they may
hold attitudes and beliefs that can detrimentally influence their
perceptions of and interactions with individuals who are eth-
nically and racially different from themselves^ (p. 382).
Developing self-awareness may prevent our biases from im-
peding how we serve culturally diverse clients.
One strategy to enhance cultural self-awareness is talking
about our diverse client interactions with a professional com-
munity in group discussions, written forums, journals, men-
torship meetings, verbal feedback sessions, or self-reflective
exercises (Tervalon andMurray-Garcia 1998). Skinner (1974)
emphasized the relationship between self-awareness and con-
trol over our own behavior,and proposed that talking about
our behavior is how we achieve self-awareness. Recent be-
havior analytic research indicates that when individuals ver-
bally describe their own behavior, the behavior may change
(Tourinho 2006). Discussion with mentors and colleagues
may help behavior analysts learn about themselves and also
change their cross-cultural interactions for the better.
Another suggestion is to be Bmindful^ by attending fully
and alertly, in the moment, to client interactions and our own
private events, without judging or evaluating the events as
they occur (Bishop et al. 2004; Hayes and Plumb 2007;
Vandenberghe 2008). We recommend practitioners hone their
ability to attend closely to clients and self, in context, for two
reasons related to self-awareness. First, such attention may
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87 Behav Analysis Practice (2016) 9:84–94
help enhance skills of self-observation and self-description
regarding our overt and covert behavior. Also, while we can
remain committed to overtly behaving in ways consistent with
values of multiculturalism, even in the presence of values and
contingencies that create bias, mindfulness may reduce the
biases that produce thoughts, feelings, and reactions to cultur-
ally diverse people (Lillis and Hayes 2007). Attending closely
to our clients and being active and alert is good practice for
building rapport, too.
Clinicians can engage in more culturally aware practice by
assessing, collecting data, and testing hypotheses rather than
accepting their own experiences and biases as the norm (Sue
1998). Scientific mindedness is a characteristic of clinicians
and human service providers who develop theories about cli-
ent behaviors by analyzing data rather than by dependence on
their personal assumptions (Sue 1998), and may reduce bias
and foster better understanding of client behavior. A reliance
on scientific, behavior analytic knowledge when workingwith
clients is also required by the Professional and Ethical
Compliance Code for Behavior Analysts (BACB 2015).
While mindful attention focuses on the interaction between
the behavior analyst and the client/family, scientific minded-
ness is a focus on interpreting information from the client and
family; both characteristics facilitate culturally aware practice.
For example, a behavior analyst consults to a family of a child
with a sleep disorder, and learns that the mother sleeps in her
five-year-old child’s bed while the father sleeps in a larger
room, alone. The practitioner may notice, and be able to co-
vertly tact, that this is not the norm of the cultural majority nor
congruent with his personal experience or values. The analyst
may assume that the mother should not sleep in the child’s bed
or notice thoughts of judgment he feels. Lillis and Hayes
(2007) recommend practitioners accept that such reactions
may be normal, given our cultural systems and the human
tendency to evaluate, but remain committed to acting positive-
ly based on our values. Through a process of assessment and
covert verbal behavior, the practitioner might accept the co-
sleeping arrangement to be culturally appropriate for and pre-
ferred by the family, and choose to develop an intervention
that keeps the arrangement in place. A blend of both self-
awareness and reliance on scientific knowledge is likely to
produce the most culturally aware assessment and
intervention.
Finally, there are several self-assessment tools that behav-
ior analysts can use to become more aware of their own cul-
tural identity. We recommend the use of assessment tools for
measuring and reflecting on the clinician’s own cultural
biases, values, and understanding. One assessment tool, the
BDiversity Self-Assessment,^ that can be utilized during the
intake process allows team members to examine their under-
standing of diversity (Montgomery 2001); this tool asks users
to reflect on their own assumptions and biases by answering
11 questions. Another assessment tool that may be useful is
the self-test questionnaire entitled BHow Do You Relate to
Various Groups of People in Society?^ (Randall-David
1989). This questionnaire asks respondents how they might
respond to individuals of various cultural backgrounds—by
greeting, by accepting, by obtaining help from, by having
background knowledge about, and/or by advocating for the
individuals. The 30 types of individuals in these questions are
then organized into five categories: ethnic/racial, social issues/
problems, religious, physically/mentally handicapped, and
political, and a concentration of checks within a specific cat-
egory of individuals or at specific levels of response may then
indicate a conflict that could prevent the respondent from pro-
viding effective treatment. Behavior analysts can then consid-
er how their biases might affect treatment and may consider
other courses of action, such as making referrals to other be-
havior analysts. A final potentially useful measure is the
Multicultural Sensitivity Scale (Jibaja et al. 2000), a 21-item
self-assessment tool developed as a valid and reliable way to
measure multicultural sensitivity. This tool was originally
used to assess the multicultural sensitivity of teachers and
was later adapted to be used by physician assistant students
(Jibaja-Rusth et al. 1994). Altogether, the behavior analyst
may find these assessments helpful in further developing their
own cultural awareness in order to further develop culturally
competent methods of service delivery.
Developing Cultural Awareness of Clients
The above section describes strategies for how a behavior
analyst may learn about his or her own cultural system.
Below, we describe how behavior analysts may learn more
about their client’s cultural system through assessment prac-
tices. Culturally aware assessment practices may allow behav-
ior analysts to obtain important cultural information about
clients in order to understand their worldviews. Culturally
aware assessment may also allow behavior analysts to identify
any potential cultural barriers such as modalities of commu-
nication and expression of emotions (see Garcia et al. 2003).
To increase the probability that assessment will identify
cultural variables, Vandenberghe (2008) recommends focus-
ing on functional relations and behavioral principles rather
than topography. For example, Filipino families often live
with extended family members, and the household situation
can seem chaotic by Western living standards. If a child has
difficulty sleeping, a behavior analyst may advise the parents
that they should separate the sleeping room from the living
room. People of Filipino descent may be shy about responding
to someone in a position of authority, so they may say Byes^ to
the behavior analyst. However, during the following session,
it might be revealed that the parents did not change anything
and that the child is still sleep deprived. In this case, a natural
reaction may be to become frustrated with the lack of parental
follow through. However, lack of follow through may also be
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88 Behav Analysis Practice (2016) 9:84–94
interpreted as an indicator that the intervention recommenda-
tion may not have been culturally appropriate.
Vandenberghe’s (2008) description of functional analytic
psychotherapy may also be a useful resource for determining
how to provide culturally aware behavior analytic practices.
Vandenberghe (2008) emphasizes the need for a behavior ana-
lyst to be aware of differences that may exist, including cultural
differences, between the behavior analyst, client, and their fam-
ilies. Specifically, behavior analysts should be knowledgeable
about the client’s culture, differentiate between an unfamiliar
cultural norm and a pathology, and take culture into
consideration during the therapeutic process. Finally, Hymes
(1962) noted that communicative competence is related to an
individual’s awareness of the laws of language structure and
language use within a given culture. Therefore, behavior ana-
lysts should be skilled in sending and receiving cultural com-
munications. Specific recommendations are described below.
Recommendations
Consider the Language of Assessment Our first recommen-
dation, which applies to all phases of assessment and treat-
ment, is that behavior analysts should reflect on the spoken
and written language he or she uses and how it will be per-
ceived by the client. We recommend behavior analysts avoid
the use of behavior analytic jargon, as it may confuse clients
and their families, and possibly lead to their failure to imple-
ment interventions. This recommendation is consistent with
the Professional and Ethical Compliance Code for Behavior
Analysts (2015). For example when the phrase Bfunctional
analysis^ is used, Japanese families assume that it is mathe-
matical jargon rather than a reference to a behavior analytic
assessment process. Avoidance of excessive or complex be-
havior analytic jargon may eliminate such problems.
It is important throughout assessment and treatment to
communicate in a manner easily understood, culturally aware,
and does not include terms that are culturally inappropriate or
confusing (Rolider andAxelrod 2005). Furthermore, it may be
important to consider who will be completing service related
forms (e.g., intake paperwork) and whether the level of liter-
acy and comprehension of the language used in the forms are
similar. If a person lacks adequate language comprehension,
completing paperwork may be difficult, embarrassing, or in-
timidating. In such a case, behavior analysts may consider
giving the person the opportunity to complete the forms orally
or have another person help with the form completion. They
may also consider using an interpreter or providing forms in
the person’s native language. Additionally, we agree with
Vandenberghe’s (2008) recommendation that the language
used to define problem behaviors should be carefully exam-
ined to ensure the behaviors are communicated in a positive
manner using multiple forms of communication that are sen-
sitive to potential cultural differences in eye contact, wait time,
meanings of words, non-vocal body language, personal space,
and quality of voice.
Understand Cultural Identity Our second recommendation
is to consider that the client, and the client’s family and com-
munity, are important sources for acquiring an understanding
the cultural identity of the individual. Therefore, we recom-
mend conducting an analysis of cultural identity with stake-
holders immediately after service initiation with the client and/
or family. The cultural identity analysis should inform the
assessment process and the designing of interventions.
During intake, the behavior analyst may, with proper consent,
gather input from key community members familiar with the
client, in addition to those whose feedback is typically sought
(e.g., teachers, professionals, administrators, and family).
Additionally, the behavior analyst should seek recommenda-
tions from the family regarding additional parties (e.g., other
community members) who should be involved. Family and
community members may be able to provide the most valu-
able information regarding the client’s culture, language, and
sociocultural framework (Salend and Taylor 2002). These dis-
cussions will allow members of the team to acquire a mutual
understanding of the client’s cultural system, which may result
in increased cultural awareness.
It is important to highlight that the client/family’s language
is an important cultural variable that should be understood in
addition to collaboration with stakeholders. For example, be-
havioral patterns may be similar across cultures, while
the language and concepts that are used can differ
(Vandenberghe 2008). In Japan, parents and teachers may
use the word Bpanic^ to describe a child’s behavior, and this
may imply a Btantrum^ or Bmeltdown.^ Because the word
Btantrum^ is often associated with baby colic behavior, par-
ents and teachers may prefer to use Bpanic^ to describe the
aggressive behavior of older children.Without knowing this, a
behavior analyst may initially misunderstand what the client’s
challenging behavior is. It is therefore important for behavior
analysts to clarify what the client or family actually mean by
the terms they use.
The behavior analyst should also consider accounting for
what treatments are appropriate, preferable, or considered
norms within a culture. As illustrated by the example of the
Filipino family at the beginning of this section, identifying
cultural norms may be important for successful assessment
and effective treatment. Information about what is acceptable
within a person’s culture is also ideally obtained beginning
with the intake process (and later during the assessment pro-
cess) by including stakeholders in the process and ensuring
that background information includes input from multiple
sources of information (assessments and interviews; Sugai
et al. 2012). For example, the grandparents rather than the
parents may be the primary caregivers in an Indian family.
Therefore, it would be important to include the grandparents
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89 Behav Analysis Practice (2016) 9:84–94
during intake in order to obtain information. During later
phases of the intervention, it may also be beneficial to contin-
ue to involve the family in development of the data collection
and to make changes in the intervention based on the family’s
interactional style. In designing the intervention, the team will
then be able to include culturally appropriate reinforcers and
skill building, again taking into account strategies that are
appropriate to the client’s culture and belief system.
It may also be important to define a client’s behavior in
positive terms and in relation to cultural norms to help ensure
culturally aware behavioral definitions. For example, in exam-
ining table manners across cultures, French parents may be-
lieve that child table manners are the essence of their culture.
In Japan, in contrast, many children will leave the table during
a meal, and it is acceptable in certain settings for them to run
around, even in restaurants. More specifically, during lunch
with family friends, a Japanese child might imitate a peer and
leave the table during lunch with a smile on his or her face. For
Japanese parents, this is the cultural norm, but French parents
often consider this behavior is inappropriate.
Use Readily Available Resources Our third and final
recommendation for this section is for behavior analysts to
consider making use of the resources that are already available
to help make their practice more culturally aware. Salend and
Taylor (2002) describe guidelines for creating more culturally
aware functional behavior assessments. These guidelines suggest
behavior analysts should involve family, community members,
and professionals to learn about the client’s culture and examine
possible sociocultural explanations of behavior. They also sug-
gest behavior analysts attend trainings and engage in activities
that allow them to reflect on how their culture might impact their
belief system (Salend and Taylor 2002).
Another resource that can help behavior analysts en-
hance their culturally awareness is provided by Sugai
et al. (2012). The authors discuss how applied behavior
analytical terms can be understood within different cultural
contexts. For example, in some cultures, the concept of
reinforcement can be illustrated by describing the act of
bowing to greet one another. In this exchange, a bow is
more likely to be given if a person is first bowed to, thus
the initial bowing behavior is reinforced. Like Salend and
Taylor (2002), these authors describe how steps in inter-
ventions, such as school-wide positive behavior support,
can be made more culturally aware—for example, by using
activities that are considerate of learning histories and the
norms and values of the culture, family, school, and
community.
Tanaka-Matsumi et al. (1996) also provided another re-
source for increasing culturally aware behavior analytic ser-
vices. Specifically, the authors provide guidelines for
conducting a culturally informed functional assessment inter-
view, in which increases in accurate case formulation,
decreases in diagnostic errors, decreases in attrition, increases
in the credibility of the therapy, and increases in the expecta-
tion of positive change, client compliance, and active partici-
pation in treatment might be a result. The authors emphasize
the importance of examining the functional relationships be-
tween a client’s behavior and culture, which may increase
buy-in from all parties involved and help acquire an accurate
description of the client’s challenging behavior.
Moving from Assessment to Treatment Once information
has been obtained through reflection on and assessment of the
client’s culture as well as the behavior analyst’s own culture,
the behavior analyst can use the information to make informed
decisions about next courses of action, such as accepting the
client, referring the client elsewhere, seeking additional infor-
mation about the client’s culture, or securing supervision from
a more experienced behavior analyst as needed. It should be
noted that lack of a cultural match does not necessarily mean
that the behavior analyst cannot provide adequate services to
the client. A behavior analyst should rely on professional ex-
perience and knowledge to serve this client, given the behav-
ior analyst’s cultural context, but should also remember that
within-group differences are greater than between-group dif-
ferences (Sue 2003). For example, a client of the same race
and socioeconomic background may not have cultural norms
that are strongly similar to those of the behavior analyst. There
are various domains of culture (e.g., family, geography, sexual
orientation, and religion) that relate to the behavior of the
individual. A behavior analyst who lacks experience and
knowledge to serve a culturally different client should seek
additional information about the client’s cultural behaviors,
values, and norms and should also seek direct exposure to
culturally similar experiences and people, if possible (Sugai
et al. 2012; Vandenberghe 2008). Finally, even when behavior
analysts strive to be more culturally aware, provision of cul-
turally aware services may not always go smoothly
(Vandenberghe 2008), so behavior analysts should view skill
development in this domain as a process and engage in ongo-
ing assessment to continually improve their practice (see the
BCultural Awareness Training in Graduate and Professional
Development Programs^ section below).
Recommendations for Increasing Cultural
Awareness within Clinical Organizations
and Professional Development Programs
In order for behavior analysts to become aware of the cultural
values of their clients, as well as their own cultural values,
service delivery and training programs must also develop sys-
tems of support and encourage professional growth in this
area. The following recommendations concern how
cultural awareness training can be integrated into clinical
90 Behav Analysis Practice (2016) 9:84–94
organizations and graduate and professional development pro-
grams. These recommendations are not all inclusive; rather,
they highlight examples of how behavior analysts can institu-
tionalize cultural awareness within their professional and
training systems.
Increasing Cultural Awareness within a Clinical
Organization
One strategy to increase the likelihood of culturally aware
behavior is to embed cultural awareness training and supervi-
sion at the institutional level within an organization.
Implementing training and supervision systems may help an
organization achieve the goal of institutionalizing the skill of
cultural awareness (see Betancourt et al. 2003, for suggestions
on cultural competency training for health care workers). The
following three recommendations are based on Brodhead and
Higbee’s (2012) recommendations for using behavioral sys-
tems to teach andmaintain ethical behavior in a human service
organization.
The first recommendation is to identify an individual with-
in the organization who can be charged with ensuring that
cultural awareness is addressed. Because it is likely not to be
reasonable or possible for all members of the organization to
focus solely on developing cultural competency, it may be
useful for an organization to identify one individual who can
help guide the development of cultural awareness in other
members of the organization. This individual’s role would
be similar to that of the ethics coordinator described by
Brodhead and Higbee (2012). The identified individual who
would focus on cultural competency would also be responsi-
ble for identifying points of discussion for individual and
group supervision and would also serve as a reference within
the organization to stay up-to-date on best practices for cul-
tural competency.
The second recommendation is to incorporate cultural
awareness training into individual supervision. During indi-
vidual supervision, the supervisor can ask the supervisee to
discuss any instances where conflicts between cultures might
result in barriers to effective service delivery. For example, a
supervisee may seek feedback on the appropriate way to re-
spond when offered food during in-home consultation. The
supervisee may also seek guidance on how the cultural values
and contingencies of a specific family should be considered
when designing a parent training, as parental values might
lead to parenting styles that are culture specific (Akcinar and
Baydar 2014). The purpose of discussing cultural awareness
during supervision meetings is to provide multiple, continu-
ous opportunities for feedback and discussion. It is recom-
mended that fidelity checklists be developed and used in su-
pervision include items that assess cultural awareness during
assessment, intervention, and ongoing consultation.
The third recommendation is to incorporate cultural aware-
ness training into group supervision and training. Similar to
company-wide trainings on ethics, functional assessment, and
skill acquisition, trainings on cultural competency can allow
for group discussion and feedback on best practices for the
cultures the organization is likely to serve. Difficult or impor-
tant questions that arise during individual supervision can be
addressed during group training, allowing for additional op-
portunities for discussion and feedback about the appropriate
service delivery under a given set of cultural variables.
Discussions can be facilitated by a company expert in cultural
competency to ensure that topics are adequately addressed
(see Wolfe and Durán 2013, for a review and suggestions for
a similar training in a public school setting).
One strategy for behavior analysts to document the efficacy
of their services may be to distribute social validity surveys to
the clients they serve. Social validity surveys can ask whether
clients are pleased with their interactions with the behavior
analyst, whether the behavior analyst is respectful of cultural
values, and whether the behavior analyst recommends cultur-
ally appropriate interventions. Such a survey could also be
useful for evaluating the effectiveness of supervision and pro-
fessional development programs in creating culturally aware
behavior analysts.
Cultural Awareness Training in Graduate
and Professional Development Programs
Developing training programs for behavior analysts that teach
cultural awareness could have a positive impact on the field of
behavior analysis. This is especially important given the re-
cent expansion of behavior analysis training programs as well
as the application of behavior analysis outside of the United
States. To address the need to develop cultural awareness
skills, behavior analysts will need to develop coursework spe-
cific to cultural awareness, develop standards for practice and
competency (Carey and Marques 2007; Diaz-Lazaro and
Cohen 2001; Fong and Tanaka 2013; Westefeld and
Rasmussen 2013), and develop continuing education oppor-
tunities to assure continued competency (Cross et al. 1989).
One strategy to ensure that the professional development of
behavior analysts addresses cultural awareness is to include
cultural awareness content in behavior analytic course se-
quences. The BACB Fourth Edition Task List does not explic-
itly cover cultural awareness or content related to cultural
systems. However, other comparable fields such as psycholo-
gy and medicine require specific training for cultural aware-
ness (American Psychological Association [APA], 2015;
Association of American Medical Colleges 2005).
Specifically, medical students are required to have cultural
competency training integrated into their curriculum in order
to assure that cultural competency is established as an impor-
tant and pervasive issue in the provision of care. Furthermore,
91 Behav Analysis Practice (2016) 9:84–94
there exist specific accreditation standards in psychology re-
lating to cultural competency in the practice of psychologists
that concern the various means by which cultural competency
can impact the conduct of the behavior analyst (APA 2015). In
addition to ethical standards regarding the practice of behavior
analysis, we recommend that the field adopt appropriate cul-
tural training standards. While it may be the case that effective
assessment and intervention will likely include an analysis of
relevant cultural variables, the absence of training standards
related to conducting and developing culturally aware practice
skills in our discipline’s task list (BACB 2015) may lead to a
failure to foster and develop the necessary skills. Specifically,
these training targets would be of the greatest importance in
BRecommendations for Increasing Culture of Awareness
within Clinical Organizations and Professional Development
Programs^ Section of the task list, which focuses on the de-
velopment of skills related to the client-centered responsibili-
ties of aspiring behavior analysts.
Another strategy to increase cultural awareness may be to
institutionalize standards of practice for serving clients from
diverse cultural backgrounds. Representing the Multicultural
Alliance of Behavior Analysis, a special interest group of the
Association for Behavior Analysis International, Fong and
Tanaka (2013) published a list of seven standards for cultural
competence in behavior analysis. These standards include un-
derstanding one’s own cultural biases and how these might
conflict with the biases of those they serve, using culturally
aware applications of behavior analysis, and advocating for
diversity in the workplace. Fong and Tanaka (2013) also sug-
gest that behavior analysts advocate for culturally appropriate
language interventions, participate in continuing education
and training related to cultural awareness, and make appropri-
ate referrals if they are not qualified to work with diverse
clients. We encourage organizations and training programs
to review Fong and Tanaka’s (2013) recommendations and
consider integrating them into supervision and coursework.
Researchers, creators of training materials, and administra-
tors of university programs can all contribute to developing
cultural awareness skills in the field. We encourage more re-
search on topics of diversity, cross-cultural implementation,
and international dissemination of ABA. It has been recom-
mended that when behaviorally oriented researchers publish
articles, the BParticipant^ section include more information
about cultural variables (Brodhead et al. 2014; Kaufman
et al. 2008). We further suggest that authors of textbooks
and training manuals, and designers of continuing education
and online trainings increase the number and variety of topics
related to culture and diversity. By adding more examples of
scenarios involving issues of diversity, cultural awareness, and
culturally aware assessment and intervention, behavior ana-
lysts may continue to lay the groundwork for pre-service be-
havior analysts to practice more effectively with a broader
range of populations. Administrators and faculty in
universities can set specific learning outcomes for teaching
about diversity and cross-cultural implementation skills.
Such initiatives can be adopted at the level of the university
or within an academic department. Behavior analytic training
programs can also develop student abroad experiences to in-
troduce students to different cultures or program experiences
involving different local cultures. Effectiveness with diverse
populations can be specified as both a value and a learning
outcome for students in our programs.
A final strategy for integrating cultural awareness into pro-
fessional development is to encourage continuing education
requirements for cultural awareness. In the field of behavior
analysis, professional development with respect to cultural
awareness receives no special attention. As a result, if behav-
ior analysts in the field come into contact with issues related to
culture in continuing education, they are likely to do so in the
general category of ethics. Even if standards for cultural
awareness are not established, we recommend that qualified
behavior analysts consider conducting continuing education
trainings on cultural awareness in order to increase the prob-
ability of behavior analysts coming into contact with impor-
tant information related to cultural systems.
Discussion
Two decades ago, Hayes and Toarmino (1995) asked, Bif be-
havioral principles are generally applicable, why is it neces-
sary to understand cultural diversity?^ Today, behavior ana-
lysts may remain unconvinced that specific training in cultural
awareness is required. The BACB Fourth Edition Task List
does not directly address cultural awareness in its own titled
guideline, and most behavior analytic graduate and certificate
programs are based in large part on the Task List (BACB
2012). We argue that few specific practice guidelines are
available to behavior analysts. However, the Professional
and Ethical Compliance Code for Behavior Analysts (BACB
2015) does touch on this topic, with the requirement that
Where differences of age, gender, race, culture, ethnic-
ity, national origin, religion, sexual orientation, disabil-
ity, language, or socioeconomic status significantly af-
fect behavior analysts’ work concerning particular indi-
viduals or groups, behavior analysts obtain the training,
experience, consultation, and/or supervision necessary
to ensure the competence of their services, or they make
appropriate referrals. (p.5)
However, we suggest that such cultural differences always
affect our work with individuals or groups. Therefore, it may
be important for behavior analysts to continue to develop their
cultural awareness skills by systematically ensuring ongoing
http:field.We
92 Behav Analysis Practice (2016) 9:84–94
training, experience, and supervision for cultural competence
and awareness.
The above recommendations are meant to serve as a starting
point for considering strategies to increase cultural awareness
among behavior analysts. Although the recommendations may
very well improve a behavior analyst’s cultural awareness, there
are several additional considerations and limitations to our rec-
ommendations. First, it is important for behavior analysts to not
make gross generalizations about clients or their families based
on the culture(s) they represent. Specifically, if an individual lives
in the United States of America, is light skinned, attends a
Christian denomination church and speaks English fluently,
one should not assume that the individual is of European
American descent. In fact, that individual might be of Hispanic
descent, speak Portuguese fluently, come from Guatemala, and
reside in the United States temporarily while competing higher
education requirements. It is very possible that avoiding such
generalization or stereotyping can be difficult when learning or
teaching about cultural practices as part of a cultural awareness
system. However, collecting information about different cultural
systems should place behavior analysts in a better position to
Binfer the possible effects of the environment^ in order to make
effective treatment recommendations (Brodhead et al. 2014,
p. 81). Therefore, we encourage behavior analysts consider our
recommendations for increasing culturally awareness prior to the
intake process.
Another limitation of this paper is that it does not provide
systematic guidelines for how behavior analysts should work
with culturally diverse clients. However, because there is a
lack of resources in the area of cultural awareness and behav-
ior analysis, we hope this paper serves as a starting point for
future discussions and analyses. Systematic guidelines for
practicing behavior analysts have been published in other
areas, such as guidelines for identifying an appropriate
function-based treatment for escape-maintained problem be-
havior (Geiger et al. 2010) and for maintaining professional
relationships (Brodhead 2015). Therefore, it may be useful for
future researchers or behavior analysts to develop systematic
guidelines for working with culturally diverse clients in order
to provide practicing behavior analysts with a systematic
framework for their work.
Finally, it is important to note that the fidelity of the behav-
ior analytic intervention should not be compromised in order
to incorporate culturally aware practices. It is very possible
that a culturally informed assessment may lead to a culturally
informed intervention that may ultimately lead to implemen-
tation with high fidelity. Whereas, an assessment that is not
culturally informed may lead to an intervention not matched to
client culture which then can’t implemented with fidelity. In
some cases, however, multiple courses of treatment may be
available to deliver the same treatment outcome. If this occurs,
we recommend that behavior analysts consider identifying the
most culturally appropriate treatment whenever possible. See
Padilla Dalamau et al. (2011) for an example of identifying
client preferences for functional communication training
interventions.
In summary, cultural variables matter even when
implementing practices supported by research and based on
the science of behavior analysis (Sugai et al. 2012). No be-
havior analyst can learn everything about every culture.
However, we can develop skills to collect the right data and
to understand ways in which culture may affect reinforcers,
goals, teams, and interventions in general. We can cultivate
awareness of diversity and willingness to honor what is right
for our clients. Behavior analysts may not be even aware of
how much our personal learning histories differ from the con-
tingencies related to our clients’ behaviors, their reinforcers,
their behavioral patterns, and the effect of the societal systems
in which they live. Continuing to cultivate openness to learn-
ing about these variables, along with an awareness of the
limitations created by our personal learning histories, may
lead us in new directions that will benefit diverse populations
with behavior analysis. The growing diversity of our popula-
tion expands the complexity and variety we can expect to
encounter, and so we must continue to develop cultural com-
petence skills through behaviors of awareness, collecting the
right data, and honoring what is important to our clients.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no competing
interests.
Ethical Approval This article does not contain any studies with human
participants or animals performed by any of the authors.
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Abstract
Strategies for Developing Cultural Awareness
Developing Cultural Awareness of Self
Developing Cultural Awareness of Clients
Recommendations
Recommendations for Increasing Cultural Awareness within Clinical Organizations and Professional Development Programs
Increasing Cultural Awareness within a Clinical Organization
Cultural Awareness Training in Graduate and Professional Development Programs
Discussion
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Behavior Analysis in Practice
https://doi.org/10.1007/s40617-019-00351-8
SPECIAL SECTION: DIVERSITY AND INCLUSION
Matthew T. Brodhead1
# Association for Behavior Analysis International 2019
Abstract
The purpose of this paper is to draw attention to and highlight some particularly enlightening arguments described by Rosenberg
and Schwartz (2019). First, I emphasize the importance of the role of culture in ethical analysis and describe how the Behavior
Analyst Certification Board (BACB) Professional and Ethical Compliance Code for Behavior Analysts (2014; hereafter referred
to as the BACB Code) unintentionally underplays the importance of culture. Second, I express support for the model of ethical
analysis proposed by Rosenberg and Schwartz and explain how their model provides an excellent and much-needed framework
for the observation (and subsequent study) of ethical decision-making in behavior-analytic practice. Finally, I go all in and join
Rosenberg and Schwartz in their call for scholars to critically analyze and discuss the BACB Code and to challenge the status quo
(or call into question those who do). Such a discussion is healthy for our science and understanding of ethics and behavior
analysis.
Keywords applied behavior analysis . culture . ethics . decision-making models . dissent
Culture Always Matters
A behavioral analysis of culture is not new. Skinner discussed
the role of culture (defined as contingencies arranged by other
people) in multiple writings, including Science and Human
Behavior (1953), Walden Two (1976), and his paper
“Selection by Consequences” (1981). Sugai, O’Keefe, and
Fallon (2012) provide a more contemporary definition of cul-
ture, defining culture as “the extent to which a group of indi-
viduals engage in overt and verbal behavior reflecting shared
behavioral learning histories, serving to differentiate the group
from other groups, and predicting how individuals within the
group act in specific setting conditions” (p. 200). In addition to
behavioral definitions of culture, other scholars, such as Sigrid
Glenn (e.g., 1993), Mark Mattaini (e.g., 2010), and Maria
Malott (e.g., 1992) have written extensively about the role of
cultural variables and their effects on human behavior.
Culture goes well beyond one’s geographical identity.
Sexual identity, socioeconomic status, and opinions about
medicine, politics, and science are all but a few examples of
broad and impactful cultural variables that affect the everyday
* Matthew T. Brodhead
mtb@msu.edu
behavior of ordinary people. Consider the simple example of
the cultural selection of verbal behavior. Coffee may be a
learned reinforcer, but the mand forms that result in access
to coffee (e.g., “Quiero café por favor” or “May I have some
coffee?”) are culturally selected (Brodhead, Durán, & Bloom,
2014). I challenge the reader to identify nonexamples of cul-
tural variables in order to emphasize the importance and enor-
mity of how our social constructs affect what we say and do.
The field of behavior analysis is a cultural system (see
Glenn, 1993) that is informed by the values of Western med-
icine (Brodhead, Cox, & Quigley, 2018a). As Rosenberg and
Schwartz (2019) astutely note, the very existence of a rule-
based system is a Western-centric belief. I note that this is not a
criticism of our science and scientists, per se. Instead, I intend
to further highlight that our core values, such as our philo-
sophical values of determinism (Skinner, 1953) and what de-
fines applied behavior analysis (Baer, Wolf, & Risley, 1968),
are built upon just one of many perspectives upon which we
are able to draw to assemble our own worldview. Put another
way, the Western model is one of many cultures that may exert
control over human behavior. From a point of binary compar-
ison, a Western model of medicine may view environmental
changes as primary variables in behavioral health and treat-
ment, whereas the Eastern model of medicine may instead
emphasize the consideration of the body and mind in
behavior-change procedures (World Health Organization,
Michigan State University, East Lansing, MI 48824, USA 2000). 1
http://crossmark.crossref.org/dialog/?doi=10.1007/s40617-019-00351-8&domain=pdf
http://orcid.org/0000-0003-4567-0051
mailto:mtb@msu.edu
https://doi.org/10.1007/s40617-019-00351-8
Behav Analysis Practice
Despite the scholarly definitions of culture and a small but
emerging base of research on this topic in behavior analysis,
the role of culture has been largely neglected in behavior-
analytic scholarship on ethical analysis. When discussions of
the role of culture in ethical analysis do exist, they have main-
ly centered around considerations of variables to take into
account when interacting and providing services to diverse
clients. One specific example is the cultural practice of gift
giving or exchanging. Bailey and Burch (2016) note that one
of the most talked about elements of the Behavior Analyst
Certification Board’s (BACB’s) Professional and Ethical
Compliance Code for Behavior Analysts (2014; hereafter
referred to as the BACB Code) has centered around BACB
Code 1.06d, which states that “behavior analysts do not accept
any gifts from or give any gifts to clients because this consti-
tutes a multiple relationship.” In addition to noting the popu-
larity of BACB Code 1.06d, Bailey and Burch make the ar-
gument that cultural analysis is irrelevant when considering
this code in ethical analysis. Specifically, they liken behavior
analysts to tradespeople (e.g., a plumber or electrician) and
say that “it seems nonsensical to expect these tradespeople
to bring gifts or accept them” (p. 73). They argue that the
cultural experience of gift exchange is not relevant to behavior
analysis and requires no further consideration or analysis.
The recommendation that cultural analysis is “nonsensical”
is incongruent with what is known to be best practice in cul-
tural competence in human-service delivery (Fong, Catagnus,
Brodhead, Quigley, & Field, 2016; Witts, Brodhead,
Adlington, & Barron, 2018). Cultural competence, in fact, is
a two-way street, a respectful convergence of ideas (e.g., cul-
tural variables) that results in the development and implemen-
tation of optimal treatment (Bolling, 2002). Cultural compe-
tence does not mean that our clients should only cross the
street in our direction.
As noted by Rosenberg and Schwartz, cultural variables
greatly add to the complexity of ethical analysis.
Unfortunately, the BACB Code has not focused on the impor-
tance of culture in ethical analysis. In addition to Bailey and
Burch’s (2016) dismissal of certain cultural practices in ethical
analysis, only in BACB Code 1.05 (Professional and
Scientific Relationships) is the term culture mentioned, and
only briefly by noting that the behavior analyst must resolve
any differences in culture that affect services. As Rosenberg
and Schwartz point out, culture is much more important and
complex than what I am sure was meant when the current
version of the BACB Code was written or how it is portrayed
in popular texts on ethics and behavior analysis.
I hypothesize that the direct and specific language of
BACB Code 1.06d has created a black-and-white approach
to ethical decision-making that may affect people who are new
to our field. Furthermore, I fear this approach has
overgeneralized to other elements of the BACB Code. This
is the same decision-making process that Rosenberg and
Schwartz argue against, and they make clear that rigid think-
ing may result in a superficial ethical analysis, at best.1 But
because of BACB Code 1.06d, there may be unintended con-
sequences of overcorrection to prevent multiple relationships
(Brodhead et al., 2018a) at the expense of potentially a greater
problem of creating a brand of practitioners who risk being
insensitive to the nuances of culture.
Another unintended consequence of the BACB Code is
that the behavior analyst is forever stuck in an ethical dilemma
of deciding whether to respect cultural differences (BACB
Code 1.05) by accepting a gift while simultaneously violating
another element of the BACB Code (1.06d). I offer this as one
example of at least a few places where the BACB Code may
face criticism and contradiction within itself. In another exam-
ple, Graber and O’Brien (2018) describe how, when behavior
analysts are not fully reimbursed for behavioral services, the
ethical dilemma that arises from the options of discontinuing
services, prioritizing of services to clients who can pay out of
pocket, or providing less care in terms of hours to clients
places the behavior analyst in a no-win ethical situation. In a
final example, Graber and Graber (2018) note that “from the
perspective of ethical theory, the Code’s restriction on punish-
ment is likely inaccurate” (p. 4). To briefly summarize, be-
cause it is a nonsubjective term (i.e., it is defined by objective
observation of behavior over the passage of time), punishment
is generally not subject to moral evaluation in ethical theory. In
the aforementioned cases, I do not believe the BACB intended
for the BACB Code to be conflicting in these ways. Nor can the
BACB possibly account for every possible instance in which
their ethical codes may or may not conflict with one another or
cause confusion (Brodhead et al., 2018a). These discrepancies
are common in the realm of professional ethics (see Graber &
Graber, 2018, for further discussion). As scholars, it is our job
to point them out and to encourage careful analysis and revision
to our ethics codes. As readers, I see it as your duty to digest
these arguments and to proceed with caution in similar situa-
tions, knowing the complexity of those situations.
It is important to emphasize that BACB Code 1.06d, as
well as the entire BACB Code itself, is designed to protect
consumers of behavior-analytic services and the behavior an-
alysts providing those services. That is, 1.06d may very well
serve as an antecedent intervention that decreases the likeli-
hood of a behavior analyst entering a multiple relationship,
which then results in maintained compliance with the BACB
Code and decreases the probability of disciplinary action and
impaired clinical judgement stemming from a multiple rela-
tionship. Furthermore, because only individuals credentialed
by the BACB can be held liable for violations of the BACB
1 My informal observations also suggest that BACB Code 1.06d has resulted
in a surge of “Should you take a glass of water from a client?” presentations at
the Association for Behavior Analysis International’s and other conferences,
likely detracting from more important and meaningful discussions related to
ethics and behavior analysis.
http:theory.In
http:andcontradictionwithinitself.In
Behav Analysis Practice
Code, the code serves as a layer of protection for the behavior
analyst in the event an organizational policy is incongruent
with the BACB Code (Brodhead, Quigley, & Cox, 2018b).
In an ethical analysis, the stated cultural values of the BACB
Code, to protect consumers and the behavior analyst, must be
kept in mind. Any behavior analyst bound to the BACB Code
must do his or her due diligence to minimize noncompliance
with it; at the same time, behavior analysts must do their due
diligence to maintain respectfulness and appreciation for cul-
tural values, as well as maintain actions that protect their
credential.
Given the current trend in behavior analysis to further un-
derstand the role of culture in service delivery and to advocate
for cultural competence (e.g., Beaulieu, Addington, &
Almeida, 2018; Brodhead et al., 2014; Fong & Tanaka,
2013; Fong et al., 2016; Li, Wallace, Ehrhardt, & Poling,
2017), including an ethical analysis (Rosenberg & Schwartz,
2019; Witts et al., 2018), I am encouraged that the next revi-
sion of the BACB Code will resolve some of the confusion
surrounding culture. In all likelihood, different problems may
emerge that spark additional scholarly conversations. For
those cases, Rosenberg and Schwartz serve as a model as to
how we may critically analyze the BACB Code to help guide
us through ethical analyses when an ethical dilemma is
present.
To conclude this section, I emphasize that ignoring the
culture of our clients, and ourselves, in ethical analysis is
incongruent with our core value of being analytic (see Baer
et al., 1968). Disregarding the importance of culture also does
not align with what is known to be best practices in cultural
competence (see Fong & Tanaka, 2013; Fong et al., 2016).
Rosenberg and Schwartz challenge the status quo put forth by
the BACB Code and popular texts on ethics and behavior
analysis by drawing attention to this fact. I hope that readers
take away from Rosenberg and Schwartz the importance of
the role of culture in service delivery and ethical analysis. I
also hope readers understand that although the BACB Code
may underemphasize the importance of culture, culture is far
from unimportant in ethical analysis.
We Need Operationalized Processes of Ethical
Decision-Making
Recently, behavior analysts have begun to describe and eval-
uate systematic processes for making decisions during
behavior-analytic practice. Examples include models for en-
gaging in effective interdisciplinary collaboration, selecting
types of function-based treatments, and accurately analyzing
data (Brodhead, 2015; Geiger, Carr, & LeBlanc, 2010;
Kipfmiller et al., 2019; Newhouse-Oisten, Peck, Conway, &
Frieder, 2017). A primary benefit of the aforementioned
models is that they provide a framework for operationally
defining, and subsequently measuring, observable behaviors
of practicing behavior analysts.
The model proposed by Rosenberg and Schwartz extends
this previous work and introduced a tool that finally allows us
to define, observe, and measure ethical decision-making be-
havior. I, for one, am personally excited about this contribu-
tion. Until now, we have failed to hold ethical analysis to the
same standards as other components of applied practice, stan-
dards of objectively defining, observing, measuring, and ana-
lyzing behavior.
I draw upon the area of autism treatment to further high-
light the importance of the contribution made by Rosenberg
and Schwartz. Scholars have very carefully operationally de-
fined the components that are necessary for well-implemented
and effective discrete-trial instruction. Likewise, the assess-
ment and treatment of challenging behavior have received
consistent attention over the course of decades, with much
detail paid to variations and situation-specific modifications
that result in optimal treatment outcomes. Discrete-trial teach-
ing, functional assessment, and treatment of challenging be-
havior are certainly important. But ethics are also important—
so important that I argue they are the umbrella that covers all
that we do.
So where is the same treatment and attention paid to oper-
ationally defining ethical behavior, so it can be observed or
taught, just as we observe or teach discrete trials and function-
al assessments? Rosenberg and Schwartz show us that opera-
tionally defining the behavioral process of ethical analysis can
be done, and done well. Their model sends a message to stu-
dents, practitioners, and scholars that the wait is over for the
objective study of ethics in behavior analysis. Gone are the
days where we must rely on telling our students and
supervisees “what not to do” in order to follow the BACB
Code. Also gone are the days where we must rely on case
studies that do not reflect the specific challenges we may face
to teach ethical decision-making. Though these case studies
may be important in establishing a baseline level of under-
standing in ethical analysis, they do not account for the
situation-specific instances a behavior analyst may face during
clinical practice (see Chapter 3 in Brodhead et al., 2018a).
Instead, we now have a tool, rooted in behavior-analytic tra-
dition, for teaching our students and supervisees how to be
analytical during their ethical decision-making process in rel-
evant practice settings (just as we would expect them to be
analytical during their discrete-trial instruction and functional
assessment process).
Do not forget that ethical behavior, like most behavior, is a
discriminated operant (Newman, Reinecke, & Kurtz, 1996).
We would never assume our employees could learn discrete-
trial teaching through osmosis; ethical behavior is no different.
Rosenberg and Schwartz get a pass on this, but the rest of us
should be accountable for holding ethics to the same behavior-
analytic standards as our other practices.
Behav Analysis Practice
I call upon scholars to study the model proposed by
Rosenberg and Schwartz. To date, there are no empirical stud-
ies on ethics and behavior analysis. I find this rather heart-
breaking, given the importance of ethics as a subject matter,
and the emphasis the BACB places on coursework and con-
tinuing education in ethics. But now, we have run out of ex-
cuses (myself included) for not studying such an important
component of our practice. We now have a framework for at
least the partial empirical study of ethics and behavior
analysis.
Challenging the Status Quo Is Healthy
Very few scholars have come forth to critically analyze the
BACB Code. Rosenberg and Schwartz serve as one
example—one that takes issue with the mandated compliance
required by the BACB and the rule-based BACB Code. Witts
et al. (2018), Graber and O’Brien (2018), and Graber and
Graber (2018) serve as three other critical analyses of the
BACB Code that I am aware of. Surely, there are other
scholars who have comments on the BACB Code (either for
or against), and I encourage them to step forward and join the
discussion. As Pat Friman (2010) noted in a not-at-all-related
article, “Come on in, the water is fine.”
Behavior analysts contact and engage with the BACB
Code on a continuous basis. Whereas we are continuously
analyzing and questioning our treatment practices as a means
to stay close and true to our behavior-analytic values, surely
behavior analysts are engaging in similar conversations about
the BACB Code, a document that bears enormous weight,
responsibility, and directive for how we behave. Aside from
any licensure laws behavior analysts may be bound to and the
BACB Task List (BACB, 2012) that defines our scope of prac-
tice, I know of no other documents that bear as much impor-
tance as the BACB Code. Let us help shape it.
To be complacent and indifferent to the BACB Code, I
argue, is to go against the core values of what it means to be
a behavior analyst. Without a critical analysis of the BACB
Code, the A in Analyst is missing, and if it exists, it is a tiny,
lowercase a that is too small for print. Dissent, in general, is
healthy for a science and allows it to grow and mature much
better than if its values were not questioned and we are led into
compliance and groupthink.
Summary
My preference for dissent and challenging widely held con-
ventions is likely a product of my teenage years, where I did
nothing but skateboard (poorly), listen to punk rock (loudly),
and read George Orwell (enthusiastically). I understand if
others are not so welcoming to the idea of dissent and
challenging important documents (e.g., the BACB Code). I
recognize that preference for compliance is likely a result of
one’s own individual learning history—a cultural value that
one may hold dear.
My cultural values of dissent and calling into question
things of importance may be incompatible with those of com-
pliance. I welcome further discussion about how our values
may converge in order to achieve the goal in which I believe
we are all here to realize: the development of a science of
behavior that produces socially significant (and ethical) be-
havior change. I hope you join us in this discussion. Until
then, I’ll be hanging out with Rosenberg and Schwartz, at least
until others join in and change my mind.
Come on in, the water is fine.
Author Note Matthew T. Brodhead, Department of
Counseling, Educational Psychology, and Special Education,
Michigan State University.
I thank my graduate students for their careful reading of an
earlier version of this manuscript.
This paper is based off a presentation given at the 2018
Association for Behavior Analysis Conference in San Diego
International, California.
Compliance with Ethical Standards
Ethical approval This article does not contain any studies with human
participants or animals performed by the author.
Conflict of interest The author declares that he has no conflicts of
interest.
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