Planning, Applying, and
Evaluating a Treatment
Program
Chapter 24
A Problem Has Been Referred:
Should You Design A Program?
• Questions to answer:
– Was the problem referred primarily for the benefit of the client?
– Can the problem and the goal be specified such that you are dealing
with a specific behavior or set of behaviors that can be counted, timed,
or measured in some way?
– Is the problem important to the client or to others?
– Have you eliminated the possibility that there are complications
involved in this problem that would necessitate referring it to another
specialist?
– Is the problem one that would appear to be easily manageable?
– If the goal is reached, might it be easily generalized and maintained?
– Can you identify significant individuals in the client’s natural
environment who might help to record observations and manage
controlling stimuli and reinforcers?
– If there are individuals who might hinder the program, can you
identify ways of minimizing their potential interference?
– On the basis of your tentative answers to these eight questions, do
your training qualifications, daily schedule, and available time seem
adequate for you to participate in the program?
Selecting and Implementing and
Assessment Procedure
•
•
For reliable baselining, define the handicap in precise behavioral terms.
Select an appropriate baselining procedure that will enable you to:
–
–
–
–
–
•
•
•
•
•
monitor the problem behavior
identify its current stimulus control
identify the maintaining consequences of the problem behavior
monitor relevant medical/health/personal variables
identify an alternative desirable behavior
Design recording procedures that will enable you to log the amount of time
devoted to the project by the professionals working on it
Ensure that the observers have received appropriate training in identifying
critical aspects of the behavior, applying the recording procedures, and
graphing data
If the baseline is likely to be prolonged, select a procedure for increasing
and maintaining the strength of the record-keeping behavior of the data
recorders
Select a procedure for ensuring the reliability of the baseline observations
After beginning to collect baseline data, analyze those data carefully to
select an appropriate intervention strategy and decide when to terminate
the baseline phase and begin intervention
Considerations for Assessment
Procedures
• What daily times can the mediator(s)
schedule this project?
• Will others in the situation help or hinder
your data collection?
• Will the surroundings help or hinder your
assessment?
• What is the frequency of the existing
behavior?
• How rapidly should the behavior change?
Strategies for Program Design and
Implementation
1.
2.
3.
Define the goal, identify the target behaviors and their desired
amount and stimulus control
Identify individuals who might help to manage controlling
stimuli and reinforcers. Also identify those who might hinder the
program
Examine the possibility of capitalizing on antecedent control.
Can you use:
a)
b)
c)
d)
e)
f)
4.
Rules?
Goal setting?
Modeling?
Physical guidance?
Situational inducement?
Motivating operations?
If you are developing a new behavior, will you use shaping,
fading, or chaining? What motivation establishing operation will
you use?
Strategies for Program Design and
Implementation
5. If you are changing the stimulus control
of an existing behavior, can you select
the controlling SDs such that they:
a) are different from other stimuli on more
than one dimension?
b) are encountered mainly in situations in
which the desired stimulus control should
occur?
c) evoke attending behavior?
d) do not evoke undesirable behavior?
Strategies for Program Design and
Implementation
6.
If you are decreasing behavioral excess:
a)
b)
c)
d)
e)
7.
Can you remove SDs from the problem behavior?
Can you withhold reinforcers that are maintaining the problem
behavior, or present motivation abolishing operations for those
reinforcers?
Can you apply DRL?
Can you apply DRO, DRI, or DRA?
Should punishment be used?
Specify the details of the reinforcement system:
a)
b)
c)
d)
e)
How will reinforcers be selected?
What reinforcers will be used?
How will reinforcer effectiveness be continually monitored, and by
whom?
How will reinforcers be stored and dispensed, and by whom?
If a token system is used, what are the details of its implementation?
Strategies for Program Design and
Implementation
8.
9.
Specify the training setting.
Describe how you will program generality of behavior change by:
a)
Programming stimulus generalization. Can you:
i.
ii.
iii.
iv.
v.
b)
Programming response generalization. Can you:
i.
ii.
iii.
c)
Train in the test situation?
Vary the training conditions?
Program common stimuli?
Train sufficient stimulus exemplars?
Establish a stimulus equivalence class?
Train sufficient exemplars?
Vary the acceptable responses during training?
Use behavioral momentum to increase low probability responses within a
response class?
Programming behavior maintenance. Can you:
i.
ii.
iii.
iv.
Use natural contingencies of reinforcement?
Train people in the natural environment?
Use schedules of reinforcement in the training environment?
Give the control to the individual?
Strategies for Program Design and
Implementation
10. Specify the details of the daily recording and graphing
procedures
11. Collect the necessary materials
12. Make checklists of rules and responsibilities for all
participants in the program
13. Specify the dates for data and program reviews and identify
those who will attend
14. Identify some contingencies that will reinforce the behavior
modifiers and mediator
15. Review the potential cost of the program as designed and
judge its merit against cost; reprogram as necessary
16. Sign a behavioral contract
17. Implement the program
Program Maintenance and
Evaluation
1.
2.
3.
4.
5.
Monitor your data to determine whether the recorded behaviors are
changing in the desired direction
Consult the people who must deal with the behavioral handicap, and
determine whether they are satisfied with the progress
Consult other sources to determine if your results are reasonable in terms
of the amount of behavior change during the period the program has
been in effect
If 1, 2, 3 are satisfactory, proceed to step 8
If 1, 2, 3, are unsatisfactory, answer the following questions:
a)
b)
c)
d)
e)
6.
7.
Have the reinforcers hat are being used lost their appeal?
Are competing responses being reinforced?
Are the procedures being applied incorrectly?
Is there outside interference that is disrupting the program?
Are there any subjective variables that might be adversely affecting the program?
If none of the answers to questions are yes, check if additional
programming steps need to be added or removed
If the results are now satisfactory, proceed to guideline 8; otherwise
consult with a colleague, or consider changing a major aspect of program,
or redoing functional analysis
Program Maintenance and
Evaluation
8. Decide how you will provide appropriate program
maintenance until the behavioral objective is
reached
9. Following attainment of the behavioral goal, outline
an appropriate arrangement for assessing
performance during follow-up observations and
assessing social validity
10. After successful follow-up observations have been
obtained, determine the costs for the behavioral
changes that occurred
11. Where possible and appropriate, analyze your data
and communicate your procedures and results to
other behavior modifiers and interested
professionals
Token Economies
Chapter 25
Some Definitions
• Conditioned Reinforcers
– Not originally reinforcing but becomes
reinforcer after being paired with other
reinforcers
• Tokens
– Conditioned reinforcers that endure, can be
accumulated and exchanged for backup
reinforcers
• Token Economy
– Behavior Modification program that uses
tokens
Advantages of Token Economies
• Can be given immediately
• Paired with many different backup
reinforcers
– Can be administered to large diverse groups
Setting up a Token Economy
• Decide on target behavior
– Define behaviors so that all involved can identify
instances of appropriate and inappropriate behavior
• Take baselines
– Baseline data important to know what is needed
– Data can help with selecting backup reinforcers
• Select backup reinforcers
– Identify backup consequences through direct and
indirect assessment
– Use wide variety of backup reinforcers
– Can use response-cost procedures to punish
inappropriate behavior
Setting up a Token Economy
• Select the type of tokens to use
– Can take many forms, but should be:
•
•
•
•
Durable
Easy to handle
Difficult to steal
Difficult to counterfeit
– Can have graded value for tokens
– Can associate different types of tokens with
different behaviors
Setting up a Token Economy
• Identify available help
– Depending on the situation, different people may need to help
• Ex: teachers, volunteers, behaviorally advanced peers, etc.
• Choose the locations
– Some locations are better than others, but often do not have a
choice of location
• Managing Consequences
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–
–
–
–
–
–
Ensure backup reinforcers are on hand
Clearly describe criteria for earning and exchanging tokens
Award tokens as immediately as possible
Use reinforcers such as praise with tokens
Keep accurate records
Provide bonuses for high-level performance
Train those administering tokens
Specific Implementation
Procedures
• Must decide on procedures for:
– Keeping data
• What kinds of sheets?
• Who will record the data?
• When will recording take place?
– The reinforcing agent
• Who will administer the reinforcement and for what
behaviors?
– Number or frequency of tokens to Pay
• More tokens to start
• Gradually decrease number of tokens
• Less pleasant activities might earn more
Specific Implementation
Procedures Continued:
• Managing the Backup Reinforcers
– How frequently will backup reinforcers be made
available?
• Frequency high in the beginning
– How much will each reinforcer cost?
• Should be related to monetary cost
• High demand items should cost more
• Low cost for backup reinforcers that have therapeutic value
• Possible Punishment Contingencies
– Can use tokens to administer punishment through
fines
– May need to teach clients how to accept fines in a
nonaggressive, relatively nonemotional way
Specific Implementation
Procedures Continued:
• Supervision of Staff
– Duties must be clearly spelled out
– Staff must be monitored closely
– Reinforcement must be offered for appropriate behavior
• Handling Potential Problems
– Problems must be planned for in advance
– Likely problems:
• Confusion
• Staff shortages
• Attempts by clients to get tokens they have not earned or
backup reinforcers for which they do not have enough tokens
• Clients playing with tokens in distracting ways
• Failure to purchase backup reinforcers
Preparing a Manual
• Token Economy Manual
– Written set of rules describing exactly how
the economy is to run
– Includes:
• Definite procedures for evaluating whether or not
the rules are being followed adequately and
procedures for ensuring that they are
• Methods for arbitrating disputes about rules
– Should be detailed
– Should be given to all staff members
Programming Generality to the
Natural Environment
• Token economy should be designed so that social
reinforcement gradually replaces tokens
• Weaning from tokens:
– Eliminate tokens gradually
• Gradually make the schedule of token delivery more and
more intermittent
– Decrease token value gradually
• Gradually decrease amount of backup reinforcement that a
token can purchase
• Or, gradually increase the delay between getting tokens and
purchase of backup reinforcements
– Gradually transfer control to the clients
Ethical Considerations
• Must take precusions to avoid abuse
• Making the system completely open to
public scrutiny may ensure that no abuse
happens
Ethical Issues
Chapter 30
Historical Implications
• Cultural history and personal experiences
with others abusing power, taught people
to react negatively to behavior
modification
• This term evokes many negative feelings
Behavioral View of Ethics
• Ethics – standards of behavior developed by
culture to promote the survival of that culture
• Ethical guidelines are an important source of
behavioral control when immediate reinforcers
influence individual to behave in a way that leads
to aversive stimuli for others
• When members of the same culture learn to
follow the same ethical guidelines, the guidelines
exert rule-governed control over behavior
Arguments Against Deliberately
Controlling Behavior
• Because of history and experiences, some
have argued that all attempts to control
behavior are unethical
• Goal of any social help profession involve
change in behavior and behavior control
• It is often necessary to change, manage,
influence, or control behavior
– It is necessary to ensure that it is done
ethically
Ethical Guidelines
• Organizations that have addressed ethical
guidelines involved in behavior
modification:
– Association for the Advancement of Behavior
Therapy (AABT)
– American Psychological Association (APA)
– Association for Behavior Analysis (ABA)
Ethical Guidelines
• Based on:
– 1977, Behavior Therapy, publication of set of
ethical questions to ask
– 1978, Stolz & Associates, a comprehensive
report on ethical issues involved in behavior
modification
– 1988, Van Houten et al., The Behavior Analyst,
published a statement of clients’ rights
– 2002, American Psychological Association’s
Ethical Principles of Psychologists and Code of
Conduct
Ethical Considerations
• Qualifications of the Behavior Modifier
– Must receive appropriate training –
academic and supervised practical training
– Procedures being used are the most up-todate
– Steps to ensure countercontrol and
accountability:
• Supervision by members of ABA, AABT, or both
• Various certification programs
Ethical Considerations
• Definition of Problem and Selection of goals
– Target behaviors selected must be most important
for client and society
– Emphasis on teaching functional, age-appropriate
skills
– For those with handicaps, focus on teaching skills
that promote independent functioning
– Goals should be consistent with the basic rights of
the client to dignity, privacy, and humane care
– Steps to ensure countercontrol and accountability:
• Require behavior modifier to clearly specify his or her
values relating to client's problems
• Client as an active participant in the selection of goals and
identification of target behaviors
Ethical Considerations
• Selection of Treatment Method
– Use the most effective, empirically validated methods with the
least discomfort and fewest negative side effects
– Use least intrusive and restrictive interventions
– No agreement on a continuum of intrusiveness or
restrictiveness
• Interventions based on positive reinforcement considered less
intrusive than interventions based on aversive control
• Intrusive and restrictive sometimes refer to the extent to which clients
are given choices and allowed freedom of movement in a therapeutic
environment
• Intrusive and restrictive sometimes refer to the extent to which
consequences are deliberately managed as opposed to naturally
occurring
– Steps to ensure countercontrol and accountability
• Informed consent
• Ethical review committees
Ethical Considerations
• Record Keeping and Ongoing Evaluation
– Maintenance of accurate data throughout the
program
•
•
•
•
Behavioral assessment before the program
Ongoing monitoring of target behavior
Possible side-effects
Appropriate follow-up evaluation after treatment
– Confidentiality to be respected at all times
– Steps to ensure countercontrol and accountability:
• Client access to records
• Frequent discussions with client about progress in the
program
• Periodic peer evaluation of data