Basic Principles

JOURNAL OF APPLIED BEHAVIOR ANALYSIS

THE RIGHT TO EFFECTIVE BEHAVIORAL TREATMENT

RON VAN HOUTEN MOUNT SAINT VINCENT UNIVERSITY

SAUL AXELROD TEMPLE UNIVERSITY

JON S. BAILEY FLORIDA STATE UNIVERSITY

JUDITH E. FAvOu AU CLAIR PROGRAM, MOUNT DORA, FLORIDA

RICHARD M. Foxx ANNA MENTAL HEALTH CENTER, ANNA, ILLINOIS

BRIAN A. IWATA UNIVERSITY OF FLORIDA

0. IVAR LOVAAS UNIVERSITY OF CALIFORNIA AT LOS ANGELES

We propose that individuals who are recipients or potential recipients of treatment designed to change their behavior have the right to a therapeutic environment, services whose overriding goal is personal welfare, treatment by a competent behavior analyst, programs that teach functional skills, behavioral assessment and ongoing evaluation, and the most effective treatment procedures available. DESCRIPTORS: behavioral treatment, clients, ethics, treatment

During the last several decades, a number of clinical procedures derived from experimental and applied behavior analysis have been developed, evaluated, and refined. These procedures have the demonstrated ability to teach new behavior and alleviate a variety of behavioral disorders. Unfor- tunately, many who would benefit from behavioral treatment are not receiving it. Behavior analysts

Report of the Association for Behavior Analysis (ABA) Task Force on the Right to Effective Treatment. Ron Van Houten served as the Task Force Chair and Brian A. Iwata served as the Council Liaison. This report was accepted by the ABA Executive Council and is also published in that organization's journal, The Behavior Analyst (1988), Vol. 11; however, the report does not necessarily reflect the view of the majority ofABA members nor does it constitute official ABA policy. Reprints may be obtained from Brian Iwata, Department ofPsychology, University of Florida, Gainesville, Florida 32611.

have a professional obligation to make available the most effective treatment that the discipline can provide. Toward this end, the following statement of clients' rights is offered to direct both the ethical and appropriate application of behavioral treat- ment.

1. An Individual Has a Right to a Therapeutic Environment A physical and social environment that is safe,

humane, and responsive to individual needs is a necessary prerequisite for effective treatment. Such an environment provides not only training, but also an acceptable living standard. The dimensions of an adequate living environment are complex and varied; nevertheless, several elements are essential. Individuals should have access to therapeutic services, leisure activities, and materials that are

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enjoyable as well as instructive. Thus, client pref- erence, in addition to factors such as age-appro- priateness and educative value, is relevant in the selection of activities and materials. An adequate environment also indudes parents, teachers, and staff who are competent, responsive, and caring. Such qualities may be characterized in terms of frequent positive interactions that are directed to- ward enjoyment, learning, and independence. Fi- nally, a therapeutic environment imposes the fewest restrictions necessary, while ensuring individual safety and development. Freedom of individual movement and access to preferred activities, rather than type or location of placement, are the defining characteristics of a least restrictive environment.

2. An Individual Has a Right to Services Whose Overriding Goal is Personal Welfare The primary purpose of behavioral treatment is

to assist individuals in acquiring functional skills that promote independence. Both the immediate and long-term welfare of an individual are taken into account through active participation by the client or an authorized proxy in making treatment- related decisions. In cases in which withholding or implementing treatment involves potential risk, Peer Review Committees and Human Rights Commit- tees play distinct roles in protecting client welfare. Peer Review Committees, comprised of experts in behavior analysis, impose professional standards to determine the clinical propriety of treatment pro- grams. Human Rights Committees, comprised of consumers, advocates, and other interested citizens, impose community standards to determine the ac- ceptability of programs and the extent to which a program compromises an individual's basic rights to dignity, privacy, and humane care; appropriate education and training; prompt medical treatment; access to personal possessions, social interaction, and physical exercise; humane discipline; and physical examination prior to the initiation of a program that may affect or be affected by an individual's health status. Professional competence aided by peer and human rights review will ensure that behavioral treatment is delivered within a context of concern for client welfare.

3. An Individual Has a Right to Treatment by a Competent Behavior Analyst

Professionals responsible for delivering, direct- ing, or evaluating the effects ofbehavioral treatment possess appropriate education and experience. The behavior analyst's academic training reflects thor- ough knowledge of behavioral principles, methods ofassessment and treatment, research methodology, and professional ethics. Clinical competence also requires adequate practicum training and supervi- sion, including experience with the relevant client population.

In cases in which a problem or treatment is complex or may pose risk, individuals have a right to direct involvement by a doctoral-level behavior analyst who has the expertise to detect, analyze, and manage subtle aspects of the assessment and treatment process that often determine the success or failure of intervention. A doctoral-level behavior analyst also has the ability, as well as the respon- sibility, to ensure that all individuals who partici- pate in the delivery of treatment or who provide support services are trained in the methods of in- tervention, to assess the competence of individuals who assume subsequent responsibility for treat- ment, and to provide consultation and follow-up services as needed.

4. An Individual Has a Right to Programs That Teach Functional Skills The ultimate goal of all services is to increase

the ability of individuals to function effectively in both their immediate environment and the larger society. Improvement of functioning may take sev- eral forms. First, it often will require the acquisition, maintenance, or generalization of behaviors that allow the individual to gain wider access to pre- ferred materials, activities, or social interaction. Sec- ond, it may require the acquisition of behaviors that allow the individual to terminate or reduce unpleasant sources of stimulation. Third, improved functioning may require the reduction or elimina- tion of certain behaviors that are dangerous or that in some way serve as barriers to further indepen- dence or social acceptability. Finally, as a member

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of society at large, an individual has a right to services that will assist in the development of be- havior beneficial to that society.

Decisions regarding the selection of service goals are not based on a priori assumptions of an indi- vidual's behavioral potential or limitations. It is conceivable that some goals may be achieved very slowly, that others may be only approximated, and that, in the process of achieving still other goals, it may be necessary to expose the individual to either immediate temporary discomfort (e.g., teaching physical exercise as a means of promoting health) or future risk (e.g., teaching an individual to cross streets or to drive an automobile). Still, unless evi- dence dearly exists to the contrary, an individual is assumed capable of full participation in all aspects of community life and to have a right to such participation.

5. An Individual Has a Right to Behavioral Assessment and Ongoing Evaluation

Prior to the onset of treatment, individuals are entitled to a complete diagnostic evaluation to iden- tify factors that contribute to the presence of a skill deficit or a behavioral disorder. A complete and functional analysis emphasizes the importance of events that are antecedent, as well as consequent, to the behavior of interest. For example, identifi- cation of preexisting physiological or environmental determinants may lead to the development of a treatment program that does not require extensive use of behavioral contingencies.

The initial behavioral analysis is performed in three stages. First, answers to the following types of questions are obtained through an interview. Is there any circumstance in which the behavior al- ways occurs? Is there any circumstance in which the behavior never occurs? Does the behavior typ- ically occur at certain times of the day? Could the behavior be associated with any form of discomfort or deprivation? Could events following the behavior serve as either positive reinforcement (e.g., atten- tion) or negative reinforcement (e.g., escape from demands)? The second stage of analysis, direct ob- servation of the individual's behavior under varied and relevant circumstances, confirms suspected re-

lationships identified during the interview. Finally, the assessment findings are incorporated into a sys- tematic treatment plan.

Successful intervention requires ongoing evalu- ation in the form of objective data to determine the effects of treatment, to quickly identify unan- ticipated problems, and, if necessary, to modify the treatment plan. The behavior analyst maintains ac- countability and solicits timely input into the de- cision-making process by sharing these data regu- larly with all concerned parties.

6. An Individual Has a Right to the Most Effective Treatment Procedures Available An individual is entitled to effective and scien-

tifically validated treatment. In turn, behavior an- alysts have an obligation to use only those tech- niques that have been demonstrated by research to be effective, to acquaint consumers and the public with the advantages and disadvantages of these techniques, and to search continuously for the most optimal means of changing behavior.

Consistent with the philosophy ofleast restrictive yet effective treatment, exposure of an individual to restrictive procedures is unacceptable unless it can be shown that such procedures are necessary to produce safe and clinically significant behavior change. It is equally unacceptable to expose an individual to a nonrestrictive intervention (or a se- ries of such interventions) if assessment results or available research indicate that other procedures would be more effective. Indeed, a slow-acting but nonrestrictive procedure could be considered highly restrictive if prolonged treatment increases risk, sig- nificantly inhibits or prevents participation in need- ed training programs, delays entry into a more optimal social or living environment, or leads to adaptation and the eventual use of a more restrictive procedure. Thus, in some cases, a client's right to effective treatment may dictate the immediate use of quicker acting, but temporarily more restrictive, procedures. A procedure's overall level of restrictiveness is a

combined function of its absolute level of restric- tiveness, the amount of time required to produce a clinically acceptable outcome, and the conse-

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quences associated with delayed intervention. Fur- thermore, selection of a specific treatment technique is not based on personal conviction. Techniques are not considered as either "good" or "bad" according to whether they involve the use of antecedent rather than consequent stimuli or reinforcement rather than punishment. For example, positive reinforce- ment, as well as punishment, can produce a number of indirect effects, some of which are undesirable.

In summary, decisions related to treatment se- lection are based on information obtained during assessment of the behavior, the risk it poses, and its controlling variables; on a careful consideration of the available treatment options, induding their relative effectiveness, risks, restrictiveness, and po- tential side effects; and on examination Qf the over- all context in which treatment will be applied.

CONCLUSION Behavior analysts have a responsibility to ensure

that their clients' rights are protected, that their specialized services are based on the most recent scientific and technological findings, that treatment is provided in a manner consistent with the highest standards of excellence, and that individuals who are in need of service will not be denied access to the most effective treatment available. In promul- gating the rights described in this document, the field of behavior analysis acknowledges its respon- sibilities by reaffirming its concern for individual welfare and by prescribing the means by which behavioral treatment can be delivered in the most beneficial manner. Received August 8, 1988 Final acceptance August 20, 1988 Action Editor, Jon S. Bailey

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