Clinical Role of a Behavior Analyst

Introduction
Behavior analysts apply evidence-based approaches in their development of treatment
plans and interventions. There, however, exists differing views on what makes up “practice” and
what makes up “evidence.” Establishing a practice that is based on evidence entails analyzing the
intervention procedures and synthesizing the information provided by a client clearly to come up
with an effective intervention program. This scenario involves a four-year-old girl Kaities who is
autistic. She has been receiving occupational therapy, physical therapy, and Discrete Trial
Teaching in a special education preschool program. Kaitie’s parents want her to be introduced to
Facilitated communication, an intervention plan that is not supported by evidence. The parents
want Kaitie’s home-based program to include the facilitated communication plan. However, that
will not be provided as the intervention will be based on evidence-supported plans. Kate has 15
hours of service home program where she meets two registered behavior technicians (RBT).
There is also a two-hour program for Kaitie’s parents aimed at supporting them in becoming
active participants in their daughter’s program. This paper has four parts; the first part explains
strategies that will help develop an effective rapport with Kaitie’s parents and help overcome
their resistance. The second part explains the process that will be used to establish Kaitie’s verbal
behavior program and intervention, part four evaluates the program, and the last part analyzes
important considerations in the assessment and intervention process.
Developing A Rapport
Building a rapport with new clients is important in all helping professions. Without a
rapport with the clients, meaningful change cannot be achieved. A client cannot implement the

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changes that are proposed by an expert if there is no connection between the expert and the
client. Rapport is crucial in establishing a therapeutic alliance between the behavior analyst and
their clients (Price, 2017). To this end, rapport is the cornerstone of therapy. Rapport with clients
is defined by different characteristics. Each individual has various unique characteristics that
should be considered when establishing a rapport with them. A behavior analyst can only build a
rapport if they actively listen to the needs of the client and ensure that they display empathy
(Price, 2017). Earning trust is important in the case of Kaitie and her parents.
In behavior analysis, change must be driven by the client. Behavior analysts must thus
ensure that the focus is on the relationship with the clients while allowing change to happen on
its own. A therapist must, however, be prepared to encounter resistance. They must have an
understanding of how to deal with the resistance since resistance results in negative outcomes
(Price, 2017). Resistance is counterproductive and may distract behavior analysts from their core
goals. Research suggests that resistance is based on the fear of negotiating the relationship with
the behavior analyst. A client may impose a familiar type of interaction with the behavior
analyst. In the case of Kaitie, the resistance is based on the need of Kaitie’s parents to adopt a
familiar treatment technique. The need to dictate the treatment technique may be used to
legitimize disappointment and anger towards the proposal that Facilitated Communication is not
an evidence-based technique.
In rebuilding rapport with the client, one important step is to show empathy while
acknowledging the perspective of the client. The behavior analyst needs to ensure that they listen
to the concerns raised by Kaitie’s parents. The analyst needs to ensure that they are not
judgmental. While there may be differing perspectives between Kaitie’s parents and the
behavioral analyst, the different perspectives should not be barriers to successful interaction

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(Shields et al., 2020). The behavior analyst must show understanding of the situation of Kaitie.
Empathy allows one to develop personalized care. All negative feelings and views towards the
proposed treatment plan need to be addressed sufficiently.
The behavior analyst must also ensure that they are flexible. Inflexibility may be
perceived negatively by the clients. As a result, a client-centered approach where the needs of the
child are at the center of the therapy needs to be adopted. The therapist also needs to ensure that
they are not perceived to be imposing ideas onto the client (Shields et al., 2020). The goals need
to be formulated based on the client. If a client is seen to be resistant, honest discussions between
the therapist and the client need to be conducted. When dealing with resistant clients, a therapist
has more responsibility to ensure that they address the root cause of the resistance. The therapist
thus needs to find new ways of interacting with Kaitie’s parents and ensuring that they mutually
agree on the goals as well as the treatment techniques that can be used (Shields et al., 2020). A
safe, trusting relationship can only be formulated if Kaitie’s parents are given an opportunity to
discuss their inner thoughts, feelings, and fears.
Verbal Behavior Assessment & Intervention
Studies have shown that intensive and early behavioral intervention shows positive
outcomes for children with autism (Ingvarsson, 2016). The process of establishing a verbal
behavior program is founded on and influenced by the work of B.F Skinner on Verbal Behavior.
Kaitie’s verbal behavior program will be based on Skinner’s verbal operant. The following
teaching and assessment methods will be used in the program;
a. Manding

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The mand by Skinner is a verbal operant that is controlled by a motivating operation and
reinforced by a reinforcer (Ingvarsson, 2016). During the intervention, the behavior analyst will
guide Kaitie through manding. This will occur where mands are used. Manding occurs when one
asks for something, for example, an apple, and the consequence or reward is being given the
apple. Using everyday language to help Kaitie verbalize her requests and then rewarding her
through providing the items asked will help her acquire verbal skills. Reinforcement of the mand
occurs when the listener, in this case, Kaitie, complies. When dealing with Kaitie, the assessment
will entail analyzing her compliance. Kaitie’s behavior will be reinforced through the analyst’s
approval and by Kaitie successfully completing the tasks analyzed.
The mand will be used because it is the only known vernal operant that uses a motivating
operation to evoke a response. Its benefits have been proven when dealing with children with
autism. First, it helps reduce maladaptive behavior and helps realize a spontaneous increase in
the language (Albert et al., 2018). mand is also effective in increasing a child’s social initiations.
The RBTs will use prompt fading, vocal prompts as well as vocal response forms to teach Kaitie
verbal behavior. Manding will begin with items that are in sight. For example, a pencil will fall,
and Kaitie will be asked where the pencil is. Then the teaching will proceed to items not in sight.
For example, she may be asked for a glass in the kitchen. The progression will be gradual, first
starting with items insight, and after progress is ascertained, they will move on to items, not in
sight.
Besides, manding can be implemented by the parents. The parents will be guided on how
to implement manding naturally at home. For instance, during breakfast, Kaitie may be prompted
to ask for milk. When she wants a spoon, she asks for the spoon, and the consequence is that she

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is provided with the spoon. It is easier for Kaitie’s parents to also implement manding even
without the supervision of a professional.
b. Echoics
An echoic is a verbal operant that entails appoint-to-point correspondence. There is a
striking formal similarity between the echoic response and the verbal stimulus that precedes it. In
practice, echoics entail an analyst or adult saying a word, and then the child repeats it. For
example, when dealing with Kaitie, an echoic entail stating the word “sit,” and then Kaitie also
says,” sit.” They involve an imitative nature of the response. Research has shown that the
acquisition of verbal imitation is one of the good outcomes of intervention (Ingvarsson, 2016).
This is mainly because an echoic behavior can be the foundation for the development of other
verbal behavior. When a child can imitative verbal responses, then it becomes very easy o bring
them under other kinds of control such as manding or tacting.
When training Kaitie, the professionals will teach interverbal responses. For example, if a
cat passes, she may be asked, “what do we call that animal/” and then the analyst will
immediately say the echoic prompt, “cat.” When Kaitie dependably echoes the prompt under the
control of the question, then learning is evident. Additionally, the analyst will also intersperse
other intraverbals that are similar. A reliable response will be an echoic prompt from Kaitie. This
will help ensure appropriate stimulus control. Kaitie’s parents will also be guided on how to
implement echoic in their everyday interactions with Kaitie to enhance learning even in the
absence of a professional.
Discrete Trial Training

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In the early stages of the intervention program, mand training and echoics will be
combined. The importance of combining that is so that the analyst can benefit from the present,
motivating operation to teach and achieve the echoic behavior. It will be achieved in the context
of incidental instruction where the RBTs will control access to activities and use Kaitie’s
initiations towards the preferred activities as an opportune teaching moment (Hart, & Risley,
2018). The RBTs will start by reinforcing any vocal responses. Over time, they will shape
Kaitie’s vocal responses. When Kaitie can effectively echo, then it will be time to teach and
practice vocal imitation in discrete trial sessions. Depending on her progress, and after
ascertaining that she has acquired a robust echoic repertoire, then it will be time to teach mands.
After Kaitie has reached this level, then more advanced verbal behavior will be introduced.
These will include various mands for information, recall, and conversational exchanges. The
RBT will be supervised for about 3 hours of the 15hours per week that they will be working with
Kaitie. Data will be collected and recorded on the fact sheets to assess her progress and advise on
areas to be improved.
Incidental Teaching
Kaitie’s parents will be trained to use incidental teaching when alone with her. This will
involve setting up an interesting environment for Kaitie. For example, they can have a play area
and engage Kaitie in her favorite games. They should be deliberate about spending quality time
with her engaging her in activities that she enjoys. The parents will also restrict access to an
object that Kaitie likes by having it placed in a place that is out of reach but visible. This way,
she can ask for the object by pointing at it. This is a critical step as it is where learning starts.
Kaitie’s parents will prompt her to communicate more by asking prompting questions. For
example, they will ask her to state the color of the teddy bear that she wants. They should ensure

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that Kaitie develops the necessary communication skills so ha she can verbalize what she wants.
They should also give her adequate time to respond. Lastly, incidental teaching entails a reward.
They should reward Kaitie by giving her the item that she desires. The parents will be made
aware that incidental teaching is time-intensive. It may require a few hours of training each day
and may continue for a prolonged period for the desired results to be achieved. The RBT will
supervise the parents as they conduct incidental teaching for about one hour a week and record
progress made, as well as advise the parents on how to make the program more effective.
Antecedent-Behavior-Consequence (ABC) Data Collection
Data will be collected through ABC. The RBTs will take the antecedent, the behavior, ad
the consequences of the said behavior and record. They will record when the desired behavior
occurs as well as note the event that triggered the said behavior or the behavior that happened
before the behavior and the consequences of the behavior. The ABC data will help the RBTs get
the correlations between triggers and behaviors. A constant stream of data will help RBTs assess
the effectiveness of the interventions as well as understand new opportunities that will facilitate
learning. Thus, the RBTs will guide Kaitie’s parents on ABC data collection so that they too can
record data as they will be spending more time with the girl. The behavior analyst will also
assess the ABC data, evaluate progress made and advise accordingly on changes to be made. In
case it is noted that Kaitie is not making progress, the implementation will change. The RBTs
will change the tacts and mands being used and lower teaching to Kaitie’s level. The approach
may also be changed altogether to incorporate activities that Kaitie enjoys to encourage her to
take part.
Errorless Learning

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In the event the data shows no progress, the implementation will change to include
errorless learning. The RBTs will introduce early and immediate prompting to guide Kaitie into
making correct responses. The aim of the immediate prompts is to ensure that she successfully
completes a target behavior (Markham et al., 2020). Over time, the prompts will fade, and Kaitie
will be able to engage in behavior on her own. For example, instead of asking Kaitie, “do you
want the teddy bear?” the RBTs will wait for her to actually ask for the teddy be are either by
pointing or stating that. This ensures that it decreases frustration ad increases motivation.
Evaluate the Program
Dounavi (2017) asserts that it is important for a behavior analyst to conduct regular
assessments and probes to ascertain the functional interdependence and independence of the
child. Evaluation will help show the progress being made as well as the effectiveness of the
intervention. The first evaluation will be formative, which will be done pre-implementation of
the home program. This will help know Kaitie’s abilities. The second evaluation will be
developmental, which will be conducted as the program is being implemented. The ongoing
assessment will help the analyst know goals that are being achieved and ones that are not (Miller,
2017). It will also be possible to know how Kaitie is responding to instructions. At this stage,
problems arising during the program will be evaluated and changes made accordingly.
If some goals are not being achieved, informed decisions will be made. For instance, the
RBT s may decide to concentrate more on those areas, change the methodology, try different
ways of instruction to see if the goals will be achieved. The obstacles to the achievement of the
goals will be addressed. For instance, if the challenge is limited time, then adjustments can be
made to ensure that the parents take turns monitoring Kaitie at home and are more deliberate
with implementing the program. Additionally, the RBTs will supervise Kaitie in her natural

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environment to see how she behaves while with her parents or peers. This will help in
understanding what her struggles are when she is in a natural setting.
If goals are being met at the anticipated rate, then the program will be implemented as
earlier planned. However, in the event that the goals are being met at a faster rate, then more
advanced instruction will be incorporated into the plan. The aim is to ensure that Kaitie achieves
as much as possible. Thus, the time allocated for the home program will be well utilized. If she
grasps a skill, then the RBTs will proceed to introduce advanced words and use different
strategies to help her acquire robust verbal behavior.
Additionally, Kaitie’s parents will also be asked to rate their daughter’s progress during
the ongoing assessment. Their feedback will be useful in helping the RBT s understand how the
program has impacted both Kaitie and the parents. Their feedback will be based on the daughter’s
overall performance and their own progress since they too will be part of the program. The
response will be important in understanding what she struggles with when she is in her natural
environment and in the absence of the analyst. Lastly, a summative assessment will be conducted
at the end of the home program. This will demonstrate Kaitie’s progress. Based on the results, an
appropriate decision will be made. If the progress is satisfactory, then the program will be
discontinued. However, if Kaitie needs some reinforcement to achieve better, then
accommodations can be made with the consent and approval of her parents to extend the
program.
Important Considerations
The BACB Ethics Code for Behavior Analysts (2020) outlines various ethical
considerations that need to be considered by behavior analysts. The foundational principles are to

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benefit others, ensure competence, behave with integrity, and treat others with compassion. In
the assessment and intervention process, these core principles need to be observed. The welfare
and rights of the client are paramount (Board, 2020). The behavior analyst must also ensure that
they protect the welfare of others that they interact within their professional capacity. Conflicts
of interest must be identified early enough and steps taken to resolve the conflicts. The behavior
analyst must also ensure that they behave in an honest manner. They must ensure that they do not
misrepresent themselves or engage in any fraudulent activities. They must also remain within
their scope of practice. The boundaries of the analysts’ competence must be observed during
assessment and intervention.
Code 2.01 dictates that behavior analysts must ensure that the needs of the clients are
prioritized in service delivery. In the assessment and treatment process, the focus should be on
the client’s unique needs (Board, 2020). Behavior analysts are required to ensure that they
implement plans that are backed by scientific research as well as driven towards maximizing the
desired outcomes for all clients and stakeholders. The analyst must observe their scope and
ensure that they do not implement programs that could cause harm to the clients. In addition,
code 2.04 disclosing confidential information and code 2.03 protecting confidential information
also apply (Board, 2020). The confidential information that is obtained from the client must be
guarded. Behavior analysts will obtain information from the clients that need to be guarded.
Accidental sharing of this information is prohibited. The analyst must ensure that they take
appropriate steps to guard confidential information to protect the welfare of the client.
Code 1.01 and code 1.03 are important in all undertakings of behavior analysts. In the
assessment and the intervention process, behavior analysts must ensure that they remain truthful
and maintain high levels of accountability (Board, 2020). Remaining truthful means that a

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behavior analyst does not engage in fraudulent and illegal practices. They must also provide
information that is both accurate and truthful. Every behavior analyst is accountable for their
actions. They must also ensure that they follow through on work commitments. In case errors are
encountered during the treatment and assessment process, the behavior analyst must take the
necessary steps to address the errors. The interests of the client must remain paramount
throughout the process of assessment and treatment. Code 1.07 also helps in ensuring that a
behavior analyst provides services that are culturally responsive. Behavior analysts interact with
clients drawn from different cultural backgrounds (Board, 2020). Extending services to clients
from diverse cultural backgrounds calls on an analyst to ensure that they are culturally
responsive. One must ensure that they evaluate personal biases and ensure they take measures to
address the biases. Biases can affect the delivery of services, and this makes it difficult to deliver
culturally-responsive services. Behavior analysts are also expected to ensure that they do not
discriminate against others. The provision of services must be made in an equitable and inclusive
manner.
Code 2.14 is also highly applicable in the assessment and treatment process. Selection of
the behavior-change intervention must be made in a manner that is consistent with behavioral
principles. It must also be based on scientific evidence and must meet the client’s diverse needs.
Any treatment plan that is implemented must be in line with behavioral principles. The risk of
behavior change interventions must be minimized as dictated by code 2.15. Harm to the client
must be kept at the lowest levels possible.

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Conclusion
Overall, Kaitie’s intervention will take place in four stages, as described above. As shown
in the paper, a behavior analyst uses evidence-based interventions to help individuals achieve
their goals. Kaitie’s facilitated communication program is aimed at ensuring that she achieves the
necessary communication milestones as set out in the goals. The program includes a behavior
analyst who will supervise the RBTs as they work with Kaitie and her parents in implementing
the interventions. The plan will include manding, echoic, Discrete Trial Training, and incidental
teaching. ABC will be used in data collection ad if the behavior analyst, the RBTs, and Kaitie’s
parents note that little or no progress is being made, then the approach will be changed. Errorless
learning will be used to enhance motivation and help Kaitie see her progress, and encourage her
as well. Overall, the periodic evaluation will help quantify progress made throughout the period.

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References

Albert, K. M., Carbone, V. J., Murray, D. D., Hagerty, M., & Sweeney-Kerwin, E. J. (2018).
Increasing the mand repertoire of children with autism through the use of an interrupted
chain procedure. Behavior analysis in practice, 5(2), 65-76.
Board, B. A. C. (2020). Ethics code for behavior analysts. Littleton, Co.: Author.
Dounavi, K. (2017). Tact training versus bidirectional intraverbal training in teaching a foreign
language. Journal of Applied Behavior Analysis, 47(1), 165-170.
Hart, B., & Risley, T. R. (2018). Promoting productive language through incidental
teaching. Education and Urban Society, 10(4), 407-429.
Ingvarsson, E. T. (2016). Tutorial: Teaching verbal behavior to children with ASD. International
Electronic Journal of Elementary Education, 9(2), 433-450.
Markham, V. A., Giles, A. F., Roderique-Davies, G., Adshead, V., Tamiaki, G., & May, R. J.
(2020). Applications of within-stimulus errorless learning methods for teaching
discrimination skills to individuals with intellectual and developmental disabilities: A
systematic review. Research in developmental disabilities, 97, 103521.
Miller, K. L. (2017). The use of evaluation in treatment programs for children with
autism. Behavior analysis in practice, 10(1), 35-44.
Price, B. (2017). Developing patient rapport, trust and therapeutic relationships. Nursing
Standard, 31(50).
Shields, N., Westle, A., Bennell, K. L., & Taylor, N. F. (2020). Physiotherapists perceived
developing positive rapport facilitates participation in exercise among people with