Operant Innovations 009 | Issues of Multicultural Diversity in the Ethical Practice of Applied Behavior Analysis | Part 3

Shauna Costello (00:01):

You're listening to operant innovations, a podcast brought to you by ABA technologies. Today, we're finishing up this talk on multicultural diversity and Dr. Danielle DeLong is going to talk about socioeconomic status, and then we're going to finish up with a Q & A with all three presenters.

Dr. Killu (00:21):

And now I'd like to turn things over to my colleague, Dr. Danielle DeLong. Who's going to talk about the socioeconomic status of our clients.

Dr. DeLong (00:29):

So yes, I'm going to be talking about the socioeconomic status of our clients. And I want to set up a situation for this client that we're going to be discussing. So the setting of your treatment is a community mental health clinic in an urban or suburban area in the County where your clinic is located, has a 20% poverty rate. Um, in your role, you treat a variety of individuals, including those with commercial or private insurances.

Dr. DeLong (00:56):

And then those who have Medicaid insurances or funding, which is a federal and state program that helps with medical costs or treatment costs for people that have more limited income and resources. So the client we're going to talk today talk about today is Sam. Sam is five years old. He's diagnosed with autism spectrum disorder and global developmental delay. He presents as European American. He speaks English and his mom described the family culture as quote unquote white. And he has Medicaid insurance. He goes to kindergarten at a local public school, and he has a special education plan that provides supports for him. And his mom is his primary caregiver. He does not have visitation with his father. So just a sidebar about Sam here, Sam is a client or an individual. We very frequently treat, um, day to day. And that the clinic that I work in and oversee PM is one of our most frequent types of presentations.

Dr. DeLong (01:52):

So the reason he is coming in for treatment is because mom wants to improve his compliance. She reports that he just doesn't do what he's told. And that when he's given a command, even if it's a one word command, Sam will quote unquote fallout. What this means is he cries. He lies on the ground. He kicks his feet. And when he has one of these fallouts, um, his mom says that she just doesn't make him, you know, do it. What he was directed to do. She doesn't require him to engage in the directed task and she eventually just walks away. Um, so Sam's mom would really like him to comply with commands and directions more frequently decreasing the frequency of fallout. This sounds like a pretty easy or straightforward um, course, you're going to do a reinforcement protocol. This is probably escape maintained behavior and what you need to do is determine if there are other commands, um, that routinely gain compliance from Sam.

Dr. DeLong (02:47):

You need to determine if there are commands that Sam's mother would really like him to follow. We want to prioritize her goals, um, throughout this treatment. And you might maybe use some behavioral momentum to support success. Um, you're going to determine reinforcers for your protocols. So you have a lot of really great, um, initial thoughts on the surface. This really doesn't seem very complicated. This is a really common treatment protocol and, and scenario for you. So, um, we'd need to find out what's reinforcing to see him. His mom says that he likes chocolate cereal, marshmallows, and Cheez-Its brand name crackers. Um, she even notes that all of these things, uh, were used as reinforcers at school with success for compliance. And she adds that she's used these reinforcers at home with success over the course of his treatment history. So you have all of this really fantastic supportive information for reinforcers and the need for a reinforcer assessment they've been used.

Dr. DeLong (03:43):

Um, she reports continued. They make a plan. You collect data for a period of two weeks. You confirm your initial thoughts, recommend a reinforcer protocol for compliance in which Sam has given one marshmallow chocolate or Cheese-Its Cracker for compliance with the recommendation that mom can, you know, change those up as she needs to according to supply or preference. Um, and then Sam's mom agrees to the plan and report. She understands and noting that she's done this before. So not only is your plan, um, concrete and understandable, but it's familiar to her. So you engage your treatment protocol and then you need to do some followups during your weekly sessions when you were engaging the protocol with, um, Sam and his mother, um, the reinforcers are provided by the clinic and you're in session data show you improve the frequency of compliance. That's great. And clinic data are really showing a positive trend at follow up and appointments two and four weeks into treatment.

Dr. DeLong (04:44):

Sam's compliance frequency unfortunately had not increased in the home set. So no change from baseline was observed. In clinic, you were seeing really great improve improvement. The frequency of compliance was increasing, but at home, Sam was not changing. So you discuss this with Sam's mom, because obviously this is concerning. And she admits that she ran out of reinforcers, but not, not recently, you know, just within the last week of our multiple weeks of treatment here, Sam's mom admits that she ran out of reinforcers on the third day of the treatment protocol. She continued to take data recorded information, and she discussed fully in both followups, the protocol and Sam's response as though she had continued providing reinforcement. And she never once mentioned that she wasn't giving the reinforcer. She didn't want to tell you this because she wanted Sam to improve. She had so much hope and desire for him to get better. She just didn't report negative results. She was embarrassed because she couldn't afford the reinforcers that Sam needed.

Dr. DeLong (06:03):

So, what did we miss? There's a lot. We learned in our four week follow up appointment that Sam and his mother, while reporting that they have stable housing, they move around a lot and quote unquote, stay at different residences as the mom was on a waiting list for subsidized housing and she can't afford rent on her own. So most recently she reports that the family moved in with her own mother just before treatment started. And it, in addition to this, while she has WIC benefits and benefits to receive supportive food resources and such reinforcers, the crackers, the cereal, marshmallows, and chocolate really aren't one of the approved foods. She also has separate food stamp benefits in addition to these WIC benefits, but the check for the food stamp benefits posts on the first of the month. So what she does is she goes out and she buys as much shelf stable food as she can to last the whole month.

Dr. DeLong (06:55):

And she reports that she tries to budget for the specific reinforcers. And it's really hard reinforcers that are used at school. We find out were provided by the school and in the past, they were sometimes sent home, which is how she was able to use the reinforcers in the home setting and achieve success. We also learned that other financial resources are used for gas so that Sam's mom can get to work. Her work is not as simple nine to five. Like many of us are privileged to have. Her work is shift work at a gas station and it varies week to week. Sometimes she runs out of money for gas. If she gets more shifts because she takes shifts as often as she can and they vary greatly. When she works, um, her and her mother is unable to watch Sam. Um, she also has to pay a babysitter because the free daycare that's available to her, doesn't always have the hours that she needs.

Dr. DeLong (07:51):

And this further limits her resources. There are a lot of challenges here for Sam and his mother. And these are challenges that are frequently observed for individuals who experienced poverty. These challenges include transportation difficulties, work, schedule difficulties, posting schedules early in the month versus later in the month, interfering with their ability to fluidly buy food throughout a month. Um, food stamps, um, can be limiting, um, women infants and children funding, and the provisions provided their housing challenges, childcare option challenges. These challenges are complex and poverty is a complex scenario for individuals to navigate. There are many barriers and they're very extensive. This doesn't just impact their ability to go from place to place. This impacts their ability to eat what is needed day to day to have a proper, um, potential sleep schedule to have stable housing. You know, moving frequently is extremely disruptive. Additionally, many families who experienced poverty also, um, experienced generational poverty in which they've experienced generation after generation, the barriers and challenges, um, of living in poverty.

Dr. DeLong (09:06):

So an individual whose parents or grandparents also had these same challenges may not have been able to teach them how you get a check or a paycheck or otherwise to last throughout the whole month, because all they have been taught is to purchase groceries. The second, the check posts to make sure that you have what you need. And so not only are we looking at, you know, a generational lack of in common and financial resource, there's a, there's a potential barrier to training when you're raised in poverty and you experience all the challenges that come with that. These are lessons that may not be learned. We also have to consider when we're working with individuals who experiences these challenges of poverty, and we have to consider Maslow's hierarchy of needs. Many of this, many of us probably saw this hierarchy of needs very early in our training.

Dr. DeLong (09:58):

Um, and we, it's not that we forget about it, but I think we forget to emphasize it for every single individual we serve. It is extremely important to understand that poverty can be invisible. It's not something we're going to necessarily see when our clients come in and we really need to dig deep in our assessments and consider their hierarchy of needs. Very often, individuals who experienced poverty do not share their story with full details. They've they failed many times or have been in situations with treatment providers where sharing the details of their, um, their needs or their life circumstances are it's embarrassing, or they can't communicate it in a way that's understood by the professional. And so they just go along with treatment, very often, individuals who experienced poverty are at that bottom rung, a physiological or safety protection and security needs and Maslow's hierarchy. And we cannot minimize the importance here of digging deeper to understand the environment and the limitations that that person is experiencing.

Dr. DeLong (11:01):

And these questions can be uncomfortable when we're asking them if somebody who maybe has more limited, limited resources, but there are necessary questions. And it's the onus of responsibility is on us as behavior analysts to dig deep and get that information to support those we serve. So when we consider the relevant, um, code, there are a lot of aspects of our code that speak to, to this, um, and speak to, um, really digging deeper and providing appropriate and valuable treatment, particularly to individuals, um, and poverty or other cultural backgrounds. So we have to consider culture, including socioeconomic status. Um, we need to obtain the training experience, consultation or supervision necessary to ensure our services and make appropriate referrals. So you need to gather comprehensive information, you know, in this situation with Sam without intending to, we didn't get what we needed. And if we're not familiar with the experience of people living in poverty and how to gather information that would reveal, um, those barriers, um, and challenges, we need to seek training.

Dr. DeLong (12:13):

We need to seek training from others who maybe have more training and socio socioeconomic, um, limitation standards, and cultural understanding. Um, we also need to emphasize as stated previously that clients have a right to affective treatment, I love how our code emphasizes that clients, um, don't just have a right to treatment. They have a right to affective treatment. That is fantastic. Effective treatment, someone argues starts with gathering the most comprehensive information possible, and may also involve asking some really challenging questions of all the clients to ensure the information we gather leads to the best possible treatment. We also need to consider the type of assessments that we use, and this needs to be determined by the client's needs, their consent, their environmental parameters, and other variables. And this would include socioeconomic status or poverty concerns. We need to not just conduct an assessment. We need to be sure we're asking those, those more challenging questions.

Dr. DeLong (13:13):

Um, you know, in our situation with Sam, we knew the reinforcers, but we just assumed they were available because the parent provided such positive feedback regarding her familiarity and understanding. We also need to consider environmental conditions that might prevent us implementing our behavior change plan. Um, it could be argued that, you know, expense free reinforcers and almost all situations, but particularly for Sam should be the first line reinforcer. And there's, there's nearly always readily available, you know, expense free reinforcers. And if we needed to, we could develop those for Sam, um, through a reinforcer and preference assessments. When an item is chosen, that has an expense, um, particularly pertaining to reinforcers, we need to, um, kind of determine the appropriateness of this because it could hinder the implementation of the behavior change program. And we need to make sure that it's readily available to the caregiver.

Dr. DeLong (14:08):

We also need to consider supervisory competence, right? We only want to supervise, um, in our area of defined competence. So as a supervisor in this scenario, I would need to make sure that I understood the boundaries and limitations of the socioeconomic status of this client and his family, um, before really, um, engaging in the treatment. Many opportunities for training are available in these areas. Should you need them? There's really great bridges out of poverty training and book, um, that the trainings that can be provided are based on the bridges out of poverty strategies for professionals and communities, um, book, it's a really fantastic resource, but very often because socioeconomic status is invisible and not well understood. We just overlook that we need to dig deeper into that aspect of training. And so as a supervisor, on a case like this, I would really need to seek that out.

Dr. DeLong (15:02):

We also need to make sure that we are designing effective supervision training for individuals who are, you know, in our practices that are working with, um, individuals, uh, socioeconomic status, uh, diversity. Um, once you establish your own competence, training other people, um, is important, it's vitally important. Um, and this is something that a lot of programs or practices really don't address. And so you need to find those resources and engage training as appropriate for the population you serve. You know, in the clinic where Sam was being treated 80% or more of the population served was, was Medicaid individuals. And we don't want to assume poverty in those individuals. There's a lot of circumstances that might result in somebody having a government funded insurance, but we do need to be asking those questions to be sure that we have all the information we need. And the last question is you know, is there ABA specific research in this space with regard to socioeconomic status or poverty for those we serve in a review of research that was conducted to determine the extent to which children living in poverty were included in educational research.

Dr. DeLong (16:09):

Um, it determined that these economically disadvantaged children have been increasingly included in the research, but there's still a lot of growth, especially considering the diverse factors that might lead to the inclusion and exclusion criteria. Um, for somebody being determined as you know, economically disadvantaged on a research study. And so challenges with this type of research can include those criteria factors considered to establish poverty, compacted, compounded factors of diversity. And so this is really an area where as a practice we need to dig deeper into and we really need to start understanding it better because it does impact our practice. Now we'll transition to back over to Dr. Cappellano who is going to kind of review some of these resources for us that we've touched on.

Dr. Cappellano (17:03):

Okay. Thank you. Um, so I'm going to go over some basic resources that the scenarios might be able to find helpful. Um, if they want more information on working with some diverse populations, um, I will say I dug into the ABA resources and came up empty handed. So all of the resources I've found have been from other disciplines. Um, Dr. DeLong had mentioned a bridges out of poverty. That's an entire curriculum. There's actually a wealth of information and resources. If you look that up, um, there's, day-long trainings you can go to, you can just read a book. Um, if you just Google bridges out of poverty, there's a lot of information that comes up. Um, there are a number of resources that have been compiled by the federal government as well.

Dr. Cappellano (17:51):

Um, so some of them are through the US department of health and human services. Um, and they have actually have a division called the office of minority health. And there are some, um, standards on, um, cultural competency in the, um, delivery of healthcare services. Um, so you can find some, some resources and information there. One publication they produce is called the national standards for culturally and linguistically appropriate services. Um, another, uh, resource by the federal government is the, what works clearinghouse. This is from the US department of education. Um, and honestly, if you just Google what works, the what works clearing house is usually the first, um, option that will populate. Um, this is a place where you can find evidence based practices in education. Um, but if you look within the options, there are a number of different options. There is, um, a whole section devoted to children and youth with disabilities, but there's also a section devoted to, um, English language learners. So this will help you, um, and understanding what our research evidence based practices in teaching, um, English learners, another division of the federal government that has some resources is SAMHSA. That is the substance abuse and mental health administration. Um, and they have a publication called improving cultural competence. And this is a guide for any kind of health and human services, mental health practice on how to improve the cultural competency of their practitioners.

Dr. Cappellano (19:35):

Uh, the council for exceptional children, um, has also has a website with some information for, um, culturally and linguistically diverse exceptional learners. So this would be for the special needs population and looking at that through a multicultural lens as well. Um, and really those, the majority of resources that I have compiled that give kind of broad information. Um, if you have further questions or inquiries, um, feel free to reach out and contact myself or any of the other, uh, contributors here. Thank you for having us.

Shauna Costello (20:12):

Yes. And thank you guys. And I've been taking some notes and questions and stuff, and that got me thinking about with tele-health coming into such a bigger practice now. And, um, this is something that I've talked to my colleagues with or about, and I did independent consulting before, like, as I was leaving the clinical world and trying to find, you know, a different job to go into, I did independent consulting and, um, I, you know, it was a consultative model with a lot of caregivers. It wasn't working with RBTs. It wasn't working, you know, necessarily with that. And I'm kind of wondering if this may be a catalyst to throw a lot of our caregiver or a lot of our BCBA or BCABAs into this consultative model where they actually do have, they're forced to become more familiar with these cultural differences and activities of daily living so that they can actually create these task analyses and programs to help teach the caregivers how to teach their children or their, um, or their yeah. You know, teenagers or their adult children, or even group home staff. Um, so I'm wondering kind of to how, how that will play, how the telehealth stuff will play into all of these cultural differences as well.

Dr. Cappellano (21:42):

Yeah. Yeah. That's a good point. Um, and I know, um, for all of us here, I think the majority of us, when, when we do clinical work in ABA, that's the model that we're used to. Um, most of us are used to on this, on this team, you know, doctors DeLong, Killu, and myself, we're, we're not the ones running the behavior plan and we don't have in general, RBTs right underneath us. Cause somebody's listening might think, I got my own RBTs. I'm gonna train them. We'll be good, but that's only half your work. Anyway, you know, the majority of the work I do is I rely on other people to carry out the plans that I write. So that means you have to work very closely. You have to discuss, you know, and practice and model and you know, all those behavioral skills trainings, but you really have to think about what is their natural environment gonna support. And even when you're in a clinic, you know, you might think, Oh, I got it. I can control everything, but that's still only a part of the day that the client spends in your clinic. You still have to think about generalizing, all that change to the natural environment and what is the client's natural environment.

Shauna Costello (22:40):

Yeah. And I fully agree, and this is straight anecdotal evidence, but, um, when I was doing independent consulting, I, I felt like I saw quicker results because I was individualizing it to the environment that they were in a majority of the day and you get more buy in, sometimes because it's the caregivers doing the work and you're really trying to individualize it to them. So, um, I, yeah, I'm kind of hoping that this telehealth thing kind of as a catalyst for some different practices too, to start, you know, expanding on how we're delivering services.

Dr. Cappellano (23:21):

Right. And right. And then ABA is not like, I dunno, dropping off your dry cleaning. Right. It's not like you, like, you drop off your kid to get fixed. You pick them up. Alright. We're all good. Now it's more of that whole collaborative model.

Shauna Costello (23:32):

And then Kim, to go over to kind of what you were saying with creating these inclusion intake documents that take, you know, cultural differences or even, um, just personal individualized differences into place, um, I mean, do you know, uh, I mean, there's, you know, things that we can do to create our own. Um, but even me recently, and I was creating a process to bring on new practicum students. I mean, what are some other things that we can take into consideration when we're creating these types of documents?

Dr. Killu (24:09):

You know, I think for the most part there are, I don't know how to say this maybe global similarities, right. But all of us have our own quirks and idiosyncrasies and preferences. Right. And I think that ties in really well with, um, Angela's comments about the task analysis and how that really has to be individualized for every single person. I mean, I've put together task analysis to, to tie your shoes and it's pretty much the same procedure, but you have someone that has a specific need or a specific preference in carrying it out.

Dr. Killu (25:02):

And as long as you get the end result, I don't really think it's that big of a deal, but let's work to see what somebody's little preferences in, in, in issues are, and just integrate that into the treatment. And I think that goes as well for the families that we're working with too, because you know, like I, and we've all heard, this as behavior analysts, the best way to change someone's behavior is to change your own. And that goes a lot for our parents and families, and they have little preferences and idiosyncrasies as well, and that's gonna carry over to any kind of intervention that we develop. I really think it's important to, I mean, we have our own protocols and we can present to people the who, what, when, where, why, and how, but there are little variations and tweaks that we can make on all of those.

Dr. Killu (25:57):

And I think it's important to really sit down when you're developing programming to talk about this is exactly what I'm proposing, but is there a way to do this that fits in better with your preferences and your needs? And I don't think we do that a whole lot at all, because we say, this is my protocol for this particular intervention, and this is how it's going to get carried out. And I mean, I don't think we can come up with a protocol for all of the variations that we may encounter with a client and a family, but let's make that part of our collaborative effort to really just sit there and talk about some nuances in how we all have little quirks. And we like things done in a different way. Even when I do an intervention, I've got my own little way of doing it. I'm still following it, but I've got a little bit of my own, um, quirks and preferences in there to make sure that I carry it out in a way that works best for me. And that also results in effective improvement for the client.

Shauna Costello (27:04):

Yeah. And I mean, when I was in a clinical setting, it's very easy for us as supervisors to be like, okay, they mastered out of this program or they're about to master out of this program. Okay. Here's the one that's going in next very easy to do that. And I mean, I've been guilty of it too. And, you know, things may be easier with the whole individualizing it to the families as you get to know the families better and have that rapport with them, but especially in the beginning, but yes, and I don't want to over-generalize to, you know, all supervisors of these types of programs because not everyone is doing it, but, you know, I think it's something that we need to take into consideration that when we are putting in new programming, that that is something that we need to make sure we're saying to the families when we're supervising. No, Hey, they're about to master out of these. These are the new ones coming in. Can you just review them quick for, for me and just getting that type of even a quick approval and just keeping that, even that communication open so that the family knows that, you know, if they're seeing programs being run and they don't like something, or, you know, something needs to be changed, that they, you have that open communication with the caregivers as well to easily change something.

Dr. Killu (28:26):

Yeah. I think by doing that, that's going to enhance your rapport and the more rapport and the better rapport you develop, the more information that you're going to get that allows you to address everyone's quirks, idiosyncrasies, preferences, et cetera, because people are going to feel more comfortable sharing that with you.

Shauna Costello (28:48):

I mean, that even speaks to, I remember one of my cases in particular when new RBTs, I mean, and I think we did this for actually a vast majority of our, of our clients, but, you know, we would switch RBTs every so often just because, you know, we didn't want, we wanted to make sure we're keeping a good rotation of RBTs. So it wasn't, you know, the things didn't get stagnant. Um, and they could generalize to multiple different people, but, you know, one thing that my staff would do where they'd have to like shadow in that house. So not only the family and caregivers are getting used to it, but the clients are getting used to it, but that they're learning the quirks and the nuances of that, of that home. So that's something I think could be really good as well.

Dr. DeLong (29:43):

One of the things I think about when I am training, particularly our technician level staff, um, or new BCBAs, um, to the clinic is that the treatment isn't ours. And I think if we remember that and we are very person centered, you know, person treated centered, I think it really helps us with, um, where you place the leadership of where the direction of the treatment. And I think that's really hard because when you go in as a quote unquote expert, kind of knowing what somebody needs, knowing how to get there, a history of experience, you know, addressing the same concerns for that. You've seen so many people, you forget that the treatment is not dependent on you and that your value and your preference for where it goes or what program comes next is secondary to the individual you're serving. And I think just, you know, that rapport, that therapeutic Alliance we know is the most salient factor to success.

Dr. DeLong (30:43):

Um, but especially for those we're training who are newer in the field or who are technician level, I think it's a real challenge because the real directive is go out, do this and make the person improve, right? Like the results are all on their shoulders. And I think in that supervisor, relationship, training relationship, this colleague discussions, we really need to focus on the fact that we aren't leading the treatment. Um, we're supporting individuals and achieving a goal. And it changes, I think that the stressors, but maybe the direction and nature of the treatment protocol as well.

Shauna Costello (31:19):

Yeah. And, you know, I've seen some supervisors in the past be like, "Oh, the family asked to put this into place, but next we're supposed to do this." I was like, "well, are you supposed to do that? Or is that just something, is that your preference" that, you know, you can't maybe add in one extra program or something else to help. And not only, you know, it makes the family and caregivers happy, but it gives them that builds that rapport. It gets in that buy in to your services and your treatment that, you know, you're willing to work with them. So, yeah, I think it's very good to remember that this isn't about us. This isn't about, you know, yes, we have specific outcomes that we would like to see, but those aren't always the most socially valid to that family or that group of individuals who are involved with our client's life and what they always want to see. So that's a very good thing to keep in that, that this is not ours or doing this for others. And then also that kind of brings me into some Danielle when you were talking about, you know, socio socioeconomic factors and the example with the edibles, does, how much does this bring up the point that maybe we should be creating or teaching these non edible reinforcers?

Dr. DeLong (32:47):

I think that's vitally important. Um, non-edible reinforcers in any environment are more available usually. Um, it's really hard to always have the right kind of snacks in all environments. At all times. I have experienced with this raising a child with a blood sugar disorder. So I assure you keeping edibles, um, runs my world and it's extremely hard. And I, I set in myself to be a, a rather prepared individual. And so asking families, um, caregivers, babysitters, teachers, paraprofessionals, um, all these people that are encountered the children we're serving to have on them at the ready, an edible for a child working on a goal or protocol, I don't think is realistic. Um, I think that it's easy though. I think so often because we're thinking that success is the goal and our success in getting our treatment, um, you know, goals and objectives met is the goal.

Dr. DeLong (33:40):

We can become kind of, um, you know, work with some blinders on and just only focus on getting those goals met and the easiest way to do it as the most salient reinforcer, or that means the most of the persons I'm going to feed them all day and then we'll get success. And then we forget that we should be putting other reinforcers, we can do preference assessments and that what's actually most beneficial to the person in the long run that we're serving is that they can always have available reinforcement. And the world, we all live in, we're not always reinforced with an edible, you know, it's a high five, it's a complimentary statement. It's, you know, more of those, um, just naturally occurring reinforcers. So I think it's extremely important that we work on developing non-edible reinforcers, even though the edibles are easy and we do get our goals quicker for mosquitoes. Um, we need to be using the entire breadth of our skillset and that includes developing and using alternative reinforcers.

Shauna Costello (34:41):

Yeah. And it's not so much it's not, you know, and it's, we're not there to just create these non-edible reinforcers. Like you said, that's going to make it so much more applicable down the road in the future to, you know, to this typical life that we all live. I mean, this is just my personal preference, but yeah, I would love to get edible reinforcers constantly. Um, you guys, might've seen me reaching over here and kind of munching. Um, I keep a bowl of Hershey kisses near me at all times because it's something I enjoy and, you know, I can set up these contingencies for myself, but not everybody can. And, but it is our goal to that, you know, down the line, make individuals as independent as possible. So maybe the down the line, they are able to set up these types of reinforcement systems for themselves or caregivers or other family members can set up these types of, you know, reinforcement systems for their, for, you know, for, um, their family.

Shauna Costello (35:44):

But, um, it's not necessarily something we need to start off. I mean, we have to start off with it because then start pairing. But yeah, it is, it is very important that we get off of these, non-edible reinforce to get to these non-edible reinforcers because food is not cheap. It's not. And, um, that kind of brings me into my next question is, and this can be for Danielle, but it could be for everybody else as well. Um, what should research, but maybe even so maybe even more so applied research, um, be focusing on with, you know, all of the potential things that you talked about today and what's missing out there.

Dr. Cappellano (36:33):

I mean, I think just in general for the research literature, first thing you have to do is you have to supply the data. So when you are doing your research studies list, the cultural backgrounds, the ethnicity, the language spoken of the participants in the research studies, because right now we don't even have the data to be able to even make conclusions. That'd be a really, I think, obvious and straightforward place for researchers to start just collect and divulge that information.

Dr. Killu (37:02):

One of the things this isn't related actually to, to research, but I think it's something that all of us as practitioners need to do. Um, and we need to stop making assumptions about people just based on the way that they look. Um, and we make assumptions based on their race or their ethnicity. And I just find it so offensive to think that because you look some in some particular way that you're going to be this type of person and have these types of needs. Um, and I think that it would really enhance our research a lot as a field if we were to get away from that. And, and I think some of that may be inherent to human nature. I really do. Um, but as a clinician, we need to step back and say, wait a minute, is what I'm thinking about you reality? Does that match up with any data that I would collect on you? Because there is, they're not necessarily congruent. And, and I think that we really need to work on that. Um, the education field needs to work on that clinical, you know, psychological behavioral analysis field needs to work on that. It's just really something, I think that's holding us all back as professionals.

Shauna Costello (38:34):

Yeah. And I, that speaks to assumptions in general. Um, and you know, kind of our learning histories and how, what it's kind of made us think from here on out. And, you know, I, and I know you, you said, you know, a way of people way people's like look or sound or, you know, that plays into it as well, but it also plays into, you know, um, gender or sexual orientation, you know, people ask me constantly, they're like, Oh, do you have a boyfriend? Or do you have a boyfriend? Like without even knowing me? Or they're like, Oh, do you have kids just cause, you know, just cause I'm a female, doesn't like, it really makes me think how many males get asked. Oh, do you have kids? Probably not very many, but I know that even in my clinical work, working with parents, they're like, Oh, do you have kids? And I hate to say this, but like, if you, if I would have just lied to them, their thoughts about me would have instantly changed.

Shauna Costello (39:34):

If I would've said yes, I do. They would have been like, Oh great. She understands me now just because she has kids. And so it's these assumptions that, you know, it's, Oh, somebody a parent or they, you know, are they coupled up with somebody else or they straight, Oh, is that, Oh, they're white. They must be, Oh, she's a me specifically. Oh, she's this very white pasty redhead. She's probably Irish Catholic, you know, things along those lines. So yeah, that really speaks to those types of assumptions and, you know, kind of where those come from in our learning history. Those are kind of the questions that I was coming up with. I know that you, I know that you three said that you might want to have some discussions, um, other discussions. Is there anything else that you want to chit chat about with each other or even mention?

Dr. Cappellano (40:25):

Um, I think one thing that we've all talked about, and I don't know if we have a solution, but I think just something for BCBAS to keep in mind is, you know, how much we value and praise independence. Um, and then, and I know that that's something that's super important in my life. I'm always, you know, kind of pushing my clients to be independent, but it's something that we take for granted and say, Oh yeah, that's obviously the most socially valid thing. And I really think we need to take a step back and think about is that the most socially valid goal for all of our clients and for some, it may be and for some, it may not be. I mean, and even just like thinking about and discussing it is really hard for me to even get away from that idea because that's so ingrained to us, um, in this country.

Dr. Cappellano (41:09):

And I think, you know, behavior analysis is of course international it's everywhere, but I, you know, a lot of our research literature and I think a lot of the leaders in our field, um, are still promoting that, you know, independence is like the number one goal. I think we have a very strong slant towards that in our field. And I don't know that I'm gonna say it's a good or a bad thing, but it's just something to be aware of. And I think we really need to be cognizant of as we move forward and making sure that we are not putting, you know, we think would best for our lives, you know, onto our clients.

Shauna Costello (41:37):

I think that's a very, very good point. Thank you so much for speaking with me on this today. I know I enjoyed hearing you guys talk at the behavior analysis of Michigan conference association of Michigan conference a couple months ago now. And I'm so happy to have you on the podcast to make sure that more people are hearing and getting to learn about multicultural differences, socioeconomic differences, inclusion inclusion is a big one, especially. Um, I just had a talk with my dad, um, who was a teacher, a middle school teacher after an inclusion talk that I sat in on last week. And I was like, dad, I never thought about this, but you know, where a lot of teachers tend to, and again, I don't want to overgeneralize to all teachers, but a lot of teachers tend to assume gender. Cause they're just like, Hey boys and girls, or, you know, instead of just saying all of you or something along those lines. So it's, it's really something that I'm so happy that you were willing to in that I want to make sure that I'm getting better at it because I fully admit I am. I still have to work on it. And I'm so happy that, you know, you, we're here to help bring out some of these, some of these things that are going on in the field to make sure that we're all staying more cognizant of them as well.

Dr. Cappellano (43:03):

Yes. Thank you. And I just want to point out too. I don't think any of us on this panel here consider ourselves experts in cultural diversity, but we recognize it's, it's a, it's an area where I feel needs to grow. And I think for everybody it's a point of growth. It's, it's something that you should be continually working on and learning.

Dr. Killu (43:20):

And I can say as the three of us have worked on projects like these, um, we've all continued to grow and learn too. And that's really what this is all about.

Shauna Costello (43:33):

Well thank you all again. I appreciate it. Thank you for listening to operant innovations. And as always, if you have questions, comments, feedback, or suggestions, please feel free to reach out to us at operantinnovations@abatechnologies.com.