Discussion Post Rubric 20 Possible Points

Category 4 Points 2 Points 0 Points

Length of Post The author’s post consisted of 150— 200 words

The author’s post consisted of 100— 149 words

The author’s post consisted of 99 words or less

Grammar, Usage, Spelling

The author’s post contained less than 2 grammar, usage, or spelling errors.

The author’s post contained 3—4 grammar, usage, or spelling errors.

The author’s post contained more than 5 grammar, usage, or spelling errors and proofreading was not apparent.

Referencing and Utilizing Outside Sources

The author posted references from peer— reviewed behavioral sources in APA format and cited one or more original behavioral references, outside of the assigned readings.

The author posted references in APA format of assigned readings but did not include an additional peer— reviewed behavioral reference.

The author neither utilized APA format for referenced material used nor cited an outside peer- –reviewed behavioral reference.

Promotes Discussion The author’s post clearly responds to the assignment prompt, develops ideas cogently, organizes them logically, and supports them through empirical writing. The author’s post also raises questions or stimulates discussion.

The author’s post responds to the assignment prompt but relies heavily on definitional explanations and does not create and develop original ideas and support them logically. The author’s post may stimulate some discussion.

The author’s post does not correspond with the assignment prompt, mainly discusses personal opinions, irrelevant information, or information is presented with limited logic and lack of development and organization of ideas Does not support any claims made.

Demonstrates Application of the Assigned Reading and Behavioral Concepts

The author’s post clearly demonstrates application and relationship to the week’s assigned reading/topic.

The author’s post refers to the assigned topic/reading tangentially but does not demonstrate application.

The author’s post does not demonstrate application of the week’s assigned topic/reading.

Be advised, there are also response costs associated with specific behaviors:

• A response cost of 3 points will be administered for not responding to a peer’s post • A response cost of 1 point will be administered for not reading all of peers’ posts • Late discussion posts will adhere to the general policy found on the Virtual Course Schedule.

Behav Analysis Practice (2016) 9:84–94 DOI 10.1007/s40617-016-0111-6

DISCUSSION AND REVIEW PAPER

Developing the Cultural Awareness Skills of Behavior Analysts

Elizabeth Hughes Fong1 & Robyn M. Catagnus2 & Matthew T. Brodhead3 &

Shawn Quigley4 & Sean Field5

Published online: 4 February 2016 # Association for Behavior Analysis International 2016

Abstract All individuals are a part of at least one culture. These cultural contingencies shape behavior, behavior that may or may not be acceptable or familiar to behavior analysts from another culture. To better serve individuals, assessments and interventions should be selected with a consideration of cultural factors, including cultural preferences and norms. The purpose of this paper is to provide suggestions to serve as a starting point for developing behavior analysts’ cultural awareness skills. We present strategies for understanding be- havior analysts’ personal cultural values and contingencies and those of their clients, integrating cultural awareness practices into service delivery, supervision, and professional development, and becoming culturally aware in everyday practice.

Keywords Culture . Cultural awareness . Applied behavior analysis . Diversity

Skinner (1953) defined culture as variables Barranged by other people^ (p. 419). That is, humans control contingencies of

Elizabeth Hughes Fong, Robyn M. Catagnus, and Matthew T. Brodhead shared first author

* Robyn M. Catagnus [email protected]

1 Arcadia University, Glenside, PA, USA 2 The Chicago School of Professional Psychology, Chicago, IL, USA 3 Purdue University, West Lafayette, IN, USA 4 The University of New Mexico Medical Group, Albuquerque, NM,

USA 5 Western Michigan University, Kalamazoo, MI, USA

reinforcement and punishment that affect the behavior and learned reinforcers and punishers of a person or a group of people. Culture may be further defined as Bthe extent to which a group of individuals engage in overt and verbal behavior reflecting shared behavioral learning histories, serving to dif- ferentiate the group from other groups, and predicting how individuals within the group act in specific setting conditions^ (Sugai et al. 2012, p. 200). Distinguishable stimuli and re- sponse classes that occur in cultures include race, socioeco- nomic class, age, religion, sexual orientation, ethnicity, dis- ability, nationality, and geographic context (Sugai et al. 2012). An individual’s unique set of distinguishable stimuli and response classes are collectively referred to as an individ- ual’s cultural identity. One benefit of determining cultural identity is it can allow behavior analysts to develop an aware- ness of a client’s personal cultural values, preferences (i.e., learned reinforcers), characteristics, and circumstances (contingencies at the third level of selection; Skinner 1981). There are possible benefits for society, too, such as to better guide assessment and intervention practices. By acknowledg- ing the importance of culture, behavior analysts can help achieve socially meaningful goals such as reducing disparities in access to services and improving the quality of services for diverse populations in behavioral health systems (U.S. Department of Health and Human Services 2001).

Culturally aware behavior analysts should understand their own cultural values, preferences, characteristics, and circumstances and seek to learn about those of their clients. That is, behavior analysts should be aware about their own personal biases and how they compare to and may affect their relationship with their client. This awareness of both self and clients may be important because, as Spring (2007) suggests, evidence-based services require a combination of clinical ex- pertise and knowledge of the client’s preferences and learning histories. Behaviorally, cultural awareness may be defined as

85 Behav Analysis Practice (2016) 9:84–94

the discriminated operant of tacting contingencies of rein- forcement and punishment administered by a group of indi- viduals. In other words, a behavior analyst who is culturally aware is able to identify the reinforcement and punishment contingencies that have been established by themselves, their colleagues, their family, and any other social group they may belong to or identify with. Behavior analysts’ ability to tact contingencies for self and others may facilitate development of a behavior change program that is informed by their clients’ specific cultural contingencies.

Further, cultural awareness may be important because be- havioral patterns that are viewed as problematic in our own culture may be the norm in other cultures (Goldiamond 2002; Vandenberghe 2008). Consider the following example of a child who was referred for a functional assessment for Bwithdrawn^ behavior. The behavior analyst and a special education observed the student became Bwithdrawn^ after re- ceiving verbal praise. In fact, the student ultimately stopped engaging in any appropriate behavior which lead to the verbal praise. While collaborating with the family to gather data dur- ing the functional assessment, they determined that the stu- dent’s Bwithdrawn^ behavior occurred because of child’s lack of comfort with receiving individual attention. In the child’s culture, the whole (i.e., community) comes before the individ- ual. However, neither the behavior analyst nor the special education teacher questioned their personal assumption that the behavior is inappropriate for the classroom or their prefer- ences about how children should act after receiving praise. Because the student’s withdrawn behavior is maintained by a lack of attention, the behavior analyst and special education teacher suggest administering praise privately. In this case, their lack of understanding about how the cultural contingen- cies support the client’s Binappropriate behavior^ may have resulted in a treatment recommendation that was incongruent with cultural values. However, a culturally aware intervention, which seeks understanding of client values, characteristics, preferences, and circumstances would honor the client’s cul- ture and allow the client to successful in a given environment.

A thorough behavior analytic intervention may be effective with individuals across various cultures (Kauffman et al. 2008; Tanaka-Matsumi et al. 1996). However, skilled, thorough, and well-trained behavior analysts may not always consider client culture. When assessing an individual’s or a group’s behavior, behavior analysts often collect data about motivating opera- tions, antecedents, behaviors, and consequences. However, common functional assessment data collection strategies and interview forms may not thoroughly explore cultural prefer- ences and norms. Behavior analysts may consider the intersec- tion of a cultural and linguistic context with the terms, concepts, and science of behavior analysis (Jones andHoerger 2009). It is possible that, without information about cultural preferences and norms, behavior analysts may unintentionally provide less than optimal service delivery.

Consider an example of a behavior analyst who provided in-home and community services to the family of a child with severe autism. The family, to whom church is very important, attended a weekly three hour church service. The behavior analyst, who did not attend church and was not a religious person, failed to inquire in detail about the family’s and child’s experience at church. Eventually, the family specifically asked the behavior analyst to teach the child the necessary skills to participate in the church service. However, the behavior ana- lyst still did not assign a high priority to teaching the child the skills needed for successful church attendance. The behavior analyst’s choices demonstrated a lack of understanding of the client’s values, characteristics, preferences, and circum- stances. In contrast, a culturally aware behavior analyst may be aware that Bthe selection of target behaviors is an expres- sion of values^ (Kauffman et al. 2008, p. 254) and that paren- tal expectations of children are likely controlled by cultural contingencies (Akcinar and Baydar 2014).

In addition to the previous two examples, being culturally aware may also increase the probability that behavior analysts will engage in behaviors that are socially acceptable to people from diverse cultural backgrounds. These behaviors include selecting culturally appropriate treatments (see Rispoli et al. 2011), recognizing that Bparenting styles that are culture spe- cific could lead to distinct behavioral consequences for a child^ (Akcinar and Baydar 2014, p. 119), and implementing culturally appropriate language acquisition programs (see Brodhead et al. 2014). Cultural awareness could also ensure that behavior analysts treat service delivery as Balways a two- way street^ (Bolling 2002), meaning that the relationship be- tween the behavior analyst and the stakeholders should in- clude input about what cultural contingencies and values may contribute to an effective relationship and intervention.

Finally, increasing cultural awareness may also decrease the probability of behavior analysts expecting the clients they serve to conform to their own cultural and scientific values and contingencies. The science of applied behavior analysis (ABA) is a unique cultural system (see Glenn 1993). Given that the science of ABA inherently embodies a certain set of values such as aWesternizedmodel of science and health care, the cultural values and contingencies of ABA may not always align with those of the client. As Bolling (2002) noted,

It is difficult for people in the US cultural mainstream, including researchers, to believe that there are any assump- tions other than their own about how the world works, what a ‘person’ is, howwe function, how timeworks, what feelings are, how to use language, what the goal of life is, how people interrelate, [and] how and where it is appro- priate to show feelings or to seek help. (p. 22)

Awareness of cultural differences and similarities may al- low for programmatic modifications that result in more

86 Behav Analysis Practice (2016) 9:84–94

culturally appropriate models of behavior analytic service delivery.

In summary, there may be many important reasons for be- havior analysts to develop cultural awareness skills.

Although there is a growing interest in conceptual (e.g., Brodhead et al. 2014; Fong and Tanaka 2013) and applied strategies for administering behavioral interventions for cli- ents from diverse cultural backgrounds (e.g., Padilla Dalamau et al. 2011; Rispoli et al. 2011; Washio and Houmanfar 2007), there is little guidance concerning how practicing behavior analysts can become culturally aware or further develop that awareness. Therefore, guidance on how to become culturally aware may be an important resource for behavior analysts.

The purpose of this paper is to offer suggestions that can serve as a starting point for how behavior analysts may further increase their cultural awareness. We believe that cultural awareness, as described herein, reflect Baer et al. (1968) state- ment that the Bbehavior, stimuli and/or organism under study are chosen because of their importance to man and society^ (p. 92). Individuals participating in behavior change programs and those who provide significant support for them should determine what is important to them, to their society, and to their culture. In this paper, we discuss strategies for under- standing a client’s cultural values and contingencies, as well as those of the behavior analyst. Then, we describe strategies for embedding cultural awareness practices into behavior an- alytic service delivery, supervision, and professional develop- ment. Finally, we conclude with additional discussion and considerations for becoming culturally aware in everyday practice.

Strategies for Developing Cultural Awareness

The following two sections describe how behavior analysts can become more aware of personal cultural values and con- tingencies and how they can develop skills to learn about their clients’ cultural identities. We will refer to cultural values and contingencies as the cultural system, except where values or contingencies play an independent role in our analysis of de- veloping cultural awareness. We will refer to cultural identity as characteristics that extend beyond individual differences to those traits that members of a given culture share with one another (Adler 1998). For example, an individual from Africa may express their cultural identity through their belief struc- ture, attire, foods eaten, or hair style. Even though this indi- vidual might identify as African, there are subcultures to which they might further identify with. Our suggestions are meant to serve as a starting point for furthering a behavior analytic understanding of cultural awareness and how that awareness can be integrated and improved upon in everyday practice. It is recommended that behavior analysts

concurrently engage in cultural awareness practices concerning their own behavior as well as those of their clients. It is important to be aware of one’s own biases or preconceived notions as a behavior analyst, as well acknowl- edging limitations in one’s cultural knowledge. Lastly, our suggestions are not intended to result in a rigid set of rules or practices. Rather, our hope is the suggestions will lead to broad practices that develop and continually refine cultural awareness, which will hopefully allow behavior analysts to be more open and flexible to the various cultures that will be experienced. Openness and flexibility in the presence of var- ious cultures will hopefully result in better outcomes for those we serve.

Developing Cultural Awareness of Self

From a behavior analytic perspective, self-awareness can be defined as verbal discrimination of our own behavior (Barnes- Holmes et al. 2001). Sugai et al. (2012) describe culture as common behaviors related by comparable learning histories, social and environmental contingencies, contexts and stimuli, so self-awareness might also include verbal discrimination of these aspects of personal experience. An understanding of our own cultural system may be an important first step toward correcting biases that affect our interactions with others (Lillis and Hayes 2007). The American Psychological Association’s (APA) (2003) multicultural guidelines encour- age clinicians to Brecognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are eth- nically and racially different from themselves^ (p. 382). Developing self-awareness may prevent our biases from im- peding how we serve culturally diverse clients.

One strategy to enhance cultural self-awareness is talking about our diverse client interactions with a professional com- munity in group discussions, written forums, journals, men- torship meetings, verbal feedback sessions, or self-reflective exercises (Tervalon andMurray-Garcia 1998). Skinner (1974) emphasized the relationship between self-awareness and con- trol over our own behavior,and proposed that talking about our behavior is how we achieve self-awareness. Recent be- havior analytic research indicates that when individuals ver- bally describe their own behavior, the behavior may change (Tourinho 2006). Discussion with mentors and colleagues may help behavior analysts learn about themselves and also change their cross-cultural interactions for the better.

Another suggestion is to be Bmindful^ by attending fully and alertly, in the moment, to client interactions and our own private events, without judging or evaluating the events as they occur (Bishop et al. 2004; Hayes and Plumb 2007; Vandenberghe 2008). We recommend practitioners hone their ability to attend closely to clients and self, in context, for two reasons related to self-awareness. First, such attention may

87 Behav Analysis Practice (2016) 9:84–94

help enhance skills of self-observation and self-description regarding our overt and covert behavior. Also, while we can remain committed to overtly behaving in ways consistent with values of multiculturalism, even in the presence of values and contingencies that create bias, mindfulness may reduce the biases that produce thoughts, feelings, and reactions to cultur- ally diverse people (Lillis and Hayes 2007). Attending closely to our clients and being active and alert is good practice for building rapport, too.

Clinicians can engage in more culturally aware practice by assessing, collecting data, and testing hypotheses rather than accepting their own experiences and biases as the norm (Sue 1998). Scientific mindedness is a characteristic of clinicians and human service providers who develop theories about cli- ent behaviors by analyzing data rather than by dependence on their personal assumptions (Sue 1998), and may reduce bias and foster better understanding of client behavior. A reliance on scientific, behavior analytic knowledge when workingwith clients is also required by the Professional and Ethical Compliance Code for Behavior Analysts (BACB 2015).

While mindful attention focuses on the interaction between the behavior analyst and the client/family, scientific minded- ness is a focus on interpreting information from the client and family; both characteristics facilitate culturally aware practice. For example, a behavior analyst consults to a family of a child with a sleep disorder, and learns that the mother sleeps in her five-year-old child’s bed while the father sleeps in a larger room, alone. The practitioner may notice, and be able to co- vertly tact, that this is not the norm of the cultural majority nor congruent with his personal experience or values. The analyst may assume that the mother should not sleep in the child’s bed or notice thoughts of judgment he feels. Lillis and Hayes (2007) recommend practitioners accept that such reactions may be normal, given our cultural systems and the human tendency to evaluate, but remain committed to acting positive- ly based on our values. Through a process of assessment and covert verbal behavior, the practitioner might accept the co- sleeping arrangement to be culturally appropriate for and pre- ferred by the family, and choose to develop an intervention that keeps the arrangement in place. A blend of both self- awareness and reliance on scientific knowledge is likely to produce the most culturally aware assessment and intervention.

Finally, there are several self-assessment tools that behav- ior analysts can use to become more aware of their own cul- tural identity. We recommend the use of assessment tools for measuring and reflecting on the clinician’s own cultural biases, values, and understanding. One assessment tool, the BDiversity Self-Assessment,^ that can be utilized during the intake process allows team members to examine their under- standing of diversity (Montgomery 2001); this tool asks users to reflect on their own assumptions and biases by answering 11 questions. Another assessment tool that may be useful is

the self-test questionnaire entitled BHow Do You Relate to Various Groups of People in Society?^ (Randall-David 1989). This questionnaire asks respondents how they might respond to individuals of various cultural backgrounds—by greeting, by accepting, by obtaining help from, by having background knowledge about, and/or by advocating for the individuals. The 30 types of individuals in these questions are then organized into five categories: ethnic/racial, social issues/ problems, religious, physically/mentally handicapped, and political, and a concentration of checks within a specific cat- egory of individuals or at specific levels of response may then indicate a conflict that could prevent the respondent from pro- viding effective treatment. Behavior analysts can then consid- er how their biases might affect treatment and may consider other courses of action, such as making referrals to other be- havior analysts. A final potentially useful measure is the Multicultural Sensitivity Scale (Jibaja et al. 2000), a 21-item self-assessment tool developed as a valid and reliable way to measure multicultural sensitivity. This tool was originally used to assess the multicultural sensitivity of teachers and was later adapted to be used by physician assistant students (Jibaja-Rusth et al. 1994). Altogether, the behavior analyst may find these assessments helpful in further developing their own cultural awareness in order to further develop culturally competent methods of service delivery.

Developing Cultural Awareness of Clients

The above section describes strategies for how a behavior analyst may learn about his or her own cultural system. Below, we describe how behavior analysts may learn more about their client’s cultural system through assessment prac- tices. Culturally aware assessment practices may allow behav- ior analysts to obtain important cultural information about clients in order to understand their worldviews. Culturally aware assessment may also allow behavior analysts to identify any potential cultural barriers such as modalities of commu- nication and expression of emotions (see Garcia et al. 2003).

To increase the probability that assessment will identify cultural variables, Vandenberghe (2008) recommends focus- ing on functional relations and behavioral principles rather than topography. For example, Filipino families often live with extended family members, and the household situation can seem chaotic by Western living standards. If a child has difficulty sleeping, a behavior analyst may advise the parents that they should separate the sleeping room from the living room. People of Filipino descent may be shy about responding to someone in a position of authority, so they may say Byes^ to the behavior analyst. However, during the following session, it might be revealed that the parents did not change anything and that the child is still sleep deprived. In this case, a natural reaction may be to become frustrated with the lack of parental follow through. However, lack of follow through may also be

88 Behav Analysis Practice (2016) 9:84–94

interpreted as an indicator that the intervention recommenda- tion may not have been culturally appropriate.

Vandenberghe’s (2008) description of functional analytic psychotherapy may also be a useful resource for determining how to provide culturally aware behavior analytic practices. Vandenberghe (2008) emphasizes the need for a behavior ana- lyst to be aware of differences that may exist, including cultural differences, between the behavior analyst, client, and their fam- ilies. Specifically, behavior analysts should be knowledgeable about the client’s culture, differentiate between an unfamiliar cultural norm and a pathology, and take culture into consideration during the therapeutic process. Finally, Hymes (1962) noted that communicative competence is related to an individual’s awareness of the laws of language structure and language use within a given culture. Therefore, behavior ana- lysts should be skilled in sending and receiving cultural com- munications. Specific recommendations are described below.

Recommendations

Consider the Language of Assessment Our first recommen- dation, which applies to all phases of assessment and treat- ment, is that behavior analysts should reflect on the spoken and written language he or she uses and how it will be per- ceived by the client. We recommend behavior analysts avoid the use of behavior analytic jargon, as it may confuse clients and their families, and possibly lead to their failure to imple- ment interventions. This recommendation is consistent with the Professional and Ethical Compliance Code for Behavior Analysts (2015). For example when the phrase Bfunctional analysis^ is used, Japanese families assume that it is mathe- matical jargon rather than a reference to a behavior analytic assessment process. Avoidance of excessive or complex be- havior analytic jargon may eliminate such problems.

It is important throughout assessment and treatment to communicate in a manner easily understood, culturally aware, and does not include terms that are culturally inappropriate or confusing (Rolider andAxelrod 2005). Furthermore, it may be important to consider who will be completing service related forms (e.g., intake paperwork) and whether the level of liter- acy and comprehension of the language used in the forms are similar. If a person lacks adequate language comprehension, completing paperwork may be difficult, embarrassing, or in- timidating. In such a case, behavior analysts may consider giving the person the opportunity to complete the forms orally or have another person help with the form completion. They may also consider using an interpreter or providing forms in the person’s native language. Additionally, we agree with Vandenberghe’s (2008) recommendation that the language used to define problem behaviors should be carefully exam- ined to ensure the behaviors are communicated in a positive manner using multiple forms of communication that are sen- sitive to potential cultural differences in eye contact, wait time,

meanings of words, non-vocal body language, personal space, and quality of voice.

Understand Cultural Identity Our second recommendation is to consider that the client, and the client’s family and com- munity, are important sources for acquiring an understanding the cultural identity of the individual. Therefore, we recom- mend conducting an analysis of cultural identity with stake- holders immediately after service initiation with the client and/ or family. The cultural identity analysis should inform the assessment process and the designing of interventions. During intake, the behavior analyst may, with proper consent, gather input from key community members familiar with the client, in addition to those whose feedback is typically sought (e.g., teachers, professionals, administrators, and family). Additionally, the behavior analyst should seek recommenda- tions from the family regarding additional parties (e.g., other c

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