Assignment Risk-Benefit Analysis
As was emphasized in the Belmont Report (1979, pp. 8-9), and specified in the BACB
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Compliance Code 4.05 (as well as many of your mentioning in the Aversives as Effective
Treatment? discussion board post), a risk-benefit analysis is one of the primary vehicles to
ensure that participants are adequately protected while receiving effective treatment. This
assignment allows for application and expansion of course content to a real-world case
evaluation. For the analysis, select a situation where a behavior has been targeted for reduction. (The behavior is elopement. Refer to the client as AW, AW is a 10 year old male in a residential program with ADHD and ODD exceptionalities).
You’re learned a lot about the ethics of behavior analytic practice in ESE 569, which builds on
what you know about the principles and tactics of providing behavioral support.
The results of the assignment should demonstrate that you have thought carefully and comprehensively about the risks and benefits to your focal
individual in his/her context based on the “special methods” you are proposing to reduce a target
behavior. It is highly likely that the complete assignment will extend to 7-10 pages.
After reading Chapter 16 of Bailey and Burch (2016), you will conduct a thorough risk-benefit
analysis of a behavior-analytic intervention using the steps described. The book contains
examples of each of the three worksheets you will complete:
General Risk Factors in Figure 16.1 on page 226
Benefits in Figure 16.2 on page 230
Risk-Benefit Worksheet in Figure 16.3 on page 233
Book reference – Bailey, J., & Burch, M. (2016). Ethics for Behavior Analysts, 3rd Edition. London: Routledge.
Each worksheet guides you through a series of questions as you evaluate an intervention. Please
note that evaluating non-exclusion time-out and exclusion time-out in one risk-benefit analysis
(example page 233) is NOT recommended because of the resulting confusion. It would be more
prudent for the decision-making process to focus on the most restrictive technique being
considered in the risk-benefit analysis.
STEPS:
Since the Risk-Benefit Analysis process is completed PRIOR to implementation of a plan,
identify a case from your current employment where a specific behavior-reduction treatment
intervention is being considered for an individual with challenging behavior. If no new treatment
is being considered for an individual, conduct a retrospective risk-benefit analysis for a behavior
reduction treatment already in place. If you are not currently working with individuals with
challenging behavior, think of a behavior-reduction program you have heard about or are
familiar with from previous experience (e.g., contingent electric shock used at the JRC). If you
have never participated in designing or implementing a behavior-change program, a hypothetical
case will be provided for you. (Let me know if you need a hypothetical case.) Note: Use
pseudonyms when referring to the focal individual. Do not use real names or locations.
Download the Risk-Benefit Analysis template and save it to your personal storage. Type directly
into this document.
The assignment is organized as follows:
Participant Description
Provide a complete description of the individual who is/was/will be receiving the treatment. Be
sure to include age, demographic information, developmental history, and identification of
medical issues as well as some indication of his/her unique personality (what s/he likes and
dislikes). Provide information about previous interventions attempted to address the behavior.
Since you will be evaluating the risks/benefits of a punishment procedure in the analysis, be sure
to specify ALL of the previous reinforcement-based procedures that have been attempted with
documentation of the results.
Describe the target behavior that needs to be reduced, identify the function, and state the desired
outcomes of the intervention being considered/implemented.
*Oddly enough, this is the section in the assignment that seems least understood. An example of a Participant Description is as follows:
Participant Description Examples
Participant Description:
Josh is a 19-year-old male who currently lives with his grandmother and has weekend
visits with his father. Josh has a history of speech and language delays. He did not start speaking
in full sentences until 5 years of age. He was diagnosed with receptive and expressive language
delays, oral motor weakness, and an articulation delay. Josh did not crawl but began walking at
almost three years of age. He had toileting issues, and could not stay dry until almost five years
of age.
Josh has medical concerns which include asthma and curvature of the spine. He was also
diagnosed with torticollis (“twisted neck”) and received treatment. He participated in speech,
occupational, and physical therapy for one year through early intervention and transitioned to
services provided by his school district when he was 3 years old.
Treatment History
Josh has participated in 10 years of mental health services. He was diagnosed with major
mood disorder, and anxiety and disruptive disorder when he was 8 years old. During this time, he
was assigned a case manager who began to coordinate his care with two mental health agencies.
Josh has received counseling services, and direct support providers through the Meet Me Where
I AM AT program. At the age of 16.5 years of age, Josh was given a diagnoses of Autism, and
then was able to apply for services through the Division of Developmental Disability (DDD).
These services included speech, occupational therapy, and physical therapy. Josh currently has a
combination of mental health and DDD providers who provide counseling, habilitation, and
respite services.
“Josh”
Preferences
Josh likes videogames as well as using his computer to play games and watch videos.
Josh likes to play basketball. Josh likes to write lyrics, and often will share them with others.
Josh can be very funny, and likes to tell jokes. He likes to go to church, and often reads the Bible
at home.
Dislikes
Josh becomes increasingly anxious when he is part of a crowd. He does not like change
in his routine. He does not like when he thinks others are bossing him around. Josh does not like
it if he is denied a preferred request. Josh does not like when he perceives things to be unfair.
Intervention History
Josh has participated in mental health services since he was 10 years old. Josh has had
behavioral health counseling for 7 years to help him work on understanding his feelings, and
developing social skills. Josh currently receives habilitation, and respite services which target his
independent living skills. A BCBA began providing services when Josh was 16 years old.
Previous interventions have involved differential reinforcement procedures to decrease
elopement. Grandmother, who is Josh’s primary caretaker, reported they were using positive
reinforcement as well as functional communication strategies to replace some of the maladaptive
behaviors. That service discontinued due to the BCBA moving out of town. The family did not
re-engage those services. Most of the therapy services have been focused on developing social
skills. Josh also participated in social skills groups for two years with limited success.
Behavior and Function
Target Behavior: Elopement = Josh leaving a designated area. He may walk, run, or even
crab-crawl when he leaves an area. Typically, he hides after elopement, usually somewhere in
the house. He has left the house previously and was found at a convenience store, park, school,
and in a neighbor’s backyard.
Function: Direct observation data have not been collected but indirect assessment lead to
the conclusion that the probable function is access to tangibles. The grandmother reports that
Josh “runs away” when he is told he can’t have something he wants. When he is found and
brought back or returns, she usually gives him the item he originally was denied.
Desired Outcome: Joshua’s elopement puts him at risk for injury. Given his age and size,
he could be arrested for loitering or trespassing. The hope is that the intervention will eliminate
elopement in order to keep Josh safe and reduce his Grandmother’s stress. Additional
interventions will be used to teach Josh to engage in emotional self-management to handle his
disappointment in socially acceptable ways.
You will then complete three worksheets to conduct the risk-benefit analysis. The “ABA
Procedure” at the top of each worksheet will be the SAME on each. This is where you
describe the scientifically based behavior reduction procedure you’re proposing (e.g.,
response cost, DRO, time-out). If the intervention consists of multiple tactics, evaluate the
strategy that is the most intrusive.
ABA Procedure
In the top row of each form, categorize the procedure to demonstrate your comprehension. For
example, “time-out” would be “negative punishment” while “DRO” would be “positive
reinforcement and negative punishment.” Subsequently, the ABA Procedure box would read
something such as: Exclusionary Time-Out (negative punishment), or DRO (positive
reinforcement and negative punishment).
Special Methods
In the blank for “Special Methods,” describe exactly how the procedure will be implemented.
Who does what, and what are the steps for implementing? For example, if you’re considering
using response cost, exactly how will that be implemented (what will be lost? how will the
consequences progress?). Provide sufficient specificity so that someone could read the
description and implement the procedure(s).
a) Complete the General Risk Factors for Behavioral Treatment worksheet. Use the
example on page 226 of the textbook as a guide for populating the worksheet, but DO
NOT COPY the narrative. The risk-benefit worksheet must be unique to your participant
and setting.
Answer the eight “General Risk Factors” questions. You do not need to add additional
questions, and you should not delete any of these questions (answer all). Refer to the
narrative in the text (pp. 225-230) to ensure that you understand the intent of the
questions.
You need to write more than “yes” or “no” in response to the questions. For example, if
the response to The nature of the behavior being treated – is it SIB or dangerous to
others? is “No,” then continue by describing the behavior and how the topography
changes as it escalates. This is where you convince readers that the procedure proposed
matches the behavior. If the answer is “Yes,” then describe the topography of the SIB or
how the behavior is dangerous.
The “Notes” should be complete and sufficiently detailed to communicate your
thinking and rationales for the answers based on your knowledge of the dimensions
of PBS and ABA.
b) Complete the Benefits of Behavioral Treatment worksheet. Use the example on page
230 of the textbook as a guide for populating the worksheet, but DO NOT COPY the
narrative. The benefits of behavioral treatment worksheet must be unique to your
participant and setting.
Answer the five “Benefits of Behavioral Treatment” questions. You do not need to add
additional questions, and you should not delete any of these questions (answer all). Refer
to the narrative in the text (pp. 231-232) to ensure that you understand the intent of the
questions. Note that the wording for # 3 has been modified. The goal of intervention is
NOT to make caregivers feel “more in charge.” This smacks of behavioral control, which
often undermines client autonomy.
The “Notes” should be complete and sufficiently detailed to communicate your
thinking and rationales for the answers based on your knowledge of the dimensions
of PBS and ABA.
c) Complete the Risk-Benefit Worksheet. Use the example on page 233 of the textbook as a
guide for populating the worksheet, but DO NOT COPY the narrative. The risk-benefit
worksheet must be unique to your participant and setting, SO THE RISKS AND
BENEFITS YOU IDENTIFY MAY BE DIFFERENT FROM THE EXAMPLE. This is
why that worksheet is blank in the file you downloaded. You can add rows if you have
more than four risks or benefits, and delete rows if you have fewer than four risks or
benefits.
In the “notes” for risks, specify how the risk will be managed. For example, if the
procedure is likely to produce an increase in the problem behavior, what will you do
about that? Ensure that the notes are specific to your participant and his/her context, and
are not just generic statements.
Create a reference section. Locate at least TWO resources from the professional literature to
substantiate your risk-benefit analysis. You may want to find a source for the proposed treatment
procedure/intervention, and/or for the risks associated with the treatment, and/or for the benefits
associated with the treatment. One of the resources must be from a peer-reviewed journal article.
The other source may be a book, thesis, or dissertation. Web-based sources (e.g., websites, blogs,
.pdf from website) cannot used to substantiate the analysis. All references must be formatted in
APA style.
Cite the professional literature in the “Notes” or “Summary” where it is relevant. For example, if
you find an article about how to manage risks to others in the setting (item 6 on General Risk
Factors worksheet), provide those suggestions in the “Notes” for that item, cite the article by
giving the author(s)’ last name(s) and year of publication. The Reference section will contain the
full APA-formatted citations.
To repeat: Cite the references in the worksheets, not the section for the participant description.
For example, if you’re using DRO, and find an article the mentions that one of the risks of using
DRO is an extinction burst, list that as a risk on the Risk-Benefit Worksheet, and then in the
notes explain (with the citation) before describing how the risk will be managed.
