Review of Ron Van Houten article 1988

According to the Ron Van Houten article (1988) “The right to effective behavioral treatment” every patient who is need of changing his/her behavior deserves the best quality medical care which will provide him/her with comfortable conditions, highly professional medical staff, regular behavioral evaluation, and, finally, special programs which will teach such patients practical skills in order they will be able to support themselves, fully or partially.
The article informs that to realize these goals, several experiments on the effective behavioral treatment have been performed, and eventually it was found out that “These procedures have the demonstrated ability to teach new behavior and alleviate a variety of behavioral disorders” (p 381). In such a situation, the role of behavior analysts becomes especially important; behavioral analysts should realize their responsibility in the achievements of these plans to provide their patients with the best possible and effective treatment.
Effective behavioral treatment plan is assumed to include at least six constituents, the first of which is An Individual Has a Right to a Therapeutic Environment.  This part of the treatment surmises that the environment where patients are treated should be secure, friendly, and meet the individual needs of the patient. Alongside with the above-mentioned characteristics, the therapeutic environment should be of an adequate size which will provide patients’ access to both training appliances and recreation activities in accordance with patients’ age, level of education, and appropriate choice of training materials and activities.  An effective therapeutic environment also presumes the presence of the patients’ family members, teachers, and highly qualified caregivers. But the main benefit of a successful therapeutic environment is that patients in such a surrounding enjoy freedom of interaction.  Freedom of movement, alongside individual safety, are other positive components of an effective therapeutic environment. Restrictive measures for patients in such an environment are minimal, too. Given all the advantages of a therapeutic environment such as the feelings of freedom and independence as well as the minimum of restrictive limitations, will certainly result in productive effective treatment.
Another right for every patient who needs behavioral change is his /her right for Personal Welfare. It is believed that any person cannot enjoy life if he/she is unable to function independently, so, the main goal of behavioral treatment is to help individuals with behavioral flaws to acquire functional skills which will give them the opportunity to operate independently. Whether the individual will acquire welfare skills soon or whether it will take time for him to gain practical skills, depends on the patient’s or the patient’s guardian’s quality of the participation during treatment. To be sure that behavioral treatment is performed with decent quality and is oriented to the client’s welfare, the behavioral treatment must be delivered by highly professional specialists whose services are regularly controlled by both human rights groups and by peer review groups.
One more right each patient who needs treatment for behavioral change is a Right to Treatment by a Competent Behavior Analyst. Given the high demands for the quality of the behavioral treatment, the professionals who are responsible for the process of treatment and the assessment of the outcoming results after the treatments is usually a highly professional whose education is adequate for their positions. To provide a high quality of treatment, every behavior analyst must possess deep and detailed knowledge and go through a long-time training in the sphere of behavioral treatment, the ability to implement new achievements of behavioral treatment in the process of treatment, and certainly must be very much experienced in such a sensitive issue as professional ethics.
Among other rights every patient who must go through behavioral treatment must enjoy is that Every Client Has a Right to Programs that Teach Functional Skills. Here it should be mentioned that the final goal of the behavioral treatment is to teach their patients to operate effectively and independently (to a certain extent), no matter whether it is a close environment or society in general. To improve their skills and be able to function successfully, people with impaired behavior, have the right to special programs that will teach them necessary functional skills. These programs are needed for the first, to improve their skills in certain activities which they will need in their everyday life. Having acquired all these skills and improved them to the level they are able to function independently, will grant them a wider and an easier access to a large variety of their favorite activities, the materials they need for different purposes (education, leisure time), and what is the most important for such people, is the ability to widen their social interconnection.  For the second, having acquired and improved their social skills, the people, who used to be very much dependable on their environment, will be able to put an end to the relationship they were bored of, or, as a minimum, to reduce them. And for the third, the improved skills will give such people the opportunity to get rid of certain abnormal behaviors (sometimes even dangerous) which used to be obstacles in their interaction with the rest of the society, for the benefit of both sides.

To add to the list of benefits, a person with behavioral abnormalities Has a Right to Behavioral Assessment and Ongoing Evaluation. This statement means that before starting behavioral treatment, people who need such a treatment, are eligible to get a full diagnostic assessment to find out the reason(s) that might have caused the abnormalities of the patient’s behavior and the abilities to function normally. It is evident that a complete diagnostic assessment will help medical staff to reveal the events of the patient’s past life that might have influenced the onset of the behavioral disorders and/ or may cause further deterioration of the patient’s behavior. To achieve a successful outcome, the diagnostic evaluation should take place regularly to get objective information which would figure out the quality of treatment as well as help medical staff to prevent they might be problems in future, and if it is needed, to change the treatment plan for better results.
And finally, every person who suffers from behavioral disorders, has a Right to the Most Effective Treatment Procedures Available. To achieve positive results in behavioral treatment, behavior analysts should use the most developed and effective methods of treatment which were practically proved by both researchers and practicing doctors. Behavioral analysts should also explain to their patients the advantages and disadvantages of the techniques they use while behavioral treatment, and never stop hunting for new methods to improve the quality of modern treatment.
To summarize everything mentioned above, it should be stated that behavior analysts are those specialists who are most of all responsible for effective treating people with behavior disorders. To get a positive outcome in treating behavioral disorders they should use the most progressive scientifically proven methods and techniques, which meet the demands of the time and quality, and, no doubt, should control equal access of all the patients who are diagnosed with behavioral disorders to the most helpful and effective treatment. 
1. What does this mean when developing treatment for your clients?
 According to the Professional and Ethical Compliance Code for Behavior Analysts (Code 2.09) (2016), Treatment/Intervention Efficacy, clients have the right to receive the most possible effective treatment which meets the latest achievements of modern medicine.  Behavior analysts must be both their patients’ protectors and their educators in the process of treatment whether it is a long-term and short-term treatment.  Also, it is behavior analysts’ duty to control the amount of treatment their patients should get to reach the goals which were defined at the beginning of the treatment process. In case when additional treatment is necessary, due to the new discovered factors, clients have the right to receive additional treatment, yet considering all the possible risk factors, side-effects of the interventions, patient’s opinion concerning the procedure, and, certainly, the level of the practitioner’s awareness and his practical experience. It is also behavior analysts’ responsibility to make a preliminary research before starting any type of treatment to evaluate possible side effects and their influence on the behavior change treatment program.

2.  How are some of the priorities for our clients?
As it has already been mentioned, the main goal of most ABA professionals is the best possible service provided for their clients. This statement is especially true concerning the patients who are already getting their treatment. Any ABA specialist must begin his /her patient’s treatment with evaluation of the environment the patient lives, the atmosphere in the patient’s family, their needs and priorities, the level of stress in the family, and the evaluation of the patient’s skills which need to be fixed. As the article states, “It would be foolish to attempt to prioritize treatment goals without looking through the lens of the individual receiving services”. Only after careful evaluation of the patient, his/ her peculiar characteristic, treatment can be started.
One of the main problems ABA specialists must encounter in their patients’ evaluation is Developmental Functioning. Why? Because every age has its own developmental functioning stages. This problem comes first especially with the kids who are under 5. Based on this peculiarity, and to achieve successful results, Meadows recommends ABA specialists to acquire “solid knowledge of developmental norms.” To stay and learn with his/ her parents for 10 minutes at home is not a big problem for an autistic kid, but to fulfill the same assignment for the same period at school is really a problem for both kids and their teachers.  The problem with developmental functioning is the ASD’s influence such kids’ activities, and social experiences. Current Problem Behaviors and Barriers to Improvement is another sphere of ABA professional. According to Meadows, kids’ abnormal behavior, such as tantrums, spitting, elopement, biting, no play skills, et, make parents seek professional help from ABA professionals. In this situation, the most important thing is to prioritize what to begin with to abstain the stress for both kids and their parents.
Functional Skills/Daily Living Skills one of the most significant areas of ABA professionals’ intervention. No doubt that having a kid with impaired behavior is a heavy burden for all the members of the family. To make the family’s life less difficult, it is crucial for ABA specialists to begin with his intervention with paying special attention to practical skills, that is practicing the most needed skills which the patient will be able to perform without relying on somebody’s assistance. Meadows recommends beginning with “requesting, making choices, toileting, dressing, tooth-brushing, establishing a bedtime routine, independent eating, etc.”, and admits that having improved these skills will help the patient not only in the nearest future but also for years to come.
Parent & Caregiver Training is no less important spheres of ABA professionals’ activities than the others mentioned above. This training becomes especially important in case one has not enough treatment hours, minimum or little access for behavioral therapy, etc. Then, parents’ training comes first. When parents or other available caregivers are trained ABA methods, they are allowed and able to help their kids. Another benefit of parents’ training is their ability to realize the quality of teaching their kids by another specialist, to stand for their kids’ rights, and save both money and time (Meadows).

 3. This article was published in 1988, how does this stand today?
A lot of changes have taken place in the methods of ABA teaching since 1988; the analysis of verbal behavior as a method began to be widely used as the method of treating autism all over the US. New ABA techniques as well as the methods of verbal behavior to a great extent have facilitated and improved the ABA specialists’ in their work with small children. But the main reason for the successful outcome in treating autistic kids is such kids’ parents’ participation in the teaching process, being both the kids’ parents and their teachers. It took a long time until autistic kids’ parents have realized that their passive attitude to their kids’ future will result in nothing. They finally concluded that, in the first place, it is their responsibility to narrow the gap between their special kids and the society they live in. More than that, such kids’ parents have perceived that they should become their kids' first teachers who must teach their kids the first skills of social communication and, consequently, to ease their life on the way to their socialization into modern society.  And such practice works very well. So, it was decided that if ABA analysts want to help autistic kids’ parents become their teachers, the ABA specialists themselves must become highly experienced teachers for autistic kids (Shramm, 2006).

 

References

Meadows, Tameika. 'P' is for Priority. BCBA.

https://www.iloveaba.com/2019/06/p-is-for-priority.html?m=1

Professional and ethical compliance code for behavior analysts.2016.

BACB-Compliance-Code-english_190318.pdf

Shramm, Robert. 2006. Educate toward recovery: turning the tables on autism.