Home Environments and Healthcare:

A Comparative Analysis of Physician and Applied Behavior Analysis Education

by:

Elizabeth A Wells

Board Certified Associate Behavior Analyst 

B.A. in Psychology Rutgers College, Rutgers University

It is interesting to note that the medical field has been looking at various ways to apply interdisciplinary approaches to their patients that they treat. There has been an interest by the medical field to reach out to other disciplines to assist them with looking at the whole picture of their patients in order to provide better care. The medical field is starting to understand that medical tests and medication interventions are not the only available avenues to assess and treat their patients.  Applied Behavior Analysis can perhaps be one of those “other” disciplines that can further assist the medical field in assessing, diagnosing and providing interventions for patients and clients.  Behavior analysts are interested in evaluating their clients’ behaviors and environments. Therefore, for this graduate project, an environment specifically different other than what the office visit physician is accustomed to, will be analyzed and presented for educational purposes. This environment setting will be utilized to address the benefits of Applied Behavior Analysis principles and interventions for the medical field. This special, familiar environment setting to a behavior analyst is the patient’s home environment.

The overall purpose of this project is to improve the delivery of healthcare services by improving the abilities of physicians and other clinicians to provide healthcare services in the home environment.  The best way to improve this specialized ability is through education.  Specific home environment education is necessary because the home environment is quite different from the clinician’s office. Unlike the office, the home environment can provide stronger evaluative information regarding the patients, their caregivers and types of supportive services required to address physical and psychosocial needs. Home visits allow better interactions and communication dialogues with patients, family members, care giving staff and other involved healthcare professionals since patients are observed and assessed in their “normal”, every day, home environment versus the clinician office. Basically, the patient’s home environment can provide a more realistic perspective about those patients/clients we diagnose and treat.

The availability of education in this area is important at this time because of a renewed interest in the physician home visit practice. This is apparent since the home healthcare industry has been rapidly growing, pilot programs have been re-instituted to train resident physicians via home visits, surveys have indicated that patients of all ages prefer to be cared for at home, shortened hospital length of stays have been the latest trend etc.  The American Medical Association has also acknowledged , given that the healthcare field is changing, the major need for improved physician education concerning home environments. As indicated by the AMA in their Report 9 of the Council on Scientific Affairs, “the home is the patient’s domain and the physician’s authoritarian role in the office/hospital becomes more of an advisory role in the home. The doctor patient relationship has more parity. Negotiation and educational skill are paramount.”

 An assumption of this project is that other home visit oriented healthcare professions, at this time, have acquired more experience in obtaining and utilizing patient information via the home environment than the medical office framework for healthcare services.  It is further asserted that the current physician education programs pertaining to home environments can become further informed through the home environment related education mandated by the “home visit” experienced healthcare professions.  Of specific focus in this study is the profession of Applied Behavior Analysis.  This study will assess  the education that prepares physicians to take the American Academy of Home Care Physicians (AAHCP http://www.aahcp.org/index.shtml ) AAHCP Home Care Credentialing Examination to the Behavior Analyst Training and Examination that is governed by the Behavior Analyst Certification Board (http://www.bacb.com ).  The purpose of the analysis is to identify areas contained in Applied Behavior Analysis  material that was found in the AAHCP training/exam material.  Additionally, suggestions on ways to include the material “missing” from the AAHCP to enhance their training of behavioral and environmental issues will also be proposed.

Furthermore, this analysis and educational presentation will address how the healthcare provider can utilize the home environment to assess, diagnose and manage those they service.  Unlike the clinician’s office environment, the home environment provides a different, more realistic setting to evaluate and apply.  The underlying assumption in this study is that assessments, diagnostics and management done in the home environment could provide more accurate information about the patient’s condition. Also, the home environment can extend a more direct opportunity to influence the care of a patient than an office visit. Thus, assessing, diagnosing and managing patients/clients in their home environments require special training.  Therefore, in order to substantiate the premise of this project, it is logical to take a look at the behavioral and environment related healthcare education administered for two healthcare professionals: the physician and behavior analyst who do home visits in their practices.  In addition, a new application of a theory will be introduced that pertains to the environmental components that can enhance assessment/diagnostics/management. This theory is under development by the study’s Principle Investigator.  The theory is entitled NESTING.theory ( Natural Environment Setting Theory)

Analysis of :

The AAHCP's claimed educational purpose:

" Promoting the art, science and practice of Medicine in the home. "

Behavior Analyst's Analysis of Training/Exam

Reasons for analysis and chosen disciplines:

The curriculums for the Behavior Analyst Certification Board/Applied Behavior Analysis and the American Academy of Home Care Physicians were chosen for a number of reasons. The principle investigator is a Behavior Consultant, is currently a Board Certified Associate Behavior Analyst and has 16 years social service expertise which also includes home environment settings. Therefore, this investigator is able to apply expertise within the Applied Behavior Analysis and psychology aspects of healthcare. The AAHCP Home Care credentialing program was chosen because of its educational objective to train its members about home practice settings and issues. Also, this investigator supports the idea of educational training to increase physicians’ knowledge about their patient home environments. Moreover, both the AAHCP and the BACB are helping professions that provide services in home environments. By using the AAHCP Home Care Credentialing training as the medical profession “example”, it provides a current measure of what the medical field is being trained on regarding the content areas of patient behavioral and environmental issues. The medical field has acknowledged that more home related education is necessary for its professionals. Thus Applied Behavior Analysis related concepts and material could further complement the interdisciplinary educational approach to patient care.

Also, the NESTING Theory   ( Natural Environment Setting Theory )     developed by this graduate student shall be presented. The Nesting theory is a  new reference term for various fields with Applied Behavior Analysis concepts as its support. Its purpose is to educate various professionals working with individuals to become more aware of the importance and the components involved in the multiple natural environment settings that individuals live in, interact with, experience, are shaped and reinforced by.   It is the belief that all clinicians can benefit from learning about home environments, how to assess, diagnose and manage them. Additionally, the introduction and presentation of the principle investigator’s NESTING theory shall tie together the importance of understanding "how the home environment is very much a part of the patient/client."

 Necessity of expanded training:    

The AAHCP’s Home Care Credentialing Training/Exam was utilized as the current measure of training for medical professionals regarding home care. By this graduate student experiencing the AAHCP's training , it confirmed a need. It was apparent from the analysis that further training about patients, behavior and home environments is necessary besides from the medical field is necessary. To educate health care professionals on the "missing" aspects about behavioral and environmental concepts, it makes complete sense to  present a basic  introductory training on the actual field that addresses this content- Applied Behavior Analysis.  This additional training module's premise is to educate individuals on some of the basics of Applied Behavior Analysis and related discipline material to be a complementary contribution for the medical field. Specifically for this graduate project, given the vast applicability of Applied Behavior Analysis for various settings and systems - this training module will mainly address the involvement of one setting- the patient’s home environment.

Additional Training  Module

Medicine, Patients, Home Environments and Basic Behavior Analysis Concepts

" Health is a state of complete physical, mental, and social well-being

 and not merely the absence of disease and infirmity."

                  -      quote by World Health Organization  

Why Focus on the Home Environment? 

Environments, environments, we all are surrounded, subjected, intertwine and interact in various environments.  In fact, many of our sciences and studies today are focusing on environments.

For instance, a recent avenue of research for microbiologists is the study of bacteria in the communities in which they live – the biofilm.  The microbiologists have found that if you analyze a bacteria in isolation rather than where it lives in a community, you might draw possible wrong conclusions about its behavior. To understand the behavior of bacteria that live in a community, you must study it in its community environment.

Further sciences that address the affects of environments are : Ecology is the study of the interrelationships between organisms and their environments. Zoologists deem it necessary to study animals and their behavior in their natural habitats. Even the National Center for Post Traumatic Stress Disorders has been studying the environmental, psychological and health related effects on people that were caused by natural and human-caused disasters. Some Sociologists are interested in evaluating and addressing the disaster environment’s consequences on humanity. There has also been a push to create controlled virtual reality environments to enhance therapeutic assessment and intervention protocols for clients/patients. So the scientific world not only studies the effects of environments, there is an additional need to adapt environments for humans too.

In order to study your subject, it is a very good idea to study them in their environments.  Thus to understand the behavior of humans, perhaps one could start where their clients/patients actually live. For this graduate project, we will evaluate a different type of environment than the typical physician office visit. Due to the ever changing demands on health care service providers, the physician home visit practice that had been abandoned decades ago has been coming back and expanding. Many professional groups such as the American Medical Association, American Academy for Home Care Physicians, Gold Foundation, Hartford Foundation etc all have cited the importance to address, evaluate, provide support, conduct further research and acknowledge the clinical benefits of physician home visits. There is a major need to further educate and train physicians about their patients’ home environments to improve clinical decisions and patient care. Physicians need to become more aware of what is all involved with a home visit which is a patient’s home environment. 

   “ Look deep into nature ( environments ),

    and then you will understand everything better.”

- quote by Albert Einstein

Social work has long valued the home visit as the best method for gathering psychosocial data.  Those working with patients with cognitive impairment have long recognized that the information provided by family members about the patient’s level of functioning at home is often more valid than the information obtained through cognitive tests in the clinician’s office. My own research work will focus on pointing out the differences between the clinician office and home visit. The home visit is a very different type of environment than the office visit. In relation to Albert Einstein’s wisdom, the home visit can provide a better understanding of the patient which in turn could create clinical benefits that an office visit can not.

Lets take a look at this:

            The doctor office                            VS                      The patient's home

                                                                                                                                    example of traditional family home

                                                                                                                                    with  lots to take into consideration !

The doctor's office is its own environment that is controlled by medical staff .  

Some patients have described the doctors' office as being orderly and sterile.

Some have even indicated  that they feel like a number, rather than a person and have long waits  in doctor offices.

On the other hand;

                                The patient's home environment is NOT controlled by medical staff .

The home can be a place of nice and organized home activities  

                                                              or  not such a nice and organized home     

It could even be a combination too !

Actually, the home is quite more a realistic setting than a doctor's office.

Home is a multifaceted reality.

Even today's latest trend is Reality TV shows !      

The public is fascinated with what transpires in real life settings with TV hit shows like The Apprentice and Survivor.

There are reality TV shows even featuring in-home settings -  such as Wife Swap , Nanny 911, Super Nanny etc.

It is also interesting to note that another TV hit   medical drama

believes in  the informational power that can be found in the patient's home.

  ' HOUSE '  on FOX        

 Dr House is the lead Sherlock Holmes     of an elite , super diagnostic medical team at Princeton Medical Hospital in NJ

who seek answers from everywhere, including conducting occasional visits

 to the patient's home environment to snoop around

for clues to aid the diagnostic process and treatment for the case.

Man must go back to nature for information.

- quote by Thomas Paine

                 Therefore,  it does make common sense that a patient's home  would be part of their nature.

So what discipline

                        deals with individuals, environments

                                                                            and behaviors related to them  

That would be Applied Behavior Analysis

Definitions of Behavior Analysis as approved and directly cited by the

 Behavior Analyst Certification Board :

  The American Psychological Association has recognized Behavior Analysis

as a valid science and as a contributing division to psychology and other disciplines.

As stated by the APA:

"Division 25 - Behavior Analysis promotes basic research, both animal and human, in the experimental analysis of behavior; it encourages the application of the results of such research to human affairs, and cooperates with other disciplines whose interests overlap with those of the Division."

When many people hear about Behaviorism or Applied Behavior Analysis-

                                                          They may think of :

Pavlov and his salivating dog and ringing bell experiment -  classical conditioning

Classical/ Stimulus- Response school of behaviorism - old school of thought

the stimulus  ( happening /cue  = the ringing of the bell that had been previously paired with food)

                                                        caused

                                    a response ( behavior = dog salivating )

                                                     OR  maybe ....

Skinner and his rats and pigeons experiments -   operant conditioning

Operant School of behaviorism -  more current school of thought

the stimulus ( happening/cue = the disc target is presented to the pigeon)

caused a response ( behavior = pigeon pecks at the disc )

what happens immediately AFTER

is a consequence ( reinforcement/reward = bird seed is released)

since the pigeon was consequently reinforced with bird seed AFTER it pecked the disc,

when the happening/cue = stimulus disc target is presented again, most likely the

pigeon 's behavior will happen again (influenced /increased)  = learned response will peck the target

to get another reinforcement = consequence bird seed

therefore the pigeon has been 'conditioned' or has 'learned how the disc target operates'

in order to get more bird seed

True, these experiments fall under Applied Behavior Analysis,          

though there is alot more to ABA than just training rats, pigeons and dogs.

 

i hope so

Lets do another example of operant conditioning

stimulus/cue  -  traffic light is red   

                                        response/behavior -  step on your brakes  

                                                                                            consequences - car stops 

                                                                                             - you are abiding the law to stop

                                                                                                                           at a red light        

                                                                                      -  you and your car are safe as a result

                                                                                               - you do not get a ticket for running           

                                                                                                                            through a red light

As with this everyday behavior, driver's have been conditioned to stop when we see a red light.

We had to first initially learn that a red light meant we had to use our brakes to stop the car.

Then we kept doing it ,  stimulus response consequence  - over and over again as a cycle that eventually just became an automatic behavior.

 Since Applied Behavior Analysis

                  involves principles of learning and behavior

 -  here are some of the basics  

ABA Definition by Baer, Wolf and Risley (1968)- pioneer contributors to the Journal of Applied Behavior Analysis JABA

Positives of Skinner philosophy:

Skinner was a major contributor to Applied Behavior Analysis. Skinner's approach did not discount that private thoughts       ( cognitive psychology) also contribute to people's behaviors. But, his work demonstrated that we can

objectively understand behavior better by observing behaviors, environments and stimuli.

So , patients have homes  

        A home is its own environment

                stimuli and events are present in homes

                           patients exhibit behaviors in their home        

                                      Behaviors can be shaped

                                                    the home can be a place to objectively observe and gain information

                                                                                            the home can be a place to shape behaviors too !

8.  The Neurologist who does a physical test that an MS patient has difficulty doing at the office and bases the prognosis solely on that weak performance

- perhaps the neurologist also should ask the MS patient to demonstrate something that they can still do within their various settings for a more realistic picture of their overall physical status. they can still sing and walk

9.  Environmentally, there has been a major 5 day heat wave  , the ER doctor misdiagnoses a patient as having a viral illness when instead the correct diagnosis is heat exhaustion. 

- Yes, even the weather can be an environmental factor to health.

10.  The professional being unaware   of how they can majorly contribute and reinforce behaviors of an individual in various settings

- there is a need to be more aware of reinforcement behavior principles. clap clap clap

Now lets apply this Nesting theory to the patient's home :

                                                                      So true, the view from the home vs just the doctor's office is quite different.

Environments are really like their own individual homes. 

    Each environment has a systematic intertwining of stimuli, behaviors and patterns

  Although, somehow they all fit together, just like what is presented in this picture. 

The elements are differentiated but they all relate to one another in some way.

What can a Doc do when they conduct a home visit ? 

The physical environment can have lots of info to observe, assess, understand, utilize, manipulate etc

So what can a physical environment tell you about a person ?

       Their personality traits ?    Their secrets ?   Their life style ?  Their values ?   etc  etc

A study conducted by Gosling et al , entitled " A Room with a Cue : Personality Judgements Based on Offices and Bedrooms." provides further insight about what our environments can indicate about us.

Synopsis:  the study wanted to look at the notion that much can be learned about people from the spaces they inhabit. They referred to individual's living environments as personality environments. These researchers, " hypothesize that individuals also select and craft physical environments that reflect and reinforce who they are. Furthermore, we propose that observers use the information available in everyday environments to form impressions of what the occupants of those environments are like."

ABSTRACT : The authors articulate a model specifying links between (a) individuals and the
physical environments they occupy and (b) the environments and observers'
impressions of the occupants. Two studies examined the basic phenomena
underlying this model: Interobserver consensus, observer accuracy, cue
utilization, and cue validity. Observer ratings based purely on offices or
bedrooms were compared with self- and peer ratings of occupants and with
physical features of the environments. Findings, which varied slightly across
contexts and traits, suggest that (a) personal environments elicit similar
impressions from independent observers, (b) observer impressions show some
accuracy, (c) observers rely on valid cues in the rooms to form impressions of
occupants, and (d) sex and race stereotypes partially mediate observer consensus
and accuracy. Consensus and accuracy correlations were generally stronger than
those found in zero-acquaintance research.
 

The study assessed 80 college students. First, the researchers had close friends of the eighty students fill out a  Big Five Inventory questionaire that rated their friend's extraversion, agreeableness, conscientiousness, emotional stability and openness to new experiences. Next, they used total strangers who had never met the 80 students. The only thing that the strangers saw, were the subjects' home dorm rooms. The strangers were given 15 minutes in the dorm and a clip board with questions addressing each 5 trait dimensions. Interestingly, the good friends group measured extraversion and agreeableness slightly better than the stranger group. However, the stranger group were more accurate at measuring conscientiousness, emotional stability and the students' openness to new experiences - all of this was accomplished by strangers simply entering someone else's home environment!

The strangers were looking at the students' personal belongings and surroundings

( stimuli / cues)-

these things provided a wealth of information/evidence to assess an individual.

Thus if a stranger can do this, so can a physician. 

So what does this home environment tell you ?

Learn to observe !!!  

There is more to a patient than just their physical body

with biological functions.

So what do individuals do in environments- well they REACT !!

Reactivity is even a subject addressed in research methods:

In a way, by a physician / health care professional conducting a home visit,

it could be considered as a research event.

A patient's home   is a place of real world human contexts. 

         - people will react to what affects them

                                                       and

                   - people will also react to what is happening to others around them

Thus, the visiting professional can assess and perhaps have some influence

within the contexts.

The home visit can be that survey questionaire. 

This includes the typical standard office visit questions along with the direct observation of the realistic , natural environment your patient resides in. The home visit allows for

an evidence based comparison, a better target 

to seek  clues and answers about the patients you care for.

Not only does the patient react to you in their environment

                                                            - the visitor is also reacting to the patient in their environment

Oh dear, I think this guy needs to react better to the cues !! 

A study conducted by Levinson, et. al. entitled  "Physician - Patient Communication: the Relationship with Malpractice Claims Among Primary Physicians and Surgeons."  evaluated communication patterns by doctors with their patients. 

The following is what was found:

OBJECTIVE: To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. DESIGN: Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. SETTINGS: One hundred twenty-four physician offices in Oregon and Colorado. PARTICIPANTS: Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. MAIN OUTCOME MEASURES: Audiotape analysis using the Roter Interaction Analysis System. RESULTS: Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. CONCLUSIONS: Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups

Main point : What was found was that about roughly half of the doctors who participated in this study were not sued. The other half of the group of doctors had a history of being sued at least twice.  The researchers found that their were differences between the two groups based on the conversations. The surgeons who had not been sued spent an additional three minutes longer talking to patients than those who had been sued. 18.3 minute average versus 15 minutes.

Also, the doctors who were not sued :

- had demonstrated better active listening skills

- were more likely to laugh and be funny during the visit with the patient

All of these things are forms of reinforcers :

-  providing positive attention to the patient

-  duration of visits were longer that resulted in more favorable responses by the patients

-  using humor can bring a welcomed smile  hee hee!  for both doc and patient

He is the best physician who is the most ingenious inspirer of hope  

- quote by Samuel Taylor Coleridge

The doctor can be a positive " behavior change agent "  when visiting the patient's home.

As a result, the " behavior change agent " becomes a part of the patient's Nest !  

               " Remember that you are the REINFORCER.

                                   (  you are the stimulus that the patient interacts and reacts to )

       May the power of reinforcement be with you ! "    

       ( you provide various consequences to your patients that can shape their behaviors - medically and personally)

- quote by Elizabeth Wells,  Behavior Analyst

Home is not where you live, but where they understand you

- quote by Christian Morgenstern

      Home is Home , please RESPECT your patient's home.

 Visiting the home is a way to provide extra special attention to the patient and their family.  

               It allows opportunities :

                        - to strengthen the doctor- patient relationship

                                          - and shape behaviors in the patient 's environment

Here are some special comments by physicians regarding the importance of understanding

and applying that knowledge to benefit the patient.

As stated well by Geriatric physician, Dr George Taler :

Some Physician Home Visit Humor  

Obvious Diagnosis

The Home environment  is very much a part of the patient/ client.

Environments are a reality in your patients' lives.

You now have acquired some knowledge

Now , take the opportunity and utilize it to benefit your practice. 
 

Applied Behavior Analysis, Nesting theory and Medicine :

Medicine and Applied Behavior Analysis disciplines can go hand in hand.

Concepts presented can apply to all ages, various types of populations,

the healthy   and not so healthy individuals.

Applied Behavior Analysis concepts and the Nesting Theory ( Natural Environment Setting Theory )

can provide some of the "missing" info and interventions that medicine has been looking for

to improve clinical decisions and patient care.

ABA and the Nesting theory can provide the "other" informational piece of the puzzle   

when diagnosing and treating patients. 

 Also, keep in mind

                 that a behavior analyst can also be part of the interdisciplinary health care team too !  

Further thoughts:         

 Applied Behavior Analysis and Nesting theory not only applies to the patient home environment.

It applies to all environments !

Think about it -    hhhhmmmmm    

                                                Even this graduate project is its own " training environment !"    

Hopefully, this was a positive training environment

that had reinforcing stimuli

that will improve your practice behavior !  

They say a picture can say a 1,000 words . . .

Therefore, this picture shall sum up this presentation well .

Exam questions to test your enhanced knowledge   

What is reinforcement ?

a. increases the probability of the response

b. may occur naturally or be planned

c. a consequence

d. a and b

e. a, b and c

What is the least important component in the environment ?

a. the social supports

b. the physical objects

c. where the bed room is located

d. how one reacts to the environment

e. none of the above, all are important

What type of conditioning is this example ?

a. classical conditioning

b. operant conditioning

c. neither

All of the following are behaviors except ?

a. taking medication

b. a smile

c. taking a nap

d. reading a book

e. a dead man

You have a patient that has been complaining about his allergies. Even the medication provided has not been helping.

What environmental question would be helpful to decipher this mystery ?

a.  are you taking your medication properly ?

b. are you sure that you did not use that cologne you are allergic to ?

c. has anything happened at home that could cause mold ?

d. have you been sleeping well lately ?

Which one is the best definition for reactivity ?

a. people react to what is happening to others around them

b. is a real world

c. people will react to what affects them

d. a and b

e. b and c

Define this behavior :  

a.  the mummy is dead, so it is not a behavior

b.  the mummy exists

c.  the mummy is moving for this exam question

d.  this mummy looks scary      

Applied Behavior Analysis is the science of ?

a. psychology

b. principles of learning and behavior

c. training dogs, pigeons and rats

d. how to positively reinforce someone

While doing a home visit assessment, a patient states that she sometimes forgets where she keeps her medication bottles.

What should be the plan of action?

a. have double prescriptions filled

b. tell her that she needs to be more careful and go find them

c. ask her to agree upon one place in the home to store all the medication there

d. say to the patient, " we should go look for where you have the medication and then decide the best place to store all the medication."

The Nesting theory is about environments ;

a. that pertain to a patient's home

b. that can be all the environments that a patient interacts with

c. human and non-human environments

d. all of the above

Physicians have home environments and patients have home environments.

a. true

b. false

Who is in more control at the doctor's office ?

a. the nurse

b. the doctor

c. the patient

d. medical staff

Who controls more in the home environment ?

a. the patient who lives there

b. the kids

c. the dog

d. Skinner

What does not live in an environment ?

a. amebas

b. a dog

c. a plant

d.  a and c

e. all live in an environment

 Medical tests provide the only true accurate information of one's health and environments.

a. true

b. false

The heart can be related to what environments ? 

a. the circulatory system

b. the human body

c. the animal body

d. love

e. all of the above

Artificial contingencies are more effective than natural contingencies

a. true

b. false

What is the most important stimulus / cue that is motivating this behavior ?

a. the bubbles from the dish detergent

b. the running water

c. the dirty dishes

d. the sink

e. washing dishes

By having a better understanding of behavior and environments, which of the following is true ?

a. you can be a behavior change agent

b. you can be the reinforcer

c. you can receive reinforcement back

d. apply the knowledge to target and improve behaviors

e. all of the above

Resources

Further suggested Book on ABA content

Don't Shoot the Dog by Karen Pryor - very good book on behavior !!

Applied Behavior Analysis related websites for resources   

 Behavior Analyst Certification Board  -  www.bacb.com

Association for Behavior Analysis - http://www.abainternational.org/

Cambridge Center for Behavioral Studies - http://www.behavior.org/

Dr Mac' site -  http://www.behavioradvisor.com   - very informative site !

Association for Positive Behavior Supports - http://www.apbs.org/main.htm

B.F. Skinner Foundation - http://www.bfskinner.org/index.asp

Educational and experience requirements for a Board Certified Behavior Analyst

Master degree in ABA related field -  ABA, psychology, Health Science, social work , etc

Mandatory 15 graduate credits in Applied Behavior Analysis

          ABA programs are 4 to 5 graduate level courses usually taken over at least 4 academic semesters

9 months of full time supervised behavior analysis/consulting experience by another Masters level clinician and Board Certified

This graduate project completes my M.S. degree in Health Science from UMDNJ which shall make me eligible to sit for the BCBA exam December 2005.    Yeah !!!!!!

Special Thanks to : 

Dr Meg Kilduff - UMDNJ- a professor that makes learning a positive reinforcing event

Dr Craig Scanlan - UMDNJ -  yes, I did survive the Scanlan grad courses and learned from them

Dr William Reichman and Dr Michael Miller - UMDNJ - for being influential and supportive Mentors early on in my career

Dr Dan Ogilvie- Rutgers University- for being so frank and making my undergrad psychology days interesting

Penn State University Applied behavior Analysis Program , Dr Neisworth and Dr Shook - yes, I am an ABA survivor !!

All the families, clients, staff and other professionals that I have worked with.

Beth's background :

Has over sixteen years experience working with various populations of all ages "with" and "without" disabilities. 

Experience includes: management of residential programs, case management, behavior management consultant, behavior analyst, cognitive rehabilitation, recreation specialist, coordinator of services and program development, grant writer, staff trainer and lecturer. Populations served- developmentally disabled, chronic psychiatric, MICA, dually diagnosed, head-injury, learning disabilities and elderly. Consulting services are provided for families and to medical, educational, business, and social service professionals.

Contact Beth :        ewells2458@aol.com

Web page 'novice' design By Beth  

References

American Academy of Home Care Physicians. (2003). Home care credentialing training. AAHCP. Retrieved July 19, 2005, from www.aahcp.org

American Psychological Association. ( 2005). Division 25. Retrieved August 15, 2005, from http://www.apa.org/about/division/div25.html

 Behavior Analyst Certification Board. (2005). Retrieved October 14, 2005, from www.bacb.com

Cambridge Center for Behavioral Studies. ( 2005). Glossary of behavior terminology. Retrieved October 2, 2005, from  http://www.behavior.org/

Cooper, J. O.,  Heron , T. E., Heward, W. L. ( 1987 ). Applied Behavior Analysis. Upper Saddle River, NJ : Prentice Hall.

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by Elizabeth Wells and Alternative Pathways

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