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Capella University *

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Dec 6, 2023

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1 Juan’s Case Study Treasure M. Jefferson Department of Social and Behavioral Sciences, Capella University PSY 7710: Ethics for Behavior Analysts Dr. Meredith Mates September 10th, 2023

2 To the family of Juan Guzman, My name is Treasure Jefferson, and I am the BCBA assigned to your grandfather’s case. After careful consideration, I have attached a Risk Assessment document below to show you my recommendations for the ABA procedure that I believe will effectively decrease your grandfather’s target behaviors. This document examines the risks and benefits of a specific applied behavioral analysis procedure. The applied behavior analysis procedure that I believe will benefit your grandfather’s treatment is the differential reinforcement of alternative behavior (DRA). DRA is used to decrease the target problem behavior by reinforcing appropriate alternative behaviors and withholding reinforcement for any instance of the problem behavior occurring (Cooper et al., 2020). This means that we would not be reinforcing Juan’s problem behaviors (his elopement of leaving the facility and his verbal aggression) and would be praising him on alternative behaviors (using appropriate conversational skills to voice when he needs to leave an area, his concerns, and how he is feeling). I saw that the previous BCaBA did not conduct a functional behavior analysis assessment, which I believe needs to be done before we try to implement any ABA procedure. The functional behavior analysis assessment aims to understand the reasoning (function of the behavior) as to why your grandfather is eloping the facility and engaging in verbal aggression (Anderson et al., 2015). When you are implementing DRA, you need to understand the function of the behavior so you can reinforce an effective alternative behavior to see his behavior improve. There will be trials and tribulations throughout this journey, and I want to outline how my team and I will ensure that your grandfather will receive the best care. The Behavior Analyst Certification Board (BACB) has a set of ethical code guidelines that we need to uphold to create effective and successful intervention treatment for our clients. I

3 will describe some of the codes that coincide with how we will create effective treatment strategies for your grandfather’s behaviors and some mistakes made before I joined his team. The code that was violated was code 2.01, which is providing effective treatment. Some codes I will implement throughout his treatment are codes 2.11 Obtaining Informed Consent, 2.14 Selecting, Designing, and Implementing Behavior Change Interventions, 2.16 Describing Behavior Change Interventions before Implementation, and 3.01 Responsibility to Clients (BACB, 2020). Code 2.01 was violated because your grandfather was not getting effective treatment. The staff stated providing intervention techniques, attempting to use chemical restraints, limiting access to areas, and having him stay in his room without providing effective treatment to understand why he behaves the way he does. This is why I am stressing to conduct a functional behavior assessment before implementing any procedure. Codes 2.11, 2.14, 2.16 ensures that my selection for DRA is scentiifcally based evidence technique and i'm laying out my plans for how I want the treatment to go, why is it important, and the timeframe of the procedure. I will also be obtaining informed consent for the FBA and for conducting the DRA. Lastly, code 3.01 ensures that I am choosing procedures that are for Juan’s best interest. I want to address that we are all concerned about Juan and his stay in the facility. We want to maintain Juan's safety and protection while still allowing him to exercise his basic rights, such as traveling around the facilities. If you have any questions, please call me at the phone shown below, Monday through Friday, 8 a.m. to 6 p.m. I am not just here for Juan, but also for you as his family, so please do not hesitate to contact me if you need anything clarified.

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4 Sincerely, Treasure Michelle Jefferson BCBA (209)834-4949

5 Risk-Benefit Worksheet ABA Procedure I will use differential reinforcement of alternative behavior (DRA) for my risk-benefits analysis worksheet. According to Cooper et al. (2020), differential reinforcement of alternative behavior decreases problem behaviors by reinforcing appropriate alternative behaviors and withholding reinforcement for any occurrence of the undesired problem behavior. Special Methods Using DRA will decrease Juan's engagement in verbal aggression and eloping from the nursing facility because we will help him use his words to voice when he is upset or needs to leave prior to engaging in the undesired behavior. We will also train staff in providing positive praise when he is using positive conversational language and when he is positively engaging in other daily living tasks with other residents and staff in his environment. Risks Risk Number Risks Notes 1 It can be hard to identify a functional replacement behavior for the alternative behavior If Juan is not motivated to engage in the replacement behavior that we recommend, then it might not be the best alternative behavior to use to decrease his elopement or verbal aggression 2 Increase in undesired behavior Juan might engage in his elopement and verbal aggression at a more frequent rate when we start to implement the DRA 3 He might not understand the consequences of his actions Juan might not understand why we are replacing his verbal aggression and elopement, to which he doesn’t understand why we are praising him for his alternative behaviors 4 It can be hard to identify every occurrence that he engages in the alternative behavior We might not praise him for every occurrence of the DRA because we aren’t that vigilant of his daily tasks all the time Benefits .

6 Benefit Number Benefit Notes 1 Better safety techniques Eliminating Juan’s elopement from the facility will ensure his safety. 2 Better coping mechanism/ Positive conversational language Using DRA will help teach Juan that before he starts to get upset to use his words to let others know what is wrong with him and address his needs to others before engaging in verbal aggression 3 Decrease in undesired behavior Because we are not providing reinforcement for Juan to engage in elopement and verbal aggression, we will start to see a decrease in the engagement of these behaviors 4 Increase in positive engagement We will see an increase in his positive behavior since reinforcing Juan when he is engaged in positive behaviors when interacting with staff and residents Summary of Risks vs Benefits I believe that the benefits of implementing DRA outweigh the risks of this procedure. If we understand the function of Juan’s elopement and verbal aggression behavior, we can understand how to effectively replace these behaviors with an appropriate alternative function. Implementing differential reinforcement of alternative behavior will help him be able to express his concerns and desires before engaging in undesired behaviors. References Bailey, J. S., & Burch, M. R. (2016). Ethics for behavior analysts (3rd ed.) . Routledge. Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts . https://www.bacb.com/wp-content/uploads/2020/11/Ethics-Code-for-Behavior-Analysts- 210106.pdf Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Pearson. Anderson, C.M., Rodriguez, B.J., & Campbell, A. (2015). Functional behavior assessment in

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7 schools: Current status and future directions. Journal of Behavioral Education , 24, 338- 371.

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