The Behavior Analyst 1988, 11, 111-114 No.

2 (Fall)

The Right to Effective Behavioral Treatment

Ron Van Houten, Chair
Mount Saint Vincent University
Saul Axelrod
Temple University
Jon S. Bailey
Florida State University
Judith E. Favell
Au Clair Program, Mount Dora, Florida
Richard M. Foxx
Anna Mental Health Center, Anna, Illinois
Brian A. Iwata
University of Florida
0. Ivar Lovaas
University of California at Los Angeles
We propose that individuals who are recipients or potential recipients of treatment designed to change
their behavior have the right to: (1) a therapeutic environment, (2) services whose overriding goal is
personal welfare, (3) treatment by a competent behavior analyst, (4) programs that teach functional skills,
(5) behavioral assessment and ongoing evaluation, and (6) the most effective treatment procedures avail-
able.

Over the last several decades, a num- the most effective treatment that the dis-
ber of clinical procedures derived from cipline can provide. Toward this end, the
experimental and applied behavior anal- following statement of clients' rights is
ysis have been developed, evaluated, and offered to direct both the ethical and ap-
refined. These procedures have the dem- propriate application of behavioral treat-
onstrated ability to teach new behavior ment.
and alleviate a variety of behavioral dis-
orders. Unfortunately, many who would 1. An Individual Has a Right to a
benefit from behavioral treatment are not Therapeutic Environment
receiving it. Behavior analysts have a A physical and social environment that
professional obligation to make available is safe, humane, and responsive to in-
dividual needs is a necessary prerequisite
Report of the Association for Behavior Analysis for effective treatment. Such an environ-
(ABA) Task Force on the Right to Effective Treat- ment provides not only training, but also
ment. Ron Van Houten served as the Task Force an acceptable living standard. The di-
Chair and Brian A. Iwata served as the Council
Liaison. This report was accepted by the ABA Ex- mensions of an adequate living environ-
ecutive Council; however, it does not necessarily ment are complex and varied; neverthe-
reflect the view of the majority of ABA members less, several elements appear essential.
nor does it constitute official ABA policy. This re- Individuals should have access to ther-
port is also published in the Journal ofApplied Be- apeutic services, leisure activities, and
havior Analysis (1988), Vol. 21. Reprints may be
obtained from Brian Iwata, University of Florida, materials that are enjoyable as well as
Gainesville, FL 32611. instructive. Thus, client preference, in
111
112 RON VAN HOUTEN et al.

addition to factors such as age-appropri- health status. Professional competence

ateness and educative value, is relevant aided by peer and human rights review
in the selection of activities and mate- will insure that behavioral treatment is
rials. An adequate environment also in- delivered within a context of concern for
cludes parents, teachers, and staff who client welfare.
are competent, responsive, and caring.
Such qualities may be characterized in 3. An Individual Has a Right to
terms of frequent positive interactions Treatment by a Competent
that are directed toward enjoyment, Behavior Analyst
learning, and independence. Finally, a Professionals responsible for deliver-
therapeutic environment imposes the ing, directing, or evaluating the effects of
fewest restrictions necessary, while in- behavioral treatment possess appropri-
suring individual safety and develop- ate education and experience. The be-
ment. Freedom of individual movement havior analyst's academic training re-
and access to preferred activities, rather flects thorough knowledge of behavioral
than type or location of placement, are principles, methods of assessment and
the defining characteristics of a least re- treatment, research methodology, and
strictive environment. professional ethics. Clinical competence
also requires adequate practicum train-
2. An Individual Has a Right to ing and supervision, including experi-
Services Whose Overriding Goal ence with the relevant client population.
Is Personal Welfare In cases where a problem or treatment
The primary purpose of behavioral is complex or may pose risk, individuals
treatment is to assist individuals in ac- have a right to direct involvement by a
quiring functional skills that promote in- doctoral-level behavior analyst who has
dependence. Both the immediate and the expertise to detect, analyze, and man-
long-term welfare of an individual are age subtle aspects of the assessment and
taken into account through active partic- treatment process that often determine
ipation by the client or an authorized the success or failure of intervention. A
proxy in making treatment-related de- doctoral-level behavior analyst also has
cisions. In cases where withholding or the ability, as well as the responsibility,
implementing treatment involves poten- to insure that all individuals who partic-
tial risk, Peer Review Committees and ipate in the delivery of treatment or who
Human Rights Committees play distinct provide support services are trained in
roles in protecting client welfare. Peer the methods of intervention, to assess the
Review Committees, comprised of ex- competence of individuals who assume
perts in behavior analysis, impose subsequent responsibility for treatment,
professional standards in determining the and to provide consultation and follow-
clinical propriety of treatment programs. up services as needed.
Human Rights Committees, comprised 4. An Individual Has a Right to
of consumers, advocates, and other in- Programs That Teach
terested citizens, impose community Functional Skills
standards in determining the acceptabil-
ity of programs and the extent to which The ultimate goal of all services is to
a program compromises an individual's increase the ability of individuals to func-
basic rights to dignity, privacy, and hu- tion effectively in both their immediate
mane care; appropriate education and environment and the larger society. Im-
training; prompt medical treatment; ac- provement of functioning may take sev-
cess to personal possessions, social in- eral forms. First, it often will require the
teraction, and physical exercise; humane acquisition, maintenance, or generaliza-
discipline; and physical examination prior tion of behaviors that allow the individ-
to the initiation of a program that may ual to gain wider access to preferred ma-
affect or be affected by an individual's terials, activities, or social interaction.
 RIGHT TO TREATMENT 113

Second, it may require the acquisition of tained through interview. Is there any cir-
behaviors that allow the individual to cumstance in which the behavior always
terminate or reduce sources of unpleas- occurs? Is there any circumstance in
ant stimulation. Third, improved func- which the behavior never occurs? Does
tioning may require the reduction or the behavior typically occur at certain
elimination of certain behaviors that are times of the day? Could the behavior be
dangerous or that in some way serve as associated with any form of discomfort
barriers to further independence or social or deprivation? Could events following
acceptability. Finally, as a member of so- the behavior serve as either positive re-
ciety at large, an individual has a right to inforcement (e.g., attention) or negative
services that will assist in the develop- reinforcement (e.g., escape from de-
ment of behavior beneficial to that so- mands)? The second stage ofanalysis, di-
ciety. rect observation of the individual's be-
Decisions regarding the selection of havior under varied and relevant
service goals are not based on a priori circumstances, confirms suspected rela-
assumptions of an individual's behav- tionships identified during the interview.
ioral potential or limitations. It is con- Finally, the assessment findings are in-
ceivable that some goals might be corporated into a systematic treatment
achieved very slowly, that others may be plan.
only approximated, and that, in the pro- Successful intervention requires on-
cess of achieving still other goals, it may going evaluation in the form of objective
be necessary to expose the individual to data to determine the effects of treat-
either immediate temporary discomfort ment, to quickly identify unanticipated
(e.g., as in teaching physical exercise as problems, and, if necessary, to modify
a means of promoting health) or future the treatment plan. The behavior analyst
risk (e.g., as in teaching an individual to maintains accountability and solicits
cross streets or to drive an automobile). timely input into the decision-making
Still, unless evidence clearly exists to the process by sharing these data regularly
contrary, an individual is assumed ca- with all concerned parties.
pable of full participation in all aspects
of community life and to have a right to 6. An Individual Has a Right to
such participation. the Most Effective Treatment
Procedures Available
5. An Individual Has a Right to An individual is entitled to effective
Behavioral Assessment and and scientifically validated treatment. In
Ongoing Evaluation turn, behavior analysts have an obliga-
Prior to the onset of treatment, indi- tion to use only those techniques that have
viduals are entitled to a complete diag- been demonstrated by researchers to be
nostic evaluation to identify factors that effective, to acquaint consumers and the
contribute to the presence of a skill deficit public with the advantages and disad-
or a behavioral disorder. A complete and vantages of these techniques, and to
functional analysis emphasizes the im- search continuously for the most optimal
portance of events that are antecedent, means of changing behavior.
as well as consequent, to the behavior of Consistent with the philosophy of least
interest. For example, identification of restrictive yet effective treatment, expo-
preexisting physiological or environmen- sure of an individual to restrictive pro-
tal determinants may lead to the devel- cedures is unacceptable unless it can be
opment of a treatment program that does shown that such procedures are necessary
not require extensive use of behavioral to produce safe and clinically significant
contingencies. behavior change. It is equally unaccept-
The initial behavioral analysis is per- able to expose an individual to a non-
formed in three stages. First, answers to restrictive intervention (or a series of such
the following types of questions are ob- interventions) if assessment results or
114 RON VAN HOUTEN et al.

available research indicate that other In summary, decisions related to treat-

procedures would be more effective. In- ment selection are based on information
deed, a slow-acting but nonrestrictive obtained during assessment about the be-
procedure could be considered highly re- havior, the risk it poses, and its control-
strictive if prolonged treatment increases ling variables; on a careful consideration
risk, significantly inhibits or prevents of the available treatment options, in-
participation in needed training pro- cluding their relative effectiveness, risks,
grams, delays entry into a more optimal restrictiveness, and potential side effects;
social or living environment, or leads to and on examination of the overall con-
adaptation and the eventual use of a more text in which treatment will be applied.
restrictive procedure. Thus, in some
cases, a client's right to effective treat-
ment may dictate the immediate use of CONCLUSION
quicker-acting, but temporarily more re- Behavior analysts have a responsibility
strictive procedures. to insure that their clients' rights are pro-
A procedure's overall level of restric- tected, that their specialized services are
tiveness is a combined function of its ab- based on the most recent scientific and
solute level of restrictiveness, the amount technological findings, that treatment is
of time required to produce a clinically provided in a manner consistent with the
acceptable outcome, and the conse- highest standards of excellence, and that
quences associated with delayed inter- individuals who are in need of service
vention. Furthermore, selection of a spe- will not be denied access to the most ef-
cific treatment technique is not based on fective treatment available. In promul-
personal conviction. Techniques are not gating the rights described in this docu-
considered as either "good" or "bad" ac- ment, the field of behavior analysis
cording to whether they involve the use acknowledges its responsibilities by reaf-
of antecedent rather than consequent firming its concern for individual welfare
stimuli or reinforcement rather than pun- and by prescribing the means by which
ishment. For example, positive rein- behavioral treatment can be delivered in
forcement, as well as punishment, can the most beneficial manner.
produce a number ofindirect effects, some
of which are undesirable.