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Standards for Interprofessional Collaboration in the Treatment of Individuals With Autism

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Abstract

Interprofessional collaboration has become an essential component in the treatment of individuals with autism spectrum disorder, as practitioners from a range of disciplines are often necessary to address the core features and co-occurring conditions. Theoretically, such cross-disciplinary collaboration results in superior client care and maximal outcomes by capitalizing on the unique expertise of each collaborating team member. However, conflict in collaborative practice is not uncommon given that the treatment providers come from varying educational backgrounds and may have opposing core values, fundamental goals, and overall approaches. Although the overarching interest of each of these professionals is to improve client outcomes and quality of life, they may be unequipped to effectively navigate the barriers to collaboration. This article reviews the potential benefits and misconceptions surrounding interprofessional collaboration and highlights common sources of conflict. As a proposed solution to many of the identified issues, we offer a set of standards for effective collaborative practice in the interprofessional treatment of autism spectrum disorder. These standards prioritize client care and value each discipline’s education and unique contributions. They are intended to function as core standards for all treatment team members, promote unity, prevent conflict, and ultimately help practitioners achieve the most integrated collaborative practice among professionals of varying disciplines.
DISCUSSION AND REVIEW PAPER
Standards for Interprofessional Collaboration in the Treatment
of Individuals With Autism
Kristin S. Bowman
1
&Victoria D. Suarez
1
&Mary Jane Weiss
1
Accepted: 9 February 2021
#Association for Behavior Analysis International 2021
Abstract
Interprofessional collaboration has become an essential component in the treatment of individuals with autism spectrum disorder,
as practitioners from a range of disciplines are often necessary to address the core features and co-occurring conditions.
Theoretically, such cross-disciplinary collaboration results in superior client care and maximal outcomes by capitalizing on
the unique expertise of each collaborating team member. However, conflict in collaborative practice is not uncommon given
that the treatment providers come from varying educational backgrounds and may have opposing core values, fundamental goals,
and overall approaches. Although the overarching interest of each of these professionals is to improve client outcomes and quality
of life, they may be unequipped to effectively navigate the barriers to collaboration. This article reviews the potential benefits and
misconceptions surrounding interprofessional collaboration and highlights common sources of conflict. As a proposed solution
to many of the identified issues, we offer a set of standards for effective collaborative practice in the interprofessional treatment of
autism spectrum disorder. These standards prioritize client care and value each disciplines education and unique contributions.
They are intended to function as core standards for all treatment team members, promote unity, prevent conflict, and ultimately
help practitioners achieve the most integrated collaborative practice among professionals of varying disciplines.
Keywords interdisciplinary .multidisciplinary .transdisciplinary .collaboration .autism
Autism spectrum disorder (ASD) continues to be one of the most
prevalent childhood disorders, characterized by deficits in com-
munication and impairments in social interactions, as well as
restricted or repetitive patterns of thoughts and behaviors
(American Psychiatric Association, 2013; Zablotsky et al.,
2015). ASD is often coupled with comorbid gastrointestinal
complications, sleep disturbances, seizure disorders, and mental
health issues, among others (Dillenburger, 2011;LaFranceetal.,
2019;Strunketal.,2017). The complex symptomatology and
high comorbidity associated with ASD frequently involve treat-
ment delivery across a range of professional disciplines (e.g.,
Cox, 2019; Kelly & Tincani, 2013; LaFrance et al., 2019;
Strunk et al., 2017). Board Certified Behavior Analysts
(BCBAs) are commonly part of a larger, interprofessional
treatment team that also includes speech-language pathologists
(SLPs), occupational therapists, special educators, clinical psy-
chologists, and medical doctors, among others (Cox, 2012;
LaFrance et al., 2019). These professionals may find opportuni-
ties to work collaboratively to improve health and educational
outcomes for individuals with ASD (Brodhead, 2015;LaFrance
et al., 2019;Strunketal.,2017), yet, oftentimes, difficulties and
problems arise in the collaborative process and impede the treat-
ment teams ability to completely unite in providing the most
efficient and effective interprofessional care. Thus, the purpose
of this article is to provide information on collaboration, outline
the barriers to providing optimal collaborative care, and propose
a set of standards to promote the transdisciplinary collaboration
of professionals in the treatment of individuals with ASD.
Interprofessional Collaboration
Spectrum of Collaboration
Literature on interprofessional collaboration indicates that
there are varying extents to which professionals from different
This article was composed to meet, in part, the requirements for a doctoral
degree in applied behavior analysis at Endicott College.
*Kristin S. Bowman
kbowman@endicott.edu
1
Applied Behavior Analysis Program, Endicott College,
Beverly, MA, USA
Behavior Analysis in Practice
https://doi.org/10.1007/s40617-021-00560-0
disciplines collaborate when working together as part of a
treatment team (e.g., DAmour et al., 2005 ; Thylefors et al.,
2005). For example, in some collaborative relationships, pro-
fessionalsmay not interact with one another ona regular basis,
whereas in others, professionals may meet regularly and de-
velop treatment plans cohesively (DAmour et al., 2005;
Thylefors et al., 2005). DAmour et al. (2005) described this
spectrum of collaboration as a continuum of professional au-
tonomy varying in degrees of interdependence (see Fig. 1).
Various terms, such as multidisciplinary,”“interdisciplin-
ary,and transdisciplinary,are frequently used to refer to
interprofessional collaborative practices (DAmour et al.,
2005). Although these terms may be mistakenly used synon-
ymously, each term indicates a different degree of collabora-
tion among treatment team professionals (Bernstein, 2015;
Boger et al., 2017;Choi&Pak,2006;DAmour et al.,
2005; Thylefors et al., 2005;seeFig.1). We recommend that
the term interprofessionalbe used as an umbrella term re-
ferring to all models of collaboration whereby two or more
professionals representing different disciplines work together
in treatment or assessment of a shared client. Terms such as
multidisciplinary,”“interdisciplinary,and transdisciplin-
aryrefer to specific models of collaboration and are de-
scribed further to clarify the distinction.
Multidisciplinary treatment is frequently recommended for
the management of ASD; however, the extent of collaboration
and integration of expertise is not typically specified (see Cox,
2012;Dillenburgeretal.,2014;LaFranceetal.,2019; Strunk
et al., 2017). According to Gehlert et al. (2010), the diverse
perspectives available through multidisciplinary models may
offer a more comprehensive analysis than what might other-
wise be achieved via a monodisciplinary (i.e., only one pro-
fessional from one field) endeavor. In a multidisciplinary
model, practitioners operate within the confines of their pro-
fessional boundaries, each delivering treatment according to
their discipline-specific view and often to address a specific
and separate deficit (Choi & Pak, 2006; Gehlert et al., 2010).
Therefore, professionals work in parallel with an emphasis on
the solitary development of goals and interventions (Choi &
Pak, 2006), rather than the collaborative process (Collin,
2009;DAmour et al., 2005; Thylefors et al., 2005).
Multidisciplinary teams are analogous to salads, wherein
various ingredients are included albeit distinct and separate
(Choi & Pak, 2006;seeFigure1). Contributions are additive
rather than integrative (Bernstein, 2015;Choi&Pak,2006).
For example, information may be exchanged between team
members to coordinate care or report progress, but frequent
and ongoing communication is not essential (Strunk et al.,
2017; Thylefors et al., 2005) because input from other team
members does not alter an individual professionalstreatment
plan (Choi & Pak, 2006;DAmour et al., 2005; Thylefors
et al., 2005). Treatment gains may eventually be hindered as
a result of this level of professional autonomy and dissociation
(Choi & Pak, 2006). Whereas the multidisciplinary model
offers more perspectives than a monodisciplinary approach,
the narrow, discipline-oriented viewpoint inhibits a broader
understanding of the complex variables influencing the client
(Gehlert et al., 2010).
Interdisciplinary teams attempt to provide a more compre-
hensive and integrative approach to client care by combining
and coordinating the expertise of the participating profes-
sionals (Collin, 2009; Cox, 2012;DAmour et al., 2005).
Interdisciplinary teams are analogous to soups or stews,
wherein ingredients cook together to produce unique flavoring
but remain distinguishable (Choi & Pak, 2006; see Fig. 1).
The distinct roles of each discipline are preserved while the
goals and responsibilities are shared (Choi & Pak, 2006;
DAmour et al., 2005; Gehlert et al., 2010; Thylefors et al.,
2005). For example, team members may conduct separate and
independent evaluations and then work cooperatively to es-
tablish goals (Choi & Pak, 2006). This joint approach requires
more frequent interactions. As a result, team members often
expand their clinical perspectives beyond the boundaries
established by their discipline (Boger et al., 2017; Choi &
Fig. 1 Spectrum of Cross-Disciplinary Collaboration. Note. The figure
depicts a continuum of collaborative practice ranging from professional
autonomy to cross-disciplinary interdependence with characteristics de-
scribing multidisciplinary, interdisciplinary, and transdisciplinary
collaboration. Images of a salad for multidisciplinary, soup for interdis-
ciplinary, and cake for transdisciplinary represent analogies described by
Choi and Pak (2006)
Behav Analysis Practice
Pak, 2006). Although interdisciplinary care trumps a multidis-
ciplinary approach, complete collaboration is not achieved
because professionals work independently to target goals that
were developed collaboratively. Thus, interdisciplinary care
may offer numerous advantages, yet may prevent a fully ho-
listic perspective of multifaceted disorders such as ASD
(Gehlert et al., 2010).
Transdisciplinary collaboration synthesizes the
discipline-specific expertise of each team member by ob-
scuring the boundaries that typically divide fields
(Bernstein, 2015;Bogeretal.,2017;Choi&Pak,2006;
Collin, 2009;DAmour et al., 2005; Thylefors et al.,
2005). Team members expand their individual roles to
include duties beyond those traditionally assumed within
their scope of practice (i.e., role expansion), as well as
impart their individual, specialized knowledge to other
team members and accept shared responsibility (i.e., role
release; Choi & Pak, 2006). Knowledge and information
are deliberately shared through frequent communication
using a common, jargon-free vocabulary to promote clar-
ity and unity (Boger et al., 2017;Choi&Pak,2006;
Collin, 2009;DAmour et al., 2005; Gehlert et al.,
2010). Worldviews specific to the individual disciplines
are assimilated into a synergetic framework (Boger et al.,
2017;Choi&Pak,2006; Collin, 2009; Gehlert et al.,
2010), allowing the treatment team to share an integrated
perspective and generate innovative, yet pragmatic solu-
tions to socially significantissues(Bogeretal.,2017;
Choi & Pak, 2006).
The level of harmony purported by transdisciplinary col-
laboration demands mutual trust, respect, and confidence
among team members (Boger et al., 2017; Choi & Pak,
2006;DAmour et al., 2005) as they are pushed outside of
their comfort zones(Gehlert et al., 2010, p. 413), away from
their autonomous, monodisciplinary views and into a perspec-
tive that transcends conventional boundaries (Boger et al.,
2017;Choi&Pak,2006). Similar to the interdisciplinary ap-
proach previously mentioned, treatment goals are conjointly
developed; however, in transdisciplinary collaboration, the
clinical skills and interventions are also shared (Boger et al.,
2017; Choi & Pak, 2006). Transdisciplinarity has the makings
of a hybrid discipline, capitalizing on the unique knowledge
and skills of each individual specialist, and combining them
into a coherent whole (Collin, 2009). That is, the resulting
product is different from and greater than the sum of its indi-
vidual parts. Transdisciplinary collaboration is analogous to a
cake, wherein the ingredients are no longer distinguishable
from one another and produce an entirely different product
that could not otherwise be created (Choi & Pak, 2006;see
Fig. 1). Role release and expansion blur the boundaries that
traditionally divide each discipline. The result is a broad, ho-
listic, and shared perspective necessary to develop compre-
hensive interventions that address multifarious, intertwined
variables (Boger et al., 2017; Gehlert et al., 2010) not other-
wise achieved in multidisciplinary or interdisciplinary collab-
oration. Thus, given the high comorbidity and complex symp-
tomatology of ASD, a transdisciplinary approach to collabo-
ration offers the most effective means of assessment and
treatment.
Benefits of Collaboration
The potential benefits of interprofessional collaboration
are vast and well documented. Although lacking empirical
support, many authors have suggested that the interpro-
fessional team unites the strengths and competencies of
individual specialists to maximize client outcomes
(Brodhead, 2015; Dillenburger et al., 2014;Garman
et al., 2006). Lawson (2004) reported that truly effective
collaboration may additionally lead to enhanced problem
solving, increased efficiency, and access to additional
resources. Additionally, Kelly and Tincani (2013)noted
that collaboration may be more preferred by clients, in-
crease treatment integrity, and result in better maintenance
of acquired skills. Furthermore, Brodhead (2015)
highlighted several professional benefits of effective col-
laborative interactions, including the opportunity to dis-
seminate ones own science and discipline, understand
other disciplines and perspectives, and develop trusting
partnerships that may enhance the quality of therapeutic
services. Similarly, Hall (2005) suggested that interprofes-
sional collaboration also yields potential benefits for
health care organizations, including higher quality client
care at reduced costs and greater job satisfaction.
With the literature touting the benefits of interprofes-
sional collaboration, it seems an obvious and rational ap-
proach (Dillenburger et al., 2014). Moreover, interprofes-
sional treatment for the management of ASD is recom-
mended by the American Academy of Pediatrics, the
United Nations Convention for the Rights of Persons
With Disabilities, and the National Institute for Health
and Care Excellence (Dillenburger et al., 2014; Strunk
et al., 2017). Therefore, it is not surprising that interpro-
fessional collaboration is growing in popularity and is
considered best practice in the management of ASD
(Dillenburger et al., 2014; Lawson, 2004; Strunk et al.,
2017). However, Cox (2019) explained that true benefit
is only achieved when the collaborative efforts produce
greater outcomes than what would otherwise be achieved
by services delivered in isolation. Unfortunately, collabo-
ration in clinical practice and research is poorly under-
stood, and the lack of an intervention-oriented concept
of collaboration poses a significant problem (Lawson,
2004). Failing to effectively collaborate may result in an
incompatible mix of treatments that may produce adverse
or even harmful outcomes for clients (Cox, 2019).
Behav Analysis Practice
Misconceptions
According to Dillenburger et al. (2014), when the concept of
collaboration is misconstrued and poorly used, the team re-
gresses into mere eclecticism”—that is, a haphazard pick and
mixor a hodgepodgeof discipline-specific interventions
(pp. 45). Moreover, Schreck and Mazur (2008) described a
buffet approachto the treatment of ASD, wherein clients
have access to a variety of treatment options (e.g., sensory
integration, pivotal response training, facilitated communica-
tion, secretin treatments, functional communication training,
gluten-free diet) and select a little of this or a little of that(p.
201).
The available empirical evidence indicates that such eclec-
tic treatment packages result in limited treatment gains (see
Eikeseth et al., 2002;Howardetal.,2005; and Howard et al.,
2014, for more details). Although some component interven-
tions may be evidence based, the eclectic mix alone is not
supported by scientific research (Dillenburger, 2011;
McMahon & Cullinan, 2016). Despite these findings, eclecti-
cism continues to be sought out by consumers and sanctioned
by practitioners (Howard et al., 2005; McMahon & Cullinan,
2016). Its favor seems to rest on the idea that an eclectic
package provides access to a wider array of interventions
and the unique benefits each has to offer (Dillenburger,
2011). However, eclecticism shares characteristics of pseudo-
science whereby treatments are erroneously deemed scientific,
give false hope, and therefore maintain their popularity
(Dillenburger, 2011).
We believe that the term multidisciplinary,which, by
definition, describes autonomous professionals providing care
with little to no collaboration, may glamorize and disguise
eclecticism. As such, multidisciplinary practice without effec-
tive collaboration may be a dangerous approach to the treat-
ment of ASD by fostering more independently delivered
eclectic treatments. The resulting mix of eclectic interven-
tions, which are ineffective and consume more time and fi-
nancial resources, may lead to conflict among team members
(Dillenburger et al., 2014;Howardetal.,2005).
Education in Collaboration
Although more integrated care is regarded as an important
component of practice in applied behavior analysis (ABA),
the degree to which behavioral professionals are trained in
collaboration is limited (Kelly & Tincani, 2013). Kelly and
Tincani (2013) surveyed over 300 behavioral professionals,
95% of whom reported working with individuals with ASD,
and found that 67% had not taken any collaboration courses at
the university level, and 45% had not participated in
professional development activities that addressed collabora-
tive practice.
Without education or training in collaborative practice, in-
terprofessional collaboration may present challenges. The oc-
cupational differences across team members may hinder col-
laboration and result in discipline silos where professionals
operate independently and autonomously (Hall, 2005;
Strunk et al., 2017). According to Hall (2005), these disci-
pline silos commence early in the development of the pro-
fessional. Typically, at the university, multiple areas of
specialization operate in isolation, and the aspiring profes-
sional is engrossed in the knowledge and culture of their
respective discipline and distinguished by a unique identi-
ty and value system. Interprofessional collaboration is
rarely observed in academia, and interactions among stu-
dents of differing professions are not necessarily encour-
aged or facilitated. The culmination of these social and
educational experiences establishes a distinct professional
worldview (see Garman et al., 2006).
Once the student has completed the requisite education
and training, demonstrated the necessary knowledge and
skills, and adopted the values specific to the discipline,
they may assume the long-awaited occupational identity
(Hall, 2005). New professionals embrace and uphold their
identity and continue to align with the profession. Loseke
and Cahill (1986) described how this discipline persona is
significant to the professional and their practice. They
read the professional journals associated with their chosen
field, attend professional conferences in this same field,
and become members of professional organizations in
their discipline. Although all of this is important to their
continued professional development and to solidifying
their identities as practicing professionals, it also limits
their exposure to the contributions and advances in other
disciplines. It continues the silo approach that defines the
higher education experience and makes the professional
development journey an extension of this discipline-
specific perspective. Thus, in interprofessional collabora-
tion, team members often exude a distinct professional
image epitomized by their discipline-specific worldview;
this both defines and preserves the scope of their profes-
sional authority and, combined with the lack of collabo-
rative education, may catalyze the division and conflict
that are common to interprofessional teams (DAmour
et al., 2005; Suter et al., 2009).
Conflict
Throughout their education and training, collaborating
professionals have been taught to function as autonomous
Behav Analysis Practice
and separate professionals, bearing their own language
and practices (Coben et al., 1997). The vocabulary of
the professional is used to represent their knowledge, ex-
pertise, and value (Lawson, 2004); however, it can bran-
dish the worldview and validate the occupational image.
Thus, mastery of the language of the discipline affords
entry into the guild and is often a source of pride. It can
be difficult to then move back to a lay translation, and it
may be associated with the fear of seeming weaker or less
skilled within the profession. Jargon may be used to en-
sure precision and to convey expertise. In the discipline
silo, it is expected and encouraged, but in interprofession-
al collaboration, it often becomes a barrier (Hall, 2005;
Suter et al., 2009). The use of discipline-specific jargon
highlights differences across disciplines, makes communi-
cation challenging, and might make some professionals
feel marginalized in treatment conversations. LaFrance
et al. (2019) cautioned behavior analysts specifically
against the use of terminology that may hinder collabora-
tive interactions, yet such challenges exist for all members
of the interprofessional team.
Furthermore, treatment team professionals may have op-
posing core values, fundamental goals, and approaches, espe-
cially in the selection of treatments and in the evaluation of
success (Cascio et al., 2016). Therefore, conflict seems likely
inevitable in interprofessional collaboration, and the coveted
harmony of integrated care is not so easily achieved (Brown
et al., 2011; LaFrance et al., 2019). When conflict arises, it
hinders cohesive collaborative practices by impeding the treat-
ment teams ability to provide efficient, quality treatment and
thwarts effective client care (Brown et al., 2011; LaFrance
et al., 2019).
Role Boundary Issues
Effective collaboration requires that professionals involved in
the coordinated treatment of an individual with ASD under-
stand, recognize, and appreciate the contributions made by
other collaborating professionals (LaFrance et al., 2019).
However, the unique roles of collaborators within the treat-
ment team are rarely addressed, and disconnect between par-
ticipating professionals is frequently observed (Brown et al.,
2011;Kvarnström,2008).
Strong identities and professional cultures can create
role boundary conflicts, which form additional barriers
to collaboration (Kvarnström, 2008; Suter et al., 2009).
Role boundary issues refer to a poor understanding of
each team members role and the value of unique contri-
butions (Brown et al., 2011;Hall,2005; Kvarnström,
2008 ;Strunketal.,2017). When the unique knowledge
base of each profession is not fully understood, individual
members may be deprived of the opportunity to contribute
their expertise, or the contributions they make may be
devalued or even neglected (Hall, 2005;Kvarnström,
2008). Individual team members may have overlapping
practice purviews, or share specific areas of expertise,
which complicates role boundaries, makes it difficult to
understand the responsibilities of each professional, and is
therefore one of the most common sources of interprofes-
sional conflict (Brown et al., 2011; Kvarnström, 2008;
Strunk et al., 2017).
These overlapping practice areas may result in role
blurring, wherein professional boundaries are less distinct
(Hall, 2005; Sims et al., 2015; Suter et al., 2009). Some
authors have noted that ambiguity in professional roles
may pose a high risk for conflict and further division
among interprofessional teams, as it may cause workload
imbalances, confusion surrounding individual responsibil-
ities, and professional burnout (Folkman et al., 2019;
Hall, 2005; Suter et al., 2009). Contrarily, other authors
have identified role blurring as a beneficial and important
characteristic of interprofessional collaboration, as it dis-
solves discipline boundaries, expands professional knowl-
edge and expertise, allows team members to adapt to
changing circumstances and needs, and enhances overall
client care (Bennett et al., 2016;Simsetal.,2015). Role
blurring is a necessary component of transdisciplinary
collaboration (DAmour et al., 2005). The transdisciplin-
ary team intentionally dissolves professional boundaries,
and its members reciprocate exchanges of knowledge and
competency to achieve fully integrated care for enhanced
client outcomes (DAmour et al., 2005; Kvarnström,
2008;LaFranceetal.,2019).
Communication Failures
Problems related to role boundaries may be further complicat-
ed by issues in communication, particularly when team mem-
bers fail to convey their position or expertise and delegate
responsibilities accordingly (Suter et al., 2009). For example,
Koenig and Gerenser (2006) described the confusion that fam-
ilies experience when professionals from their childstreat-
ment team (e.g., SLP, BCBA) provide conflicting recommen-
dations. This can lead to the belief that professionals are not in
agreement on practices for best treatment, and may result in
distrust from those receiving interprofessional care. As world-
views clash and other disagreements arise, team members
must exercise skillful communication practices to quickly
and effectively resolve dissonance and present a cohesive
Behav Analysis Practice
and unified team to clients and their families (Brown et al.,
2011;Cox,2019; Suter et al., 2009).
Communication among interprofessional team members is
necessary to share knowledge, exchange ideas, and coordinate
effective care for clients. Failure to do so often results in pro-
fessionals retreating to their discipline silos (Hall, 2005;
Strunk et al., 2017; Suter et al., 2009). Discipline-specific
treatments are not delivered in a vacuum but are interdepen-
dent on one another for optimal success, and this requires
ongoing and effective communication among practitioners
(Cox, 2019).
Although communication challenges can impede effective
collaborative practices, more alarmingly they have been
linked to patient harm . Suter et al. (2009)reportedinforma-
tion from several sources stressing the potentially disastrous
consequences of poor collaboration. The Canadian Medical
Protective Association found patient safety was jeopardized
by team discord and poor communication. The Joint
Commission on Accreditation of Healthcare Organizations
reported that 65% of events resulting in patient death, perma-
nent harm, severe temporary harm, or intervention required to
sustain life were caused by failures in communication (The
Joint Commission, 2017). Additionally, when poor commu-
nication practices inhibited the sharing of information, quality
of care was diminished and patient outcomes were adversely
affected (Suter et al., 2009). Although these reports are not
specific to individuals with ASD, they illustrate the critical
need for effective and efficient communication and the grave
impact of conflict in collaboration.
Organizational Constraints
Interprofessional collaboration is often further hindered, or in
some cases prevented, by the surrounding organization
(Kvarnström, 2008;Strunketal.,2017). In its authority, the
organization may make changes to the interprofessional team
by replacing or altering the number of team members, increas-
ing client caseloads, modifying work schedules, or providing
inadequate environmental conditions (Brown et al., 2011;
Kvarnström, 2008). The team may then lack the appropriate
professionals essential to effective client care and be deprived
of the time needed for efficient communication and prompt
conflict resolution (Brown et al., 2011;Kvarnström,2008).
These organizational constraints have the potential to invoke
feelings of inadequacy, impede synergy, and obstruct quality
client care. In many cases though, team members are practic-
ing under separate organizations, and additional challenges
concerning the lack of a shared organization hinder the teams
ability to collaborate completely.
Standards for the Transdisciplinary
Collaboration of Professionals Treating
Individuals With ASD
Given the plethora of existing barriers to effective inte-
grated care and the limited training and education in col-
laborative practices, it is apparent that standards promot-
ing a transdisciplinary model in the treatment of individ-
uals with ASD may be beneficial. Many professionals
recognize the potential advantages of interprofessional
collaboration but are challenged with developing a cohe-
sive approach. The standards provided in what follows are
meant to help navigate the pitfalls observed in collabora-
tive practice and ensure that the many benefits of trans-
disciplinary collaboration are realized. As DAmour et al.
(2005) noted, it is unrealistic to think that simply
bringing professionals together in teams will lead to
collaboration(p. 126). For this reason, the purpose of
the proposed standards is to provide a set of guidelines
for collaborative practice that promote appreciation of
each disciplines education and expertise and function
to facilitate problem solving. The Appendix displays a
self-assessment checklist that can be used by collaborat-
ing professionals to determine whether the proposed
standards are being adequately upheld.
Preamble
These standards are intended to serve as a template
for collaboration teams. Items should be added, omit-
ted, extended, and modified in a manner that best
serves the needs of the treatment team and facilitates
effective collaborative practices. The contents are as
follows:
1. Collaborative communication
1A.Open communication
1B.Sharing information
1C.Ongoing communication
1D.Active communication
1E.Informal communication
1F.Mutually understood language
2. Distinguished roles in collaboration
2A.Case coordinator
2B.Role delineation
2C.Respect of unique knowledge
3. Role of organization
3A.Necessary means
3B.Internal equality
3C.Professional environment
Behav Analysis Practice
4. Client care
4A.Visible team care
4B.Client-centered care
4C.Social validity
5. Conflict resolution
5A.Timely resolution
5B.Bringing attention to conflict
5C.Perspectives within conflict
5D.Resolution protocols
5E.Involving clients
6. Joint partnerships
6A.Professional flexibility
6B.Interdependent practice
6C.Collective ownership
7. Evidence-based practice
7A.Treatment recommendations
7B.Comprehensive approach
7C.Reliance on data
8. Collaborative culture
8A.Collaborative education and training
8B.Ethics
8C.Self-assessment
8D.Unity of purpose
Expanded Standards
1. Collaborative communication
All team members should prioritize communication by en-
suring it is open, frequent, and thorough, recalling that serious
consequences of communication failures include client harm
and interprofessional conflict. Should this standard be
breached, the treatment team should have a discussion over
the breaching, and aim to collaboratively develop a solution
for the future.
1A. Open communication
i. Individual members must openly and respectfully com-
municate, with confidence and ease, expressing any
thoughts or opinions spanning any relevant topic area
(Coben et al., 1997). The team must encourage ex-
changes by actively listening. That is, team members
must provide their full attention, refrain from
interrupting, demonstrate understanding of their col-
leagues perspective, and offer full consideration and ap-
preciation of the contributions.
1B. Sharing information
ii. Each team member must be committed to effectively and
deliberately sharing information, skills, expertise, ideas,
responsibilities, and resources to integrate the contribu-
tions of all team members and provide the most effective
client care (Bronstein, 2003;DAmour et al., 2005;Hall,
2005;Lawson,2004).
iii. All team members, as well as clients and their families,
must be actively involved in the planning and develop-
ment of therapeutic goals. Team members must commu-
nicate deficits identified in their assessments, propose ef-
fective treatment options, and collectively design realistic,
measurable goals that honor the clients objectives and the
teams mission and shared vision (Bronstein, 2003).
iv. Any intervention changes must be promptly communi-
cated to all members of the collaboration team
(Newhouse-Oisten et al., 2017).
v. The reporting team member should describe any new
intervention that is under consideration by stating the
objectives or purpose of the intervention and indicating
the extent of supporting scientific evidence (Newhouse-
Oisten et al., 2017). Resources on the intervention
should be shared with all team members.
vi. Information regarding client progress or relative set-
ting events must be documented and communicated
to all team members. Data should be reported in a
central database, accessible to all members, and col-
lectively analyzed and interpreted (Newhouse-Oisten
et al., 2017).
1C. Ongoing communication
vii. The collaboration team should establish opportunities
for ongoing communication (Cox, 2019; Newhouse-
Oisten et al., 2017). They should
a. hold regularly scheduled meetings for all team mem-
bers to occur no less than monthly (Newhouse-Oisten
et al., 2017) and ensure that consistent scheduling is
maintained to enable the participation of all members.
b. schedule additional meetings as needed for select
members according to client care needs. Meetings
being held between select members should always
include an invitation to all members of the team, even
if their presence is not necessary.
c. create an email group for regular and frequent ex-
changes regarding client updates, intervention chang-
es,progress,andsoon(Newhouse-Oistenetal.,
2017).
Behav Analysis Practice
d. consider the development of an ongoing repository of
all treatment information, including summaries of in-
terprofessional meetings.
1D. Active communication
viii. Communication should take place within the context of
direct clinical work, such as cotreating sessions and
joint assessments with members from two or more dis-
ciplines (LaFrance et al., 2019).
ix. Team members should participate in team rounds regu-
larly to discuss client progress and concerns and effec-
tively coordinate client care (Suter et al., 2009).
1E. Informal communication
x. The collaboration team should provide opportunities for
informal exchanges of knowledge and information
(LaFrance et al., 2019). They should
a. hold in-service presentations and discussions hosted
by each team member, on a rotating basis,
representing the science of each discipline.
b. schedule lunch meetings to encourage friendly inter-
actions among members and allow the team to infor-
mally review and evaluate the successes and failures
of collaboration (LaFrance et al., 2019).
c. review journal articles selected by each team member,
on a rotating basis, reviewing research from their re-
spective field and allow for open discussion
(LaFrance et al., 2019).
1F. Mutually understood language
xi. Professionals will use language that is mutually under-
stood by all members of the treatment team and avoid the
use of discipline-specific jargon (Boger et al., 2017; Cox,
2019;LaFranceetal.,2019).
xii. Professionals will freely provide supplementary expla-
nations when language is not understood by other col-
laborating professionals and will assess for mutual un-
derstanding throughout communication.
2. Distinguished roles in collaboration
Team members should convey their clinical competencies
and share their unique perspectives with team members. The
discipline-specific skill sets and competence of team members
are clearly outlined and respected, while input is considered
from all team members. Should this standard be breached, the
treatment team should have a discussion over the breaching by
reviewing assigned roles. Moreover, the treatment team
should aim to collaboratively develop a solution for the future
by adjusting each members role as needed.
2A. Case coordinator
i. A role of case coordinator should be assigned to a separate
member of the team for each case. The case coordinator
will oversee the treatment plan, facilitate team rounds, co-
ordinate communication among members, and aid conflict
resolution when needed. The role of case coordinator may
be assigned according to expertise, the clientscoredeficit
areas, and so on as deemed appropriate (Coben et al.,
1997).
2B. Role delineation
ii. Team members must actively participate in decisions
regarding role delineation on each case by conveying
their scope of competence and how it may contribute
to the team and the care of each individual client
(Suter et al., 2009). For example, individual team
members may have discipline-specific competencies
that cannot ethically (or legally) be imparted to other
individual team members. Thus, role delineation is
not intended to be divisive, but rather ensure profes-
sionals practice within their scope of competence
while feedback and input from other team members
remain valuable.
iii. The delineation of each members case-specific role
should be described within the treatment plan or a sepa-
rate document if necessary and signed by each member
of the treatment team in agreement.
2C. Respect of unique knowledge
iv. Professionals should avoid competitive pride and am-
bition and should be understanding of and interested
in the value of other professionalsunique knowledge
within the collaborative team (Cox, 2012). In other
words, collaborating professionals should engage in
behavior that is indicative of their respect for the
other team membersunique knowledge, such as lis-
tening to suggestions and recommendations, being
receptive to feedback, and asking for clarification
when needed with the ultimate goal of synthesizing
varying perspectives into a collective approach.
Behav Analysis Practice
3. Role of the organization
An organization should provide the needed support in
collaborative practice and integrated care. Team members
should share resources and benefits provided by the orga-
nization and rely on the organization for training, media-
tion, and protection. Should treatment team professionals
not belong to a shared organization, this standard should
be individualized to each professionalsrespective
organization.
3A. Necessary means
i. The organization should support the team by providing
the necessary means for ongoing and effective collab-
orative practices (Suter et al., 2009). This may include
a. staffing appropriate service providers.
b. permitting conjoint treatment sessions.
c. allowing time for meetings and interactions for all
disciplines.
d. providing physical space for collaboration.
e. assigning an administrator to assist with clerical
tasks and other logistical needs.
f. assisting with timely conflict resolution when
needed.
g. offering professional development courses in inter-
professional education.
h. including collaboration in the mission of treatment,
in initial training, and in ongoing professional
development.
i. encouraging research across disciplines, with each
discipline controlling certain elements of the study
as appropriate.
j. encouraging clinical protocol development across
disciplines, to address commonly encountered, com-
plex problems in systematic and evidence-based
ways.
k. holding clinical rounds in which disciplines report
on goals and progress.
l. rotating journal clubs by discipline so that all mem-
bers of the team are exposed to state-of-the-art
knowledge across disciplines.
m. holding professional development events for all
staff with speakers from different disciplines.
3B. Internal equality
ii. When possible, the organization will ensure that no mem-
ber of the team holds a direct supervisory position over
other members of the team and that all members assume
equal positions within the company. Such equality will
prevent multiple relationships on the interprofessional
team that may inhibit open communication, shared re-
sponsibilities, and the actions of the case coordinator. If
necessary, a within-discipline supervisor for each team
member may be assigned to assist and serve as a resource
in any cross-disciplinary issues.
3C. Professional environment
iii. The organization will foster an environment of profes-
sional equality where all disciplines and professionals
will be equally valued. The organization must be mindful
of ways that value may be measured and perceived by
team members (e.g., wages, duties, opportunities, and
attention) and work to ensure all professionals are
respected and appreciated.
4. Client care
The treatment team will prioritize client safety and access
to effective, integrated care while encouraging and honoring
client feedback. Should this standard be breached, the overall
welfare of the client should be immediately assessed. If the
breaching of this standard is found to impact the overall wel-
fare of the client, or cause the client harm in any way, the
intervention or professional known to be harmful should be
immediately removed, and the team should work to ensure the
client is kept safe.
4A. Visible team care
i. The team will provide visible team care(DAmour et al.,
2005). In other words, recipients of services will be aware
of the collaborative efforts taking place behind the
scenes.Collaborative practices will be fully transparent
to promote client awareness of cohesive, integrated care.
To do this, the parents/legal guardians of clients, or the
clients themselves if of age, should be invited to team
meetings, updated on collaborative discussions frequently,
and involved in reviewing treatment plans and progress
with multiple team members.
4B. Client-centered care
Behav Analysis Practice
ii. The team will practice client-centered care by respecting
the clients values, preferences, and needs, as well as in-
volving the client and family in shared decision making
(Barry & Edgman-Levitan, 2012; Bronstein, 2003;
Garman et al., 2006).
iii. The overarching goal of the treatment team should be to
ensure that direct recipients of services access the most
effective treatments with minimal risk of harm. The treat-
ment team should protect the client from any danger and
advocate on behalf of the client for effective treatment
and adequate care.
4C. Social validity
iv. Social validity measures should be collectively de-
signed by the collaborative team in accordance with
the teams mission and vision. More specifically,
social validity measures should be collected on the
clients experience receiving collaborative care, as
well as on the collaborative teams experience de-
livering collaborative care. As social validity mea-
sures are obtained for each client, the results should
be reviewed and openly discussed during team
meetings. Modifications to current collaborative
practices should be made when necessary to ensure
social validity.
5. Conflict resolution
Any arising conflict should not impede the delivery of
effective and efficient treatment. Collaborating profes-
sionals should avoid conflict by engaging in effective
collaborative practices and exhibit professionalism in
times of disagreement. Should this standard be breached,
team members should problem solve quickly to develop
a solution that is in the best interest of the client.
Specifically, the assigned case coordinator should ar-
range for a team meeting wherein the conflict solutions
are proposed.
5A. Timely resolution
i. Conflict must be recognized and addressed promptly. Due
to its grave consequences, conflict cannot be avoided or
ignored.
5B. Bringing attention to conflict
ii. Those who are aware of conflict must bring it to the at-
tention of the team. Parties involved must skillfully nego-
tiate their differences under the leadership of the case
coordinator (Brown et al., 2011; Suter et al., 2009).
5C. Perspectives within conflict
iii. The team must openly and humbly discuss conflict, ac-
knowledge the perspectives of all members, and cooper-
atively identify solutions (Brown et al., 2011; Coben
et al., 1997).
5D. Resolution protocols
iv. The team should develop and use conflict resolution pro-
tocols based on common sources of conflict. For exam-
ple, decision-making models such as those provided by
Brodhead (2015)andNewhouse-Oistenetal.(2017)may
be useful in assessing conflicting intervention proposals.
5E. Involving clients
v. Clients should not be involved in conflict resolution. The
team is expected to maintain a unified appearance
throughout client interactions. If a clients perspective is
needed to appropriately resolve conflict (e.g., opposing
treatment recommendations), this should be done in the
most professional manner and only after all team members
have consented.
6. Joint partnerships
Treatment team members should develop joint part-
nerships by engaging in close interactions, accepting
shared responsibilities, and exhibiting trust and respect
for all members of the team, their role, science, and
discipline (DAmour et al., 2005). All team members
should value othersunique knowledge base and en-
courage creativity. The treatment team should provide
a work environment that promotes unity and fosters a
culture of respect and ethical practice. Should this stan-
dard be breached, team members should have a discus-
sion regarding the importance of joint partnerships with-
in collaboration and work cooperatively to develop a
plan that will encourage unity within the treatment
team.
6A. Professional flexibility
Behav Analysis Practice
i. Professionals will demonstrate flexibility by obscuring the
traditional role boundaries that typically exist between
disciplines.
ii. Members should extend their role by increasing their
knowledge and skills within their respective fields, ex-
pand their role by learning from the other disciplines,
and release their role by sharing their own expertise with
other members (Thylefors et al., 2005).
iii. Professionals should engage in close interactions and ac-
cept joint responsibilities (DAmour et al., 2005).
Members should adapt under fluctuating conditions and
the needs of interprofessional treatment by
complementing other team members and adjusting to
their strengths and weaknesses (Bronstein, 2003;
Thyleforsetal.,2005).
6B. Interdependent practice
iv. Members should abandon philosophies of autonomy
and demonstrate a mutual dependence on one anoth-
er to promote cooperative interactions and maximize
client outcomes (Bronstein, 2003;Cox,2019;
DAmour et al., 2005; Thylefors et al., 2005).
Effective client care is obtained through collabora-
tive practice when members rely on one another to
fulfill their role and complete professional tasks
(Bronstein, 2003;DAmour et al., 2005; Thylefors
et al., 2005).
v. All team members should practice within their boundaries
of competence and be transparent and honest when inter-
ventions or proposed treatments appear to be outside of
ones scope of competence.
vi. Members should be confident in their own role and the
value they bring to the team and understand the role of
other members and the benefit of their contributions
(Bronstein, 2003).
6C. Collective ownership
vii. The team must assume collective ownership of all struc-
tures, programs, plans, tasks, goals, interventions, data,
and overall client care (Bronstein, 2003;DAmour et al.,
2005). The decision making, problem solving, conflict
resolution, accountability, philosophies, and values must
be shared by all team members and require a joint un-
dertaking as part of the collaborative process (DAmour
et al., 2005).
7. Evidence-based practice
The team should be firmly committed to evidence-based
practices and should openly renounce pseudoscience and re-
ject those interventions that have proven to be harmful or
ineffective. Should this standard be breached, or should a
breach be suspected, the case coordinator should promptly
schedule a meeting for team members to discuss existing lit-
erature on the proposed intervention and consider client values
and context.
7A. Treatment recommendations
i. Individual team members must recommend treatments
that (a) do not put the client in any danger and will not
cause harm; (b) are empirically supported, financially
reasonable, and easy to access; and (c) are effective,
plausible, and feasible to adhere to. Should team mem-
bers recommend treatments that do not meet the afore-
mentioned criteria, a team meeting should be held
wherein collaborative members review the interven-
tion according to the specified criteria (see Brodhead,
2015). Ideally, members should unanimously consent
to the recommendation. If members disagree, the rea-
sons for rejection should be openly discussed. A time-
limited pilot test of the intervention may be imple-
mented, and continuation may be determined follow-
ing thorough data analysis.
7B. Comprehensive approach
ii. Evidence-based practice will include using evidence pro-
vided by high-quality research, the professional expertise
provided by the team members, and the values, needs, and
preferences of the client (DiGennaro Reed et al., 2018).
iii. Although individual disciplines may adhere to differing
levels of scientific evidence, the team as a whole must
subscribe to standards of evidence that will be used to
evaluate research studies.
a. Research criteria for established interventions should
include a thorough description of the treatment
methods, a profile for each participant, and two ran-
domized control trials or nine single-case research
designs conducted across two or more research teams
(DiGennaro Reed et al., 2018).
b. The team should use resources such as systematic
reviews and meta-analyses to review the available
evidence on specific interventions. Otherpublications
such as the National Standards Project by the
Behav Analysis Practice
National Autism Center at May Institute and the
Evidence Maps produced by the American Speech-
Language-Hearing Association have assembled sci-
entific data on various interventions and are intended
to guide decisions for effective treatment.
iv. If an intervention with minimal empirical support has
been identified as potentially beneficial, the team should
become familiar with the treatment by consulting any
corresponding position statements, reviewing available
research, or discussing with team members and other
experts (Brodhead, 2015). If evidence of harm is found,
the intervention should not be used (Brodhead, 2015). If
the treatment does not pose a risk to the clientssafety,
the efficacy of the intervention may be evaluated through
a single-subject research design within the context of
treatment, wherein procedural and fidelity measures are
operationally defined. The team should discuss the risks
and potential benefits with the client, gather informed
consent, implement appropriate data collection methods,
and make treatment decisions following a thorough anal-
ysis of the data.
7C. Reliance on data
v. As scientists, team members should always yield to
the data. Data should be collected on all interventions
by the appropriate members of the team. Data should
be analyzed frequently to assess client performance,
and modifications to treatment programming should
be made accordingly.
Collaborative Culture
The collaborative culture is created through the open commu-
nication, joint partnerships, and interdependent practice of the
team members. It is rooted in a shared ethical code (Cox,
2012) and nurtured through frequent evaluation of integrated
care and continuous education in collaborative practice. At the
heart of the collaborative culture is the teams unity of pur-
pose, which explains the goals of the team and the reason for
their existence (Lawson, 2004).
8A. Collaborative education and training
i. The team should collectively engage in professional de-
velopment devoted to client-centered care and interpro-
fessional collaboration.
ii. Members should read published articles in journals asso-
ciated with the profession of other team members (e.g.,
speech-language pathology, ABA, medicine; Koenig &
Gerenser, 2006).
iii. Team members may attend professional conferences
from other disciplines and encourage transdisciplinary
presentations at such conferences.
8B. Ethics
iv. Each member should publicly share their code of ethics,
and all codes should be cross-referenced for commonal-
ities and differences (see Cox, 2012). Although many
codes will coincide, the differences will be noted, and
the team should adopt and adhere to the most stringent
codes to preserve unity within the team.
v. Quarterly ethics-related professional development
events should be used to increase understanding and
facilitate discussion among team members.
8C. Self-assessment
vi. Team members must assess their individual collabo-
ration competency, accept feedback from clients and
other team members, and use the information to im-
prove their collaborative interactions and practices.
To maintain the highest standards of practice, the
team should conduct self-assessments of collabora-
tion (see the Appendix).
vii. The team will review client outcomes and social validity
measures. If the results are not positive, the team must look
to the collaborative processes (Kelly & Tincani, 2013).
viii. Teams will also assess the degree of their collaborative
practices and determine where they fall on the spectrum
of interprofessional collaboration (Figure 1).
ix. Teams should use additional assessment items, such as
conflict resolution protocols and formal interprofessional
rating scales, or a custom scale may be developed accord-
ing to the standards for transdisciplinary collaboration.
8D. Unity of purpose
x. The unity of purpose is a common purpose, shared
by all team members, that cannot be successfully
accomplished without true interdependence
(Lawson, 2004). The unity of purpose should be at
thecoreoftheteams function and may be illustrat-
ed in a mission statement: Themissionofthetrans-
disciplinary team is to produce measurable gains
and maximize outcomes for individuals with ASD
by combining and capitalizing on the expertise of
multiple disciplines. To that end, we commit to func-
tion as a cohesive and collaborative unit, accentuat-
ing the strengths of our members, and sharing evi-
dence from our respective sciences to provide supe-
rior integrated care.
Behav Analysis Practice
Discussion
Although the proposed standards may promote more effective
and efficient collaboration, there are potential limitations to
the total use of them. First, the recommendations provided
for the breaching of specific standards are brief. Additional
recommendations regarding the most effective problem-
solving strategies to be used in the event of breaching are
needed and would be a valuable contribution. Second, adher-
ence to the standards overall, especially pertaining to the role
of the organization, may prove challenging, as treatment team
members are frequently employed by separate and indepen-
dent organizations. Thus, we recommend that interprofession-
al team members operate under a single organization wherein
that organization values the collaborative efforts of the treat-
ment team and provides additional support in achieving opti-
mal integrated care. In this context, the use of the standards is
likely to be morefeasible. We challenge large organizations to
consider the benefits of employing professionals from varying
fields (e.g., medicine, psychology, speech, ABA) and facili-
tate a transdisciplinary approach.
Third, some of the proposed standards require that treatment
team members spend additional time and effort to make collab-
oration successful. Therefore, it is important to identify ways in
which professionals can be best motivated to achieve successful
collaboration using the proposed standards. Moreover, collab-
oration is not universally taught to students of human service
disciplines (see Kelly & Tincani, 2013); hence, many enter the
workforce ill equipped to effectively engage in interprofession-
al collaboration. Within behavior analysis, students are largely
trained to value and exude the worldview of radical behavior-
ism. At times, the adherence to this worldview may appear (to
members of other professions) to diminish the contributions of
other perspectives. Given this lack of training in collaboration at
the education level, it is important to identify ways to develop
repertoires that would increase the probability that team mem-
bers will adopt the proposed standards.
In addition, the skills embedded in these standards are com-
plex and need to be systematically defined and taught. It is our
hope that discussing this as a goal across professions will lead
to progress in the definition, refinement, and instruction of
these skills. Within behavior analysis, attempts should be
made to operationally define and measure these skills, use
behavioral skills training or the teaching interaction procedure
to teach practitioners these skills, and develop rubrics to assess
the demonstration of these skills.Including collaborative com-
petencies in the scope of training for behavior analysts would
help ensure that new practitioners are familiar with and can
demonstrate the essential component skills. Expanding the
focus of training and supervision to include interprofessional
collaboration would ensure that students and trainees in be-
havior analysis are coached in this crucial area well before
they are expected to perform in transdisciplinary contexts.
Indeed, other soft skills have recently been highlighted as
relevant and essential for behavior analysts (e.g.,
compassionate care skills and cultural humility; Taylor et al.,
2018;Wright,2019). Finally, we recognize that these stan-
dards for effective collaboration may present as somewhat
idealistic, but the hope is that they offer organizations and
professionals a basis for developing cooperative partnerships
that promote superior care and access to empirically supported
interventions for individuals with ASD.
Conclusion
The prevalence rate of individuals diagnosed with ASD has
been steadily increasing over the last 20 years, and at the time
of this writing is currently 1 in 59(Centers for Disease Control
and Prevention, n.d.). Therefore, the need for effective and
efficient interprofessional collaboration is greater than ever
and is gaining attention within the field of behavior analysis
on both individual and organizational levels. For example, the
Professional and Ethical Compliance Code for Behavior
Analysts enjoins cooperative interprofessional practice to ap-
propriately serve clients (Behavior Analyst Certification
Board, 2014, Section 2.03). The Behavioral Health Center
of Excellence encourages interprofessional collaboration
within their standards for accreditation as a high-quality, eth-
ical, and efficacious applied behavior-analytic organization
(Behavioral Health Center of Excellence, 2019). We contend
that a transdisciplinary approach to collaboration affords treat-
ment team members the opportunity to work together in cre-
ating the most meaningful change and greatest possible im-
pact. The purpose of this article was to describe the current
need for effective interprofessional collaboration and provide
clear criteria that promote transdisciplinary care in the service
provision for individuals with ASD. Other needed outcomes
may be supported by the standards. For example, the impact
of transdisciplinary practice on treatment gains could be ex-
plored in empirical research. Additionally, future research
should investigate the components of the proposed standards
and the effects of modifying the standards on the overall col-
laborative experience and client outcomes. The proposed stan-
dards for transdisciplinary treatment could also help in the
creation of training modules in this important area, especially
in the context of both academic course content and in the
provision of supervised experience.
Behav Analysis Practice
Appendix
Standards Adherence Self-Assessment Checklist
Assessing the Collaboration of Treatment Team Professionals in the Treatment of Individuals
with ASD
A checklist for collaborating professionals to determine if transdisciplinary practice is being used to maximize the delivery of
effective and efficient treatment.
The purpose of this self-assessment is to provide an evaluation of transdisciplinary collaboration by
indicating the treatment team’s adherence to the standards using a Likert scale. This checklist is to be
completed by the treatment team during a team meeting.
1 (never) 2 (rarely) 3 (sometimes) 4 (often) 5 (always)
Collaborative Communication
Thoughts or opinions are openly expressed and received by treatment-team
members.
12345
Assessment results are shared by team members and interventions are
collectively designed
12345
Data and assessments are accessible to all team members. 12345
Monthly meetings take place wherein all team members are present. 12345
Literature across disciplines is shared and reviewed by team members regularly. 12345
The language used by team members is mutually understood, and any
language that is not understood is made clear through explanation.
12345
Cotreatment and joint assessments occur. 12345
Score
Distinguished Roles in Collaboration
A case coordinator is assigned for each case. 12345
Each team members’ role, specific practice area, and contribution is clearly
delineated.
12345
Each team members scope of competence is clearly understood. 12345
Respect of each members unique knowledge and contribution is demonstrated. 12345
Behav Analysis Practice
Score
Role of the
Organization
All members of the treatment team hold equal positions, and no member
holds a direct supervisory position over other members
1
2
3
4
5
All disciplines and professions are equally valued.
1
2
3
4
5
Score
Client Care
Visible team care is provided wherein recipients of services are aware of
the team’s collaborative efforts.
1
2
3
4
5
The client’s values, preferences, and needs are considered by all team members.
1
2
3
4
5
Social validity measures are collectively designed in accordance with the
team’s mission and vision.
1
2
3
4
5
Social validity measures are obtained for each client.
1
2
3
4
5
Score
Conflict Resolution
Conflict is addressed promptly by being brought to the attention of the team
for resolution.
1
2
3
4
5
The perspectives of all treatment-team members are considered when
problem solving through conflict.
1
2
3
4
5
Score
Joint Partnerships
Team members obscure discipline-specific role boundaries and
exhibit mutual dependence.
1
2
3
4
5
Team members practice within their boundaries of competence.
1
2
3
4
5
The team assumes collective ownership of programs, data, and overall client
care.
1
2
3
4
5
Behav Analysis Practice
Score
Evidence-Based
Practice
Team members are firmly committed to evidence-based practice. 12345
Team members’ recommendations are effective, reasonable, and feasible. 12345
Resources that have reviewed the scientific data on various treatments for
ASD are used in decision making regarding courses of action in treatment.
12345
Data are collected on all interventions. 12345
Score
Collaborative Culture
Team members participate in continuing education events devoted to
interprofessional collaboration.
12345
Each collaborating discipline’s code of ethics is shared with the other team
members and the most stringent codes are adopted by the team.
12345
Team members assess their individual collaboration competency and are
accepting of feedback from clients and other team members.
12345
A shared unity of purpose exists and is at the core of the team’s function. 12345
Score
Scoring
Add the circled responses for each section to obtain section scores. Below are section scores that
indicate standards have been adequately upheld.
Collaborative Communication –– A score of 28 or more
Distinguished Roles in Collaboration –– A score of 17 or more
Role of the Organization – A score of 8 or more
Client Care –– A score of 18 or more
Conflict Resolution –– A score of 9 or more
Joint Partnerships –– A score of 13 or more
Evidence-Based Practice –– A score of 17 or more
Collaborative Culture –– A score of 15 or more
A cumulative score of 125 or more indicates the collaborative practice aligns with a transdisciplinary
approach.
Cumulative Score
Behav Analysis Practice
Compliance with Ethical Standards
Informed consent Informed consent was not applicable as this review
did not involve human participants.
Conflict of interest The authors declare they have no conflict of interest.
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... Interdisciplinary treatment involves professionals from different disciplines who each maintain their respective disciplinary role, work together to coordinate tasks and care for a client, have frequent communication and collaboration about the treatment plan and progress, and have shared goals and responsibilities (Bowman et al., 2021). Interdisciplinary treatment is often considered valuable for individuals with complex needs, including people with neurodevelopmental disabilities (NDD), although more research in this area is needed (Bowman et al., 2021;LaFrance et al., 2019). ...
... Interdisciplinary treatment involves professionals from different disciplines who each maintain their respective disciplinary role, work together to coordinate tasks and care for a client, have frequent communication and collaboration about the treatment plan and progress, and have shared goals and responsibilities (Bowman et al., 2021). Interdisciplinary treatment is often considered valuable for individuals with complex needs, including people with neurodevelopmental disabilities (NDD), although more research in this area is needed (Bowman et al., 2021;LaFrance et al., 2019). ...
... Therefore, effective pre-service training and increased opportunities for interdisciplinary work is essential to enhance the skillsets of ABA providers (Kirby et al., 2022) and improve the overall interdisciplinary care of individuals with NDD and their families (Hall, 2005). When implemented effectively, interdisciplinary care can improve the family-centered coordinated care that children receive (Rohrer et al., 2021;Suen et al., 2021); however, there are still a multitude of challenges and barriers that hinder the effectiveness of interdisciplinary care including cost of services and billing (Bowman et al., 2021), which are beyond the scope of this paper. ...
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Supporting people with neurodevelopmental disabilities often requires interdisciplinary collaboration and effective partnerships with clients and their families. Behavior analysts receive intensive training and supervision in a variety of domains; however, expanding interdisciplinary training for behavior analysts is needed. Interdisciplinary training programs, such as the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs, offer trainees the opportunity to hone their skills as advocates for people with neurodevelopmental disabilities and collaborators as part of an interdisciplinary team. Historically, many LEND programs have not offered training positions specifically to behavior analysis students or professionals, although some behavior analysts have participated as trainees in other disciplines such as psychology or special education. The benefits, barriers, and possible future directions of interdisciplinary training for behavior analysts within a LEND program are discussed through the experience of the University of Cincinnati LEND Program which added an Applied Behavior Analysis (ABA) training track in 2020.
... In addition to the potential benefits of professional collaboration, Bowman et al. (2021) described several potential challenges, including role boundary issues, communication failures, and organizational constraints. Role boundary issues may arise from the overlapping and sometimes unclear delineation of responsibilities among professionals from different disciplines. ...
... This may be particularly challenging for OT practitioners and behavior analysts, given their broad scopes of practice (Gasiewski et al., 2021). Communication failures, including overuse of discipline-specific jargon and the absence of a common language, can lead to misunderstanding and mistrust among team members (Bowman et al., 2021). OT practitioners and behavior analysts rely upon different theoretical frameworks and terminologies unique to their fields (Gasiewski et al., 2021). ...
... Vol:. (1234567890) (Bowman et al., 2021). There may also be organizational constraints that impede collaboration, such as limited time, funding, and space for collaborative meetings. ...
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Sensory-based interventions are commonly utilized by pediatric occupational therapy practitioners when working with children with disabilities. The purpose of this study was to examine the effects of fixed-time breaks with access to sensory stimuli on behavior that interfered with participation in pediatric occupational therapy sessions. Two boys who were diagnosed with autism spectrum disorder and who were receiving applied behavior analysis services participated in this study. These children had previously been discharged from occupational therapy at another community-based clinic due to their problem behaviors that interfered with their participation in occupational therapy sessions. Three occupational therapy practitioners collaborated with a doctoral-level behavior analyst to design the conditions of the study. At first, the occupational therapy practitioners implemented breaks from task with access to sensory activities contingent upon problem behavior. Then, in a second condition, the practitioners presented breaks from task with access to sensory activities under a yoked fixed-time (FT) schedule. Each condition was repeated. Results showed that for both participants, problem behavior occurred more often when breaks were presented contingent on problem behavior than when breaks were presented under the FT schedule. The results suggest that when breaks with access to sensory activities are used therapeutically, the timing of the breaks could be an important factor. Moreover, these findings were the result of the collaborative efforts between practitioners of occupational therapy and behavior analysis. In this context, we discuss the nature of the collaboration and the respective roles. A framework for future collaborations is also presented.
... Recognising the diverse and multi-faceted presentations of autistic children, the expertise of a range of health professionals is essential (Bowman et al., 2021;Gasiewski et al., 2021). Occupational therapists aim to enhance the occupational performance and participation of autistic children by modifying occupations and environments as well as building skills such as executive functioning and cognition, fine and gross motor coordination, sensory processing, and emotional regulation Key Points for Occupational Therapy • Interprofessional collaboration is valued by occupational therapists supporting autistic children. ...
... Unlike traditional multidisciplinary team approaches that involve professionals working in parallel with less integration of their knowledge and skills, interprofessional collaboration promotes actively participating in the assessment and implementation of services together (Pfeiffer et al., 2019). Effective interprofessional collaboration has been shown to support sustained improvement of lifestyle, academic, and physical and mental health outcomes for autistic individuals while simultaneously benefitting the practitioners who engage in this approach (Bowman et al., 2021;Henderson et al., 2023). ...
... It has been suggested that, most commonly, health professionals work in siloes and that this can create inconsistency between intervention pathways and result in client confusion and poorer outcomes (Strunk et al., 2017). Several challenges have been noted to affect the collaborative process and hinder health professionals' capacity for effective interprofessional collaboration when supporting autistic children (Bowman et al., 2021). For example, workplace policies such as the absence of training in an interprofessional approach to service delivery and workload schedules were found to limit collaboration (Strunk et al., 2017). ...
Article
Introduction Autistic children commonly receive simultaneous services from various health‐care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health‐care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children. Methods This study employed an exploratory qualitative descriptive design. Semi‐structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data. Consumer and Community Consultation This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines. Findings Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that ‘clinicians' capacity to collaborate’ at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that ‘relationships are key to collaboration’ with these often established through shared workplaces or clients. The third, ‘shared perceptions make collaboration easier’ described how shared perceptions of collaboration, the occupational therapy role, and autism‐related frames of reference were perceived to influence interprofessional collaboration. Conclusion Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model. PLAIN LANGUAGE SUMMARY This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.
... offers many benefits such as improved problem solving and has a synergistic effect on the patient. For example, it allows the patient to access more resources and receive quality treatment [31]. Interprofessional care is recommended in Canada [7], as well as in the United Kingdom, the United States, and by the United Nations Convention for the Rights of Persons With Disabilities [31]. ...
... For example, it allows the patient to access more resources and receive quality treatment [31]. Interprofessional care is recommended in Canada [7], as well as in the United Kingdom, the United States, and by the United Nations Convention for the Rights of Persons With Disabilities [31]. Although intersectional collaboration is recommended for optimal care of patients, this practice is not readily available across Canada [7]. ...
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Purpose People with learning disabilities have complex challenges and needs that differ from people without these conditions. Accessing needed health and mental health care may be affected by level of independence and severity of learning challenges. Our study examined factors and associations which impact help seeking and satisfaction with mental health care in a Canadian nationally representative sample. Methods Logistic regression and multinomial logistic regression was used to analyze the 2012 Canadian Community Health Survey- Mental Health (CCHS 2012) cross-sectional survey. We investigated the odds of distressed individuals (1) perceiving a need for mental health care, (2) seeking out professional mental health care, and (3) if their needs were met by mental health services. The presence of a learning disability was assessed as a moderator variable in all models. Results Distressed adults with learning disabilities did not perceive a need for mental health care as often as distressed adults without a learning disability (OR = 3.82;95%CI:1.64,8.93 vs. OR = 12.00;95%CI:9.19,15.67). Distressed adults with a learning disability weren’t as likely to seek out mental health services, but were more satisfied with the mental health care they received as compared to adults without a learning disability. Conclusion The findings suggest that adults with learning disabilities have unmet needs. They are less likely to perceive a need for treatment, or to seek treatment, when they are distressed. Future investigation is necessary to understand the factors that influence perceived need and treatment seeking in this under-served population.
... Multidisciplinary teams can work together to ensure that research practices are ethical and that findings are communicated responsibly to the public. International collaborations can help harmonize regulatory standards and ensure that advances in genetic research benefit individuals with ASD globally [354]. To facilitate these collaborations, funding agencies and research institutions must prioritize and support initiatives that promote teamwork and data sharing [355]. ...
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BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings. Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD, influencing both diagnosis and therapeutic strategies. AIM To explore the genetic architecture of ASD, elucidate mechanistic insights into genetic mutations, and examine gene-environment interactions. METHODS A comprehensive systematic review was conducted, integrating findings from studies on genetic variations, epigenetic mechanisms (such as DNA methylation and histone modifications), and emerging technologies [including Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 and single-cell RNA sequencing]. Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar. RESULTS Genetic studies have identified numerous risk genes and mutations associated with ASD, yet many cases remain unexplained by known factors, suggesting undiscovered genetic components. Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving. Epigenetic modifications, particularly DNA methylation and non-coding RNAs, also play significant roles in ASD pathogenesis. Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data. CONCLUSION Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments. Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice. Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies, ultimately enhancing outcomes for individuals affected by ASD.
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The transition to employment for young adults with intellectual and developmental disabilities (IDD) is a growing field of research and practice in need of increased attention. For many adults with IDD, the transition planning process can seem like a bridge to nowhere. In particular, adults with extensive support needs (ESN) are often excluded from employment opportunities due to lower rates of participation in school or community-based employment preparation experiences and the loss of special education services and collaborative support provided under the Individuals with Disabilities Education Improvement Act (IDEIA) during the school years. We present an overview of the post-school realities and employment challenges for many people with ESN and introduce a person-centered, collaborative approach uniquely designed to guide educators and practitioners who support adults with ESN. We provide recommendations for self-advocates, teachers, and employers to UNITE (U = Understand, N = Navigate, I = Invest, T = Train, and E = Elevate) to increase opportunities for inclusive work experiences that will sustain throughout the lifespan.
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Quigley and colleagues (2024, Behavior Analysis in Practice, https://doi.org/10.1007/s40617-024-01001-4) described a treatment recommendation scenario within a multi-disciplinary team setting for an adult with a developmental disability. The authors presented the information in a standard format to share how the involved parties identified, evaluated, and responded to the recommendation based upon their understanding of ethical decision-making. In this response, the right to effective treatment is emphasized as a primary obligation of the treatment team. The review of the procedure reveals that the intended intervention is one that is both unproven to be effective and similar to an intervention known to be harmful. Multiple available resources support the need to avoid the use of this intervention. Implications and suggestions for decision-making in clinical contexts are highlighted.
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Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with varying symptomatology that affects individuals throughout their lives. This paper explores the intersections of sociology, pedagogy interventions, and occupational therapy in addressing the needs of individuals with ASD. Sociological perspectives offer insights into social determinants of health, the construction of disability, and family dynamics, informing holistic interventions. Pedagogical strategies are focused on individualized approaches, multi-sensory techniques and social skills development to create inclusive learning environments. Occupational therapy interventions focus on functional skills development, promoting independence, and enhancing participation in daily activities. Collaborative efforts between professionals, educators, families, and individuals with ASD are essential for implementing effective interventions and promoting social inclusion. Future research directions include longitudinal studies, technology integration, and culturally responsive practices to optimize outcomes. By integrating sociological, pedagogical, and occupational therapy approaches, professionals can allow people with ASD to reach their full potential and lead fulfilling lives.
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This paper aims to identify the dominant types of team organization in cross-professional Swedish human service organizations and the relationship between team type and perceived efficiency as well as team climate as an aspect of work satisfaction. A questionnaire was responded to by 337 individual professionals from 59 teams, mainly from psychiatric care (50.7%) but also from social, neuropaediatric and vocational (re)habilitation, school health care and the occupational health service. The interprofessional model of team organization was the most frequent (62%), followed by the transprofessional (33%), and the multiprofessional team, (5%). A moderate positive correlation was found between team type and perceived efficiency as well as team climate. The greater the interdependence and the closer the cooperation , the higher the efficiency and the better the climate. No differences were found between professions or organizational domiciles with respect to team type. This paper suggests (1) a more consistent vocabulary with 'cross-professional' as the generic term covering different team types and (2) that a contingency approach to teamwork is tested in future research.
Chapter
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Several ethical considerations must be addressed when developing and maintaining interdisciplinary treatment teams. Failing to address ethical considerations may result in challenged service delivery and treatment fidelity because different interdisciplinary team members possess different training backgrounds and theoretical perspectives. This chapter examines ethical considerations in the development and implementation of interdisciplinary teams helping individuals with Autism Spectrum Disorders. Following this examination, several proactive and reactive strategies are offered to improve the likelihood of successful interdisciplinary collaboration and cooperation.
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In an effort to provide clarity about the unique contributions of several professions within the context of multidisciplinary treatment, we reviewed the definitions, philosophical underpinnings, and national requirements pertaining to both scopes of practice (i.e., model licensing acts, legislation, and regulatory boards) and training (i.e., task lists, accreditation standards and course requirements, and exam blueprints) of 4 behavioral health professions. The professions we selected (behavior analysis, psychology, speech-language pathology, and occupational therapy) are likely to provide treatment alongside one another and often to the same clients. In a review of documents pertaining to scopes of practice and training for each profession, we found overlapping content. However, the similarities between professions diminished when we reviewed more specific guidelines such as learning objectives, educational requirements (i.e., coursework), supervised clinical experience (e.g., internships), and national examinations. This was especially true when considering each profession’s underlying approach to treatment (i.e., philosophical underpinnings) and, hence, service activities. We discuss our findings in light of service overlap and make a call for greater collaboration between professions, as related to the separate content knowledge and expertise of professionals in each field and the impact on client outcomes. Link to full-text: https://rdcu.be/cOcaS
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Purpose There is a need to develop more knowledge on how frontline managers in health care services facilitate the development of new roles and ways of working in interprofessional collaborative efforts and the challenges they face in daily practice. The article is based on a study that examines the modes of governance adopted by frontline managers in Norway, with a special focus on leadership in collaborations between the Norwegian profession of social educator and other professions. Materials and methods A qualitative research design was chosen with interviews of eleven frontline managers from district psychiatric centers, municipal health care services and nursing homes. Results The results show that frontline managers largely exercise leadership in terms of self-governance and co-governance and, to a lesser degree, hierarchical governance. Self-governance and co-governance can facilitate substantial maneuverability in terms of professional practice and strengthen both discipline-related and user-oriented approaches in the collaboration. However, one consequence of self-governance and co-governance may be that some occupational groups and professional interests subjugate others, as illustrated by social educators in this study. This may be in conflict with frontline managers’ abilities to quality assure the services as well as their responsibility for role development in their staff. Conclusion The results show that frontline managers experience challenges when they try to integrate different professions in order to establish new professional roles and competence. Frontline managers need to support individual and collective efforts in order to reach the overall goals for the services. They must be able to facilitate change and support creativity in a working community that consists of different professions. Moreover, the social educator’s role and competence need clarifications in services that traditionally have been dominated by other clinical and health care professions.
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Our everyday lives contain numerous examples of the pursuit of quick fixes and fad treatments lacking objective research to support their use. The Internet is saturated with anecdotal stories of effectiveness and other false claims, which make it challenging to separate legitimate treatment options from offerings by “snake oil salesmen.” Humans are not immune to their effects. This phenomenon is commonly found in resources for autism treatment and can have devastating effects on consumers and families. Thus, the purpose of this chapter is to describe different approaches to understanding phenomena (science, pseudoscience, and antiscience) and how to distinguish empirical evidence and evidence-based practice. A careful review of the criteria that constitute evidence-based practice is offered. The chapter also provides recommendations for practitioners to stay abreast of the scientific literature and presents a model for addressing implementation of unsubstantiated interventions. Helpful checklists and key questions for use in clinical practice accompany the chapter.
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Despite considerable evidence that programmes grounded in Applied Behaviour Analysis (ABA) should be at the forefront of education and intervention in the treatment of Autism Spectrum Disorder (ASD) programmes of an eclectic nature are regularly implemented. Theoretical orientations undoubtedly influence the instructional practices adopted by educators but exploration of the significance of educational theory in the development of eclectic programmes remains lacking. This paper outlines the importance of competing theories to autism education, specifically Constructivist and Behavioural theories, and demonstrates how eclectic programmes may be misinformed when educators view approaches through a Constructivist lens. We conclude that it is imperative to interrogate and challenge the theoretical orientations of educators responsible for the development and implementation of comprehensive programmes of education (CEP’s) for young children with autism if we are to bridge the divide between evidence and practice in relation to ASD education.
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Applied behavior analysis (ABA) has the intent to improve the human condition in a broad range of categories of practice and for diverse groups of individuals across cultures. The data on the diversity of the professionals practicing in the field of ABA are sparse. Access to ABA intervention is inequitable, and cultural differences are not adequately addressed in many current established behavioral interventions. Cultural humility is a framework used by other professional disciplines to address both institutional and individual behavior that contributes to the power imbalance, the marginalization of communities, and disparities in health access and outcomes. This article discusses the adoption of culturally humble practices, specifically through the use of self-reflection, by the field of ABA to address disparities and improve outcomes. A specific framework from the field of social work is shared, and an adaptation to the behavior-analytic practice of self-management is provided.
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The practice of behavior analysis has become a booming industry with growth to over 30,000 Board Certified Behavior Analysts (BCBAs) who primarily work with children with autism and their families. Most of these BCBAs are relatively novice and have likely been trained in graduate programs that focus primarily on conceptual and technical skills. Successfully working with families of children with autism, however, requires critical interpersonal skills, as well as technical skills. As practitioners strive to respond efficiently and compassionately to distressed families of children with autism, technical skills must be balanced with fluency in relationship-building skills that strengthen the commitment to treatment. The current article provides an outline of important therapeutic relationship skills that should inform the repertoire of any practicing behavior analyst, strategies to cultivate and enhance those skills, and discussion of the potential effects of relationship variables on treatment outcomes.
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Using a multidisciplinary approach can be a key factor in initiatives designed to increase the effectiveness of health care services currently offered to children with autism spectrum disorder (ASD). Although healthcare delivery in the United States uses a multidisciplinary approach, it has been found that interprofessional collaboration between disciplines does not always take place resulting in practitioners working independently of each other. Due to the growing complexity of autism and the number of different professions that work with these individuals, there is a need for improved interprofessional collaboration using a multidisciplinary approach. In order to be successful in promoting interprofessional collaboration, health care workers need to develop ways to challenge and dispel the notion of profession-centrism by embracing the professional cultures of their colleagues and reducing the barriers to multidisciplinary training. A synthesis of findings from the research indicated that there are a limited number of disciplines collaborating using a multidisciplinary approach and working with children with autism.
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Behavior analysts often work as part of an interdisciplinary team, and different team members may prescribe different interventions for a single client. One such intervention that is commonly encountered is a change in medication. Changes in medication regimens have the potential to alter behavior in a number of ways. As such, it is important for all team members to be aware of every intervention and to consider how different interventions may interact with each other. These facts make regular and clear communication among team members vital for treatment success. While working as part of an interdisciplinary team, behavior analysts must abide by their ethics code, which sometimes means advocating for their client with the rest of the team. This article will review some possible implications of medicinal interventions, potential ethical issues that can arise, and a case study from the authors’ experience. Finally, the authors propose a decision-making tree that can aid in determining the best course of action when a team member proposes an intervention in addition to, or concurrent with, interventions proposed by the behavior analyst.