Wednesday, 23 October 2013

The challenge for behaviour analysis in the UK: Some thoughts on the future



If you have read some of my other blogs, you could be forgiven for thinking that my interest in the application of behavioural interventions is dominated by their use in the field of autism. Quite the contrary. The autism and behavioural interventions community is an important part of behavior analysis in the UK, but it is clearly not the full story.

We are at an interesting point in the development of behavior analysis in the UK. The UK Society for Behaviour Analysis [http://uk-sba.org/] has been established recently and held its first Annual General Meeting a couple of weeks ago. There is also an increasing recognition of the value of interventions in a variety of areas that are based on core behavioural principles. Just focusing on the health and social care domain, the UK National Institute for Health and Care Excellence (NICE) has recommended a range of behavioural interventions and approaches within its guidelines including:

  • Behavioural activation for depression
  • Dialectical Behaviour Therapy for personality disorder and self-harm
  • Behavioural parent training to support families of children with behavior problems
  • Behavioural intervention, including functional assessment, for challenging behaviours in people with dementia, adults with autism, and children with autism
  • Behavioural skills teaching methods for adults with autism

NICE is also currently working on a guideline that will recommend interventions for challenging behaviours in adults with intellectual disability. Given that national guidance in the UK already identifies Positive Behavioural Support (PBS) as the intervention model of choice, it seems likely that PBS will emerge as a strong part of the future NICE guideline.

That short overview is health/social care focused, but behavioural interventions are the bed-rock of evidence-based approaches in a range of other situations including teaching in schools, behaviour management in schools, “nudges” to change behaviour on a large scale across the population, safety in high risk industries, and “incentivizing” performance in many business contexts.

If we take a broad perspective about behavioural interventions, it seems that the momentum is with the application of behaviour analysis in the UK. Several behavioural interventions are already recommended for use. This should be a fantastic time. The opportunity is significant because the needs are significant. If we imagine the often-used picture of an iceberg, behavioural interventions are only addressing a tiny fraction of the children and adults in the UK who could benefit. As an example, we carried out a census of schools and school units in the UK who follow explicitly a behavioural educational model across the whole of the curriculum [http://www.sciencedirect.com/science/article/pii/S1750946711001875]. These schools catered for a total of 258 children with autism. This does not compare favourably to the total population of school aged children with autism in the UK.

So, there is a massive amount of work to do to disseminate behavioural interventions more widely. This is the current and future challenge for behaviour analysis in the UK.

How might the behaviour analysis community in the UK meet this challenge? First, we need a body in the UK that explicitly focuses on the dissemination of behavioural interventions across all sectors in society. The existence of the new UK-SBA is a real benefit in this respect. If the UK Society can avoid navel-gazing such as a primary concern with the needs of behaviour analysts rather than the needs of society, there is great hope.

A second issue is that it is important to identify the areas for growth and to run with the opportunities. This might involve re-claiming existing behavioural interventions for behaviour analysis. Thus, we need, for example, to re-claim parent training and behavioural activation for depression. In addition, we need to understand where the energy is for change. Because of the significant interest across the UK in the Winterbourne View scandal [see http://profhastings.blogspot.co.uk/2013/05/winterbourne-view-will-happen-again-and.html], there is great energy for PBS at the moment.

Third, those with strong behavioural competencies and allegiance to behaviour analysis need to be out there in the debates about evidence based intervention in a variety of contexts. It is amazing when you look how many evidence based interventions are built on basic behavioural principles. It is not necessary to rub others’ noses in it so to speak, but we need skilled communicators who can keep the connection with behavioural theory and practice as much as possible. Essentially, we need influencers who are the friendly face of behaviour analysis and can use their influence to support the dissemination challenge.

A final point is that actually behaviour analysts/behavioural psychologists need to explicitly study/research why there is such a large gap between the needs behavioural interventions can address and actual roll-out in society. We need behavioural analyses and interventions to deal with this problem directly. For example, anecdotally, the language used by behaviour analysts is off-putting and confusing. So, we need to understand the barriers to the uptake of behavioural interventions and then we can remove them.

5 comments:

  1. Very much agree - need less academic focus and more client benefit focus

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    Replies
    1. Not sure I'd say less academic focus, but certainly to ensure the focus is on dissemination and benefit to others rather than the professional standing of behaviour analysts...

      Delete
  2. Suzy Yardley, Clinical Manager@Peach24 October 2013 at 14:50

    This is a great summary of the current position, and the opportunities for Behaviour Analysis as a profession. Our job is to make it clear where and how we can help, within existing systems. Also agree we need to be pragmatic, and include as many dedicated folk who are already making a difference using behavioural approaches as possible when holding events and forming groups. Then there will be as many people as possible helping to push the ball and keep it rolling.

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