Applied Behavior Analysts (ABAs) working in the healthcare industry apply the scientific principles of behavior analysis to treat problematic behaviors in patients who may be suffering from developmental difficulties, head trauma, neurological diseases, or other mental health issues. Working as part of a healthcare team or individually, they assess patients, develop treatment plans, and supervise the implementation of behavior intervention plans (BIPs) in homes, hospitals, or long-term care facilities.
Applied behavior analysis originated within the healthcare sphere, and ABAs have been providing therapeutic treatments as part of the healthcare system since the 1960s. But it was something that happened in the late 1990s that drove the growth of the field and public awareness of the role of ABAs in healthcare.
The Range of Conditions ABAs in Healthcare Treat
Between 1993 and 2007, diagnoses of Autism Spectrum Disorder (ASD) across the United States exploded, increasing up to eight times in some states. As one of the few scientifically proven treatment methods for ASD, it suddenly became important for healthcare providers to be capable of providing applied behavior analysis.
It’s hard to overstate the effect of the ASD epidemic on the practice of behavior analysis in the healthcare industry. According to a 2015 report released by research firm Burning Glass Technologies, nearly half of all behavior analyst jobs are in the healthcare industry, and the majority of those involve providing services related to the treatment of ASD.
ASD is not the only disease or disability that ABA is effective in treating, however. ABAs also assist in treating conditions that include:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Obsessive-compulsive disorder (OCD)
- Fears and phobias
- Anger management issues
- Anxiety disorders
ABAs in the healthcare industry may work in private practice, either individually or as part of a team of clinicians, such as at an autism treatment center. Or they may work in a psychiatric hospital or long-term care facility, addressing post-acute care issues with residential patients.
Some ABAs work primarily with patients in their own homes, helping caregivers construct environments to encourage increased sociability and stability, as happens when they use techniques such as Verbal Behavior Therapy with autistic children in their home environment. VBT breaks language down into simple patterns and can be taught through simple repetition and reinforcement. This can dramatically improve communication skills in the patient’s daily life.
How Applied Behavior Analysts Function as Part of the Healthcare Team
ABAs working in healthcare typically function as part of a larger team of medical providers. They provide a resource and serve as a source of insights and advice on patient behavior management, incorporating their knowledge of behavior analysis into treatment plans.
Most patient engagements begin with a functional behavior assessment (FBA). Conducting the FBA involves performing a careful and systematic investigation of elements in the patient’s environment that lead to problematic behaviors, often using the Antecedent-Behavior-Consequence model, or ABC. This approach involves isolating behaviors, then looking at the antecedent that prompted them, and the consequence that reinforces that behavior.
For problematic behaviors, such as physical violence or disruptive speech, the challenge for the behavior analyst is in finding ways to impose consequences that create a negative perspective on the antecedent, to discourage the behavior. For positive behaviors that they want to encourage, the analyst looks for ways to create a rewarding consequence to reinforce those behaviors.
The ABA has a number of tools in their toolbox for establishing such systems.
- Discrete Trial Training (DTT) – Involves breaking down complex behaviors into a number of elements, which are separately and sequentially reinforced to build up into the desired behavior.
- Pivotal Response Treatment (PRT) – Rather than targeting specific behaviors, PRT involves a holistic examination of motivations and responsiveness in the patient.
- Natural Environment Training (NET) – NET uses reward systems already established in the patient’s life and pairs them with desired behaviors to create a naturalistic pattern of behavior response.
Once the ABA has matched the FBA observations with the appropriate treatments, they will create a Behavior Intervention Plan, or BIP, which provides a consistent framework for healthcare professionals and other care providers to deliver the required reinforcements. The ABA often coaches other members of the team, and other individuals, such as parents or teachers, who may be responsible for taking care of the patient in other settings.
Healthcare ABAs will conduct follow-up assessments and adjust the BIP as necessary to keep the patient on track as his or her care and diagnosis changes over time.
Treatment goals often include skills that are designed to lead to increased independence and confidence for the patient, including:
- Communication skills
- Motor skills development
- Academic skills
- Play and leisure
Using a Token System in Long-term Residential Health Settings
Applied behavior analysts might advise other healthcare providers on the most appropriate methods of interacting with patients who have extensive behavioral issues. Or, they might enlist other specialists for assistance in executing larger behavioral management plans that rely on consistency and firmness to be effective.
For example, in many residential mental health facilities, ABAs work with staff to create an effective token economy to help encourage and maintain positive behavior patterns. A token economy is a generic system that can be applied to reinforce or reduce almost any behavior by introducing tokens that can be given out as rewards (or taken away as punishment, although this is less common). The tokens may eventually be exchanged for a treat or pass to a preferred activity of some sort.
Common in residential care settings where disruption must be kept to a minimum, token economies teach delayed gratification while imposing mindfulness on the behaviors of the actors. ABAs work carefully to balance token economies to maintain stability and gradually improve the behaviors of participants.
They may also have to educate other healthcare staff on the appropriate use of tokens; doctors and nurses, for example, could be coached to distribute a token when a patient who has historically been problematic takes his or her medications without complaint.
Planning for a Career in Applied Behavior Analysis in the Healthcare Industry
The complexities of administering behavior analysis treatments in the healthcare environment require a strong educational background and ongoing learning throughout an ABA’s career. A master’s degree or higher will certainly be necessary to find a job in behavior analysis in healthcare.
Most positions will also require a BCBA® certification. The Board Certified Behavior Analyst certificate is issued by the Behavior Analyst Certification Board, a non-profit organization established in 1998 to help states fulfill professional credentialing needs in the field. The organization also publishes treatment guidelines and codes of conduct for ABAs, setting a national standard for ABAs to adhere to. The BACB has also been instrumental in helping states shape their licensing laws.
Twenty-seven states require some form of licensing for practitioners of behavior analysis, and all of them require candidates for licensure to hold advanced degrees and specialized training in the field. Undergraduate degrees in psychology or education are common among those that make the transition to graduate studies in applied behavior analysis.
Many individuals interested in a career in healthcare as an ABA will also gain valuable experience by volunteering in clinical settings. Many community human services organizations that handle special needs populations are constantly on the lookout for volunteers, and some private clinics offer volunteer opportunities for people interested in a career in behavior analysis.
Additional Resources for Applied Behavior Analysts in Healthcare
The ABA Toolbox – A resource site outlining many common ABA treatment techniques.
Behavior Analyst Certification Board – A national certification and standards body governing ABA practices.
Association of Behavior Analysts International – An international associations that performs ABA advocacy and has many resources for job-seekers and active behavior analysts.
Association of Professional Behavior Analysts – A nonprofit organization dedicated to advocating for and advancing the practice of behavior analysis.
I Love ABA! – A blog site with many links to free resources, tips for getting into the industry, and in-depth discussions of the work of healthcare ABAs.
Volunteer Match – An organization that lists volunteer opportunities in a variety of fields, including private and community services agencies that use applied behavior analysis.