This is the introduction for the special issue on clinical and applied behavior analysis and ethics. This article outlines the three articles in this issue and highlights them in the context for ongoing and continued discussion and exploration of ethical inquiry of behavior analysis and behavioral p

OVER THE YEARS INCREASED need has developed for effective interventions in residential settings for conduct disordered and delinquent youth. In particular the adolescent population has been difficult and suffering high amounts of recidivism. One promising treatment to develop has been Mode Deactivation therapy. Jack Apsche originally formulated mode Deactivation Therapy (MDT) in response to the lack of effective therapies offered in residential treatment centers. Interventions are primarily verbal and involved validating the client's experiences, clarifying core beliefs and changing behavioral responses that are based on fear and improper attempts to cope. In developing the treatment, Apsche drew on recent work in cognitive behavior therapy in particular, Becks concept of modes and methods to deactivate triggered responses (Apsche & DiMeo, 2010). His treatment is similar to many of the current movements in clinical behavior analysis in that it is contextual in nature with a focus on the therapeutic relationship during the interaction to trigger and shape response, while attempting to balance ideas of both acceptance and change around complex behavioral problems involving trauma, psychopathology, beliefs, and personality factors (Apsche, 2010). A recent meta-analysis has shown mode deactivation therapy to be effective in the treatment of residential children with multiple behavioral and psychiatric difficulties (Apsche, Bass, & DiMeo, 2010) In addition, this meta-analysis found the effect size of the treatment to be greater than that of traditional cognitive therapies, dialectical behavior therapy and social skills training. Finally, some support was offered that externalizing problems such as aggression emerge from internalizing problems such as anxiety. Mode Deactivation theory has received a flurry of recent interest. This is evidenced by multiple journal articles written documenting the ineffectiveness of treatment as usual and the effectiveness of MDT (Apsche & Ward, 2002; Apsche, Bass, Murphy 2004; Apsche, Bass, Civ 2005) Thoder and Cautilli, 2011 succinctly described MDT: Mode deactivation therapy (MDT) is offshoot of CBT that examines aspects of personality that lead to criminality and delinquency and, ultimately, remediate problematic schemas. MDT is based on the work of Aaron Beck, M.D. Beck (1996) suggests that the model of individual schemas do not adequately address a number of psychological problems. Incorporating this premise, MDT addresses a more global methodology (Apsche & Ward, 2002; Beck, 1996). The concept of modes is defined as a network of cognitive, affective, motivational, and behavioral components that integrate sections of a personality (Beck, 1996). Modes consist of beliefs that contain the specific memories, the system on solving specific problems, and the experiences that produce memories, images, and language that form perspectives (Apsche & Ward, 2002). (p.42). In 2006 and in 2011 these writers evaluated the effectiveness of MDT. These evaluations were independent of each other. The second occurred 5 years after the first and 10 years after the introduction of the MDT model. The current status of the literature (insert bass, etc here) evidences a robust therapeutic model which provides a model of care for adolescents who have extensive abuse histories, have been in multiple placements and generally are avoided by providers due to their extreme behavior. Underwood, Baggett-Talbott, Mosholder, and Von Dresner (2008) found that many of the therapies utilized in residential treatment centers is normed on those with less intense problems and thus the difficulty in treating those in residential care. MDT provides an alternative for this shortcoming. MDT has provided sound if not superior results to Cognitive Behavior Therapy alone or Treatment as Usual (supportive therapy, crisis management only, or medication management alone). …

Emotional and behavioral disorders (EBD), as defined by Cook, Gresham, Kern, Barreras, Thorton, and Crews (2008), refers the full spectrum of students with social, emotional, and behavioral problems that do and do not receive special education (p. 132). The problematic behaviors can be of an internalizing or an externalizing characteristic--with children experiencing bouts of mild or clinical depression, attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and even non-clinical externalizing behaviors--and, largely, educational programs of the past have been unsuccessful in helping these children thrive (Cook et al., 2008; Jull, 2008). Children with EBD often have behavioral problems that lead to marked impairments in the academic performance (Nordess, 2005). On average, children with EBD receive lower grades and fail more courses with a drop-out rate exceeding 50% (Sacks & Kern, 2008). As of 2009, it was reported that students with EBD comprise 8% of all students with disabilities and the numbers are continuing to rise. Cook and colleagues (2008) confirm and expand on this claim by reporting the children with EBD are at a greater risk for poor school adjustment, for engaging in delinquent behaviors, and for adult psychopathology. This often leads the family to seek mental health services in the community. Creating a more pleasant and successful academic career is important, as children with EBD experience less than desirable social and economic outcomes, higher rates of unemployment, criminality, substance abuse, and aberrant sexual behavior (Sacks & Kern, 2008). Often times, the mental health system and the school system engage in treatment programs for these students. In Pennsylvania, this is referred to as behavioral health rehabilitative services (BHRS). Behavior Analysis & Therapy Partners (BATP) is a for-profit behavioral health agency whose clinicians serve a highly diverse population with respect to age (pre-school to elderly), diagnoses, presenting problems, and socio-economic status, including those with EBD. Depending on assignment, its BHRS division delivers treatment to children, many of whom have EBD, in the home, community, and/or school system. The BHRS are administered through a behavioral consulting process in which a behavioral specialist consultant (BSC) works with a consultee (parent, teacher, or other socializing agent) to provide services to advance a formal problem-solving model that uses applied behavior analysis (ABA) intervention specification within a targeted behavior-ecology context (Bergan & Kratchowill, 1990). The BSC helps the child indirectly by affecting the consultee. Conversely, BATP offers the services of a mobile therapist (MT) and/or a therapeutic staff support (TSS) intervene in the child's environment directly. According to Cautilli, Rosenwasser, and Clarke (2000), the MT affects behavior change by using behavioral therapy with both the individual child and the family while the TSS is a direct-care staff person who affects behavior change by providing proactive behavioral management and emotional support to the child. Both the TSS and the MT follow the treatment plan written by the BSC. BATP, like all BHRS, takes a family-focused approach in which both the families of the children and the children themselves are considered partners and experts with regards to the development and evaluation of services (Andersen-Butcher & Ashton, 2004). For BATP, this means the implementation of a parent training model and a use of siblings in the treatment, and the conjoing collaboration of the family, child, and treatment team on goal-setting. Rosen, Heckman, Carro, and Burchard (1994) found that youths who receive wraparound services appear to be satisfied with the services and are less likely to act out when they feel involved and feel that their contingency-oriented care is unconditional. …

About 5% of juvenile offenders are responsible for the majority of crimes committed by juveniles (Moffit, 1993; Mulder, Brand, Bullens, & Van Marle, 2010; Schumacher & Kurz, 2000). This group continues with their criminal careers into adulthood and evolves into committing more serious offenses (Mulder et al., 2010; Moffitt & Caspi, 2001). Conduct problems are observed early in this group of adolescents (Patterson, 2002). In fact, some of the initial behavioral difficulties are manifested and observed in children as young as two or three years of age (Keenan, 2001; Loeber and Farrington, 2000; Nee & Ellis, 2005). The peer groups of these children are exposed to their deviant attitudes and behaviors and can show a related increase in their own deviancy. Deviancy training often occurs through deviant talk and the bonding and reinforcement of such talk in other children (Snyder, Stoolmiller, Patterson, Schrepferman, Oeser, Johnson, & Soetaert, 2003). Nee and Ellis (2005) purported that for treatment to be effective, it needs to be responsive to the evolving needs of the child and, later, the adolescent. It is important that interventions for antisocial behavior be dictated by the needs of the clients and be provided at a level of intensity corresponding to the level of disruptive behaviors present. As the problems are solidified, later programs need to target the function of the antisocial behavior and often can be very intensive (e.g., Thoder, Hesky, & Cautilli, 2010). Often, the youth with more ingrained antisocial thoughts and behaviors are placed in residential treatment programs by adolescents (Barker, 1998;Underwood, Baggett-Talbott, Mosholder, & Von Dresner, 2008 ). Many of the evidenced based treatments that exist in Residential Treatment Centers (RTCs) have been normed on groups with less intense problems then residential youth (Underwood, Baggett-Talbott, Mosholder, & Von Dresner, 2008). In addition, the opportunities for youth in residential facilities to learn inappropriate behavior is high (Barker, 1998). These factors may contribute to why overall, the U.S. Surgeon General Report (1999) residential programs to be ineffective. Non-behaviorally based residential programs have shown a failure to reduce aggressive and antisocial behavior (Joshi & Rosenberg, 1997). In longitudinal study, by year seven, children discharged from publicly funded RTCs in six states in the United States were either readmitted to mental health facilities (about 45%) or incarcerated in a correctional setting (about 30%) (Greenbaum et al.,1998). That makes the rate of failure approximately 75%. The need for effective residential treatment is critical. The use of behavioral principles in more intensive programs have been found to reduce aggressive and disruptive behavior (Chen & Ma, 2007). When taken into a psychologically informed context, contingency management systems can have a powerful effect (Andrew, Zinger, Hoge, Bonta, Gendereau C Lipsey, 1999; Pealer & Latessa, 2004; Roush, 2008). …

Initially, when we thought of doing this article, the first author (JC) felt distain. I (JC) must admit that I am not much of a prognosticator. Skinner (1990) argued that we do not the future but we know the past. We attempt to discriminate relevant variables in the present from the past and respond to them. For example, if the reader has an interest in robotics, neural networks (e.g., Thrun, & Mitchell, 1993), and operant conditioning (e.g., Thrun & Schwartz, 1995) models of behavioral development. The world has aging populations. Often this population experiences problems with mobility. Today, this problem is handled by giving them scooters. Scooters have a problem in that once you start using them, the mobility rarely returns and they are not very flexible as to the places that you can go. In the movie Forrest Gump, Forrest had bracers for his legs made from metal to help him walk. Given this set of learning experiences, one can easily suggest envision solving the problem of older people walking as the creation of a device like Forrest's braces only with an operant neural network based chip. When the person is younger (say early 50s), they are made a set of braces. They are instructed to wear the braces for a week or so. Through this wearing, the person's muscles train the chip as to the person's movement range and muscle reactions. The chip is stored for year and when the person is experiencing problems in mobility (maybe 80 or 90 years old), the bracers are taken from the closet, the chip placed back in, and put on the person in effect creating an exoskeleton. This will instantly help the person to walk but it is farm more helpful then that- it can help the person to regain the strength to be independent again. The device can be designed so that each day of consecutive wearing, it gradually transfer .02% of the workload back to the existing muscle structures of the person who is the wearer. Thus, in a year or so, it gradually rebuilds the muscle to walk without the device. The above sounds like a plan, maybe or maybe not. Lots of environmental variables might render the device worthless. For example, biological research on stem cells might develop to the point of recreating muscle tissue rapidly regenerating the lost muscle. Another possible break to the plan would be that since scooter technology already exists, it has many people working on its improvement as a technology to increase mobility, as opposed to our suggested exoskeleton. Finally, some unforeseen advance in some other field could change the landscape even further relegating our work to worthless. Like with the above an ever shifting environment and stimuli emerge, rarely can we make predictions with 100% certainty. The same can be said to be true for licensing. Is it a breath of new air for behavior analysts or a threat and bringer of doom? What we can predict is the community's reaction. When a vague stimuli emerges, signal detection theorists (Greene & Swets, 1966; Swets, 1992) tell us, response can be organized into the following classification system (Table 1) So we can ask if the stimulus of licensing is good for the profession. Since it is a vague stimulus our responses will fall into one of the four boxes (Table 1). Yet, our responses are also behavior under operant control and prone to local contingencies that effect the statement. For example, we believe licensing to be good for several reasons (1) it will establish behavior analysis as a profession in a given state. Once it is a profession (a) parents or advocate groups can ask local Universities Why don't you have such a program? and thus create pressure on Universities to develop and staff behavior analytic programs. (b) More university programs will mean more faculty positions and granter number of research grants are researchers argue things like well thousands of clinicians are using stimulus control techniques in work with their clients but the process of stimulus control is not researched. …

HISTORICAL CONTEXT AND CURRENT CONCERNS The need for states to regulate the practice of behavior analysis and for behavior analysis in turn to become a recognized applied discipline is a growing issue (see Cautilli & Dziewolska, 2008). While behavior analysis is an independent academic discipline having its own training programs, offering degrees at the master's and doctoral levels, these programs are often not tailored to prepare the graduate for licensure in existing mental and behavioral health professions, such as counseling, marriage and family therapy, or clinical psychology. There are manifold reasons for this. One of the major historical reasons is that the behavioral model of human development originated outside of the field of psychology at the University of Kansas in the Family Life Department located in the department of home economics (Baer, 1993), which placed it outside of psychology and opened its training programs to greater focus on behavioral intervention, while focusing less on other aspects of psychological knowledge. Another historical factor that remains powerfully influential is that behaviorism was and still is viewed as a dead area by many in both academic and clinical psychology. The cognitive revolution in academia (1) (see Robinson-Riegler & Robinson-Riegler, 2003) and the prevalence of psychoanalytic and humanistic models--as well as the incorporation of some New Age ideas--in the clinical realm can be viewed as contributing factors (see Dawes, 1994; Lilienfeld, Lynn, & Lohr, 2003). Indeed, some academic institutions effectively expelled behaviorists from psychology departments (for one battle see Wyatt, 1991). In spite of psychology's relative neglect of behavior analysis, the field of behavior analysis has made significant contributions to many areas of human treatment, including neurological rehabilitation (Wood, 1987), developmental disorders such as autism (Mental Health: A Report of the Surgeon General, 1999), and behavioral elements of psychiatric disorders (Salzinger, 1998). A burgeoning area of interest in which applied behavior analysis has shown success is crime reduction, which places behavior analysis as a sought after service in the now growing field of community re-entry. Overall, behavioral programs based on the operant and respondent conditioning procedures of behavior analysis have been shown to lead to a 13-20% reduction in criminal recidivism (Redondo-Illescas, Sanchez-Meca, & Garrido-Genoves, 2001). While this is modest by intervention standards in other areas, these numbers taken across the entire prison population represent a substantial reduction in criminal activity and a substantial reduction in the pain brought by crime to victims and their family members, as well as the family members of offenders. Studies have shown that behavior modification/analysis procedures can reduce criminal activity of those with ADHD by as much as 50% (see Satterfield & Schell, 1997; Satterfield, Satterfield, & Schell, 1987). In addition, parenting models based on operant conditioning procedures have been shown consistently to reduce conduct disorders in children and adolescents, prevent delinquency, and have sustained long term effects (Cautilli & Tillman, 2004; McMahon & Wells, 1998). With sex offenders, behavioral programs are a promising practice for reducing socially inappropriate sexual desires and behavior (Marshall, Jones, Ward, Johnston, & Barbaree, 1991). It is our belief that in a free market society the public should have access to choose this type of professional--yet current insurance laws block such access. These laws suggest that only licensed professionals can receive reimbursement in essence locking behavior analysts out of this market. Since behavior analysis is not yet a licensed profession, ready access to these effective interventions may be limited. Given the historical context mentioned above, most programs in clinical psychology or counseling do not provide more than a cursory glance at the theory, techniques, or clinical evidence that undergird applied behaviorism (Dorsey & Mikolsky, in preparation). …

Greer &. Ross (2007): Verbal Behavior Analysis: Inducing and Expanding New Verbal Capabilities in Children with Language Delays Language impairments affect 7% of preschool children (Ziegler, 2005). Some of these children will catch up to their peers, but many will continue to have problems at school age. For example, Paul (2000) found that 16% of children with expressive language delays at age 2 continued to present with language impairments at the age of 7. Additionally there is evidence that early problems with oral language are related to later problems with the development of literacy skills (Bartlett, et al., 2002). Moreover, when language impairments accompany developmental disabilities (e.g., autism, mental retardation), they are likely to remain a life-long challenge. Professionals from a variety of disciplines have developed approaches to language intervention over the past 80 years (Paul, 2007). Within that context, behavioral approaches have emerged among the most effective, especially for teaching children with autism and related disabilities (Goldstein & Hockenberry, 1991). Traditionally, behavioral approaches emphasized modeling, imitation, systematic prompting, differential reinforcement and discrete trial instruction as a primary instructional format (e.g., Lovaas, 1981). However, more recently the behavioral framework has been expanded to include an emphasis on functional analysis and especially Skinner's (1957) functional analysis of verbal behavior. Additionally, natural environmental teaching (NET) strategies (e.g., incidental teaching, mand-model) were added to the repertoire of important instructional formats, and a review of recent studies supports the effectiveness of these formats (Petersen, 2006 for children with language delays. Skinner (1957) originally developed the verbal behavior model to account for the continuity between operant behavior and language. Others are responsible for applying the model to language instruction (e.g., Sundberg & Partington, 1998; Greer & Ross, 2007). These applications have gradually come to be known as the verbal behavior (VB) approach. Carr and Firth (2005) recently reviewed the published literature on VB practices and pointed to the need for additional research. We believe that his call for research has been addressed in part by Greer and Ross's (2007) book: Verbal Behavior Analysis: Inducing and Expanding New Verbal Capabilities in Children with Language Delays. This book represents the culmination of considerable research, practice, and critical thinking by a Greer and his colleagues (e.g., Greer & Keohane, 2006; Greer, Keohane, & Healy, 2002; Tsai, & Greer, 2006). It addresses many interesting and important questions about the verbal behavior approach, and it offers an evidence-based framework for best practices in behavioral language intervention, including detailed information about assessment, instructional strategies, and procedures for evaluating treatment efficacy. It is highly engaging and conveys complex theoretical information in a clear and reader-friendly style. It is an excellent source of information for students planning a career in communicative disorders, for behavior analysts who wish to enhance their understanding of Skinner's verbal behavior framework, for parents of children with communicative disorders, and for professionals in the fields of developmental disabilities and early intervention. An important feature of this book is that it includes an empirical account of verbal behavior development, and it t may be the first comprehensive account of language development that incorporates Skinner's (1957) verbal behavior model. It describes a developmental trajectory marked by developmental cusps (Rosales-Ruiz & Baer, 1966; Bosh & Hixson, 2004). In some linguistic and cognitive accounts of language development, stages of language growth have been attributed to neurological factors such as a language acquisition device (e. …

Indeed, the neuro feedback conceptualization remains an appealing and compelling one: simple shaping of EEG patterns by operant conditioning that correlate with problem behavior and looking for adjunctive (Falk, 1971) decreases in the problem behavior. Indeed, there was much to enjoy about the article; however, one claim from the article appears to need some citation as support or proof. authors claim: a series of reports to Corrections officials, Quirk indicated that the three year recidivism rate from the biofeedback unit (using these techniques) had never been more then 45% and in some groups had fallen to Overall, among nearly 3000 felons trained by Quirk's volunteers, the rate of recidivism was consistently close to 15%. (p. 501) This claim is unreferenced. Indeed, in the only other publication that I was able to find (e.g., Quirk, 1995) the best results indicate that subjects had 20% recidivism. In this study, the number of people trained was approximately 300 not 3000. It is unclear if the three thousand represents the overall training number of O.C.I or if it is the number of people in published studies. From review of studies, I conclude it must be the former and not the latter. While 20% could be considered a good recidivism rate, the study offers neither control group nor a reference to the recidivism rate for the Ontario area for the type of offenses that Von Hilsheimer and Quirk (2006) worked to correct. Without that information, the number remains an unsubstantiated claim. In addition, it is important to remember that as Quirk (1995) states The O.C.I. serves adult males sentence to less than 2 years of incarceration (p. 10). Thus, Quirk was not working with highly recidivistic or violent offenders. In addition, O.C.I. was a treatment facility for offenders and it is unclear if offenders were receiving other treatments while there. It is not unreasonable to think that offenders who engaged in high rates of neurotherapy as a treatment also engaged in high rates of other treatments. methodology in the Quirk (1995) used a titration design to show that those who received more therapy improved more; however, with no objective standards to compare the recidivism rate- the number must remain questionable. Indeed, the paper would have been greatly enhanced by citing a report on recidivism for that area of Ontario. In addition, since these studies occurred in the 1970s, the fact that they have not been replicated in over 35 years increases my skepticism that they will ever be replicated. Interestingly the 15% number has become part of the clinical lore, which seems to have encompassed most of the biofeedback and neurofeedback community. …

Behavior analysis continues to struggle with professional recognition. This occurs contrary to the mounting research evidence that shows behavior analysis to be the treatment of choice for a variety of problems. One population in particular that behavior analytic studies have shown success with is in lowering recidivism of offenders. Keywords: Behavior analysis, professional recognition, recidivism, offenders ********** A recent meta-analytic article, looking a program impact for offender populations, found that Behavior Therapy (operant and respondent conditioning principles, antecedent control strategies, self-control training, etc.) and Cognitive Behavior Therapy were the only two treatments that produced an effect (Redondo-Illescas, Sanchez-Meca, & Garrido-Genovaes, 2001). These two interventions lead to a 12-15% decrease in recidivism over a two years post treatment. All the other interventions produced effects substantially much lower including therapeutic communities, non-behavioral treatments, dissuasion, and diversion programs. With crime so out of control across this nation, it would seem that a call for action for behavioral programs in prison would be one of the top public out cries but it is not. Part of the reason for this is that behavioral programs have received a great deal of bad press in the treatment communities and are often beholden to other professions in the community. For example, behavior analysts might work under nurses or psychiatrists in the hospital. This has an effect on the behavior targeted for intervention programs. Take for example the literature by behavior analysts on token systems in the institutions in the 1970s. The whole body of literature was on focused on building behaviors- a constructional view (Golddiamond, 1974), with patients setting goals and interventions directed toward community living on the outside (Atthowe, 1973; Bassett, Blanchard, & Koshland, 1975; Milby, Pendergrass, & Clarke, 1973; Fairweather, Sanders, Cresseler, & Maynard, 1969; Rybolt, 1975; Swartz & Bellack, 1975). Yet, when Page, Caron, & Yates (1975) did their famous survey of token systems they found that out of 280 programs surveyed almost all token systems were co-opted to just enforce nursing routines. This is the problem when one field is beholden to another. Being beholden to other professions is harmful or at least not in the consumer's best interest. The tools of behavior analysts become secondary to helping the other profession achieving its professional goals. Thus, instead of building behaviors that would prevent rehospitalization, the behavior analyst find himself or herself designing programs focused solely on getting the client to take medication and comply with hospital routines. …