Strategies for Tac.ng and Responding to Mands for Cultural Rela.vity Emi;ed by Clients David J. Cox, M.S.B., BCBA Director of Research & Ethics Chair – STE Ethics Commi;ee STE Consultants, LLC Berkeley, CA
Overview • Some Assump.ons • Cultural Sensi.vity versus Cultural Rela.vity • The Limits of Rela.vity • Drawing the Boundaries • Some Strategies
Some Assump.ons • Defini.on of Culture 1, 2, 3, 4, 5, 6 • Defini.on of Individual & Cultural Values • Adherence to Guidelines for Responsible Conduct is a “Good” thing. • Idiosyncrasies of Interac.ons • Understanding YOUR Personal and Professional Culture
1. Skinner, B.F. (1973). Beyond Freedom and Dignity. Indianapolis: Hacke; Publishing. 2. Harris, M. (1983). Cultural anthropology. New York: Harper & Row. 3. Mallo;, R.W. (1988). Rule-‐Governed Behavior and Behavioral Anthropology. The Behavior Analyst, 11(2), 181-‐203. 4. Baum, W. M. (1995). Rules, Culture, and Fitness (1995). The Behavior Analyst, 18, 1-‐21. 5. Glenn, S.S. (2004). Individual Behavior, Culture, and Social Change. The Behavior Analyst, 27, 133-‐151. 6. Sugai, O’Keefe, & Fallon (2012). A contextual considera.on of culture and school-‐wide posi.ve behavior support. Journal of PosiIve Behavior IntervenIons, 14, 197-‐208.
Some Assump.ons • Defini.on of Culture • Defini.on of Individual 7, 8, 9 & Cultural Values 10, 11 • Adherence to Guidelines for Responsible Conduct is a “Good” thing. • Idiosyncrasies of Interac.ons • Understanding YOUR Personal and Professional Culture 7. Skinner, B.F. (1953). Science and Human Behavior. New York: The Free Press. 8. Baum, W.M. (1994). Understanding behaviorism: Science, behavior, and culture. New York: Harper Collins College Publica.ons. 9. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experienIal approach to behavior change. New York: The Guilford Press. 10. McSween, T.E. (1995). Thevalues-‐based safety process. New York: Van Nostrom Reinhold. 11. Totsi, D. (2005). How to be a successful change consultant. (Available from Vanguard consul.ng:
[email protected]).
Some Assump.ons • Defini.on of Culture • Defini.on of Individual & Cultural Values • Adherence to Guidelines for Responsible Conduct is a “Good” thing 12, 13, 5 • Idiosyncrasies of Interac.ons • Understanding YOUR Personal and Professional Culture
5. Baum, W.M. (1995). Rules, Culture, and Fitness (1995). The Behavior Analyst, 18, 1-‐21. 12. Glenn, S.S. (1988). Con.ngencies and Metacon.ngencies: Toward a Synthesis of Behavior Analysis and Cultural Materialism. The Behavior Analyst, 11, 161-‐179. 13. Ma;aini, M.A. (1996). Envisioning Cultural Prac.ces. The Behavior Analyst, 19, 257-‐272.
Some Assump.ons • Defini.on of Culture • Defini.on of Individual & Cultural Values • Adherence to Guidelines for Responsible Conduct is a “Good” thing • Idiosyncrasies of Interac.ons 14 • Understanding YOUR Personal and Professional Culture 15
14. Muller, J.H. & Desmond, B. (1992). Ethical dilemmas in a cross-‐cultural context – A Chinese example. Western Journal of Medicine, 157, 323-‐327. 15. American Society for Bioethics and Humani.es (2009). Recogni.on of Context and Nego.a.on of Differences. In: Improving Competencies in Clinical Ethics ConsultaIon. American Society for Bioethics and Humani.es Press.
Sensi.vity vs. Rela.vity • Cultural Sensi.vity: – Sensi.vity 16: the organism’s capacity to respond differen.ally to different s.muli or condi.ons. • In most behavioral usages, sensi.vity is measured in terms of thresholds.
– Sensi.za.on 16: the lowering of a threshold, as when prior delivery of an aversive s.mulus lowers the intensity at which a noise elicits a startle response. 16. Catania, A.C. (2013). Learning: FiXh EdiIon. New York: Sloan Publishing.
Sensi.vity vs. Rela.vity • Cultural Sensi.vity:
– Cultural Sensi.vity: the prac..oner’s capacity to respond differen.ally to different cultural s.muli or condi.ons in the form of behavioral pa;erns emi;ed by their clients. – Cultural Sensi.za.on: the lowering of the prac..oner’s threshold for tac.ng/responding to cultural s.muli or condi.ons emi;ed by their clients.
Sensi.vity vs. Rela.vity • Cultural Rela.vity:
– Rela.vism17: Assump.ve Framework • “a family of views whose common theme is that some central aspect of experience, thought, evalua.on, or even reality is somehow rela.ve to something else”.
– Ethical Rela.vism18: Dependent Variable – Cultural Rela.vism17: Independent Variable
17. Stanford Encyclopedia of Philosophy. (2003). Rela.vism. Obtained from the website: h;p://plato.stanford.edu/entries/rela.vism/ 18. Encyclopedia Britannica (2014). Ethical Rela.vism. Obtained from the website: h;p:// www.britannica.com/EBchecked/topic/194016/ethical-‐rela.vism
Sensi.vity vs. Rela.vity • Cultural Rela.vity:
– Rela.vism17: Assump.ve Framework – Ethical Rela.vism18: Dependent Variable • The Dependent Variable = Ethical Behavior • “a moral philosophical framework that a given set of values or statements about right or wrong are only valid in reference (i.e. rela.ve) to the local context or situa.on”.
– Cultural Rela.vism17: Independent Variable 17. Stanford Encyclopedia of Philosophy. (2003). Rela.vism. Obtained from the website: h;p://plato.stanford.edu/entries/rela.vism/ 18. Encyclopedia Britannica (2014). Ethical Rela.vism. Obtained from the website: h;p:// www.britannica.com/EBchecked/topic/194016/ethical-‐rela.vism
Sensi.vity vs. Rela.vity • Cultural Rela.vity:
– Rela.vism17: Assump.ve Framework – Ethical Rela.vism18: Dependent Variable – Cultural Rela.vism17: Independent Variable • The Independent Variable = Culture • The principle that an individual human’s beliefs and ac.vi.es should be understood by others in terms of the influences of that individual’s own culture.
17. Stanford Encyclopedia of Philosophy. (2003). Rela.vism. Obtained from the website: h;p://plato.stanford.edu/entries/rela.vism/ 18. Encyclopedia Britannica (2014). Ethical Rela.vism. Obtained from the website: h;p:// www.britannica.com/EBchecked/topic/194016/ethical-‐rela.vism
Sensi.vity vs. Rela.vity • Cultural Sensi.vity: – A;ending/Responding to pa;erns of behavior tacted as falling within the category of “cultural” and of which are emi;ed by a client.
• Cultural Rela.vity:
– How one is jus.fying the correctness or social appropriateness of a given behavior or value.
The Limits of Rela.vity • Paternalism • Commonly Cited Reasons – Clinical Fu.lity 19 – Conscien.ous Objec.on 20 – Clinical Inappropriateness 21 – Professional Society Viola.ons 20 19. Halliday, R. (1997). Medical fu.lity and the social context. Journal of Medical Ethics, 23, 148-‐153. 20. Buryska, J.F. (2001). Assessing the ethical weight of cultural, religious and spiritual claims in the clinical context. Journal of Medical Ethics, 27, 118-‐120. 21. Orr, R.D. & Genesen, L.B. (1997). Requests for “inappropriate” treatment based on religious beliefs. Journal of Medical Ethics, 23, 142-‐147.
Drawing Boundaries20 • Four Classes: 1. 2. 3. 4.
Strong Paternalism Weak Paternalism Weak Rela.vity Strong Rela.vity
• NB: SelecIonist class boundaries are fuzzy and condiIonal whereas essenIalisIc classes have sharper boundaries 22.
20. Buryska, J.F. (2001). Assessing the ethical weight of cultural, religious and spiritual claims in the clinical context. Journal of Medical Ethics, 27, 118-‐120. 22. Palmer, D.C. (2013). Some Implica.ons of a Behavioral Analysis of Verbal Behavior for Logic and Mathema.cs. The Behavior Analyst, 36, 267-‐276. 21.
.
Drawing Boundaries • Four Classes: 1. Strong Paternalism •
Does the claim conflict with laws, the Guidelines 23, or the dimensions of Applied Behavior Analysis 24?
2. Weak Paternalism 3. Weak Rela.vity 4. Strong Rela.vity 23. Behavior Analyst Cer.fica.on Board (2013). Guidelines for Responsible Conduct for Behavior Analysts. Obtained from the website: h;p://www.bacb.com/index.php?page=57 24. Baer, D.M., Wolf, M.M., & Risley, T.R. (1968). Some Current Dimensions of Applied Behavior Analysis. Journal of Applied Behavior Analysis, 1, 91-‐97. 24.
.
Drawing Boundaries • Four Classes: 1. Strong Paternalism 2. Weak Paternalism •
Does the claim pose a conflict of interest, conflict of “conscience”, or toy with the boundaries of the interven.on parameters defined from the specific funding stream?
3. Weak Rela.vity 4. Strong Rela.vity
Drawing Boundaries • Four Classes: 1. Strong Paternalism 2. Weak Paternalism 3. Weak Rela.vity •
•
Does the claim require a significant realloca.on of resources from the originally proposed goals and the program approved by a client’s funded contract? Shiq could be in terms of .me, staffing, materials, environments, behaviors targeted, money, etc.
4. Strong Rela.vity
Drawing Boundaries • Four Classes: 1. 2. 3. 4.
Strong Paternalism Weak Paternalism Weak Rela.vity Strong Rela.vity •
Does the claim fall within all legal, professional, funding, and current programma.c parameters and require li;le realloca.on of resources?
Drawing Boundaries • Four Classes: 1. 2. 3. 4.
Strong Paternalism Weak Paternalism Weak Rela'vity Strong Rela.vity
Some Strategies • Antecedent Responding: 1. Converse Early and Oqen Regarding Behavior Targets and Strategies for Targe.ng 2. Ask about how they spend their .me outside of/ away from therapy. 3. Informed Consent as an On-‐Going Process 4. Co-‐manage or assign a behavior analyst/direct staff of the same cultural group as the client.
Some Strategies • Antecedent Responding: 6. Iden.fy in advance a cultural authority 7. Establish a Local or Regional Ethics Commi;ee 8. “Know Thyself” 9. Understand how to contact a Clinical Ethicist or Bioethicist
Some Strategies • Consequence Responding: 1. Consult with a Behavior Analyst of the Same Cultural Group as the Client 2. Contact Cultural Authority for Clarifica.on 3. Quick to listen, but slow to speak. 4. Ensure Accurate Discrimina.on 5. Contact the ABAI Hotline
Summary • Cultural Sensi.vity versus Cultural Rela.vity • The Limits of Rela.vity • Drawing the Boundaries • Some Strategies
References 1. American Society for Bioethics and Humani.es (2009). Recogni.on of Context and Nego.a.on of Differences. In: Improving Competencies in Clinical Ethics ConsultaIon. American Society for Bioethics and Humani.es Press. 2. Baer, D.M., Wolf, M.M., & Risley, T.R. (1968). Some Current Dimensions of Applied Behavior Analysis. Journal of Applied Behavior Analysis, 1, 91-‐97. 3. Baum, W.M. (1994). Understanding behaviorism: Science, behavior, and culture. New York: Harper Collins College Publica.ons. 4. Baum, W. M. (1995). Rules, Culture, and Fitness (1995). The Behavior Analyst, 18, 1-‐21. 5. Behavior Analyst Cer.fica.on Board (2013). Guidelines for Responsible Conduct for Behavior Analysts. Obtained from the website: h;p:// www.bacb.com/index.php?page=57 6. Buryska, J.F. (2001). Assessing the ethical weight of cultural, religious and spiritual claims in the clinical context. Journal of Medical Ethics, 27, 118-‐120. 7. Catania, A.C. (2013). Learning: FiXh EdiIon. New York: Sloan Publishing. 8. Encyclopedia Britannica (2014). Ethical Rela.vism. Obtained from the website: h;p://www.britannica.com/EBchecked/topic/194016/ethical-‐rela.vism
References 9. Glenn, S.S. (1988). Con.ngencies and Metacon.ngencies: Toward a Synthesis of Behavior Analysis and Cultural Materialism. The Behavior Analyst, 11, 161-‐179. 10. Glenn, S.S. (2004). Individual Behavior, Culture, and Social Change. The Behavior Analyst, 27, 133-‐151. 11. Halliday, R. (1997). Medical fu.lity and the social context. Journal of Medical Ethics, 23, 148-‐153. 12. Harris, M. (1983). Cultural anthropology. New York: Harper & Row. 13. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experienIal approach to behavior change. New York: The Guilford Press. 14. Mallo;, R.W. (1988). Rule-‐Governed Behavior and Behavioral Anthropology. The Behavior Analyst, 11(2), 181-‐203. 15. Ma;aini, M.A. (1996). Envisioning Cultural Prac.ces. The Behavior Analyst, 19, 257-‐272. 16. McSween, T.E. (1995). Thevalues-‐based safety process. New York: Van Nostrom Reinhold.
References 17. Muller, J.H. & Desmond, B. (1992). Ethical dilemmas in a cross-‐cultural context – A Chinese example. Western Journal of Medicine, 157, 323-‐327. 18. Orr, R.D. & Genesen, L.B. (1997). Requests for “inappropriate” treatment based on religious beliefs. Journal of Medical Ethics, 23, 142-‐147. 19. Skinner, B.F. (1953). Science and Human Behavior. New York: The Free Press. 20. Skinner, B.F. (1973). Beyond Freedom and Dignity. Indianapolis: Hacke; Publishing. 21. Stanford Encyclopedia of Philosophy. (2003). Rela.vism. Obtained from the website: h;p://plato.stanford.edu/entries/rela.vism/ 22. Sugai, O’Keefe, & Fallon (2012). A contextual considera.on of culture and school-‐wide posi.ve behavior support. Journal of PosiIve Behavior IntervenIons, 14, 197-‐208. 23. Totsi, D. (2005). How to be a successful change consultant. (Available from Vanguard consul.ng:
[email protected]).
Contact Informa.on Thank You! David J. Cox
[email protected]
