JOURNAL OF APPLIED BEHAVIOR ANALYSIS
THE RIGHT TO EFFECTIVE BEHAVIORAL TREATMENT
RON VAN HOUTEN
MOUNT SAINT VINCENT UNIVERSITY
SAUL AXELROD
TEMPLE UNIVERSITY
JON S. BAILEY
FLORIDA STATE UNIVERSITY
JUDITH E. FAvOu
AU CLAIR PROGRAM, MOUNT DORA, FLORIDA
RICHARD M. Foxx
ANNA MENTAL HEALTH CENTER, ANNA, ILLINOIS
BRIAN A. IWATA
UNIVERSITY OF FLORIDA
0. IVAR LOVAAS
UNIVERSITY OF CALIFORNIA AT LOS ANGELES
We propose that individuals who are recipients or potential recipients of treatment designed to
change their behavior have the right to a therapeutic environment, services whose overriding goal
is personal welfare, treatment by a competent behavior analyst, programs that teach functional skills,
behavioral assessment and ongoing evaluation, and the most effective treatment procedures available.
DESCRIPTORS: behavioral treatment, clients, ethics, treatment
During the last several decades, a number of
clinical procedures derived from experimental and
applied behavior analysis have been developed,
evaluated, and refined. These procedures have the
demonstrated ability to teach new behavior and
alleviate a variety of behavioral disorders. Unfortunately,
many who would benefit from behavioral
treatment are not receiving it. Behavior analysts
Report of the Association for Behavior Analysis (ABA)
Task Force on the Right to Effective Treatment. Ron Van
Houten served as the Task Force Chair and Brian A. Iwata
served as the Council Liaison. This report was accepted by
the ABA Executive Council and is also published in that
organization's journal, The Behavior Analyst (1988), Vol.
11; however, the report does not necessarily reflect the view
ofthe majority ofABA members nor does it constitute official
ABA policy. Reprints may be obtained from Brian Iwata,
Department ofPsychology, University ofFlorida, Gainesville,
Florida 32611.
have a professional obligation to make available
the most effective treatment that the discipline can
provide. Toward this end, the following statement
ofclients' rights is offered to direct both the ethical
and appropriate application of behavioral treat-
ment.
1. An Individual Has a Right to a
Therapeutic Environment
A physical and social environment that is safe,
humane, and responsive to individual needs is a
necessary prerequisite for effective treatment. Such
an environment provides not only training, but
also an acceptable living standard. The dimensions
ofan adequate living environment are complex and
varied; nevertheless, several elements are essential.
Individuals should have access to therapeutic
services, leisure activities, and materials that are
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RON VAN HOUTEN et al.
enjoyable as well as instructive. Thus, client preference,
in addition to factors such as age-appropriateness
and educative value, is relevant in the
selection of activities and materials. An adequate
environment also indudes parents, teachers, and
staff who are competent, responsive, and caring.
Such qualities may be characterized in terms of
frequent positive interactions that are directed toward
enjoyment, learning, and independence. Finally,
a therapeutic environment imposes the fewest
restrictions necessary, while ensuring individual
safety and development. Freedom of individual
movement and access to preferred activities, rather
than type or location ofplacement, are the defining
characteristics of a least restrictive environment.
2. An Individual Has a Right to Services
Whose Overriding Goal is Personal Welfare
The primary purpose of behavioral treatment is
to assist individuals in acquiring functional skills
that promote independence. Both the immediate
and long-term welfare of an individual are taken
into account through active participation by the
client or an authorized proxy in making treatmentrelated
decisions. In cases in which withholding or
implementing treatment involves potential risk, Peer
Review Committees and Human Rights Committees
play distinct roles in protecting client welfare.
Peer Review Committees, comprised of experts in
behavior analysis, impose professional standards to
determine the clinical propriety of treatment programs.
Human Rights Committees, comprised of
consumers, advocates, and other interested citizens,
impose community standards to determine the acceptability
of programs and the extent to which a
program compromises an individual's basic rights
to dignity, privacy, and humane care; appropriate
education and training; prompt medical treatment;
access to personal possessions, social interaction, and
physical exercise; humane discipline; and physical
examination prior to the initiation of a program
that may affect or be affected by an individual's
health status. Professional competence aided by peer
and human rights review will ensure that behavioral
treatment is delivered within a context of concern
for client welfare.
3. An Individual Has a Right to
Treatment by a Competent Behavior Analyst
Professionals responsible for delivering, directing,
or evaluating the effects ofbehavioral treatment
possess appropriate education and experience. The
behavior analyst's academic training reflects thorough
knowledge of behavioral principles, methods
ofassessment and treatment, research methodology,
and professional ethics. Clinical competence also
requires adequate practicum training and supervision,
including experience with the relevant client
population.
In cases in which a problem or treatment is
complex or may pose risk, individuals have a right
to direct involvement by a doctoral-level behavior
analyst who has the expertise to detect, analyze,
and manage subtle aspects of the assessment and
treatment process that often determine the success
or failure ofintervention. A doctoral-level behavior
analyst also has the ability, as well as the responsibility,
to ensure that all individuals who participate
in the delivery of treatment or who provide
support services are trained in the methods of intervention,
to assess the competence of individuals
who assume subsequent responsibility for treatment,
and to provide consultation and follow-up
services as needed.
4. An Individual Has a Right to Programs
That Teach Functional Skills
The ultimate goal of all services is to increase
the ability of individuals to function effectively in
both their immediate environment and the larger
society. Improvement of functioning may take several
forms. First, it often will require the acquisition,
maintenance, or generalization of behaviors that
allow the individual to gain wider access to preferred
materials, activities, or social interaction. Second,
it may require the acquisition of behaviors
that allow the individual to terminate or reduce
unpleasant sources ofstimulation. Third, improved
functioning may require the reduction or elimination
of certain behaviors that are dangerous or that
in some way serve as barriers to further independence
or social acceptability. Finally, as a member
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of society at large, an individual has a right to
services that will assist in the development of behavior
beneficial to that society.
Decisions regarding the selection ofservice goals
are not based on a priori assumptions of an individual's
behavioral potential or limitations. It is
conceivable that some goals may be achieved very
slowly, that others may be only approximated, and
that, in the process of achieving still other goals, it
may be necessary to expose the individual to either
immediate temporary discomfort (e.g., teaching
physical exercise as a means of promoting health)
or future risk (e.g., teaching an individual to cross
streets or to drive an automobile). Still, unless evidence
dearly exists to the contrary, an individual
is assumed capable offull participation in all aspects
of community life and to have a right to such
participation.
5. An Individual Has a Right to Behavioral
Assessment and Ongoing Evaluation
Prior to the onset of treatment, individuals are
entitled to a complete diagnostic evaluation to identify
factors that contribute to the presence of a skill
deficit or a behavioral disorder. A complete and
functional analysis emphasizes the importance of
events that are antecedent, as well as consequent,
to the behavior of interest. For example, identification
ofpreexisting physiological or environmental
determinants may lead to the development of a
treatment program that does not require extensive
use of behavioral contingencies.
The initial behavioral analysis is performed in
three stages. First, answers to the following types
of questions are obtained through an interview. Is
there any circumstance in which the behavior always
occurs? Is there any circumstance in which
the behavior never occurs? Does the behavior typically
occur at certain times of the day? Could the
behavior be associated with any form ofdiscomfort
or deprivation? Could events following the behavior
serve as either positive reinforcement (e.g., attention)
or negative reinforcement (e.g., escape from
demands)? The second stage of analysis, direct observation
of the individual's behavior under varied
and relevant circumstances, confirms suspected relationships
identified during the interview. Finally,
the assessment findings are incorporated into a systematic
treatment plan.
Successful intervention requires ongoing evaluation
in the form of objective data to determine
the effects of treatment, to quickly identify unanticipated
problems, and, ifnecessary, to modify the
treatment plan. The behavior analyst maintains accountability
and solicits timely input into the decision-making
process by sharing these data regularly
with all concerned parties.
6. An Individual Has a Right to the Most
Effective Treatment Procedures Available
An individual is entitled to effective and scientifically
validated treatment. In turn, behavior analysts
have an obligation to use only those techniques
that have been demonstrated by research to
be effective, to acquaint consumers and the public
with the advantages and disadvantages of these
techniques, and to search continuously for the most
optimal means of changing behavior.
Consistentwith the philosophy ofleast restrictive
yet effective treatment, exposure of an individual
to restrictive procedures is unacceptable unless it
can be shown that such procedures are necessary to
produce safe and clinically significant behavior
change. It is equally unacceptable to expose an
individual to a nonrestrictive intervention (or a series
of such interventions) if assessment results or
available research indicate that other procedures
would be more effective. Indeed, a slow-acting but
nonrestrictive procedure could be considered highly
restrictive ifprolonged treatment increases risk, significantly
inhibits or prevents participation in needed
training programs, delays entry into a more
optimal social or living environment, or leads to
adaptation and the eventual use ofa more restrictive
procedure. Thus, in some cases, a client's right to
effective treatment may dictate the immediate use
of quicker acting, but temporarily more restrictive,
procedures.
A procedure's overall level of restrictiveness is a
combined function of its absolute level of restrictiveness,
the amount of time required to produce
a clinically acceptable outcome, and the conse-
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quences associated with delayed intervention. Furthermore,
selection ofa specific treatment technique
is not based on personal conviction. Techniques are
not considered as either "good" or "bad" according
to whether they involve the use ofantecedent rather
than consequent stimuli or reinforcement rather
than punishment. For example, positive reinforcement,
as well as punishment, can produce a number
of indirect effects, some of which are undesirable.
In summary, decisions related to treatment selection
are based on information obtained during
assessment of the behavior, the risk it poses, and
its controlling variables; on a careful consideration
of the available treatment options, induding their
relative effectiveness, risks, restrictiveness, and potential
side effects; and on examination Qfthe overall
context in which treatment will be applied.
CONCLUSION
Behavior analysts have a responsibility to ensure
that their clients' rights are protected, that their
specialized services are based on the most recent
scientific and technological findings, that treatment
is provided in a manner consistent with the highest
standards of excellence, and that individuals who
are in need of service will not be denied access to
the most effective treatment available. In promulgating
the rights described in this document, the
field of behavior analysis acknowledges its responsibilities
by reaffirming its concern for individual
welfare and by prescribing the means by which
behavioral treatment can be delivered in the most
beneficial manner.
Received August 8, 1988
Final acceptance August 20, 1988
Action Editor, Jon S. Bailey
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