Stranger in a Strange Land: Implementation Science for Behavior Analysis

1. Stranger in a Strange Land: Implementation Science for Behavior Analysis Ronnie Detrich Wing Institute ABAI, 2014

2. Talking Points • Provide an example of successful culture change. • Describe principles of effective dissemination. • Behavior Analyst as cultural anthropologist.

3. Large Scale Change • Efforts typically have relied on rational discourse to persuade others to change. • Generally a weak model for change. • Not everyone shares the assumptions necessary for argument to be persuasive. • Not everyone is influenced by data. • Alternative strategies are necessary.

4. Texas Cleans Up • In the mid-1980s Texas was spending $20 million to clean up roadside litter. • Various campaigns had been ineffective • Keep America (Texas) Beautiful (Lady Bird Johnson)

6. What Did They Do? • Target audience: Males between 18-35 • Series of public service announcements by iconic Texans including: • Willie Nelson • Joe Ely • Texas Tornados • Fabulous Thunderbirds

7. No One More Iconic than SRV

9. Effects of Don’t Mess with Texas • Reduced roadside litter by 72% between 1986-1990. • Effects are maintaining. • Considered the most successful anti-littering campaign in history. • Phrase has become part of the culture of Texas - extends well beyond littering.

10. Science of Implementation • Identifies variables that result in broad scale adoption of new practices.

11. Influencing Dissemination • Rogers (2003): Diffusion of innovation is a social process, even more than a technical matter. • The adoption rate of innovation is a function of: • its compatibility with the values • beliefs • past experiences of the individuals in the social system.

12. Principles for Effective Dissemination:Improving the Odds (Rogers, 2003) • Innovation has to solve a problem that is important for the “client.” • Innovation must have a relative advantage over current practice. • It is necessary to gain support of the opinion leaders if adoption is to reach critical mass and become self-sustaining. • Innovation must be compatible with existing values, experiences and needs of the community.

13. Stranger in Strange Land: Behavior Analyst as Cultural Anthropologist • Anthropologist identifies valuesand behaviors that define a culture. • Values=reinforcers within the culture. • Behaviors=maintained by those reinforcers. • Assessing culture: • Identifies important cultural practices and maintaining reinforcers. • Identifies potential obstacles to culture change • Suggests strategies for change.

14. Defining Cultural Practice • Cultural practice: behavior that most members of the defined culture do. • Both overt and verbal behavior. • Can be measured via direct observation and surveys. • Measurement method depends on behavior of interest. e. g. Aarons-Evidence-based Practice Attitude Scale

15. Metrics for Measuring Cultural Practice • Incidence rates: • frequency that specific behaviors occur within a period of time. • Prevalence: • percent of population that engages in behavior.

16. Some Assumptions • High incidence rates + widespread prevalence = contingencies supporting practice. • Changing cultural practices requires changing the relevant contingencies.

17. Possible Interactions Incidence High Low Cultural Practice • Cultural Practice • Inadequate Frequency High Prevalence Not Cultural Practice Not Cultural Practice • Subset of population engages in behavior • Effective contingencies in place for this subset of culture Low • No contingencies to support behavior

18. Analytical Task Incidence High Low What contingencies support practices? • Barriers to higher frequencies? • Lack of time? • Lack of resources? • Unclear expectations? High Prevalence Differences between high/low performers? Barriers to greater prevalence/incidence? Low • Verbal repertoires? • Training? • Unclear expectations? • Training? • Experience? • Peer group?

19. Closing Thoughts • Not everyone is persuaded by data and scientific explanation. • To be effective, it is necessary to attend to audience variables and “make the case” in the most effective way. • Behavior analysts should behave like cultural anthropologists.

20. Thank you. Slides available at winginstitute.org

21. Example • Incidence • Example: CBM probes completed = 10 per 2 weeks. • Goal: 20 students x 20 teachers x 2 weeks = 800 probes. • Prevalence • 20% (4/20) of teachers completed at least one CBM probe in 2 week period. • Goal: 100% (20/20) of teachers complete CBM probes every 2 week.

22. Possible Interactions Incidence High Low Cultural Practice Cultural Practice High Prevalence Not Cultural Practice Not Cultural Practice • Subset of population engages in behavior effective • Contingencies in place for this subset of culture Low • No contingencies to support behavior

23. Measuring Verbal Behavior • Some occasions prevalence more important measure than frequency. • Verbal behavior measures • Example: “attitudes” toward data-based decision making. • Task is to identify breadth and depth of “attitude.” • Example: Aarons (2005) measured attitude toward EBP among mental health workers. • Verbal behavior does not always correspond to overt behavior. • Important to measure all behavior not just verbal. • Ferster (1967) what people do more important than what they say.