Mi Trinh, BA, Carolina Arguello, BA, and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment
In November 2020, The Association for Behavior Analysis International (ABAI) shared a resource titled “Interprofessional Collaborative Practice Between Behavior Analysts and Speech-Language Pathologists.” This document was developed by Trina D. Spencer, PhD, BCBA-D, Lina Slim, PhD, BCBA-D, CCC-SLP, Teresa Cardon, PhD, BCBA-D, CCC-SLP, and Lindee Morgan, PhD, CCC-SLP, who served as members of the workgroup and are applauded for their efforts. We are highlighting this important document as behavior analysts and speech-language pathologists share many clients diagnosed with autism spectrum disorders and often experience an overlap in scopes of practice across several areas. While successful collaboration often leads to better outcomes, conflicts may arise from incompatible goals, competition for scant resources, unclear boundaries, diminished opportunities for communication, role tensions, and misconceptions and misunderstandings that members of one discipline may have about the other. Unfortunately, some behavior analysts may not understand their scope of practice, overestimate their scope of competency, or disregard the value and need for other professions, particularly given that the science of behavior analysis applies to all behaviors.
The responsibility of a behavior analyst, as described in the Ethics Code for Behavior Analysts (Code 1.05), states that prior to working with a novel population or behavior, the behavior analyst must receive training and supervision, conduct a review of relevant research, and consult or work with a professional on that treatment plan. Otherwise, the behavior analyst is bound to refer clients to a competent professional with experience in that area to best support the client and their individual needs (Code 3.13). Additionally, behavior analysts have a responsibility to collaborate with colleagues (Code 2.10) within the field and with professionals from other fields. We remind our readers of these expectations as it provides an important backdrop for the document summarized herein. Readers are encouraged to familiarize themselves with the 4th Edition of the BACB Task List that showcases entry level scope of practice and with other articles related to scope of competence (e.g., Brodhead et al., 2018).
“Interprofessional Collaborative Practice Between Behavior Analysts and Speech-Language Pathologists” offers behavior analysts a framework that addresses: 1) interprofessional collaboration with speech-language pathologists; and 2) understanding and articulating the scope of practice and scope of competence of each professional.
Know Your Scope
The scopes of practice for both speech-language pathologists and behavior analysts are set forth by their regulating bodies, the American Speech-Language-Hearing Association (ASHA), and the Behavior Analyst Certification Board (BACB®), respectively. The authors urge behavior analysts to be transparent about both their scope of practice and their scope of competence. They should be prepared to collaborate and consult bidirectionally when necessary.
As the document suggests, behavior analysts should only practice in the space where their scope of practice overlaps with their scope of competence. They should always act in accordance with the Ethics Code for Behavior Analysts. Authors’ note: readers can refer to this BACB document to better understand the changes occasioned by the new version which will become effective January 1, 2022.
The first principle described in the BACB®’s Ethics Code for Behavior Analysts states that behavior analysts must ensure they do no harm by respectfully collaborating with others in the interest of their clients (Core Principle 1). This leads us to the next set of actions that reflect how behavior analysts and speech-language pathologists can collaborate effectively:
- Respect each other’s professional backgrounds and professional priorities when discussing and creating clients’ goals;
- Understand the unique role each professional will hold within the collaborative relationship; and
- Communicate to enhance client benefit and work together.
However, as the authors have noted, potential for conflict can still exist between behavior analysts and speech-language pathologists, particularly when they are treating the same clients with autism. Individuals diagnosed with autism often have an Individualized Education Program (IEP) or Behavior Intervention Plan (BIP) that includes a set of goals written by various professionals on their team. In some cases, behavior analysts and speech-language pathologists may have overlapping scopes of competence as well, although their training and theoretical framework for effecting change varies: behavior analysts operate from a behavioral perspective while speech-language pathologists typically focus on a linguistic or developmental point of view. Both practitioners can contribute to the clients’ goal creation; however, the issue arises when these professionals are not in agreement. In these situations, professionals should always remain humble, be open-minded, and find ways to collaborate. The authors propose that behavior analysts can incorporate a developmental approach within behavioral programs to achieve better outcomes for clients and such a suggestion has been echoed by others (e.g., Schreibman et al., 2015).
Collaboration Between Professionals
Given that behavior analysts and speech-language pathologists may share the same space with overlapping practices, establishing a collaborative relationship would ensure the best outcomes for clients. Some opportunities for collaboration are discussed: speech-language pathologists would benefit from collaborating with behavior analysts by drawing from their expertise in behavior management techniques, functional communication training, single case design methodology, data collection strategies, preference assessments, and principles and tactics of effective teaching. Each of these areas is within a behavior analyst’s scope of practice. Similarly, behavior analysts would benefit from collaborating with speech-language pathologists by drawing from their skill expertise in developmental norms, articulation/phonology, structures of language, feeding, language sampling, and augmentative and alternative communication. Moreover, working together in a collaborative manner may reduce opportunities of misunderstanding and inaccurate assumptions, prevent unwanted duplication of goals and ensure that clients’ benefit remains at the forefront of these conversations.
Collaboration can result in a fruitful relationship between behavior analysts and speech-language pathologists. However, this should not stop here. There are many other professionals (e.g., medical professionals, occupational therapists, psychologists, neurologists, etc.) that may be working with individuals with autism. True collaboration between each of these professionals for individuals with autism means access to a bounty of services. Ensuring each professional has their own set of specific goals or mutually agreed upon shared goals and avoiding conflicting or unintended duplicative goals can save time and money for families. While this article provides an excellent guide for foundations in collaboration between behavior analysts and speech-language pathologists, we believe collaboration between these two professionals should extend to all professionals on an individual’s team to optimize successful outcomes and improve quality of service delivery.
Interprofessional Collaboration Competencies
As stated in this document, ABAI Practice Board’s recommends that professionals and their institutions adopt the World Health Organization’s (WHO) Framework for Action on Interprofessional Education and Collaborative Practice (IPEC) and uphold interprofessional practice (IPP) and interprofessional education (IPE) to build competency (Spencer et al., 2020, WHO, 2010). IPP entails collaboration between professionals of various backgrounds to ensure delivery of high-quality treatment. IPE entails collaboration between students of different professional backgrounds (e.g., SLP student and BCBA student).
The authors describe four interprofessional competencies to provide guidance for behavior analysts that emerge from the principles set forth by the WHO. The first competency requires behavior analysts to uphold integrity and respect for other professionals when working on the same treatment teams to ensure effective interprofessional collaboration. The second competency suggests behavior analysts be transparent about their roles, responsibilities, and any limitations to other professionals on their team as well as acknowledge their colleagues’ values and philosophies. The third competency recommends communicating with other team members in a professional, positive, and constructive manner. Lastly, like any other members of the team, behavior analysts are responsible to work with the shared goal of optimizing clients’ outcomes based on evidence-based practice. True collaboration does not merely mean working well together with individual goals, but it means contributing to improve the overall performance of the team as well as the outcomes for the clients.
Looking to the Future
This document is an important first step in promoting collaboration, fostering respect, and building synergistic relations – all of which would be beneficial to the individuals with autism who are commonly served. Given the tensions that sometimes exist between behavior analysts and professionals from fields such as psychology, education, and occupational therapy, extension of this document to other relationships is warranted and worthwhile.
The distinction between scope of practice and scope of competence is a critically important one and we appreciate the authors contrasting these two areas. Although not discussed as frequently or explicitly as it should, behavior analysts must make sound and careful decisions about continuing education selections and when and why to avail themselves of opportunities for consultation, supervision, referral, and additional training. Far too often selection of continuing education experiences is not as intentional and individualized as they could be.
Specific models of collaboration would be immensely helpful both clinically and related to training. There are both global and specific ways that behavior analysts and speech-language pathologists can coordinate their services. The list below is not meant to be exhaustive:
- The assessment data of one provider can better inform the implementation efforts of the other provider;
- Barring funding constraints, periodic co-treatment and/or direct observation of sessions can be useful;
- One provider can focus on the systematic assessment and promotion of carryover/generalization of the acquisition efforts of the other provider; and/or
- A behavior analyst can implement a functional communication training intervention for a nonverbal student relying on the speech-language pathologist’s expertise with AAC.
With respect to professional development, a few suggestions could involve attending conferences hosted by other disciplines, attending a continuing education event with a colleague from another discipline, sharing ideas on implementation and collaboration, and generously sharing specific resources connected to the treatment goal being addressed at a particular time. Our examples are not meant to be exhaustive but rather illustrative of the way professionals from these two disciplines can embody collaboration.
Finally, it is important to recognize another topic that has received much attention in recent years. Several authors have noted that providing compassionate care in all of our relationships can improve communication and collaboration of professionals and caregivers, as well as amongst professionals (e.g., Kirby et al., 2017; Taylor et al., 2018). It cannot be overstated that compassionate care in clinical relationships can strengthen the social validity of our services with respect to goals, outcomes, and intervention selection and implementation.
Missteps will undoubtedly occur. Creating a collaborative space and learning how these missteps can be resolved and ideally prevented would benefit client and team functioning. Demonstrating appropriate assertion, advocacy, compassion, grace, and humility are skills that can add to these important relationships.
We are grateful that this working group produced this important piece as it is timely and much needed; and we look forward to ongoing conversations that will ensue.
American Speech-Language-Hearing Association (2016). Interprofessional education/interprofessional practice (IPE/IPP). Retrieved from www.asha.org/Practice/Interprofessional-Education-Practice
Brodhead, M. T., Quigley, S. A., & Wilczynski, S. M. (2018). A call for discussion about scope of competence in behavior analysis. Behavior Analysis in Practice, 11, 424-435. https://doi.org/10.1007/s40617-018-00303-8
Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017). A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behavior Therapy, 48(6), 778–792. https://doi.org/10.1016/j.beth.2017.06.003
Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser A. P., Bruinsma, Y., McNerney, E., Wetherby, A., & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411-2428. https://doi.org/10.1007/s10803-015-2407-8
Spencer, T. D., Slim, L., Cardon, T., & Morgan, L. (2020). Interprofessional collaborative practice between behavior analysts and speech-language pathologists. Association for Behavior Analysis. https://www.abainternational.org/media/180194/abai_interprofessional_collaboration_resource_document.pdf
Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654–666. https://doi.org/10.1007/s40617-018-00289-3
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. https://www.who.int/hrh/resources/framework_action/en
Citation for this article:
Trinh, M, Arguello, C., & Celiberti, D. (2021). A review of Interprofessional collaborative practice between behavior analysts and speech-language pathologists. Science in Autism Treatment, 18(5).
Other related ASAT articles:
- Perspectives: Applied behavior analysis in speech-language therapy (2000)
- Perspectives: The myths I believed about behavior analysis (2017)
- Clinical Corner: What is verbal behavior? Is it different from ABA, and does my child need it to learn language?
- Clinical Corner: Integrating ABA and speech pathology
- Clinical Corner: Ethics and evidence-based practice
- Resources for implementation of evidence-based practices
- Review: A review of compassionate care in behavior analytic treatment
Other related resources:
Donaldson, A. L., & Stahmer, A. C. (2014). Team collaboration: The use of behavior principles for serving students with ASD. Language, speech, and hearing services in schools, 45(4), 261-276. https://doi.org/10.1044/2014_LSHSS-14-0038
Gerenser, J. E., & Koenig, M.A. (2019). ABA for SLPs: Interprofessional collaboration for autism support teams. Brookes.
Koenig, M., & Gerenser, J. (2006). SLP-ABA: Collaborating to support individuals with communication impairments. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 1(1), 2-10. https://dx.doi.org/10.1037/h0100180
LaFrance, D. L., Weiss, M. J., Kazemi, E., Gerenser, J., & Dobres, J. (2019). Multidisciplinary teaming: Enhancing collaboration through increased understanding. Behavior Analysis in Practice, 12(3), 709-726. https://doi.org/10.1007/s40617-019-00331-y