Peer Perspectives

Combining the Fields of Social Work and Applied Behavior Analysis

By Liliana Uribe, DSW, LCSW

The social work profession was born when volunteers advocated for the needy and transformed into a holistic perspective of viewing clients and their challenges within their environment (NASW, n.d.). Since the creation of the social work profession, social workers have been skilled at conducting case management services in addition to clinical services.

Case management services include but are not limited to assessment, planning, implementation, coordination, monitoring, and evaluation of the client’s needs (Harkey, 2017). Social work is well known for understanding the challenges of clients and their impacts based on the client’s surroundings and daily interactions with individuals/systems, thus the hallmark perspective of the person-in-environment approach. In addition, case management services are unique to the client’s needs.

Behavioral analysis focuses on the behavioral challenges of a client to improve wanted behaviors and decrease unwanted behaviors (Behavior Analyst Certification Board, n.d.). Behavioral analysis is based on changing behaviors by education, repetition, and rewards and consequences (Behavior Analyst Certification Board, n.d.). Behavior analysis is used primarily with children diagnosed with spectrum disorders and other behavioral conditions such as ADHD and learning disabilities or delays.

Social work and behavior analysis at first sight appear to be completely different in respect to modalities of service. However, both professions can work well together. As a current lead analyst for children with behavioral challenges and a licensed clinical social worker, I am realizing the need for analysts to encompass case management and clinical experience. My clients at one point have required case management services and/or a holistic perspective of viewing the client’s and family’s challenges in a bigger picture.

A Holistic Perspective Combined Within the Behavior Analysis Field
A holistic perspective is defined as exploring all parts of an individual, including physical, spiritual, (CareersInPsychology.org, n.d.) and behavioral contexts (Harkey, 2017). However, within the behavior analysis field, the spiritual being of a child is not as important; the focus is on the behavior itself and how it impacts the life of that child. Understanding the child’s needs related to the cause of behavior is key and often, if not always, involves the parents and family. Thus, the need to practice within the whole person and person-in-environment contexts.

Understanding relationship dynamics within the family is important, as it could be the trigger for the behavior in reduction. Other environments such as the school setting and social settings outside of the school and home could also be triggers to the behavior in reduction. A holistic perspective within the field of behavior involves assessing the family’s challenges as whole. These challenges can include conflicts related to divorce/separation, behavioral health issues of parents and extended family members directly involved with the child, financial challenges, occupational challenges, and challenges to meeting basic needs of food, shelter, and safety.

Behaviors are not made and sustained in a bubble, but rather impacted by any and all environmental factors. How can analysts work effectively in reducing maladaptive behaviors while increasing adaptive behaviors when a family’s basic needs aren’t being met? Would parents of children with behavioral challenges be able to focus on the needs of their children when they are struggling to meet the needs of the family?

In my experience, parents often believe that the problem is that of the child and often do not participate in behavioral sessions despite the expectation that they eventually implement the techniques in the sessions on their own. The notion of “its not my problem but theirs” stems from parents having other difficulties related to environmental factors that impair their ability to focus on their children and the behavioral program. Hence, the need to have a person-in-environment, holistic perspective in implementing behavior services with children and their families.

Many of my behavior sessions have turned into crisis interventions with the parents because of the issues outside of the behaviors of their child. Regardless of whether, as a behavior analyst, my scope is not to engage in mental health services, it is nearly impossible to ignore the immediate needs of a family when they are directly impacting my client, the child.

Case Management and Behavior Analyses
Case management is a form of service that involves assessing client needs and referring to the appropriate resources. It encompasses education, evaluation, coordination, and follow-up. Case management is a “professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs” (Commission for Case Manager Certification, 2015).

Behavior services face challenges in conducting sessions in school settings where many children engage in maladaptive behaviors. While schools allow the lead analyst to meet with the child, many schools deny access to the registered behavior technician (RBT) who implements the behavior plan with the child daily. This causes a significant barrier in providing effective and efficient behavior services, especially when the maladaptive behaviors occur in the school setting.

With such challenges with the school settings, it requires the entire behavior team to advocate for their client. This entails screening, assessing, stratifying risk, planning, implementation/care coordination, following up, transitional care, communicating post transition, and evaluating (Harkey, 2017). In addition, parents request analysts and/or RBTs to support them going to doctor’s appointments, individualized education program meetings, parent-teacher meetings, and other therapies. It’s important to note that these types of services are not billable as they are considered indirect service (Sacipa, 2013).

Implications for Practice
The need for behavioral services continues to rise. It is important to help families with children with behavioral challenges using a holistic perspective. Agencies that focus on providing behavioral services have a department that focuses on the case management needs of a family and the child. It is next to impossible to work effectively with such children when the needs of the entire family are ignored because it is not behavioral in nature. If we cannot add or change the structure of such agencies, we must provide support to the analysts and RBTs who are conducting case management services within behavioral-focused services: Provide in-house trainings on how to assess family needs and coordinate necessary services to enhance the behavioral program.

— Liliana Uribe, DSW, LCSW, works as a lead analyst for children with behavioral challenges. She currently teaches for the Simmons University MSW program and Southern New Hampshire University undergraduate, and has extensive experience in several fields, including medical, academia, behavioral, and clinical with adults, older adults, and children. She has recently opened a private practice where she focuses on women’s health challenges.

References
Behavior Analyst Certification Board. (n.d.). About behavior analysis. Retrieved from https://www.bacb.com/about-behavior-analysis/.

CareersInPsychology.org. (n.d.). Holistic counseling on the rise. Retrieved from https://careersinpsychology.org/holistic-counseling/.

Commission for Case Manager Certification. (2015). Code of professional conduct for case managers — with standards, rules, procedures, and penalties. Retrieved from https://ccmcertification.org/sites/default/files/docs/2018/ccmc-18-code-of-conduct_1.pdf.

Harkey, J. (2017). Case management at the intersection of social work and health care. Social Work Today, 17(1), 20-23.

NASW. (n.d.). Social work history. Retrieved from https://www.socialworkers.org/News/Facts/Social-Work-History

Sacipa, Y. (2013). Medicaid coverage and prior authorization for applied behavior analysis services. Retrieved June 4, 2019, from http://ectacenter.org/~pdfs/listserv_compilations/ABA_Presentation_May_2013.pdf.