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Behav Analysis Practice (2016) 9:84–94
DOI 10.1007/s40617-016-0111-6
DISCUSSION AND REVIEW PAPER
Developing the Cultural Awareness Skills of Behavior Analysts
Elizabeth Hughes Fong 1 & Robyn M. Catagnus 2 & Matthew T. Brodhead 3 &
Shawn Quigley 4 & Sean Field 5
Published online: 4 February 2016
# Association for Behavior Analysis International 2016
Abstract All individuals are a part of at least one culture.
These cultural contingencies shape behavior, behavior that
may or may not be acceptable or familiar to behavior analysts
from another culture. To better serve individuals, assessments
and interventions should be selected with a consideration of
cultural factors, including cultural preferences and norms. The
purpose of this paper is to provide suggestions to serve as a
starting point for developing behavior analysts’ cultural
awareness skills. We present strategies for understanding behavior analysts’ personal cultural values and contingencies
and those of their clients, integrating cultural awareness
practices into service delivery, supervision, and professional
development, and becoming culturally aware in everyday
practice.
Keywords Culture . Cultural awareness . Applied behavior
analysis . Diversity
Skinner (1953) defined culture as variables Barranged by other
people^ (p. 419). That is, humans control contingencies of
Elizabeth Hughes Fong, Robyn M. Catagnus, and Matthew T. Brodhead
shared first author
* Robyn M. Catagnus
[email protected]
1
Arcadia University, Glenside, PA, USA
2
The Chicago School of Professional Psychology, Chicago, IL, USA
3
Purdue University, West Lafayette, IN, USA
4
The University of New Mexico Medical Group, Albuquerque, NM,
USA
5
Western Michigan University, Kalamazoo, MI, USA
reinforcement and punishment that affect the behavior and
learned reinforcers and punishers of a person or a group of
people. Culture may be further defined as Bthe extent to which
a group of individuals engage in overt and verbal behavior
reflecting shared behavioral learning histories, serving to differentiate the group from other groups, and predicting how
individuals within the group act in specific setting conditions^
(Sugai et al. 2012, p. 200). Distinguishable stimuli and response classes that occur in cultures include race, socioeconomic class, age, religion, sexual orientation, ethnicity, disability, nationality, and geographic context (Sugai et al.
2012). An individual’s unique set of distinguishable stimuli
and response classes are collectively referred to as an individual’s cultural identity. One benefit of determining cultural
identity is it can allow behavior analysts to develop an awareness of a client’s personal cultural values, preferences (i.e.,
learned reinforcers), characteristics, and circumstances
(contingencies at the third level of selection; Skinner 1981).
There are possible benefits for society, too, such as to better
guide assessment and intervention practices. By acknowledging the importance of culture, behavior analysts can help
achieve socially meaningful goals such as reducing disparities
in access to services and improving the quality of services
for diverse populations in behavioral health systems
(U.S. Department of Health and Human Services 2001).
Culturally aware behavior analysts should understand their
own cultural values, preferences, characteristics, and
circumstances and seek to learn about those of their clients.
That is, behavior analysts should be aware about their own
personal biases and how they compare to and may affect their
relationship with their client. This awareness of both self and
clients may be important because, as Spring (2007) suggests,
evidence-based services require a combination of clinical expertise and knowledge of the client’s preferences and learning
histories. Behaviorally, cultural awareness may be defined as
Behav Analysis Practice (2016) 9:84–94
the discriminated operant of tacting contingencies of reinforcement and punishment administered by a group of individuals. In other words, a behavior analyst who is culturally
aware is able to identify the reinforcement and punishment
contingencies that have been established by themselves, their
colleagues, their family, and any other social group they may
belong to or identify with. Behavior analysts’ ability to tact
contingencies for self and others may facilitate development
of a behavior change program that is informed by their clients’
specific cultural contingencies.
Further, cultural awareness may be important because behavioral patterns that are viewed as problematic in our own
culture may be the norm in other cultures (Goldiamond 2002;
Vandenberghe 2008). Consider the following example of a
child who was referred for a functional assessment for
Bwithdrawn^ behavior. The behavior analyst and a special
education observed the student became Bwithdrawn^ after receiving verbal praise. In fact, the student ultimately stopped
engaging in any appropriate behavior which lead to the verbal
praise. While collaborating with the family to gather data during the functional assessment, they determined that the student’s Bwithdrawn^ behavior occurred because of child’s lack
of comfort with receiving individual attention. In the child’s
culture, the whole (i.e., community) comes before the individual. However, neither the behavior analyst nor the special
education teacher questioned their personal assumption that
the behavior is inappropriate for the classroom or their preferences about how children should act after receiving praise.
Because the student’s withdrawn behavior is maintained by
a lack of attention, the behavior analyst and special education
teacher suggest administering praise privately. In this case,
their lack of understanding about how the cultural contingencies support the client’s Binappropriate behavior^ may have
resulted in a treatment recommendation that was incongruent
with cultural values. However, a culturally aware intervention,
which seeks understanding of client values, characteristics,
preferences, and circumstances would honor the client’s culture and allow the client to successful in a given environment.
A thorough behavior analytic intervention may be effective
with individuals across various cultures (Kauffman et al. 2008;
Tanaka-Matsumi et al. 1996). However, skilled, thorough, and
well-trained behavior analysts may not always consider client
culture. When assessing an individual’s or a group’s behavior,
behavior analysts often collect data about motivating operations, antecedents, behaviors, and consequences. However,
common functional assessment data collection strategies and
interview forms may not thoroughly explore cultural preferences and norms. Behavior analysts may consider the intersection of a cultural and linguistic context with the terms, concepts,
and science of behavior analysis (Jones and Hoerger 2009). It is
possible that, without information about cultural preferences
and norms, behavior analysts may unintentionally provide less
than optimal service delivery.
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Consider an example of a behavior analyst who provided
in-home and community services to the family of a child with
severe autism. The family, to whom church is very important,
attended a weekly three hour church service. The behavior
analyst, who did not attend church and was not a religious
person, failed to inquire in detail about the family’s and child’s
experience at church. Eventually, the family specifically asked
the behavior analyst to teach the child the necessary skills to
participate in the church service. However, the behavior analyst still did not assign a high priority to teaching the child the
skills needed for successful church attendance. The behavior
analyst’s choices demonstrated a lack of understanding of the
client’s values, characteristics, preferences, and circumstances. In contrast, a culturally aware behavior analyst may
be aware that Bthe selection of target behaviors is an expression of values^ (Kauffman et al. 2008, p. 254) and that parental expectations of children are likely controlled by cultural
contingencies (Akcinar and Baydar 2014).
In addition to the previous two examples, being culturally
aware may also increase the probability that behavior analysts
will engage in behaviors that are socially acceptable to people
from diverse cultural backgrounds. These behaviors include
selecting culturally appropriate treatments (see Rispoli et al.
2011), recognizing that Bparenting styles that are culture specific could lead to distinct behavioral consequences for a
child^ (Akcinar and Baydar 2014, p. 119), and implementing
culturally appropriate language acquisition programs (see
Brodhead et al. 2014). Cultural awareness could also ensure
that behavior analysts treat service delivery as Balways a twoway street^ (Bolling 2002), meaning that the relationship between the behavior analyst and the stakeholders should include input about what cultural contingencies and values
may contribute to an effective relationship and intervention.
Finally, increasing cultural awareness may also decrease
the probability of behavior analysts expecting the clients they
serve to conform to their own cultural and scientific values
and contingencies. The science of applied behavior analysis
(ABA) is a unique cultural system (see Glenn 1993). Given
that the science of ABA inherently embodies a certain set of
values such as a Westernized model of science and health care,
the cultural values and contingencies of ABA may not always
align with those of the client. As Bolling (2002) noted,
It is difficult for people in the US cultural mainstream,
including researchers, to believe that there are any assumptions other than their own about how the world works,
what a ‘person’ is, how we function, how time works, what
feelings are, how to use language, what the goal of life is,
how people interrelate, [and] how and where it is appropriate to show feelings or to seek help. (p. 22)
Awareness of cultural differences and similarities may allow for programmatic modifications that result in more
86
culturally appropriate models of behavior analytic service
delivery.
In summary, there may be many important reasons for behavior analysts to develop cultural awareness skills.
Although there is a growing interest in conceptual (e.g.,
Brodhead et al. 2014; Fong and Tanaka 2013) and applied
strategies for administering behavioral interventions for clients from diverse cultural backgrounds (e.g., Padilla
Dalamau et al. 2011; Rispoli et al. 2011; Washio and
Houmanfar 2007), there is little guidance concerning how
practicing behavior analysts can become culturally aware or
further develop that awareness. Therefore, guidance on how to
become culturally aware may be an important resource for
behavior analysts.
The purpose of this paper is to offer suggestions that can
serve as a starting point for how behavior analysts may further
increase their cultural awareness. We believe that cultural
awareness, as described herein, reflect Baer et al. (1968) statement that the Bbehavior, stimuli and/or organism under study
are chosen because of their importance to man and society^
(p. 92). Individuals participating in behavior change programs
and those who provide significant support for them should
determine what is important to them, to their society, and to
their culture. In this paper, we discuss strategies for understanding a client’s cultural values and contingencies, as well
as those of the behavior analyst. Then, we describe strategies
for embedding cultural awareness practices into behavior analytic service delivery, supervision, and professional development. Finally, we conclude with additional discussion and
considerations for becoming culturally aware in everyday
practice.
Strategies for Developing Cultural Awareness
The following two sections describe how behavior analysts
can become more aware of personal cultural values and contingencies and how they can develop skills to learn about their
clients’ cultural identities. We will refer to cultural values and
contingencies as the cultural system, except where values or
contingencies play an independent role in our analysis of developing cultural awareness. We will refer to cultural identity
as characteristics that extend beyond individual differences to
those traits that members of a given culture share with one
another (Adler 1998). For example, an individual from Africa
may express their cultural identity through their belief structure, attire, foods eaten, or hair style. Even though this individual might identify as African, there are subcultures to
which they might further identify with. Our suggestions are
meant to serve as a starting point for furthering a behavior
analytic understanding of cultural awareness and how that
awareness can be integrated and improved upon in everyday
practice. It is recommended that behavior analysts
Behav Analysis Practice (2016) 9:84–94
concurrently engage in cultural awareness practices
concerning their own behavior as well as those of their clients.
It is important to be aware of one’s own biases or
preconceived notions as a behavior analyst, as well acknowledging limitations in one’s cultural knowledge. Lastly, our
suggestions are not intended to result in a rigid set of rules
or practices. Rather, our hope is the suggestions will lead to
broad practices that develop and continually refine cultural
awareness, which will hopefully allow behavior analysts to
be more open and flexible to the various cultures that will be
experienced. Openness and flexibility in the presence of various cultures will hopefully result in better outcomes for those
we serve.
Developing Cultural Awareness of Self
From a behavior analytic perspective, self-awareness can be
defined as verbal discrimination of our own behavior (BarnesHolmes et al. 2001). Sugai et al. (2012) describe culture as
common behaviors related by comparable learning histories,
social and environmental contingencies, contexts and stimuli,
so self-awareness might also include verbal discrimination of
these aspects of personal experience. An understanding of our
own cultural system may be an important first step toward
correcting biases that affect our interactions with others
(Lillis and Hayes 2007). The American Psychological
Association’s (APA) (2003) multicultural guidelines encourage clinicians to Brecognize that, as cultural beings, they may
hold attitudes and beliefs that can detrimentally influence their
perceptions of and interactions with individuals who are ethnically and racially different from themselves^ (p. 382).
Developing self-awareness may prevent our biases from impeding how we serve culturally diverse clients.
One strategy to enhance cultural self-awareness is talking
about our diverse client interactions with a professional community in group discussions, written forums, journals, mentorship meetings, verbal feedback sessions, or self-reflective
exercises (Tervalon and Murray-Garcia 1998). Skinner (1974)
emphasized the relationship between self-awareness and control over our own behavior,and proposed that talking about
our behavior is how we achieve self-awareness. Recent behavior analytic research indicates that when individuals verbally describe their own behavior, the behavior may change
(Tourinho 2006). Discussion with mentors and colleagues
may help behavior analysts learn about themselves and also
change their cross-cultural interactions for the better.
Another suggestion is to be Bmindful^ by attending fully
and alertly, in the moment, to client interactions and our own
private events, without judging or evaluating the events as
they occur (Bishop et al. 2004; Hayes and Plumb 2007;
Vandenberghe 2008). We recommend practitioners hone their
ability to attend closely to clients and self, in context, for two
reasons related to self-awareness. First, such attention may
Behav Analysis Practice (2016) 9:84–94
help enhance skills of self-observation and self-description
regarding our overt and covert behavior. Also, while we can
remain committed to overtly behaving in ways consistent with
values of multiculturalism, even in the presence of values and
contingencies that create bias, mindfulness may reduce the
biases that produce thoughts, feelings, and reactions to culturally diverse people (Lillis and Hayes 2007). Attending closely
to our clients and being active and alert is good practice for
building rapport, too.
Clinicians can engage in more culturally aware practice by
assessing, collecting data, and testing hypotheses rather than
accepting their own experiences and biases as the norm (Sue
1998). Scientific mindedness is a characteristic of clinicians
and human service providers who develop theories about client behaviors by analyzing data rather than by dependence on
their personal assumptions (Sue 1998), and may reduce bias
and foster better understanding of client behavior. A reliance
on scientific, behavior analytic knowledge when working with
clients is also required by the Professional and Ethical
Compliance Code for Behavior Analysts (BACB 2015).
While mindful attention focuses on the interaction between
the behavior analyst and the client/family, scientific mindedness is a focus on interpreting information from the client and
family; both characteristics facilitate culturally aware practice.
For example, a behavior analyst consults to a family of a child
with a sleep disorder, and learns that the mother sleeps in her
five-year-old child’s bed while the father sleeps in a larger
room, alone. The practitioner may notice, and be able to covertly tact, that this is not the norm of the cultural majority nor
congruent with his personal experience or values. The analyst
may assume that the mother should not sleep in the child’s bed
or notice thoughts of judgment he feels. Lillis and Hayes
(2007) recommend practitioners accept that such reactions
may be normal, given our cultural systems and the human
tendency to evaluate, but remain committed to acting positively based on our values. Through a process of assessment and
covert verbal behavior, the practitioner might accept the cosleeping arrangement to be culturally appropriate for and preferred by the family, and choose to develop an intervention
that keeps the arrangement in place. A blend of both selfawareness and reliance on scientific knowledge is likely to
produce the most culturally aware assessment and
intervention.
Finally, there are several self-assessment tools that behavior analysts can use to become more aware of their own cultural identity. We recommend the use of assessment tools for
measuring and reflecting on the clinician’s own cultural
biases, values, and understanding. One assessment tool, the
BDiversity Self-Assessment,^ that can be utilized during the
intake process allows team members to examine their understanding of diversity (Montgomery 2001); this tool asks users
to reflect on their own assumptions and biases by answering
11 questions. Another assessment tool that may be useful is
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the self-test questionnaire entitled BHow Do You Relate to
Various Groups of People in Society?^ (Randall-David
1989). This questionnaire asks respondents how they might
respond to individuals of various cultural backgrounds—by
greeting, by accepting, by obtaining help from, by having
background knowledge about, and/or by advocating for the
individuals. The 30 types of individuals in these questions are
then organized into five categories: ethnic/racial, social issues/
problems, religious, physically/mentally handicapped, and
political, and a concentration of checks within a specific category of individuals or at specific levels of response may then
indicate a conflict that could prevent the respondent from providing effective treatment. Behavior analysts can then consider how their biases might affect treatment and may consider
other courses of action, such as making referrals to other behavior analysts. A final potentially useful measure is the
Multicultural Sensitivity Scale (Jibaja et al. 2000), a 21-item
self-assessment tool developed as a valid and reliable way to
measure multicultural sensitivity. This tool was originally
used to assess the multicultural sensitivity of teachers and
was later adapted to be used by physician assistant students
(Jibaja-Rusth et al. 1994). Altogether, the behavior analyst
may find these assessments helpful in further developing their
own cultural awareness in order to further develop culturally
competent methods of service delivery.
Developing Cultural Awareness of Clients
The above section describes strategies for how a behavior
analyst may learn about his or her own cultural system.
Below, we describe how behavior analysts may learn more
about their client’s cultural system through assessment practices. Culturally aware assessment practices may allow behavior analysts to obtain important cultural information about
clients in order to understand their worldviews. Culturally
aware assessment may also allow behavior analysts to identify
any potential cultural barriers such as modalities of communication and expression of emotions (see Garcia et al. 2003).
To increase the probability that assessment will identify
cultural variables, Vandenberghe (2008) recommends focusing on functional relations and behavioral principles rather
than topography. For example, Filipino families often live
with extended family members, and the household situation
can seem chaotic by Western living standards. If a child has
difficulty sleeping, a behavior analyst may advise the parents
that they should separate the sleeping room from the living
room. People of Filipino descent may be shy about responding
to someone in a position of authority, so they may say Byes^ to
the behavior analyst. However, during the following session,
it might be revealed that the parents did not change anything
and that the child is still sleep deprived. In this case, a natural
reaction may be to become frustrated with the lack of parental
follow through. However, lack of follow through may also be
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interpreted as an indicator that the intervention recommendation may not have been culturally appropriate.
Vandenberghe’s (2008) description of functional analytic
psychotherapy may also be a useful resource for determining
how to provide culturally aware behavior analytic practices.
Vandenberghe (2008) emphasizes the need for a behavior analyst to be aware of differences that may exist, including cultural
differences, between the behavior analyst, client, and their families. Specifically, behavior analysts should be knowledgeable
about the client’s culture, differentiate between an unfamiliar
cultural norm and a pathology, and take culture into
consideration during the therapeutic process. Finally, Hymes
(1962) noted that communicative competence is related to an
individual’s awareness of the laws of language structure and
language use within a given culture. Therefore, behavior analysts should be skilled in sending and receiving cultural communications. Specific recommendations are described below.
Recommendations
Consider the Language of Assessment Our first recommendation, which applies to all phases of assessment and treatment, is that behavior analysts should reflect on the spoken
and written language he or she uses and how it will be perceived by the client. We recommend behavior analysts avoid
the use of behavior analytic jargon, as it may confuse clients
and their families, and possibly lead to their failure to implement interventions. This recommendation is consistent with
the Professional and Ethical Compliance Code for Behavior
Analysts (2015). For example when the phrase Bfunctional
analysis^ is used, Japanese families assume that it is mathematical jargon rather than a reference to a behavior analytic
assessment process. Avoidance of excessive or complex behavior analytic jargon may eliminate such problems.
It is important throughout assessment and treatment to
communicate in a manner easily understood, culturally aware,
and does not include terms that are culturally inappropriate or
confusing (Rolider and Axelrod 2005). Furthermore, it may be
important to consider who will be completing service related
forms (e.g., intake paperwork) and whether the level of literacy and comprehension of the language used in the forms are
similar. If a person lacks adequate language comprehension,
completing paperwork may be difficult, embarrassing, or intimidating. In such a case, behavior analysts may consider
giving the person the opportunity to complete the forms orally
or have another person help with the form completion. They
may also consider using an interpreter or providing forms in
the person’s native language. Additionally, we agree with
Vandenberghe’s (2008) recommendation that the language
used to define problem behaviors should be carefully examined to ensure the behaviors are communicated in a positive
manner using multiple forms of communication that are sensitive to potential cultural differences in eye contact, wait time,
Behav Analysis Practice (2016) 9:84–94
meanings of words, non-vocal body language, personal space,
and quality of voice.
Understand Cultural Identity Our second recommendation
is to consider that the client, and the client’s family and community, are important sources for acquiring an understanding
the cultural identity of the individual. Therefore, we recommend conducting an analysis of cultural identity with stakeholders immediately after service initiation with the client and/
or family. The cultural identity analysis should inform the
assessment process and the designing of interventions.
During intake, the behavior analyst may, with proper consent,
gather input from key community members familiar with the
client, in addition to those whose feedback is typically sought
(e.g., teachers, professionals, administrators, and family).
Additionally, the behavior analyst should seek recommendations from the family regarding additional parties (e.g., other
community members) who should be involved. Family and
community members may be able to provide the most valuable information regarding the client’s culture, language, and
sociocultural framework (Salend and Taylor 2002). These discussions will allow members of the team to acquire a mutual
understanding of the client’s cultural system, which may result
in increased cultural awareness.
It is important to highlight that the client/family’s language
is an important cultural variable that should be understood in
addition to collaboration with stakeholders. For example, behavioral patterns may be similar across cultures, while
the language and concepts that are used can differ
(Vandenberghe 2008). In Japan, parents and teachers may
use the word Bpanic^ to describe a child’s behavior, and this
may imply a Btantrum^ or Bmeltdown.^ Because the word
Btantrum^ is often associated with baby colic behavior, parents and teachers may prefer to use Bpanic^ to describe the
aggressive behavior of older children. Without knowing this, a
behavior analyst may initially misunderstand what the client’s
challenging behavior is. It is therefore important for behavior
analysts to clarify what the client or family actually mean by
the terms they use.
The behavior analyst should also consider accounting for
what treatments are appropriate, preferable, or considered
norms within a culture. As illustrated by the example of the
Filipino family at the beginning of this section, identifying
cultural norms may be important for successful assessment
and effective treatment. Information about what is acceptable
within a person’s culture is also ideally obtained beginning
with the intake process (and later during the assessment process) by including stakeholders in the process and ensuring
that background information includes input from multiple
sources of information (assessments and interviews; Sugai
et al. 2012). For example, the grandparents rather than the
parents may be the primary caregivers in an Indian family.
Therefore, it would be important to include the grandparents
Behav Analysis Practice (2016) 9:84–94
during intake in order to obtain information. During later
phases of the intervention, it may also be beneficial to continue to involve the family in development of the data collection
and to make changes in the intervention based on the family’s
interactional style. In designing the intervention, the team will
then be able to include culturally appropriate reinforcers and
skill building, again taking into account strategies that are
appropriate to the client’s culture and belief system.
It may also be important to define a client’s behavior in
positive terms and in relation to cultural norms to help ensure
culturally aware behavioral definitions. For example, in examining table manners across cultures, French parents may believe that child table manners are the essence of their culture.
In Japan, in contrast, many children will leave the table during
a meal, and it is acceptable in certain settings for them to run
around, even in restaurants. More specifically, during lunch
with family friends, a Japanese child might imitate a peer and
leave the table during lunch with a smile on his or her face. For
Japanese parents, this is the cultural norm, but French parents
often consider this behavior is inappropriate.
Use Readily Available Resources Our third and final
recommendation for this section is for behavior analysts to
consider making use of the resources that are already available
to help make their practice more culturally aware. Salend and
Taylor (2002) describe guidelines for creating more culturally
aware functional behavior assessments. These guidelines suggest
behavior analysts should involve family, community members,
and professionals to learn about the client’s culture and examine
possible sociocultural explanations of behavior. They also suggest behavior analysts attend trainings and engage in activities
that allow them to reflect on how their culture might impact their
belief system (Salend and Taylor 2002).
Another resource that can help behavior analysts enhance their culturally awareness is provided by Sugai
et al. (2012). The authors discuss how applied behavior
analytical terms can be understood within different cultural
contexts. For example, in some cultures, the concept of
reinforcement can be illustrated by describing the act of
bowing to greet one another. In this exchange, a bow is
more likely to be given if a person is first bowed to, thus
the initial bowing behavior is reinforced. Like Salend and
Taylor (2002), these authors describe how steps in interventions, such as school-wide positive behavior support,
can be made more culturally aware—for example, by using
activities that are considerate of learning histories and the
norms and values of the culture, family, school, and
community.
Tanaka-Matsumi et al. (1996) also provided another resource for increasing culturally aware behavior analytic services. Specifically, the authors provide guidelines for
conducting a culturally informed functional assessment interview, in which increases in accurate case formulation,
89
decreases in diagnostic errors, decreases in attrition, increases
in the credibility of the therapy, and increases in the expectation of positive change, client compliance, and active participation in treatment might be a result. The authors emphasize
the importance of examining the functional relationships between a client’s behavior and culture, which may increase
buy-in from all parties involved and help acquire an accurate
description of the client’s challenging behavior.
Moving from Assessment to Treatment Once information
has been obtained through reflection on and assessment of the
client’s culture as well as the behavior analyst’s own culture,
the behavior analyst can use the information to make informed
decisions about next courses of action, such as accepting the
client, referring the client elsewhere, seeking additional information about the client’s culture, or securing supervision from
a more experienced behavior analyst as needed. It should be
noted that lack of a cultural match does not necessarily mean
that the behavior analyst cannot provide adequate services to
the client. A behavior analyst should rely on professional experience and knowledge to serve this client, given the behavior analyst’s cultural context, but should also remember that
within-group differences are greater than between-group differences (Sue 2003). For example, a client of the same race
and socioeconomic background may not have cultural norms
that are strongly simi
