Association for Behavior Analysis International

This symposium gathers elements of what has been learned so far in a variety of areas of behavioral inquiry about the spread of the novel coronavirus and the effects of COVID-19. Because many of the phrases in our new lexicon—“social distancing,” “flattening the curve”—are calls to emit a particular set of behaviors (hand-washing, mask wearing) and to avoid others (proximity to others, face touching), with reinforcers conditional on group behavior (reduction in cases reported), behavior analysts are well suited to help inform our global responses. Papers in this symposium will cover diverse and interlocking topics: (1) how the pandemic has affected service delivery, and how behavior analysts can use telehealth ethically and effectively; (2) the necessity of looking beyond the proximal influences on mortality, such as pre-existing conditions and age, to those of harmful contextual conditions of disadvantaged populations; (3) behavioral economic methods to study social isolation decisions amidst different public health messages; and (4) the importance of behavior-based safety protocols that take into account current contingencies and limitations of training systems. The discussant will provide comments on each paper and highlight the links among them.

In the wake of the coronavirus (COVID-19) pandemic, ABA providers have been recognized as essential workers who are not subject to emergency shelter-at-home directives. This recognition has challenged behavior analysts to redesign treatment models to minimize the spread of the virus while also minimizing disruption to medically necessary services. As a result of federal and state guidance to insurance carriers to authorize telehealth for services that would otherwise be authorized for in-person treatment, ABA providers have had the option to shift their in-person models to telehealth, and behavior technicians are, for the first time, permitted to deliver 1:1 ABA remotely. The adoption of a telehealth model by both providers and families has been met with varying degrees of enthusiasm and success. The decision by some providers to continue home-based services or keep centers open has sparked discussions about ethics and revealed the need for clear guidance. As experts in shaping behavior, ABA providers have a critical role to play in minimizing spread of the virus by identifying, disseminating, and implementing best practices. With the integration of health and safety protocols into center-based practices and an effort to maintain telehealth options, ABA providers will be positioned to apply the lessons of COVID-19 to future events and preserve access to ABA in times of crisis.

The linchpin of COVID-19 mitigation has been social distancing (staying at least 2 m away from others, refraining from large gatherings). This tactic places human behavior squarely in the center of slowing the spread. Unfortunately, the rapid nature of this virus made proper behavioral analysis of social distancing nearly impossible for several reasons: 1) Acquiring steady-state responding is long and arduous. 2) Employing proper within-subject design considerations requires extended baselines for some individuals, reversals of policy potentially placing the public at substantial health risk, or manipulating experimental policies in rapid alternation. 3) Direct observation of social distancing is difficult, infeasible, and potentially unethical. However, contemporary behavioral economic research has generated hypothetical decision tasks to safely and swiftly assess behavior that is difficult to observe, risky, and/or ethically-challenging to study via prototypical operant methods. Backed by decades of operant study, behavioral economists evolved delay discounting and operant demand methods to safely proxy public health crises such as safe sexual practices, the opioid epidemic, and illicit drug trade. Rigorous validation methods suggest participant responses on such tasks significantly relate to actual/overt human responses. Toward this end, we adapted behavioral economic methods to safely surveil how a crowdsourced sample of adults would make social isolation decisions amidst different public health messages. Results suggest small but significant effects in favor of strategic messaging. Translated to potential population-level outcomes, these small effects have the potential to prevent the spread of infectious disease to a large portion of the population, and thereby help save lives.

Appropriate application of hygiene focused behaviors is the essential component that can make a change in today’s uncertain environment, where we suffer from the risks of COVID-19 infection and often feel powerless. Behavior Based Safety (B-BS) seems to be the only evidence-based method that ensures both high levels of production and high frequency and accuracy of prevention behavior. However, some aspects of the classic BBS process do not seem suitable for the current needs: presentations to managers, trade unions and workers, the constitution of a management team, the establishment and activities of a project group plus the training of observers and safety leaders take months before the start and further weeks before achieving a significant growth, indicating an acceptable success. Unlike the usual BBS processes, these long times and rituals would result in a huge risk for the infection to spread. Hence, late successes in terms of behavior would not be as successful in terms of results. A B-BS protocol that specifically focuses on COVID-19 situation has been developed in order to: a) be largely prepared in advance, b) allow the start of the process in just 4 days, c) provide an accurate measurement through bi-daily observations and, d) get the ultra-rapid ascent of the performance curves within 10 days from the start of the process. The protocol does not only focus on the appropriate implementation of the health requirements determined by companies and hospitals, but it also highlights the importance of when such behaviors actually need to be adopted in order to guarantee safety to individuals. Furthermore, through the adoption of specific checklist as templates and the daily/weekly supervision by a single skilled Behavior Analyst, it is possible to comply with all the scientific principles of BBS but transferred to new intervention technologies. Some insights will also be presented on whether to develop a superordinate system to verify the correct application of the protocol and its results, suitable by public institutions, downstream of a consensus conference of the scientific community on the guidelines to be suggested.