Board certified behavior analysts and school fidelity of Applied Behavior Analysis services: qualitative findings

Abstract

The Federal government mandates the use of evidence-based practice for interventions with students. Applied Behavior Analysis (ABA) is one of these evidence-based practices, but despite this, many school systems do not implement ABA as described in the literature, which leads to loss of fidelity and integrity with implementation, and often results in ineffective interventions in the classroom. The research question “What are the experiences of Board Certified Behavior Analysis (BCBAs) who use evidence-based practices in conjunction with staff in schools for interventions with American K-12 students using ABA?” was developed to ascertain, from a BCBA’s perspective, why ABA interventions are not implemented with fidelity in classroom settings. Participants were BCBAs in the United States who consult and collaborate with school staff to implement ABA services for children with autism spectrum disorders (ASD). Findings indicate that BCBAs are not given adequate time or resources to provide sufficient training in ABA, that principles of ABA are sometimes misused in training in such a manner that exacerbates myths of ABA, and that a general lack of support from school administrators exists, all of which lead to a loss of implementation fidelity. This lack of implementation fidelity in turn leads to decreased outcomes for students with ASD in schools when ABA is not implemented with fidelity.

Introduction

The current study was conducted to address a gap in the literature regarding lack of fidelity in Applied Behavior Analysis (ABA) interventions for children with Autism Spectrum Disorder (ASD). Lack of implementation fidelity results in reduced growth and development of vital social, communication, and academic skills; this lack of appropriate skill development in turn can lead to increases in disruptive behaviors and self-injurious behaviors. These outcomes are detrimental to a student’s individual development and school success and students often become disruptive to the learning of others in a classroom setting as well. This study addresses a significant concern among BCBAs, school administrators and teachers, and university administrators who develop preservice teacher training programs, as the continued global increase in the rates of ASD diagnoses greatly impacts a child’s school years.

In order to improve school-based ABA programs for students with ASD, a clear understanding of the lack of fidelity of ABA implementation needs to be established. The current study informs practice in terms of BCBA consultation with school districts as well as the need for school districts to prioritize the appropriate implementation of ABA programs. Outcomes of the study can be applied to teacher professional learning, district program development, and financial planning by providing school leaders with evidence for the importance of implementing ABA with fidelity.

Literature review

Training and needs in applied behavior analysis

ABA is a set of procedures used for changing behavior, which has been widely used with children and adults with ASD (Shepley et al. 2018). The mission of ABA is to provide a foundation, rooted in empirical evidence, to guide the use of scientific practice that leads to increased independence in all areas of life (Smith 2014). Communication, which is a primary necessity in order for individuals to experience autonomy and to have basic needs met, is the most frequent focus of an ABA program (Alexander et al. 2015). Federal mandates in the field of education require the use of evidence-based practices for students in special education (Stahmer et al. 2018), which makes the successful implementation of these practices key for student success in school and in adult life after leaving school (Stains and Vickrey 2017).

The role of Evidence-Based practice in ABA

ABA has been widely established as an evidence-based practice for children with ASD (Fennell and Dillenburger 2018, Pantazakos 2019). Despite literature to support the use of ABA, when the practice is used in public schools in America, interventions often lack fidelity and integrity of implementation (Cihon et al. 2017, Fennell and Dillenburger 2018, Stahmer et al. 2015). The current study analyzes the challenges to implementing ABA for K-12 students with ASDs in schools.

Fennell and Dillenburger (2018) found that special education teachers in America perceived their knowledge of ABA as being significantly higher than their actual application of behavior analytic practices. This lack of applied knowledge was found in both teachers who had specifically trained in the use of ABA and those who had not. Board Certified Behavior Analysts (BCBAs), who are highly trained ABA professionals, are most often the individuals who complete the consultation and training of teachers who will implement ABA procedures, though there is a distinct lack of published research generated by BCBAs.

Problems with ABA implementation

Existing research on ABA implementation has largely been completed by educational researchers and points to a lack of appropriate training and follow up. Teachers and paraprofessionals in special education are most often the individuals who become trained in the use of ABA. Many of these teachers have, at a minimum, a bachelor degree that incorporates strategies for classroom management and use of basic behavioral interventions; however, many teachers still feel underprepared when entering the classroom setting and having to address challenging behaviors (Flower et al. 2017), though most paraprofessionals have only a high school diploma (Layden et al. 2018). Even with extensive training, regular ongoing mentoring, and adequate time to manage interventions, special education professionals typically only achieve a moderate level of procedural fidelity of implementation of ABA procedures (Stahmer et al. 2015).

Sustained use of evidence-based practice has been reported when the use of empirical procedures are taught during graduate education programs (Stahmer et al. 2015), though these findings have not been shared by many researchers. Layden et al. (2018) found a correlation between supervisor expectations and evidence-based practice fidelity, with highest levels of fidelity being reported in organizations that monitor implementation fidelity, though these authors also report a lack of consistency with these findings. When evidence-based practice is not sustained with continued fidelity of implementation, student disruptive and maladaptive behaviors typically return to baseline levels or even increase, thus rendering the intervention ineffective overall (Hagermoser-Saneetti et al. 2018).

Several ideas have been proposed regarding why implementation fidelity and intervention integrity are not being met consistently. ABA is based upon technical language that can prevent successful implementation when jargon is used without ensuring that all trainees understand the terms being used (Cihon et al. 2016). Behaviorist perspectives, including the philosophies that underlie ABA, are often described as being at odds with humanistic perspectives (Shyman 2016). This has been cited by some as a primary reason that ABA procedures are not being carried out in schools, as some teachers and parents prefer more humanistic neurodiverse strategies over ABA, which they perceive as lacking in methodology that prioritizes student consent and choice (Pantazakos 2019). A pervading myth regarding ABA is that reinforcement is the same as bribing kids with candy, which is derived from the use of food as a primary reinforcer (Arntzen et al. 2010). While food is sometimes used as reinforcement in ABA, reinforcement is by no means bribery or only the use of food as reinforcement.

Improving implementation with fidelity

Methods to improve the implementation integrity and fidelity have been widely researched. Using the principles of ABA to teach school staff to use ABA has been proposed by some (Albright et al. 2016, Collier-Meek et al. 2017). Collier-Meek et al. (2017) studied the use of an antecedent-behavior-consequence procedure to shape the implementation of ABA among school staff. Results indicate increased success of training with this procedure, though follow-up was not completed to determine whether the training led to continued implementation fidelity. Albright et al. (2016) found positive training outcomes with the use of the ABA process of stimulus equivalence to teach graduate students to correctly identify the function of a behavior, which is a core tenet of ABA. This study also lacks long-term data to determine the impact of training on implementation fidelity. Additionally, as Sarokoff and Sturmey (2004) found, teachers can be trained to implement ABA procedures through direct training of behavioral skills. With this type of instruction, teachers are taught behavioral skills through the use of modeling, reinforcement, and repeated trials of instruction, which are the key skills they would use with students. This enables teachers to learn the skill by practicing the skill in an authentic context.

Purpose of the study

The literature review reveals a lack of implementation fidelity of ABA programs with students with ASD in schools. The majority of ABA fidelity studies are quantitative in nature, with observations of intervention implementation serving as the primary means of analysis (Al-Nasser et al. 2019, Burns et al. 2008, Garland et al. 2012). From these studies, it is evident that ABA interventions are often not implemented with fidelity, though a gap exists in the literature as to why this lack of fidelity occurs. The current study is intended to elicit qualitative data from BCBAs working in schools in order to determine the underlying causes of lack of fidelity of ABA implementation. Qualitative methods are used to allow participants to provide answers to open-ended questions regarding training for ABA interventions, administrative support for ABA interventions, and the reasons why fidelity is difficult to maintain even when support for interventions is present. BCBAs and school districts can use the current study to make recommendations for changes in their current practice that leads to higher fidelity of implementation, which improves student outcomes as well.

Research question(s)

What are the experiences of BCBAs who use evidence-based practices in conjunction with staff in schools for interventions with American K-12 students using ABA?

Sub-questions (Open-ended survey questions to participants):

1. Please describe the general process you use when consulting with school staff to use ABA interventions in K-12 schools. You can list the steps in the process, or provide more specific details.

2. What types of training or methods of training do you use when training school staff to implement ABA interventions?

3. What assessments and/or monitoring procedures do you use to evaluate the fidelity of implementation of ABA interventions used by school staff?

4. How often do you provide follow-up training to school staff after initial training has been completed?

5. Please describe the types of follow-up training you provide to school staff after completion of the initial training phase.

6. In your experience, what are the biggest barriers to school staff implementing ABA interventions with fidelity?

7. In your experience, what are the best ways to overcome barriers school staff face when implementing ABA interventions with fidelity?

Context of the study

Both researchers in this study are school personnel at public schools who work with children with ASDs who are the recipients of ABA services. The first researcher is an administrator, and the second researcher is a BCBA and an Intervention Specialist. The shared interest of the researchers is a desire to improve implementation fidelity of ABA interventions within classrooms so that students are recipients of the most optimal, effective interventions.

Methods

A survey with open ended questions was used to elicit qualitative data from BCBAs consulting with school administrators and teachers to provide ABA services to students with ASD. Open ended questions were chosen by the researchers so that participants could provide a range of responses and share their personal experiences with regard to implementation fidelity. Data were analyzed using thematic analysis as part of the generic qualitative design to develop themes from participant responses. Generic qualitative design with inductive analysis was chosen because the researchers were not attempting to compare results across participants, rather the goal was simply to discover whether patterns emerged from participant responses. The survey questions were included with the Institutional Review Board (IRB) application, which was approved by the Capella University IRB.

Participant selection

Participants included individuals who are BCBAs. Recruitment took place via an emailed survey to all BCBAs who elected to receive emails regarding research studies through the Behavior Analysis Certification Board (BACB). The BACB provides the email survey service for a fee to researchers who are conducting behavior analytic studies. The BACB survey service was chosen to ensure that participants came from a variety of schools throughout the country and that the potential bias of using participants known to either researcher was reduced. Participants expressed their willingness to participate by engaging with the survey linked in the email. All participants who completed the survey were included in the random sampling survey study. Participation was anonymous; answers to open-ended questions were recorded without identifiers. The target population for this study was 10 participants, and the survey was closed after 10 full responses were received. Due to the use of qualitative design, the researchers sought out a limited number of respondents in order to be able to closely and more accurately investigate the data for similar themes. Surveys were completed by participants online, at their convenience, through Survey Monkey software. Upon completion of the survey, the participant responses were collected and examined question by question. The data, which in this study refers to the narrative responses typed by each participant into the Survey Monkey software, was aggregated so that only one question by one participant was examined at a time. This allowed the second researcher to examine each question individually to become familiar with the data.

As the first step in the inductive data analysis process, the second researcher first read through all collected data to become familiar with participant responses. This step was completed by reading all responses of each participant, question by question, and highlighting phrases that appeared meaningful in relation to each question (Percy et al. 2015). In this case, the second researcher began with the first survey prompt: “Please describe the general process you use when consulting with school staff to use ABA interventions in K-12 schools. You can list the steps in the process, or provide more specific details”. Any information related to processes or specific steps were highlighted. This process was completed for each of the survey questions.

Upon completion of the first step, the second researcher reviewed highlighted data in relation to the research question. Any data that was not relevant to the question was moved to a separate file and reviewed at the end of analysis to ensure that no relevant data was missed. Relevant data was coded with a number, based on the content in the data (Percy et al. 2015). As an example, all data related to Functional Behavioral Assessment was coded “1”, and all data related to implementation fidelity was coded “6”. Data was then organized by the coded numbers so that all pieces of data related to the same topic were grouped together. Data was examined holistically to ensure that all data was correctly coded and had been correctly placed with similar data.

Each coded number of data was examined collectively to discern patterns in the responses. Similar responses were grouped together in the coding document and patterns were given identifying phrases, such as “assessment types”, “problems with fidelity”, and “administrative support” which were developed by the second researcher. See Table 1 Patterns Table for these patterns.

Table 1.

Patterns of data.

Pattern	Supporting Data (Participant #)
Consultation with teachers	Consult with teachers (1)
	Use consultation form for new students (2)
	Checking in with classrooms (4)
	Review results with team (7)
	Meet with team every 1-2 weeks to check progress (7)
	Consult with teachers (9)
	Daily consultation (6)
	Daily to monthly depending on student (7)
	Weekly follow-up (1)
	On-going consultation and support (5)
	Coaching in the moment (6)
	Preparing for ongoing consultation (1)
	Allowing for consulting time between BCBA and staff (1)
	Consistent check-in/feedback (4)
Team Discussions	Scheduling monthly meetings to discuss interventions (4)
	Discuss possible options (8)
	Team problem-solving (8)
	Q&A (2)
	Discussion (3)
Staff Training	Direct training to staff (2)
	Train on specific programming (2)
	Train on fidelity and implementation (3)
	Train instructional staff and administrators (3)
	General training on ABA basics (5)
	Train paraprofessional to implement programming (6)
	Train staff on procedures (7)
	Provide training needed to conduct FBA (7)
	Train staff on behavior plan (7)
	Provide training for different interventions (10)
	“In the moment” training (1)
	Training via lecture or modeling (1)
	Present as much training when students are not present to
	allow for questions to be asked (1)
	Train DTT (2)
	Prompting (2)
	Chaining (2)
	Shaping (2)
	Behavior skills training (7)
	Lack of formal training (1)
	Training frequency (2)
Observations and feedback	Observe students (1)
	Classroom observations (5)
	Feedback of observations (8)
	Observe (9)
	Observation checklist (5)
	IEP review checklist (5)
	Observation (6)
	Implementation checklist developed by curriculum
	provider, when available (7)
	vIdeo observation (8)
	Self-created checklist of BIP (10)
	Observe (8)
Data collection and analysis	Data collection (5)
	Collect data (10)
	IOA data (1)
	Frequency (3)
	Duration (3)
	Intensity (3)
	IEP progress reports (3)
	Data review (5)
	Review of student data (6)
	Smiley faces for each of 3 parts of the day (9)
	Review charts (7)
	Review graphed data (8)
Programming development	program development (5)
	Develop and assist with implementation of IEP, BIP (5)
	Develop and write programming for students (6)
	Create interventions to test (7)
	Write behavior plan (7)
	Write BIP (10)
Modeling	direct modeling and feedback (6)
	Model verbal teaching (3)
	Modeling (4, 5, 8, 9)
	Feedback (4, 8)
FBA procedures	interview parents and staff for FBA (7)
	Conducting FBA (5)
	Coach staff through FBA (7)
	Provide professional development and coaching support (8)
	Conduct FBA (10)
	Coaching (5)
	In the moment coaching (8)
	Ongoing coaching and support (6)
	Use research to guide coaching (6)
Reinforcement and role play	use candy as reinforcement for bigger groups (2)
	Reinforcement procedures (2)
	Positive reinforcement (3)
	Praise (9)
	Role play (3, 4, 5)
Coaching	Ongoing coaching and support (6)
	Use research to guide coaching (6)
	Team coaching (8)
Lack of administrative support	Administration not supportive of BCBA role and not willing
	to provide time for training (1)
	Staff not supportive of being trained due to lack of
	administrative support (1)
	Not enough teachers understand behavior analysis (3)
	Staff not willing to grow/change (3)
	No buy-in (5)
	Lack of motivation and reinforcement for staff behavior (5)
	No administrative buy-in to provide sufficient staff (9)
	Staff buy-in (2)
	Buy-in from special education director (3)
Lack of resources	Not enough time (1)
	Not enough staff to cover training (3)
	No money for training (3)
	Unqualified support staff being hired (3)
	Ongoing effective training in vivo (6)
	Staffing ratios (7)
	No available space (7)
	Staff available to collect data (9)
	Time (10)
	Planning for staff training (1)
	Not letting school schedule fit student needs (1)
	More education for staff (3)
	More money for BCBA and RBT staff (3)
	Educating superintendent down on value of services (3)
Lack of understanding	misunderstanding/misinformation of basics of ABA (5)
	Perception that reinforcement is bribery (5)
	Lack of understanding ABA as a science (8)
	Staff think ABA should be done in a clinic/don’t
	Understand its’ use in a school (8)
	Thinking it will make students robotic (8)

Notes: DTT, Discrete Trial Teaching; IEP, Individualized Educational Plan; IOA, interobserver agreement; FBA, functional behavioral assessment.

Similar patterns were then clustered together as themes, with each theme being given a general descriptor, such as “training development”, “use of ABA principles”, and “lack of support”. This information can be found below in Table 2 Themes Derived from Patterns.

Table 2.

Themes derived from patterns.

Theme	Patterns comprising the theme
Train, develop, and implement programs	Consultation with teachers
	Team discussions
	Staff training
	Observations and feedback
	Data collection and analysis
	Programming development
Use ABA principles to guide processes	Modeling
	FBA procedures
	Reinforcement and role play
	Coaching
Problems with implementation	Lack of administrative support
	Lack of resources
	Lack of understanding/buy-in

Notes: ABA, Applied Behavior Analysis; FBA, Functional Behavioral Assessment.

Finally, once the data grouping was complete, the second researcher arranged the data into a chart by theme and corresponding pattern (Percy et al. 2015). Quotes to demonstrate each theme from the data can be found in Table 3 Participant Quotes by Theme.

Table 3.

Participant quotes by theme.

Theme	Quotes
Train, develop, and implement programs	“For students who are not currently receiving
	behavior intervention services we use a
	consultation form for access.” (10)
	“I provide direct training to staff who work with the
	students including training on specific
	programming, behavioral IEP goals,
	particular ABA interventions to be used per
	student (e.g. DTT training) as well as
	training on fidelity and implementation of
	behavior plans at school.” (2)
	“When effective interventions are identified, I write
	a behavior plan, train staff, complete fidelity
	checks and then meet with the team every 1
	to 2 weeks to review progress or
	make changes”. (4)
	“I use the implementation checklists developed by
	the National Professional Development
	Center mostly. If a curriculum or research-
	based fidelity checklist has been developed
	specifically for certain programs/procedures,
	I use those.” (4)
	“I am the lead teacher/special educator in a
	specialized program for students that utilizes
	ABA across domains. I develop and write
	the programming for students both
	behaviorally and academically and then train
	paraprofessionals to implement this
	programming.” (6)
Use ABA principles to guide processes	“I train DTT, prompting, chaining, shaping, and
	appropriate reinforcement procedures” (10)
	“modeling; verbal teaching (while I am teaching –
	to train my staff why I am doing what I am
	doing); positive reinforcement”. (8)
	“I will go in and observe and provide feedback to
	staff, as well as looking at the graphed data
	to see if behavior is improving.” (10)
Problems with implementation	“Lack of understanding of ABA as a science. I've
	been a BCBA and principal for a school for
	students with autism and many other
	administrators and educators think back to
	Lovass and 40 hr per week. They don't see
	how ABA can be integrated in school
	because of thinking it is only 1:1 and can
	only be done in a clinic. Thinking that it will
	teach students to be more rigid, robotic. I
	have had to educate others on ABA as a
	field of science and how it can look in
	classroom settings.” (8)
	“Not enough sub staff to cover for permanent staff
	to train or go to trainings. Not enough
	instructional staff applying for jobs (part
	time) who are really ideal for the job - so
	having to hire people, even if they are not
	the best fit.” (3)
	“…misunderstand/misinformation on basic
	concepts of ABA, the perception that
	reinforcement is bribery, mentalism, buy-in,
	mo and reinforcement of staff behavior” (6)
	“Money for training; People not willing to
	grow/change.” (8)
	“More education; More money and value to people
	who are BCBA’s or RBT’s/Educating from
	the top district superintendent down - but
	especially buy in from the director of special
	education.” (8)
	“Lack of formal training; Not enough time to meet
	on a regular basis; Staff is often ‘given’
	other duties when they have a free block;
	Admin not understanding the importance of
	our role, and training of staff; Staff not
	always receptive to our services and support
	because they don’t understand our roles.” (11)
	“Allowing consult time with the staff when the
	BCBA is on site; Not letting the school
	schedule to drive the student’s schedules” (11)

Patterns and themes across participants were examined and consistent themes were analyzed to describe each theme. Combined data were analyzed for consistency by the first researcher, then was once again examined by the second researcher to synthesize data in relation to the research question (Percy et al. 2015). The analysis and synthesis of the themes is reported below in the Findings section, which includes themes (patterns of patterns) and relevant quotes from participants to support each theme.

Rigor and trustworthiness are key elements of qualitative research. Guba’s model of trustworthiness was used in this study, with the focus on the four components of the model: truth value, applicability, consistency, and neutrality (Krefting 1991). Truth value was upheld due to the use of direct participant quotes to back up developed themes, which provide examples of the lived experiences of individuals. The findings are applicable to other BCBAs who work in schools, though the goal of qualitative research is to discern the unique experiences of individuals, therefore generalization to larger populations may not be relevant in all cases. Human variation is expected when seeking unique experiences, therefore consistency in responses was identified where it occurred, as were differences in data. The researchers did not know the participants or collect any demographic information from participants, therefore neutrality was maintained throughout the study.

Findings

Findings of the study revealed insights into the ways that ABA procedures are implemented in schools and the challenges BCBAs face when consulting with school districts. Fourteen patterns emerged, which were then organized into three primary themes by the combined effort of the researchers. The first set of patterns: consultation with teachers, team discussions, staff training, observation and feedback, data collection and analysis, and programming development were combined under the theme of train, develop, and implement programs. The second theme, use of ABA principles to guide processes, was derived from patterns including modeling, FBA procedures, reinforcement, role play, and coaching. The final three patterns: lack of administrative support, lack of resources, and lack of understanding and buy-in, comprised the final theme of problems with implementation.

Each theme is discussed in relation to the three components of qualitative data analysis: quality, data, and analysis. To ensure quality, a definition of the finding is presented to explain what was discovered in the theme. Quotes that exemplify each theme are included to present examples of data to further define and explain each theme. In the analytical component data is discussed to clarify claims about the data and how the chosen quote exemplifies a clear understanding of the data in relation to the research question.

Theme 1: Train, develop, and implement programs

The theme of Train, Develop, and Implement Programs is defined as the use of staff training techniques, development of ABA programming based on individual student needs, and the implementation of said ABA programs. Findings indicated that participants primarily utilize consultations with teachers as the means of bringing ABA into schools. As Participant ten stated, “For students who are not currently receiving behavior intervention services we use a consultation form for access.” Most participants reported using consultation sessions to discuss student needs, determine how to proceed, and as follow-up to training. Participant two noted “I provide direct training to staff who work with the students including training on specific programming, behavioral IEP goals, particular ABA interventions to be used per student (e.g. DTT training) as well as training on fidelity and implementation of behavior plans at school.” As much as possible, BCBAs observe both students and staff in vivo, review collected data, and meet with staff to do direct training based on individual staff needs. As explained by Participant four: “When effective interventions are identified, I write a behavior plan, train staff, complete fidelity checks and then meet with the team every 1 to 2 weeks to review progress or makechanges”. The use of implementation checklists is explained more deeply by Participant four in the comment “I use the implementation checklists developed by the National Professional Development Center mostly. If a curriculum or research-based fidelity checklist has been developed specifically for certain programs/procedures, I use those.” Program development is largely completed by the BCBA, but at times the teachers and other staff members are involved. As participant six stated, “I am the lead teacher/special educator in a specialized program for students that utilizes ABA across domains. I develop and write the programming for students both behaviorally and academically and then train paraprofessionals to implement this programming.”

The primary research question sought an understanding of how BCBAs use evidence-based practices in conjunction with school staff to implement ABA. Participants noted the use of a consultation model as the primary means of interaction with school staff, and within this consultation evidence-based practices can be found. Specific ABA practices, such as DTT (discrete trial teaching), ongoing follow-up and training, progress monitoring, and use of fidelity checklists were noted, all of which are evidence-based practice in ABA. Ideally, the entire Individualized Education Plan (IEP) team would meet frequently to develop, review, and revise goals and behavior plans (Ruble et al. 2010), though it was widely noted that consultation was most often used in place of fully implemented evidence based practice with regard to staff training, development of ABA programs, and ongoing implementation of programming.

Theme 2: Use ABA principles to guide processes

The definition of Use ABA Principles to Guide Processes includes participant comments related directly to the use of specific ABA strategies and principles to train and monitor staff implementation of ABA skills. This definition includes the use of reinforcement and ABA strategies to teach staff to implement ABA as well as any ABA skills or strategies to increase staff motivation and implementation fidelity as well. As programming begins and is carried out with students, BCBAs often use the principles of ABA to train staff members to use ABA. “I train DTT, prompting, chaining, shaping, and appropriate reinforcement procedures” (Participant 10). Modeling was used the most often, with Functional Behavioral Assessment (FBA) procedures, reinforcement, and role play being used frequently as well, as was expressed by Participant eight “modeling; verbal teaching (while I am teaching - to train my staff why I am doing what I am doing); positive reinforcement”. Many BCBAs reported use of coaching to increase evidence-based practice as well. Participant ten described a general process, “I will go in and observe and provide feedback to staff, as well as looking at the graphed data to see if behavior is improving.”

The use of ABA practices in the provision of ABA training was common among participants, which is an example of the adequate use of evidence based practice in staff training (Alexander et al. 2015). Modeling of expected behavior was reported by the majority of participants, which is an excellent use of ABA practices to teach staff (Bashan and Holsblat 2012). Use of reinforcement, primarily through the provision of candy, was mentioned frequently.

Theme 3: Problems with implementation

Problems with implementation, as a theme, is defined as any and all problems or concerns cited by participants as barriers to implementing ABA with fidelity. These problems were often cited as being the result of lack of resources, such as time and staff, as well as limited buy-in from teachers and administrators. As participant three stated, “Not enough sub staff to cover for permanent staff to train or go to trainings. Not enough instructional staff applying for jobs (part time) who are really ideal for the job - so having to hire people, even if they are not the best fit.” Survey participants commonly noted that a lack of understanding of the science of ABA and misconceptions about ABA procedures are still prevalent among school administrators, which leads to a lack of support for ABA service provision in schools.

Participant eight noted “Lack of understanding of ABA as a science. I've been a BCBA and principal for a school for students with autism and many other administrators and educators think back to Lovass and 40 hr per week. They don't see how ABA can be integrated in school because of thinking it is only 1:1 and can only be done in a clinic. Thinking that it will teach students to be more rigid, robotic. I have had to educate others on ABA as a field of science and how it can look in classroom settings.” This lack of understanding leading to lack of buy-in was discussed by several participants, for example: “misunderstand/misinformation on basic concepts of ABA, the perception that reinforcement is bribery, mentalism, buy-in, mo and reinforcement of staff behavior” (Participant 6); “Money for training; People not willing to grow/change” (Participant 8); “More education; More money and value to people who are BCBA’s or RBT’s/Educating from the top district superintendent down - but especially buy in from the director of special education” (Participant 8); “Staff buy in” (Participant 10);“Lack of formal training; Not enough time to meet on a regular basis; Staff is often ‘given’ other duties when they have a free block; Admin not understanding the importance of our role, and training of staff; Staff not always receptive to our services and support because they don’t understand our roles.” (Participant 11); “Allowing consult time with the staff when the BCBA is on site; Not letting the school schedule to drive the student’s schedules” (Participant 11).

All participants shared an experience with lack of implementation fidelity, most often in the form of lack of administrative support to ensure that true ABA implementation fidelity is possible. While many BCBAs are developing programming and providing some form of training that meets minimum standards for evidence based practice, most have reported that they are not able to implement with fidelity due to a lack of resources and a general lack of understanding of the goals and procedures of ABA and how ABA is beneficial to students and schools alike.

Discussion

Findings in relation to current literature and gaps in literature

Findings support the current literature, both of which reveal a lack of implementation fidelity. This lack of implementation fidelity is particularly prominent when ABA is implemented in public schools (Cihon et al. 2016, Collier-Meek et al. 2017, Fennell and Dillenburger 2018, Stahmer et al. 2015), which was a primary finding of this study as well. Stahmer et al. (2015) found that even with extensive training, school staff still did not implement ABA with true fidelity. The current study found that training occurred infrequently and inconsistently, mostly due to a lack of resources and support from administrators. As with previous research (Pantazakos 2019, Shyman 2016), this study reported a lack of understanding of the true nature of ABA among school personnel, which led to a lack of support for the use of ABA in schools.

According to recent literature, ABA interventions in schools are often not implemented with fidelity (Al-Nasser et al. 2019, Burns et al. 2008, Garland et al. 2012), though literature on the topic rarely seeks to find an underlying cause for the lack of implementation. The current study presents data to provide possible reasons for lack of implementation fidelity in ABA programs, which, in general, break down to a lack of staff training, inadvertent proliferation of myths of ABA in staff training, and insufficient resources and buy-in provided by administrators.

Limitations of the study

The sample size for this study was small, which limits the generalizability of findings (Patton 2014). Participants were Board Certified Behavior Analysts who work in schools, though others, who are not certified in Applied Behavior Analysis, may be implementing ABA as well, so this presents a limited perspective from participants. Findings were collected early in the fall, which may have limited the amount of ABA programming BCBAs may have had an opportunity to develop before completion of the study. This study also relied on participants to self-report their experiences, which may have impacted data depending upon the personal opinions of the participants toward the implementation process (Patton 2014), thus limiting the ability of the researchers to determine whether responses were accurate according to the standards of evidence based practice. Researchers also tailored the survey questions to elicit responses related to the research question that would also enable participants to share their experiences and opinions or observations about the process of ABA in order to ascertain a bigger picture of the implementation of ABA in schools.

Unexpected findings

Overall the findings of this study were as expected. The recent literature indicates that ABA interventions in schools are often lacking in implementation fidelity, which was supported by the data collected in this study. The underlying reasons for this lack of implementation were anticipated to be lack of resources and support and lack of adequate training provided to staff. These outcomes were borne out by the collected data, though it was not expected that modeling of ABA skills during training would use candy as reinforcement, as this is often part of the mythology surrounding ABA as a system of “bribery” or “food rewards” and is often cited as a reason for the very lack of support for ABA programs that participants noted.

Implications of the findings

ABA is an empirically validated process for teaching students with ASD (Smith 2014). Findings of this study indicate that ABA procedures are being implemented in schools, though the levels of fidelity of implementation are inconsistent for a number of reasons. Providing adequate resources and administrative support to staff for the training and collaboration of ABA procedures would be beneficial to staff who work with students with ASD. Future researchers could replicate the study to determine if similarities exist between BCBAs and other practitioners working with ABA programs in schools or to study schools that specialize in providing ABA services with fidelity. Policy could be informed through using study outcomes to drive education and training of school administrators and teachers to provide understanding and support for the use of ABA in schools.

Suggestions for future research

Future studies could examine the specific amounts and types of training provided to school staff in relation to ABA implementation, and the use of ABA by professionals who are not BCBAs. Likewise, future studies could use a larger sample size of participants and include more targeted questions to determine the underlying reasons for a lack of administrative support for the use of ABA.

Author contact information

Chana Max, Ph.D. shiffymax@gmail.com

Nicole Lambright, M.Ed., BCBA niccilambright@icloud.com

Disclosure statement

No potential conflict of interest was reported by the authors.