You have followed best practices and developed a behavior plan collaboratively with the child’s parents. Now you notice that the parents are not implementing the plan and are wondering what to do next. Below are several potential behavior-analytic perspectives you could consider when approaching the parents’ barriers to implementation.
From the philosophical perspective within behavior analysis, the parents are doing exactly what they are expected to do, given their histories and current circumstances. In other words, while you may not approve of the parents’ decision not to implement the collaborative behavior plan, faulting the parents for “resisting” or blaming them for maintaining strategies other than the planned ones are reactions at odds with a behavior-analytic stance. Behavior analysis teaches that all behavior – yours, ours, the child’s, the parents’ – can be understood in the context of history and current circumstances. Thus, when you notice a tendency to point the finger or to blame, that’s a surefire sign that you are not practicing behavior analysis and are better off reminding yourself that the organism is always right. What could have gone wrong?
From an applied behavior-analytic perspective, examine whether you conveyed and taught sufficient information and skills and provided ongoing support to promote fluency, generalization, and maintenance. You might review the task analysis and the behavioral skills training used to teach parents to implement the plan and to facilitate the shaping of novel parenting repertoires. Has your implementation plan allocated sufficient time to shaping? Have you provided ongoing support in the form of coaching, and out-of-session support for fluency and generalization of skills?
From an experimental analysis of behavior perspective, as past behavior patterns are the best predictors of future patterns, any attempts to change these patterns take effort and are uncomfortable. The impulsive, relatively effortless choice is to maintain the status quo. Studies in the behavioral economics of parental decision-making have suggested that parents often prefer treatment options that are quick and relatively effortless to those that are time-consuming and laborious. This holds true for most people, particularly when we are already busy and managing many other demands. Has your implementation plan considered the parents’ input on the duration of the treatment plan, effort needed, delay to seeing the first results, immediate discomfort in the service of long-term improvement, or uncertainty about the outcomes? Parents want to feel close and connected to their children, and strategies that lead to such connection may involve short-term discomfort while the family system changes. Notice that delay, effort, discomfort, and uncertainty weaken contingencies and make it harder to stick to a plan. To contact such outcomes, parental behavior might have to be scaffolded; have you arranged additional and meaningful support for parents along the way?
From a clinical behavior-analytic perspective, ambivalence about changing one’s interactions with others (“Should I? Why? Why not? Can I?”) is expected. Research on techniques such as motivational interviewing suggests that health service providers can systematically improve their collaborations with clients. Indeed, when a parent does not follow through – rather than “a good talking to”, they need “a good listening to.” What concerns arose during the behavior plan implementation that the parents – and you – did not foresee during the initial planning phase? Some of the barriers may relate to the delay, effort, discomfort, or uncertainty noted above. Others may be understood in a larger context, such as sociocultural rules that conflict with implementation (“I shouldn’t have to do attend to things that other parents take for granted,” “Any child should-ought-want to do [target behavior] without support,” “Nobody should have to rote-learn”).
From an organizational behavior management perspective, contingencies within larger systems might be invisible yet affect the way in which we interact with parents. For example, does your company allot the necessary time to work with the parents rather than the child? Do reimbursement procedures neglect parents as implementers? Has your behavior-analytic training prepared you to conceptualize barriers to implementation and address them within multiple contexts, by listening and engaging in collaborative problem-solving? What are your barriers to collaborating with the parents on a new plan that works better for the child-parent unit across systems, such as home and school?
As you can see, barriers to change are common and expected. They are not anyone’s “fault.” Indeed, they are part and parcel with health services implementation and can be addressed as such – deliberately, gently, and systematically.
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Gilroy, S.P., & Kaplan, B.A. (2020). Modeling treatment-related decision-making using applied behavioral economics: Caregiver perspectives in temporally-extended behavioral treatments. Journal of Abnormal Child Psychology, 48, 607-618.
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