ncreasing Cultural Understanding and Diversity in Applied Behavior AnalysisElizabeth Hughes

ncreasing Cultural Understanding and Diversity in Applied Behavior AnalysisElizabeth Hughes Fong , Seana Ficklin, Helen Y. LeeAuthor Affiliations Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis.Behavior Analysis: Research and Practice, 17(2), 103-113. https://doi.org/10.1037/bar0000076 AbstractIn recent years, the demands for behavior analysis to serve consumers with diverse cultural backgrounds have significantly increased. The field is in great need of culturally competent behavior analysts who can integrate appropriate cultural considerations to their programs. The field of behavior analysis can address this growing need by fostering cultural competency in professional training through increasing relevant training opportunities and the development of culture- and diversity-relevant educational curricula and materials, and by supporting efforts to increase the number of ethnically and racially diverse behavior-analytic workforces in academic and professional settings. Together, we can promote cultural awareness and cultural competencies in professional behavior-analytic training. However, there are challenges for fostering culturally diverse professionals, especially during the academic training phase, which include language barriers, negative perceptions about cultures that are different from one’s own, microaggressions in work and academic settings, lack of mentoring opportunities, adverse campus climates, and tokenism. Some potential ways to address such challenges include the development of culture- and diversity-related curricula, mentoring opportunities, and greater support for minority and culturally diverse students and faculty. The purpose of this commentary was to increase awareness about the importance of cultural understanding and competency, as well as a diverse workforce in the field of behavior analysis, a necessary step to better serve those consumers from multicultural backgrounds. KEYWORDS: behavior analysis, diversity, multiculturalism Today’s behavior analysts serve consumers from increasingly diverse ethnic, racial, and socioeconomic backgrounds, and this trend will likely continue as the field expands. To better serve consumers from different cultures, including historically marginalized ethnic and racial populations in the United States, the field of applied behavior analysis (ABA) needs to recognize the cultural diversity of consumers and critically examine the role of culture in effective treatment design, practice, and delivery. Cultural competency is no longer an option but a necessity for serving an increasingly multicultural background of consumers. Behavior analysts need to be aware of how their own cultural values and beliefs or the lack of understanding of their consumers’ cultures can negatively impact treatment and service delivery. To this end, we believe good starting points are the promotion of cultural understanding and skills in behavior-analytic education and training and of supporting diversity in the ABA workforce. Together, we can enhance the quality of ABA services to consumers from diverse ethnic and racial minority groups by providing culturally more effective and satisfying programs.In the United States, racial and ethnic demographics have been undergoing significant changes, with a rapid and considerable growth of non-White populations during the last decade (Humes, Jones, & Ramirez, 2011; U.S. Census Bureau, 2013). For example, the non-White Hispanic population grew by 43% between 2000 and 2010, and non-White Hispanics are projected to constitute one third of the United States population by the end of 2060 (U.S. Census Bureau, 2013). Meanwhile, public health services in the United States are significantly ill-equipped to meet the needs of rapidly growing multicultural populations over the past few decades, and significant disparities already exist in health-care quality and access (Brady, Ho, Kelley, & Clancy, 2007; DHHS, 2014). This unfortunate trend reflects a long history of health-care inequality in the United States and an ongoing struggle to remediate the disparity.Elimination of the health-care disparity between the majority and ethnic and racial minority populations became a major part of the national health agenda particularly after the 1960s, as a result of a number of historical and ongoing social and cultural events and changes took place, for example, the civil rights movement, mental health reforms, and growing immigration (Derose, & Escarce, & Lurie, 2007; Hoffman, 2003; Smith, 1998). Over the years, various stakeholders, including federal agencies and public and private organizations, have worked to address this inequality, and numerous scholars have examined its causes, potential solutions, and their outcomes (Fiscella, Franks, Gold, & Clancy, 2000; Smedley, Stith, & Nelson, 2002; van Ryn & Burke, 2000). A large body of literature has indicated that health-service disparity is the result of complex multidimensional layers of barriers and requires ongoing and wide-ranging corrections (Baker et al., 2010; Flores, Abreu, Olivar, & Kastner, 1998). The barriers include consumers’ lack of proficiency in the English language (illiteracy), their negative perceptions of health establishments, an insufficient number of health professionals with diverse cultural backgrounds, and unsupportive social and academic systems that fail to foster the potential of students of color to become competent professionals. Presently, the extent to which ABA professionals provide service to culturally diverse and minority populations is unclear, as are the percentages of professionals with different cultural backgrounds (e.g., ethnic and racial backgrounds) and the types of challenges professionals face when working with individuals from cultural populations that are different from theirs.The ABA field currently lacks culturally relevant behavior-analytic knowledge and professional training materials. Yet, according to a recent large-scale survey study by Fong, Jarmuz-Smith, Dogan, Serna, and Woolery (2015), behavior analysts are increasingly interested in obtaining such knowledge. The study found that the more experienced behavior analysts are, the greater the importance they assign to including cultural competency in professional training for working with consumers from different cultures. The study concluded that there is a growing and immediate need for developing and testing professional development programs aimed at increasing cultural competency.As the field of behavior analysis currently goes through an important phase in its growth, it is necessary to recognize the cultural diversity of its consumers and the impact of this diversity on research and the theory, practice, and delivery of ABA services. Cultural sensitivity can contribute to creating better service for consumers from different cultural backgrounds and greater service equality for minority populations. In particular, we believe that increasing diversity in the behavior-analytic workforce, together with developing culture-relevant education and training materials, can play a pivotal role in improving the cultural competencies of behavior analysts and better serving diverse populations. In this commentary, we examine the important role of culture in health services and the importance of fostering racially and ethnically diverse professionals. Then we discuss social barriers that need to be addressed to achieve this cultural diversity, as well as potential solutions to these challenges. Finally, we present our conclusion and future research directions.Importance of Cultural Understanding and DiversityCulture plays a critical role in how individuals develop and function in a society; it guides and shapes their values, beliefs, and behavior throughout their lives (e.g., Shweder & LeVine, 1984). According to Skinner (1971), culture is a collection of the contingencies of reinforcement into which individuals are born and to which they are exposed throughout their lives. The contingencies are part of both the social and the physical environment and may not be readily observable, especially in the case of social contingencies in which the reinforcers are values and ideas that generate the behavior. Different cultures offer unique contingency environments that shape and influence individuals’ behavior (Glenn, 2004; Skinner, 1971). In particular, culture influences the perceptions and behaviors of clinicians as well as consumers, including their expectations regarding appropriate behavior in social situations (Glenn, 2004; Skinner, 1971).Individuals’ cultural identities and connections to their families and communities are especially relevant in the mental health-service setting. Culture may influence how a condition impacts an individual and may manifest as a syndrome (culture-bound syndrome) and also affects how these are treated (Marsella & Yamada, 2000). Specifically, culture can influence the likelihood of individuals seeking help or treatment, the type of treatment they seek, and the coping styles they use, within a broader ecological context of available support systems and stigmata attached to their conditions (DHHS, 2001).At the most basic level, cultural competency begins with recognizing one’s cultural identity (Fong, Catagnus, Brodhead, Quigley, & Field, 2016). Cultural identity can be viewed in terms of distinguishable stimulus and response classes: Being aware of one’s cultural identity allows for an awareness of how one’s values, preferences, characteristics, and circumstances may differ from those of others. This self-awareness can, in turn, help behavior analysts be vigilant regarding unintentional biased perceptions or disregard for others’ cultural beliefs and behaviors, thus allowing them to develop assessments and interventions that are better suited to the needs of their clients. Findings from psychological studies have, in fact, shown that clinicians’ competency in cultural knowledge can significantly improve the quality and effectiveness of health-service delivery to minority populations (e.g., Ngo-Metzger et al., 2006). Moreover, cultural sensitivity and understanding can also help clinicians build better relationships with consumers with ethnic and racial minority backgrounds who may have negative perceptions of the establishment due to past unfair social and political treatments.A report from the Office of the Surgeon General (DHHS, 2001) suggested that minority patients were more likely to perceive that differences between their cultural values and beliefs and those of mainstream ethnic majority clinicians could result in bias and inadequate service on the part of the clinician. That is, when clinicians hold negative stereotypical images of a minority, this can influence the type and timing of the diagnosis and treatment options they give to consumers. A study comparing the treatment rate of European American and African American boys who received a diagnosis of attention-deficit/hyperactivity disorder (ADHD) found that the African American boys were less likely to be recommended for and receive treatment than were their European American counterparts (Maddox & Wilson, 2003). Clinicians who are not culturally aware are more likely to misunderstand cultural influences in differences in normative behavior can lead to pathologizing behavior (e.g., misperception and misdiagnosis), and therefore may be more likely to misdiagnosis minority clients (McIntyre, 1996). In addition, studies have shown that differences in the treatment of ethnic and racial minorities can also result from other factors, such as limitations of available health-care options, bias or stereotyping in diagnosing minority consumers, and a lack of culturally competent clinicians (Bailey & Owens, 2005).However, with proper education and training, professionals of any cultural background can develop the necessary skills to treat and interact with consumers who come from outside their culture. For example, Diller and Moule (2005) suggested that teachers can be educated in cultural competency by focusing on developing personal and interpersonal awareness and sensitivities, acquiring different bodies of cultural knowledge, and mastering a set of skills for effective communication and teaching. The National Education Association (2008; NEA) further developed these ideas and identified four basic cultural competency skill areas for educators: valuing diversity, being culturally self-aware, understanding the dynamics of cultural interactions, and institutionalizing cultural knowledge and adapting to diversity. Specifically, professionals need to value diversity and respect different cultural values, traditions, and communicative styles; be aware of ways in which their own cultural beliefs, values, and knowledge shape who they are within their social and cultural community and how they behave with others; and understand that a number of factors can influence dynamic cultural interactions, including historical experiences. Finally, there is a need to institutionalize the practice of integrating the cultural backgrounds of students and knowledge about these into learning environments. The NEA argued that with the development of educators’ cultural attitudes, skills, and knowledge toward valuing diversity, they will be better equipped to serve diverse children. Similarly, by cultivating cultural competence in behavioral analysts’ education and training, the field of ABA can better serve diverse populations.In addition to focusing on educating ABA professionals in general, another way to strengthen cultural competence in the field is to increase the number of culturally diverse professionals. Health studies have long established that increasing the number of ethnically and racially diverse health professionals is a critical component for serving their communities more efficiently (e.g., Phillips & Malone, 2014) and closing the gap in health-care disparity (Thomas, 2014). Cultural natives can overcome communicative barriers with non-English-speaking or illiterate consumers and can also more accurately understand culture-related environmental contingencies and contexts, and thus help in assessing and designing socially (culturally) appropriate behavior programs. They can also help in building trust and maintaining rapport with consumers by virtue of being members of a racial or ethnic group, and therefore knowledgeable about its cultural nuances in social interactions.The ABA profession can benefit from culturally knowledgeable analysts in its efforts to effectively reach and work with diverse cultural populations. Culturally diverse professionals can introduce ABA to ethnic and racial communities that may not be familiar with the field, and can also share their cultural knowledge with other professionals who may not readily understand or may even miss subtle environmental contingencies (Bolling, 2002). A culturally diverse group of behavioral analysts can serve as a valuable pool of informers who can share their cultural knowledge and contribute to the development of cultural concepts relevant to behavior-analytic theory, research, and practice in line with the core mission and principles of ABA.In sum, building cultural competency will contribute to the critical task of enhancing ABA professionals’ ability to work effectively in cross-cultural settings. The best ways to accomplish the latter involve developing culture-relevant educational and training materials and curricula along with fostering diversity in the behavior-analytic field by having more minority and culturally diverse groups participate and share their cultural knowledge to advance ABA.Barriers to Increasing DiversityAlthough various government and public and private organizations and institutions have devoted considerable effort to increasing ethnic and racial diversity in the health-care service area, barriers continue to exist. Among various views that have been used to examine the challenges associated with achieving health equality, the critical race theory (CRT) framework provides useful insights for understanding the social and economic factors that underlie systematic resistance to diversity. CRT attempts to understand race, racism, and inequality by examining the power relationship in which the dominant culture’s ideology impacts populations of people who are in the minority with respect to race, gender, and class (Solórzano, 1997, 1998; Solórzano & Delgado Bernal, in press; Solórzano & Yosso, 2000). In this view, the health-service disparity is a result of imbalanced social and economic power relationships among major and minor ethnic and racial populations that have manifested as discouraging messages in subtle and overt everyday interactions and limited access to resources (Solórzano, 1997, 1998; Solórzano & Delgado Bernal, in press; Solórzano & Yosso, 2000). CRT offers insights, perspectives, methods, and pedagogies that can guide our efforts to identify, analyze, and transform the structural and cultural aspects of education that maintain dominant and subordinate racial positions inside and outside the classroom (Matsuda, Lawrence, Delgado, & Crenshaw, 1993; Tierney, 1993). In what follows, we review some key features identified by CRT to describe the barriers to achieving diversity that need to be overcome. These include racial microaggressions, inadequate opportunities to receive mentoring, adverse campus racial climates, and tokenism.MicroaggressionsRacial microaggressions are brief, unconsciously denigrating messages to people of color in the form of subtle snubs or dismissive looks, gestures, and conversational tones during everyday exchanges (Sue et al., 2007). There are three forms of microaggressions: microinsults, -assaults, and -invalidations. Microinsults are race-based statements that are rude and demeaning to a person (Clark, Mercer, Zeigler-Hill, & Dufrene, 2012), such as insensitive statements made to minorities about the “surprising” capabilities they possess. Microassaults are more blatant forms of racism meant to insult or hurt the intended victim (Sue et al., 2007), and microinvalidations are statements or actions that invalidate or nullify a person’s feelings, experiences, or beliefs based on his or her race (Clark et al., 2012).The literature suggests that such microaggressions are potential sources of stress for students of color, especially in negative racial climates on campus. These stressors may involve the European American majority’s preconceived notion of how minorities make it to college.According to Sue et al. (2008), African American students and staff have been perceived in numerous focus-group studies as less intelligent than ethnic majority individuals, as potential criminals, or even as coming from an inferior culture. Such negative perceptions can have psychological implications and contribute to racial disparities in employment, education, and health care (Sue, 2010). When the microaggressions are severe, minority students report emotional distress: they feel overlooked, isolated, and rejected, which leads to depression and anxiety—and these can, in turn, impact students’ academic engagement and subsequent outcomes (Fredricks, Blumenfeld, & Paris, 2004). Microaggressions, together with minority individuals’ feelings of alienation and powerlessness, can lead to mental exhaustion and significantly interfere with students’ ability to fully engage in academic studies (Yosso, Smith, Ceja, & Solórzano, 2009).Lack of Opportunities to Receive MentoringInadequate opportunities to receive mentoring constitute another barrier for minority students’ and junior faculty’s success in academic and professional settings. According to Johnson and Ridley (2004), mentoring is an informal, unofficial, mutually agreed upon, and voluntary interaction between two people in which one or more experienced persons share expertise with a less experienced person. The mentoring process involves the mentee observing, questioning, and observing while the mentors demonstrate, explain, and model. Although the literature suggests that mentorship has a strong and essential role in facilitating ethnic minority students’ success in completing a degree program, mentoring opportunities remain low, particularly opportunities with another minority member as a mentor (e.g., Gilbert & Rossman, 1992; Johnson, 2002).As new faculty members, junior faculty can better decipher an institution’s expectations with respect to retention, tenure, and promotion under the guidance of a mentor (Vasquez et al., 2006). Minority faculty report that lack of support and guidance is a greater problem for them in adjusting to their jobs than for their European American counterparts, especially at predominantly European American institutions (Vasquez et al., 2006).Adverse Campus Racial ClimateAn open, ethnically and racially diverse climate is essential for encouraging minority students to pursue further academic education. The social climate of professional environments is reflected in multiple layers of institution-level access to academic resources, beyond a cordial and friendly social atmosphere for creative collaborations. A collegial racial climate that is positive entails greater inclusion of minority students, faculty, and administrators, more diverse academic curricula and programs related to the historical and contemporary experiences of people of color, an active policy and programs to support the recruitment, retention, and graduation of minority students, and a university mission statement that includes the institution’s commitment to pluralism (Yosso et al., 2009). These elements are least likely to exist on campuses that have negative racial climates.Creating and maintaining a genuinely diverse racial environment has proved to be an ongoing social and political challenge. Some scholars have pointed out that, today, with colorblindness and race-neutral politics being popular notions, it is easier for many universities and institutions to endorse what seems to be a diversity of convenience than to pursue genuine diversity or pluralism (Yosso et al., 2009). That is, universities may celebrate diversity with ethnic food and fiestas but at the same time fail to provide equal access and opportunity for minority students. Such haphazard endorsement of diversity does not necessarily translate into tangible outcomes, access to resources, or a positive campus racial climate for minority students. The racial environment of college campuses can thus impact the academic performance, retention, and dropout rates of ethnic minority students.TokenismTokenism is a policy or practice that makes a perfunctory effort or gesture to create a false appearance of social inclusion and diversity by including a limited number of members of marginalized groups (e.g., based on race or gender; Jackson, Thoits, & Taylor, 1995). As a result, small groups of members of ethnic minorities can be perceived as representing an entire race of people and culture on some college campuses. As a form of tokenism, this perception overwhelms members of ethnic minorities, who are disproportionately called upon to mentor, supervise, and facilitate the majority of campus and departmental initiatives with multicultural underpinnings (Bradley, 2005). For example, African American faculty can suffer from committee overload with a disparate assignment to a wide variety of committees (Haizlip, 2012). At the same time, others may perceive that the minority faculty member is incompetent and unqualified to be a university faculty member (Haizlip, 2012).Recommendations for Increasing Cultural Understanding and DiversitySeveral recommendations for increasing cultural understanding and diversity have been proposed, with the ultimate aim of assisting the field in building culturally competent professionals. The recommendations we have compiled from the literature are meant to serve as a starting point for future work. These are developing culturally relevant curricula and training opportunities in academic and other training settings, providing positive mentoring opportunities and support to minority students and faculty, and creating a diversity-friendly campus environment.Developing Culture- and Diversity-Related Curricula and Training OpportunitiesOver the past few decades, various health-care professionals have been encouraged to increase their cultural understanding and competencies to accommodate diverse ethnic and racial populations. Notably in psychology, there has been a significant increase in programs that incorporate and emphasize cultural sensitivity and diversity in their curriculum development, as well as in internship settings (Rogers, Hoffman, & Wade, 1998; Rogers, & Molina, 2006). The American Psychological Association accreditation guidelines (American Psychological Association [APA], 2003) prominently acknowledge that multicultural and culture-specific knowledge can help researchers, teachers, therapists, and other applied practitioners become more competent in their ability to understand and interact with consumers from different cultures. The APA accreditation committee, which accredits training programs in counseling and clinical and school psychology, requires that these programs provide diversity education for students, as well as create an ethnically and racially diverse faculty and student body (APA, 2002).In comparison, there is presently a dearth of literature or educational materials for cultural competency in ABA. There is a great need to develop culture- and diversity-related curricula and training opportunities in line with the theory and practice of behavioral analysis. This requires the concerted effort and dedication of scholars and practitioners under the guidance of the highest levels of leadership in ABA across national and regional associations, academic institutions, and organizations. For example, a task force composed of experts in culture and ABA could begin by assessing the current status of the field, its needs, and recommendations.In academic settings, ABA faculty can play a considerable role in creating an inviting multicultural atmosphere in the classroom and in developing appropriate culture-related curricula. When professors are perceived as amiable, nonjudgmental, and enthusiastic and their overall leadership in the classroom is encouraging and positive, students report a greater positive experience regarding their multicultural training (APA, 2003; Lenington, 1999).Increasing Opportunities for MentoringIncreased opportunities to receive mentoring from advanced students and faculty members can significantly boost undergraduate minority students’ academic attitudes and performance.The literature suggests that although a racial and ethnic match between mentor and mentee can be useful, mentees nonetheless value the opportunity to receive mentoring and the accompanying benefits even in the absence of such a match, for example, when European American professors and senior professionals mentor ethnic minority students (Atkinson, Neville, & Casas, 1991).Moreover, when minority professionals provide mentorship to other ethnic minority and nonminority students, they report a sense of personal satisfaction in helping others and increased enthusiasm about their own work (Atkinson, Casas, & Neville, 1994). Thus, developing a greater pool of mentors, including those with European American and minority cultural backgrounds, and providing more opportunities for minority students to serve as mentors themselves can contribute to positive academic and educational experiences.Along with academic guidance, mentoring programs can help minority college students develop a sense of belongingness. Programs such as the Holmes Scholars Network (Lamb, 1999), the Compact of Faculty Diversity (Smith & Parker, 2000), and the Preparing Future Faculty Program (DeNeef, 2002) that create a sense of belongingness actively encourage minorities to pursue additional education for careers that lack sufficient minority representation through supportive social networks and relationships. Some scholars have also pointed out that in addition to creating a positive social atmosphere, it is important for mentorship efforts to include opportunities for career development, such as attending and presenting at national conferences, publishing academic work, supervising, and networking with other practitioners, scholars, and students of color, both within the university and nationally (Haizlip, 2012).Recognizing the benefits of mentoring, many national organizations and institutions have developed and implemented various mentoring programs. For example, the Committee for the Advancement of Professional Practice (CAPP), which oversees the American Psychological Association, has developed multiple mentoring models and programs to train practitioners in essential professional skills and has disseminated the knowledge by working with state, provincial, and territorial psychological associations (SPTAs; Burney et al., 2009). These include the Massachusetts Psychological Association graduate student and early-career psychologist (ECP) programs, the Texas Psychological Association externship program, practice advocacy programs, and the State Leadership Conference (SLC) Diversity Initiative. The core mission of these mentoring programs is to train students with a wide breadth of knowledge related to effective professional and clinical skills (Burney et al., 2009).Similarly, the ABA field needs to develop effective mentoring models that can support the existing body of minority students and early professionals and also to engender future mentors. National and regional level initiatives can promote and encourage mentoring and networking opportunities for minority students. In addition, mentors should receive training on how to effectively mentor junior or new faculty, as well as provide effective mentoring to multicultural backgrounds of mentees.Increasing and Supporting Minority FacultyIncreasing the presence of minority faculty in academia promotes student diversity and professional development. More positive attitudes toward diversity and the availability of trustful and valued faculty mentors and opportunities for research in ethnic-congruent areas influence how a department is perceived by prospective minority students (Jones, 1990; Muñoz-Dunbar & Stanton, 1999; Rogers et al., 1998; Speight, Thomas, Kennel, & Anderson, 1995). Also, a critical mass of minority students in a department can facilitate recruitment of new minority graduate students, who can, in turn, potentially become faculty members (Maton, Kohout, Wicherski, Leary, & Vinokurov, 2006). Thus, this cycle can ultimately enhance the recruitment, retention, and achievement of both undergraduate and graduate minority students as well as minority faculty members (Maton et al., 2006).Presently, the percentage of ABA faculty who are members of minorities and the support and challenges that exist for their career development is not clear. The field can begin by providing the necessary support for increasing minority-faculty recruitment and developing opportunities and incentives for their academic development, especially in the early stages of their careers. These opportunities could include receiving mentoring from senior faculty members who can help navigate the process of tenure and promotion and ultimately the retention of minority-faculty members (Ortega-Liston & Soto, 2014), support for conference travel to present academic work and network with other professionals, and small grants for conducting research. In addition, the exploration of doctoral training grants to increase the number of diverse students should be considered. There, efforts should go hand-in-hand with encouraging greater cultural diversity and ethnic and racial inclusion in the field through institutional policies.Acknowledgments of Past and Current EffortsThe APA (2010) Ethical Principles of Psychologists and Code of Conduct includes several relevant guidelines

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