Alai-Rosales et al. (2023) Be Humble, Learn, and Care- Culturally Responsive Evidence-Based Practice.pdf

Be Humble, Learn, and Care: Culturally Responsive 9 Evidence-Based Practice Shahla Alai-Rosales, Malika Pritchett, April L...

Be Humble, Learn, and Care: Culturally Responsive 9 Evidence-Based Practice Shahla Alai-Rosales, Malika Pritchett, April Linden, Isabel Cunningham, and Noor Syed 9.1 Be Humble, Learn, and Care: including the child, should see value in the pro- Culturally Responsive cess and outcomes and, also, contribute to the Evidence-Based Practice efforts. Cultural differences oftentimes produce tensions, avoidance, or exclusion. These difficul- In the midst of our culturally abundant and com- ties set the occasion for close examination of plicated world, our goal as interventionists is to intervention practices and growth, as individual contribute to the betterment of the lives of all the practitioners and as a field. children and families we serve. As the world Culture is a way of describing the common changes through migration and the lifting of learning histories, behavior patterns, and values oppressive structures, greater numbers of people that groups of people share; these are differenti- who are different from one another will interact ated from groups who have other sets of histories, and negotiate the process of living together and behavior patterns, and values (Sugai et al., 2012). supporting one another. Interventions to help For any given person, cultural identity is fluid and people with autism are highly interactive acts that intersectional (Osborne, 2015). That is, each of enter into some of the most central parts of living: us will identify with multiple cultural groups, and communication, social interactions, and activity that identification is porous and dynamic. engagement. Furthermore, the process of behav- Furthermore, some cultural groups will experi- ior change involves tremendous collective effort ence more oppression, hardship, trauma, and over time in each of these areas of life. Everyone, greater disparities in access and distribution of resources than others. Conversely, some cultural groups will experience more privilege, greater S. Alai-Rosales (*) · A. Linden · I. Cunningham access to resources, and affluence than others. Department of Behavior Analysis, University of North Texas, Given these subcultures and intersectionalities, Denton, TX, USA cultural groups overlap. It would not be uncom- e-mail: [email protected] mon or unheard of, depending on cultural groups M. Pritchett (*) in which one identifies, to experience both privi- Center for Community Health and Development, lege and oppression. Cultural groups are delin- University of Kansas, Lawrence, KS, USA eated in many ways: by race, ethnicity, religion, e-mail: [email protected] economics, gender, neurology, physicality, abil- N. Syed ity, sexuality, and more. As the world shifts and Center for Autism Inclusivity, SUNY Empire State College, the voices of people from different groups are Saratoga, Springs, NY, USA able to participate in societal discourse, we find © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 151 J. B. Leaf et al. (eds.), Handbook of Applied Behavior Analysis Interventions for Autism, Autism and Child Psychopathology Series, https://doi.org/10.1007/978-3-030-96478-8_9 152 S. Alai-Rosales et al. that we are interfacing in hard and evolutionary moil, we also see the advent of new ways of ways, including in our intervention programs. addressing our human condition. A scientific There are many, many cultures in the world. Each approach to human behavior, the systematic cultural context will bring a range of different study of interactions and patterns between our responses in relation to research evidence and behavior and our physical and social environ- interventions, particularly given the overlapping ments, is an advancement in the evolution of our metacontingencies which surround each culture. species (Skinner, 1953). There is no doubt that The greater the differences between the cul- this science has led to a considerable amount of tures of the people involved – the interventionist, evidence that suggests ways to accelerate and the child, the family, and the community – the decelerate behavior that improves the lives of greater the potential for misunderstandings, con- children with autism (e.g., Leaf et al., 2022, this flicts, and harm. At the same time, if we bring a volume). The cultural tensions lie in the condi- posture of humility, learning, and care, there are tions under which we change behavior and what also opportunities for deeply meaningful and behaviors are changed and when; in other words, progressive outcomes for everyone involved. sought-after behavior change may or may not be As professionals interact with ever-widening a contextual (e.g., cultural) fit. cultural groups, we strive to respond in ways that And, above all, there is tension around who is produce betterment for all. For years, many of the directing the changes and why and how they are helping professions have struggled with how to making decisions. The difficulties we see in learn to do this and how to talk about it in both intervention and practice are part of the broader research and practice (Miller et al., 2019). For the conflicts we see in the world all around us; cul- purpose of this chapter, we will rely on the broad tural values about change are colliding in hard term cultural responsiveness (Ladson-Billings, and evolutionary ways. 1995; Miller et al., 2019; Wlodkowski & The challenge is to evolve effective, care- Ginsberg, 1995). The concept of cultural respon- based interventions that foster wellbeing for all siveness involves an emphasis on transformation. without excluding, hurting, alienating, or margin- That is, we expect to be changed and to change alizing. This will involve imagining and shaping the structures of our practices and how we a broader and encompassing set of values that approach intervention and training so that our contain an ethic of compassion for people from a combined efforts produce greater progress, inclu- variety of cultural contexts (Ala’i & Re Cruz, sion, equity, and social justice for all. 2021; Pritchett et al., 2021). This includes, but is Responsiveness should be a foundational ele- not limited to, the agreement that there is merit ment of our assessments, our procedures, our and wisdom in recognizing our growing interde- measures, our training, and our interactions and pendence as a species on a shared biosphere, that the foundation for organizational structures that each child born into the world is a responsibility support and give access to those activities. of the collective of humanity, that each child has Learning to provide interventions that respond to the right to education and happiness, and that we the unique preferences, needs, and values of an are in the process of learning how to value and individual child and their families in their spe- nurture one another in equitable and just ways cific cultural context is the work of a lifetime. (e.g., Karlberg & Farhoumand-Simms, 2006; Guided by postures of humility and learning Maparyan, 2012, b; McGoldrick & Hardy, 2019; (Wright, 2019), it can also be a life-affirming UN General Assembly, 1948). These are the val- process for children, families, therapists, and ues that direct an examination of how we engage supervisors. in evidence-based practice across cultural The purpose of this chapter is to explore ways contexts. in which behavior analysts can be culturally For the interventionist, the task is to consider responsive and inclusive in clinical practice and research evidence in the context of a specific research. As we feel the tremors of a world in tur- child and their cultures. Generally, this involves 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 153 careful consideration of the child’s needs, responsible and responsive care (e.g., Slocum strengths, and preferences, the family’s et al., 2014; Smith, 2013). In the seminal paper preferences and valued outcomes, and, also, cul- on evidence-based practice, scholars from some tural risk and protective factors that are likely to of the most respected medical institutions in the affect that child’s quality of life in their present western world wrote about the increasing ten- conditions and across the lifespan. The growing sions in the medical community regarding the and collective wisdom of the interventionist, role of evidence and the role of clinical expertise family, and community can help shape a satisfy- (Sackett et al., 1996). They emphasized the rela- ing future in which the child has an increasingly tionship and importance of both sources: better quality of life (Schwartz & Kelly, 2021). Good doctors use both individual clinical expertise To this task, teams can bring an ever-evolving and the best available external evidence, and nei- research and wisdom base in the design and ther alone is enough. Without clinical expertise, implementation of interventions. Both the wis- practice risks becoming tyrannised by evidence, for even excellent external evidence may be inap- dom and evidence base are influenced by the plicable to or inappropriate for an individual interventionists’, families’, and societies’ patient. Without current best evidence, practice responses to culture. risks becoming rapidly out of date, to the detriment Our hope is to share methods to integrate evi- of patients. (Sackett et al., 1996, p 72) dence and wisdom to inform culturally respon- sive practice. As we touch upon the labor in They also discuss the interaction between the diverse areas of scholarship, we will consider two: central concepts as they relate to culture, such as Evidence based medicine is not “cookbook” medi- evidence-based practice, responsivity, perspec- cine. Because it requires a bottom up approach that tive, reflection, transformation, social justice, and integrates the best external evidence with individ- equity. We would also like to make it clear that ual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individ- the research base that we rely on in applied ual patient care. External clinical evidence can behavior analysis is produced and regulated by inform, but can never replace, individual clinical one dominant culture. Our overall aim is to expertise, and it is this expertise that decides describe how an evidence-based practice whether the external evidence applies to the indi- vidual patient at all and, if so, how it should be approach can increase possibilities and opportu- integrated into a clinical decision. Similarly, any nities for valued progress even in the midst of a external guideline must be integrated with indi- research base developed primarily by one group vidual clinical expertise in deciding whether and of people. how it matches the patient’s clinical state, predica- ment, and preferences, and thus whether it should We will do this by exploring the notion of be applied. Clinicians who fear top-down cook- evidence-based practice as it relates to culture books will find the advocates of evidence based and highlighting a few important emerging les- medicine joining them at the barricades. (Sackett sons for increasing culturally responsive inter- et al., 1996, p 72) ventions. This chapter may seem challenging. It will not be prescriptive, and it will focus on creat- Evidence-based practice is a balance and synthe- ing conditions that allow for increased clinical sis of research evidence and clinical expertise. wisdom and cultural responsivity. Slocum et al. (2014) wrote about how this par- ticular perspective on evidence-based practice applies to practice of behavior analysis. They 9.2 Evidence-Based Practice also highlighted the importance of considering in the Context of Culture the client values and context: Evidence-based practice of applied behavior anal- There are many ways of describing evidence- ysis is a decision-making process that integrates based practice in applied behavior analysis, and (a) the best available evidence with (b) clinical all are an attempt to describe how we provide expertise and (c) client values and context. This 154 S. Alai-Rosales et al. definition positions EBP as a pervasive feature of 9.2.1 The Research Evidence Base all professional decision-making by a behavior analyst with respect to client services; it is not lim- ited to a narrowly restricted set of situations or Generally, research in autism is conducted in uni- decisions. The definition asserts that the best avail- versities and research centers. Researchers able evidence should be a primary influence on all engage in a lengthy process of identifying decision-making related to services for clients (e.g., intervention selection, progress monitoring, research questions, obtaining human rights etc.). It also recognizes that evidence cannot be the approval for the research, obtaining participant sole basis for a decision; effective decision-making consent, conducting the research, preparing a in a discipline as complex as ABA requires clinical report of the research findings, and submitting expertise in identifying, defining, and analyzing problems, determining what evidence is relevant, the findings to scientific journals. If peers find the and deciding how it should be applied. In the research meets current scientific standards and absence of this decision-making framework, prac- has merit to contribute to our understanding of titioners of ABA would be conceptualized as intervention, it is published and becomes part of behavioral technicians rather than analysts. Further, the definition of EBP of ABA includes cli- the research base. Journals, libraries, and institu- ent values and context. (Slocum et al., 2014, p. 44) tions make this information available to the prac- ticing interventionist in different ways (e.g., How do we develop clinical expertise that helps through subscriptions, courses, workshops). us be responsive to client needs, values, and con- Within the last two decades, concerted efforts text? How do we relate culture to research evi- have increased to make the research evidence dence? This is a question being asked in many more accessible and to provide a context for syn- areas of health care (e.g., DelVecchio Good & thesizing a great deal of information. For exam- Hannah, 2015). This tension is perhaps most ple, there are articles that prepare practitioners to apparent at the intersections of behavioral inter- locate and find relevant research (e.g., Carr & ventions and culture. The answers to these ques- Briggs, 2010; Gillis & Carr, 2014), research tions are complicated. It will take more than clearinghouses (e.g., National Autism Center, making sure that stimuli include representative 2015; National Professional Development pictures, that specific holidays are respected and Center, 2014), and textbooks and volumes that honored, that correct names are used, or that consolidate and summarize findings for both pro- translators are available. It is each of those things fessionals and parents (e.g., Leaf et al., 2022, this and much more. volume). To begin the process of integrating client val- Part of our ethical and professional responsi- ues, preferences, and contexts with evidence and bility is to demonstrate knowledge of the basic clinical expertise, we offer a twofold examina- principles of behavior change and to keep abreast tion. First, it is helpful to understand the research of research developments as they relate to our base and how it is developing, how the base is specific areas of practice. To ensure that there is a being established, who is involved in knowledge minimum level of competence, interventionists production, and how it is regulated. Second, it is are required to have degrees, certifications, and, important to examine the development of clinical sometimes, licenses. All of this requires diligence wisdom in relation to culture. That is, what are and a tremendous effort on the part of the the sources and types of clinical wisdom? What practitioner. are the specific areas of tension and potential? In relation to culturally responsive interven- How does one know if expertise is progressing? tions, there are several issues to consider about Finally, how do we increase the probability of this research base. First, it is only within the past continued growth and responsiveness? few years that professional organizations have 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 155 released data regarding professional membership Pritchett et al., 2021). The second point is the demographics (Association for Behavior Analysis degree to which the research base has been par- International, n.d.; Behavior Analysis ticipatory is limited (Fawcett, 1991; Pritchett Certification Board, n.d.). These data, limited in et al., 2021). That is, research participants are not content, breadth, and duration, indicate that the collaborators in the process of setting and carry- leadership (i.e., researchers, editorial board ing out the research agendas. Furthermore, nei- reviewers, professors who teach courses, direc- ther the Association for Behavior Analysis tors who oversee intervention programs, scholars International nor the Behavior Analyst who compile research reviews and write books) Certification Board set disciplinary pre- or post- is primarily of the dominant culture, that is, west- educational requirements regarding cultural ern, white, Global North inhabitants. This repre- diversity and practice for professionals in behav- sentation is also seen in recent surveys of ior analysis in order to teach leaders, researchers, practitioners. In one of the more comprehensive or practitioners how to interact with culture and and earliest surveys, the results indicated that a context, a core feature of evidence-based practice majority of practitioners are white females work- in behavior analysis (Slocum et al., 2014). ing with children with autism and have little or no Finally, translational research is not always con- training about culture and diversity (e.g., Beaulieu ducted before publication; in fact, it is often con- et al., 2019). The process of systematically sidered a separate research type. While this is including research participant demographics has understood from the perspective of researching only recently begun, and, even then, demographic scholars, one may argue that research conducted data about researchers and participants appears to in laboratory settings, as brief designs, etc., lacks be largely absent (Pritchett et al., 2021). It should cultural contextual fit or at the least has not been also be noted that most of the research publica- assessed beyond these specific contexts. In other tions are in English and are products of the Global words, generalizability of such research is not North. All of this is to say that the research base truly present. has largely been developed and created by a In summary, the research base is primarily homogenous cultural group. This is similar to created, produced, and implemented by a rela- other sciences and helping professions (e.g., tively homogeneous group, and there are no for- Adams et al., 2015; Dirth & Adams, 2019; mal training requirements for behavior analysts Henrich et al., 2010). regarding cultural values and context. From this, There are two important points here. First, the we can conclude that we are only seeing a portion homogeneity of the research foundation does not of the questions, methods, opportunities, frame- negate the relevance or utility of the knowledge. works, and outcomes possible. On the one hand, we have made tremendous progress in understanding how to accelerate meaningful change; many children with autism 9.2.2 Developing a Cultural have made measurable progress, and the out- Wisdom Base comes have been valued (e.g., Leaf et al., 2022, this volume). On the other hand, emerging schol- Fortunately, a practitioner with clinical expertise arship within and outside of the field tells us that is in a unique and important position and can there are important voices that have not been part bring wisdom to the process of contextualizing of the process and that the cultural positionality, the research base with a given child and their the identity, of the researcher will influence the family’s needs, priorities, goals, and values research questions, participant inclusion, the (Slocum et al., 2014; Leaf et al., 2016). To under- experimental methods, the data interpretations, stand the expansiveness and implications of the and the suggested applications of research in a practitioner’s role in contributing to the progres- myriad of ways (Ala’i & Re Cruz, 2021; England, sion of the evidence-based practice, we will share 1994; Jacobson & Mustafa, 2019; Jafar, 2018; a description of a paradigm shift occurring within 156 S. Alai-Rosales et al. the technology industry and relate this to the case and action for a common product or purpose that of intervention. Boland and Tenkasi (1995) paradigmatic shifts occurred and innovations described the phenomena of “knowledge- were able to surpass all previous technologies. intensive firms” that exist to produce new Boland and Tensaki also described those knowl- understandings that, in turn, produce valued edge groups that are unsuccessful; such teams are innovations. They give the example of cellular characterized by a lack of skills in self-reflection phone development that required 5 disciplines in and narrative, difficulty reconciling one another’s the first development phase and at least 14 dis- priorities and projections, frequent ignoring, dis- tinct disciplinary technologies in the later phases. counting, and a lack of appreciation for the per- In the tech industry, the cell phone is considered spective of one another as well as certitude that a “killer app,” meaning that it made previous everything is known and correct within their own technologies irrelevant and archaic. Of course, particular frameworks. These barriers limit cre- previous technologies were essential for the ative problem-solving and advancement. foundations of the cell phone, but before today’s At present, the desired outcomes are increased current version, few could have imagined a quality of life and enhanced wellbeing of the device that intensively combined and synergized children and families we serve, now and across the knowledge of so many disciplines and tech- time. The perspective taking, sharing, and mak- nologies to create a new way of interacting with ing should occur within our intervention teams of the world. In some ways, this is similar to what is diverse people with different lived experiences required of the interventionist. There is an obliga- and vantage points. Each interventionist comes tion to deeply understand the evidence base and with a particular set of learning histories and, to understand the processes involved in honor- hopefully, a deep knowledge of the evidence base ably serving children and families that had no and its contextual strengths and limitations. Each voice in the development of that evidence base. family and child come with a set of learning his- This requires the interventionist to develop skills tories developed within their cultural communi- and knowledge that exist in other disciplines, to ties. All cultures have developed funds of reflect deeply on their own positionality and knowledge, values, and priorities and have had biases, to work collaboratively with the child and particular positions within the social structures of family, and to generate a series of programs that society (e.g., Moll et al., 1992). Each of the posi- create a new way for each child. tions is the product of generations of societal Boland and Tenkasi (1995) posited that an structures and individual and group learning his- essential part of the successful development of tories that place people of different cultural advanced technologies is based on a process of groups in relative advantage and disadvantage. the disciplines engaged in both perspective tak- These conditions create a compelling need for ing and making. This applies not only across dis- increased cultural responsiveness and clinical ciplines but within disciplines. That is, each wisdom in interventions, especially with cultures disciplinary branch learns to narrate, shape, and often at a disadvantage, that is, people that are not reflect upon their own perspectives and contribu- from white, affluent, Global North, Christian cul- tions and to listen, integrate, and reflect upon the tures. This point is amplified in social and aca- contributions of the other disciplinary groups. In demic discourse as well as systematic qualitative this process, both data and narrative share impor- studies with people of other cultures. tance. Data allowed the participants to under- Neither interventionists nor the families know stand conditional truths under specific conditions, the outcome of the intervention journey. Each is and narratives gave context and meaning to the part of a dynamic system in which cultural data. When the groups worked together toward a boundaries and positions are always in motion common mission, they developed new perspec- (DelVecchio Good & Hannah, 2015). Each tives and new bodies of knowledge. It is within comes in with knowledge, values, priorities, and this intensive knowledge sharing, production, contingencies that are to be discovered, acted 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 157 upon, and synergized in a context. The context is the history in the context of humility). The call the child’s quality of life (current and future) in for responsive care was introduced in behavior their specific cultural context, the research base, analysis (e.g., Fong & Tanaka, 2013; Iwamasa, and the team’s willingness to learn and care 1997; Iwamasa & Smith, 1996) and has increased (Schwartz & Kelly, 2021). The goal is for each in number (e.g., Fong et al., 2017; Miller et al., member to learn about their own skills, knowl- 2019; Zarcone et al., 2019) and has become more edge, values, and contingencies and how they fit specialized since the March 2020 uprisings (e.g., within the context of the child’s life. Fortunately, Ardila Sánchez et al., 2020; Esquierdo-Leal & there are scholars outside of the intervention con- Houmanfar, 2021; Gingles, 2021a; Sadavoy & text that are studying the ways culture interacts Zube, 2021). Wright (2019) published the first with societal structures and patterns of interac- work specifically addressing cultural humility in tions (e.g., Annamma et al., 2016; Benjamin, behavioral practice. 2019; Love, 2019; McGoldrick & Hardy, 2019; We start specifically with humility for several Project Implicit, n.d.). On the one hand, this is reasons. First, it is foundational in developing daunting because there are as many sources, if “third ways” in situations of uncertainty and ten- not more, than were related to something like cell sion. Second, it is a prime example of how non- phone development. On the other hand, our disci- western frameworks can expand our way of pline is working fast and furiously to access, navigating our shared world. It is both a useful unpack, and apply much of the learning from out- concept for this particular situation and a way to side the field. For example, Behavior Analysis understand that concepts and practices can differ and Practice published a special issue on Diversity across cultures; it is a concept that both teaches and Equity (Zarcone et al., 2019), and another is and exemplifies how cultural responsiveness can in progress on Racism and Police Brutality improve our ability to act toward the common (Gingles, 2021b). good. Our labor in creating culturally responsive Within a western context, the notions of evidence-based practice then comes to create humility are related to intellectual reasoning and what Barrera and Kramer (2009) called a “third decision-making and “… the correctness or way,” an outcome that is a process of taking wrongness of one’s beliefs, truth seeking, accep- seemingly divergent and sometimes contentious tance of one’s fallibilities as knower/believer, and positions to create a new, provisional approach. the nature of open mindedness occupy the center That is, in the case of evidence-based practice stage of discussions about humility at present” and culture, it means crafting a new way that har- (Li, 2016, p.150). Within health care, including monizes the family cultural values and contin- behavior analysis, there are also the added dimen- gencies, the child’s immediate and long-term sions of personal and institutional accountability growth and happiness, the research evidence, and for power imbalances and the need to address the sources of knowledge from other areas, such these imbalances and inequities through critical as sociology, anthropology, public health, and analysis as well as the central role of openness to education (Miller et al., 2019). We can do this, in cultural diversity and ongoing learning about part, by perspective taking and making, a set of how to improve practice (Wright, 2019). skills that is intertwined with humility, ongoing In an exploration of the concept of humility, learning, and care. Li (2016) noted that the concept may run con- trary to other western cultural values, creating an 9.2.2.1 Humility ambivalence related to and in contrast with val- The concepts of cultural competence, responsive- ues related to concepts such as assertiveness and ness, and humility have relatively long histories self-confidence. Li contrasts this with eastern in fields such as social work, education, psychol- cultures influenced by Confucianism and high- ogy, and health care (see Tervalon & Murray- lights some of the possible cultural differences. Garcia, 1998, and Foronda, 2020, for reviews of She looked at this across several quantifiable and 158 S. Alai-Rosales et al. qualitative dimensions. For example, controlled environments for a person or group of people. word searches across the samples of western and Oftentimes, the people who are the receivers of Confucian-heritage cultures (CHC) indicate that interventions are vulnerable, and other people the word “humility” appears in much higher are making decisions about what should be usage in everyday frequency in CHCs; in con- changed and how. When people express objec- trast, the word “pride” is used at a much higher tions to the status quo, there are discussions, frequency in western cultures than in CHCs. The tensions, divisions, and sometimes reconcilia- more a word appears, the more relevance it has to tions. Some of the controversies that directly the culture, “it is likely that in a culture where intersect with culture are discussed in the humility is more commonly emphasized, people emerging literature. For example, discussions may be more apt to think, feel, behave and judge relate to the use of aversive control (Morris & each other accordingly. Likewise, parents and Hollins, 2021; Sidman, 2001; Singer et al., teachers socialize their children to do the same” 1999; Van Houten et al., 1988), gender (e.g., (Li, 2016, p. 151). Li went on to suggest that hon- Donovan, 2021; LeBlanc et al., 2020; Leland oring ongoing self-cultivation and learning is et al., 2021; Nordyke et al., 1977), race (e.g., emphasized throughout all CHC societal rela- Gingles, 2021a; Gingles, 2021b; Li, 2021; oli tionships and that there is an implicit duty to oth- et al., 2021; Pritchett et al., 2021), indigenous ers in each of these relationships, a required peoples (e.g., Busch & Levasseur, 2021), inter- reciprocity, to humbly continue learning for the sectionality (e.g., Cirincione-Ulezi, 2020), eth- good of the collective. She introduces the CHC nicity (e.g., DuBay et al., 2018), religion (e.g., concept of “liability of self-fullness,” that every Aljohani, 2021), language (e.g., Baires et al., time one learns something it is wise to try and 2021), neurodiversity (e.g., Friedman, 2021; return to the stance of knowing it is not enough. Iland, 2021: Kirkham, 2017), poverty (e.g., The “liability of self-fullness” is an important Uwayo et al., 2021), and commodification (e.g., part of practicing cultural humility. It encourages Keenan et al., 2010). Sometimes the discussions us to try and do our best with what we know and are in other forms, such as podcasts. For exam- realize we do not know enough to serve the well- ple, Beautiful Humans (Gingles & Donovan, being of the collective and continue developing n.d.) and Shades of ABA (Bradley & Moore, as human beings. In the present case, it requires n.d.) are two active venues that address specific holding the tension of a research base that has challenges and biases in practice and research. suggested that children can make genuine and Such venues have expansive representation and valued progress and know that the research base content that is not controlled by the dominant is incomplete and that it is not enough. The majority culture. research base has not accounted for or included It is important to note that the degree of the perspectives of many cultures and ways of gatekeeping, scrutiny, and peer review varies being. Our training programs, research, and prac- considerably in this emerging discourse. That is tice do not contain an explicit responsibility and both the beauty and the tension. Social media method for humble learning in relationship to and non-refereed publications have welcomed one another, to the families we serve, and to the voices that are barred or inadvertently excluded collective wellbeing of people from many from the discourse. The intention of peer review cultures. is to increase confidence that scientific commu- Fortunately, some of the specific areas for nication is credible and meets the standards of increased learning are being explored within quality for discourse and experimentation in a and outside of our field. Most of these topics are given field (Kelly et al., 2014). It is difficult to uncomfortable. The process of intervention will have peer review in the area of cultural congru- always be controversial; intervening means that ence of research practices because there are few there is an intentional and explicit series of “peers” in relation to cultural diversity. That is, actions to change or not change responses and the majority of the scientific “peers” are also 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 159 cultural peers from the dominant majority. As a 9.2.2.2 Learning field, we have not systematically addressed Learning to be responsive to the unique needs of methods to reduce cultural bias, expand diver- people requires comfort in provisional spaces sity, increase transparency, and further collab- and accessing bodies of knowledge production orative research methods so that the voices of within and outside of the research evidence in participants are consistently included (Pritchett intervention. This will require interacting with et al., 2021). Although some advances have texts and articles on the topics from within the been made, refereed publications have strug- discipline (Ala’i & Re Cruz, 2021; Conners & gled in expanding the base of diverse research- Capell, 2021; Mathur & Rodriguez, 2021; ers and reviewers with knowledge and lived Sadavoy & Zube, 2021) and outside of the disci- experiences that are divergent from the status pline on topics such as critical race theory and quo or majority. Several people in leadership disabilities (e.g., Annamma et al., 2016) and have begun to publish discussions of these ten- technology (e.g., Benjamin, 2013). It will also sions in an attempt to tact the problems and involve learning from other disciplines that have develop solutions (Leaf et al., 2021). While had a longer focus in this area (e.g., Lynch & continued dialogue is welcomed by many lead- Hanson, 2011; McGoldrick & Hardy, 2019). ers, “non-traditional” spaces (e.g., social The topics to study and learn about will be media) often remain the sole avenue for some directed by understanding the community you groups of people to be part of such conversa- serve. That is, who are the members of the com- tions and to offer differing perspectives. munity? Do all members of the community have Without understanding the larger context and a voice? Are there disparities or incongruencies broader discussions taking place, both peer- reported in the literature about populations served reviewed publications and social media venues in your communities? Are there groups barred can sometimes appear to be binary and one- from receiving services in your communities? sided conversations. This process of disruption, Who receives services later? Do the demograph- fissure, and tension is also characteristic of our ics of your staff match the demographics of the times. Part of our humble responsibility is to populations served? What are the concerns and navigate these terrains and develop productive tensions being voiced by and on behalf of the methods and venues for dialogue, arbitration, people you serve? How do those concerns inter- and mediation so that we can nurture relation- act with the research base? ships and welcome diverse perspectives and Ideally, such questions and learning should be knowledge while creating new paradigms part of our initial training (Mathur & Rodriguez, (Maparyan, 2012). 2021; Najdowski et al., 2021) and part of ongo- The range of considerations and tensions is ing practice. In the meantime, as a way of orga- astonishing, and one could feel overwhelmed and nizing, communities of practice can be formed to paralyzed by many of the binary and seemingly study and systematically understand the complex opposing conditions. It is compounded by the information on cultural responsiveness and to lack of formal cultural training for intervention- make transformative changes in the way we ists in behavior analytic practice (Fong et al., engage in evidence-based practice (Anderson- 2017) and that many of the injustices, exclusions, Carpenter et al., 2014; LeBlanc et al., 2020; and tensions are normalized to the degree that Miller et al., 2019; Wenger, 2000). Specific strat- they are not acknowledged or recognized in the egies are being developed to address approaches published research. The path forward involves to training and culture that are specific to behav- learning with great humility, to engage in the ior analytic interventions (Mathur & Rodriguez, “liability of self-fullness” with a sense of respon- 2021) and address the distinct feature of a com- sibility to the collective to do the best you can munity of practice committed to increasing cul- with great care. tural responsiveness (Miller et al., 2019). 160 S. Alai-Rosales et al. Time and Resources Have to Be Allocated to expand your understanding, learn the parameters Learn That means portions of agendas and of social importance, and help you learn ways to work days should have designated time to include and tailor research evidence to meet the improve responsiveness to culture: to review and needs of the people you serve. reflect on practices; discuss new sources of infor- mation; map the needs, strengths, and shortcom- Another area emphasized is the necessity of ings of the community; decide necessary actions; improving our interaction skills across cultures. and reflect and evaluate those actions taken. It How to communicate and have safe and progres- also means that resources should be allocated to sive conversations with clients and peers of meeting times, additional training, bringing in diverse backgrounds, values, and learning histo- outside experts, and assessing the effects for ries is a complex skill and not an easy one to both the people being served and not those develop (e.g., Baires et al., 2021; Barrera & not served in our communities. And it means that Kramer, 2019). Because culture is ever evolving time has to be allocated to act. This involves time and the learning process is ongoing, it will be allocations for entering and nurturing genuine perpetually uncomfortable. Conditions have to be relationships with the people that are part of the created to practice the components of effective interventions, to have extended conversations, intercultural communication, to receive feed- and to learn who they are and what they value, back, and to improve. Essential to this process is both now and in the future. It also means spend- understanding the power differentials that exist in ing time observing and considering desired and the provider-receiver relationship and that these current ecologies, including shared goals and val- conditions require a humble posture and acknowl- ues, such that interventions begin to sustainably edgement that the learning will be eternal (Baires shape current climates toward these preferred et al., 2021; Wright, 2019). The community of environments (e.g., Bernal et al., 1995; Schwartz practice is the group that can help create increased & Kelly, 2021). Finally, both time and resource fluency and courage. Members can provide simu- allocation should be made for formal evaluations, lated practice and feedback of component skills, to be discussed ahead. provide a forum for reflecting upon and generat- ing ideas to improve actual interactions, explore discomforts with the process, and generally nur- Create Conditions for Progress This involves ture these developing skills by acknowledging identifying and creating opportunities for learn- effort and progress. The community can also ing. Some of the central areas of opportunity identify intervention points that require improved relate to self-reflection, communication, valued communication to increase responsiveness to outcomes, and measures of progress. Cultural context and values. awareness and self-reflection are key components Conditions can also be created to better under- in any helping profession’s approach to culture stand valued outcomes and how these relate to and interventions. This involves a process of cultural context and the evidence base. We start understanding your own identity and positional- with creating conditions for the people we serve ity, that is, your cultural context and how it relates to feel comfortable in the perspective sharing and to the people around you in terms of experiences, making process. Among other things, it is impor- privilege, access, and power. A community of tant to remember that everyone is in the process practice is an ideal place to start this process. of learning. Mistakes are part of the learning pro- There are a variety of training opportunities and cess. The hope is that mistakes are as benign as articles (many cited in the reference list of this possible, do minimal harm, and are quickly chapter) that can serve as a basis for learning. repaired. Intentionality is necessary to learn in Each of these can be part of a community of prac- order to prevent similar mistakes from reoccur- tice with group discussions that tie back to the ring moving forward. Each of us understanding populations you work and serve with and that can and articulating our values and perspectives is a 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 161 work in progress that is affected by our environ- Nurture Progress Here, the focus is on estab- ments. The degree to which we feel safe doing lishing and developing ongoing methods to sup- that will depend on where we are in relation to port progress. The central considerations are privilege and oppression in our communities. In clear and evolving goals, safe and progressive all cases, it is a matter of developing skills. When interactions, and multi-dimensional and multi- any person is learning how to exert agency, there sourced measures of progress. One of the first is an increased responsibility to create conditions steps is to create a format for program evaluation, for choices and preferences to be expressed, in a widely underutilized mechanism for assessing both research and practice (Morris et al., 2021). organizational health in relation to goals and The centrality of choices and balancing responsi- societal context, that includes various people bilities and liberties has been an ongoing dia- from varied cultures within that subset of society logue in our field and is heightened during (Miller, 2017). The second step is to have ongo- conditions of cultural differences (Bannerman ing discussions and planning around the goals of et al., 1990). the community of practice. What are the values The tension and learning lie in how to develop of your community? Do your program evalua- strong interventions around those preferences tions incorporate indicators of these values in and responsibilities within cultural groups, across action, in outcomes (Binder, 2016)? How are cultural groups, and in ways that will serve chil- they changing over time? What are you learning? dren with autism in the present cultural context How does it relate to the research? And most and in a cultural context that will change over the importantly, are the children making better prog- lifetime. Ultimately, this means how we under- ress? Are the families more involved? How did stand and work with individuals to increase qual- they participate in the process? Is there more ity of life, now and in the future. One of the main variation in the way programs are designed that considerations is how our understanding of this reflects cultural values and happy progress? Do interacts with an evidence base that is largely the people you work with feel that you care about molecular in nature (Zarcone et al., 2019) and their identities and values? Do they feel the out- does not have often concentration on dependent comes reflect that care? measures related to quality of life across the lifes- pan within the context of behavior change inter- ventions or research (Ala’i-Rosales et al., 2019; 9.2.3 Expansive Care Fawcett, 1991; Pritchett et al., 2021; Schwartz & Kelly, 2021). Again, it does not mean to say val- we are each other’s harvest: we are each other’s business: ued improvement is not demonstrated in the we are each other’s magnitude and bond. research base; it means that this research base (Brooks, 1970) does not often include these issues, which increases the responsibility of the practitioner to We offer a portion of Pulitzer Prize poet consider procedures across ecologies and time Gwendolyn Brooks’ work as the introduction to (Lutzker & Campbell, 1994) and to create assess- care for several reasons. One of the ways to ments of social importance and valued change understand people is through talking to them, (Ferguson et al., 2019). Social validity can cover hearing their poetry and music, seeing their art, a wide range of formats, from measures of affect listening to their stories, understanding how they to choices in free and restricted operant contexts spend their days and prioritize their activities, to interviews. The important thing for all social finding out what values they hold dear and what validity is that the data collection methods are teachings guide them and their perspectives on culturally informed and interpreted and not just life and the afterlife, and asking what gives their arranged to make the programs look good or as lives meaning and substance. In fact, as authors, an afterthought after failing to include the family we share this is as part of our poetry, as part of and child throughout the entire process (Schwartz what informs our perspectives. By virtue of our & Baer, 1991; Wolf, 1978). differing and uniquely combined positionalities 162 S. Alai-Rosales et al. (women, brown, black, raised in poverty, immi- Kramer, 2019; Blell et al., 2010; LeBlanc et al., grant, and children of immigrants), many sources 2020; LeBlanc et al., 2021; McLaughlin & Carr, of wisdom, in addition to research evidence, 2005; Rohrer et al., 2021; Tarbox & Rodriguez, inform our perspectives and direct the guiding 2021; Taylor et al., 2019; Walser & O’Connell, principles and focus of this chapter (Jafar, 2018). 2021). For example, both Rohrer et al. (2021) and For us, Brooks’ poetry reflects some core values; Taylor et al. (2019) discuss approaches that may we find meaning and hope in acknowledging and be likely to establish and enhance therapeutic acting on humanity’s essential unity and respon- relationships, including improving these skills to sibility to one another. Brooks writes of humani- understand the different ways of expressing care ty’s maturity, born of generational suffering, that and understanding meaning across cultures (e.g., declares that we are all interconnected and will Hurn & Tomlin, 2013; Zoch et al., 2018) and affect one another, that those effects will be in learning to change behaviors to adapt, to “sway,” direct proportion to our efforts, and that we are in our interactions across cultures (Lynch & bonded in our responsibility to one another. An Hanson, 2011). ever-expanding number of voices across the world echo these sentiments in many different 9.2.3.2 Procedures and Outcomes: arenas, from global policies to scholarship in the Show You Care humanities to the ethics of the helping profes- Here, the emphasis is on developing methods to sions (e.g., Birdsong, 2020; Karlberg, 2008; systematically include participants and cultural Maparyan, 2012; McGoldrick & Hardy, 2019; context (e.g., Fawcett, 1991; Fong et al., 2016; Pritchett et al., 2021; UN General Assembly, Fong et al., 2017; Fong & Tanaka, 2013; Morris 1948). & Hollins, 2021; Pritchett et al., 2021; Schwartz Viewing our interdependency is the first part & Kelly, 2021). As practitioners, our role is to of genuine and mature care. If interdependency understand these dimensions and to facilitate the and equitable wellbeing is acknowledged as a family’s voice in the design of interventions. This core value, the next step is to examine how this involves sharing and creating perspective and to value translates to different areas of practice. do so for people of different cultural groups in Caring and ways to show genuine care for all in equitable ways. That is to say, we should care- applied behavior analysis were part of our gene- fully consider the evidence base and to what sis (Baer et al., 1968; Wolf, 1978). The discus- degree it shows evidence of increased quality of sions centered around care and culture have life and of including people of diverse cultures in increased in the last few decades in at least a few the research. It also means learning about the specific areas related to practice: (1) relationship family’s life and values across many important development and communication, (2) procedures dimensions in which we humans can vary (Lynch and outcomes, and, perhaps the most difficult & Hanson, 2011). This includes, but is not lim- area, (3) structural oppression and biased deliv- ited to, the privileges and oppressions we experi- ery systems. We will briefly discuss some of the ence; the degrees of affluence and poverty in our caring actions interventionists can take in each of life circumstances; who we rely on, trust, and these areas. turn to for help and support; how, what, and when we communicate; how we interact and respond to 9.2.3.1 Attention to Relationship time; how we respond to hierarchies of power; Development refugee and/or immigration conditions; family and Communication: Show constellations; gender identification; languages You Care spoken; religious and spiritual practices; and There are an increasing number of scholars that trauma related to cultural identity. Time should direct our attention to the importance of the ther- be dedicated and methods employed to under- apeutic relationship in behavior analytic treat- stand the participants’ cultural perspective and ment and the dimensions of how to improve those values along these dimensions and for the inter- relationships (e.g., Baires et al., 2021; Barrera & ventionist to consider how this contrasts with the 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 163 research and one's own personal experiences. the injustices in our own communities; welcom- The family and the interventionist begin the ing and creating spaces for diverse voices within process of perspective taking and making as they our organizational structures; developing com- integrate the best available research for the child’s munities of practice and strategic organizational wellbeing in the present and in the future. Of plans specifically addressing values, goals, and course, over time, the child becomes a more and outcomes related to equity and justice; and more active participant in this process. Behavior encouraging solidarity, because of and in spite of analytic evidence-based practice includes the our differences, for the wellbeing of all. The sug- participant context and values, by welcoming and gested efforts can be studied and considered as listening to the voices of the participants in we act and learn as individuals, as a discipline, selecting goals, determining dependent mea- and as our world evolves. sures, and producing satisfaction with outcomes that address cultural and quality dimensions of importance (Schwartz & Baer, 1991; Slocum 9.3 Conclusion and Onward et al., 2014; Wolf, 1978). As the world undergoes social transformation, 9.2.3.3 Structural Oppression we can better our interventions for all children and Biased Delivery Systems: with autism in the context of their cultures, we Show You Care can create and nurture genuine and caring com- Oppressive and biased systems are perhaps the munities of practice, we can center voices and most difficult and overwhelming area to navigate expressed dreams and life outcomes of the people (Broder-Fingert et al., 2020; Cihon & Mattaini, we serve, and we can learn in those communities 2019; Levy et al., 2021; Mathur & Rodriguez, with humility. The children and families we serve 2021). Our interventions require moving beyond depend on it. We are doing hard work; there is a molecular analysis and improvements (Ardila large evidence base we should learn and many Sánchez et al., 2020; Cihon & Kazaoka, 2021; skills we should master. And still, it is not enough. Zarcone et al., 2019). The pandemic and the We have to place what we are doing in the larger resulting disruptions of all our societal structures context of culture and the human condition. We are giving us a chance to hear the voices of many recognize that, on the one hand, we now know oppressed people (e.g., Hill, 2020; Roy, 2020). In more than ever and can facilitate powerful our own field, the pandemic and uprisings high- changes and, on the other hand, they are not lighted injustice, made difficult discussions with always the right changes, nor are they always unfamiliar words and concepts more “permissi- accessible. That is the liability of our self- ble,” and laid the groundwork for a series of arti- fullness. It is also our way forward. cles and social media forums that specifically address socio-political concerns. Vigorous and heated explorations about what we can learn and References what we might do during these times have emerged. These dialogues have laid the ground- Adams, G., Dobles, I., Gómez, L. H., Kurti , T., & Molina, L. E. (2015). Decolonizing psychological science: work for us to specifically address cultural Introduction to the special thematic section. Journal responsiveness at a systemic level. As behavior of Social and Political Psychology, 3(1), 213–238. analysts, we are exploring what we can learn and https://doi.org/10.5964/jspp.v3i1.564 what we might do during these times. Several Ala’i, S., & Re Cruz, A. (2021). The pedagogy of nepantla. In J. A. Sadavoy & M. L. Zube (Eds.), authors have suggested how individual behavior Scientific framework for compassion and social jus- analysts and behavior analytic organizations can tice (1st ed., pp. 204–211). Routledge. https://doi. take action (e.g., Ardila Sánchez et al., 2020; org/10.4324/9781003132011-32 Levy et al., 2021; Mathur & Rodriguez, 2021; Ala’i-Rosales, S., Cihon, J. H., Currier, T. D. R., Ferguson, J. L., Leaf, J. B., Leaf, R., McEachin, J., & Weinkauf, Miller et al., 2019). They include learning about S. M. (2019). The big four: Functional assessment 164 S. Alai-Rosales et al. research informs preventative behavior analysis. Benjamin, R. (2019). Assessing risk, automating racism. Behavior Analysis in Practice, 12(1), 222–234. https:// Science, 366(6464), 421–422. https://doi.org/10.1126/ doi.org/10.1007/s40617-018-00291-9 science.aaz3873 Aljohani, W. A. (2021). Islamophobia. In J. A. Sadavoy Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological & M. L. Zube (Eds.), Scientific framework for com- validity and cultural sensitivity for outcome research: passion and social justice (1st ed., pp. 168–173). Issues for the cultural adaptation and development of Routledge. psychosocial treatments with Hispanics. Journal of Anderson-Carpenter, K. D., Watson-Thompson, J., Jones, Abnormal Child Psychology, 23(1), 67–82. https://doi. M., & Chaney, L. (2014). Using communities of prac- org/10.1007/BF01447045 tice to support implementation of evidence-based pre- Binder, C. (2016). Integrating organizational-cultural vention strategies. Journal of Community Practice, values with performance management. Journal of 22(1–2), 176–188. https://doi.org/10.1080/10705422. Organizational Behavior Management, 36(2–3), 185– 2014.901268 201. https://doi.org/10.1080/01608061.2016.1200512 Annamma, S. A., Connor, D. J., & Ferri, B. A. (2016). Birdsong, M. (2020). How we show up: Reclaiming fam- Dis/ability critical race studies (DisCrit): Theorizing ily, friendship and community. Hachette Book Group. at the intersections of race and dis/ability. In D. J. Blell, Z. D., Alai-Rosales, S., & Rosales-Ruiz, J. (2010). Connor, B. A. Ferri, & S. A. Annamma (Eds.), The effects of a supportive communication training DisCrit: Disability studies and critical race theory in workshop on the verbal behavior of behavior analysts. education (pp. 9–32). Teachers College Press. Behavior and Social Issues, 19(1), 144–166. https:// Ardila Sánchez, J. G., Cihon, T. M., Malott, M. E., Mattaini, doi.org/10.5210/bsi.v19i0.3088 M. A., Rakos, R. F., Rehfeldt, R. A., Richling, S. M., Boland, R. J., & Tenkasi, R. V. (1995). Perspective mak- Roose, K. M., Seniuk, H. A., & Watson-Thompson, J. ing and perspective taking in communities of know- (2020). Collective editorial: Ten guidelines for strate- ing. Organization Science, 6, 337–507. https://doi. gic social action. Behavior and Social Issues, 29(1), org/10.1287/orsc.6.4.350 15–30. https://doi.org/10.1007/s42822-020-00038-8 Bradley, A., & Moore, T. (Hosts). (n.d.). Shades of ABA. Association for Behavior Analysis International. (n.d.). [Audio podcast]. https://anchor.fm/shadesofaba 2020 Membership Diversity Data. https://media. Broder-Fingert, S., Mateo, C. M., & Zuckerman, K. E. abainternational.org/dei/DEI%20Data%202019- (2020). Structural racism and autism. Pediatrics, 2020%20Membership.pdf 146(3), e2020015420. https://doi.org/10.1542/ Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some PEDS.2020-015420 current dimensions of applied behavior analysis. Brooks, D. C. (1970). The emancipation of women. Journal of Applied Behavior Analysis, 1, 91–97. Macmillan. https://doi.org/10.1901/jaba.1968.1-91 Busch, L., & Levasseur, A. (2021). Indigenous rights: Baires, N. A., Catrone, R., & May, B. K. (2021). On the Finding the trail: Indigenous considerations for decol- importance of listening and intercultural communi- onizing research and clinical work. In J. A. Sadavoy cation for actions against racism. Behavior Analysis & M. L. Zube (Eds.), A scientific framework for com- Practice. Advanced online publication. https://doi. passion and social justice (1st ed., pp. 159–167). org/10.1007/s40617-021-00629-w Routledge. Bannerman, D. J., Sheldon, J. B., Sherman, J. A., & Carr, J. E., & Briggs, A. M. (2010). Strategies for mak- Harchik, A. E. (1990). Balancing the right to habilita- ing regular contact with the scholarly literature. tion with the right to personal liberties: The rights of Behavior Analysis in Practice, 3(2), 13–18. https:// people with developmental disabilities to eat too many doi.org/10.1007/BF03391760 doughnuts and take a nap. Journal of Applied Behavior Cihon, T. M., & Kazaoka, K. (2021). Culture: A cultural Analysis, 23(1), 79–89. https://doi.org/10.1901/ behavioral systems science perspective on the strug- jaba.1990.23-79 gle for social justice. In J. A. Sadavoy & M. L. Zube Barrera, I., & Kramer, L. (2009). Using skilled dialogue (Eds.), A scientific framework for compassion and to transform challenging interactions: Honoring iden- social justice (1st ed., pp. 100–106). Routledge. tity, voice, & connection. Paul H. Brookes. Cihon, T. M., & Mattaini, M. A. (2019). Editorial: Barrera, I., & Kramer, L. (2019). Skilled dialogue: Emerging cultural and behavioral systems science. Authentic communication and collaboration across Perspectives on Behavior Science, 42, 699–711. diverse perspectives. Balboa Press. https://doi.org/10.1007/s40614-019-00237-8 Beaulieu, L., Addington, J., & Almeida, D. (2019). Cirincione-Ulezi, N. (2020). Black women and bar- Behavior analysts’ training and practices regarding riers to leadership in ABA. Behavior Analysis in cultural diversity: The case for culturally competent Practice, 13(4), 719–724. https://doi.org/10.1007/ care. Behavior Analysis in Practice, 12(3), 557–575. s40617-020-00444-9 https://doi.org/10.1007/s40617-018-00313-6 Behavior Analysis Certification Board. (n.d.) - BACB Certificant Data. https://www.bacb.com/ - bacb-certificant-data/ Behavior Analysis in Practice. Benjamin, R. (2013). People’s science: Bodies and rights Advance online publication. https://doi.org/10.1007/ on the stem cell frontier. Stanford University Press. s40617-021-00577-5 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 165 Conners, B. M., & Capell, S. T. (2021). Multiculturalism Friedman, C. (2021). Reducing ‘challenging’ behav- and diversity in applied behavior analysis: Bridging ior by training support staff to promote dignity and theory and application. Routledge. https://doi. respect. Journal of Developmental and Physical org/10.4324/9780429263873 Disabilities, 33(3), 449–458. https://doi.org/10.1007/ DelVecchio Good, M. J., & Hannah, S. D. (2015). s10882-020-09757-7 “Shattering culture”: Perspectives on cultural com- Gillis, J. M., & Carr, J. E. (2014). Keeping current with the petence and evidence-based practice in mental health applied behavior-analytic literature in developmen- services. Transcultural Psychiatry, 52(2), 198–221. tal disabilities: Noteworthy articles for the practicing https://doi.org/10.1177/1363461514557348 behavior analyst. Behavior Analysis Practice, 7(1), Dirth, T. P., & Adams, G. (2019). Decolonial theory and 10–14. https://doi.org/10.1007/s40617-014-0002-7 disability studies: On the modernity/coloniality of Gingles, D. (2021a). Black lives matter. In J. A. Sadavoy ability. Journal of Social and Political Psychology, & M. L. Zube (Eds.), Scientific framework for compas- 7(1), 260–289. https://doi.org/10.5964/jspp.v7i1.762 sion and social justice (1st ed., pp. 38–44). Routledge. Donovan, A. R. (2021). Gendered language: Moving Gingles, D. (2021b). Igniting collective freedom: An toward a compassionate gender expansive society. integrative behavioral model of acceptance and com- In J. A. Sadavoy & M. L. Zube (Eds.), Scientific mitment toward Black liberation. Behavior Analysis framework for compassion and social justice (1st ed., Practice. Advance online publication. https://doi. pp. 122–127). Routledge. org/10.1007/s40617-021-00584-6. DuBay, M., Watson, L. R., & Zhang, W. (2018). In Gingles, D. & Donovan, A. (Hosts). (n.d.). Beautiful search of culturally appropriate autism interventions: Humans [Audio podcast]. Beautiful Humans Change. Perspectives of Latino caregivers. Journal of Autism https://www.beautifulhumanschange.com/podcast and Developmental Disorders, 48, 1623–1639. https:// Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The doi.org/10.1007/s10803-017-3394-8 weirdest people in the world? Behavioral and Brain England, K. V. L. (1994). Getting personal: Reflexivity, Sciences, 33(2–3), 61–83. https://doi.org/10.1017/ positionality, and feminist research. The s0140525x0999152x Professional Geographer, 46(1), 80–89. https://doi. Hill, M. L. (2020). We still here: Pandemic, policing, pro- org/10.1111/j.0033-0124.1994.00080.x test, and possibility. Haymarket Books. Esquierdo-Leal, J. L., & Houmanfar, R. A. (2021). Hurn, B. & Tomlin, B. (2013). Cross-cultural communi- Creating inclusive and equitable cultural practices cation: Theory and practice. Palgrave Macmillan UK. by linking leadership to systemic change. Behavior Iland, T. (2021). Neurodiversity and ableism. In J. A. Analysis in Practice, 14, 499–512. https://doi. Sadavoy & M. L. Zube (Eds.), Scientific framework org/10.1007/s40617-020-00519-7 for compassion and social justice (1st ed., pp. 212– Fawcett, S. B. (1991). Some values guiding community 216). Routledge. research and action. Journal of Applied Behavior Iwamasa, G. Y. (1997). Behavior therapy and a cultur- Analysis, 24(4), 621–636. https://doi.org/10.1901/ ally diverse society: Forging an alliance. Behavior jaba.1991.24-621 Therapy, 28(3), 347–358. https://doi.org/10.1016/ Ferguson, J. L., Cihon, J. H., Leaf, J. B., Van Meter, S. M., S0005-7894(97)80080-9 McEachin, J., & Leaf, R. (2019). Assessment of social Iwamasa, G. Y., & Smith, S. K. (1996). Ethnic diversity in validity trends in the journal of applied behavior anal- behavioral psychology. Behavior Modification, 20(1), ysis. European Journal of Behavior Analysis, 20(1), 45–59. https://doi.org/10.1177/01454455960201002 146–157. https://doi.org/10.1080/15021149.2018.15 Jacobson, D., & Mustafa, N. (2019). Social identity 34771 map: A reflexivity tool for practicing explicit posi- Fong, E. H., & Tanaka, S. (2013). Multicultural alliance of tionality in critical qualitative research. International behavior analysis standards for cultural competence in Journal of Qualitative Methods, 18, 1–12. https://doi. behavior analysis. International Journal of Behavioral org/10.1177/1609406919870075 Consultation and Therapy, 8(2), 17–19. https://doi. Jafar, A. J. N. (2018). What is positionality and should org/10.1037/h0100970 it be expressed in quantitative studies? Emergency Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, Medicine Journal, 35(5), 323–324. https://doi. S., & Field, S. (2016). Developing the cultural aware- org/10.1136/emermed-2017-207158 ness skills of behavior analysts. Behavior Analysis Karlberg, M. (2008). Discourse, identity, and in Practice, 9(1), 84–94. https://doi.org/10.1007/ global citizenship. Peace Review: A Journal s40617-016-0111-6 of Social Justice, 20(3), 310–320. https://doi. Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing org/10.1080/10402650802330139 cultural understanding and diversity in applied Karlberg, M., & Farhoumand-Simms, C. (2006). Global behavior analysis. Behavior Analysis: Research and citizenship and humanities scholarship. International Practice, 17(2), 103–113. https://doi.org/10.1037/ Journal of the Humanities, 2(3), 2189–2198. bar0000076 Keenan, M., Dillenburger, K., Moderato, P., & Röttgers, Foronda, C. (2020). A theory of cultural humility. Journal H.-R. (2010). Science for sale in a free market econ- of Transcultural Nursing, 31(1), 7–12. https://doi. omy: But at what price? ABA and the treatment of org/10.1177/1043659619875184 166 S. Alai-Rosales et al. autism in Europe. Behavior and Social, 19, 126–143. Lynch, E. W., & Hanson, M. J. (2011). Developing cross- https://doi.org/10.5210/bsi.v19i0.2879 cultural competence: A guide for working with chil- Kelly, J., Sadeghieh, T., & Adeli, K. (2014). Peer review dren and their families (4th ed.). Paul H. Brookes in scientific publications: Benefits, critiques, & A sur- Publishing. vival guide. EJIFCC, 25(3), 227–243. Maparyan, L. (2012). The womanist idea. Routledge. Kirkham, P. (2017). ‘The line between intervention and Mathur, K., & Rodriguez, K. A. (2021). Cultural respon- abuse’–autism and applied behaviour analysis. History siveness curriculum for behavior analysts: A mean- of the Human Sciences, 30(2), 107–126. https://doi. ingful step towards social justice. Behavior Analysis org/10.1177/0952695117702571 in PracticeAdvance online publication. https://doi. Ladson-Billings, G. (1995). Toward a theory of cul- org/10.1007/s40617-021-00579-3 turally relevant pedagogy. American Educational McGoldrick, M., & Hardy, K. V. (2019). Re-visioning Research Journal, 32(3), 465–491. https://doi. family therapy: Addressing diversity in clinical prac- org/10.2307/1163320 tice (3rd ed.). Guilford Press. Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., McLaughlin, D. M., & Carr, E. G. (2005). Quality of Ala’i-Rosales, S., Ross, R. K., Smith, T., & Weiss, rapport as a setting event for problem behavior: M. J. (2016). Applied behavior analysis is a science Assessment and intervention. Journal of Positive and, therefore, progressive. Journal of Autism and Behavior Interventions, 7(2), 68–91. https://doi.org/1 Developmental Disorders, 46(2), 720–731. https://doi. 0.1177/10983007050070020401 org/10.1007/s10803-015-2591-6 Miller, K. L. (2017). The use of evaluation in treatment Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., programs for children with autism. Behavior Analysis Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, in Practice, 10, 35–44. https://doi.org/10.1007/ D. (2021). Concerns about ABA-based intervention: s40617-016-0130-3 An evaluation and recommendations. Journal of Autism Miller, K. L., Re Cruz, A., & Ala’i-Rosales, S. (2019). and Developmental Disorders, Advance online publi- Inherent tensions and possibilities: Behavior anal- cation. https://doi.org/10.1007/s10803-021-05137-y ysis and cultural responsiveness. Behavior and Leaf, J. B., Cihon, J. H., Ferguson, J. L., & Weiss, M. J. Social Issues, 28, 16–36. https://doi.org/10.1007/ (Eds.). (2022). Handbook of applied behavior analysis s42822-019-00010-1 intervention for autism. Springer. Moll, L. C., Amanti, C., Neff, D., & Gonzalez, N. (1992). LeBlanc, L. A., Sellers, T. P., & Ala’i, S. (2020). Building Funds of knowledge for teaching: Using a qualita- and sustaining meaningful and effective relationships tive approach to connect homes and classrooms. as a supervisor and mentor. Sloan Publishing. Theory Into Practice, 31(2), 132–141. https://doi. LeBlanc, L. A., Gingles, D., & Byers, E. (2021). org/10.1080/00405849209543534 Compassion: The role of compassion in social jus- Morris, C., & Hollins, N. A. (2021). On the uncanny tice efforts. In J. A. Sadavoy & M. L. Zube (Eds.), similarities between police brutality and cli- Scientific framework for compassion and social justice ent mistreatment. Behavior Analysis in Practice. (1st ed., pp. 60–65). Routledge. Advance online publication. https://doi.org/10.1007/ Leland, W., Stockwell, A., & Vaidya, J. (2021). Supporting s40617-021-00576-6 ontogenic and cultural compassion building for the Morris, C., Detrick, J. J., & Peterson, S. M. (2021). LGBTQ2IA community. In J. A. Sadavoy & M. L. Participant assent in behavior analytic research: Zube (Eds.), Scientific framework for compassion and Considerations for participants with autism and devel- social justice (1st ed., pp. 180–186). Routledge. opmental disabilities. Journal of Applied Behavior Levy, S., Siebold, A., Vaidya, J., Truchon, M. M., Analysis, 54(4), 1300–1316. https://doi.org/10.1002/ Dettmering, J., & Mittelman, C. (2021). A look in jaba.859 the mirror: How the field of behavior analysis can Najdowski, A. C., Gharapetian, L., & Jewett, V. (2021). become anti-racist. Behavior Analysis in Practice. Toward the development of antiracist and multicul- Advance online publication. https://doi.org/10.1007/ tural graduate training programs in behavior analysis. s40617-021-00630-3 Behavior Analysis in Practice, 14(2), 462–477. https:// Li, J. (2016). Humility in learning: A Confucian perspec- doi.org/10.1007/s40617-020-00504-0 tive. Journal of Moral Education, 45(2), 147–165. National Autism Center. (2015). Findings and con- https://doi.org/10.1080/03057240.2016.1168736 clusions: National standards project, phase 2. Li, A. (2021). Solidarity: The role of non-black people of Author. https://www.nationalautismcenter.org/ color in promoting racial equity. Behavior Analysis national-standards-project/ in Practice, 14, 549–553. https://doi.org/10.1007/ National Professional Development Center. (2014). s40617-020-00498-9 Evidence-based practices for children, youth, and Love, B. L. (2019). We want to do more than survive: young adults. https://autismpdc.fpg.unc.edu/national- Abolitionist teaching and the pursuit of educational professional-development-center-autism-spectrum- freedom. Beacon Press. disorder Lutzker, J. R., & Campbell, R. (1994). Ecobehavioral Nordyke, N. S., Baer, D. M., Etzel, B. C., & LeBlanc, family interventions in developmental disabilities. J. M. (1977). Implications of the stereotyping and Brooks/Cole. modification of sex role. Journal of Applied Behavior 9 Be Humble, Learn, and Care: Culturally Responsive Evidence-Based Practice 167 Analysis, 10(3), 553–557. https://doi.org/10.1901/ Tarbox, J., & Rodriguez, K. (2021). Acting to support jaba.1977.10-553 compassion-focused applied behavior analysis. In Osborne, N. (2015). Intersectionality and kyriarchy: J. A. Sadavoy & M. L. Zube (Eds.), Scientific frame- A framework for approaching power and social work for compassion and social justice (1st ed., justice in planning and climate change adapta- pp. 8–15). Routledge. tion. Planning Theory, 14(2), 130–151. https://doi. Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2019). org/10.1177/1473095213516443 Compassionate care in behavior analytic treat- Pritchett, M., Ala’i-Rosales, S., Cruz, A. R., & Cihon, ment: Can outcomes be enhanced by attending to T. M. (2021). Social justice is the spirit and aim of relationships with caregivers? Behavior Analysis in an applied science of human behavior: Moving from Practice, 12(3), 654–666. https://doi.org/10.1007/ colonial to participatory research practices. Behavior s40617-018-00289-3 Analysis in Practice. Advance online publication. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humil- https://doi.org/10.1007/s40617-021-00591-7 ity versus cultural competence: A critical distinction in Project Implicit. (n.d.). https://www.projectimplicit.net defining physician training outcomes in multicultural Rohrer, J., Marshall, K., Suzio, C., & Weiss, M. J. (2021). education. Journal of Health Care for the Poor and Soft skills: The case for compassionate approaches Underserved, 9(2), 117–125. https://doi.org/10.1353/ or how behavior analysis keeps finding its heart. hpu.2010.0233 Behavior Analysis in Practice, 14, 1135–1143. https:// United Nations (UN) General Assembly (1948). doi.org/10.1007/s40617-021-00563-x Universal declaration of human rights.. UN General Roy, A. (2020). The pandemic is a por- Assembly. https://www.un.org/en/about-us/ tal. Financial Times. https://www.ft.com/ universal-declaration-of-human-rights content/10d8f5e8-74eb-11ea-95fe-fcd274e920ca Uwayo, M., Hernandez, M., & Ross, D. (2021). Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, Understanding the needs of economically disadvan- R. B., & Richardson, W. S. (1996). Evidence based taged children and families. In J. A. Sadavoy & M. L. medicine: What it is and what it isn’t. BMJ (Clinical Zube (Eds.), Scientific framework for compassion and research ed.), 312(7023), 71–72. https://doi. social justice (1st ed., pp. 151–158). Routledge. org/10.1136/bmj.312.7023.71 Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Sadavoy, J. A., & Zube, M. L. (2021). A scientific frame- Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). work for compassion and social justice. Routledge. The right to effective behavioral treatment. Journal Schwartz, I. S., & Baer, D. M. (1991). Social valid- of Applied Behavior Analysis, 21(4), 381–384. https:// ity assessments: Is current practice state of the art? doi.org/10.1901/jaba.1988.21-381 Journal of Applied Behavior Analysis, 24(2), 189– Walser, R., & O’Connell, M. (2021). Acceptance and 204. https://doi.org/10.1901/jaba.1991.24-189 commitment therapy and the therapeutic relationship: Schwartz, I. S., & Kelly, E. M. (2021). Quality of life Rupture and repair. Journal of Clinical Psychology, for people with disabilities: Why applied behav- 77(2), 429–440. https://doi.org/10.1002/jclp.23114 ior analysts should consider this a primary depen- Wenger, E. (2000). Communities of practice and social dent variable. Research and Practice for Persons learning systems. Organization, 7(2), 225–246. with Severe Disabilities, 46(3), 159–172. https://doi. https://doi.org/10.1177/135050840072002 org/10.1177/15407969211033629 Wlodkowski, R. J., & Ginsberg, M. B. (1995). A frame- Sidman, M. (2001). Coercion and its fallout (2nd ed.) work for culturally responsive teaching. Educational Authors Cooperative. Leadership, 53(1), 17–21. Singer, G. H. S., Gert, B., & Koegel, R. L. (1999). A Wolf, M. M. (1978). Social validity: The case for sub- moral framework for analyzing the controversy jective measurement or how applied behavior analy- over aversive behavioral interventions for people sis is finding its heart. Journal of Applied Behavior with severe mental retardation. Journal of Positive Analysis, 11(2), 203–214. https://doi.org/10.1901/ Behavior Interventions, 1(2), 88–100. https://doi. jaba.1978.11-203 org/10.1177/109830079900100203 Wright, P. I. (2019). Cultural humility in the practice Skinner, B. F. (1953). Science and human behavior. of applied behavior analysis. Behavior Analysis in Macmillan. Practice, 12(4), 805–809. https://doi.org/10.1007/ Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, s40617-019-00343-8 T. D., Lewis, T., & Wolfe, K. (2014). The evidence- Zarcone, J., Brodhead, M., & Tarbox, J. (2019). Beyond a based practice of applied behavior analysis. call to action: An introduction to the special issue on The Behavior Analyst, 37(1), 41–56. https://doi. diversity and equity in the practice of behavior analy- org/10.1007/s40614-014-0005 sis. Behavior Analysis in Practice, 12(4), 741–742. Smith, T. (2013). What is evidence-based behavior analy- https://doi.org/10.1007/s40617-019-00390-1 sis? The Behavior Analyst, 36(1), 7–33. https://doi. Zoch, M., Alarcón, J., Bettez, S., & Hardin, B. (2018). org/10.1007/BF03392290 Textured dialogues: A community project about Sugai, G., O’Keeffe, B. V., & Fallon, L. M. (2012). immigrants’ multimodal perspectives on the mean- A contextual consideration of culture and school- ing of education. Multicultural Perspectives, 20(1), wide positive behavior support. Journal of Positive 39–46. https://doi.org/10.1080/15210960.2018.140 Behavior Interventions, 14(4), 197–208. https://doi. 8346 org/10.1177/1098300711426334