Drexel University Online - March and May

B.F. Skinner’s iPhone: The Era of Technology-Enabled Clinicians

B.F. Skinner was an American humanist, philosopher, behavioral scientist, author, and inventor. In his latter capacity, Skinner had a keen interest in the education of children. In fact, in a notable quote that captures his personal philosophy he suggested that: “It has always been the task of formal education to set up behavior which would prove useful or enjoyable later in a student’s life.” In consequence, in 1953, in an effort to make education both effective and enjoyable, Skinner built the first teaching machine. The efficiency and effectiveness of the teaching machine can be attributed to the automaticity of feedback, the delivery of educational reinforcement, the inherent individualized pacing system, a logical instructional sequence, and active student engagement. Given Skinner’s interest in the use of technology for learning and behavior change, we suspect that if he were walking the streets of Cambridge, Massachusetts today he would definitely have an iPhone in his hand (all right, we concede, maybe it would be an Android). Nevertheless, we suspect Skinner would be using mobile technology to facilitate learning and human engagement for the compassionate advancement of our culture. Therefore, in an effort to celebrate B.F. Skinner’s legacy, we have outlined below two innovative methods for supporting the education of children, and rendering the educational process enjoyable, through the use of technology.

Behavioral Intervention Technologies (BITS)

According to Northwestern University’s Center for Behavioral Intervention Technologies (CBITS) (http://cbits.northwestern.edu), “Behavioral Intervention Technologies are applications that use technologies such as mobile phones, computers, tablets, and sensors to support behaviors that improve health, including mental health.” We have generalized the findings of Northwestern University’s “proof of concept” studies and, through our own clinical work, have explored the utility of using Behavioral intervention Technologies for supporting children with Autism Spectrum Disorder and their families. More specifically, we have examined the practicality of both web-based and mobile phone interventions. Our fieldwork shows that both of these technological platforms result in highly favorable clinical outcomes.

Web-Based Intervention: A Case Study

The goal of one of our clinicians was to support a young boy (we will use the pseudonym Ammon to refer to him) to engage in the observances, rituals, and routines of his family. More specifically, Ammon was expected to: (a) attend to his personal hygiene (e.g., brush his teeth, shower, put on deodorant, and change his clothing on a daily basis); (b) take responsibility for household chores such as putting his clothing in a laundry basket at the end of the day; and (c) participate in family-strengthening routines (e.g., listening to family joys during the evening meal). However, during the initial assessment phase, it was determined that Ammon engaged minimally in the aforementioned activities, or not at all. Despite Ammon’s inappreciable family engagement, it was determined through a strength-based assessment that Ammon had a keen interest in sport teams, player’s statistics, and scores. He also had a strong interest in technology and a sociable relationship with the clinician that supported his home-based program. Therefore, based on Ammon’s personal strengths and interests, a web-based intervention was designed that:

 

  • Emphasized self-monitoring and self-reporting
  • Provided a practical structure for adherence to a daily reporting requirement
  • Emphasized daily connectedness with his clinician via web-based email correspondence
  • Supported a multi-source feedback system (e.g., Ammon, his mother and father, and the primary clinician), and
  • Allowed for a web-based social and technological interface conducive to the promotion of socially significant behavior change

Specifically, the web-based intervention designed for Ammon required him to email his personal scorecard (i.e., the total percentage of household obligations he fulfilled during the course of the day) to his clinician at the close of each day. In turn, he would receive a reply from her with validation and instructive feedback. The personal scorecard appealed to Ammon’s established interest in data and connected to his propensity to talk about scores, facts, and figures. The outcome of the intervention was impressive. More to the point, the web-based intervention resulted in the percentage of fulfilled obligations shifting from a low of 31% prior to the introduction of the web-based plan (based on 14 days) to 97% over the most recent seven days of the intervention. In addition to the web-based clinical system motivating and supporting Ammon, it also appreciatively impacted his relationship with his family and resulted in the generation of healthy interactions. Essentially, the program resulted in a pivotal change in Ammon’s home circumstances. Moreover, the individualized program was, at once, strength-based and technology enabled.

Mobile Phone Intervention: A Case Study

In another case study, we used an innovative mobile intervention program model to support a young boy (we will use the pseudonym Piers to refer to him) to address his enervating anxiety around other children. Although Piers valued personal friendships, he was unable to remain in the presence of another child long enough to forge any kind of relationship. Moreover, he resisted joining any of the social skills group meetings facilitated by his clinician. In an effort to address Piers’ social anxiety, a mobile phone with a short message service (SMS) component was purchased. It should be noted that Piers had a monsterful interest in both mobile phones and text messaging and had been asking his parents to buy a phone for his personal use. Subsequent to the purchase, Piers’ clinician began communicating with him, via text messages, under non-emotional circumstances (i.e., text message rapport building) and Piers quickly became a text-messaging virtuoso. During this phase of the mobile phone intervention, Piers and his clinician developed their own SMS shortcuts. For example, Piers decided that if he sent an instant message consisting of the single word “Orange,” then his clinician would allow him to exit an uneasy situation. Once Piers was outfitted with a mobile phone, text messaging capability, a reliable (and honored) system for communicating his needs, and a proven arrangement for exiting uncomfortable situations, he volunteered to join a social skills group for the first time. The intervention resulted in a multitude of desirable outcomes, including:

 

  • Piers’ active participation in a social skills group
  • Spontaneous communication and contributions within the context of social skills group meetings (e.g., a discussion about pets)
  • Contextualized use of text messages to communicate with his clinician
  • The ability to exit a social context upon texting the code word “Orange” to his clinician, and
  • The ability to return to the group meeting, on his terms, after regulating his heightened emotional state

Essentially, the mobile phone intervention resulted in personal empowerment, self-control, self-efficacy, and self-determination. As clinicians, we put a premium on such outcomes when working with children with an Autism Spectrum Disorder.

Conclusion

We believe that the two case studies presented would have sent B.F. Skinner wandering around the 22.4 acres of Harvard Yard. And during the process, he certainly would have sent us a Snapchat Story about the smart use of technology to support both useful and enjoyable behavior change. In our opinion, the esteemed researchers from Northwestern University’s Center for Behavioral Intervention Technologies are in the forefront of creative technology-enabled intervention, and the procedures they have introduced are heraldic of a new way of working with individuals that require behavioral support to facilitate changes in their quality of life. As clinicians, we support the use of technology as a medium for coordinating the delivery of evidence-based practices and are proud to be living and working during this new era of technology-enabled clinicians.

 

Michael J. Cameron, PhD, BCBA-D is the Chief Clinical Officer for Pacific Child and Family Associates (PCFA). Melissa Cline, MSEd, BCBA is a Clinical Supervisor for Autism Services North (ASN), an affiliate program of PCFA. Rebecca Hise, MS, BCBA is a Clinical Supervisor for Autism Intervention Specialists (AIS), an affiliate program of PCFA. For more information, please visit www.pacificchild.com.

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