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International Electronic Journal of Elementary Education
January 2023, Volume 15, Issue 3, 233-245

A Summary of the Recommendations
to Increase Cultural Responsiveness in
the Field of Applied Behavior Analysis
Sarah V. Kristiansen*

Abstract

Introduction

Cultural contingencies help shape the development of an
individual’s behavioral repertoire. Researchers within field of
behavior analysis have, within the past decade, reiterated
the importance of connecting behavioral principles to
a client's cultural practices. The incorporation of cultural
preferences within behavioral services is paramount to
the effectiveness and sustainability of those services. The
present paper summarizes the guidance of researchers
for practitioners beginning to develop this repertoire and
apply it to their clinical practice. This paper begins by
acknowledging that the foundation of the field of applied
behavior analysis set the stage for understating how
cultural considerations make the field applied. Different
themes related to increasing the cultural responsiveness
of the field are summarized by reviewing the supporting
literature. The research is further summarized into guiding
principles for practitioners as they begin to sharpen this skill.
The paper ends with a call for scientist practitioners and
researchers to capture data related to culturally responsive
service provision to inspire efforts in empirical evaluation of
the recommendations provided.

Culture is the backbone of the science of behavior analysis. Differentiation in cultures forms as the result
of interactions between individuals which result in specific
specific repertoire being shaped by social consequences
(Glenn, 2004). These interactions are responsible for a
large portion of human learning and the combination of
consequences over time within a specific context is what
makes a culture unique (Glenn, 2004). The cultural identity
of specific group of individuals will determine behavioral
nuances that are considered appropriate or inappropriate
(e.g., shaking hands as a greeting, avoiding direct eye
contact, hugging when welcoming a grandparent).
Understanding the existing cultural repertoires of a family,
community, or social group gives a behavior analyst a
starting point to develop a client-centered intervention
plan. An emphasis on culture is a necessary component of
behavior analytic intervention because cultural responsive

Keywords:

Cultural Responsiveness, Cultural Humility, Cultural Awareness,
Applied Behavior Analysis

Received : 27 Janaury 2023
Revised : 15 February 2023
Accepted : 15 March 2023
DOI : 10.26822/iejee.2023.296

* Correspondance Details: Sarah V. Kristiansen, Insti-
tute for Applied Behavioral Science, Endicott College,
USA.
E-mail: skristia@endicott.edu
ORCID: https://orcid.org/0000-0002-8857-6316

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intervention practices can more readily support the
naturalistic reinforcement of beneficial behaviors
(Neely et al., 2020).

Researchers have given the field a foundation upon
which to start developing culturally responsive
repertoires to serve diverse populations (Arango &
Lustig, 2022; Beaulieu et al., 2019; Conners & Capell, 2021;
Fong et al., 2016; Fong et al., 2017; Fong & Tanaka, 2013;
Gatzunis et al., 2022; Jimenez-Gomez & Beaulieu, 2022;
Kirby et al., 2022; Mathur & Rodriguez, 2021; Najdowski et
al., 2021; Wright, 2019). The recent adoption of the new
Ethics Code for Behavior Analysts (referred to as “the
ethics code” here after) outlines that incorporating
cultural considerations into clinical practice is not only
recommended, but required if a certified behavior
analyst is in compliance with this code (Behavior
Analyst Certification Board {BACB}, 2020). Arango
and Lustig (2022) identified specific areas within the
ethics code that pertain to cultural responsiveness.
Within the Core Principles section, the code requires
the equitable treatment of clients and stakeholders,
“regardless of factors such as age, disability, ethnicity,
gender expression/identity, immigration status,
marital/ relationship status, national origin, race,
religion, sexual orientation, socioeconomic status,
or any other basis proscribed by law” (BACB, 2020,
p. 4). Also, within the Core Principles the ethics code
outlines that certified behavior analysts should
continuously make efforts to increase their own scope
of competence related to serving clients of diverse
backgrounds (BACB, 2020). The same themes are
reflected in the ethical guidelines for members of the
American Psychological Association (APA) and the
American Occupational Therapy Association (AOTA;
AOTA, 2020; APA, 2017). The ethical guidance from
both organizations places an emphasis on making
efforts to understand and preserve an individual’s
cultural identity when providing services. The focus on
cultural components across fields that often interact
with one another affirms the importance of these
considerations. As Arango and Lustig (2022) remind us,
an ethical approach to serving multi-cultural clientele
is one that takes into consideration the relevant
contextual variables within a family’s environment as
well as the family’s treatment preferences.

While practitioners await further recommendations
within this area, they also anticipate the empirical
evaluation of these suggestions. Specifically,
identifying the suggestions that are most valuable
for supervisors, practitioners, researchers, and
organizations to invest resources into. This paper will
reflect on the foundations of applied behavior analysis
(ABA) and how those who were present during the
field’s inception set the precedent for exploring this
important issue. Main themes and recommendations
surrounding cultural responsiveness will be outlined
with supporting articles identified for each theme.

A review of the few empirical demonstrations of
developing a culturally responsive repertoire will be
discussed and recommendations for future researchers
will be given. Finally, the recommendations of some
of the most cited articles which focus on cultural
considerations will be combined to give practitioners
guiding principles as they begin developing this
repertoire. It is the intention of this paper to serve as
a starting point for practitioners who recognize the
importance of developing a culturally responsive
practice but are unsure where to start within the
literature. An additional goal is to encourage scientist
practitioners and researchers to conduct empirical
investigations on this topic to further guide the field of
applied behavior analysis in these efforts.

The terms used throughout this paper as well as other
terms related to cultural responsiveness are outlined
in Table 1 to assist readers in discriminating between
terms. Articles that describe these terms are cited
within the Table. Differentiation between terms is
found throughout the published literature on the
topic of cultural responsiveness (Gatzunis et al., 2022;
Mathur & Rodriguez, 2022); therefore, for the sake of
clarity, the terms used frequently within this paper
are clearly outlined. Cultural responsiveness will be
used when discussing overall incorporation of family
preferences, values, and cultures into clinical work
(Mathur & Rodriguez, 2022; Miller et al., 2019). When
referring to verbal behavior surrounding one’s own
biases and how this might affect practice, the term
cultural awareness will be used (Arango & Lustig,
2022; Fong et al., 2016; Gatzunis et al., 2022; Martinez
& Mahoney, 2022). Cultural humility will refer to the
ongoing development and improvement of an
individual’s cultural awareness (Gatzunis et al., 2022;
Jimenez-Gomez & Beaulieu, 2022; Kirby et al., 2022;
Martinez & Mahoney, 2022; National Institute of Health,
2020).

Connection to the Origins of ABA

The science of ABA has long been one that values
client input and incorporates client preferences (Baer
et al., 1968; Wolf, 1978). An emphasis on embracing the
preferences of those we work with is not new for the
field of behavior analysis. Baer and colleagues’ (1968)
seminal article describes that the behaviors chosen
for intervention should be important to the individual
affected by intervention. Baer and colleagues (1987)
updated and expanded this original call for socially
significant behavior change by reminding readers
that social significance can be determined by both the
individual experiencing intervention as well as those
who support them throughout the experience (i.e.,
those who have likely helped shape the individual’s
cultural identity). Several current publications have
linked the foundational dimensions described by Baer
et al. (1968, 1987) to a culturally responsive approach

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Table 1
Common Terms Used in Discussions of Cultural Responsiveness in Human Services, Behavior Analysis and the
Medical Field

Term Definition References

Culture “The extent to which a group of individuals engage in overt and verbal
behavior reflecting shared behavioral learning histories, serving to dif-
ferentiate the group from other groups, and predicting how individuals
within the group act in specific setting conditions” (Sugai et al., 2012, p.
200).

Sugai et al., 2012

Cultural sensitivity Recognizing and embracing differences between the practitioner’s cul-
tural background and that of their clients. Understanding how this back-
ground can create biases and working these realizations into clinical
practice and interactions. This process takes place both at an individual
and organization-wide level. This term is often used to reflect verbal
behavior that tacts cultural differences as well as overt behaviors that
incorporate accommodations for those differences in service provision.

Arango & Lustig, 2022
Gatzunis et al., 2022
Martinez & Mahoney,
2022

Cultural Compe-
tence

The repertoire of behaviors, policies, and values that are combined
within an organization to allow professionals to work effectively across
culturally diverse situations. This term is often used to describe the group
of actions an individual or organization has taken to create systematic
change. When discussed, authors describe culturally competent or-
ganizations as those that impact large, community systems by creating
policy change, systems changes, and advocating for disadvantages
populations. This term has not been used recently to reflect an individu-
al’s behavior as it conveys an idea of reaching a level of “mastery”.

Arango & Lustig, 2022
Fong & Tanaka, 2013
Miller et al., 2019

Cultural Aware-
ness

Often describes as verbal behavior. An individual can tact the differenc-
es between their cultural backgrounds and that of their clients and can
also name the ways that these two backgrounds may be different and
how those differences could affect services.

Arango & Lustig, 2022
Fong et al., 2016
Gatzunis et al., 2022
Martinez & Mahoney,
2022

Cultural and Lin-
guistic Diversity

“(T)he social (cultural) differences between groups that may control
verbal behavior” (Brodhead et al., 2014, p. 76).

Brodhead et al., 2014,
p. 76

Cultural Humility Describes ongoing process of evaluating and modifying one's own
behavior following interactions with individuals of backgrounds different
than one's own. Continuously increasing openness to different view-
points. The process of continuously improving upon one’s own cultural
awareness.

Gatzunis et al., 2022
National Institute of
Health, 2020
Jimenez-Gomez &
Beaulieu, 2022
Kirby et al., 2022
Martinez & Mahoney,
2022

Culturally Respon-
sive Teaching

Incorporating the diverse experiences of both a student and faculty
population into a program’s curriculum to ensure equitable educational
experience for all students, regardless of background.

Gatzunis et al., 2022
Jimenez-Gomez &
Beaulieu, 2022, Miller et
al., 2019

Cultural Reciproc-
ity

The process of evaluating ongoing interactions between individuals of
differing cultures. Making changes and compromises in line with each
party’s values as needed.

Kirby et al., 2022

Cultural Respon-
siveness

The process of collaboration with clients and stakeholders to ensure
intervention is reflective of the client’s values and goals. Involves combin-
ing a cultural awareness repertoire with actively listening to the values
and preferences of clients.

Mathur & Rodriguez,
2022
Miller et al., 2019

Culturally and
Contextually Rel-
evant

Used when discussing educational curricula and materials and de-
scribes designing these supports to ensure that each student can
experience the maximum amount of benefit from what is developed
and taught

Sugai et al., 2012

Note: The terms above have been defined based upon either direct quotes from authors studying a specific topic or from a combination of authors describing a
specific term. The terms used most often throughout the current paper will include cultural responsiveness, cultural humility, and cultural awareness.

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to services (e.g., Beaulieu et al., 2019; Brodhead, 2019;
Fong et al., 2016; Jimenez-Gomez & Beaulieu, 2022;
Mathur & Rodriguez, 2021; Neely et al., 2020; Sugai
et al., 2012; Syed et al., 2023; Wright, 2019). Baer and
colleagues described that what sets the science of
behavior analysis apart from similar ones is its applied
nature which aims to make behavioral changes
that are significant for the learner in their natural
environment. An efficient and collaborative way
of determining the importance of goals is to discuss
them in collaboration with the client and take into
consideration the client’s specific context and the
ongoing contingencies that will support whether
the goals are likely to maintain. Baer and colleagues
(1968, 1987) also identified that behavior analysts are
analytic in their work. Culturally aware practitioners
demonstrate this dimension by understanding the
variables within a client’s environment that sustain
behaviors and might support behavior change (Baer
et al., 1968; Brodhead, 2019). If client context is not taken
into consideration, a behavior analyst might miss the
influence of these variables. Not including a family’s

cultural background into behavior analytic decisions
would be, as Brodhead (2019) describes, “incongruent
with our core value of being analytic” (p. 828).

The importance Baer and colleagues (1968, 1987)
placed on social significance in ABA has not recently
been reflected in the field’s published work. Ferguson
and colleagues (2018) conducted a review of the
Journal of Applied Behavior Analysis that assessed
whether studies evaluated social significance in
research by collecting measures of social validity. The
results indicated that, from 1999-2004 only between
3-7% of articles assessed for social validity in some
form. This number increased only slightly from 2007-
2016 with an average 13% of articles reporting social
validity measures. One dimension of social validity that
closely aligns with culturally responsive intervention
is the selection of goals based on their importance
for the learner. Ferguson and colleagues reported
that this dimension was the least likely evaluated
throughout the articles reviewed. This lack of focus
on input from clients and stakeholders could lead the

Table 2
Content Areas Related to Cultural Responsiveness and Relevant Citations

Area of Interest Publications that Offer Recommendations

Developing One’s Own Culturally Responsive Repertoire Arango & Lustig, 2022
Dennison et al., 2019
Fong et al., 2016
Fong et al., 2017
Gatzunis et al., 2022
Machalicek et al., 2021
Neely et al., 2019
Wright, 2019

Developing Culturally Responsive Educational and Organization-
al Systems

Fong & Tanaka, 2013
Mathur and Rodriguez, 2021
Nadjowski et al., 2021
Sugai et al., 2012

Cultural Considerations in Supervisory Relationships Gatzunis et al., 2022

Guidance for Cultural Sensitivity in Family Interactions, Assess-
ment, and Protocol Development

Beaulieu & Jimenez-Gomez, 2022
Dennison et al., 2019
Jimenez-Gomez & Beaulieu, 2022
Martinez & Mahoney, 2022
Rohrer et al., 2021
Neely et al., 2020
Tereshko et al., 2022

Cultural Considerations in Research Procedures Ruzycki & Amhed, 2022
Syed et al., 2023

Commentaries on Culture in Behavior Analysis Arango & Lustig, 2022
Brodhead et al., 2019
Conners & Cappell, 2021
Fong et al., 2017
Hayes & Toarmino, 1995
Miller et al., 2019
Lechago, 2022
Wright, 2019

Note: A sampling of literature across different areas related to cultural responsiveness in behavior analysis. This table is meant to serve as a guide for practitioners/
researchers beginning to develop repertoires related to cultural responsiveness.

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?? / Kristiansen

non-behavior analytic community to believe that ABA
has strayed from its original intention of putting clients
at the center of services.

This potential stray from incorporating client
preferences and cultural differences into practice
may stem from an over-generalization of the
understanding that behavioral principles are
universally applicable (Hayes & Toarmino, 1995). This
might mean that practitioners create goals based
on responses they see as socially concerning, but do
not follow through by discussing these goals with the
individual or their family. The goal is targeted because
the analyst is confident that the behavior can be
changed given the universal principles of behavior.
However, Hayes and Toarmino (1995) explain that
the most thorough analysis of a specific behavior
will include analysis of the relevant components of
the individual’s cultural identity. An understanding
of a client’s culture can inform practitioners of a
myriad of details important to programming (e.g.,
existing environmental arrangements, cultural norms,
existing sources of reinforcement). Goldiamond (1974)
described a constructional approach to the field
of behavior analysis as one in which the learner’s
current repertoire is always the starting point in goal
development. A culturally responsive program would
take this same approach in incorporating a family’s
priorities and existing repertoires into intervention and
building skills from there (Goldiamond, 1974).

The importance of considering the diverse background
of families is amplified by the immense changes
occurring in the cultural makeup of countries. The
most recent United States Census reflects the rapidly
changing demographics of the country. The 2020
census estimates that non-White individuals make
up 38.4% of the country’s population (United States
Census Bureau, 2022). This is a nearly 9% increase
from the previous decade’s data. It is an enormous
increase from the census conducted in 1970, soon
after the release of Baer and colleagues’ (1968)
seminal publication which put an emphasis on goal
relevance for clients. The 1970 census reported that
individuals of color represented only 12.6% of the total
population (Singer, 2022). This is especially important
given the mismatch between the racial makeup of
the United States with the racial makeup of certified
behavior analysts with only 21.5% of BCBA or BCBA-D
certificants identifying as Black, Indigenous, or people
of color (Syed et al., 2023). The national conversation
is going through a long-overdue shift on listening
to the preferences people of color who represent
almost half of the country's population. In response
to this cultural shift, other fields have start to prioritize
cultural responsiveness training for early professionals
(Jernigan et al., 2016). The field of behavior analysis
is just beginning to accomplish the same training for
professionals implementing the science.

Current Recommendations

Start with Self

The recommendation from numerous publications on
building a culturally responsive repertoire is to begin by
evaluating one’s own cultural background and biases
(Arango & Lustig, 2022; Dennison et al., 2019; Fong et al.,
2016; Fong et al., 2017; Kirby et al., 2022; Lechago, 2022;
Mathur & Rodriguez, 2021; Neely et al., 2020; Wright,
2019). The new ethics code calls for practitioners
to carefully evaluate their own cultural awareness
before beginning a professional relationship by
identifying areas of strength and opportunities for
growth (BACB, 2020). Practitioners can evaluate their
own competence by reflecting on interactions with
families, determining the appropriateness of those
interactions, and making decisions about whether
the relationship is a good cultural fit or if a colleague
might better serve the client (BACB, 2020). This might
be done by taking notes on an interaction with a
family following an intake meeting that describe
language used during the interaction, reactions
observed, or comments made by the family. These
notes could be reviewed before the next interaction
and modifications made based upon the family’s
responses. A practitioner could review these
notes with a mentor they rely on for developing a
culturally responsive repertoire. Determining whether
interactions are improving in terms of cultural
responsiveness should be assessed by checking in
with families and asking whether language used,
family education strategies, and recommendations
are in line with their preferences. This should be done
frequently throughout a therapeutic relationship.
Recognizing and acknowledging one’s own biases
can aid in a practitioner’s understanding of how their
own environment may affect their approach towards
a clinical case. Reflecting on these biases can also help
a practitioner see how their own circumstances differ
from the circumstance of the family or client they are
working with. Identifying biases could also include a
practitioner covertly labeling any assumptions that
are made before and after interactions with potential
clients. For example, when first arriving to a family’s
home, the practitioner can ask themselves how the
neighborhood the client lives in, the vehicle they see
in the driveway, or even the report written by the
diagnosing physician is influencing their assumptions
about a family. Tacting these assumptions and
recognizing them as biases might lead to differences
in overt behaviors displayed during interactions with
the family.

An evaluation of this type of bias might lead
practitioners to create interventions that are more
in line with a family’s cultural identification. In a brief
example, a clinician who grew up eating dinner in a
dining room, at a table with at least one other family

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member, with sparse back and forth conversation
might assume that a family’s goal of “eating a meal
together” takes place in the family home in a similar
manner. However, the family they are working with
may have a full schedule and the ideal exemplar
of eating a meal together for this family commonly
resembles going to a busy restaurant, engaging in
loud conversation, and laughing together at the end
of the day. Mathur and Rodriguez (2021) warn that
families might be hesitant to offer goals counter to
the behavior analyst’s recommendations because
the behavior analyst is seen as the “expert” and the
family would not want to risk losing clinical support.
A self-examination of bias could help the clinician
create a protocol that, from its beginning, takes family
preferences into consideration. Fong and colleagues
(2016) eloquently outline ideas on how professionals
can embark upon this process. A sampling of these
ideas includes discussing diverse client interactions
with mentors or in small professional groups to gain
feedback. Fong and colleagues remind us that self-
reflection and talking about one’s own behavior
can help bring awareness to interactions that may
have been inappropriate. Fong and colleagues
also emphasize the importance of being an active
listener and recommend that, “practitioners hone
their ability to attend closely to clients and self, in
context” (p. 86). Gatzunis et al. (2022) provided similar
recommendations to those supervising mentees of
diverse cultural backgrounds. Gatzunis and colleagues
offer a comprehensive checklist that supervisors
can use for self-evaluation. The checklist, called the
Culturally Responsive Supervision Self-Assessment
(CRSS) Tool, reminds supervisors to self-reflect on how
individual biases may influence interactions. The tool
combines the cultural background of the supervisor,
the supervisee, and the clients being served to make
a respectful interaction for all parties more likely. The
ubiquitous recommendation of self-reflection supports
the idea that to truly learn about how other cultures
might impact programming, one must first understand
how their own background creates bias.

Creating Culturally Responsive Systems

Several papers have emphasized the importance
of beginning to teach cultural awareness at the
inception of behavior analytic careers (e.g., Beaulieu
et al., 2019; Fong et al., 2016; Fong et al., 2017; Mathur
& Rodriguez, 2021; Najdowski et al., 2021). Training
cultural responsiveness from the beginning of a
behavior analyst’s familiarity with the field would
support simultaneously learning the importance
of cultural identity and that behavioral principles
are universally applicable. As an example, an early
career behavior analyst learning about functional-
assessment procedures while simultaneously being
taught the importance of cultural considerations in
assessment procedures (Dennison et al., 2019) would

be better situated to choose an assessment the client is
comfortable with. Initially teaching behavior principles
through the lens of cultural humility could prepare
practitioners to incorporate these considerations
more readily into intervention decisions.

Mathur and Rodriguez (2021) provide specific
components that could be involved in the
implementation of a culturally responsive curriculum.
The curriculum outlines competencies that are specific
to client interactions such as creating treatment goals
as a result of collaboration with a family. Also included
are repertoires that reach beyond the impact that
a clinician can have on a single family. Mathur and
Rodriguez (2021) suggest behavior analysts engage
in educational events specifically focused on the
cultures within their community. Further, actions
to help develop equitable supports for individuals
with disabilities within their community are outlined
as competencies. These actions include outreach
to local pediatricians, collecting data on referral
demographics, and actively advocating for those
experiencing oppression (Mathur & Rodriguez, 2021).
The curriculum created by Mathur and Rodriguez
was inspired through a review of similar curricula
from other disciplines. The medical field, for example,
has begun the process of evaluating the results of a
culturally responsive curriculum specific to training
of medical residents (Jernigan et al., 2016). Although
there remains no empirically evaluated training
on cultural responsiveness for behavior analytic
practitioners (Lechago, 2022), it is encouraging to see
that thoughtful consideration of cirricula components
is beginning.

Cultural Considerations in Supervisory Relationships

Once a behavior analyst enters the workforce, the
responsibility of continuing to develop a culturally
aware skill set lies with the individual, their supervisors,
mentors, and the organizations that employs them.
Additionally, it is the supervisor’s responsibility to
understand the differences between their own as well
as their supervisee’s cultural backgrounds. Gatzunis
and colleagues (2022) outlined the importance of
culturally responsive supervision and developed the
previously mentioned tool that could be used during
a supervisory relationship to evaluate whether the
guidance of the mentor is sensitive to the background
of both the supervisee as well as the individuals
receiving services. The tool incorporates ongoing
evaluation throughout the supervisory relationship
to detect changes in bias and culturally responsive
behaviors (Gatzunis et al., 2022). As with the first
recommendation, this tool begins with the supervisor’s
self-evaluation of their own cultural background and
how this evaluation could potentially affect services.
The ethics code (BACB, 2020) also acknowledges the
importance of cultural responsiveness in supervision

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by outlining that supervisors evaluate their own scope
of competence when supervising it is also required
that supervisors incorporate topics related to diversity,
equity, and inclusion into supervision experiences.
Further, it is the supervisor’s responsibility to ensure
that their mentees are familiar with the current
ethical code (BACB, 2020). This holds the supervisor
responsible for contributing to the development of
their mentees own cultural awareness (BACB, 2020;
Gatzunis et al., 2022).

Guidance for Protocol and Assessment Development

Guidance has also been given to practitioners in
developing specific interventions that incorporate the
cultural preferences of clients. Several commentaries
begin by suggesting an open conversation and
listening to individuals and the communities who
support them throughout services (Beaulieu &
Jimenez-Gomez, 2022; Kirby et al., 2022; Lechago et al.,
2022; Mathur & Rodriguez, 2021). Hayes and Toarmino
(1995) describe the importance of understanding
the functionality of behavior both from an individual
as well as a community (i.e., cultural) perspective.
Following information gathering, clinicians should
ensure that the goals selected for intervention are
aligned with the values of the client as well as their
stakeholders and are appropriate given the client’s
context (e.g., workplace, community, family dynamic;
Fawcett, 1991). A clinician’s ability to collect this
information will vary across the different skill sets of
individuals being served. If a clinician is working with
an individual with limited communication skills, specific
assent procedures could be discussed with the family
to ensure that client preferences are being prioritized
during intervention. If a client or family disagrees
with a clinician regarding the implementation of
protocol that would be detrimental to the client’s
ultimate goal, practitioners should take the time to
discuss these contingencies collaboratively. In an
example, if a client is hesitant to begin an intervention
to decrease facial skin picking in public settings but
has an ultimate goal of going on a few successful
dates, the clinician could discuss the interaction
between the proposed goal and the ultimate goal to
give the client more context regarding the clinician’s
recommendation. Beaulieu and colleagues (2022)
reiterate the importance of considering the feasibility
of the maintenance and generalization of skills within
the client’s natural environment. Determining whether
the program would sustain should be a key factor in
considering whether it should be started.

Implementing Culturally Responsive Strategies at an
Organizational Level

Fong and Tanaka (2013) provide focused
recommendations for how behavior analytic
organizations can support the effort to increase the
cultural responsiveness of the field. These standards

include practices to support the diversification of the
work force by mentoring and supporting candidates
from diverse backgrounds. Recommendations for
workplace activities such as ongoing training and
clearly stated goals surrounding culturally responsive
efforts were suggested. One recommendation Fong
and Tanaka provide that has been echoed through
clinical and research publications (e.g., Brodhead et
al., 2014; Fong et al., 2016; Jimenez-Gomez & Beaulieu,
2022) is that demographic data surrounding the cultural
and ethnic makeup of the individuals an organization
serves are imperative to capture. Organizations should
be thoughtful regarding the allocation of time and
funds towards these initiatives, given their importance
and the amount of time and effort that will go into
creating systems-wide changes. Fong and Tanaka’s
suggestion of creating and adhering to organization-
wide goals surrounding diversification and cultural
education can help ensure that the time taken in the
process of developing these strategies is not placed
solely on the individual clinician. Fong and Tanaka’s
recommendation to, “ensure that staff at all levels
and across all disciplines receive ongoing education
and training in culturally and linguistically appropriate
service delivery” (p. 18) would mean a giant
organizational shift for those who do not already have
similar systems in place. However, organizations can
follow Goldiamond’s (1974) advice, once again, and
start with the current organizational repertoire to build
towards an overall goal in incremental, meaningful
steps. This could mean that an organization begins by
adding culture-specific content/trainings to already
scheduled meetings. After feedback is collected,
the organizations could plan for future meeting time
to increase the training opportunities for their staff.
Providing staff with resources and support in this effort
should be considered part of an organization’s long-
term continuing education commitment.

A Call for Empirical Investigation

Getting Started

A decade has now passed since Fong and Tanaka’s
(2013) call for building stronger cultural alliances
through behavior analytic services. An empirical
question that remains to be determined is how these
recommendations are impacting the repertoire of
today’s behavior analysts and the clients they serve.
Research in this area will be difficult as the process of
identifying and measuring relevant behavior change
associated with the development of a culturally
responsive repertoire can be a difficult undertaking
(Mathur & Rodriguez, 2021). Is it possible to measure
and capture the shifts in a bias? How can we ensure
that the actions taken by practitioners are seen from
the family’s perspectives as genuine, rather than just
a box to be checked (Rohrer et al., 2021)? We might
start with evaluating the suggestions provided in

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the articles mentioned throughout this paper and
determining those that make the strongest impact.

We can also examine the example of another current
issue within behavior analysis that is interdependent
to cultural humility, that of compassionate care
(Lechago et al., 2022; Rohrer et al., 2021). Rohrer et al.
(2021) summarized the status of the field of behavior
analysis as it relates to compassionate care and
suggested a checklist, called the Compassion and
Collaboration Tool, that could be used in guiding
practitioner behavior in this area. The Compassion
and Collaboration Tool was informed by publications
that taught compassionate care skills to those within
health care and other human services fields. The
checklist’s publication was followed by Rohrer and
Weiss (2022) who evaluated whether these skills could
be taught to pre-certification masters students. The
researchers delivered behavioral skills training to
teach different skill sets outlined by the Compassion
and Collaboration Tool. These skill sets included basic
skills (e.g., nodding while listening, providing a positive
introduction at the beginning of the interaction),
showing interest in the family (e.g., asking about
preferences, incorporating the caregiver’s feedback
into the intervention), and joining in with the family
(e.g., providing empathy statements and statements
that demonstrate the practitioner will join in the family
on therapeutic efforts; Rohrer & Weiss, 2022). Rohrer
and Weiss had only four participants, but the results
showed excellent progress within a multiple baseline
design across skill sets. This study set the stage for
continued research within this and similar areas. The
same type of work has just recently begun around
cultural responsiveness, providing hope to potentially
inspire researchers and encourage this line of work to
gain momentum (Neely et al., 2020).

Neely and colleagues (2020) conducted one of the
first assessments of a culturally responsive curriculum
implemented by educators in a classroom setting. The
curriculum described observable actions a teacher
could make to support a classroom’s inclusion of
cultural differences. These components included
environmental details such as displaying classroom
rules in the primary languages of the students
and using diverse representations of authors and
individuals included in pictorial prompts. Additionally,
teacher responses to students were evaluated as
well as whether these responses were in the student’s
primary language. A multiple-probe design evaluated
the effects of training on the specific components of
the curriculum. All teachers increased the percentage
of curriculum components implemented in their
classrooms following the training and satisfaction
with curriculum implementation was generally high.
Neely and colleagues' study serves as a good starting
point for researchers to begin empirical evaluations
using similar methods. Continued conversations and
updated research methodology regarding culture

will always be needed as cultures continually shift
(Lechago, 2022). Commentaries and advice from
experts in this domain should keep coming, but as it is
generated, researchers should purposefully evaluate
recommendations to guide and improve future efforts.

Operationalizing and Measuring Success

Specific behavior change would be the goal of
the aforementioned research, but how can it be
determined that the time committed to this effort
has made a difference? The ultimate indicator should
be intervention sustainability. Families often have
a variety of obligations within their daily lives and
practitioners should make sure that an intervention is
worth the response effort committed. If a family sees
the value in the results of an intervention, it is aligned
with their values, and able to be implemented with the
resources they have available, the intervention is more
likely to be sustained. Additionally, evaluation should
frequently be conducted as to the acceptability of
the procedures. Alai-Rosales et al. (2022) suggest that
clinicians frequently ask themselves, “Do the people
the clinician is working with feel happy about the
progress that was made? Are the families involved
and did they participate throughout the process?” (p.
161). These questions asked throughout the duration
of intervention can help guide the practitioner as to
when reevaluation and adjustments are needed.

To ensure that clinician and organization success
in cultural responsiveness is not siloed to one
demographic, several publications recommend
categorizing social validity data collected according
to the demographic data of clients (e.g., Beaulieu et
al., 2019; Dennison et al., 2019; Lechago, 2022). Doing
so would allow for satisfaction to be evaluated across
client cultural identities to identify areas in which
additional training may be needed. Data could also
be collected on referrals from other providers or
families. This data may be helpful in determining if
families or providers of certain cultural backgrounds
are recommending an organization’s services to others
more or less often. An additional suggestion when
conducting social validity surveys is to ensure that the
questions asked are those that will inform clinicians
with respect to cultural responsiveness. For example,
asking questions such as, “Does this program reflect
a goal that you and your family prioritizes?” or “Do
you feel comfortable implementing all aspects of this
program?” would be more beneficial in the evaluation
of cultural responsiveness when compared to, “Are
you satisfied with the level of behavior decrease/
increase?” These surveys should also be prioritized
for translation to the family’s primary language.
Families should be given opportunities within these
surveys to anonymously reflect upon the clinician’s
demonstration of respect for their preferences and
culture. As previously mentioned, specific behavior
change to support cultural responsiveness is a good

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start, but not the end goal. The goal of all services should
be to make a socially valid change. Families who feel
a practitioner has taken the time to understand their
preferences and values are more likely to continue with
implementation of recommendations (Beach et al.,
2006). Services that incorporate culturally responsive
practices give the best chance for family satisfaction
and sustained behavior change (Jimenez-Gomez &
Beaulieu, 2022).

Guidance for Practitioners

The articles mentioned throughout this paper offer a
variety of methods that could be used as guidance
in developing a culturally responsive repertoire. When
combining ideas from the foundation of the field of
behavior analysis with the current theme of cultural
consideration, five themes emerge that practitioners
should consider as they embark on the process.

Be a Behaviorist

The first recommendation is that the guidance from
a behavior analyst must follow the principles of
the science. Above all, it the duty of practitioners to
adhere to the principles of behavior analysis and to be
effective (Baer et al., 1968; Dennison et al., 2019; Kirby
et al., 2022). This does not mean that benign non-
behavior analytic recommendations are not tolerated,
but that the practitioner is a behavior scientist with
respect to their careful evaluation (Bowman et al.,
2021; Newhouse-Oisten et al., 2017). Pseudoscientific
methods are commonly found among suggested
interventions designed to support individuals
diagnosed with autism spectrum disorder (Normand,
2008; Travers et al., 2016). Normand (2008) describes
the importance of being skeptical in the evaluations
of interventions suggested or preferred by a family.
Skepticism, in this sense, means carefully considering
the research supporting suggested interventions
and evaluating those interventions in a systematic
way (Normand, 2008). Travers and colleagues (2016)
describe skepticism as, “a repertoire of behavior that
is developed gradually and in lockstep with scientific
literacy” (p. 268). Behavior analysts should listen to the
preferences and suggestions of families from varying
cultures, but also be skeptical in their acceptance and
application of these recommendations.

There are several publications that offer guidance
in evaluating non-behavioral treatment preferences
expressed by families. Bowman and colleagues (2021)
provide standards for transdisciplinary collaboration
that include actions such acknowledging and
avoiding pseudoscientific suggestions. Newhouse-
Oisten et al. (2017) guides practitioners through an
ethical decision-making matrix that evaluates the
use of evidence-based and non-evidence-based
treatments. Brodhead and colleagues (2015) highlight
the importance of translating recommendations from

parents and colleagues to the behavioral principles
that might make up the intervention. A translation to
behavioral principles can allow the behavior analyst
to better understand the variables that could affect
behavior. Using this approach provides a behavioral
lens for evaluating recommendations suggested by
families and others. This is the lens through which all
additional recommendations should filter.

Be Flexible

Thanks to almost decades of research, there are a
multitude of options for the selection of procedures
that utilize behavior analytic principles. Sticking
to only a prescribed way to conduct a specific
intervention is not a practice that reflects cultural
responsiveness. Families will rarely be familiar with
the behavior analytic literature, and their confidence
in the field’s effectiveness will likely not be as strong
as their practitioners' (Rosenberg & Schwartz, 2019).
Competent professionals should also be comfortable
in evaluating the work of another discipline through
a behavioral lens as previously mentioned. This is,
no doubt, a skill set that will need to be honed. The
translation and evaluation of procedures that may
not be well established within the behavioral literature
could go a long way in demonstrating to a family that
their recommendations are taken seriously (Brodhead
et al., 2015; Jimenez-Gomez & Beaulieu, 2022). Bowman
and colleagues (2021) provide general guidance in
this area and outline that overall, treatments to be
implemented, “do not put the client in any danger
and will not cause harm”, “are empirically supported,”,
and “are effective” (p. 1201). Developing a repertoire
for evaluating and translating the research of other
disciplines could help increase the flexibility of
practitioners in collaborative intervention efforts with
families.

The suggestion of flexibility might seem antithesis to
what the research supports. After all, some of the most
well-regarded behavior analytic publications are
those that suggest specific decision-making models
that guide practitioners to select interventions given
specific contexts (Geiger et al., 2010). This does not
mean that these tools are obsolete when working
with families with different cultural backgrounds.
Rather, when using them, practitioners should overlay
a family’s values and preferences onto the decision
making matrices. Preferably, a practitioner could
conduct this decision-making process with the
family to make a collaborative decision regarding
protocol implementation (Geiger et al., 2010). This
will help ensure the intervention not only reflects the
clinician’s observations and recommendations but
also those variables that are important in sustaining
the intervention in the client’s natural environment.

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Be Humble

In the effort of increasing cultural awareness,
mistakes will be made and each of them is a learning
opportunity. Neuringer (1991) gave the first guidance
to the field of behavior analysis in the importance of
professional humility. Neuringer reminds the field that
behavior analysts should be comfortable admitting
and correcting mistakes. A humble behaviorist
is one that admits ignorance, and this should be
applied within the context of cultural humility as well
(Neuringer, 1991). Practitioners that adopt a position
of humility will help to advance the field and can aid
in the dissemination of the science to more diverse
communities (Kirby et al., 2022). When working with
a family who offers a suggestion a practitioner is
unfamiliar with, they should admit the limitation in
knowledge (Kirby et al., 2022). An appropriate response
to the family might be “I’m not well-versed in that. Let
me do some research and get back to you.”

Taking a truly scientific stance embraces the concept
that knowledge is provisional, which is also the case
with cultural knowledge (Neurenger, 1991). As Lechago
(2022) describes, “culturally responsive behaviors must
be trained such that they are sensitive to the constantly
changing contingencies and interactions within and
across the multiple consumers that we serve” (p. 15). A
culture that a practitioner thought they were familiar
with might present differently across different families,
leading an action to cause offense. This means that
the ultimate goal is not to fully understand a culture,
but to be good at graciously admitting mistakes when
they occur and acting to correct them.

Be Brave

Conversations surrounding cultural preferences
might initially be awkward for a clinician as they first
start to develop their own repertoires. It is important
that the clinician weighs the importance of these
conversations with the temporary discomfort of
having them. Dennison and colleagues (2019) make a
wonderful suggestion to take time and talk about past
experiences and hardships that the family has faced
as intervention begins. If this type of conversation
seems awkward or disingenuous at first, role play
with a colleague and solicit feedback on questions or
comments that came across inappropriately. Above
all, behavior cannot be shaped if it is not emitted.
Clinicians cannot learn from mistakes that they were
too worried to make. It may be helpful to solicit the
support of a supervisor or colleague when these types
of conversation are upcoming and to let them know
the conversation is happening. This would allow the
supervisor to hold the practitioner accountable for
having the conversation and reporting back regarding
how it went. When beginning these conversations,
take the advice of Alai-Rosales et al. (2022) and “do
the best you can with great care” (p. 159).

Commit Time to the Effort

Many have suggested making efforts to understand
the diverse cultural backgrounds of families that will be
receiving services (e.g., Arango and Lustig, 2022; BACB,
2020; Dennison et al., 2019; Fong et al., 2016), which
has now been formally incorporated in the updated
ethics code (BACB, 2020). This type of activity might
not come naturally as our environments generally
support the perpetuation of the cultures of which
we are a member (Miller et al., 2019). Machalicek
et al. (2021) describes the importance of putting in
time and completing measurable activities to begin
engaging with different cultures. This could seem like
a daunting task for practitioners with full caseloads
and little personal time, but Machalicek et al. give
recommendations for small tasks that can be built
upon to make meaningful changes. Incorporating
culturally relevant topics into supervision meetings,
listening to podcasts, reading books by authors of a
culture that differs from one’s own, or following social
media accounts that focus on issues in diversity are
just a few suggestions that could be incorporated
into a practitioner’s busy schedule (Machalicek et
al., 2021). To say that the lives of practitioners are
busy is an understatement. The idea of finding time
for this type of activity might seem difficult, but it is
necessary. Additionally, organizations that employ
behavior analysts should take time to prioritize
this type of training and self-reflection. Trainings
could be offered that educate interventionists and
supervisors regarding the unique cultural landscape
of a community where a clinic is located. A standing
agenda item in supervision meetings could be to
discuss the biases that a clinician identified during
sessions that week. Larger companies could identify
experts or members of specific cultures who are
available to review protocol development. Time
during parent training activities could be dedicated
to talking with families about family background,
previous therapy experiences, or how they have
used the procedures that week. These are just a few
ideas that might help practitioners incorporate the
development of this repertoire within already existing
professional activities.

Conclusion

Those who practice behavior analysis compromise
culture that is uniquely its own (Glenn, 1993). Just as
an alumni group, members of the same church, or
members of a specific community would conduct
themselves when around their own members, so too
do behavior analysts. Different cultures are not always
siloed and must work together towards common goals.
In this way, the culture of behavior analysis interacts
with the cultures of the clients that they serve. It is the
behaviorist’s responsibility, not the families, to make
changes to allow for behavior analysis to fit into each

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family’s culture. It is understood that the best way to
establish lasting change is to build from an already
existing repertoire, and a family’s culture is the place
to start and learn from (Goldiamond, 1974).

For a young field, behavior analysis has come far but
also has much more work ahead of it. Many of the
research ideas presented previously are already in
progress by colleagues, meaning that the empirical
support for culturally responsive recommendations is
well on its way. Vargas (2022), summarizing Skinner,
suggests that “a culture increases its survival when it is
sensitive to collateral and deferred effects” (p. 8). The
satisfaction of those who experience intervention are
the field’s collateral effects. It is the incorporation of
the cultural preferences of others that will help bolster
the acceptance of applied behavior analysis and
solidify its survival.

Acknowledgement

Sarah would like to thank Dr. Noor Syed, Meaghan
Kantrowitz, and Gina Cross for their thoughtful
comments on early versions of this manuscript. Given
the topic of this paper, she would like to disclose the
identities that have influenced her behavior as a
practitioner. Sarah was born and raised in the southern
United States and currently resides in Texas. She
identifies as Christian and White. She has been in the
field of behavior analysis for 14 years and practiced as
a practitioner for 9.

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