By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
The Bernal framework, developed by Bernal and colleagues in 1995, identifies multiple dimensions along which interventions can be adapted for cultural appropriateness: language, persons, metaphors, content, concepts, goals, methods, and context. As applied to ABA consultation by Sivaraman and Fahmie, this framework provides specific dimensions for evaluating and modifying behavior analytic services. For example, the language dimension extends beyond translation to include culturally resonant communication styles, while the goals dimension ensures treatment objectives reflect family cultural priorities rather than solely practitioner judgment. The framework transforms the general ethical mandate for cultural responsiveness into actionable clinical steps.
Adaptation should address multiple dimensions simultaneously. Start by assessing the family's preferred language and communication style, and adapt materials accordingly. Explore the family's understanding of their child's behavior and how they conceptualize the presenting concerns. Adjust the format of training sessions to align with family preferences, which may include home-based sessions, group formats with culturally similar families, or involvement of extended family members. Select examples and analogies that resonate with the family's daily life. Negotiate goals that reflect the family's priorities. And adapt implementation strategies to fit the family's routines, household structure, and cultural norms around parenting and child-rearing.
Acknowledge the cultural difference openly and express genuine interest in learning about the family's cultural context. Avoid assuming you already understand their experience based on cultural generalizations. Ask open-ended questions about their values, priorities, and expectations for services. Be transparent about your own limitations and willingness to learn. Seek consultation from colleagues with relevant cultural expertise or community cultural brokers. Monitor the therapeutic relationship for signs that cultural misalignment may be affecting engagement. And recognize that building trust across cultural differences requires time, consistency, and demonstrated respect for the family's perspective. Code 1.07 of the Ethics Code supports this ongoing learning process.
This distinction requires cultural knowledge, clinical expertise, and genuine collaboration with the family. When you observe a behavior that you might typically target for intervention, ask yourself whether this behavior could be normative within the client's cultural context. Consult with the family about their perception of the behavior and whether they view it as a concern. Seek input from cultural informants who can provide context. Research the cultural norms around the specific behavior in question. If the behavior is normative within the client's culture and not harmful, it is likely not an appropriate treatment target regardless of its departure from mainstream expectations. Code 3.01 requires assessments to be appropriate to the individual, which includes cultural appropriateness.
Language in culturally responsive consultation encompasses far more than translating materials from one language to another. It includes the communication styles used during sessions, such as the degree of formality, directness, and use of technical terminology. It involves the metaphors and analogies used to explain behavioral concepts, which should draw from the family's cultural experience. It addresses the way information is organized and presented, which may need to differ across cultures. It includes attention to nonverbal communication norms, such as eye contact, physical proximity, and gesture use. And it requires awareness that even within a shared language, regional, generational, and class differences in usage can affect comprehension and rapport.
Approach these situations with curiosity and respect rather than assuming that the evidence-based practice must take precedence. Explore the cultural basis for the family's practices and seek to understand what function those practices serve within their cultural framework. Look for ways to integrate the family's cultural practices with evidence-based strategies. When genuine conflicts exist, have a transparent conversation that respects both the evidence base and the family's cultural values. Present options and their likely outcomes rather than issuing directives. In many cases, creative adaptation can honor both the behavioral principles and the cultural context. When the family's preferences cannot be accommodated without compromising safety, explain the safety concerns clearly and collaboratively seek an alternative.
Start by reading the published literature on cultural considerations in behavior analysis and related fields for the populations you serve. Seek out continuing education specifically focused on cultural responsiveness in ABA. Connect with professional organizations and special interest groups focused on diversity in behavior analysis. Develop relationships with community organizations that serve the cultural populations on your caseload, as they can provide invaluable insight and guidance. Consult with colleagues from diverse backgrounds who can share their perspectives and experiences. Participate in community events and cultural activities that increase your understanding of the populations you serve. And most importantly, learn from the families themselves by asking about their cultural context and listening to their responses.
Cultural considerations significantly affect informed consent in several ways. The consent materials themselves may need to be translated and adapted for cultural accessibility, going beyond literal translation to ensure concepts are explained in culturally meaningful terms. The consent process may need to accommodate cultural norms around decision-making, as some cultures involve extended family members or community leaders in decisions about a child's treatment. The amount and format of information provided may need to be adapted based on the family's health literacy and preferences. The practitioner should assess whether the family truly understands the proposed treatment rather than assuming that a signed form indicates comprehension. Code 2.11 requires informed consent, and achieving truly informed consent across cultural differences requires cultural adaptation of the process itself.
Yes, when cultural adaptation is done thoughtfully. Cultural adaptation involves modifying the delivery and packaging of an intervention to fit the cultural context while preserving the core behavioral principles that make it effective. For example, adapting parent training to include extended family members, using culturally resonant examples, and modifying session formats does not change the underlying principles of reinforcement, prompting, and shaping that drive skill development. The distinction between surface-level adaptations (language, examples, format) and deep-structure modifications (changing the active ingredients of the intervention) is important. Surface-level adaptations generally enhance rather than compromise effectiveness. Deep-structure modifications require careful evaluation to ensure the intervention's efficacy is maintained.
While you may not be able to change systemic barriers such as insurance coverage gaps or geographic provider shortages on your own, you can take meaningful action within your role. Advocate within your organization for outreach to underserved populations, flexible scheduling, sliding fee scales, and multilingual services. Develop referral relationships with community organizations that serve diverse populations. Participate in professional advocacy efforts to expand ABA access through insurance reform, workforce development, and policy change. Use your clinical expertise to serve on community boards or advisory committees that address health disparities. And within your direct practice, remove barriers where you can by adapting your consultation approach to meet families where they are, both literally and figuratively.
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.