Consultation: Behavioral

Behavioral consultation (BC), most commonly associated with John Bergan and Thomas Kratochwill, is an indirect service provided to a client (e.g., child, parent, teacher, patient) by a consultant who works directly with a consultee (e.g., parent, teacher, administrator, medical doctor) to define a problem and develop and evaluate an intervention. The consultee then provides direct services to the client.

Because BC is based upon behavioral theory and procedures that have been effective in teaching new skills and reducing learning and behavior problems, it has become particularly popular in school settings. In comparison to other models of consultation, BC emphasizes direct observations of client behavior, implementation of empirically validated interventions, and systematic evaluation of interventions to guide decisions and determine efficacy.

BC is a four-stage problem-solving model used to design, implement, and evaluate interventions. The four stages of the model are conducted in three separate interviews with the consultee. These stages are:

• 1.
  Problem identification (where problems are clearly defined and prioritized)
• 2.
  Problem analysis (where goals are established and intervention is designed and implemented)
• 3.
  Treatment implementation (where intervention is monitored and changes are made if necessary)
• 4.
  Treatment evaluation (where plan effectiveness is evaluated, future plans are determined)

The role of the consultant in BC is to provide information and resources to the consultee based on empirical evidence. The consultant helps the consultee identify the problem and develop a plan to make positive changes in the client's environment. This may or may not include changing the consultee's behavior as well. One aspect that has been highlighted in BC is emphasizing communication and relationship skills of the consultant.

As the mediator between the consultant and the client, the consultee's primary role is to be an active participant in the problem-solving process. This includes acting as information provider and decision maker to design and implement interventions, and as evaluator to determine the efficacy of interventions in changing client behavior.

Although each participant has a specific role, the success of the behavioral consultation process is considered to be a function of the interdependent contribution between consultant and consultee. The consultee is free to reject consultant recommendations at any point in the problem-solving process.

Researchers have examined different facets of BC including changes in clients (most often children and adolescents), consultees (teachers, parents, etc), consultants, and the system. Although not exhaustive, outcome data have included a variety of measures, including:

• Changes in perceptions of problem behaviors resulting in consultation referrals
• Consultee preferences for conducting consultations in different ways (e.g., expert versus collaborative models of consultation)
• Effects of different consultation training procedures
• Effects of different methods of communicating with consultees (i.e., verbalizations)
• Actual consultee and client behavioral change

Researchers also have looked at the efficacy of BC by examining outcome data across published research articles. In general, two main types of studies have appeared in the literature that compare outcomes across studies: the voting method and the metaanalysis. The voting method occurs when researchers collect available published studies in a particular area (in this case, BC) and report percentages of positive outcomes. For example, in 1979, Fredric Medway found that 84% of consultation studies resulted in positive changes for both consultees and clients. Of the reviewed models of consultation, BC was found to be the most effective in producing changes in clients and consultees. Susan Sheridan and her colleagues conducted a review of consultation research from 1985 to 1995 and found that the majority of reviewed studies (76%) resulted in positive outcomes; whereas 33% reported no or mixed changes, and 4% resulted in negative changes. When examining those studies using BC only, 89% of the reviewed studies had [Page 112]positive results; whereas 11% were neutral, and none had negative outcomes. Sheridan also reported that BC was the most commonly employed model of consultation across reviewed studies (46%).

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