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Running head: Benchmark-Professional Capstone and Practicum
Reflective Journal 1
Benchmark-Professional Capstone and Practicum Reflective
Journal 8Benchmark-Professional Capstone and Practicum
Reflective Journal
Lorena F. Toro Cruz
Grand Canyon University: FNP690
November 25,2019
Benchmark-Professional Capstone and Practicum Reflective
Journal
Week One
New Practice Approaches
The writer and the mentor choose this topic on the first week
since the writer was explaining to the mentor what the project
was on, how the mentor can help and most important how the
writer was planning to execute it. The health care system is
changing every day for that reason all individuals that work on
it need to keep their mind open for constant change. The writer
had work on the medical field for a couple years and even that
is just a couple she/he already see the change. This conversation
gives the writer and the mentor the idea of going around and
asking nurses what was the most drastic change that they have
seen in their carriers. The writer notice that most nurses had
said that doctors are starting to respect the work they do for the
patients but unfortunately the patients and their family members
had lost the respect for them. When the writer heard that she/he
realized that the topic she chooses is perfect and they need to
create a new approached for this problem.
Week Two
Interprofessional Collaboration
The writer had the opportunity to observe a code gray
which is when a patient gets violent towards the staff members.
The patient was an alcoholic and had stop drinking two days

ago. He was confused and acting irrational, he was saying
things like “you people have me here against my weal “” you
guys want to kill me “etc. This patient tries to punch one of the
nurses and she yelled for help and the code gray was call. All
male nurses and security personnel attend to the code and try to
calm the patient down. he was given some medication and was
put on restrains. The hospital security guards stay with the
nurse until the patient calm down. I was surprise on seen how
they all collaborated with this horrible situation and got the
patient to calm down and prevent for that nurse not to get hurt.
In this topic Interprofessional collaboration is the mayor key,
everyone must help and try to learn how to manage these
situations. Also, we must work together so management see that
there is a problem that needs to be fix. If that nurse would it
have the proper training, she could it got hurt and force to go
out of the job as.
Week Three
Health Care Delivery and Clinical Systems
This week the focused is on health care delivery and
clinical system, which the writer had to do some research on
before she got to the place her mentor works. Healthcare
delivery systems main job is to help individuals to have access
to quality and cost-effective healthcare. Every unit try to create
a plan that work good for the organization ,the writers mentor
work between two different units which are: Direct Observation
Unit (DOU) and the Intensive Care Unit (ICU ) and the writer
can see the different protocols and routines that they have set up
so that they can provide the best care .The writer is glad she
was able to work on both units and identified the different ways
they provide care .As simple as it looks but every unit in the
hospital experience different challenges and they have to find a
way how to resolved them so that they can provide od service.
Week Four
Ethical Considerations in Health Care
During this week my mentor and I were discussing all the
ethical consideration when dealing with individuals that are

violent. Many nurses and hospital personnel consider that these
violent patients should not be accountable for their actions
because they are not with in the right mind. They believed that
nurses in the field need to serve and care for others no matter
what the work conditions are. The writer believes that why
these violent people are accountable when they hurt someone
else but not when they hurt the people that are trying to help
them feel better. One of the nurses give me the example that
during the war the nurses had to perform their job in the worst
conditions. In a way they were right but why do we have to deal
with abused when we don’t have to. In my opinion nurses had
been abused for so many years that it has become part of the job
description and this is wrong.
Week Five
Population Health Concerns
As the weeks past the writer noted that the patients that
were being seeing in the hospital are mostly drug user, alcoholic
homeless that do not take care of their health. This bring a big
concern to the writer because she was seeing younger and
younger people going through those doors. As a example the
day the writer was on the hospital a patient on his early twenties
came in for a alcohol consumption and drug overdose .They had
to be intubated and take all necessary precautions to keep him
alive but the doctors believed that the kid had a really poor
prognosis .They also inform the writer that his cousin was in a
near by hospital in the same condition .This is an epidemic that
is going to wipe down a hold generation is they do not try to
work with the community and solved their problems .
Week Six
The Role of Technology in Improving Health Care Outcomes
When the writer mentioned to her/his mentor that the topic for
the week was “The Role of technology in improving health care
outcome “,the mentor showed the writer a website that the
hospital provides for their employees so that they can get
accurate information about medications, IV compatibility,
disease process and interpretation of labs . This website was

created only for individuals that work for this organization and
you need a code of authorization to get in. The hospital is strict
about nurses using outside resources, they want them to only
use this website or get information directly from lab, pharmacy
and the doctor. The hospital management believes that this
website help individuals prevent medical errors and most
important accurate patient education .The writer was surprise
how all the information need it to educated her self and the
patient was in this program , she /he is grateful that computers
and programs like this ones are available for nurses and other
medical providers out there , this makes the search faster,
easier, safe and accurate.
Week Seven
Health Policy
This week my preceptor plan for us to go speak with
her supervisor and ask her what would be the process that the
writer need it to take if she want to present her project to the
hospital administration .When my preceptor boss was telling us
how hard is to present your project and getting approved , I
learned that it was going to be a couple years before I see any
policy against work place violence . I guess for now I must try
to concentrate in the educational campaigned and try to get
people to treat nurses better. Also educate all medical personnel
in how to prevent and deescalate violent situations.
Week Eight
Leadership and Economic Models
During this week the writer told her mentor that the
topic is leadership and economic models for that reason the
mentor decided for the writer should follow one of the workers
form the admitting office. The mentor felt that the writer
understood the concept of leadership and was able to lead a
group of people for that reason she believed she would learn
more if the observed how the admission process work from the
financial side. The mentor wants it for the writer to see how
difficult was for most individuals to be able to pay for their stay
and medical care. Most individuals seen by the admissions

coordinator did not have insurance, so she explained to them all
the necessary forms and procedure that they must filled out to
get coverage. It was sad how many of them would refuse
admission or would tell the nurses that they can not offered
their medications. It was this family that they didn’t want to
send their mom back to the nursing home she was in since they
didn’t do a good job , but that was the only place the insurance
would cover and they did not had money to paid out of packet .
Also, the writer saw a little bit of biases, the individuals that
had insurance were treated better than those that did not had
one.
Week Nine
Health Disparities
The Hospital where that the writer is following her
mentor is in a community in which the educational levels are
low. Also, most individuals do not have adequate resources to
follow a proper diet, health regiment or even exercise routines.
For that reason, patient is at higher risk for having health
problems like obesity, substance abuse, and intentional and
unintentional injury. For this and other reason the hospital
management allow student to come to the hospital and do their
practices there, they believed the people from this community
would benefit from any educational section that these students
might provide for them. During this week the writer mentor help
her/his put together an information sheet on prevention of work
violence so they can distribute it to employees and patients. The
writers mentor believed that this a the perfect thank you from
the writer to all the individuals that answer their questions and
help the writer with her/his project.
Week 10
The writer and her presented went around the hospital providing
patient and employees with the information pamphlet abut
workplace violence and thanking all those individuals that were
part of the project. Also, the writers mentor helps her/him going
over all her final activities and having all her projects done. The

writer is so thankful with her mentor, she was amazing and so
helpful through the last weeks. I hope in the future I can be a
mentor to new nurses and help them achieved their goals as the
writer mentor di with her/him.
411
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2000, 33,
411–418 NUMBER 4 (WINTER 2000)
CURRENT RESEARCH ON THE INFLUENCE OF
ESTABLISHING OPERATIONS ON BEHAVIOR IN
APPLIED SETTINGS
BRIAN A. IWATA
THE UNIVERSITY OF FLORIDA
RICHARD G. SMITH
UNIVERSITY OF NORTH TEXAS
AND
JACK MICHAEL
WESTERN MICHIGAN UNIVERSITY
This article provides commentary on research published in the
special section of the
Journal of Applied Behavior Analysis devoted to establishing
operations (EOs). Three major
themes are highlighted: (a) identification of the influence of
EOs on behavior in applied
settings, (b) the use of EO manipulation as an assessment tool,
and (c) the development

of interventions based on the alteration of EO influences.
Methodological issues pertain-
ing to research on EOs are addressed, and suggestions for future
investigation are pro-
vided.
DESCRIPTORS: establishing operations, antecedent events
Applied researchers have long recognized
the fact that antecedent events other than
discriminative stimuli can influence the oc-
currence of operant behavior; however, the
exact nature of that influence and what to
call it have been ambiguous throughout
much of the field’s history. As a result, in
most of the early research published in the
Journal of Applied Behavior Analysis (JABA),
authors referred to antecedent conditions in
general terms such as setting events or con-
textual variables, emphasized the procedural
aspects of antecedent manipulations (e.g., as
in deprivation, satiation, or reinforcer sam-
pling), and often attributed observed chang-
es in behavior to the process of stimulus
control. A conceptual foundation for orga-
nizing research on antecedent variables was
We thank Eileen Roscoe and April Worsdell for
compiling the citation data presented here.
Correspondence should be addressed to Brian A.
Iwata, Psychology Department, The University of
Florida, Gainesville, Florida 32611.
provided by Michael (1982), who presented
a much-needed distinction between the dis-

criminative and motivational properties of
antecedent events and proposed the term es-
tablishing operation (EO) as a functional de-
scription for events of the latter type. Ap-
plied researchers gradually came to recognize
practical implications of the EO and, since
the late 1980s, have found the concept of
the EO increasingly helpful in describing,
studying, and arranging antecedent influenc-
es over behavior, as evidenced by the grow-
ing number of citations to Michael’s (1982,
1993) articles and the use of the term in
JABA (see Figure 1).
Current applied research on EOs tends to
fall into three broad categories: (a) general
demonstrations of the influence of an EO
on behavior, (b) the use of EO manipula-
tions to clarify results of behavioral assess-
ments, and (c) attempts to improve (increase
or decrease) behavior by incorporating EO
manipulations as treatment components. Ar-
412 BRIAN A. IWATA et al.
Figure 1. Cumulative number of articles published in JABA in
which the term EO has been used or in
which citation to Michael’s (1982, 1993) articles has appeared.
ticles in this special issue illustrate all three
types of research, although the boundaries
between these categories are sometimes
blurred because discovery of an EO effect
often has immediate implications for assess-

ment or treatment.
Identification of EO Influences
Two studies provide basic demonstrations
of EO influences. Klatt, Sherman, and Shel-
don present data showing that, when access
to reinforcing activities is restricted, persons
with developmental disabilities subsequently
engage in those activities for longer periods
of time. These results are helpful in suggest-
ing ways to schedule leisure and educational
activities so as to increase participation. A
somewhat darker implication is that, when
the occurrence of problem behavior is re-
stricted, it too may increase subsequently.
For example, if protective equipment is used
to reduce stereotypic self-injury, individuals
may engage in the behavior more often
when the protective equipment is removed.
Thus, extension of the Klatt et al. method
to problem behavior may reveal a limitation
of interventions that reduce behavior tem-
porarily but do not alter EOs permanently
or disrupt maintaining contingencies.
Another interesting aspect of the Klatt et
al. study is that the dependent variable was
consumption of a reinforcer rather than the
rate of a response that produced that rein-
forcer. An analogous basic experiment might
measure the effects of food deprivation on
food consumption rather than on food-
maintained bar pressing. This raises a con-
ceptual question about the characteristic of

the EO reflected in the Klatt et al. data. The
evocative effect of the EO was not shown,
which would require a change in the fre-
quency of behavior that historically had been
413RESEARCH ON ESTABLISHING OPERATIONS
followed by the reinforcer, because, in this
case, the activities were the reinforcers. It
could be argued that changes in reinforcer
consumption reflected a change in reinforcer
effectiveness. However, a test of reinforcer
effectiveness—the extent to which behavior
that has been followed by a reinforcer in-
creases—was not conducted. It may be that
increased consumption is specific to partic-
ular types of reinforcers rather than a general
property of EOs. For example, although the
sight of a slotted screw can serve as an EO
for asking for a screwdriver, it is unlikely
that receiving two screwdrivers would be
more reinforcing than receiving one screw-
driver.
Friman presents a demonstration that
‘‘transitional objects’’ (i.e., inanimate objects
for which a strong preference is shown by
young children) may occasion behaviors in
a way that suggests the influence of an EO.
Friman observed a child’s thumb sucking
when social stimulation was available and
unavailable and when the child’s favored ob-
ject (a cloth) was available and unavailable
(consequences for thumb sucking were held

constant across conditions). Results show
that thumb sucking occurred only in the
presence of the cloth, suggesting that thumb
sucking was neither maintained by social re-
inforcement nor occasioned by discrimina-
tive properties of the cloth. Instead, the mere
presence of the cloth seemed to function as
an EO for thumb sucking. Friman correctly
notes that the process by which the presence
of the cloth altered the reinforcing effects of
thumb sucking was unknown. Because the
relationship does not appear to be an un-
learned one, it seems plausible to attribute
its influence to the effects of a conditioned
EO. In addition to expanding the scope of
analysis and interpretation to areas more
common in traditional child development,
Friman hints at an interesting possibility for
research by extending the concept of the EO
to account for complementary reinforcer re-
lationships (i.e., situations in which con-
sumption of one reinforcer is correlated with
increased consumption of a different rein-
forcer). For example, it is likely that access
to certain reinforcers (e.g., television) creates
a condition (inactivity) that increases the ef-
fectiveness of some reinforcers (consumption
of snacks) but not others (exercise, which
also could be performed while watching the
television).
EO Manipulations During Assessment
As Michael (2000) noted, the EO has be-
come an important focus in research on be-

havioral assessment, especially in functional
analysis methodologies, which require care-
ful consideration of and control over ante-
cedent and consequent events. Four of the
articles in this issue involve identification of
EO influences within the context of func-
tional analyses. Berg et al. present data in-
dicating that the sequence of assessment
conditions may create a situation in which
exposure to an EO in one condition influ-
ences behavior in a subsequent condition.
The authors illustrate this effect with atten-
tion as the reinforcer. Three participants
were exposed to different test conditions in
which attention was (a) delivered contingent
on problem behavior, (b) withheld, or (c)
available as one alternative in a concurrent-
choice arrangement. Behaviors of interest
were observed to occur at high levels during
these conditions when they were immediate-
ly preceded by a condition in which atten-
tion was generally unavailable but not when
they were preceded by a condition in which
attention was delivered frequently. These re-
sults are important because they indicate
that the reinforcing effects of consequences
in a given condition may be strengthened
(established) or weakened (abolished), re-
spectively, by presession deprivation or ex-
posure. As noted by the authors, their results
are similar to those reported by Vollmer and
Iwata (1991), but the implication of the

Berg et al. data is timely because the context
in which their demonstration was conducted
may exemplify certain types of functional
analysis arrangements. It is important to
note, however, that assessment conditions
were very brief (5 min) and that the pre-
session and test conditions were run back to
back with no time separating the two. Thus,
it is unclear if similar results would be ob-
tained under other arrangements (i.e., longer
sessions, breaks between sessions).
Worsdell, Iwata, Conners, Kahng, and
Thompson also examine general EO influ-
ences during functional analyses but focus
on the effects of within-session, rather than
between-sessions, manipulations. They ex-
posed 6 individuals whose self-injurious be-
havior (SIB) was maintained by social-posi-
tive reinforcement to functional analysis
conditions in which the EO and reinforce-
ment contingency were present and absent
in various combinations. High rates of SIB
were observed consistently (across all 6 par-
ticipants) only when the EO and its relevant
contingency were both present. None of the
participants engaged in high rates of SIB
when the contingency was absent, and in-
consistent results were obtained when the
EO was absent. These results underscore the
importance of including contingency manip-
ulations in tests of behavioral function; they
also indicate that consistent performance is
most likely to be observed when antecedent
and consequent events are manipulated in

concert. The authors are generally critical of
assessment models in which EO influences
are examined under extinction, although as
Michael (2000) noted and as Berg et al. ob-
served with 1 participant, EO exposures may
evoke the behavior of interest regardless of
the availability of reinforcement, at least
temporarily.
McComas, Hoch, Paone, and El-Roy
show that the conditions that establish es-
cape as negative reinforcement may be high-
ly idiosyncratic. Their results extend a grow-
ing body of research on a wide range of po-
tential EOs for escape and highlight the util-
ity of systematic EO (demand) assessments
within functional analyses of problem be-
havior. The study also extends previous work
in the area of treatment by showing positive
effects with EO interventions that did not
include extinction. The results of Charlie’s
analysis are particularly interesting. Whereas
interventions for the other 2 participants in-
volved the alteration of response require-
ments, Charlie was permitted to decide the
order in which tasks would be performed.
This was sufficient to decrease his escape be-
havior despite the fact that he always per-
formed the same tasks in the same way.
Thus, although task demands appeared to
function as reflexive conditioned EOs for Eli
and Ben because the demands reliably pre-
ceded aversive task requirements, a different
and unknown process resulted in Charlie’s
sensitivity to predetermined task sequences

as EOs for escape.
O’Reilly, Lacey, and Lancioni contribute
another report in an interesting series of
demonstrations of EO influences on prob-
lem behavior by showing that background
noise exacerbated the escape-maintained
problem behavior of a child with Williams
syndrome. One of the characteristics of Wil-
liams syndrome, hyperacusis, or hypersensi-
tivity to sound, was evidenced by the occur-
rence apparent pain-attenuating behaviors
(e.g., placing hands over the ears) across as-
sessment conditions. Problem behaviors, on
the other hand, occurred primarily during
demand conditions and increased dramati-
cally in the presence of background noise.
These results suggest that noise had multiple
influences: It evoked pain-related behavior
(probably as an EO) and also altered the ef-
fects of demands as an EO. This second ef-
fect suggests a relationship in which noise
apparently strengthened further an existing
EO, in that the effects of demands as an EO
for escape behavior were enhanced in the
presence of noise. Subsequent work in this
area might clarify the nature of relationships
between independent EOs. In the present
study, one EO strengthened another and
evoked higher rates of problem behavior. It
would be interesting to determine the extent

to which the opposite arrangement might
produce therapeutic benefit. That is, would
exposure to an EO for appropriate behavior
cancel out the effects of an existing EO for
problem behavior?
Treatment of Problem Behavior with
EO Manipulations
The final two studies in this special sec-
tion illustrate attempts to determine, within
the context of treatment, whether observed
changes in behavior can be attributed to an
EO manipulation. The studies by Kahng,
Iwata, Thompson, and Hanley and by Ha-
gopian, Crockett, van Stone, DeLeon, and
Bowman are related in another way, in that
the intervention of interest was noncontin-
gent reinforcement (NCR), whose therapeu-
tic effects have been attributed to both sa-
tiation (elimination of the EO for problem
behavior via frequent reinforcer delivery)
and extinction (termination of the contin-
gency between the occurrence of problem
behavior and the delivery of a reinforcer).
After determining (via functional analysis)
that 3 participants’ problem behaviors were
maintained by social-positive reinforcement,
Kahng et al. delivered the maintaining re-
inforcers under rich fixed-time schedules
(NCR) but not as consequences for problem
behavior (extinction), and observed rapid re-
ductions in problem behavior. The authors
continued to collect data during extinction
periods (no reinforcement available) follow-

ing each NCR session in an attempt to iden-
tify the functional properties of NCR (see
the article for details on experimental logic).
One participant showed no increase in prob-
lem behavior at the end of NCR sessions,
suggesting that the behavior had been extin-
guished during those sessions. The other 2
participants, however, showed increases in
problem behavior at the end of NCR ses-
sions, suggesting that the transition from the
availability (NCR) to the unavailability (ex-
tinction) of reinforcement reinstated an in-
fluential EO and, as a result, evoked prob-
lem behavior. Other interesting effects (an
apparent transition from satiation to extinc-
tion and failure to obtain extinction even
under thin NCR schedules) are reflected in
the data for these 2 participants. Kahng et
al. pose questions about data interpretation
in their discussion that illustrate difficulties
in attempting to identify processes by which
NCR affects behavior and suggest that mul-
tiple influences related to both satiation and
extinction might also account for behavior
change under differential-reinforcement-of-
other-behavior schedules.
Hagopian et al. present a more direct ap-
proach than that taken by Kahng et al. They
implemented NCR without extinction (i.e.,
maintaining reinforcers were delivered under
a fixed-time schedule and also were contin-
gent on the occurrence of problem behavior)
and observed immediate reductions in the
problem behavior of 3 participants. These

results suggest that behavior change was the
result of satiation; however, no change was
observed in reinforcer consumption, raising
the question of whether satiation had, in
fact, occurred. Hagopian et al. later suggest
the possibility that NCR may decrease be-
havior by altering its EO yet may not pro-
duce some of the other behavioral effects as-
sociated with satiation. This seems quite
plausible and consistent with Michael’s
(2000) comment that, whereas deprivation
can be easily operationalized through refer-
ence to duration of restricted access, satia-
tion cannot, due to its association with other
behavioral effects. The Hagopian et al. data
are thus helpful in illustrating the EO-alter-
ing effects of NCR in the apparent absence
of satiation. The authors provide additional
data related to the consideration of extinc-
tion effects.
Some Suggestions for Future Research
We have attempted to interject questions
for consideration in future research within
our discussion of each of the articles that
appear in this special issue. We fear that a
more exhaustive attempt would be incom-
plete, given the extensive treatment of meth-
odological and conceptual issues found in
the reviews by McGill (1999) and by Smith

and Iwata (1997). Instead, we close this in-
troduction by suggesting several general
themes for research that are raised through
consideration of the articles as a group.
A methodological question arises in con-
ducting research on EOs: Should their evoc-
ative effects be examined in the presence or
absence of reinforcement? Although, as not-
ed previously, the presence of an EO should
evoke behavior regardless of the availability
of reinforcement, EO evaluations under con-
ditions of extinction may prevent detection
of an EO influence if the unavailability of
reinforcement is readily discriminated or if
extinction occurs quickly (as has been ob-
served in a number of studies). The absence
of reinforcement also raises the question of
whether the behavior of interest is, in fact,
maintained by the putative reinforcer. For
example, being left alone for a period of time
may evoke behavior that has been main-
tained by nonsocial (automatic) as well as
social reinforcement. Although the evocative
effect on behavior of being left alone is un-
ambiguous in this case, identification of the
behavior’s maintaining reinforcer requires a
further demonstration: differential control
over the behavior in the presence of the EO.
For these reasons, we believe that EO inves-
tigations are best undertaken in the presence
of relevant reinforcement contingencies.
A second general issue related to the iden-
tification of EO influences is specification of
the historical basis of the EO, to the extent

that it is possible. Given certain methodo-
logical controls (e.g., manipulation of ante-
cedent and consequent events, ruling out
discrimination as a source of influence), it is
possible to attribute changes in behavior to
the presence and absence of an EO with a
relatively high degree of confidence. A more
difficult yet helpful step would involve ad-
ditional analysis to determine how the EO
acquired and maintains its reinforcer-estab-
lishing and evocative properties. Was the EO
unconditioned or conditioned? If condi-
tioned, is its influence due to pairing with
another EO or some other consequence?
Does the influence appear to be reflexive or
transitive? Answers to questions such as these
would give applied researchers additional
options for intervention as well as some
helpful insights for prevention.
Antecedent manipulations that influence
behavior by way of an EO are fairly straight-
forward when they involve the mere presen-
tation or removal of an event whose struc-
tural features are invariant. However, be-
cause most EOs currently being studied in
applied research have multidimensional
characteristics (quality, magnitude, duration,
rate, etc.), attempts to identify the influence
of EOs might benefit from both qualitative
and quantitative analyses. Social interaction
provides a good example, and parallels can
be drawn with other types of events. A con-
clusion that deprivation from social inter-
action does or does not function as an EO

requires qualification: What kind of social
interaction? With whom? For what dura-
tion? Researchers would do well to remem-
ber that identification of an apparent EO
influence (or failure to find such an influ-
ence) may be a function of particular fea-
tures of procedural implementation with re-
spect to the class of variables being manip-
ulated. Similarly, procedures that diminish
the effectiveness of a positive reinforcer may
involve reinforcer removal rather than pre-
sentation. Consider the reinforcing effects of
parental attention for a child who has just
been put to bed. Is the child less likely to
cry for parental attention after receiving a lot
of it just prior to bedtime? Or would a pe-
riod of diminished attention be more likely
to attenuate its reinforcing effects, perhaps
by strengthening the reinforcing effects of an
alternative behavior (e.g., lying quietly, shut-
ting one’s eyes, etc.)?
Significant refinements in the functional
analysis of behavior disorders have already
been realized through incorporation of EO
manipulations, which improve the accuracy
or efficiency of assessment by increasing the
likelihood that a target behavior of interest
will occur in the presence of its maintaining
reinforcer. However, technical details are too
scattered, perhaps among dozens of reports,

to be of much immediate use to those in-
terested in clinical implementation. In ad-
dition, some EOs that influence behavior on
either a within- or between-session basis are
just now being investigated, as evidenced by
articles in this issue. Thus, research in the
area of functional analysis might benefit fur-
ther from a series of simple demonstrations
of how to maximize or minimize the influ-
ence of EOs during the course of assessment,
followed by integration of this information
with what is already known about maximiz-
ing contingency strength.
Research on the treatment of behavior
disorders also has benefited from systematic
EO manipulations. For example, the rapidly
growing number of studies incorporating
NCR as a treatment is directly related to
conceptual and empirical work on the EO,
and the same might be said more generally
for the larger class of antecedent interven-
tions. As an aside, the Hagopian et al. and
Kahng et al. studies on NCR in this issue
raise interesting questions with respect to
terminology. As already noted, it is unclear
whether NCR, as a result of diminishing the
effectiveness of reinforcement for problem
behavior, produces a state of satiation; if not,
it may be better to merely refer to such an
effect as an EO or ‘‘abolishing’’ operation.
The other effect of NCR—discontinuation
of the response–reinforcer relation—is also
subject to terminological ambiguity. For
purposes of improving procedural specificity,

Michael (2000) prefers to distinguish be-
tween the operations of (a) discontinuing re-
inforcement altogether (the first type of un-
pairing that results in extinction of R2 in his
example) and (b) delivering reinforcement
irrespective of the occurrence of behavior
(the second type of unpairing). Because
NCR involves the latter procedure, adopting
Michael’s distinction means that NCR may
disrupt a response–reinforcer relation by un-
pairing the two elements but that this does
not constitute extinction. (It should be not-
ed that Catania, 1992, prefers to call both
operations extinction.) Regardless of whether
Michael’s distinctions lead to changes in ter-
minological usage, they provide a useful
framework for classifying operational differ-
ences.
Of greater concern than terminology is
the fact that the procedural elements of cer-
tain treatments remain somewhat elusive.
For example, independent variables contin-
ue to be described in rather global terms,
such as curriculum revision, choice making,
and simply antecedent intervention. Al-
though data resulting from the use of these
interventions often show evidence of behav-
ior change, it is unclear how this change
was effected or if it resulted from an ante-
cedent manipulation rather than a change
in behavioral consequences. For over 30
years, the JABA editorial process has been
instrumental in promoting continued re-
finement in the specification of consequenc-
es. Now that research on EOs seems to have

been firmly established in this journal, we
look forward to further improvement in the
specification, measurement, and evaluation
of EO effects.
REFERENCES
Catania, A. C. (1992). Learning (3rd ed.). Englewood
Cliffs, NJ: Simon & Schuster.
McGill, P. (1999). Establishing operations: Implica-
tions for the assessment, treatment, and preven-
tion of problem behavior. Journal of Applied Be-
havior Analysis, 32, 393–418.
Michael, J. (1982). Distinguishing between discrim-
inative and motivational functions of stimuli.
Journal of the Experimental Analysis of Behavior,
37, 149–155.
Michael, J. (1993). Establishing operations. The Be-
havior Analyst, 16, 191–206.
Michael, J. (2000). Implications and refinements of
the establishing operation concept. Journal of Ap-
plied Behavior Analysis, 33, 401–410.
Smith, R. G., & Iwata, B. A. (1997). Antecedent
influences on behavior disorders. Journal of Ap-
plied Behavior Analysis, 30, 343–375.
Vollmer, T. R., & Iwata, B. A. (1991). Establishing

operations and reinforcement effects. Journal of
Applied Behavior Analysis, 24, 279–291.
Received August 29, 2000
Final acceptance August 29, 2000
Action Editor, F. Charles Mace
Rubic_Print_FormatCourse CodeClass CodeAssignment
TitleTotal PointsNRS-490NRS-490-O504Benchmark -
Professional Capstone and Practicum Reflective
Journal100.0CriteriaPercentageUnsatisfactory 0-71%
(0.00%)Less Than Satisfactory 72-75%
(75.00%)Satisfactory 76-79% (79.00%)Good 80-
89% (89.00%)Excellent 90-100%
(100.00%)CommentsPoints EarnedContent100.0%New Practice
Approaches10.0%New practice approaches are not present.New
practice approaches are present, but incomplete or otherwise
lacking in required detail.New practice approaches are present.
Some minor details or elements are missing but the omission(s)
do not impede understanding.New practice approaches are
present and complete. The submission provides the basic
information required.New practice approaches are present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Intraprofessional
Collaboration (4.3)10.0%Intraprofessional collaboration
information is not present.Intraprofessional collaboration
information is present, but incomplete or otherwise lacking in
required detail.Intraprofessional collaboration information is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Intraprofessional
collaboration information is present and complete. The
submission provides the basic information
required.Intraprofessional collaboration information is present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Health Care Delivery And

Clinical Systems (4.1)10.0%Health care delivery and clinical
systems information is not present.Health care delivery and
clinical systems information is present, but incomplete or
otherwise lacking in required detail.Health care delivery and
clinical systems information is present. Some minor details or
elements are missing but the omission(s) do not impede
understanding.Health care delivery and clinical systems
information is present and complete. The submission provides
the basic information required.Health care delivery and clinical
systems information is present, complete, and incorporates
additional relevant details and critical thinking to engage the
reader.Ethical Considerations In Health Care (5.4)10.0%Ethical
considerations in health care information is not present.Ethical
considerations in health care information is present, but
incomplete or otherwise lacking in required detail.Ethical
considerations in health care information is present. Some
minor details or elements are missing but the omission(s) do not
impede understanding.Ethical considerations in health care
information is present and complete. The submission provides
the basic information required.Ethical considerations in health
care information is present, complete, and incorporates
reader.Population Health Concerns (5.3)10.0%Population health
concerns information is not present.Population health concerns
information is present, but incomplete or otherwise lacking in
required detail.Population health concerns information is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Population health
concerns information is present and complete. The submission
provides the basic information required.Population health
concerns information is present, complete, and incorporates
reader.The Role Of Technology In Improving Health Care
Outcomes (4.3) 10.0%Information on the role of technology in
improving health care outcomes is not present.Information on
the role of technology in improving health care outcomes is

present, but incomplete or otherwise lacking in required
detail.Information on the role of technology in improving health
care outcomes is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.Information on the role of technology in
improving health care outcomes is present and complete. The
submission provides the basic information required.Information
on the role of technology in improving health care outcomes is
present, complete, and incorporates additional relevant details
and critical thinking to engage the reader.Health
Policy10.0%Health policy information is not present.Health
policy information content is present, but incomplete or
otherwise lacking in required detail.Health policy information
content is present. Some minor details or elements are missing
but the omission(s) do not impede understanding.Health policy
information content is present and complete. The submission
provides the basic information required.Health policy
information content is present, complete, and incorporates
reader.Leadership And Economic Models10.0%Information on
leadership and economic models is not present.Information on
leadership and economic models is present, but incomplete or
otherwise lacking in required detail.Information on leadership
and economic models is present. Some minor details or elements
are missing but the omission(s) do not impede
understanding.Information on leadership and economic models
is present and complete. The submission provides the basic
information required.Information on leadership and economic
models is present, complete, and incorporates additional
relevant details and critical thinking to engage the reader.Health
Disparities (1.5)10.0%Information on health disparities is not
present.Information on health disparities is present, but
incomplete or otherwise lacking in required detail.Information
on health disparities is present with minor elements missing that
do not impede understanding.Information on health disparities
is present and complete. The submission provides the basic

information required.Information on health disparities is
present, complete, and incorporates additional relevant details
and critical thinking to engage the reader.Presentation 5.0%The
piece is not neat or organized, and it does not include all
required elements.The work is not neat and includes minor
flaws or omissions of required elements.The overall appearance
is general, and major elements are missing.The overall
appearance is generally neat, with a few minor flaws or missing
elements.The work is well presented and includes all required
elements. The overall appearance is neat and
professional.Mechanics of Writing (includes spelling,
punctuation, grammar, language use)5.0%Surface errors are
pervasive enough that they impede communication of meaning.
Inappropriate word choice or sentence construction is
used.Frequent and repetitive mechanical errors distract the
reader. Inconsistencies in language choice (register), sentence
structure, or word choice are present.Some mechanical errors or
typos are present, but they are not overly distracting to the
reader. Correct sentence structure and audience-appropriate
language are used. Prose is largely free of mechanical errors,
although a few may be present. A variety of sentence structures
and effective figures of speech are used. Writer is clearly in
command of standard, written, academic English.Total
Weightage100%

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