I Love ABA!

Welcome to my blog all about Applied Behavior Analysis!

This blog is about my experiences, thoughts, and opinions on ABA. My career as an ABA provider is definitely a passion and a joy, and I love what I do.

This is a personal blog: The views and opinions expressed here represent my own and not those of the people, institutions, or organizations that I may be affiliated with.

Saturday, April 11, 2015

Supervisor Tips: I Choose You!

Photo source: cnn.com, popsugar.com

As a BCBA, if you work for a company/agency you may not have much say over which clients you will/will not serve. You get assigned a caseload of very diverse clients, and continue to be assigned cases until the caseload maximum is reached.
However if you choose to offer services independently as a BCBA, then it is very much up to you to decide who to work with. This may not be something most people consider or contemplate as they move closer and closer to certification, but: How will you choose which clients you will serve?

Once someone obtains certification, they are now qualified to work independently (depending on the state). I've briefly talked about working independently on my blog before, but this post is specifically about making the judgment call of when to select, and when to decline, a particular client.

Many ABA professionals don’t have experience working independently. I started out in this field working independently, but that isn’t everyone’s background. Most people start out under a company or agency, and don’t branch out to independent work until post- certification. Thankfully the Board does provide guidelines to help with this:

Accepting clients - The Behavior Analyst accepts as clients only those individuals or entities (agencies, firms, etc.) whose behavior problems or requested service are commensurate with the behavior analyst’s education, training, and experience. In lieu of these conditions, the behavior analyst must function under the supervision of or in consultation with a behavior analyst whose credentials permit working with such behavior problems or services.

Providing consultation - Behavior Analysts arrange for appropriate consultations and referrals based principally on the best interests of their clients, with appropriate consent, and subject to other relevant considerations, including applicable law and contractual obligations.

Who is your client? - The term client as used here is broadly applicable to whomever the Behavior Analyst provides services whether an individual person (service recipient), parent or guardian of a service recipient, an institutional representative, a public or private agency, a firm or corporation.

Termination with clients- Behavior Analysts make reasonable efforts to plan for facilitating care in the event that behavior analytic services are interrupted by factors such as the behavior analyst’s illness, impending death, unavailability, or relocation or by the client’s relocation or financial limitations. Behavior Analysts do not abandon clients. Behavior Analysts terminate a professional relationship when it becomes reasonably clear that the client no longer needs the service, is not benefiting, or is being harmed by continued service.

So what’s the takeaway summary here?

There are clear ethical guidelines for how a BCBA can initiate services with a client, how you must present yourself/market your services, how to professionally interact with a client, and how to terminate services with a client.
These ethical guidelines should give even the greenest, brand new BCBA, clear cut boundaries of how to maintain a professional business relationship with clients.

I’d like to add some points and tips to the above guidelines, based on what I have experienced and had to learn the hard way:

  • Know thyself- Part of being a professional is being able to truly evaluate your own strengths, weaknesses, and limits. To put it bluntly, don’t bite off more than you can chew. If you work a full time job, plus you are in school, and a client contacts you to inquire about consultation, can you really add that to your already full plate? Your decision making should be governed by what you can do well, not by sympathy or finances. If you know that you could squeeze more onto your plate, but they will go to the bottom of your priority list, the quality of your work will be poor, or they will get what’s left over of your time and concentration, then its unethical to add that client. Is this sometimes hard to explain to people??? Yes….. It sure is :-).  I have worked with many great professionals who were very kind and caring people, but unfortunately that can sometimes translate into someone who doesn’t know how to say “No”.
  • Honestly state your expertise – This is very similar to the 1st point, but part of being a professional is being able to honestly and clearly state your clinical expertise. Most of my experience in the world of ABA has been with early intervention. If someone contacted me to consult on a case with a 28 year old man, would I be interested? It’s possible, yes. However, based on my expertise and training am I the ideal BCBA to work with this individual? Probably not. It’s important to work within the realm of your expertise, and when necessary seek out additional training or mentorship so you can perform your job with excellence. If you have never worked with a type of client before, then you need to clearly explain that to the potential client so they can make an informed decision about whether to hire you or not.
  • Boundaries! – I’m going to say that again: Boundaries! It’s that important that I needed to say it twice. When I first started in this field, I was really, really, bad at maintaining boundaries and speaking up for myself. Over the years, I learned how to be assertive, not aggressive, when clients trampled my boundaries. If you are going to work independently, you have to know how to clearly communicate your boundaries to clients, and then actually enforce them. Sometimes a client will unintentionally step on your toes, and sometimes it will be quite intentional :-). You may tell a family during the initial meeting “I don’t work on weekends”, and then 6 months in you suddenly find yourself meeting with them every Saturday. How did that happen?? It happened because at some point you failed to enforce your own boundaries.
  • “Termination” is not a dirty word – Every BCBA and every client will NOT be a good match. Just because a family contacts me to request services and I have availability, that doesn’t mean it’s an automatic green light. I know myself well enough to know I work better with certain kinds of families or clients, and being a certified Behavior Geek, oops, I mean Behavior Analyst, I know a thing or two about reading behavior. If during the initial intake process the parents aren’t completing my forms, they lost the contract, they are a no-show for an assessment appointment (or 2), etc., those are like blinking neon signs that maybe you don’t want to initiate ABA services after all. Of course, there is such a thing as grace and giving people the benefit of the doubt, but only you can decide what you are willing to put up with. I have had to initiate termination of services with private clients before, and it can get a bit…challenging. People may not agree with you that termination is best, or they may feel you just need to be more patient, more understanding, etc. Only you can decide how valuable your time really is. If you are working with a client and having persistent, recurring issues with non-involvement, disrespect, or low commitment to treatment, it may be time to part ways.

Reference: BACB Guidelines for Responsible Conduct (I suggest paying particular attention to section 2.0)

Wednesday, April 1, 2015

Quote of The Day

Photo source: autism-society.org, webkinzinsider.com

In case you weren't aware, April is Autism Awareness Month. I'm sure the blue lights, television commercials, and billboards will start popping up soon.

I have shared on my blog before how I feel about April Autism Awareness, I view it as a good and bad thing. Of course the good being that people who still havent heard about Autism or have outdated, incorrect views of what Autism is, can get accurate information and facts. 
The bad would be, okay now that you have been made aware....now what?? How did that increased awareness make life better for the individuals I serve?
 Did they receive desperately needed insurance funding? Has the school finally agreed to give them a 1:1 paraprofessional? Did the family get much needed respite care?

A client of mine who has a similar bittersweet opinion of Autism Awareness month gave me permission to post a brief op-ed piece she wrote. I think its amazing, so I wanted to share it:

"Yep! This is the month: Autism Awareness....which I think has both its pros and its cons. 
However, politics aside, let's talk about the most important aspect of awareness of any issue: what will you DO about it. 
Today is not as popular as tomorrow will be when the world is asked by ASD powerhouse Autism Speaks to "Light it up Blue!" Today, is a quieter day started by a FB effort to remember the ASD kiddos who lost their lives due to wandering. 

No colors or bracelets, no t-shirts or bumper stickers...just remember. 

But, as I believe that "awareness" is condescending and self-affirming when not accompanied by action, decide what you can do on a local level: 
1) Find out how to schedule education for you or your organization on what to do if you locate a wandering child with developmental delay.
2) Consider sponsoring a child, or enrolling your own child in swimming lessons, as most wanderers have died by drowning.
3) Pursue training or education in ABA based strategies on teaching personal accountability to kids with ASD or developmental delays. 

Awareness is only the first step...ACTION is the end goal. 
Honoring the ASD community is not just about wearing blue...it's about living in the blue with us!"

Written by Nicole Cox

Thursday, March 19, 2015

Slow & Steady

Photo source: policyexchange.org.uk, queenbeeberta.blogspot.com

*Recommended reading: Progress IS Success

I will generalize a good bit in this post, because if I listed all the different types of learners and their possible rates of learning this post would be 60 pages long, and none of you would read it. :-)

When working with whats often referred to as Early Learners, usually those “learning how to learn” skills are being taught: eye contact, following directions, problem behavior reduction, adaptability to change, etc. Early learners are often those individuals who may be nonverbal/nonvocal, engage in near constant self-stimulatory behaviors, have minimal self -help skills (feeding, dressing, toileting, etc.), and learn at a slow pace.

With these learners, progress is often subtle and slow.
Like, pouring out molasses slow.

For professionals who choose to focus on early intervention, it can often be because we LOVE the quick progress and seeing new skills emerge so rapidly (I know that’s why I love early intervention).
It’s extremely reinforcing to a professional to teach a client 5 new words in 1 week. For parents, its extremely gratifying and exciting to see the results of quality, intensive early intervention.

So when a learner doesn’t have that quick pace of skill acquisition, they don’t generalize skills well, and they don’t maintain learned skills easily, what impact does that have on parents and professionals? Well, I would say the impact is pretty similar: discouragement, self-doubt (“Am I doing the right thing?”), and frustration. 

I notice that my early learner clients often frustrate and confuse the direct staff much more than other clients do. Staff come out of a session with an early learner sweaty, tired, possibly with a few bruises or scratches, and feeling incompetent.
Staff burnout can occur more frequently with early learners, and from a professional’s perspective it can be harder to get parents on board with treatment when the child is an early learner. The parents don’t see rapid progress, so they think the ABA is ineffective or the BCBA doesn’t know what he/she is doing.

Not that you asked, but I simply love working with early learners. I think because my first few clients when I joined this field were the typical moderate to severe early learner, something tugs at my heart when I meet an early learner client. I just want to jump in and get to work and help that family, even though I know it will be difficult and slow going. Another reason I love working with this population is that I have learned over the years to look at progress through a unique lens. Yes, I have those clients with mild Autism who are working on advanced skills like cognition, self-care, problem solving, conflict resolution, academics, etc. I also have those early intervention clients who quickly move from babble, to Echoics, to spontaneous Tacting, in a nice little progression that makes you feel like you are the most amazing BCBA ever! (who says BCBA’s don’t need immediate gratification?)

But I have learned not to let my slow learners frustrate me and cause me to doubt my abilities. So my gift to you today, whether you are a parent or a professional, is to let you borrow my unique lens so you can view early learners the way I do.
Print this post out and put it up on your refrigerator, and read it to yourself whenever you have been painstakingly teaching a skill for week after week…..after week, and feel completely without hope.

Tips for Teaching Early Learners

  • Have you remembered ICEL? When a learner is not making progress or has plateaued, we don’t first blame the learner. Look at your teaching first (Are you moving through targets too quickly? Are you over prompting?), the curriculum next (are your programs flawed or poorly written?), the environment next (is the reinforcement schedule dense enough?), and the learner LAST.
  • Are you looking at the BIG picture? When you collect quality data, you will be able to see gains and progress that may be invisible on the surface. To put it another way, the direct staff who work with the client day after day may feel like no progress is being made. This is because they are too close to the situation. As the supervisor who comes in monthly, I can look at the data as a whole and see that tantrums are decreasing from 10 minutes a day, to 8 minutes a day, to 6 minutes a day, etc. I stay focused on the small and the big picture, so I know that we are making progress.
  • Are you focused only on the programs you run? This is a big error I see direct staff make. Yes, the programs you teach day after day are important and it can be highly frustrating to see slow progress with those programs….but therapy is more than just the goals we target. Therapy is also teaching learners that interacting with people brings about good things, and learning can be fun. My early learners may make slow progress with their programs, but often their eye contact improves like crazy, or their ability to stay calm if a peer starts tantrumming next to them, or their ability to stay dry and have minimal accidents each day, or their willingness to try new foods. I see these changes and improvements, and I know that what we are doing IS benefiting that child.
  • Are your expectations too high? Do you know what I expect from my clients? That they learn. That’s it. I know that some learners will progress very rapidly, and some won’t. Some learners will be very impacted by their Autism, and others will be only minimally impacted. As long as learning is occurring, thats what matters. This isn’t a race, and constantly comparing your child/ client to others will only lead to disappointment. You may need to adjust your expectations so you can appreciate the baby steps.
  • Lastly, are you sure you’re doing ABA? Seem like a silly question? It’s not. I consult with schools or families all the time who proudly show me their “ABA” program that I have to explain to them is not actually ABA. ABA requires ongoing data collection. ABA requires training and oversight to implement correctly. ABA modifies the environment to make certain behaviors more likely to occur. ABA is rooted in reinforcement and motivation, not punishment and coercion. ABA is the application of evidence supported strategies, not pulling from a bag of tricks. If you are experiencing persistent slow, or no, progress with your learner, maybe you need to check out the 7 Dimensions of ABA  to make sure you haven’t missed the mark.