I Love ABA!

Welcome to my Blog!

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.

Friday, November 21, 2014

Quote of The Day

Teach - To impart knowledge of or skill in; to show or explain how to do something; to give instruction in.

You may not be a educator, but that doesn't mean you don't have the opportunity everyday to teach important life skills to an individual on the Spectrum.
 This is for all my readers who painstakingly, patiently, and enthusiastically teach skills to children, adolescents, or adults, and impact their life in a big way...because that is what amazing teachers do. They impact lives.

Monday, November 10, 2014

'Tis IEP Season!

It’s that lovely time of year for me again, where I have multiple IEP meetings to attend across multiple clients, or reports to write to submit at IEP meetings, or data to compile to share with the IEP team.

As I did in my Top 10 post , I will often share information on my blog that I find myself saying over and over again to various clients/consumers. I like to be helpful :-)
Or, I come up with posts due to being frustrated or irritated with a situation (now you’re probably going to go back and re-read all my posts to see if you can identify the ones I wrote while highly frustrated. Have fun with that!) .

To all the educators, administrators, and school professionals who approach the IEP meeting as a truly collaborative process can I just say THANK YOU. You make my job so much easier, and other ABA professionals like me.  We as ABA professionals understand that schools everywhere are dealing with more and more special need students, and smaller and smaller budgets to help them. We understand that you teachers have entire classrooms to teach, and don’t have the luxury to work 1:1 like we do. We understand that just like us, teachers work a full shift, and then go home and work another full shift of administrative work.  We appreciate all that schools do to help our clients and to support their families.

However, this post is more directed at the educators, administrators, and school professionals who make the job of the ABA professional much harder. You refuse to read our reports that we take hours to put together. You dismiss our data, or barely glance at it. You insult the families we work with in IEP meetings, or tell a concerned parent to “calm down” or call them “unreasonable”. You add stress and anxiety to a family that is already stretched thin from living with Autism 24-7.

I hope that a quick and simple list of ways to effectively collaborate with the BCBA or the ABA team can help shed some light on how you can have a better relationship with us, and maybe also help explain where we are coming from. 

Despite what some of you may think, we don’t show up at IEP meetings hoping it will go badly. 
We show up to support the family, to represent the science of ABA, to advocate, and most importantly: to speak for our client. I know of families who will bring a photo of their child into IEP meetings specifically to keep the focus on the individual receiving services, and not on egos, degrees, titles, or arguing over accommodations.

10 Ways the IEP Team Can Effectively Collaborate with the Home ABA Team

  1. Let’s Talk about Data- Yayyyyy data! Everyone loves it so. Whats that? You don’t love data?? Hmmmm…..thats odd. You don’t love knowing how effective your teaching is, being able to demonstrate the quality of an intervention, or coming to the IEP meeting prepared with graphs and data to back up everything you are saying? It’s one thing to tell a parent “The BCBA doesn’t need to come into the classroom because since Jordan started school his behavior has come a long way!” (pssst, by the way…..vague statements like this are not helpful for an ABA professional), but it’s another thing to say “Well, as you can see on this graph the target behavior has clearly decreased in both frequency and duration over the past 3 weeks. Since the behavior is in a downward trend, why would the BCBA need to come in?”
  2. Classroom Observations- In order for the ABA professional to do their job, they often need to see the problem behavior in action. This is why we ask to come into your classroom to observe our client, at the particular times when the behavior usually occurs. We also need to observe what is going on in the environment: what happened before the behavior, after the behavior, who was present, was it loud, quiet, etc. All of this helps us determine why the behavior is happening and once we know that we can come up with a plan of action. Which we can then share with you. Please allow us to come into your classroom to do this.
  3. Classroom Facilitation- For some individuals, they may require more support or intervention than the classroom can provide (even a special education classroom). This means that the ABA team would attend school with the client in order to collect data, manage behaviors, or break down skills so that child can benefit from instruction. The facilitator is not there to harass or offend you, they are there to help the client. Just the data collection alone that is often necessary to properly serve a client, may be far too time consuming for the typical teacher. This is why allowing the ABA team into the classroom can be a great idea.
  4. Conducting a FBA- When problem behaviors that disrupt or interfere with learning are regularly occurring or are increasing in some manner (getting more intense, occurring more often), the next step needs to be a Functional Behavior Assessment. This is a process of closely analyzing and observing the behavior to determine the function. What is the motivation or pay off for the individual who engages in the behavior? What is reinforcing or maintaining the behavior? Without completing this step, any strategy, procedure, or intervention that you come up with is basically a guess. I can tell you, the family won’t appreciate you “guessing at” how to manage their child’s behavior. A FBA should be conducted or supervised by someone qualified to do so (which is why the ABA professional may ask who completed the FBA).
  5. Creating the BIP- Once the FBA has been completed, the next step is a plan of action. Often called the Behavior Intervention Plan this document details exactly how to both prevent and react to the problem behavior. Please understand that the ABA team will be very interested to read and review the BIP because we probably have a Behavior Plan for the client in the home setting. For the client’s best interest, these documents need to be comparable to each other. We have to make sure we are not intentionally or unintentionally reinforcing a problem behavior in one environment that is being punished in another environment. Again, a BIP needs to be created or supervised by someone qualified to do so.
  6. The 3 R’s, but what about friends??- It’s an IEP….we’re in a school….I get that. Obviously academic goals are important, and ABA professionals want their clients to perform at or above grade level if they can. We also want our clients to learn how to interact socially,  display social eye contact, share, take directions from multiple adults, wait, transition with a group, play Tag at recess, etc. The ABA team and the parents may want to add multiple socio-behavioral goals to the IEP. We push for this because in the home setting we don’t have a pool of 200 other 1st graders to use. School has a unique advantage over us, in that you can teach my client to appropriately respond to a greeting multiple times a day, using a different person each time. I can’t do that in a home 1:1 setting.
  7. Sharing is Caring- At any time, you can request the home ABA team share documents, reports, or data with you. We actually like it when you ask us to share because it shows you want to collaborate. However, please reciprocate. Let us know how our client is doing in your classroom, are they making friends, what problem behaviors are you seeing, etc. For example, I know teachers collect data on the IEP goals or when physical management needs to be used (like a restraint) but the families I work with almost never see this data. Why? It would be extremely helpful for us to know this information.
  8. Act as if my client is your only student- Let me give you a tip: parents of children with special needs can be very egocentric. That isn’t an insult, it often is a way of survival for them because in order to help their child they have to narrow in and focus on that child day and night, and fight for services and support. Due to this, you talking about your student from last year who is “just like Joey”, or your son who is “just like Joey”, or the student down the hall who is “just like Joey” will not go over well with Joey’s parents. They do not want to hear about what worked for a different 4 year old with Autism. They only want to talk about their 4 year old with Autism. So do yourself a favor, and use the IEP meeting to only talk about their child (another free tip: please don’t say “You know, I do have other students!” Parents find that really offensive).
  9. Don’t Diss ABA- So the family sitting across from you at the meeting took the time to be sure the BCBA or ABA Therapists came to the meeting. That’s a good indicator that you are talking to someone who is Pro-ABA. It’s just not a good idea to make negative, distorted, or unfactual statements about ABA. It could also be quite embarrassing to say you are “trained” in ABA because you took a class or attended a workshop recently. Please do not compare putting up a sticker chart, or giving praise to a student, to the science of ABA. Avoid making statements about how the teacher doesn’t have time to “do ABA”, or it isn’t necessary at school, as the BCBA present may take that as a personal challenge. :-)
  10. Be Nice- So #10 is the most important item on the list, and seems like it would be unnecessary to have to say. Yet I often walk into meetings full of school professionals who are frowning, look angry, or all have their arms crossed. Why? Let’s not approach the meeting like a battle. Please don’t walk into the IEP meeting with a look on your face that says “I wish I was anywhere but here”. Because you know….we can see your face. So smile! Shake our hand, introduce yourself, and Be Nice.  

Tuesday, November 4, 2014

Its So Hard to Say Goodbye

Ahhhhh, how to say goodbye to a client/family that you have painstakingly and diligently been working with for months, or often for years………

Transitioning a client out of services is not something I see talked about much online, or see presented often in trainings/workshops. I find that a bit odd, but it seems like there may be some uneasiness around talking about this topic. The reality is, most ABA professionals only serve a client for  a few years or so.

At some point we all have to experience a client transition process, which is a really nice word for terminating services. See? “Terminating services” just doesn’t sound very pretty.

So if you are a professional who has never been formally taught about how/when/why to transition clients out, then keep reading :-)

ABA therapy in most scenarios begins when children are young... on average, between 3-6. In most scenarios, the child receives intensive intervention initially, and then once they enter school services fade to after school hours only. Over the next 1-3 years it usually becomes clear if the client will soon be fading out of services or if they will need some level of life long support. I am choosing my words very carefully here, because all situations and cases are different. So I can only speak in generalities.

 That school age child may go on to receive ABA into adolescence, and then into their teen years.  Therapy does not have to cease just because the client ages, although many professionals or agencies only serve younger clients so this can happen. In some situations (although I have not seen this as commonly) the ABA services continue right up into adulthood, and the ABA team helps the individual find employment, make friends at their group home, or learn self-care skills like shaving.

While this lovely, rosy outcome can occur, where a client has the same ABA team from the time they start services to the time they stop services, its not super likely. What is more common is that the ABA therapist moves, the BCBA has a few kids and decides she doesn't want to work full time anymore, or the client/family loses their funding. In other words, termination of services is often due to some life event that is out of our control.

When planning for a termination of services, this is a conversation that needs to happen much sooner than most people think. I usually talk about termination during the intake process. During the intake process, its helpful to explain to the family what the criteria is around transitioning, what happens during transitioning, and how they will be notified when nearing discharge.  It’s much easier for families to hold on to an unrealistic fairy tale that the ABA team will never leave, if no one EVER talks to them about termination of services.

Here are some tips and suggestions  based on where I have worked, and how I have terminated clients in the past. The discharge process can vary greatly from one company to the next.

How to End Services with a Client

  • Determine why the client is nearing discharge (both voluntary and involuntary). A sample list could include: family chooses to end services, completion of treatment goals, demonstration of improved functioning, absence of significant progress, integration into an inpatient community program or comparable treatment setting, persistent issues with treatment integrity (example: the child is only available for 2 days a week, but the clinical recommendation is therapy 4-5 days a week), company/Consultant inability to effectively provide quality ABA services, and/or persistent noncompliance with company policies including lack of parental involvement.
  • Begin a systematic fade out plan. Discuss this with the family, and together decide how services will be gradually reduced (if the family chose to discontinue services, this may not be possible). For example, reduce the amount of therapy hours, transition to a Parent Training/Consultation model, if seeing the client at home & school transition to just seeing them at home.
  • Provide as much notice to the family as possible, preferably in writing. I am used to funding sources which require 6 month reporting, so I will often alert families that at the next authorization period (6 months away) we will begin transitioning services.
  • It is customary to prepare some type of Discharge Report for the family that sums up the service history and provides helpful information for the next provider or professional.
  • With the Discharge Report, there should be some type of referral list for the family. This may take some research, like if the family is moving out of state. You want to be able to point the family in a good direction to seeking other professionals who can work with them, even if you are discontinuing working with them for negative reasons.
  • Decide who will collect any company property from the home, and be sure to do this on or before the last date of services. I have been in the awkward position of driving to a home to pick up materials that someone else should have gotten WEEKS ago, and it’s not fun searching through an annoyed mom’s living room to find all the Block Design cards or having to ask her “I only see 2 flashcard sets, didn’t we give you 3??”

*Quick Tip: Here is a sample Discharge Summary Report

Friday, October 24, 2014

Program: Making Choices

I have mentioned before on my blog that the skill of making choices is something I like to teach my kiddos pretty quickly once I start working with them. Particularly for the younger or nonverbal clients, when I meet them they often spend their days having choices made for them. They wake up in the morning and mom picks their clothing. They they go to school and the teacher tells them what work to complete. Then its home again, where dad puts dinner in front of them. Their day is a series of following other peoples instructions and demands. Does that sound fun to you? Sure doesn’t sound fun to me.

When creating a Behavior Plan, teaching the skill of choice making is often an antecedent intervention I recommend. I find that many problem behaviors are maintained or strengthened by the individual having a lack of control over their environment, or a lack of a communication system to let others know what they want or need. Hopefully all my readers know this, but just because a kiddo doesn’t speak does not mean they have nothing to say or don’t desire anything

·         So why teach choice making? Making a choice is really making a decision. What you are really doing is teaching the individual how to evaluate (Which one do I want), decide (Hmm, I want that one), and accept (If I pick red that means I can’t have blue). Beyond teaching decision making, allowing for choice making during teaching or therapy involves the kiddo in what is going on. You are now a team working together to complete something both of you are interested in. It’s just human nature that if I help decide or somehow invest in something, I am going to care more about the outcome. Lastly, teaching an individual to make a choice is a communication skill. If a nonverbal 3 year old can lead me to her toy cabinet and point to a teddy bear, she is now communicating with even though she can’t say “I want to see that teddy bear”.
·         How can choice making skills be taught? There are lots of ways to create a choice making program. What is most important is to focus on this key criteria:
1)   Begin with tangible and visual choices over abstract choices. Hold out a doll and a train to the child and tell them to “Pick one”, before you try to have them choose before eating dinner at 5:00 or 7:00. Also, start with just 2 choices to keep it simple.
2) If the kiddo doesn’t choose anything, then you choose. They need to understand that “I can pick, or you can pick”.
3)   If the kiddo tries to reach for both items, don’t allow them to. Move the items away and explain they need to pick one. Then try again.
4)   Once the kiddo has made a choice, that’s it. Do not allow them to keep bouncing between two choices, or to say “But I want that one”. Once a choice has been made, remove the other choice. This is very important especially when initially teaching the skill.
5)   Accept the form of communication the individual is capable of. This could be telling you their choice, gesturing, sign language, pointing, etc. Be sure to reinforce appropriate choice making so the skill will increase in the future.

There are a few ways teaching choice making can go wrong. It’s important to consider how to program for and prevent issues such as: When should the choice options begin to increase? When should choice making move from tangible objects to more abstract concepts? Does the child understand that choosing something means saying “yes” to that thing, and “no” to the other things? What if the child wants to choose both items, or make more than one choice? What happens if the individual makes a choice but meant to pick something else (didn’t understand what they were picking)? When is offering a choice not appropriate?

*Tip – This isn’t just a skill useful for early learners, or lower functioning clients. For older clients or higher functioning clients, I embed TONS of choice making into their therapy. They not only choose where we work (in your room or in the backyard?), which programs to complete and in what order, but their individual preferences are included in the materials they use and telling me what they want to work for. I also teach them about good choices vs. bad choices (I call them Green & Red Choices). Green choices add things: reinforcement, fun, and my attention/interaction. Red choices remove things, or cause fun things not to happen. When the individual is having difficulty listening, completing work, or using nice words, I may give them a reminder such as “Are you making a green or a red choice right now?”, and then together we discuss how to get back to making green choices.

Resource: “Solving Behavior Problems in Autism” by Linda Hodgdon