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, 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



Monday, October 13, 2014

Bedside Manner





“People don't care how much you know until they know how much you care” 
Theodore Roosevelt

*Super highly recommend reading: On Autism and ABA (no really, go read this)


I was very recently having a discussion with some colleagues about a quite real issue in this field of…lets say a lack of bedside manner. I have posted previously about ABA Haters. While there are some people who are anti-ABA because they truly are against what we do and do not wish to see individuals with special needs receive intervention, there are others who don’t really hate ABA. They hate US. By “us” I mean the professionals who provide ABA services. They find us to be about as enjoyable to work with as sucking on a lemon.

For some families out there, it was after an experience with a not so nice, not so humble, and not so patient ABA provider that they formed their current opinions about ABA as a field. Which is sad, but also upsets me as a professional in this field. I wish I could say that I have never seen or experienced anything even close to the horror stories some of my clients tell me, but…..no. I have experienced:

~Clients who call me with every compliant or concern because my supervisor never returns their phone calls
~Rude and arrogant company owners who won’t come out to my sessions and provide supervision because my client lives in a not so nice neighborhood
~Unprofessional colleagues who tell parents they “aren’t working/trying hard enough” when their child consistently doesn’t make progress, or laugh in a parents face when they ask about GFCF diets
~Unscrupulous agencies who hire direct staff and send them directly into the field after 1-2 days of “shadow” training
~The egotistical BCBA who took me to one of my first IEP meetings and verbally berated everyone at the table, while speaking in an alphabet soup of jargon that no one could understand

 Your role as an ABA Therapist, BCBA, Behavior Tutor, etc., is not to be “The Wizard Who Knows All”. Your role is to disseminate the science, share your expertise, and cooperate with people to teach them the steps to do what you do. I have heard many company owners say to clients “our ultimate goal is for you to not need us….for you to learn all of this so thoroughly that you can implement it yourself”. 

Hmmm, really?
 If that is really the goal then handing a stressed out single mother a 12 page behavior plan won’t meet that goal. Definitely not.

Consider this a call to action to my fellow troops in the field. Strive daily to NOT be the type of professional who views their caseload as “me” vs “them”. The client is not your enemy. They also are not idiots. Do they have your knowledge of behavior and data analysis? Maybe not. What they do have is an impressive data base of knowledge about their child (or student) that you need, in order to do your job. 

Repeat after me: I do not know everything. I need this parent/teacher/staff to work collaboratively with me, and they won't care how much I know until they know how much I care.

To sum it up, here is an excerpt from an open letter written by a parent to any therapist who may work with her child:

You are with my child for an hour, maybe a couple hours or half a day. I am with my child 24 hours, 7 days a week. Do not talk down to me either or good luck to you. I have to hold strong even at 3am and he decides it's time to get up after 3 hours of sleep for me……. When we discuss goals- make them functional for his life at home with me - not just your hour or two hour session. I need to know what works even when we are all bone dead tired or stressed to the max or when we have some down time to cuddle. Until you know what it’s like to be with my child 24/7, don't ever assume your way is best or think I "should" have done something. Cooperation is the key word here.

Sunday, October 5, 2014

Diary of an ABA Consultant





Consultation - A meeting with an expert or professional, such as a medical doctor, in order to seek advice about a problem or question.

Consultation is often one of the many hats a BCBA wears. Not every ABA client receives the traditional tiered delivery model, where an ABA agency assigns a 2-3 person team of direct staff and a Supervisor to the case. I know of many families who would LOVE to have access to something like that but for various reasons they don't. They may live in areas where there are no ABA providers/agencies. Or they have no funding source options and cant afford to pay a company $150-$200 an hour to receive services. 

It is possible that consultation can look like going to see a family and training the parents how to work with their child directly (training parents to be ABA therapists). I don't see that very often though. What I see much more often is more of a Parent Training model. (BCBA's also can provide independent consultation to schools, but this post is about consulting with parents)

Consultation is something I enjoy doing and it gives me the opportunity to put into practice my philosophy of "simple ABA" because I have to be able to explain what I do in a very concise & practical way. A consultation client in most cases will be someone you don't see regularly, who has a very limited budget, may have very limited availability to meet with you,  and knows very little about the application of ABA. They may ask you very loaded questions not understanding they wont get a simple answer (such as "When will she start talking?"). It isn't unusual that one parent will seek out your consultation services and the other parent will be very much against it. It also isn't unusual for the family to want you to tell them where their child is on the "functioning scale", or in other words, how bad is it?? (ethically and tactfully avoid that landmine).
It isn't unusual that these consultation clients will have difficulty understanding the boundaries of the service you provide, which I have had to explain (again, sprinkle some tact on top!) that I am not a Marriage Counselor, Dietician, Physician, Psychologist, Psychiatrist, or Occupational Therapist, and can't answer questions outside of my expertise. 
I can understand families wishing there was a BCBA/Pediatrician/SLP/Family Therapist/Psychologist they could hire, I just haven't come across that individual yet :-)

In my experiences, there are some "To Do's" that can make the consultation process go smoother, particularly if you've only ever supervised direct staff. Its very different to work directly with the family. 

Do


  • Its customary to offer an initial consultation meeting at no charge. This can be conducted in person or over the phone but it should be a brief meeting to determine if you are able to meet the client's needs, and for you to answer the initial questions (there will be many). Not everyone who contacts you for consultation will be an ideal client, and its best to let the family know that as soon as possible so they can begin contacting other professionals.
  • If possible, meet with all relevant caregivers during your initial visit. You want to get an idea of who you will be working with, their attitudes about ABA, what level of involvement do they expect to meet, is everyone agreeing about what behaviors to intervene on, etc.
  • Conduct an Intake Interview, where you clearly and fully state your expertise, your fees, review your parent involvement policy (you should have one), etc. Don't let a client be surprised to find out you charge for writing reports, or that you dont work on weekends. Information like that should be stated upfront at the start of the consultative relationship.
  • Simplicity is key. Remember your audience. Give the family simple and manageable strategies that busy and working parents can successfully implement. For example, as I mentioned in my Top 10 post one of the first things I recommend to new clients is putting a daily schedule in place. So many times I walk into homes with no routine or structure,  and its no surprise that the child with special needs spends their day bouncing between problem behaviors. 
  • Be helpfully honest. I dont like the term "brutally honest", thats a good way to get kicked out of someones home. I prefer "helpfully honest". You wouldnt even know this family if they hadn't contacted you for help. So clearly, they WANT to know your thoughts and opinions. Don't hesitate to jump in there and point out issues you see. I had a consultation intake appointment just a few days ago, and I noticed right away the child consistently communicated using problem behavior. Tugging or hitting at an adult meant "I want something", crying and falling to the floor meant "I'd like some attention", etc. So I pointed that out, and started explaining to the parents how they could use the behaviors as opportunities to teach communication. As long as you share information respectfully, your honesty should not come across in an abrasive way.


Don't


  • Avoid badmouthing or putting down the competition. It is very common that a family will say to me "Well the last BCBA we spoke to said to avoid ABC company and that XYZ agency is no good". Yikes! You really don't want slanderous statements just floating out there with your name attached to them. You never know who that will get back to. If you are not in a position to be able to recommend local professionals, then just provide the family with a list of providers/companies and explain you cannot recommend anyone in particular. Then give them some information on what to look for in a quality provider.
  • Don't think just because you are dealing with a family living in Nowheresville, Utah, that you can do sloppy work and its ok. You never know who will see it. I have had multiple consultation clients show me what the last BCBA gave them for a report, or an invoice, or a program binder, and sometimes its shocking. Your name will be on that report or assessment for years to come, and every professional who comes after you will take a look at what you wrote. Simple is good. Cutting corners is not.
  • Lastly, my biggest tip would be do NOT underestimate what you have to offer. I had to learn this myself, the hard way. You arent working for some agency, or having to accept whatever the funding source is paying. This is your private client who contacted you for services. That means it is ok to explain to a family that lives 3 hours away that you will need mileage reimbursement. It is ok to tell a family with 5 big dogs that you have pet allergies, and they will need to have the dogs outside or in a closed room when you visit the home. It is ok to explain to a consultation client that you are not accessible 24 hours a day, and it isn't alright to call you at 11pm. Know your worth as a professional, set a competitive rate for your services, and don't be afraid to speak up if the client is trying to take advantage of you.