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.

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.

Saturday, September 27, 2014

Quote of The Day


"Normal is an illusion. What is normal for the spider is chaos for the fly"

If there's 1 thing I could say to all my clients and it would fit and be applicable across the board, it would be: Forget "normal".

Chasing "normal" will cause you to lose sleep at night, will destroy your marriage, will drive a wedge between your relationships with family members, and will cause you to resent and eventually grow distant from your friends who are NOT living with Autism.
See, normal isn't real

Normal is what most people say they desire but almost no one can say they possess.

ABA or whatever path/treatment/therapy you select for your child with Autism is not about "normal". Its about helping that child be successful and thrive and overcome obstacles.

There are other parents out there who have it way worse than you, and there are other parents out there who have it way better than you. That will always be the case. The sooner you can let go of your own idealized version of normal, the easier the journey gets.

I have a niece with special needs and physical handicaps, and as an ABA professional I could choose to look at her as a series of deficits and strengths, or skill sets to improve upon, but I just see her as my lovebug. Thats it. There's things she can do, and things she cant do, just like everyone else. Guess what? None of us can do every single thing we desire to do. 

A shift in your perspective is the key to escaping the "normal" trap.



Sunday, September 21, 2014

Keeping the F-U-N in A-B-A








How FUN are your ABA sessions with your clients?

Do you make your clients smile or laugh? Are they excited or happy when you arrive at their house? Do they start excitedly talking to you or pulling your arm to come play with them as soon as you walk in?
Do you find yourself getting bored in your ABA sessions? Here’s a secret: If you are bored, your client was bored about 30 minutes ago.

It’s time to inject some FUN into therapy!

ABA therapists often have lots of precise and technical knowledge about behavior, learning, motivation, and systems of reinforcement. We can manage program binders, train parents and teachers, and collect and analyze data. The problem is, sometimes in this field people focus so much on running protocols that they forget that learning should be enjoyable. Particularly if you have a large caseload and spend your days driving from client to client, it can become monotonous and mundane.

You and your client both should enjoy working together. Neither of you should regularly feel bored or frustrated, if that’s happening then something needs to change. Think about it like this: if you had an ABA Therapist who came to see you regularly, what type of person would you want to show up? How would you want them to talk to you? What reinforcers would you want them to use?
Compare what you would want from a therapist with the type of therapist you are. Do you stack up? Would YOU want to be your client??

Consider this an invitation to start having more fun in your therapy sessions. It makes the clients happy, it makes the parents happy, it makes the siblings jealous :-) , and it prevents workplace burnout. I have fun with my clients…maybe not every day, but I enjoy going to see my kiddos.

If you have realized by now that your ABA sessions are about as exciting as completing trigonometry problems (sorry to the math fans) then here are some tips to being the FUN ABA therapist who has happy children trailing behind him/her like the Pied Piper.

Establish rapport-Pairing---> Understand what it is, and that it never really ends. Does your arrival signify fun things or the end of fun things? Do you walk in and say “Let’s get to work” or “Hey Danny! I’m so happy to see you today”? Your presence should be so tied to reinforcement and good things that you become a reinforcer to the client.
Schedule sessions during optimal learning times – For the itty bitty ones, this may mean you don’t do a session right before their nap time. For the school age kids, this means they don’t get off the bus, and BAM, there you are with a clipboard. It’s important to know your client, and know when they are in that optimal learning zone and schedule sessions with that in mind.
Tailor teaching strategies and modify materials based on the learner – I have one client who loves dinosaurs, so he has a dinosaur token board. I have another client who hates to read so we do his Sight Words program using magazines. I have a super girly client who loves My Little Pony so all her social stories are about ponies. Do your session materials and the strategies you use take into consideration your clients personality, interests, likes, and strengths?
Don’t fight against M.O., work with it – If your clients Dad just got home from work and your client keeps running out of the room to go see him, how about if Dad joins the session? Or if the client keeps staring out the window, how about if we work outside today? Why fight against your client’s motivation when that just makes your job harder?
Vary and rotate reinforcers often – Would you want to work for the same thing everyday? Does that sound fun to you? I see it all the time: the therapists have a Reinforcer Box with the same 4-5 toys and stuffed animals in it and it never changes. It’s no surprise when the client would rather engage in problem behaviors than sit and work---> It’s more fun to irritate you than it is to work for that same white teddy bear over and over. Mix it up! You should regularly surprise your client with new reinforcer choices  (like watching a cool video).
Embed client choice in sessions – How much choice does your client have in the session? For my clients who understand choice making we give them TONS of choice: Where should we sit--Should Mom come in the room-- Which program are we doing first--Which reinforcer do you want to work for--Should we take a break now or wait 10 minutes--Should we play Monopoly or Guess Who, etc.  Clients who are constantly making choices feel in control of the session and invested in the session, which is exactly how you want them to feel.