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 30, 2016

School Selection Merry-Go-Round

Photo source: www.rhythmlift.com, www.treehugger.com 

Round and round and round, without actually going anywhere. For many parents, that is what the school selection process can feel like.

As part of what I do, I have helped lots of families make decisions about ideal school placement for their children. It is always an emotional discussion, full of more questions than answers. While I am sure every parent wishes their BCBA knew of the local schools that are just PERFECT for their child, in reality the best we can do is equip parents with information to make a solid choice.

I was recently talking to a family I work with, and the father stated that he wished there was some type of list to help parents know which school choices are the best for children with Autism. The mother then stated that even if such a list existed, that doesn’t mean it would be applicable for their child. In other words, there is no list of “Perfect schools for Allison” or “Perfect schools for Marcus”.

It’s so tough seeing parents wrestle with school decisions, especially if their options are limited. There are many variables that can limit your options of ideal school placement, such as lack of funding/income, the child has significant behavior issues, living in an international location, or minimal experience with advocating within a school system. So just to be clear, this post is not a guarantee to finding the perfect school for your child. Instead the purpose of this post is to help parents understand how to think about school placement, how to evaluate their options, and how to let go of the search for “perfect” and instead search for “ideal”.

Below is a summary of the information I would share with any client who asked me, “So where should David/Caleb/Jazmin go to school next year?”:

  • Tip #1 – With the help of your ABA team, first develop an understanding of your child’s needs. Is the goal to do a ½ day of intensive ABA and a ½ day of school? Is the goal to have your child in a culturally diverse school rich with social experiences? Is the goal to have your child in a rigorous school that will challenge them academically? Is the goal to have your child in a school that offers specialized services (such as Speech Therapy)? Understanding what your child needs will point you to an understanding of what kind of school they need to be in. I usually start this discussion with parents by asking “What is MOST important to you about a potential school?”
  • Tip #2 - Gather as much intel on potential schools as you can, through the school website, by meeting with administration, by observing in a classroom, etc. Other parents will be a great resource to you as well. If you neighbor has a 5-year-old with Autism attending the elementary school up the street, ask about their experiences. What are the pros? What are the cons? What treatments or services does the school offer? This leads me to my next tip…..
  • Tip #3 – What’s good for the goose may in no way possible be good for the gander. While it can be helpful to talk to other parents about their experiences, all kids are unique. Just because ABC school down the street is supposed to be perfect for kids on the Spectrum, it could be a horrible fit for your child. Avoid making quick decisions based entirely off of what other people have experienced. I see this happen more often with special needs schools; all it takes is one unique situation that the school isn’t equipped for and suddenly the “perfect school” starts getting a bad rep. So whether good or bad, do not make school placement decisions based only on what others have experienced.
  • Tip #4 – The “Big 3” as I like to call them, are the main criteria you need to have for evaluating a potential school. Ready to hear the 3? Okay: Allowing the ABA team inside, Behavior Plan, & Active Collaboration. Let me explain this a bit by saying that I usually am having this school conversation with a family who requested my services. So by nature of requesting my services that means their child is receiving ABA therapy, and has some significant behavior concerns. So if that is not the case for your child, then the Big 3 may not be so relevant. However, if the Big 3 are indeed relevant for you then keep reading. It is imperative that the home ABA team have collaboration and open communication with the school. That could mean classroom facilitation, it could mean taking the child out of the classroom for 1:1 therapy, or it could mean the BCBA attends every IEP meeting. The home behavior plan must be included in the IEP, and needs to be implemented at school. The teacher needs to be able to contact the BCBA with concerns, and vice versa. Everyone has to be one big Brady Bunch kind of family, or all kinds of problems and skill/behavioral regression can occur.
  • Tip #5 – My last tip is intended to save you lots of stress, worry, and heartache when it comes to selecting a school. Let go of the idea of perfection. Just wave bye-bye to it, and drive away. I don’t know of any parents (of special needs or typically developing kids) who can say “I just LOVE my child’s school 100%!”. If you can say that about your child’s school, congrats…..but I don’t know of any parents who can say that :-). You will have to deal with some things you don’t like, some policies you don’t agree with, a few “dud” teachers (they won’t all be great), some tense and awkward IEP meetings, etc. As long as your main concerns are being addressed (refer back to Tip #1), and your child is progressing, consider the school to be a great placement for your child. The sooner you can let go of the mythical perfect school, the sooner you can get off the school selection merry-go-round.

**Recommended Reading:

Saturday, April 16, 2016

ABA Therapy Materials

Photo source: www.scholastic.com, www.pinterest.com

I have gone over how to put together the ABA program binder, how to get therapy started, and how to select programs. Imagine my surprise when I realized I haven't covered what materials are needed to kick off an ABA program....I think this is one of those topics that is easy to assume is common knowledge. It really isn't though, and both families and staff often need help with gathering and storing materials.
Most people don't have any idea how materials heavy ABA therapy can be. Added to that is the fact that not every provider supplies their own materials.  Some companies will charge the parents to use their materials, and some will not. It is typical that if the company provides materials, then they don't belong to the parents. Meaning whenever services end, those materials have to be returned or the cost must be reimbursed.

This information will be helpful to supervisors too, because it can be a bit overwhelming to get organized when you first start supervising cases. There's just so much to do. I'm  happy to help streamline the process a bit.
Please do not take this post as a absolute list of MUST HAVES. These are suggestions, based on what I usually use and how I like to set up my cases/my organizational style. Feel free to modify as needed. :-)

The "Materials Closet"-
During intake I will usually ask the family where in the home therapy could take place, and where program materials can be stored. Then we work together to pick an ideal location. You want a location that doesn't get heavy foot traffic if possible, and that's out of the reach of the little ones. Usually a closet fits that criteria, especially if you add shelves or cabinets that can be locked. Or, you can add a lock to the closet door and just keep the closet locked. Reinforcers should always be kept out of reach, or the staff can bring their own reinforcers with them to sessions. I like to keep the materials closet neat and organized, which is a responsibility all staff should share. At the end of each session all supplies and materials need to be put back inside the closet, in their appropriate folder/bag/drawer. I suggest labeling everything, color coding is nice, and checking over the materials regularly to make sure things aren't broken, stored incorrectly, or missing.
As an example, here is what I usually place in the materials closet: program binders, flashcards (active and maintenance), extra pens/pencils/post it notes/paper/crayons/markers, etc., timers, clipboards, writing paper and construction paper, blank data sheets, various small manipulatives (can be used for matching, sorting, sequencing patterns, etc), academic workbooks, picture books, 3 hole punch, and materials for particular programs. For example, if we are teaching Puzzles then inside the closet we would have at least 2 peg puzzles, inset puzzles, and possibly jigsaw puzzles.

Organizational Tools-
I love all of these.

Staff Resources-
In the front of my program binders I like to include training resources. These are usually general documents that explain Pairing, Preference Assessments, how to complete data sheets, etc. You can also choose to keep a file folder of resources with the program materials, for example the token board or a behavioral visual aid that is only used as needed. If you have the room, it can also be helpful to store some books or articles that staff can refer to during sessions (e.g. the Cooper book). On a recent case I kept resources on feeding interventions with the program materials, so staff could refer back to it as needed. If there are parent training goals, I also like to have a separate parent training binder. In the front of that binder, I will include resources/handouts for the parents.

Spend time, not $$-
As much as possible I like to make my own materials. Once a target is mastered that flashcard may never be seen again, or only when running maintenance. Google images is my friend :-) Type what you need into Google (e.g. cat), select images, and then print the one you want. I suggest always printing at least 2 different images so you can teach generalization (print a brown cat, and a white cat).  For sight words, letter identification, number identification, etc., don't you dare buy flashcards! Get some index cards and a black Sharpie, and make them yourself. Also, fancy toys break or get destroyed during a rough session. So go to your local thrift store and stock up on used toys and books. Another tip: laminate everything. You will thank me after the client tries to chew on all the flashcards. Who will be spending time making all of this stuff will depend on the case...sometimes the parents help make materials for my cases, sometimes I assign the Lead therapist to do it, and sometimes I do it.

**Helpful Tip:
When starting a case I discuss suggested materials with families and also give them this brief handout to help them get started with finding things. ABA materials do not have to break the bank, especially if you get creative and make things yourself.

Saturday, April 2, 2016

Quote of The Day

Photo source: www.slideshare.net
Not so much a quote, more something to ponder....

Want vs. Need

If as a provider, you are in a state of perpetual conflict and frustration with a client because they:

 1- resist or argue with all your recommendations
 2- refuse or decline to participate with treatment
 3- continually modify or change your treatment plan

----- then you just may be in a situation where the client/consumer is wanting your help but is not at a point of seeing the need for your help. There is a huge difference, my friend.

Wants often present with limited understanding, limited appreciation, and a predetermined threshold of how much effort will be put forth to attain the want.

Something to ponder, right?

Thursday, March 24, 2016

Ethics Crash Course

Photo source: www.ethics.efpa.eu, www.asme.org

Ethics can be defined as a standard of practice and conduct. Ethics help to define and establish what is appropriate, what is inappropriate, and also help protect the public/consumers.

If you work in this field in some capacity --even if you just work part time for a small company --you need to be aware of the ethical standards for this field. Why, you ask? Well, you can cause harm to yourself and/or others if you are providing services in an unethical manner.

Like other BCBA's, I have often been in the position of leading the "new staff training".  What I have noticed is these trainings often gloss over, or completely leave out, information about ethics. I don't agree with that at all. Let's face it: this is a young field. It is not uncommon to work with very young staff who may have never had a "real" job before. Or whatever they were doing before ABA was a non-professional position. I have had many situations of having to pull a new staff aside to discuss their work attire, cell phone use, or defensiveness when receiving correction. This is why I started generally going over professionalism with all my new staff, with a crash course in ethical behavior.

Hopefully this information will provide a good jumping off point for creating your own staff resources, or could possibly be integrated into a comprehensive training. This information could also be used to create company policies, or an employee handbook.
I strongly suggest using lots of real examples when teaching about ethics. I vividly remember sitting in a training years ago as a new ABA therapist, and the trainer was explaining that we cannot take food out of the children's lunchboxes (this was a center facility). I remember thinking to myself what a dumb thing to go over in a training, but then the trainer explained a therapist was just fired for repeatedly eating the children's food!
So now when I'm putting together trainings of my own, I always aim to include actual ethics fails that I have seen to make things much more relevant. :-)

Here is a quick overview of the topics I try to cover with my staff. I have found that when problems happen or when families complain, usually it is about one of these issues.

Crash Course Suggestions:

Professional Dress
Most of my direct staff are young females, many of whom have never had a job before where they work in someone’s home. Yoga pants, halter tops, high heels, huge earrings, super tight pants…I’ve seen it all! And NONE of it is appropriate. This is a job where you often work with children, typically kneeling, bending over, squatting, running…. you get the point. Improper clothing is one of the top things parents complain to me about when it comes to direct staff.
Confidentiality & Privacy
This is a big one. If your staff are new to a professional position, this will be completely foreign to them. I used to work at a facility in a very small town, and it was hard to get the staff to understand they could not gossip at the local bar about their clients after work. It is imperative to protect client information, which can include data sheets, verbal information, client address, client diagnosis, etc. Especially if the client receives insurance funding, HIPAA compliance is a must!
Professional Boundaries
I started in this field as a direct therapist, so I get it: it is easy to get chummy with the families you serve and start to form friendships. Parents will blur the boundaries when they like you, because hey…you are always at their house! As the professional, it is YOUR job to set clear boundaries and to maintain them. All of the ethical burden falls on you, and it is much easier to maintain a clear boundary than it is to try and establish a boundary after lines have been crossed.
Respecting the Dignity of the Client
This would be things like allowing a 10- year old client to cuddle with you while sitting on your lap, or teaching play skills to an adult client using Barbie dolls. At all times the dignity of the individual you are serving needs to be at the front of your mind. Think about how you would want to be treated if you were the client. Your nonverbal clients won’t be able to tell you if their rights are being violated, so again, all of the ethical burden falls on you.
Boundaries of Competence
It is very important to know the limitations of your competencies, and to seek out appropriate supervision and training. If you are not qualified or knowledgeable to do something, its best to step back. I know this can be hard depending where you work…. some companies pay no attention to staff competency when staffing cases. This also refers to knowing when to be quiet. I have had to correct new staff for giving parents medical advice, recommending supplements, or suggesting changes to the behavior plan. Learn the following phrase and be prepared to say it often: “You need to speak to the BCBA about that:-)
The Social Media Minefield
So as technology continues to get fancier, this is a topic I have to address more and more with staff. It’s inappropriate to “friend” clients on social media, OR to discuss/vent about your clients on social media. Even if you don’t name names. Be very careful, I have seen people face legal action over things like this. Just because you don’t say a name, if you describe the client enough that I can figure out who you are talking about then you have violated that client’s privacy, as well as behaved unethically.