Sunday, October 20, 2013

ABA Interview!




Its time for another ABA interview!
If you work in the field of ABA and would like to share your story and experiences feel free to contact me directly. I'd love to hear from you.


This interview comes from an amazing young lady who has Aspergers. She contacted me to share her opinions about my Stimming post (please read that post for her very astute explanation of her reasons for stimming) and I asked if she would like to share her story on my blog. Then she actually said yes! :-)

I am very excited to share her interview, as I happen to think she is a bit brilliant.


 Interview

1.       If you would like to, state your name.  Tracy.
 
2.       Please state your age. Thirteen.

3.       What Autism Spectrum Disorder do you have? How old were you when you were diagnosed? I'm an Aspie. I don't know how old I was.

4.       At what age did you become aware that you might have a diagnosis? How were you told that you have a diagnosis? I don't remember. I think I was seven or eight.

5.      What types of treatments or interventions have you experienced for your diagnosis? Which ones were the most beneficial? A whole mishmash. I don't think a particular therapy was most helpful in general, more particular teachers.

6.       What do you think about ABA therapy as a treatment method? I think it could help with some things, but being so compliance-based I think it shouldn't be used so very intensely (a 40 hour week is quite a lot!) so often or on older kids and adults (I don't believe in mental age.), because it could make it harder for them to be independent; it could make it harder for them to make decisions for themselves and be themselves, and foster unhelpful perfectionism.

7.       Do you think ABA could be dangerous or harmful for an individual with an ASD? Yes. Anything could, really. Some aversives and restraints can be very physically dangerous.

8.      Have you ever experienced any ABA therapy? If so, what was that experience like? I haven't.

9.       If you have experienced therapy before (ABA, ST, OT) do you have a favorite therapist? What was it about that person that made them your favorite? I've had a bunch of lovely therapists. My favorites were the ones who didn't condescend, who trusted that I knew myself relatively well.

10.   Do you see your ASD as a deficit or an asset?  It's not that simple. Life as an Autie is more intense, detailed, alive. Being as I am definitely has some setbacks---- I think most of us, Auties and NTs alike, would at least theoretically like a little pill to “cure” ourselves and the people we spend time with of our “door-slamming, soda-drinking, glasses-losing”- ness.

11.    At school, what kind of challenges do you deal with because of your ASD? I'm always worrying that people will hate me. But I know a lot of people who feel that way, and not all of them are Autistic, but I don't know.

12.   Do you engage in any self-stimulatory behaviors (stims)? How do you feel when you stim? I rock, flap, tap, spin, hair twirl... everything except breathe fire. Asking me how I feel when I stim is like me asking you, “How do you feel when you make facial expressions?” The answer is long and incomplete.

13.    If you were not allowed to engage in stims how would that make you feel? Do you think that stimming is beneficial to you? If someone blocked me every time I stimmed, I'd feel:
 A. like I was a failure for doing something wrong every five seconds.
 B. like I was being told the rhythm in which to breathe.
I do think it's beneficial to me. It helps me calm down, it helps me pay attention, it helps me think, it is a reaction to joy.

14.  What situations or settings tend to increase your stims? Intense emotion.

15.  Are you still able to focus on people and things around you when you are engaging in stims? Yes, most of the time; as well or better than if I wasn't stimming. Even while spinning in a circle I can have a conversation, though then of course I can't take in the same visual info.

16.  How do you communicate best (writing, vocally, drawing, etc)? How have you dealt with difficulty communicating your thoughts or emotions? Which way I best communicate varies. Generally writing. I've dealt with difficulty communicating by trying to censor myself less, and adding humor to conversations to make them more comfortable.

17.   What kind of social difficulties do you experience on a regular basis? How do you manage them? Worrying that people will hate me. Mistaking one person for another. Being socially awkward in general. I manage it by doing stuff anyway. I mess up, but the good parts outweigh the bad.

18.  In your own words, how do NT’s  differ from individuals with an ASD? Auties are more thoughtful, more passionate, and experience emotions and sensations more intensely.

19.  What are some of your hobbies?  I'm a writer. I draw and read and do logic puzzles and ride horses and walk and listen to music and bike.

20.  Have you seen any movies about individuals with an ASD? Can you name a favorite? I haven't seen any Autie movies. I read The Curious Incident of The Dog in The Night-Time. I loved how fleshed-out Christopher was.

21.   What do you like most about yourself? Being a writer.

22.  What goals do you have for your future? Marriage? Children? College, etc? Those could all happen. As of now, I'm in middle school.

23.  What would you like people who teach individuals with ASD’s to know? It's easy to not allow an Autie a personality, to attribute everything to fixations and splinter skills. But really, we're people, imperfect people, with good days and bad days. Fixations may just be loves.

24.   What would you like people raising a child with an ASD to know? I'd like to tell them congratulations. I’d like to tell them to read work by Auties. I'd like to tell them there's no normal child locked inside a shell…. there's an Autie child, and the child does in fact love and have emotions, and most likely loves them.

25.  As far as disability advocacy, what issues do you feel are most important in regards to ASDs (education, public sensitivity, etc)? Such a complicated question. I think we need to give Auties more freedom.

26.  What are some of the biggest misconceptions and myths that people have about individuals with ASD? Hee hee. Love this……We're robots who can't feel. We're just dumb. Auties are violent criminals. Auties are eternal children. One thing is true, though: Auties have absolutely no sense of humor. Neither can we be sarcastic. (sarcasm)

27.   What do you think about Sensory techniques as a therapeutic method? Do you think they are helpful or harmful? Love 'em. Bouncy balls and swings help to manage emotions, and to concentrate. Assisted stimming!

28.  What qualities and characteristics do you think any individual should have who wants to work with individuals with an ASD? I think someone who works with Auties should have a sense of humor, the bigger the better, and should be open-minded, willing to learn and to work through their mistakes.

29. Is there anything you want to add? Autie blogs for anyone interested:
yesthattoo.blogspot.com
timetolisten.blogspot.com
autistichoya.com
ballastexistenz.wordpress.com
juststimming.wordpress.com (Truly beautiful poems. Read Quiet Hands, if nothing else.)



Saturday, October 12, 2013

Quote of the day




If I accept you as you are, I will not help you; 
however,
if I treat you as though you are what you are capable of becoming, I help you become that.

~Johann Wolfgang Von Goethe, German writer & Poet




Tuesday, October 1, 2013

ABA Staff Training





I LOVE staff training. Its one of my favorite parts of my job. I value staff training so much because as a BCBA I could come up with the most innovative and technically sound treatment plan out there, but if the direct staff under me do not properly execute, then whose fault is that? I believe its my fault. Part of my job is to properly train and supervise direct staff, and also to evaluate staff as being a good fit for the demands of the job. When I train direct staff, I am giving them the tools they need to be excellent at their job. And who wants to feel that they are excellent at their job?? (the answer is everyone)

Training is such a critical issue in this field, because of the tiered service delivery model. The professionals who are credentialed to run or supervise an ABA program (e.g. BCBA), typically do not staff ABA programs. There are many reasons for this, but I'll name 3: (1) The demand for ABA staff FAR exceeds the supply (2) BCBAs are expensive (3) The tiered model frees up a BCBA to have a larger caseload.

 When working with or collaborating with other professionals (like OTs or teachers) they often ask me who can provide ABA therapy. Well technically, at this time anyone CAN provide ABA therapy, but should anyone do it? Definitely not. The BACB is currently moving towards a certification process for direct level staff, but in my experiences ABA therapists are typically college students with little to no ABA experience. These individuals will require extensive training and support once they are hired.

ABA therapy isn’t complicated, but its not easy. A quality supervisor and excellently designed treatment plan can be implemented by almost anyone. When I first started in this field, I knew nothing about ABA but I was taught to implement skill acquisition programs and behavior plans, collect data, and generalize skills across environments. The problem is that far too often, therapists are hired without a supervisor. Or the supervisor is insanely overworked and stretched too thin, and their quality of supervision suffers. Or unscrupulous ABA therapists offer themselves out to work for families independently, and falsely present themselves as being more knowledgeable than they actually are. 
Training is, in my opinion, one of the most pressing issues in the field of ABA. Families are hiring ABA therapists directly to avoid the high cost of agencies, but they don't understand the importance of hiring a supervisor for that therapist.


Parents please don't feel like I’m picking on you. I see this issue happening in schools as well. School systems with minuscule financial budgets, but plenty of children on the spectrum, often place individuals in the role of Behavior Specialist or Autism Expert, who really should not be in those roles. Anyone implementing ABA therapy can teach a variety of critical life skills, such as language, toilet training, and strategies for problem behaviors. If someone has marginal or poor quality training, they could cause a lot of damage. They could inadvertently teach or strengthen inappropriate behaviors, that a qualified professional will then have to come in and "un-teach".

The BACB Guidelines for ABA Treatment  provides the following recommendations for hiring and training Behavior Technicians (ABA therapists):

Minimum hiring standards: High school degree minimum, AA degree preferred, pass TB test and criminal background check.

Minimum training standards: Pass initial competencies composed of both oral and written scenarios as well as direct observation, demonstrate ability to correctly respond to treatment protocols, receive case assignments that match their skill level and experience, and receive both initial and  ongoing training and supervision from a Behavior Analyst.

Training content: Should include CPR, HIPAA and ethical behavior, mandated reporting, ASD knowledge, data collection, basic ABA procedures, and developmental milestones.

The BACB Guidelines refer to a minimum standard. Having been in this field for many years, I can say that some agencies provide excellent initial training, and some...…don’t. I strongly believe that often the high turnover rate in this field is due to staff burnout, which is what happens when poorly trained and low paid therapists are sent into situations they are not prepared for. The therapist spends a session getting headbutted repeatedly, and abruptly quits.
High turn over impacts everyone negatively, most importantly the individual receiving treatment.  The importance of putting time, money, and resources into giving new staff quality training can't be overstated.

I have conducted and created staff and parent trainings, and from my experiences as well as my review of research, here is what does and does not work when it comes to staff training:

  • Didactic training (lecture) just isn’t enough. Training should also incorporate feedback, rehearsal, direct coaching/modeling, and hands- on experience. Training should also be modified to the needs of the trainees, the situations they face, the type of clients they serve, etc.
  • Pre and post tests are often helpful to evaluate effectiveness of training, as well as provide information about individual deficits that can be targeted during on the job training
  • Any adult learning should incorporate active discussion and encourage questions/participant comments, rather than a model where learners passively sit and listen
  • Numerous studies have shown that the mere training of skills to direct staff is insufficient in maintaining a steady performance of those skills. In other words, just because I teach the concept of reinforcement to a therapist does not mean they will successfully implement reinforcement when working in a clients home
  •  I know many companies who use a training model of “shadowing”, which would include following an employee around as they go into the field to work with clients. That method alone is not sufficient to properly train staff, and will likely not lead to maintenance of skills learned over time
  • Organizational Behavior Management strategies, such as self management procedures, are empirically supported to improve and maintain staff performance. For example, a therapist could track her accuracy with delivering quick reinforcement, and then review this data with the supervisor
  • Supervisors need to regularly directly observe direct staff, provide specific praise and feedback, performance modeling, and set clear expectations for improvement


*Staff Training Resources

Arnal L., Fazzio D., Martin G. L., Yu C. T., Keilback L., Starke M. Instructing university students to conduct discrete-trials teaching with confederates simulating children with autism. Developmental Disabilities Bulletin. 2007;35:131–147.


Catania C. N., Almeidia D., Liu-Constant B., Digennaro Reed F. D. Video modeling to train staff to implement discrete-trial instruction. Journal of Applied Behavior Analysis. 2009;42:387–392.


Downs A., Downs R. C., Rau K. Effects of training and feedback on discrete trial teaching skills and student performance. Research in Developmental Disabilities. 2008;29:235–246


ATS Resource: Creating Training Programs that Work