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. 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 although they can call you in the middle of the night, you won't answer the phone. I was complaining to a colleague of mine recently about a disappointing phone interview I had with an international client, who wanted to pay me a very low rate for my services. My friend said "We are professionals providing a specialized service, that took us years to learn, college courses, an intensive exam, and lots and lots of coffee! There is a reason for the rates we charge". Well said :-)

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