No matter where you provide services as an ABA professional (in a school, in someone’s home, etc.), getting the cooperation, support, and active participation of key stakeholders is the most necessary part of your job. I like to call this obtaining the “Buy In”. Buy in is basically the process by which the consumer willingly becomes an active and vital part of the treatment team. An ABA therapy program is always a joint effort -- treatment plan goals may be implemented by staff and possibly parents, overseen by a BCBA, and generalized by a variety of other people.
The key stakeholders are typically whoever initiated your services/hired you, but can also include relevant caregivers or professionals who interact with your client on a regular basis….grandparents, daycare staff, teacher, Occupational Therapist, respite providers, nanny, etc. With proper buy in, these people can help to implement and generalize your treatment plan. Without proper buy in, these people can derail or detonate your treatment plan.
Keep in mind that as an ABA professional, much of what you come up with to address behaviors of concern may NOT be implemented by you. Don’t you think it’s an important and necessary step to set those stakeholders up for success before you hand them the treatment plan you poured your blood, sweat, and tears into? …(well maybe not blood, but certainly a few tears)
So firstly, if you work for an agency/company/school district that has no policies or procedures (such as a Parent Involvement Policy) in place for dealing with persistently uninvolved and resistant stakeholders, then I’m sorry. You have an uphill battle ahead of you, and unfortunately the powers that be want you to think it’s due to your lack of effort if you can’t get a chronically uninvolved parent “on board”. Sometimes, despite your efforts, interventions, patience, and perseverance, ABA therapy just isn’t a good fit for that consumer. The way I like to look at this issue, and the way I have explained it to staff, is that there is just one of me and I get 24 hours in my day like everyone else. A client who is on my caseload, yet consistently firmly resists, attempts to change, or derails my treatment plan is taking up a space that I could give to another family.
If you do work for a company/employer with policies in place regarding the participation and involvement of stakeholders, then your best bet when you hit a snag with a client is to follow the written guidelines or protocols. Know these procedures well, and what your role is as the direct staff or the supervisor. Sometimes a consumer will start off great and enthusiastic, and then over time their involvement fades. What I see more frequently, is right from the start there may be issues with consumer follow through, participation, or following outlined procedures. This is always an indication that more intentional efforts are necessary to get buy in from that consumer.
If you work independently, then you need to have your own policies and procedures in place requiring active consumer participation. It is then your responsibility to enforce your policies. You really can’t blame a client for consistently breaking a policy if you never deliver any consequences.
So what are some effective ways –right from the start—to get the buy in you need, so you don’t find yourself in an unpleasant or hostile confrontation with a consumer? Glad ya asked :-)
Buy In tips!
- Explain that you expect buy-in- So the first tip is pretty simple. Have you taken the time to explain to the consumers you serve that their active and ongoing support and involvement is necessary to the success of therapy? No? Then how do you expect them to know that? I often find that particularly for families brand new to ABA therapy, they have no idea what I will expect, what they should expect, should they watch the session, should they disappear upstairs.....they truly don't know. As the professional, the responsibility is on you to outline what participation will entail, and what the consequences are for a persistent lack of participation.
- Connect goals to W.O.R.K. - I intentionally am using the word "work", and not a happy -face -feel- good word like "success", "positive outcomes", etc. Just ask any direct staff in this field if their job is work or not. I guarantee they will assure you no matter how fun their session may look, they are working! We want to make it clear to consumers that for each treatment plan goal, there is work involved to meet that goal. Lack of buy in can water down the effectiveness of a treatment plan, and at that point the likelihood of achieving goal mastery starts to decrease. For each goal of treatment the consumer states, help them to connect those goals to specific things you will need them to do.
- Clearly outline the magnitude of the problem - It can be necessary at times to *tactfully* help a consumer understand the weightiness of treatment goals. If a consumer doesn't feel the need of the ABA team, and underestimates their importance, then why would they actually follow what the team says?
- Transparency - You need to exhibit the behaviors you want the consumer to exhibit. Return their phone calls promptly, meet deadlines, if they give you a document to review then get it back to them quickly. I encourage my clients to give their input on everything from what materials we will use, to which direct staff work best with their child. Even clinically, you should be updating the consumer on what goals you have in mind, why you are selecting specific assessment tools, etc. Being transparent helps create an atmosphere of "Let's work on this together".
- Bend, but don't break - A very important tip is to always try to meet your consumer where they are. I once worked with a single mother of 3 special needs children, all under the age of 5. While I could have given her data to collect, honestly I just did not think that would be realistic. So instead, we came up with a system where she would videorecord behavioral incidents and we would meet and discuss the incident together and view the tape. I had to bend my expectations slightly based on the needs of this family. As professionals, we all have certain expectations from the consumers we serve. You will save yourself lots of frustration and stress if you learn that sometimes rules need to bend. Notice I didn't say BREAK the rules......don't just shrug your shoulders with a difficult client and give up on expecting them to participate. Evaluate your expectations, and discuss with the consumer if there are alternative ways for them to participate.