BCBA Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan, develop, and monitor a variety of behavioral support service delivery options to meet the needs of individual clients. The BCBA also consults with and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive treatment plans; and collaborates with related services providers as appropriate. The BCBA also provides direct staff supervision, and evaluation of staff performance both verbally, and in writing.

Essential Duties: 


  • Use appropriate assessment instruments and data to develop and implement teaching programs that reflect behavioral outcomes and objectives 
  • Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements.
  • Establish and maintain data measurement, collection, and analysis systems for clients
  • Maintain appropriate documentation and prepare and complete reports as required
  • Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification and other expectations, and meet or exceed professional standards
  • Maintain highly organized, consistent, thorough, and systematic recordkeeping (session notes, data sheets, etc.)
  • Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client
  • Develop strategies for the stability of quality services when clients experience transitions
  • Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed
  • Provide staff development, training, and modeling for team members (including client caregivers) in strategies and methodologies for successful implementation of the treatment plan
  • Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed 
  • Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings 
  • Participate in professional growth activities such as conferences, classes, team meetings and program visitations; remain a lifelong learner
  •  Accept all other responsibilities as assigned.



This is a real job description for a BCBA position, and it's fairly accurate to most online job postings.

Yes, the typical day-to-day role of any BCBA will vary greatly depending on where they live, which setting they work in, the population they serve, etc. So to keep things simple and brief, I will focus on clinicians who primarily manage cases and supervise direct staff (as this is overwhelmingly what most BCBA's do).

The problem with most job descriptions (that may be written by administrative staff, not clinicians) is they leave out important details about the actual job.
I hear fairly often from people pursuing their BCBA, full of misinformed ideas about what it will be like on the other side. Or, I hear from current BCBA's who have been working in the field for years and are now burned out and exhausted because they weren't prepared for the realities of the job.

-- If you think you may be at a point of professional burnout, my 1st recommendation to you would be to stop & assess: When was the last time you felt passionate about your work? When was the last time you felt valued by leadership/your employer? Has your dissatisfaction at work started to seep into your personal/family life?
If so, please check out the resources below about dealing with burnout. It's a serious problem in many human service fields, and as BCBA's we are not immune.


While there are some great resources out there about professional burnout, my 2 cents is that clinicians would need triage to "stop the bleeding" much less if they enter the field with a realistic picture of what they're getting into. Let's prevent the bleeding, not patch it up.


Using the example job description above, I'll just sprinkle some fresh reality on top of it ;-) :


Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan (always planning....most clinicians are continuously monitoring the effectiveness of their interventions which requires intentional thinking about what will come next), develop, and monitor a variety (what works for Mickey will not necessarily work for Minnie, so this requires staying abreast of current research and trends within the field to best serve your clients) of behavioral support service delivery options to meet the needs of individual clients (no matter how impressive your intervention is, ultimately if social validity is low then you have more tweaking to do). The BCBA also consults with (this can be translated as 'remains available to', or in other words 'on top of your regular duties') and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive (comprehensive is key, and this is why we spend so much time planning and thinking--> the more deficits the client needs assistance with, the more comprehensive your intervention) treatment plans; and collaborates with (again, this is best translated as 'remains available to') related services providers as appropriate. The BCBA also provides direct staff supervision (it is common that direct contact with the client or with staff is billable time, but not so much the other important components of the position that still must happen), and evaluation of staff performance (this could include staff feedback, written evaluations, meeting with each supervisee monthly, or a mixture of all of the above. Again, this may not be considered billable time).



Essential Duties: 





  • Use appropriate assessment instruments (Some companies do not provide business equipment/tools for you, so you will have to purchase these) 
  • Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements (Being a quality BCBA requires excellent self-analysis skills....you must seek to continually improve your skillset)
  • Establish and maintain data measurement, collection, and analysis systems for clients (Some companies provide access to data management systems, others do not)
  • Maintain appropriate documentation and prepare and complete reports as required (Keeping in mind that what is required will change)
  • Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification (Credentialing is a PROCESS, and an employer with top-quality billers is a must) 
  • Maintain highly organized, consistent, thorough, and systematic recordkeeping (As needed, you must be able to produce accurate, timely, complete client documentation)
  • Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client (The 'across settings' part can  be challenging, especially for school or center based services where you don't see the client's home life)
  • Develop strategies for the stability of quality services when clients experience transitions (As the BCBA, you are responsible for successful client transition. This could include if hours decrease, if the program decreases in intensity of goals, or if services terminate)
  • Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed (Everything you create as a BCBA must be open to revision as needed. Much of your time will be spent editing protocols, programs, or revising systems) 
  • Provide staff development, training, and modeling for team members in strategies and methodologies for successful implementation of the treatment plan (You must make time for this, which can be challenging)
  • Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed (When working with severe behavior or populations in crisis, your employer should provide adequate training, protective equipment, and support. Also, ethically you must practice within the boundaries of your clinical competence)
  • Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings (See why time-management skills are critical?)
  • Participate in professional growth activities such as conferences (Your employer may or may not pay for this)
  •  Accept all other responsibilities as assigned. (Pretty  much a vague and blanket statement isn't it? I would add the following reality check to this section: Accepting an insane caseload does not make you Superman/Superwoman, it will make you a very miserable BCBA. Understand that owning an ABA company does not qualify someone to actually be a good/ethical/honest employer, and hating the boss is the #1 reason why employees quit. Understand that staff turnover is scary high in this field..... there is a reason for that.  Understand that as a clinician there are many tasks you will complete that you just can't bill for. Understand that when you get home at the end of the day you likely still are not done with documentation/tasks. Understand that 'work life' may creep into your weekends too. Understand that many ABA employees report feeling underappreciated, devalued, and ignored by their employers, particularly at the RBT level.  Understand that there is a mental fatigue that comes with this type of work, and the more dissatisfied you are with your employer the more it increases. Understand that as clinician you will get frustrated by ever- changing funder requirements, and increased time-sensitive demands upon clinicians. Understand that employment offers for ABA positions often come with more strings attached than Pinocchio.... if you don't agree with something in the offer letter, do not sign it) 





*Resources:

Preventing Burnout 

Running on Empty

BCBA Burnout

Battling Burnout

Stress in the ABA Workplace

Addressing ABA Employee Turnover

Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in heath care. Health Care Management Review, 29, 2–7

Griffith, G. M., Barbakou, A., & Hastings, R. P. (2014). Coping as a predictor of burnout and general health in therapists working in ABA schools. European Journal of Special Needs Education, 29, 548–558.

Gibson, J. A., Grey, I. M., & Hastings, R. P. (2009). Supervisor support as a predictor of burnout and therapeutic self-efficacy in therapists working in ABA schools. Journal of Autism and Developmental Disorders, 39, 1024–1030




What is your work to you?

A daily grind?
A paycheck?
Monotonous?
A place where you are surrounded by incompetent idiots?
Your main source of frustration?


What should your work be to you?


"The place God calls you to is where your deep gladness and the world's deep hunger meet"

Frederick Buechner  


Question: What are you creating??


I hear statements all the time from teachers, parents, supervisees, etc., that will sound something like "S/he is getting SO aggressive", or "These behaviors came out of nowhere!".

There can be a disconnect in the language used to make it sound as if suddenly, on its own, for some random reason, problem behaviors are rapidly escalating.


Can that happen? Hmmmm, possibly.

*Self-harmful behaviors can have an underlying and undetected medical cause.
*A significant life disruption (change of school, death of a parent) can lead to what most people call "acting out" behaviors, in a child who previously had no history of aggression.
*Sometimes very old behaviors can make a resurgence, for reasons that are not always clear.

However, upon close analysis, systematic manipulation of the environment (controlling variables), thorough caregiver interview, and direct observation, the culprit in these scenarios is often: CREATION.
To be more specific, someone/some variable has created a scenario that is reinforcing problem behaviors. Pretty much 100% of the time no one intended to create the problem behavior, but regardless, the problem behavior is now here. Fully created.


I talk a lot on my blog about how to intervene upon problem behavior, or how to decrease the intensity of problem behavior, but what many people need to know is "What does it look like to actually create problem behavior?" (so one can do the opposite, of course!).

1. Lack of consistency - Want to create some problem behaviors right here, right now? Your 1st step is to be as inconsistent as possible. Inconsistent rules, expectations, consequences, and hearing one thing from mom and a different thing from dad, can all cause problem behavior to rapidly increase. Think of consistent consequences and problem behavior as being like oil & water.

2. Lack of "pay off" for appropriate behaviors - On a different note, let's take the focus off the problem behavior for a moment. When the individual does NOT tantrum, spit, throw things, or kick, what happens?? Do they receive the same (or higher) amount of adult attention when they are quiet, calm, and on task? No? Then that is why problem behavior is going sky high.

3. Response effort is too high - Response effort is a fancy way of describing what I have to do to get what I want. Would you wash my car for $10? Maybe. But I doubt you would wash it for $.10. A dime is likely not valuable enough for you to do the work of washing a dirty car. From the perspective of your child/client, is what you are offering them WORTH what you are asking them to do?

4. Foundational skills are neglected or skipped - Sometimes what looks like problem behavior can actually be a skill-deficit. What in the world am I talking about?? Skill Acquisition. That's what. When your child/client/student does not have the ability to perform a skill, instead of saying "I don't know how to do that, can you help me?", they may be much more likely to break a pencil, run out of the classroom, bite, etc.

5. Function-based treatment, what's that?? - Treatment that is designed based on opinions, non-evidence based interventions, therapist/teacher preferences, etc., is not likely to work. Function-based intervention seeks to understand the "why" behind problem behavior, and then provides the learner/child/client with a more appropriate way to get that "why" met.

6. Wait, and wait, and wait to intervene - I see this one a lot. Maybe the most. Here is a scenario: David is 3 years old. He hates going to Kroger with his parents. If they take him, he will yell, refuse to sit in the cart, and hit his head. Fast forward to David at age 10. He is bigger and stronger now. He still hates going to Kroger, but now he also hates going to Publix or Wal-Mart. If a parent takes him anyway, he falls to the ground and slams his head against the floor. See what happened there? The problem behavior grew and expanded over time, as David learned more effective ways to get what he wanted (to leave the store). It is vitally important to intervene on problem behaviors early, and effectively. The sooner you can address the barriers of problem behaviors, the sooner you can teach new skills and better ways to communicate with others, across settings, and as the individual ages.



*More Resources:

ABA & Reducing Problem Behaviors

Autism & Problem Behavior

Functions of Behavior

Reducing Problem Behaviors

"No More Meltdowns" by Jed Baker










If just reading the words "The Report" gave you a migraine headache and some unpleasant stomach cramps, then sounds like you are already familiar with the report writing process ;-)

If you had no reaction, then let me introduce a part of the job description for a supervisor/BCBA: Report Writing.


In most scenarios, when you begin working with a new client there is an assessment process that concludes with writing up a formal report. Depending on the funder, this report needs to be updated at specific intervals, such as every 6 months.
The purpose of the report is to summarize the treatment plan, and justify the need for services (or with a progress report, to continue to justify the need for services).

For newly certified clinicians the learning curve of report writing can be quite steep (I know it was for me). The report may need to include specific sections such as: Client Demographic Information, Client Diagnosis, Current Medication, Current & Former Therapies, School Schedule, Assessment Results (complete with grids/graphs), Functional Behavior Assessment, Coordination of Care, Transition Planning, etc.

Having strong written communication skills helps, as does being adept at Case Conceptualization, and compiling the report from strong assessment results. If the assessment process was rushed, skimpy, or otherwise flawed, then don't expect to write a stunning report from that data. The data collected during the assessment process are the foundation for the report to come. Don't neglect to gather important information during Intake/Assessment, as this will cause problems down the road.

But first, a quick disclaimer: The clinical report is not a one-size-fits-all document. Your employer and/or the funding source will have specific requirements for how reports must be written. It's also important to consider the target audience: who is going to read the report? Reports are often written in very technical language that may be difficult for laypersons to understand, which means that someone needs to interpret the report to laypersons and review each section in detail. When in doubt, follow the report guidelines communicated to you by your employer, or the funding source.


So let's jump in to some very generalized tips to clinical report writing:


  • I already mentioned above, but before even starting the report the assessment data are KEY. Having organized, accurate information (including any graphs or data sheets) at your fingertips will save SO much time when sitting down to write the report. Random pieces of paper scattered all over your desk? Not so much.
  • Follow the template provided to you. Your employer should have given you a report template to use (which can often vary from one funder to the next). Following the template saves time, and decreases the chances you will have to make tons of edits later. If your employer embedded drop down menus into their template? Gold star for them. If you work for yourself, make a template. It saves time. 
  • If possible (because this may not be your choice), use an electronic data management system for reports. An electronic system will store collected program data, and generate its own graphs, so when it comes time to update the initial report you will save SO much time by not having to enter all this information in yourself. Oh and by the way, the amount of time you can bill for report writing will be a drop in the bucket compared to how much time it takes you to write it. So saving time in this process will be suuuuuper important.
  • Always, always, always, always --> read your completed report multiple times before submitting. Be on the lookout for spelling errors, referring to a graph and then forgetting to include the graph, weird formatting glitches, dropped words/missed words, correct client name, etc. Trust me when I say you don't want to hand off a completed report to a family, school, or supervisor, and have them notice a really simple error that you missed. It's embarrassing. 




A well written report presents a full snapshot of the client, and thoroughly lays out a plan of action (including the clinical reasoning for choosing the plan of action). Selected goals are developmentally appropriate for current abilities, behaviors targeted for reduction are identified and described, and any barriers to instruction/progress are clearly stated with a specific plan for how to overcome these barriers during the period of authorization for services.



*Resources:

Example of a Treatment Plan Template

Another Example of a Treatment Plan Template

Best Practices in Client Documentation

BACB Practice Guidelines

Papatola, K. J., & Lustig, S. L. (2016). Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum. 




If you are a clinic/business/agency owner, is it important to you that your team looks forward to coming in to work?

If not, then you have no idea the kind of harmful impact a miserable employee can have on their team members, on their superiors, and on the consumers being served.



"How ABA can help a child be successful in a classroom setting"
Guest post written by: How To ABA




Many children start out their ABA journey with an intensive individualized ABA program.  This means that they can be receiving 20-40 hours a week of one-on-one ABA support with a skilled Instructor Therapist and oversight by a Behavior Analyst.  
I say this is a journey because it is not always the end goal for a child to have this level of support – both financially and educationally.  However, it doesn’t have to be all or nothing.  There is a misconception that ABA is all about the one-on-one model but in reality, ABA principles can do so much more to support a child in different settings and environments so that they are successful.

When children transition from 1:1 ABA into a classroom environment, the outcome can either be fantastic or disastrous.   With the right amount of thought and planning, using ABA principles can help a child transition to a classroom and away from needing 1:1 support.  

Here are some tips and strategies to keep it on the more fantastic side in the classroom:

Visual Schedules
If I was sent into work one day without my calendar and appointment book, I’d be lost!  I can be told what my meetings are and where I need to be but if it’s not written down, I’m likely to forget.  This is similar for our students in the classroom.  Visual schedules make the words more meaningful and permanent.  I’ve heard so many times from teachers, “But he knows what to do!” and that may or may not be true.  But why are we expecting more of our students then we would want for ourselves? We can make it easier on our students by having the visuals available for them and this also makes the prompting less intrusive.  Instead of needing to verbally remind them, we can direct them back to their schedule and thus removing the need for constant reminders.  

Tip: A visual schedule is something that can always be available to a student in an age appropriate way.  While a younger student can use pictures, an older student can be following a text-based to-do list.

Classroom Setup
In ABA we’re all about the interactions between the environment and behavior.  So wouldn’t it make sense to set up the environment for the behavior we want to see?  In a classroom, this means using the physical space to set your students up for success.  You can use dividers to block off areas that become distracting.  You can create an area in the classroom that is used for calming down and regulation.  Strategic planning can be as simple as making sure that your student’s materials are easily accessible to minimize traveling around the room (which can result in unwanted behaviors).  Is the student having difficulty transitioning from circle time back to his desk? Put his desk as close as possible to where circle time occurs.  Does the student need frequent breaks? Put his desk near the door so it can be less disruptive. 

Reinforcement Systems:
Reinforcement is a proactive way to set our students up for success.  Instead of waiting for the problem behavior to occur, we want to set up ways for the student to access all the good stuff by showing the appropriate behaviors.  Don’t wait!  The first thing to do is to make sure that the behavior expectations in the classroom are clear.  Review rules like, “Keep your hands to yourself” and “Use an indoor voice” so that student understands what they mean.  Then, reinforce, reinforce, reinforce.  If you want the rules to be followed, there has to be something in it for the student to follow them!  Reinforcement can be immediate (e.g.: getting a favorite toy every time they show the desired behavior) or delayed (e.g.: collecting points toward a treat at the end of the day). If your student is new to the classroom environment, you can tweak the system to be individualized for that student’s goals.  If your student is working on “greetings” then have a reinforcement system in the classroom that rewards appropriate greetings with adults and peers.  The more we reinforce a skill, the more we’ll see it and then we can build on it in the classroom. 

Tip: Sometimes reinforcement systems take some time and some tweaks to find what works.  Don’t give up!  Keep trying until you find the right combination of time, effort, and reward for that student.

Peer Leaders:
Using other students as leaders is another great strategy.  If your student is going into a classroom with peers who are at a higher level, you can choose one of those peers to act as the peer model or leader. Give that peer jobs such as holding all the crayons and waiting for your student to ask for one.  If the teacher gives an instruction and your student hasn’t followed it yet, have the peer go and get that student instead of you.  Pair up your student with an appropriate peer model for structured lessons such as turn-taking or group work.

Tip: Reinforcement can be for everyone! Did the peer do a really great job waiting for your kiddo to say hi? Offer a small sticker or reward to both!

Priming
Priming is another great ABA strategy that can be applied in a classroom.  If you know that your student struggles with a certain subject, ask for the materials beforehand so that you can pre-teach or prime some of the content.  That way, when the teacher teaches the content during class, it makes it easier for the student to pay attention and follow the instructions in a group.  You can also use this strategy for a difficult time of day, like gym or recess.  Prime your student before going into the gym with what the rules are in the gym.  Remind your student about the behavior expectations and what’s in it for him to follow the rules.  Some role-play and modeling might also be helpful in acting out the specific scenarios before they happen.

Is it Working?
How do you know if any of these systems are working? DATA!  Keep ongoing data on the behaviors you want to increase and the behaviors you want to decrease.  Is the child having LESS tantrums when transitioning inside form recess?  Is the child becoming MORE independent with self-help skills?  Is the child able to request for what she wants MORE often?  Watching for the trends in these behaviors will let you know if what you’re doing is working or if something needs to be changed.  As the child becomes more successful and more independent, slowly fade the amount of support and prompting they are receiving in the classroom. 




Guest Post Authors: 

We’re Shira and Shayna and we started How to ABA as a way to share and collaborate with other ABA professionals.  We know how overwhelming and lonely it can be in this field, especially when first starting out.  We’ve taken our resources and materials that we’ve collecting over many years of ABA practice and we’re sharing them all in one place! How to ABA and The Bx Resource offers programs, downloads, community, support, and CEU’s  - so you can help your clients and save more time!  With our combined strengths of teaching, program development, and finding the practical application of ABA to real-life situations, we love helping other professionals help their clients and feel supported along their journey!

You can find us at www.howtoaba.com.





"Choose Your Words Wisely…"
Guest post written by Amy Prince






As a Speech Pathologist, words are my jam - my favorite thing - really my super power. 



But as I have done this job for a few years (and a few more and a few more) I have come to understand that some words are so much more valuable than others. 

 Image result for apple


The first time it hit me that I needed to be more conscious about the words I chose, it was an apple (or at least my first clear memory).  I was working with a sweet kiddo (all my kiddos are sweet...and cute...and I am not biased, I swear!!) who was minimally verbal and even more minimally motivated.  Between the lack of play skills and the fact that social connections were not reinforcing, my sessions we more struggle than celebration.  One consistent thing about me, a habit I have not outgrown, is the fact that I am a snacker, and I get hangry without my snacks.  And I love a perfectly ripe Fuji apple. 



On this day, I was working with this little guy during that witching 3pm hour (100% snack time).  I had placed my apple on the table in anticipation of my very own positive primary reinforcement at the close of his session.  So he sat in his chair...and I tried to play...put all my effort into being fun...and he signed “more” which was in his repertoire.  I provided more of the toy...NOPE, wrong...tried more of another toy and again, wrong.  So I moved away and instructed him to “Show me”...and he went straight for my apple.  He’d never had an apple in my room, so a request for recurrence was not appropriate, but he was definitely showing a clear preference - more clear than I had seen in the past.  So I asked (not expecting an answer), “Do you want to eat apple?”, and he responded, “eat”.  I quickly checked with mom, then allowed a bite.  Then another “eat” and another and another...so I pushed, modeling “eat apple”...and he imitated, “eat apple”.  By the end of the apple, his request to “eat apple” was independent - mediated only by me holding the apple as a visual prompt.


This doesn’t make apples magic (but they are for some kids).  And I have no desire to venture down the rabbit hole of core vocabulary versus fringe vocabulary with you.  But, what is does mean is SALIENT is IMPORTANT.  Salient...noticeable, remarkable, essential.  These are the words we need.  And these are the words that will facilitate real communication.


So today, roughly 9 years after the magic apple, my cause is your words.  I teach on topics like “Want for nothing” - which is an entire presentation about killing the word want. 

Well, not killing, but maybe really really reducing:  You don’t want cake...you want to EAT cake.  You don’t want new shoes....you want to WEAR new shoes.  You don’t want Hawaii...you want to GO to Hawaii. 


The path I hope to forge is one where even our most limited speakers can do more with the words they have.  And, there is a little known tool, a TTR (Type Token Ratio) used in speech pathology...a TTR, documents lexical richness, or variety in vocabulary. TTR is the total number of UNIQUE words (types) divided by the total number of words (tokens) in a given segment of language. The closer the TTR ratio is to 1, the greater the lexical richness of the segment.



Typically (anecdotally?) we advise starting with five really useful verbs.  For many kids, these five are excellent:
  • Get
  • See
  • Have
  • Hold
  • Play



Now, these are not for everyone.  Sometimes we switch out and add:
  • Eat
  • Go

(Or whatever falls solidly within the interest area of the child!!)



We find that those lend themselves so well to building phrases.  And they can build a variety phrases - and they don;t all sound the same because they are using a variety of words!
  • Go up
  • Go outside
  • Go get
  • Go play

~ or ~

  • Get car
  • Get toy
  • Get marker
  • Get Thomas

~ or ~

  • Hold Slinky
  • Hold ball
  • Hold iPad
  • Hold popper


You see the pattern?  For some children you may choose 5 verbs, for others the number is endless. 


Goals?  Yup…


Here is the school version…

In one year’s time, little Timmy will independently request using two or more words (verb and noun) within structured settings, showing use of 5 or more unique verbs within a 10 minute language sample.


Or something like that!



So, my request to anyone who has stuck around to read all of this is NO MORE WANT...be creative, respect kids by gifting them a rich vocabulary...and remember that that does not necessarily mean a huge vocabulary - just add variety! 



Guest post author:

Amy Prince, along with Amber Ladd, is the owner of The TALK Team, a speech pathology clinic with locations in Fresno, CA and Visalia, CA.  
They also co-own TALK ABA, Inc, an ABA clinic in Fresno, CA, focused on ABA service with an emphasis on communication and social skills.  Amy and Amber are both dually certified Speech Pathologists and Board Certified Behavior Analysts.  
Find out more at www.thetalkteam.com or email Amy at amy.prince@thetalkteam.com


The Talk Team








     



    



Suggested Reading:

The "Why" of Selecting Intervention Goals



A large part of the BCBA role is designing treatments/intervention. There are many tools to help facilitate this process, such as caregiver or client interview, administering a full assessment, record review, observation, Functional Analysis, etc. A competent BCBA will collect information from a variety of sources and then compile the information to come up with a plan of action.

In an ideal world, this plan of action would be as comprehensive, detailed, and lengthy, as it needed to be for the individual client to benefit from treatment. But since this is rarely an ideal world, all kinds of issues and constraints can lead to having to prioritize treatment goals. Basically, this means to ask (and answer) the question: "What are the MOST important things to work on?".
While many clients may need some level of support for the rest of their lives, often therapy services have a specific timeframe or clock to work within, as well as limits on how services must be provided (what location, at what intensity, etc.) that are set by the funding source and not by the clinician.

The 1st thing to know before jumping into prioritizing goals, is to throw any pre-formed ideas out the window. I will give some general guidelines below, but even with these guidelines the most important variable to consider when prioritizing ABA treatment goals is the individual receiving treatment. Yes, this is more important than looking at the assessment grid.

The context of the learning environment, individual reinforcement history, the needs and concerns of caregivers, level of family stress, and the functionality of specific skills are all highly important variables that must be weighed carefully against clinician recommendations.
Just because I think an 8 -year- old should know how to independently ride a bike, that doesn't mean bike riding is an important skill for the family. It also doesn't mean that bike riding is functional for the particular client, or even a preferred interest. So it would be foolish to attempt to prioritize treatment goals without looking through the lens of the individual receiving services.

Once a thorough assessment of client needs and strengths has been conducted, then the guidelines below should be helpful for deciding what needs to be targeted, and in what order of priority:


  1. Developmental Functioning - For the clients chronological age, what should they be able to do? Particularly with very young clients (under 5) I recommend having a solid knowledge of developmental norms to be able to help the client contact success across settings. Being able to sit and attend in a group for 10 minutes may not be a big goal for the parents, but you can bet it's a big goal at school. ASD impacts developmental functioning, so it's important to prioritize intervention goals that will help the client access age-appropriate settings, activities, and social experiences.
  2. Current Problem Behaviors/Barriers to Improvement - This is likely the #1 reason why consumers reach out to ABA professionals for help, so it's usually no mystery which challenging behaviors are causing the most stress to the household. Tantrums, spitting, elopement, biting, no play skills, etc., all put a strain on the entire family. However, it will be very important to prioritize where to begin with behavioral intervention as to avoid overwhelming either the client or the household with an 88- page behavior plan. Start small, but with high impact.
  3. Functional Skills/Daily Living Skills - This is my 2nd favorite area to target for intervention, because most consumers who initiate ABA therapy services due so because daily life is hard. In order to make daily life less hard, it's critical to focus on practical, self-help skills. For example: requesting, making choices, toileting, dressing, tooth-brushing, establishing a bedtime routine, independent eating, etc. When daily living skills improve, it lessens the weight and stress placed on other members living in the household. Improving daily living skills also helps to increase the independence of the client, for years to come. 
  4. Parent & Caregiver Training- My favorite area to target for intervention! If the client has low treatment hours, minimal availability for therapy, minimal access to other services or treatment, less than ideal educational placement, etc., then really the #1 goal of treatment should always be parent training. When parents or caregivers are trained in behavior analytic methodology, they are empowered to help their child themselves. This is the equivalent of handing someone a fish, vs. teaching someone HOW to fish. When you teach parents how to fish, you give them the ability to teach their child for years to come, to advocate for their child's needs, and to recognize low-quality therapies and clinicians before precious time, energy, and money can be wasted.



*Further Resources:













Related Post: Structure in the Home Setting



For pretty much any parent the summer break from school will require some decision making and planning to keep the kids busy and engaged over the summer months. While this is a universal parenting concern, for parents with special needs children the loss of a daily routine/structure when school is out for the summer can bring anxiety, fear, and frustration, for both the parents and the children. 
A characteristic of ASD is difficulty with changes to routine, or a need for sameness to make sense of the environment. So if the child is used to getting up at 7am to get ready for a 6 hour school day with Ms. Bailey, and now suddenly they are just at home all day, this is a situation ripe for challenges.

It doesn't HAVE to lead to challenges though, as long as some strategies are put in place after careful planning and preparation.

With my clients, around this time of year I see tons of problem behaviors re-emerge, new challenging behaviors pop up, families stress levels increase, and due to everyone vacationing or needing to shift schedules around, often the one area of sameness over the summer break (the therapy schedule) can fluctuate quite a bit.

It would be great if both the parent and the therapy team could keep the same schedule (or possibly even increase hours) over the summer months, but this does not always work out. 


So with the consistency of both home and therapy being subject to change, how can a parent help their ASD child maintain routine over the summer? Glad you asked:


  1. Planning begins wayyyy before summer starts- With most of my clients I like to start talking about summer planning around the top of the year. What is the family's plan for the summer break? Will therapy hours continue, reduce, or increase? What activities will the child participate in? Just asking these questions gets everyone thinking about how best to prepare the child for the upcoming break, and allows enough time to prepare the child using repetition. Depending on the ability level of the child, this preparation may need to include skill acquisition, a revised daily schedule, visual supports, and/or conversation about the fact that school will be on pause for a few months.
  2. Work with the treatment team to decide what to focus on- The treatment team could be the child's teacher, the IEP team, the ABA team, etc. Whoever is working with the family to help the child learn and gain skills, should be considered a member of the treatment team. These professionals can give valuable information about what to focus on over the summer. Should reducing problem behaviors be the #1 goal? What about academics? Or self-help skills? For lots of my younger clients, we target toileting heavily during summer break because of the increase in time to practice but also it's hot so wearing less clothes means it's easier to spot accidents.  
  3. Minimize "time off"- I know, I'm Debbie Downer. But ask any teacher about what happens to children's math and reading skills over the summer break. For most students, the beginning of a school year has to include "catch up" time to focus on what was lost over the summer. For special needs children who may have extra difficulty either gaining new skills or retaining known skills, this is an even bigger problem. That means that the intentional planning must keep in mind the big picture (long-term success and progress). Therapists know that a huge decrease in consistency will effect progress, so while it's fine to start the day later or end the day earlier --it IS summer after all-- I definitely don't recommend taking off for vacation for a month, stopping therapy entirely, or allowing the child to engage in solitary play or with electronics all day long. 
  4. Consider amping up the structure in the home-  I think it's safe to say that the child didn't spend their school day playing on an iPad, watching YouTube, and eating Popsicles. There was probably structure in place, where low-preferred and high-preferred activities alternated, and academic demands occurred daily. To switch from such a structured setting to a non-structured setting, can be very upsetting and jarring. Instead of thinking about summer break as a time to just "hang out", think about ways to incorporate structure into the home setting. Nope, I am not saying that every parent needs to make a mini-classroom in their living room. Your child may not need quite that much structure. But, it is very likely they do need more structure in the home setting, more transitions, more instructional time, and more time interacting with people instead of with objects.




Lastly, a super-colossal-important tip is to be very intentional about selecting summer activities. Most of the clients I work with are in a ton of summer activities, from Lego camps to gymnastics to karate, and on and on. Unfortunately, just because my clients attend these activities does not mean that they participate. And of course if the child is just placed in the room like furniture but not actually participating, then the activity is not likely to beneficial.

What I often see is that these settings are simply not equipped to help my client benefit from being there. When I say "benefit from being there", I mean: my client doesn't wander around the periphery of the group, they don't stare up at the sky while everyone else is playing basketball, and they don't spend all of craft time crying under the table.


Focus on placing your ASD child in summer activities where staff are either knowledgeable about ASD & behavior, or they are open to a trained facilitator attending with your child. Emphasize that you expect your child to be a part of the group, not just in physical proximity to the group. Explain how your child interacts socially, their communication style, and what their biggest motivators are, as well as the specific skills you want your child to gain from the group. For example: "We enrolled him in this basketball camp not just for gross motor and physical activity, but also because he struggles to interact with other kids his own age and we really want him to work on that. Please help him to take turns with the other kids and respond when the children talk to him".



*Resources:

Strategies for a Successful Summer Break

Preparing a Child With Autism for Summer Vacation

(Video) Making the Most of Summertime for Kids With Special Needs


*Recommended Reading:

Ready for the Interview

The Other Side of the Interview






The interview process is a time where both the Interviewer and Interviewee assess each other to determine Goodness-of-Fit, and make a decision about partnership. Sound odd? It shouldn't. As an employee/contractor of a company, family, or organization, you are partnering up with the vision, goals, and plans of the organization when you agree to work there. Even if just for a brief contract where you offer your expertise, you are leaving a stamp on that company for years to come.


I've posted before about the interview process from the perspective of a parent hiring ABA professionals, or an ABA professional landing a great job. But what about the perspective of the interviewer? If you own an ABA company/employ direct staff, or hold a Director/Executive position, then you likely will have the responsibility to recruit, hire, and possibly train staff. Are you up to it? Based on my own experiences in this field....no. You're likely not :-).

I have had some just dreadful interviews for ABA positions. Totally terrible. Regardless of company size, if the company CEO was clinical or non-clinical, or whether I was interviewing as a contractor or an employee, I have observed that many people wearing the hat of "interviewer", should probably give that hat to someone else. A bad job interview is like a bad appetizer at a restaurant, in that it definitely doesn't leave you wanting more.
If you are finding that it's difficult to fill positions, or that applicants are turning down job offers from you regularly, there is definitely a reason for that. You may be thinking it's the pay rate, or the area, or just super hard to recruit in-demand ABA professionals, but might I suggest it's your interviewing skills?? If I am not impressed or intrigued during a 1st interview, I definitely won't return for a 2nd. Guaranteed.

So, let's look at what does work---->

When interviewers get it right (I mean, realllly right), they leave the interviewee excited about the opportunity to partner up with them. If either the interviewer or the interviewee feel resigned, so-so, or apathetic about the possibility of working together, that's a pretty good sign that something about the interview process was lacking.

To get the interview process right, and succeed at the goal of recruiting and hiring the BEST (which should always be your goal), I 've made a list of helpful tips for anyone in the position of interviewing professionals for ABA positions. 
Feel free to share this resource, and use it as a teaching tool to improve upon your interview process. 
Here's to attracting & hiring the BEST!


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