Something I do regularly as part of clinical consultation, is what I call Quality Assurance.

 

Basically, providing clinical guidance to a family or fellow professional who wants to know: “Is this normal? Is this what ABA should look like? What should I expect from services? Can I request that the provider start/stop doing (blank)?”.  Issues can range from the simple to the complex, such as answering questions like “Is this a good Behavior Plan?” to “How many hours a week of therapy does my child need? Does it have to be 40?”.

 

Doing this regularly, I hear LOTS of crazy stories. Lots of sad stories. And lots of “Wait…..What?!” stories. I love when I get to tell the client everything looks great, and the intervention being provided is sound, ethical, and evidence - based. But I don’t always get to say that

 

Of course every scenario and situation is different, so its hard to summarize the main takeaways for ensuring you and your child are receiving high-quality therapy services.

 

But.

 

There are a few general points that I usually explain to people during these consults, that I would love to openly share. I hope its helpful for any who need it.

 

First things first--- if you are wondering or questioning if you are receiving high-quality services, or if intervention is “working”, then unfortunately I’d have to say….. probably not. 

People who are accessing great special education, Speech services, Occupational therapy, or ABA, generally don’t wonder if they are. The wondering and questioning is usually a sign that your “parent gut” is picking up on an issue. When you dig into it further, usually more issues or problems are revealed. So tip #1 is if you are currently skeptical or doubtful of the services being provided, DO NOT ignore that. Don’t minimize it and don’t brush it off. Investigate further.

 

Tip #2 is: Attitude matters. I talk to so many people who say “Well he/she is an expert in their field, so who cares if they’re kind of arrogant... condescending…rude…never returns phone calls…..mistreats me”. Nope. Full stop. It is not okay for a professional to treat you like trash, just because they are highly knowledgeable and in demand. Asking for qualifications + basic human decency is not too big of an ask.

 

Tip #3: As the parent or caregiver, you should expect to be involved in your child’s intervention process. Any school, therapist, or provider, who is treating you like an unwanted green bean dish at the buffet is not acting with your best interests in mind. It is not unusual to expect to have treatment goals explained to you, in detail, minus the jargon, until you understand. It is not unreasonable to expect your questions to be answered, and your feedback to be incorporated into treatment. This is your CHILD we are talking about. Of COURSE you should expect to be treated respectfully and like a team member.

 

Tip #4: You should know the ethical obligations of the service provider. If you are receiving ABA services, do you know what is considered unethical behavior for a BCBA? What about for a RBT? No? Then how will you know if the team is behaving unethically? I’ve spoken with families of children who exhibit highly violent or dangerous behaviors, and there isn’t even a Behavior Plan in place. That shouldn’t happen and is unethical treatment. If you don’t know what you should be getting, its kinda hard to ask for it.


Last tip: Look for progress. This is probably the #1 complaint people have when I speak with them, is their child has been participating in XYZ treatment for ABC amount of time and nothing is better Nothing has improved. Language is still a huge area of deficit, no new skills are being demonstrated, behavior at home is still awful and challenging, they still can’t go out to eat as a family, the child still isn’t toilet trained, etc. Now the specific amount of progress, I can’t tell you that part. It varies by individual. But you should expect to SEE the intervention working. If your child was tantrumming for 5 hours a day when services began, is it less now? If your child would only eat 4 foods when services began, is it more now? Has the intervention helped any of the areas that are highest priority to you as the parent? No? Then why continue??

 


Regardless of the specific intervention, treatment, or therapy, these basic tips should help answer many of those “parent gut” questions that start whispering to you that something is wrong, even if you can’t pinpoint specifically what is wrong.

Listen to that instinct, do more digging, ask more questions, and reach out for clinical help or guidance when you need to!


 


*Recommended Resources:


Ethical Guidelines for ABA Providers

Ethical Guidelines for Speech Pathologists

Ethical Guidelines for Occupational Therapists

IEP/Special Education Law Resource

Informed Consent in Therapy (when disabled adults or children are being treated, it is the parent who must give informed consent)

Parent Participation in Therapy

Code of Ethics for Educators 

Disputing an IEP 

Parent Involvement in the Therapeutic Process Improves Care 


 



“She’s/He’s just a bad kid”

 

Dig deeper.

 

Have you considered:

Maybe you just don’t know how to teach him?

Maybe he has a trauma experience you know nothing about?

Maybe he’s misdiagnosed?

Maybe he’s undiagnosed?

Maybe he’s undermedicated?

Maybe he’s overmedicated?

Maybe he has mental health issues?

Maybe she can’t focus in this environment?

Maybe your low expectations are impacting her performance?

Maybe you just aren’t that reinforcing?

Maybe this material is beneath her ability level?

Maybe this material is far too challenging?

 


“Bad” is a lazy word meant to signal a conclusion, where further data, analysis, assessment, and modification of strategy is clearly needed.




 





Recently, there were many publicized and non-publicized mass closings in the ABA industry. This means many people lost their jobs. It also means many clients abruptly lost access to needed services.


Since this happened, I've talked to parents from all over wanting to know how to recognize a private equity backed company or how to spot warning signs or clues of a low-quality provider. 

It won't always be possible to see shutdowns/company closures coming, and just because things start off going well doesn't mean they will continue that way. Just ask all the families who started off 2020 happily receiving ABA services, and then COVID hit, and then.....yeah.

While there is always some level of trust required, and some element of risk when initiating services with any provider, I also care very much about helping caregivers develop the skills to weed out low-quality providers and avoid the worst of the bunch. 


The biggest tip I can give is the title of this post: interview providers.

Please don't just Google providers in your area, and sign up for services with the company that answers the phone the quickest. This is far, far too important not to do your due diligence. Treat this with the same level of seriousness as researching a new car to buy, or choosing your child's pediatrician, or deciding which private school is best. Choices are great, but choices also come with a responsibility to carefully evaluate each choice. Despite what many people think, nope, low-quality ABA treatment is NOT better than no treatment at all.



TONS of resources below--- use them, share them, download and print them. Listen to your "parent gut", ask questions, and watch for discrepancies between what you are being told and what you actually receive. No provider should start off the client/company relationship lying to you, hiding information, dodging your calls, etc. Yet, I hear stories like that from families all the time (e.g. "Its been bad like this since the very beginning..."). Be a picky parent, and advocate for what you know your child needs. 

Many of the anti-ABA voices out there are products of low-quality, unethical, and terrible ABA services. The potential for harm and mistreatment is high in situations where clients are working with poorly trained, poorly supervised, poorly equipped, or horribly overworked RBTs, BCaBA's, or BCBAs. If it doesn't feel right, it probably isn't right. Conversely, if it seems too good to be true it likely is.



**Caregiver resources**


Hiring Solo Providers: Hiring Direct Staff, Hiring a BCBA, Parent-Led services

Choosing a Company: Center or Clinic, Choosing an ABA Provider, Questions to Ask a Potential Provider, Tips for Choosing a Provider, Sample Interview Questions , More Tips for Choosing

Evaluating the Quality of Treatment: Is it ABA?, Is it Good ABA?, High Quality Treatment, How to Recognize High Quality ABA, What is Good ABA, 30 Indicators of Quality ABA, Helping Parents Choose Treatment

What is Private Equity: PE and ABA, PE and Autism Care, The Impact of PE, List of PE backed providers

Ethical Responsibilities of RBTs, BCBAs, and BCaBAs (Practitioners have ethical guidelines, not companies/organizations. Consumers can file complaints about unethical organizations to their insurance provider, Better Business Bureau, applicable accreditation board, or are encouraged to consider legal action): BACB Ethics, ABA Ethics Hotline, Reporting Licensed Practitioners

Signs of a Low-Quality/Unethical Provider: Good v. Bad ABA, Signs of Low Quality Staff, Exploring Quality in ABA

Food for Thought about the current state of the industry: Low standards in the ABA Industry 

Free Handouts: Tips for Screening ABA Providers , What to Expect When Initiating ABA Services


 Birthday parties. Let's talk about it.


Parties, gatherings, events, picnics, etc., where there will be lots of people, noise/music, activity, chatter/laughing, and hidden, unspoken rules for "appropriate" behavior.

The event may even be outdoors, which brings a whole host of safety concerns.

Or, the event could be near a body of water (pool party), which definitely adds even more safety concerns.


For parents with Autistic children, or another disability, do you just not go??? Is that the way to do this? How do you get a child through elementary school without ever attending a birthday party?? These days, kids have to invite the whole class. So in an average school year, your child may receive several birthday invitations, to loud, active, parties full of running, screaming kids, hopped up on sugar and soda.

Before we jump into what to do, let's back up a bit and describe the challenges: Why are birthday parties sometimes so not fun, and so very hard

Birthday parties/large gatherings are (often) loud, full of junk food/ice cream/candy/cake, full of people, tantalizing presents, music or entertainment, and the expectation to socialize ("You kids go play"). All of this can combine for quite the sensory nightmare.

Your Autistic child may find the event overstimulating, scary, uncomfortable, or painful (overstimulation that one cannot leave can be painful). Your child also may be unable to tell you any of that, which leaves demonstrating the discomfort through their behavior.

I have seen this up close many times, both "on the clock" and off the clock. I've been at kids birthday parties and seen that girl or boy seriously struggling and having an awful time, or attended birthday events with clients to provide support during the party. 

I think its critical to reset expectations and have a clear understanding of just how scary parties can be for Autistic children or adolescents (I'm not mentioning adults because, typically, adults with disabilities are not forced to attend events they seem not to enjoy, the way small children are).


The questions below should be carefully considered based on your child's age, temperament, sensory profile, and support needs, with strategies in place in case the party experience goes badly. Have a plan, then have a backup plan, and don't go it alone. Bring at least 1 other adult with you, or if you are hosting the event, assign helpers among family ands friends who know what to do and will quickly jump in if your child is having a hard time.


Things to Consider:

Do you have to attend/throw the party? No really, think about that. What would happen if you just...didn't go? Or what would happen if your child didn't have a 4th birthday party? I'm pretty sure the earth would still keep spinning. Sometimes, the level of support that would be needed as well as the needed accommodations aren't feasible. In that case, is it better to force your child through something they are unlikely to enjoy, or to just skip it? I'm not saying forever, and this could even be a case by case decision. Small party at a neighbor's home? Sure. Huge community pool party with 6 clowns, a DJ, and group party games? Maybe not.


- Don't try to stay the whole time, instead play it by ear. For some children, they aren't excited about the cake (feeding issues are common with Autism). They don't care about the social games or group activities. They don't yet have the ability to wait, so they won't understand why they can't start ripping into set aside food or activities (and may not understand why they can't open someone else's gifts). What will YOUR child do at the party that they find fun, entertaining, and is safe? Think about that, before you take them to a 2 hour birthday party.

- Understand that vigilant supervision may be needed. This does mean dropping your child off may not be a safe option (as the party host will be super busy), and if you stay with your child, you may need to keep them in eyesight at all times. It isn't unusual for my clients to 100% "veer off from the group" during parties, only to be found sometime later upstairs in a closet, or trying to access YouTube on the family laptop, or casually digging through someone's refrigerator. These can be very embarrassing moments, that could easily be prevented by keeping a close eye on your child, especially if the party or event will be held outdoors.

- Speaking of embarrassing, there is nothing embarrassing about accommodations or supports. If you are taking your child to a party or event where they can't wear their noise canceling headphones, or freely STIM (family members, sadly, can be very judgmental about stimmy kids at birthday parties)  without being treated poorly, that may not be the kind of event you want to attend. Again, parties are overstimulating for many Autistics. So it makes sense that they will do MORE of what helps them calm or regulate in response to being at the party. In other words, if most of the kids are quietly playing Candyland, but your child is in a separate room happily squealing and jumping, while chewing on a straw, will this be a problem for other people at the party? If so, I don't think your child is the problem.

- Take preferred foods, toys, and leisure items with you. Please do not expect that your child who eats 3 foods at home, will magically attend a birthday party and chow down on Cheetos, cake, and pizza. If they won't eat it at home, they likely won't eat it at the party. Also, don't withhold stim items or comfort toys because the child is in public, and other people will see. Those favored items may help keep your child calm and comfortable, in a chaotic and loud setting. On that note, it can be helpful to bring items your child may grab, snatch, or steal, if they see it in public. For example, I worked with a boy once who loved to suck on pencils. If he was out somewhere and saw a pencil, he would try to grab it and put it in his mouth. So in that situation, I'd recommend bringing oral sensory items with you so the child doesn't need to hunt throughout someone else's home for something to satisfy that chewing desire. Think about things like this in advance, and plan accordingly.

- The biggest tip, and the one I see cause parents the most pain and distress, is this: Please don't expect your child to be a different person socially, just because you're at a birthday party. If your child is not very social at home, they likely won't be very social with 23 other kids present. In fact, they may exhibit new behaviors you usually don't see at home (such as pushing, swatting at, or running off to get away from the other kids). This can be very hard for parents to watch. So can bullying and stigma, such as if your child DOES want to join the play, and the other kids are being mean or cruel to your child. Remember that earlier tip about close supervision? It's very important to watch how your child interacts with the other children, so you can stop any bullying or rudeness in its tracks, and so you can monitor when your child's social battery is "full". Most of my clients fill up that social battery very fast.....maybe 15-25 minutes of social interaction, and they're done. And that is OKAY. Not all children want to "Go play" with their peers for hours and hours. Observe your child, redirect them to solo play or maybe a calming activity as needed, and when they seem to be all done with being around so many people, its time to head for the door so the event can end on a high note. Don't be ashamed or embarrassed to say "S/He's ready to go now. Thanks for inviting us, bye guys!". 



I hope the largest theme coming across in this post is that large events/birthday parties aren't necessarily about you, as the parent. They aren't about the party host, the games, the clown, catching up with friends, hanging out, etc. They are about helping your child be successful, in what is likely a highly overstimulating scenario.

It is important to provide your child with the support and tools they need to engage with the event, to endure the event (again, consider if it would be best not to go if they seem to just be "enduring" parties), or to excel at the event. Whether the bar is set at engagement, endurance, or excelling, will depend on your child. 
And don't lose hope and feel defeated if right now, you are at an endurance level. That doesn't mean things will always be that way! As your child grows and matures, and most importantly as they develop more skills and abilities, they may begin to enjoy parties. Maybe even, to have fun at parties.
Give it time, and be patient. Both with your child, and with yourself.





*Recommended Resources & Resources:




Ghanouni, P., & Quirke, S. (2022). Resilience and Coping Strategies in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 1–12. 






 



I have been presenting/speaking, writing, and training on the topic of ABA Reform/anti-ABA sentiments for some time now. I have spent time engaging in intentional community and dialogue with people who disagree with ABA, and even have traumatic experiences from therapy services (some which really should never have been called “ABA”), as well as doing the work daily in my sphere of influence to train up/mentor/coach supervisees on this topic. Lots of listening, closing my mouth, being open to changing my own mind, being open to critique and feedback, and letting people tell their own stories.

 

I’m not alone in this. I know many ABA clinicians and providers who are also moving away from defensiveness and being closed off to criticism or shutting down Autistic voices because they disagree with ABA. I know people personally who have completely changed the way they practice, and I have mentors in this field that I look up to who have helped model for me the way forward, towards a more compassionate and respectful ABA. There is still lots of work to be done, and I know many providers committed to doing that work, every day, across all their clients.

 

However—

 

I get lots of comments, questions, and emails, from anti-ABA people who want me to do more. They want me to close up shop, rip up my certification, terminate all my client contracts, and find something else to do. They want ABA to just go away. Reform isn’t enough, changed mindsets isn’t enough, and listening to the Autistic community isn’t enough.

 

To that, I want to openly and publicly say: I respect your point of view, and I’m not here to tell people what to think. You have formed an opinion and are 100% convinced it is correct.  You believe ABA is conversion therapy, it is abuse, it is terrible, and that any ABA provider must therefore be terrible. You aren’t interested in dialogue or collaboration, you want ABA providers to shut up, and go away.

 

I hear you.

 

But I’m committed to change. For myself, for those professionals within my sphere of influence, for the clients and the client families I support and work with every day, and for the field in general, as far as my own advocacy and activism will allow. I speak out regularly about better ways to do ABA, issues with this field/industry, and the need to better support clinicians, and better train Technicians. I feel strongly about ALL of these issues.

 

To Autistics I say: keep speaking up and keep speaking out. Yes, you will find that trying to dialogue with some ABA providers or company owners will be an exercise in futility. But, there are those of us out here who WILL listen. Who won’t shut you down, who are willing and interested in engaging in respectful communication and truly want to learn. We are here.

 

You may not want to speak to us, you may not want to dialogue with us, and you may not want us to continue supporting individuals and families, but again: We are here. We will remain here, and we will commit to growth, own up to our mistakes, and stop acting like we know it all. We don’t know all. No one knows all.

 

So for those who ARE interested in learning, growing, communication, collaboration, and improving the quality and soul of ABA services: We are here.

 

Let’s work together.

 


** Recommended Reading:

What is ABA/Can it be Reformed?

Toward ABA Reform

A Perspective on Todays ABA

https://www.iloveaba.com/2020/11/aba-haters-pt-ii.html

https://www.iloveaba.com/2021/08/trauma-informed-aba.html

https://www.iloveaba.com/2018/03/normalization.html

ABA Reform Movement podcast episode

List of ABA Facebook Groups

Toward Trauma Informed Applications of Behavior Analysis 

What is Trauma Informed ABA podcast episode

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?. Behavior analysis in practice12(3)

Compassionate Care in ABA


 



"McABAs" is my own created term to refer to the low-quality, murky billing practices, mass produced interventions ("cookie cutter" programs), undertrained or nontrained RBTs, and overworked and harried clinicians, kind of ABA providers.


Similar to how when your body is hungry and in need of sustenance, I don't recommend reaching for a greasy fast food bag of empty calories, if you are in need of high-quality, professional, ethical behavior analytic services I don't recommend calling up a McABA.





The problem is, low-quality providers may not look/seem like a low-quality provider. Unlike fast food chains, you can't just look for the obvious golden arches or the blatant drive thru window.


As a caregiver, parent, or person seeking ABA services for themselves, it is critical to learn to weed through your options, weigh one place against another, and look for red flag concerning signs and indicators of a low-quality provider.



The following resources should help:


https://www.iloveaba.com/2018/04/weeding-out-bad-youre-fired.html


https://www.iloveaba.com/2012/10/choosing-aba-agency.html


https://www.iloveaba.com/2011/08/how-to-have-very-short-career-in-aba.html


https://www.iloveaba.com/2021/07/choosing-aba-provider-pt-ii.html


https://marybarbera.com/tameika-meadows-finding-good-aba-therapy/









 Autism Awareness 2022.


It's April again.


If you haven't read my thoughts on moving from awareness to action, see HERE.


Advocate. Support. Inform. Educate. Accept. But please do more than just be aware.







 


Across multiple industries, staffing deficits are a big problem right now. 

There are many different explanations for this, but certainly in a post-COVID world all of us are redefining work, evaluating our priorities, and learning how precious our time is…..if people are unhappy at work/in their career, it makes sense that the past 2 years would push them to DO something about that.

 

But let’s talk about RBT’s, specifically.

 

The RBT credential is an entry level position into this field. When a clinician company hops, it is usually for a different BCBA position. After all, there was tremendous time, energy, money, and schooling that went into the decision to become a BCBA, so most will try a new company out before trying a new profession.


For RBT’s though, many are not that connected to the field. They may still be figuring out if this is what they want to do long-term. Or, they may already know that they plan to pursue education, mental health, counseling, or other degrees, and are working as a RBT now for valuable experience. The point being, its often true that RBT’s not just company hop, but industry hop/leave the field. Especially right now, when the impacts of quarantine and the pandemic are still lingering. Client cancelations, health scares (e.g. sessions canceled for a week until a clear COVID test), companies lowering rates or decreasing benefits to ease financial strain, funders decreasing reimbursement rates, etc. All of this contributes to the experience of the RBT.

I mean, just look at current gas prices. If you think that isn’t impacting the job satisfaction of RBT’s who spend most of their day driving from client to client, then you are deluding yourself.

 

So, what can be done?

 

What is often attempted is increasing incentives. Things like: pizza day, bonuses, raffle drawings, trivia nights, casual Fridays, referral bonuses, public recognition/"Shout Outs" from management, use of a company iPad, etc.

Here’s the problem though: did anyone ask for that

 


What are your frontline staff asking for? When people leave, WHY did they leave? When people turn down an offer, or decline moving forward in the interview process, WHY did they lose interest? What happened? When staff complain or bring up concerns, are they addressed and resolved? Or bounced from person to person in the company? Is management toxic to deal with, unprofessional/gossipy (especially in center based settings), incompetent, etc.? Toxic managers are one of the largest reasons why people leave otherwise good companies.


 When I speak with unhappy RBT supervisees, the issues they describe to me tend to be systemic/management level problems (meaning, the supervisee cannot fix the issue), or a symptom of RBT mistreatment/low regard. For example:


  • Low pay/Pay rate has not budged since hire/Low hours (hired as FT but only working PT hours)
  • Client cancelations or schedule changes that cause loss of income
  • Poor fit to clients on caseload/Working outside of clinical competency
  • Not supported by BCBA/Minimal supervision
  • Issues with admin or management (rude, unprofessional, incompetent, etc.)/Inaccessible owner, management, or HR/Management does not support or "back" the RBT when there are issues with the client parent
  • No company policy on parent involvement or participation/No company policy on respecting the staff or employees/No consequences when client families regularly arrive late to sessions or cancel frequently
  • Excessive driving (only client is 2 hours away)
  • No benefits/No healthcare due to unable to maintain FT hours
  • Company does not provide needed equipment and supplies to perform job/RBT must provide their own supplies
  • Being expected to do extra work for free (required to train new hires for free)
  • Insufficient training on company required technology (required to use data software, but minimal training on it or support when it isn't working correctly)


If I was working with a client, and providing access to pizza, gift cards, and trivia nights, but the target behavior was not improving, my conclusion would be that I need to reevaluate my reinforcers. Looks like they aren’t so reinforcing after all!



Okay, then let’s apply that same conclusion to our workforce. If they are continuing to quit in large numbers, the reinforcers and motivating variables are lacking. Something is wrong, something is off. And as owners, bosses, managers, and stakeholders in this conversation (supervising BCBAs may not actively hire or employ RBTs, but we can certainly advocate and speak up for them in the workplace) we need to do better for our highly important RBT workforce.


 

So, what do RBTs want?

Heck, I don’t know. 😊

 


You need to ask THEM that. Individually. Consistently. Intentionally. At the onset of employment. As well as on a recurring basis once they take the job.

 

Don’t wait for people to become unhappy and dissatisfied and only then start pouring on the incentives, gift cards, and bonuses. Be proactive and intentional about building a strong workforce, demonstrating value (link), and probing individual employee preferences and reinforcers, so that the workplace can be an enjoyable setting (and reinforcing stimulus) for the people wo work there.

 


…… Or it’s highly likely they won’t work there for long.


 

*Recommended Reading & Resources

Improving Employee Retention

Predictors of Burnout in Behavior Technicians

Reinforcer Preference Assessment 

Identifying Staff Reinforcers 

How to Retain Great Employees


 

 



"The mind is not a vessel that needs filling, but wood that needs igniting" Plutarch


"Autism isn't something a person has, or a shell that a person is trapped inside. There's no normal child hidden behind the autism" J Sinclair 


There used to be a school of thought in the Autism world that the individual was somewhat of an "empty vessel" waiting to be filled. A blank slate, trapped within a hard to understand shell and wanting to emerge.


No. 

And what a harmful, disparaging view of individuality.


Autism is not being without/lacking, it's being differently tuned with interacting with the world, environment, people, and situations. 

It's sometimes being MORE when the situation calls for less, or being LESS when the situation needs more....Less attentive, less sensitive. Or possibly more attentive or more sensitive. 

There is no one clear way to be Autistic. 

What is super important to know is that every client you work with already is full of information and knowledge when you meet them. Some cannot share or demonstrate that knowledge, but that doesn't mean it isn't there. Or maybe they show it in a way you aren't used to, or aren't prepared for. 

Regardless, the capacity to learn and grow is within all of us. 

 Recommended Read: Toxic Staff 



If toxic staff is 1/2 of the conversation about what creates and perpetuates sick, dysfunctional work culture, then toxic leadership is definitely the other 1/2 of the conversation. You can't discuss one without discussing the other.

Unhealthy work demands, narcissistic managers, unrealistic productivity metrics, all of these contribute to the "revolving door" staffing issues that many, many ABA companies face.


Who is at the top? Who is getting promoted to the top (and who isn't)? And what characteristics and concerning behaviors do those in leadership consistently exhibit?


Examples? Sure:

Employees who sacrifice/neglect their OWN families to work long nights and weekends for clients are seen as “go getters” and “customer satisfaction focused”

A lot of hype and focus is placed on giving “110% every day”, with little discussion about how that is also the definition of burn out culture

Leadership decisions are not to be questioned. They are to be accepted. Questioning or disagreeing leads to the employee being seen as "insubordinate", "disrespectful", or "problematic"

“Hit the ground running” is a euphemism used to communicate the expectation that you will jump headfirst into a project or assignment and not bother anyone with questions, or requests for assistance

“Soft skills” like compassion, empathy, or person-centered treatment is retwisted as being “too soft”, “too emotional”, or just weak. You are encouraged to be firmer with clients, “convince” families of hours they don’t want, and project “confidence”

 


And on and on and on. 

Source: www.betterup.com 


Toxic leaders create and worsen toxic work cultures, resulting in staff who are timid, fearful for their jobs, indecisive/do not trust their ability to be a self-directed employee, and hesitant to provide constructive feedback. These are not fun places to work, and the work being produced typically reflects that.

Taking that a step further, what happens when people working in a field intended to help, support, coach, teach, or instruct vulnerable populations, is suffering under toxic leadership? What is the impact on quality of care and client outcomes? I don't think this is a question of "Will this affect the clients", but a question of "How will this affect the clients".

If the point of a leader in a company is to guide, instruct, and lead those under you, then following a toxic leader is like walking on a circular road that doesn't go anywhere. Its a pointless exercise in futility, and a good way to ignite a great resignation



In my latest book, 'The Practical ABA Practitioner', I talk at length about my experiences in this field working for toxic owners/managers. The way those experiences impacted my job satisfaction, my passion for Behavior Analysis, and my emotional and mental health (burnout, anyone?). My experience is not unique. Employees: talk to your colleagues. How many of them have sat under toxic leaders, and what impact did that have on them? Employers: talk to your team. How many of them view their current managers or supervisors as toxic, and how does that impact their day-to-day work?

Dangerous leaders are not just dangerous because of their pathological mindset and questionable behavior. They are dangerous because they expect the people under them to become like them. To focus on profits over people, to "hustle hard"/work until they drop, and to prioritize company health over their own mental health. 


When we examine the rates of position resignation in this field, as well as clinician burnout, how much of that is caused by toxic leadership? Many companies have systems and procedures in place that can actually encourage professional burnout. When employees feel isolated from colleagues and distant from ownership/management (silo mentality), or when unrealistic caseload expectations are presented as being non-optional, staff will try to rely on their smarts and training to get them through these challenges. But sometimes, it isn't the staff that needs to change, it's the system that needs to change.

 How well does the employer evaluate staff for signs of professional burnout? Are boundaries or guardrails put in place so that staff are not experiencing excessive driving, highly variable scheduling, regularly dealing with highly challenging consumers, or working 12 hour days 6-7 days a week? Does the work culture intentionally promote cooperation, teamwork, and open communication? Can staff  directly access management to voice complaints, or even just vent? Or, do staff know that complaining about people higher up than them will lead to swift retaliation? All of these issues can lead to staff who feel devalued and unappreciated on a regular basis.



It takes healthy, rested, emotionally stable people to perform the challenging work of supporting vulnerable populations through behavior analytic interventions in the community, home, and classroom. Toxic work cultures don't only impact your team, they also impact the very clients you are supposed to be helping.

Source: www.hcamag.com 




** More Info:

Preventing Burnout 

Lipman-Blumen J. (2010) Toxic Leadership: A Conceptual Framework. In: Bournois F., Duval-Hamel J., Roussillon S., Scaringella JL. (eds) Handbook of Top Management Teams. Palgrave Macmillan, London.

What is Ethical Leadership?

Developing Leadership in Your ABA Team

Esquierdo-Leal, J.L., Houmanfar, R.A. Creating Inclusive and Equitable Cultural Practices by Linking Leadership to Systemic Change. Behav Analysis Practice 14, 499–512 (2021).

A New Model for Ethical Leadership 









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