"Burnout is the process of spending too much time doing things that don't properly utilize your unique Tool Kit" - Runnin' on Empty


If you are new to this field or perhaps if not new, recently became a BCBA, you may not have a very strong understanding yet of who you are as a clinician.

It's ok, it took me time too... Lots and lots of time.

It's hard to solve a problem you don't realize you have, so this is something I didn't even think about for many years in this field. I accepted work opportunities based on what was available, and when those opportunities didn't work out or left me feeling quite underwhelmed I just moved on to a new opportunity.

But, doesn't it make more sense to intentionally and strategically map out your career based on who you are and how you want to practice? Then why aren't are more of us doing that?


Burnout, which is known fact of life in this field, can very much be connected to a lack of goodness-of-fit. Think about a vegan who works full-time at a BBQ restaurant. Or a pacifist working for a guns manufacturer. Or a daycare teacher who can't stand children. 
How much personal satisfaction and enjoyment do you think those employees would report after a work shift? I'm guessing low to none.

It's easy to just tell someone working in this field that Clinical Identity is important, but how many of us really understand how to ~discover~ our clinical identity?

Expect this process to take some time (I know, waiting is the worst), as knowing who you are not doesn't happen in the blink of an eye. It will also take perspective, which means you need to do more than one thing. If you've always worked with adult populations, or always worked in school settings, then how do you know what else might be a good fit for you? You kind of can't know that, if you only do one thing over and over.

Let's start at the beginning by first defining what is meant by a clinical identity: 
Defined as one’s professional self-concept based on attributes, beliefs, values, motives, and experiences (Ibarra, 1999; Schein, 1978).

Basically, your clinical identity is a combination of why you entered this field in the first place, combined with what keeps you in it. There you go, nice and simple definition :-)


Still struggling to put your finger on the unique clinical identity that fits YOU? Here are some tips:


    

  •    Take money off the table (no, I’m serious). If you had to work for free, what would you choose to do?
  •    Think about the last time you were truly passionate about work. What were you doing?
  •   What part of the work you do makes you full (energizes you, excites you, lifts you up)? What part empties you (depletes you)?
  •    Seek feedback: ask people who have worked with you, alongside you, or for you, to honestly list your best and worst clinical attributes
  •   Does your current work allow a place for your unique personality, or does it require minimizing or turning off parts of your personality? *If you’ve never taken a personality inventory before, I super recommend doing that.
  •   Write down your value system. Use this list during interviews to determine if your personal values and the values of the organization are complementary, or if they clash.
  •   Anger can be highly educational. Identify the things that make you the most angry/frustrated/annoyed about your work. Honestly examine why these things bother you so much (they likely conflict with your value system).
  •  What is your ‘niche’? What is it that you bring to the table that no one else can?




*References:

Slay, H.S., & Smith, D.A. (2011). Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Human Relations, 64(1), 85-107.   

Michael Tomlinson & Denise Jackson (2019) Professional identity formation in contemporary higher education students, Studies in Higher Education


*Recommended Resource:

Carving out your Clinical Identity





Impairments in social communication are a key deficit of Autism, and can be seen across the varying range of the spectrum.

Social communication is a big word that can include many difficulties, such as making friends, maintaining friendships, being appropriate near peers, sharing or turntaking, empathy or perspective taking, initiating peer play, joining ongoing peer play, responding to peers, self-advocacy, conflict-resolution, etc. 
When clinicians throw around the term "social skills", we are really talking about a lottttt of skills!

Some people have the mistaken belief that ABA therapy only focuses on 1:1 instruction, and therefore isn't appropriate to target peer social interaction. Nope, not true.
ABA therapy can absolutely include targeted social skills instruction. Depending on the age of the learner and their specific social deficits, that will impact how social goals are assessed and selected. 

Parents of very young children usually want to work on: sharing, playing with peers instead of isolating, playing with toys instead of hoarding toys, reducing aggression towards peers, etc.

Parents of teens or young adults usually want to work on: initiating conversation, increasing MLU (jargon translation= you want your child to use more than 1-2 words to make a statement or answer a question), buying items in the community, talking to community helpers (e.g. a police officer), etc.


There are also many ABA programs that offer formal social skill groups to families, where learners are grouped together based on interests, abilities, age, or other factors, to participate in games and activities as a group. But the games are far more than just "games", they are actually carefully designed to target specific social skill deficits. If you are already receiving ABA therapy services, ask if your child can participate in a social group with other clients.


Behavior Analysis has many empirically validated strategies to add to the social skills conversation, and also (depending on the funding source) the ABA provider can target social skills in a group format, at school, or out in the community, to ensure proper generalization. For example:


  • Reinforcement for the win! Social skills training should include reinforcement individualized to the learner, and also should work to pair (transfer) reinforcement to peers, as pre-intervention the learner may not find interacting with peers to be all that fun ;-(
  • Data collection. If no one is collecting data, reviewing that data, and evaluating that data to make treatment decisions then what is happening is not ABA.
  • Generalization. Also known as, "real life". Learning social skills in the ABA clinic, or at school, or on the playground, will not necessarily generalize to other settings and other kids. Intentional generalization into real-world, real life scenarios is a must.
  • Structure. This may sound weird, but it does NOT mean that the learner must do the same thing, in the same order, for each peer interaction. It means that the learner should be able to predict what will happen in social group today, they know the rules of social group, and they understand what rewards they contact during social group. These things should be somewhat predictable, from the perspective of the learner.
  • Break down concepts visually or tangibly. Help learners understand abstract concepts through video modeling, games, visuals, or manipulatives, that they can touch, see, etc.
  • Follow an evidence based curriculum.....just not too closely. While it is important to have a tool to create the lesson plan for social instruction, I'd also recommend individualizing the curriculum as much as possible across learners. Modifying the curriculum to make the content more relevant to the learner will go a long way to helping social instruction gains "stick".
  • Behavior management. So obviously, challenging or disruptive behaviors will interfere with learning during social interaction time. These behaviors can also frighten, intimidate, or annoy other children present, which works against the goal of interacting with peers. This is why ABA providers are a qualified to implement these kinds of interventions, because we already have the tools to decrease inappropriate behaviors and increase appropriate behaviors, and keep the social interaction on track.




*Resources:


Crafting Connections (I love this book!)

Social Skills Training for Youth with Autism Spectrum Disorders, Otero, Tiffany L. et al. Child and Adolescent Psychiatric Clinics, Volume 24, Issue 1, 99 - 115

A Review of Peer-Mediated Social Interaction Interventions for Students with Autism in Inclusive Settings, Watkins, L., O’Reilly, M., Kuhn, M. et al. J Autism Dev Disord (2015) 45: 1070


Baker, J.E. (2004). Social Skills Training: For Children and Adolescents with Asperger Syndrome and Social-Communication Problems. Shawnee Mission, KS: Autism Asperger Publishing Co.



"Confidence is Key"
Guest Post written by: Emily Lauren Beard



Much of what I have learned over the last year working as a Registered Behavior Technician (RBT for short) has changed my life completely. I found my job as an RBT mostly by accident. I knew that I wanted to work with children, and I knew I wanted to make a difference
I began a Master’s program for Mental Health Counseling, but I knew that ultimately, I wanted to work in a field that provided therapy for children with disabilities. After a semester of graduate school, unhappy and confused, I decided to go a different direction and look for a different career path.  After months of research, I found ABA therapy and immediately knew that was where I needed to be. I connected with a local behavior therapy clinic outside of my hometown near Jackson, MS, received a job offer, and began training to become a Registered Behavior Technician. As I approach my 1-year anniversary working at Blue Sky Behavior Therapy in Ridgeland, MS, I have begun to think about all the ways I have grown as a therapist.

I want to tell you a story about a few of the most important lessons I have learned about myself, my life, and my job as a helping professional:


This job is about the children, not you.  
 Ouch, that hurt. At least it did the first time I heard it.

My supervisor had just finished taking notes about the session I had just run with a particularly challenging client. This kiddo was sweet, no doubt, but I learned very quickly that if you didn’t have it together – your emotions, a plan for task presentation, control over the situation – the session could take a nosedive quickly.

What I realized during this session in my first few months of training is that being prepared is a must. Adaptability – the quality of being able to adjust to new conditions (Lexico.com, 2019) is a skill that is most definitely learned on the job. One minute we were at the table working hard at sorting pictures by their category and the next, my sweet kiddo was hurling a giant spit wad at my face from across the room. Chairs were knocked over, cards and toys were scattered all over the room, and my client was standing on top of the table.

All the sudden, my heart rate increased, my palms began sweating profusely, I couldn’t breathe and the whole room became blurry and it was as if time had stopped. I began asking myself, “What is my boss going to think of me?”, “Am I going to get fired?”, and “How could I possibly let this happen? I am so stupid!”

Yep. You read that right.

Not once in that moment did I even think about the client and how I could deescalate the entire situation. I was not thinking about the child’s safety or what he could have needed. I was thinking about me.

Luckily my supervisor was there and was all too familiar with the disruptive and problematic behaviors this child engaged in. She quickly deescalated the situation and had him sitting back at the table, working on identifying common objects, compliant and calm as could be, in under 10 minutes.

Looking back on this and discussing with my supervisor, I realized that this job is a selfless one. Walking into a session means leaving yourself – your fears, anxieties, stress – at the door. This job is not about you. It is about the client and what he/she might need to be successful at the skills that we are teaching.


This job requires confidence – a trait that unfortunately, you do not possess.
Over the next few months as I trained with a variety of clients with very specific skill deficiencies and behaviors, I learned that confidence means having the ability to go into a session believing in the work that has prepared you for this moment. Confidence means knowing you’ve got the skills, you are good at what you do, and that you are prepared for the unexpected....and believe me when I say this – kids can smell fear from a mile away. 

If you go into a session afraid of looking silly or not being quick enough, the child will know. They may possibly use it to their advantage. If you look like you don’t know what you are doing or can’t be quick on your feet, your session could go poorly. The session could end in tears, a torn-up room, and sometimes worse, a broken relationship with your client.


You can reach your goals.
Luckily, my boss saw my potential and believed that I could become a successful and confident RBT. Eventually I began to believe it, too. The more sessions I sat in on, the more trials I ran, the more confident I became.

Now don’t get me wrong, this was a long and grueling process. Some days it felt as if I was just tossed to the wolves. I learned to think on my feet and adjust as I went along. I learned that the work that I do is not about me. Sure, I earn a paycheck and have financial stability and that’s great. However, when I walk into my office, the client lobby, the therapy rooms, my goal is to help my client be successful and learn life skills that will make them happier and healthier. The joy that I feel when I see my client finally master a goal that has taken them weeks to understand outweighs any fear or anxiety that I might carry with me deep inside.

I am here to tell you that being an RBT is not an easy job. It is not for the faint of heart or the ones just in it to make money. This job is for the compassionate, hard-working, selfless individuals who wish to see others achieve their goals.

If you are one of these compassionate go-getters, believe me when I say: You can do this!
You can gain confidence in your skills. 
You can be successful. 
You CAN see lasting change in your own life, and the life of your clients.





*References:
Adaptability. 2019. In lexico.com
Retrieved November 29, 2019, from https://www.lexico.com/en/definition/adaptability




Guest Post Author:

Emily Beard is an Registered Behavior Technician at Blue Sky Behavior Therapy, a clinic with locations in Ridgeland, MS and Winona, MS.

Find out more at www.blueskybx.com or email Emily directly at emilybeard.proofreader@gmail.com


For truly any child, the sibling relationship can be a combination of great/horrible, best friends/worst enemies, play partner/nemesis.
Anyone with a sibling knows this is the truth, especially when you and your sibling(s) were young kids.

BUT, when a child with ASD is tossed into the mix then totally normal sibling hi-jinks can take a more drastic turn.

A big concern of the families I work with is sibling interaction, or lack thereof. Usually, the issues fall into one of these categories:

- The typically developing children ignore the Autistic child, and have learned it's easier to just leave them alone
- The typically developing children fully give in to whatever the Autistic child wants, and have learned that letting their sibling bully them is better than making their sibling upset
- The typically developing child IS the bully, and has learned that their Autistic sibling won't put up much of a fight/won't stick up for themselves


As a professional, I see it as a great benefit when my clients have siblings living in the home because now I have a built-in pool of peers to reach for whenever we are targeting social-emotional or play goals. Win-win!
Usually though, the sibling relationship is so strained and broken that we can't include the brother or sister in the session until we work on sibling interaction first.

So there is the 1st tip: until the sibling relationship is repaired, just tossing the kids together to work on skills will likely not end well.

Need more tips? Okay:


  1. Step back from the problems, and focus on what you DO want to see - Are there issues with name-calling and teasing? Then you want to see respect. Are there issues with hitting or kicking? Then you want to see calm bodies. Are there issues with always having to win every game? Then you want to see playing by the rules. When it comes to behavior: focus on what you DO want, rather than what you don't want.
  2. Start small- Baby-step your way to success rather than jumping into the deep end. If your children start attacking each other 5 minutes into playing Candyland, then let's play the game for 3 minutes. Or 2 minutes. Start at a level where everyone can be successful, and gradually increase your expectations over time.
  3. Teach functional communication - Ensure that your children are able to communicate (vocally or non-vocally) what they do and do not want. Usually when functional communication is lacking, there will be lots of aggression instead. Make sure the children are taught how to communicate "I don't want to play", so there will be no need to hit, punch, or kick. 
  4. It's OK to dislike your sibling - Sometimes my clients just don't seem to like their siblings very much. Especially if the sibling is much younger. While we can't force "like", what we can do is maintain an expectation of respect. It is not okay to throw blocks at your baby sister because she's annoying. Nope.  Instead, how about taking a break from the situation, asking to wear headphones, or practicing patience and self-calming? 
  5. Remember, relationships evolve over time - This should be good news for someone! As adults, we tend to forget that in our childhood we felt differently about our siblings at different ages. This is completely normal. I have some clients I have worked with for years, and I have seen the ebb and flow in their children's relationships. From "I can't stand you!" to "I want to sit next to Erica!". This will happen. Just because your children have a terrible relationship right now does not mean it will always be that way.


Lastly, any quality ABA provider can include sibling interaction goals into the treatment plan, provide parent training to help you generalize strategies when the therapists are not around, and intentionally plan for play dates or community outings with all the siblings (basically, moving from rehearsal to a live show).





*Resources:






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.





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