Therapy on the Moon

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Therapy sessions "on the moon" will mean something different based on where you regularly work.
For me, my bread and butter is in- home services. I feel like I have been doing that since the Roaring 20's. 😉

So for ME, what pushes me outside of my comfort zone and makes me feel overwhelmed is when I go into community or school settings to work with my learners, because its a wildly different environment than what I am used to. But this could easily be a vice versa situation for someone else, if they have never worked in home.
Real life example- I have lots of hilarious conversations like this with direct staff all the time:

Therapist: "Tameika, I have a problem! I showed up for the therapy session today and the entire extended family was in town visiting and the therapy materials were scattered all over the house, they got a new dog and it peed on my shoe, and there were workmen repairing the roof and I could barely hear myself talk"

My response: " whats the problem?"

Due to my experiences, I have in my mind what is typical of working inside peoples homes and over the years I have learned how to think on my feet, and throw out plan A and grab desperately at Plan B. I do it on auto-pilot at this point. However, if you plop me down inside a chaotic daycare, or a circus-like grade 2 classroom, or an outing with my client to a crowded Six Flags, I may not be quite so cool and collected.

It's all about perspective, really.

To properly prepare staff for their role, its important to consider what their idea of "normal" is. If they are coming from a center based background, their first school based client will be a very interesting experience. Or if they have only ever worked in residential settings with adults, teaching Color ID to a tantrumming 3 year old will be kind of like...Therapy on the Moon. It will be so far outside their comfort zone and practical knowledge base as to make them feel overwhelmed, inept, and a nervous wreck.

I work with many direct staff who have an extensive background of doing one kind of thing. So while they may be amazing at doing X, if you just throw them into Y without prior preparation, it likely won't go well.

What's that you asked? How can we better equip staff to perform their job with excellence across settings?
Well I will tell you!

  1. Discuss the setting in advance, and review potential land-mines: Step 1 will definitely involve knowing the setting (which may require reconnaissance in advance by the BCBA), so the staff can get a quick rundown of what to expect from the setting. If its a classroom, how many teachers are there? How many students? Whats the daily schedule? Can we use classroom supplies or do we need to bring our own? Can we deliver tangible reinforcers inside the classroom? Can we pull the learner out for 1:1 time? How does the school feel about us going in? Do they understand how we will manage problem behavior (typically *but not always* this means we will NOT remove our client from the room just because they escalate/kick off a tantrum).
  2. Help the staff find similarities, as well as critical differences: How will data collection differ because of the environment? How will DTT time differ because of the environment? If the parents will not be present in this setting, how will the direct staff include them in treatment goals/progress? BUT, what is still the same regardless of the environment? Something I really like to drill into my staff is to finish (or return to) a teaching trial, no matter what. So if the fire alarm goes off, finish the trial. If a younger sibling runs off with your data sheet, finish the trial. If Big Bird walks in and starts passing out know what to do.
  3. Set up the environment for success (as best you can): This will take pre-planning, and collaboration with the powers- that- be at the new environment. If a classroom, is it ok for you to store therapy materials? Or do you need to bring those with you every day? If in home, do the parents know you need a set aside area to keep the program binder, flashcards, etc.? If a community setting, have you thought about a discreet way to carry reinforcers around? Where is the nearest bathroom located? What about distracting room features (like a huge window that looks onto the playground)?
  4. Promote and Praise creative thinkers: The reality is, the direct staff will spend more time in this setting by themselves than they will with their supervisor. So its critical that they have the freedom to think through problems as they pop up, disregard non ideal options, and choose an action step. Praise, and heavily model this creative thinking process for the staff. Teach them that yes, there is an action plan, but sometimes for unforeseen reasons that plan will need to be discarded. And then what? Well, then you quickly think on your feet based on your clinical knowledge, and what treatment goals are being targeted.
  5. Play Nicely: The last tip is to approach the powers -that- be with an attitude of respect and collaboration. They may not have the ABA knowledge you have, they may not fully understand your role, and they also could have different goals for the learner than you have. Maybe you are targeting problem behavior, but their main focus is on language. Or vice versa. Your role in this new environment is also part ambassador. Be sure to carry yourself professionally and ethically, and to let it be clear you are always available to offer assistance or strategies, but you also are not there to step on any toes. Its a delicate dance, and a fine line to walk, but it does get easier with practice.

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