I Love ABA!: Staff training

Showing posts with label Staff training. Show all posts

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

Tameika Meadows, BCBA, Blog Author

"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.

Tameika Meadows, BCBA, Blog Author

See Part I, which is helpful for families needing to know how to prepare the home for ABA services.

I couldn't just leave this topic 1/2 complete.

Of course, it is important for families to know what to expect of home-based ABA services and general "Do This" & "Don't Do This" guidelines, but it's also important for ABA staff and clinicians to know when home based ABA services are inappropriate, the home setting is unsafe or hazardous, the home setting needs stricter guidelines, or is downright dangerous to staff and/or the client.

I'm not ignoring ABA that occurs in other settings, but for clinic or school based ABA services the environment/facility is typically set up in advance. It is monitored and controlled by management or clinicians, and regularly cleaned and maintained. Certain items are prohibited to be on-site, there may even be security or at the least, janitorial staff.

The home setting is unique because as the staff going in, we do not have full control over the environment. We don't know what hazards are present unless someone tells us. Sometimes we don't even know how many people (or animals) will be in the home from one session to the next. We may not know what is broken/damaged in the home, or may pose a health concern when we arrive on Day 1, ready to work.

So, this is a pretty big deal.

To all the company owners and supervisors/BCBAs, this kind of "home safety checklist" needs to be developed with a home inspection occurring before the case starts (during intake/assessment). RBTs should not have to walk blindly into the home of a stranger, with no idea what dangers or challenges may be present.

I recommend that whoever schedules the assessment and makes initial contact with new families explain the company policy related to home safety, make sure to answer any parent questions or address parent concerns, and do a walk-through inspection (this could also occur virtually).

Companies will vary with what is required or expected of the home setting, and sometimes state regulations or funder specifications will apply.

Unsafe/Inappropriate conditions in the home may negatively affect the client, such as: profuse sweating through the session because sessions occur in the non-ventilated and dusty attic, the parent blaring loud rock music throughout the session, or being unable to let the client play in the backyard due to huge amounts of dog feces.

Unsafe/Inappropriate conditions in the home can also negatively affect staff, such as: excessive and unwanted flirting and sexual jokes from the client's father, having to park in a nearby unsafe area as only street parking is available, or bringing pests into your own home that crawled into your materials bag during the session.

How exactly is learning or teaching supposed to occur under these conditions??

I could fill this post with pages and pages of home-based horror stories, but instead I'll just simply say: Home based ABA won't be possible for every family that wants it, for a variety of reasons.

And that's ok.

Services may need to occur at school, at the clinic or center, or in the community (such as at a library) until issues in the home can be adequately and safely addressed both for the benefit of the client, and staff.

**Resources:

Free checklist download to help set policy/establish minimum requirements for home-based ABA services to occur.

Home Based Employee Safety

Ensuring Safety during In-Home sessions

Firearms & Home-Based ABA: Considerations for Safe Practice

Tameika Meadows, BCBA, Blog Author

When it comes to the treatment or reduction of challenging, disruptive, dangerous problem behaviors, regardless of the setting or populations served, this will often be referred to as “Crisis Intervention”.

This concept is far broader than ABA, as many institutions and facilities will create, monitor, and implement crisis interventions whether anyone on site has received ABA training, credentialing, or licensure, or not (examples: police, schools, daycares, residential settings, prisons, etc.).

Being such a broad topic, that can look about 10,000 different ways depending on the setting and availability of highly trained specialists, it should come as no surprise that crisis behavior scenarios frequently result in injury or even death. If you do some online searches for news stories related to seclusion and restraint, regardless of the setting, you will see what I mean.

This issue is also larger than disability.

Yes, most of the horror stories we see on the news where someone was seriously injured during a restraint DO involve people with disabilities (whether it was known at the time, or not). But in the absence of disability or mental health issues, crisis management can still lead to serious injury or death. That could be for the person(s) responding to the crisis, or to the person(s) having the crisis.

This is a very weighty and complex topic, and I can’t possibly cover everything anyone should know about crisis intervention. However, due to the seriousness of crisis scenarios and the increased risk of harm (again, for the person intervening, the person or having a crisis, or even both of those people), I very much want to share some resources and information about managing behavioral crises.

First, some terms. Here is my favorite definition of a crisis:

A time of intense difficulty, trouble, or danger; a time when a difficult or important decision must be made.

During a behavioral crisis, the individual is having intense difficulty or trouble. They are having a hard time (not giving you a hard time). Decisions must be made, not just regarding what to do RIGHT NOW, but in the future, in case this happens again. Which, without the proper supports in place, the crisis event is highly likely to happen again.

Viewing a crisis through this lens takes the responsibility off of the individual having the crisis, and onto the supports in place (or lack thereof). When a crisis event occurs, ask yourself these questions:

1. 1. Does this individual know how to safely de-escalate during a crisis event?

2. 2. If yes, then why are they not using that tool?

Truly individualized and effective de-escalation tools are best understood as the means by which an individual in a crisis state can identify they are approaching a crisis state, select a de-escalation method, implement the method, and lastly evaluate how well the method worked once they are calm again.

Depending on the setting, availability of support help, and the understanding of de-escalation (or lack thereof), this “returning to neutral” process can take minutes, hours, days, or may not occur at all. It may involve a team of people, a caregiver or support person, or happen independently. When it doesn’t occur at all, that typically results in emergency room visits or admittance into an inpatient facility.

I do not know your work setting, the populations you serve, or your job title, but if you are reading this post I have to assume you have either experienced a crisis event with a client/student/etc. or want to be equipped if it should happen.

Right here I have to point out a very common myth, that can be quite dangerous when people believe it: In the field of ABA, clients who exhibit (or have a history of exhibiting) highly violent or dangerous problem behaviors may be classified as exhibiting “severe behavior”. It is a myth that only severe behavior clients can have crisis events. That is not true at all. Clients with non-violent or less disruptive problem behaviors, under the right set of combined circumstances, could have a behavioral crisis. For example, what if their home routine is significantly disrupted, they are ill, dealing with a change of medication, and also recently started puberty? These setting events when combined, could trigger a crisis event. For this reason, it is important for professionals and practitioners to be properly trained and equipped for crisis conditions, far before they are needed.

Now I want to speak specifically to ABA implementers (RBT’s, paraprofessionals, etc.) who work directly with clients: If you are working with clients where you are regularly responding to crisis events or working with clients with a known history of crisis events, you should be following the policies of the physical management training you received. If you have not received any physical management training, then you should not be working with those clients. It is dangerous for you, and dangerous for them.

Again, crisis events could potentially happen at any time, with any client/student/etc. It would be unwise to think “Oh I don’t work with severe behavior individuals, so this doesn’t apply to me”. For ANY of us (disabled or not, mental health issues or not) the right set of circumstances could trigger a crisis event.

If you were in the midst of a crisis event, who would you want helping you? Someone reacting on impulse or instinct, or someone who has been thoroughly and properly trained on safe de-escalation?

So what can be done? Glad you asked.

There are many, many crisis intervention and de-escalation resources readily available. If you are not in the position to set policy or choose employee trainings, you can still request additional training from your employer and send them recommendations of evidence-based methodologies. You can also always communicate when you feel ill-equipped or prepared to work with a specific student/client/etc. or feel unsafe.

Research shows that in the absence of individualized, evidence- based crisis interventions, individuals will contact injury to self and others (Burke, Hagan-Burke, & Sugai, 2003), receipt of medications with serious side-effects that rarely correct the causes of the behaviors (Frazier et al, 2011), receipt of intrusive, ineffective interventions that are punishment-led (Brown et al, 2008), and increased negative interactions (Lawson & O’Brien, 1994).

In ‘Effects of Function-Based Crisis Intervention on theSevere Challenging Behavior of Students with Autism ‘, the following procedures are recommended for crisis intervention planning-

Be cognizant of crisis needs and function when designing a behavior plan for students with crisis behaviors, and operationally describe steps to be taken for each phase of escalation. When describing these steps, be aware of the behavioral function. Change the quality of reinforcement delivered between appropriate and inappropriate behavior, and prompt appropriate behavior before providing access to calming activities. Train staff to competence on the intervention strategies (which most often includes role play scenarios during training, not just discussion/lecture).

*Recommended Resources (please share!):

~Find the number for the mental health crisis/emergency support services in your state, and save it in your cell phone

~For caregivers, if your child is on medication the Physician/Psychiatrist will likely have an after-hours or emergency help desk. Save that number in your cell phone

https://crisisintervention.com/

https://www.pcmasolutions.com/

https://www.marcus.org/autism-training/crisis-prevention-program

https://qbs.com/safety-care/

Crisis Intervention Strategies

Prevention of Crisis Behavior

Crisis Help in Georgia

ASD & Crisis Behaviors

Handbook of Crisis Intervention and Developmental Disabilities

ASD & De-Escalation

Crisis Prevention Institute

ASD & Stages of Behavioral Escalation

Nationally Certified Crisis Training Providers

Tameika Meadows, BCBA, Blog Author

Recommended Reading: What is the ABA Reform Movement (ABA Haters Pt. II)?

You may be a caregiver, professional, teacher, or someone simply interested in ABA as you read this.

Regardless of how connected you are to the ABA community, you might not be aware of ABA Reform, what it is, why it is needed, and changes that are being made, right now, in both large and small ways.

In case you are unaware, let me walk you through the ongoing conversation a bit. It will help shed some light on why "Trauma Informed ABA" is a thing, and why it’s a much-needed thing:

Both within and outside of the professional ABA community, there are people who want to see ABA adapt, listen more to the very populations we serve, reflect on our past (and sometimes current) practices, grow, learn, and in general: Evolve. The way to bring about this change does differ, with some people wanting ABA therapy to end/be abolished, some people wanting to see wide, sweeping change at the top levels of the field, and other people believing that practitioners doing their job differently everyday, in small and impactful ways is how we accomplish change. Different people have different perspectives, so it makes perfect sense to me that although many people are talking about changing and improving ABA therapy, there is little consensus on just how to do that.

So how does this connect to trauma informed ABA?

Trauma Informed ABA can be operationally defined as recognizing that someone's history, lived experience through their own eyes, and mistreatment or microaggressions has a direct impact on how they behave. It is viewing someone through the context of who they are in the world, and how they self-identify OR are identified or labeled by others. For example, a history of abuse, crisis event, significant illness or injury, neglect, mistreatment, prejudice, misjudgment, or social rejection, are all traumatic events that should influence how any intervention or therapy is applied and carried out.

In a nutshell, trauma informed ABA is an intentional decision to provide services and care in a highly personalized, unique, person-respecting manner, and to recognize that we are all products of our environment. For good, or for bad.

If you are an ABA professional, you may be thinking "Well....obviously. I already do this in my practice". I'd invite you to dig a little deeper and consider some of the strategies and techniques you implement through the lens of your client (put yourself in their shoes).

For example, I've worked with many young children who have been kicked out/asked to leave multiple daycares or preschool settings before I ever met them. How did those experiences affect them? What must it have felt like to be in a setting where you are excluded, not wanted, misjudged, and your needs weren't met? What kind of interventions and consequences to problem behavior were attempted before the facility realized they could not meet the child's needs? How did those failed attempts at consequences make that child feel? But here is the problem: for most of the clients I serve, I cannot just ask them these questions. Even if they communicate by speaking, they don't always have the vocabulary, cognitive understanding, or desire/motivation to answer these kind of questions. And of course, asking someone's caregiver or parent to speak on the client’s traumatic experience is not quite the same as asking the person who lived through it. Is it starting to sink in now??

As ABA professionals, we must approach each client uniquely and specifically, meaning we make little assumption from one client to the next. We modify and tailor intervention to what the client needs and prefers, not what we think is best or should happen. We collaborate with caregivers, parents, and other professionals working with that client, and we design intervention in a way that respects client dignity, autonomy, choice, and again: preferences. If my client hates washing dishes, is it unethical to utilize reinforcement to teach them this skill because their parents want them to wash dishes? If my client has a meltdown in a public space, should I immediately take them out to respect their dignity in that moment or is that "reinforcing escape behaviors"? If my client is non-compliant, is physical prompting necessary? How do I respond during a session when my client revokes their assent? What about a client who is older or able to communicate, and tells me they don’t want to receive ABA therapy. How should I respond? How do I select treatment goals for a client who has no means to communicate? How do I make sure I am embedding client choice? Is it ethical to create a Behavior Plan for stereotypy? What about teaching play skills? Is this ethical or not?

These are not easy questions to answer, which is the whole point.

For client A who has a very specific background, I may answer these questions one way. But then with client B who has a history of trauma, school refusal/aversion to authority figures, or past experiences with a low-quality ABA provider, my answers could be completely different. And that is how this should work, with the intervention package looking quite different from one person to the next. That’s a GOOD thing.

If the care being provided is individualized, focused on what is best for that individual (and not just their caregivers/parents), and trauma informed, then the intervention will ultimately be far more helpful, impactful, and SAFER/less harmful to the individual receiving therapy services.

There's tons of valuable information, research, and resources about trauma informed ABA (here is a massive list of resources). I urge any ABA professional reading this to dig into this methodology and embed it into the way you do your job. Listen to Autistics who speak about their life experiences, meltdowns, sensory issues, and their daily challenges. I have worked with many Autistic RBTs or BCBAs, and learned so much from them talking about their own experiences as a child, in school, in therapy, as an adult, etc.

In order to gain new perspective, you have to be willing to be wrong. Be willing to say "Wow, I didn't know that", “I don’t know/I need to research that further”, or "I never thought it about that way". This how we learn.

There is a movement happening all around us, and while it may have many differing voices, that does not negate the need for change. We CAN do better at how we help our clients, how we listen to our clients (especially those who do not communicate by speaking), and how we serve the disabled community.

*Check out these great resources to learn more:

Trauma Informed Behaviorism

Trauma Informed Care for Behavior Analysts

'What is Trauma Informed ABA?'

A Perspective on Today's ABA (Dr Hanley)

ABA Provider Listening Pledge (video)

The Compatibility of ABA & Trauma Informed Practice

Examining Challenging Behaviors from a Trauma Lens

Parent perspective on the importance of listening to Autistic voices

Tameika Meadows, BCBA, Blog Author

Recommended Reading (seriously, go read this now): Autism & ABA & A$$holes

ABA peeps: Do you want to be a good Behavior Analyst? Or a Great Behavior Analyst?

'Behavioral Artistry' as described and defined in the 2019 Kevin Callahan et al. article, is the difference between being a practitioner following learned "recipes" or paint-by-number strategies, and a creative, passionate clinician, qualitatively better at their job.

We know the process of obtaining the BCBA credential: verified coursework, hands-on practical supervised experience, and passing a rigorous exam (www.Bacb.com). Completing these steps to satisfaction will yield a BCBA.

But will that BCBA be....pleasant? Professional? Funny? Warm? Engaging? Enjoyable to work for? Caring? Empathetic? Socially Mature?

Does it matter what we know (skillset), if the experience of working with us/for us is terrible?

I'm going to answer for everyone and say: No.

If you have been working in this field for some time and have not come across the stereotypical "cold, robotic" BCBA, then how exciting for you. Unfortunately, your experience of not working for or with this type of person does not deny their existence. I have worked for quite a few arrogant, rude, empathy-deficient BCBA's, and have also helped fellow BCBA's (and myself) to self-correct when that good ole' bedside manner needs a realignment.

This is a problem.

It's a problem because BCBA's most often fulfill a role focused on people, and socially valid behavior change. People need to like us, in order for services to be most effective. People need to listen to what we have to say, value our recommendations, and trust our data in order to yield any results.

As a BCBA, do your supervisees enjoy working for you? Are they having a pleasant experience being supervised by you? Do your clients enjoy seeing you show up at their school, home, or clinic? Do the client parents or families enjoy working with you? What about your colleagues, the leadership over you, or other professionals you interact with to do your job (educators, SLP's, OT's, physicians, etc.)? Beyond data sheets, reports, and graphs, what is the qualitative experience people have when they encounter you at work?

Basically, the big question here is: **What are the behaviors that make some BCBA's better than others?**

The concept of Behavioral Artistry was developed out of a need to address the interpersonal behaviors of Behavior Analysts (which ones are most needed? what happens when they are lacking?), and directly tie those behaviors to clinical outcomes. In case you missed that---> insufficient interpersonal skills can have negative impacts on treatment delivery, and client success. See why this topic is so important?

BCBA's with better interpersonal skills (as measured by specific behavioral characteristics), LOOK better when doing the job. They laugh more, they smile more, they pay attention better, they listen more carefully, they are more objective, they are more creative, they are optimistic, they are persistent, and other people have a better experience working with them.

I always find it so odd that in a role where many of us are working to help our clients be more flexible (Super Flex, anyone??), as BCBA's we can be some of the most rigid and inflexible clinicians, when compared to other disciplines. Why is that? Who exactly does that benefit??

In 2016 Leaf and colleagues examined the pervasive use of ABA in autism treatment, and pondered ways behavioral interventions could become less effective:

"A danger inherent in any large scale, quickly growing area is a loss of focus on meaningful purpose, process, and outcomes. In the field of ABA, this might translate into dogmatic lack of attention to clinical significance, selection of impractical procedures, ritualistic data-collection, over-abundant use of off-putting, dehumanizing terminology, disregard of logistical realities, and insensitivity to consumer issues"

Any part of this quote sound familiar? Or like anything you've experienced at work? Particularly in the current climate of the ABA industry, where Big Business can be more focused on profit than quality.

Behavioral Artists are best viewed as organically talented BCBA's (meaning their greatness is more about who they are, than what they know) who consistently demonstrate specific interpersonal characteristics such as the following:

Likes people: is able to establish rapport; demonstrates concern; wants to facilitate positive change;
Has “perceptive sensitivity”: pays careful attention to important indicators of client behavior that may be small, subtle, and gradual;
Doesn’t like to fail: sees difficult clients as a personal challenge to overcome, and as an opportunity for the client to succeed;
Has a sense of humor: recognizes and accepts that much in the educational and human services professions is bizarre, illogical, and humorous;
Looks “for the pony”: is optimistic and sees behavior change in a “glass half-full” context; always believes programming will be successful; is less likely to burn out;
Is thick-skinned: doesn’t take negative client actions towards herself or himself personally; maintains objectivity and positivity; and
Is “self-actualized”: does whatever is necessary and appropriate to facilitate and produce positive behavior change; is not under audience control; is creative

If we want to be great clinicians (which...… why wouldn't we want to be great?), then the measuring stick used needs to go far beyond goals mastered, assessment grids completed, and billable hour quotas met. Productivity does not equal excellent interpersonal skills.

The measuring stick used must include qualitative measures, such as client feedback, supervisee feedback, warmth, and compassion.

References:

Callahan, K., Foxx, R. M., Swierczynski, A., Aerts, X., Mehta, S., McComb, M. E., Nichols, S. M., Segal, G., Donald, A., & Sharma, R. (2019). Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners. Journal of autism and developmental disorders, 49(9), 3557–3570

Leaf JB, Leaf R, McEachin J, Taubman M, Rosales S, Ross RK, et al. Applied behavior analysis is a science and therefore, progressive. Journal of Autism and Developmental Disorders. 2016;46:720–731.

Are All BCBA's Robots or Just Mine?

Providing Compassionate Care

Tameika Meadows, BCBA, Blog Author

*Recommended Reading: ABA Haters

I feel very unqualified to write this post.

The ABA Reform movement (also referred to as Autistic Activists & Allies) is not new, but you may be unaware of it. Many ABA peeps are.

There's a vocal community of Autistics and pro-neurodiversity/anti-ABA parents, individuals, and professionals who work diligently to spread the word about their viewpoint of ABA. Sometimes this is due to actual experience with ABA therapy, but not always.

If you want to understand why an Autistic dislikes ABA therapy, obviously the best person to ask would be an #ActuallyAutistic.

However, there are a couple of reasons why I am writing this post anyway, despite feeling unqualified to do so:

1. Lots and lots of parents come to my blog as a source of information about ABA. I don't want my silence on this topic to make it seem like I think ABA therapy is perfect with no flaws. I do think this industry has flaws, I have worked for low-quality employers, and I think parents making treatment decisions for their child need to know how to navigate this issue.

2. Although there are some in the ABA Reform movement who are pushing more for "ABA Eradication" and less for "ABA Reform", I think ABA professionals should be a part of this conversation. We are the ones in the field, day in and day out, working with vulnerable populations who don't always have a voice (either figuratively or quite literally). We cannot just stand by and watch this ABA conversation happen, we need to join the conversation.

If you think ABA, as a treatment or as an industry, is perfection and needs no improvement, you may want to stop reading now. <------------------------------------------

If however, you see the field's issues with clinician burnout, inefficient staff training, low-quality employers, person-first treatment planning, questionable research, teaching Autistics to mask, or respecting client dignity, and want to be a part of the CHANGE for the better, then read on.

My 1st post on anti-ABA'ers, or "ABA Haters" was written several years ago. I keep it up because I think it's important to see the evolution of change.

Most of us do not change our minds about something instantly. It is a process. We receive new information, analyze that information, reject it and return to old thinking, or accept it and enter into a different level of understanding. Of course, I'm also minimizing the reality of defensive mechanisms, circular logic, and cognitive dissonance, and how these concepts impact our ability to change our mind.

I used to think people were anti-ABA because they had never experienced quality ABA services, or maybe received ABA decades ago when there was less accountability of providers, more "old school" tactics used, etc. I thought if they could see for themselves what ABA can do, how it can help, and how we impact lives everyday, that anti-ABA'ers would "come around".

I have since changed my mind on that.

For those of you that don't know, receiving low-quality/unethical ABA treatment is not the only reason why someone may hate ABA.

Other reasons could include: being against the idea of "treatment" for a neurological difference, seeing Autism as a cultural identity and not a problem to solve, being against the high intensity of ABA services, taking issue with the tiered service-delivery model ABA uses, being angered by ABA providers or companies using "cure" or "recovery" talk (yes, this still happens today), viewing the origins of ABA as unethical and inhumane, viewing the current state of ABA as unethical and inhumane, and a strong displeasure with the lack of Autistic voices/input in the top Autism advocacy organizations, Behavior Certification Board for Behavior Analysis, leadership/ownership of ABA agencies and companies, or leadership in ABA state associations.

These are valid points, and they deserved to be heard without the lens of professional defensiveness.

Again, there are some in the ABA Reform community who think the best way to fix ABA is to

Shut.

It.

Down.

But there are others who do want to see ABA improved, implemented more compassionately, and become more receptive to Autistic feedback and experiences. More about support and accommodations, and less about trying to force someone to not look or act Autistic.

Below are a ton of great resources for more information about Autistic voices, differing views on ABA, and anti-Ableism advocacy. The best consumer is an informed consumer, and I think it's important to present the information and let people decide what is best for them.

It is so important to be aware of what the main population served by ABA providers (*It is true that not all ABA professionals work within the Autism community, but a gigantic chunk of us do*) has to say about ABA therapy, and the ways it can improve.

If you aren't willing to at least non-defensively listen, then what you're really saying is you aren't willing to change your mind. And how sad is that?

*Resources-

Do Better Professional Movement

The Great Big ABA Opposition List

Autistic Self-Advocacy Network

BCBAs + Autistics Towards a Reformed ABA Facebook group

ABA Reform Facebook page

Beautiful Humans Podcast: The ABA Reform Movement Ep. 26 (Go take a listen, this is an amazing conversation!)

A Perspective on Today's ABA from Dr. Greg Hanley

5 Important Reasons Even "New ABA" is Problematic

The Controversy Around ABA

Stimming Deserves Acceptance

Nice Lady Therapists

"I Am a Disillusioned BCBA"

ABA Inside Track Podcast: Trauma Informed Care Ep 134

Behavioral Observations Podcast: What is Trauma Informed ABA Ep 131

What's Wrong with the Autism 'Puzzle Piece' Symbol

"Why Autism Speaks Doesn't Speak for Me"

Avoiding Ableist Language: Suggestions for Autism Researchers

"Why Autism ABA Goes Against Everything B.F. Skinner Believed In"

Eye Contact for Recipients Validation

"Autism Doesn't Have to be Viewed as a Disability"

"How To Ask an Autistic"

Outdated Autism Terms & Language

Autism Wars

The Controversy over Autism's Most Common Therapy

For ABA Practitioners: How to Respond to ABA Hate

Tameika Meadows, BCBA, Blog Author

Hiring Managers, Clinical Directors, or anyone in the position to recruit and hire ABA staff:

Everyone wants that Type-A, super ambitious clinician, but what happens when the overachiever hits the wall at 90mph?? What impact will that have on client outcomes?

Tameika Meadows, BCBA, Blog Author

*Recommended Read:" Behavior Analysis & The Diversity Issue", by Chelsea Wilhite, BCBA

With the current backdrop of race, the police, and social activism happening in the US (and around the world), many ABA providers are seeking ways to improve the quality of services provided to all clients. ALL clients, regardless of race, may have encounters with the police where they may "appear" to be disrespectful, disobedient, or dangerous, simply due to cognitive, communication, social, behavioral, or emotional challenges.

How can we better help our clients advocate for themselves and their own needs? How can we better support black and brown clients? How can we better support clients who due to the severity of their problem behavior, or simply their size/height, are at an increased risk for police interaction?

All important questions to ask, but a far more pressing question to consider is: How does a lack of diversity within the field, prepare providers to support and understand a diverse clientele?

As part of the BACB ethical guidelines, providers are obligated towards cultural competency and awareness of how the dynamics of ethnicity and race could impact treatment, assessment, and overall quality of services. This could include gender, race, culture, national origin, religion, etc. (source: www.Bacb.com).

I have spent most of my career living and working in one state, and even so I regularly interact with clients of varying races, languages spoken (even if English is spoken, communication can be challenging), religion, sexual orientation, etc.

It's 2020..... I don't think anyone is exempt from needing to improve (and improve some more, and improve some more) upon their OWN biases, and areas of ignorance when it comes to relating across cultures. If you work in this field, or plan to work in this field, you must be aggressively committed to being the best practitioner you can be to people who are nothing like you, don't believe what you believe, do not look like you, and didn't grow up how you grew up.

Now that you understand this isn't optional, let's take a look at current diversity in ABA:

Stats are lacking. Many of our industry boards/organizations do not publicly share demographic info, and the process of collecting this info is always voluntary for practitioners. As a result, we do not have hard, cold facts about diversity in this field. The exception to this would be gender data, which is more available.
As a field, our training/education requirements around diversity and cultural competence are much less robust than the expectations around ethics, supervision, etc. There are also no CE requirements on this topic.
Research can be very hard to find that focuses on practitioner (not client) diversity, and how this impacts our field, and our profession. More research is badly needed in this area. (I for one would love to see research about the the practitioner experience of lack of diversity. Meaning, when you are always the only black BCBA in the room, what impact does that have?)

Source: (www.brianconnorsbcba.com)

How do these problems impact ABA as a whole? Glad you asked.

"The foundation of ABA looks at the antecedent (what comes before the behavior), the actual behavior and the consequence (what follows the behavior). What follows the behavior will either continue or strengthen the behavior or weaken the behavior. Therefore, the environment we live within could be providing a consequence which either strengthens or weakens the behavior. ....This developed culture is displayed in behaviors which get the need met of the individuals in the cultural group.

As a behavior analyst, we are often working toward removing a behavior which the child’s social environment has deemed “inappropriate”. Certainly many times the behaviors are not effective in giving the child a healthy lifestyle. We need to remember the behavior is getting a need met and may be effective in their current environment. We must also remember when determining a replacement behavior, the behavior is appropriate to the child’s cultural community." (Source: www.thekeyconsult.com)

A very important takeaway here is that you do not serve clients in a vacuum. No one is just "one" thing, including your clients. We are all a product of the many environments that have shaped us, throughout our life. To neglect to face this head on during all phases of treatment (from marketing, to hiring staff, to assessment, to actual services) is at least disrespectful to the dignity of the individual, and at most harmful to your clients.

This 2016 article (Developing the Cultural Awareness Skills of Behavior Analysts) has some great recommendations to address this issue head on. To name a few:

Understanding our own cultural, ethnic, and racial biases is the first step towards competence, and growth. As I like to put it, "know your own stuff".
Learn more about the clients cultural worldview through assessment, open dialogue, and by being sensitive to issues of power/authority and how they creep into conversations of race.
Consider language barriers. As I said above, even when I have worked with families who had been living in the US for years, sometimes language was a real barrier. Even if someone speaks English, they may struggle to communicate or to understand when English is spoken to them. This applies to written communication as well (paperwork, forms, emails, texts, etc.).
How diverse are your resources? Beyond flashcards, photos, manuals/books, or the like, have you thought about teaching materials? If working with a Korean child, do you regularly bring only non-Korean dolls/toys to sessions? Does that matter? Why or why not?

So, how are YOU doing with applying these strategies? How is your employer doing with applying these strategies? Is your ABA workplace diverse? If you only look at senior leadership positions (CCO, CFO, CEO), is your workplace still diverse?

Or are we applying our science to this issue in theory, but not in practice?

References:

https://www.bacb.com/ethics/#ethics_requirements

https://www.brianconnersbcba.com/blog/where-is-the-diversity-in-applied-behavior-analysis

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the Cultural Awareness Skills of Behavior Analysts. Behavior analysis in practice, 9(1), 84–94. https://doi.org/10.1007/s40617-016-0111-6

https://thekeyconsult.com/culture-applied-behavior-analysis/

The Current Status of African Americans Within the Field of Behavior Analysis

Certificant Demographic Information, source: www.BACB.com

Tameika Meadows, BCBA, Blog Author

Here we all are, in the midst of an unprecedented life event and trying our best to continue providing ABA services to the clients who need our help now more than ever.

So yeah, no pressure or anything. :-)

Prior to this pandemic, maybe you had some clinical telehealth experience, maybe you didn't, but either way I hope to provide either a review of information you already know, or a crash course in Telehealth 101.

I suspect that for many of us even after the current crisis ends, telehealth could become the New Normal as far as the way we do our jobs. Don't you think?
If so, then it's pretty important to get your skill set up to speed with using technology to serve consumers.

So take a breath, relax, and let's dive in to some strategies for implementing your ABA magic remotely!

You can listen to the audio presentation here.

* HUGE* resource file for this presentation: Click Here to Download
Sharing is caring, pass this resource along to your ABA colleagues! We're in this thing together.

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

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